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Cards (Phase II) > Tulane (High Yield) > Flashcards

Tulane (High Yield) Flashcards

1
Q

What can echocardiography determine?

A

Chamber size, wall thickness, wall motion, valves, pericardium, intracardiac tumors, thrombi, and vegetations

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2
Q

Heart murmur that increases with valsalva and decreases with squatting…

A

Hypertrophic cardiomyopathy

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3
Q

What defines a cardiac myxoma?

A

Attachment to intertribal septum

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4
Q

Timing/presentation of Chronic Rheumatic Heart Disease

A

Years to decades after Acute Rheumatic Carditis

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5
Q

What differentiates Monckeberg medial calcific sclerosis from other types of atherosclerosis

A

Monckeberg medial calcific sclerosis is non-inflammatory (occurs in the elderly); also it occurs in the media as opposed to the intima

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6
Q

What are the 2 most common heart murmurs

A

Aortic stenosis and mitral regurgitation (both systolic)

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7
Q

When can the pulse (carotid upstroke) be felt?

A

During S1 (beginning of systole)

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8
Q

What murmur(s) radiate to the carortids

A

Aortic stenosis

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9
Q

What murmur(s) radiate to the axilla

A

Mitral regurgitation

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10
Q

What does an S4 indicate?

A

Hypertensive heart disease (stiff, thickened ventricle)

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11
Q

“Weak and delayed pulse” is a hallmark of what heart abnormality

A

Aortic stenosis

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12
Q

What is the most common cause of R-sided heart failure?

A

L-sided heart failure

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13
Q

What type of murmurs increase with inspiration

A

R-sided murmurs

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14
Q

What pressure differential defines aortic stenosis?

A

More than 40 mmHg across the valve

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15
Q

2 important causes of pulmonic stenosis

A

Early weight loss products (phentermine, fenfluramine) and cardiac carcinoid

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16
Q

Blood supply of the posterolateral papillary muscle? Why is this important?

A

Right coronary artery; if occluded can cause papillary necrosis or acute mitral regurgitation (highly fatal)

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17
Q

What does prolonged PR interval in the setting of endocarditis indicate?

A

Aortic regurgitation

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18
Q

Diastolic murmur preceded by “opening snap” is usually what?

A

Mitral stenosis

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19
Q

Definition of functional mitral regurgitation

A

Valve structure is the same, but heart structure has changed (making leaflets unable to coapt properly)

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20
Q

Presentation of cardiac carcinoid

A

Flushing and weakness (remember association with pulm stenosis and tricuspid regurgitation)

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21
Q

“Tombstone” appearance of ST elevation…

A

STEMI

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22
Q

Pathology behind majority of deaths from MI

A

Arrhythmias (often V tach or V fib) caused by acute underperfusion

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23
Q

Hallmark of plaque rupture on EKG?

A

ST segment elevation

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24
Q

Components of vulnerable plaque

A

Thin fibrous cap, rich lipid core with foam cells, active metalloprotease activity

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25
Q

ST elevation in leads II, III, and aVF

A

RCA occlusion (reciprocal depression seen in other leads)

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26
Q

Diastolic murmurs can be one of 4 things

A

􏰆􏰆Aortic regurgitation
􏰆Pulmonic regurgitation
􏰆Mitral stenosis
Tricuspid stenosis

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27
Q

Process by which aortic stenosis can cause angina

A

Aortic stenosis causes LV hypertrophy, which can impede elasticity of coronary arteries, slighting their ability to fill in diastole (even though AS affects systole)

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28
Q

What type of murmur is caused by aortic regurgitation, and why?

A

Early diastolic “decrescendo” murmur; ventricular filling during diastole opposes magnitude of regurgitation through aorta

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29
Q

Indications of hyperkalemia/hypokalemia on an EKG

A

Peaked T waves (+ wide QRS) = hyperkalemia; flat “u waves” = hypokalemia (in severe cases also diffuse ST depression)

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30
Q

Implication of an inverted T wave

A

Ischemia

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31
Q

Sarcoidosis predisposes what EKG change/arrhythmia?

A

AV block (1st degree)

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32
Q

BBBs on auscultation, broadly?

A

Splitting (“changes the 2nd heart sound”)

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33
Q

1st Degree AV block causes

A

Ischemia, Drugs (Verapamine, diltiazem, digoxin, beta blockers), Aging (fibrosis), Inflammation (e.g. sarcoidosis)

34
Q

What do large (amplitude) QRS complexes (at least in v3) indicate?

A

LVH

35
Q

RAA indication on EKG, implication on echo, clinical feature

A

Peaked P waves; tricuspid regurgitation; tripod posture (to allow intercostals to augment expiratory phase)

36
Q

Leads representing LCA

A

I and aVL

37
Q

Diffuse, concave ST elevation (with PR segment depression)

A

Acute pericarditis (remember: leather saddle)

38
Q

Define Kussmaul’s sign and associated pathologies

A

Neck veins fail to collapse with inspiration; constrictive pericarditis and restrictive cardiomyopathy

39
Q

2 important causes of constrictive pericarditis and clinical feature

A

Radiation (e.g. for lung ca), previous TB; pericardial knock (in early diastole, “lub dub BOOM” d/t calcification of pericardium)

40
Q

Pericardial tamponade clinical presentation

A

High yield: Beck’s triad (low BP, muffled/distant heart sounds, incr. JVP), pulsus paradoxus (not unique, but on inspiration BP falls b/c CO falls d/t LA compression)
Less yield: dyspnea, orthopnea, electrical alternans (QRS complexes have different heights), RV collapse on echo (apparently RV is thin walled)

41
Q

Normal ABI

A

> 1 (pressures should be higher in lower extremities than upper)

42
Q

Where do AAA most often arise and why?

A

Distal to renal arteries; no vasa vasorum in arterial wall = most susceptible area

43
Q

CVD pathology associated with syphilis

A

[Thoracic] aortic aneurysm

44
Q

Differentiate between ACS and Aortic dissection

A

In dissection pain radiates from chest to back (also look for “tennis ball sign” on CT)

45
Q

Wide, fixed splitting of S2 on ausculatation

A

ASDs

46
Q

Most common site of ASD

A

Foramen ovale (osmium secundum defect)

47
Q

3 predisposing factors for PDA

A

High altitude, prematurity, Rubella

48
Q

Consequence of PDA reversing

A

Cyanosis of feet (PDA is distal to great arteries)

49
Q

Demographics of coarctation of the aorta

A

Males:females 4:1

50
Q

Genetic abnormality associated with coarctation of the aorta

A

Turner syndrome (monosomy X)

51
Q

Genetic abnormality associated with pulmonic stenosis

A

Noonan syndrome (wide set eyes, ocular problems, ptosis, shield chest, webbing, hypo plastic jaw, receding hairline, kyphoscoliosis)

52
Q

What is the most common neonatal cyanotic heart defect? How does it need to be treated?

A

Transposition of great vessels; emergent surgery

53
Q

Clinical features of Eisenmenger syndrome

A

Prominent neck veins, “a wave,” clubbing of all fingers and toes, loud P2

54
Q

S3 classic finding of what type of heart failure

A

Systolic (HFrEF)

55
Q

S4 classic finding of what type of heart failure

A

Diastolic (HFpEF)

56
Q

What is De Musset’s sign and what does it indicate?

A

“Head bobbing” with each heart contraction; aortic regurgitation

57
Q

Sarcoidosis usual clinical presentation

A

Usually women with photophobia, rash, hypercalcemia, Hilar adenopathy, can have V tach but death is usually caused by AV block

58
Q

What type of HF is associated with infiltrative disorders and why?

A

HFpEF (diastolic HF), because myocytes get stiff (e.g. in amyloidosis, sarcoidosis, metastatic cancer)

59
Q

Subendocardial infarct on EKG

A

ST segment depression (NSTEMI)

60
Q

Transmural infarct on EKG

A

ST segment elevation (STEMI)

61
Q

What are cannon “A” waves and what do they represent?

A

Atria contracting against closed AV valve (atria and ventricles beating asynchronously); diagnostic of complete (3rd degree) AV block

62
Q

What arterial occlusion can affect the sinus and AV nodes (in most individuals)

A

RCA

63
Q

What does a Q wave represent on an EKG

A

Myocardial cell death

64
Q

For what reasons would you withhold NTG for a patient with chest pain?

A

Hypotension or PDE5 inhibitors

65
Q

RCA occlusion has the potential to affect what (4) structures

A

Posterior ventricular wall + septum, posteromedial papillary muscle (remember mitral regurgitation connection), SA node and AV node

66
Q

What indicates Left Axis Deviation, and what does Left Axis Deviation indicate?

A

Upright QRS in lead 1, flipped in aVF (vice cersa for RA deviation); direction of depolarization of the myocytes is not normal (strongly associated with CAD)

67
Q

Anyone who develops new LBBB years after an MI is considered to have a…

A

STEMI (remember the case, “chest pain and new LBBB is considered a STEMI”)

68
Q

Why does PR prolongation cause a soft S1?

A

Delay in ventricular activation causes AV valves to be able to “float” back into position instead of “snapping” back d/t ventricular contraction

69
Q

Kawasaki Disease Symptoms

A

CRASH & burn: Conjunctivitis, Rash, Adenopathy, Strawberry Tongue, Hand & Feet Erythema, Fever (“burn”)

70
Q

Etiology of Granulomatosis with Polyangiitis

A

T cell mediated HSR

71
Q

Differences between true aneurysm, false aneurysm and dissection

A

In true aneurysm no layers are torn; in false aneurysm intima and media are torn; in dissection only intima is torn

72
Q

“Speckled” appearance of heart on echo

A

Amyloidosis (causes refraction)

73
Q

CVD pathology commonly arising from multiple myeloma

A

Secondary amyloidosis (can cause restrictive cardiomyopathy)

74
Q

“Myocardium stains green with Congo Red…”

A

Amyloidosis

75
Q

Defining cause of “hypertrophic cardiomyopathy”

A

Mutation in encoding sarcomere proteins causes myofiber “disarray”

76
Q

Describe systolic anterior motion (SAM) of the mitral valve (at least in the setting of HCM)

A

Narrow orifice caused by VS hypertrophy impedes outflow, which increases velocity, “sucking” one of the MV leaflets in which exacerbates the outflow obstruction

77
Q

Maneuvers that lower LV EDV

A

VENDS: Valsalva, Exercise, Nitrates, Diuretics/Dehydration, Standing (from recumbent position)

78
Q

Maneuvers that increase LV EDV

A

“Higher Loads Be Softer” - Handgrip, Lying down, Beta blockers, Squatting

79
Q

Only two maneuvers increase aortic stenosis murmurs. What are they?

A

Squatting & Lying Down

80
Q

Leading causes of sudden cardiac death

A

HCM (1), anomalous coronary artery (2), Congenital Long-QT Syndrome and Brugada Syndrome

81
Q

Important maneuvers for MVP

A

Handgrip (murmur later and softer, happens with squatting too) & Valsalva (murmur earlier and louder)

82
Q

Causes of low voltage (on EKG) to consider

A

Infiltrative disorders (e.g. amyloidosis, sarcoidosis), pericardial tamponade, emphysema, hypothyroidism

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