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Cardiology

Instructions:

Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. EDV - ESV
Stroke volume
Aortic and pulmonary closing
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Hematocrit

2. CO x Total peripheral resistance
Mean arterial pressure
Total anomalous pulmonary trunk venous return
Mitral>aortic>>tricuspid - high pressure valves affected most
Wegener's

3. fibrinous pericarditis several weeks post MI

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4. What are aschoff bodies
Granuloma with giant cells
Eisenmenger's syndrome
Lymphangiosarcoma
Vasocxn - while other tissues it causes vasodilation

5. What happens in phase 2 of the cardiac ventricular action potential?
10%
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Late systolic crescendo murmur with a midsystolic click
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

6. MAP is also known as
Buerger's disease
Afterload (proportional to peripheral resistance)
LAD
Dressler's - autoimmune

7. prolonged PR interval
Postinfarction fibrinous pericarditis
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Dressler's - autoimmune
1st degree AV blodck

8. Which class of drugs decrease preload
Dilated cardiomyopathy
Mitral valve prolapse
Increase contractility
Venodilators (nitrogylcerine)

9. When and why do you hear the S4 sound
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Hyperlipidemia
Eccentric - concentric hypertrophy causes diastolic disfunction
Kids

10. How does digitatlis increase contractility?
Pos inotropy - exercise
Increase intracellular Na - resulting in increased Ca
Inc Kf - capillary perm
The operating point of the heart

11. What kind of dysfunction ensues in restrictive cardiomyopathy
MI
Increase intracellular Na - resulting in increased Ca
Diastolic
Turners

12. What does mitral prolapse predeispose to?
Temporal arteritis
MI
The operating point of the heart
Infective endocarditis

13. When do coronary arteries fill?
RF
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Preload
During diastole

14. Central chemoreceptors do not respond directly to which parameter?
EKG
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Arteriolosclerosis in malignant hypertension
P02

15. What does TAPVR stand for
R to L shunt caused by stenoic pulmonic valve
Total anomalous pulmonary trunk venous return
Left heart failure
Stroke volume

16. How does aldosterone raise MAP
Mitral and tricuspid closure
5-10 days - macs have degraded structural components
Vasocxn - while other tissues it causes vasodilation
Inc blood volume

17. What is the characteristic pulse in aortic stenosis?
ASD
Pulsus parvus and tardus - weak - can lead to syncope
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Eccentric - concentric hypertrophy causes diastolic disfunction

18. what happens to capillaries in lymphatic blockage
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
2-4 day - early coag necrosis on the first day
Inc interstitial osmotic pressure pulling fliud out of capillaries
Conduction delay through AV node - nl < 200 msec

19. Rank the pacemakers cells
Transmural
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Increase contractility
SA>AV>bundle of His>ventricles

20. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
RF
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
P02
ASD - VSD - AV septal defect (endocardial cushion defect)

21. What is the danger of torsades to pointes?
Subendocardial
Can progess to V fib
Raynaud's
MAP

22. What do patients die early from in rheumatic heart disease?
Early deaths from myocarditis
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Transmural
Aortic dilation - bicuspid aortic valve - RF -

23. When does extracellular calcium enter the cardiac muscle cells during contraction?
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
HypoK and bradycardia
The plateau period
Transfusion

24. How are cadiac myocytes eltrically coupled?
Decreases
Lower right - MC - upper right - AO - upper right AC - lower left MO
Arteriorles
Gap junctions

25. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
LV failure - pulm venous distention transudation of fluid
Extracellular calcium - calcium induced calcium release
140/90
Hematocrit

26. What is the most common cause of MI
Pulsus parvus and tardus - weak - can lead to syncope
Mitral and tricuspid closure
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Acute thrombosis of coronary artery

27. What masks atrial repolarization?
QRS complex
No - no pressure gradient
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

28. Which class of drugs decreases afterload?
LCX - I - aVL
Vasodilators - (hydrAlAzine)
Vasocxn
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

29. What 4 things drive myocardial 02 demand?
LAD - V1- V2
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
Inc RA pressure - due to filling against closed tricupsid valve

30. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Viridans streptococci
Hemorrhage
2nd degree AV block - mobitz type 1
The plateau period

31. How are the sarcomeres added in eccentric hypertrophy?
Fick principle
MI
Infective endocarditis
In series

32. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
In HF
The aortic before pulmonic - inspiration increases diff
S. aureus

33. How do catecholamines increase contractility?
Increasing activity of Ca pump in SR
Rapid upstroke - voltage gated Na channels open
Squat. Compression of femoral arteries - inc TPR - dec
Adult type aortic coarctation

34. What are the complications of atherosclerosis?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Total anomalous pulmonary trunk venous return
MI
Inc Kf - capillary perm

35. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Truncus - tet of fallot
Can progess to V fib
Diastolic
No

36. What does hypoxia cause in the lung versus other tissues?
Subendocardial - fewer collaterals and higher pressure
Vasocxn - while other tissues it causes vasodilation
Dec P02 - inc PC02 and dec pH
Increased SV

37. with what heart sounds do ASD usually present?
Coarcation of aorta
Pulmonary flow murmur and diastolic rumble
2-4 day - early coag necrosis on the first day
Holosystolic - harsh sounding murmur - loudest over tricuspid area

38. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Wolff - Parkinson white syndrome
Angiosarcoma
Decreases
Dilation

39. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Purkingee>atria>ventricles>AV node
Left atrial pressure
Atrial contraction
S. bovis

40. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
No - no pressure gradient
Pulse pressure
LCX - I - aVL
Filling is incomplete and CO falls

41. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
5-10 days - macs have degraded structural components
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
LAD
Systolic dysfunction

42. Which vessels account for the most total peripheral resistance
HTN - bradycardia - and respiratory depression
Arteriorles
CK- MB
ASD

43. Where are pacemaker cells?
Wolff - Parkinson white syndrome
SA and AV nodes
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

44. serum marker for wegener's
C - ANCA
Chordae rupture - GN - suppurative pericarditis - emboli
Black > white > asian
ASD - VSD - AV septal defect (endocardial cushion defect)

45. In normal S2 splitting - which valve closes first? What increases it?
TAPVR
Purkingee>atria>ventricles>AV node
The aortic before pulmonic - inspiration increases diff
Dilation

46. What are the four most common locations for atherosclerosis?
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Postinfarction fibrinous pericarditis
Fast volatge gated Na channels
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

47. What supplies the posterior left ventricle?
Yes
Stroke volume
CFX
Decreases

48. What does prolonged QT predispose to?
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Torsades de pointes
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Group a beta hemolytic strep

49. What is the early and late lesion in rheumatic heart disease
Right sided
Granuloma with giant cells
Conduction delay through AV node - nl < 200 msec
Mitral valve prolapse

50. What is a normal EF
LCX - V4- V6
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
During diastole
At least 55%