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Cardiology

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Answer 50 questions in 15 minutes.
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1. What does the LAD supply?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Apex and anterior interventricular septum
If sodium channel
Increasing activity of Ca pump in SR

2. polypoid capillary hemangioma that can ulcerate and bleed
EKG
Pyogenic granuloma - associated with trauma and pregnancy
In RA return (inspiration)
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

3. What happens with a decrease of extracellular Na
Decrease in activity of Na/Ca exhanger and increase in contractility
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Vasodilators
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

4. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Systolic dysfunction
Fast volatge gated Na channels
Hematocrit
Polyarteritis nodosum

5. How does aldosterone raise MAP
Rapid upstroke - voltage gated Na channels open
ASD
Group a beta hemolytic strep
Inc blood volume

6. L to R shunt becomes R to L due to increase pulm pressures from original congenital heart defect

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7. The cause of dyspnea on exertion?
QRS complex
Mitral valve
Decrease in activity of Na/Ca exhanger and increase in contractility
Failure of LV to in CO during exercise

8. What does HTN predispose to?
Systolic dysfunction
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Glossopharyngeal to soliary nucleus of medulla
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

9. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Kaposi's sarcoma
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Anterosuperior displacement of the infundibular septum

10. 2/3 diastolic + 1/3 systolic
MAP
2-4 day - early coag necrosis on the first day
Increased SV
Aortic/pulmonic stenosis and mitral/tricuspid regurg

11. congenital heart defect in an infant with a diabetic mother?
Transposition of great vessels
Atherosclerosis
Total anomalous pulmonary trunk venous return
Aburpt halting of valve leaflets

12. What causes hepatomegaly?
7 weeks
Inc central venous pressure - inc resistance to portal flow
Hypertrophied cardiomyopathy
Henoch - Schlonlein purpura

13. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
During diastole
Inc Kf - capillary perm
Vasodilators
...

14. What kind of dysfunction ensues in restrictive cardiomyopathy
Preload
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Aortic and pulmonary closing
Diastolic

15. In an EKG - What is the PR interval?
Pulmonary flow murmur and diastolic rumble
Conduction delay through AV node - nl < 200 msec
V fib
Changes in CO as a function of preload

16. What are the complications of atherosclerosis?
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Chordae rupture - GN - suppurative pericarditis - emboli
SV/ EDV
Late systolic crescendo murmur with a midsystolic click

17. Which murmur is heard with mitral prolapse?
MAP
Late systolic crescendo murmur with a midsystolic click
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Atrial contraction

18. What is the association with wide S2 splitting?
The operating point of the heart
Viridans streptococci
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Pulmonic stenosis and RBBB

19. What happens in phase 4 of the cardiac ventricular action potential?
Resting potential high K perm
Acute thrombosis of coronary artery
Rhabdomyomas
Posterior descending (80% off the RCA - 20% off the circumflex)

20. What causes the early cyanosis in Tet of Fallot?
...
Glossopharyngeal to soliary nucleus of medulla
Chordae rupture - GN - suppurative pericarditis - emboli
R to L shunt caused by stenoic pulmonic valve

21. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Right sided
LV failure - pulm venous distention transudation of fluid
LAD
If sodium channel

22. What is the time frame for arrhythmia risk in the evolution of MI
The first 4 days
Indomethacin closes - and pge keeps it open
Vasodilators - (hydrAlAzine)
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

23. Fatal arrhythmia
HypoK and bradycardia
Transmural
V fib
Medullary vasomotor center senses baroreceptors and JGA

24. What is the gold standard for dx of MI in the first 6 hours
3rd degree block - pacemaker - Lyme disease
Fast volatge gated Na channels
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
EKG

25. What are the diastolic heart sounds?
S. bovis
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
The plateau period
Aortic/pulmonic regurg and mitral/tricuspid stenosis

26. What does the starling curve show?
5-10 days - macs have degraded structural components
Sudden tensing of chordae tendinae
Venodilators (nitrogylcerine)
Changes in CO as a function of preload

27. EDV - ESV
Proportional to viscosity and inversely proportional to the radius to the 4th power
Stroke volume
QRS complex
MAP

28. what conditions are associated with pulsus paradoxus
Medullary vasomotor center senses baroreceptors and JGA
Aburpt halting of valve leaflets
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Fast volatge gated Na channels

29. What is the classic X ray finding for tet of fallot?
Hypertrophied cardiomyopathy
Granuloma with giant cells
Angiosarcoma
Boot shaped heart

30. which medications are used to maintain patency or close the ductus arteriosus?
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
ANP
Indomethacin closes - and pge keeps it open

31. What is the early and late lesion in rheumatic heart disease
SA and AV nodes
Mitral valve prolapse
During diastole
P02

32. fibrinous pericarditis several weeks post MI

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33. How does a patient with Tet of fallot learn to improve symptoms?
Late systolic crescendo murmur with a midsystolic click
Mitral valve prolapse
V fib arrhythima
Squat. Compression of femoral arteries - inc TPR - dec

34. In normal S2 splitting - which valve closes first? What increases it?
ASD - VSD - AV septal defect (endocardial cushion defect)
ASD
The aortic before pulmonic - inspiration increases diff
In HF

35. What causes ankle - sacral edema - jugular venous distention
RV failure - in venous pressure
Strawberry hemangioma
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
LCX - V4- V6

36. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Adult type aortic coarctation
CO
Inc TPR and LA return (expiration)
Stable angina

37. What are anitschkow's cells
LAD - V1- V2
Activated histiocytes
CHF
Vasodilators

38. What happens in phase 3 of the cardiac ventricular action potential?
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Cyclophosphamide and corticosteroids

39. What does autoregulation do?
Maintain blood flow to organ over wide range of perfussion pressures
Cystic hygroma
V fib arrhythima
Ventricular depolarization - nl < 120 msec

40. Churg Strauss - presentation and test
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Neg inotropy - HF - narcotic overdose
Increased efferent SANS and decreased efferent PANS
Decrease in cAMP

41. When and why is the S3 sound heard?
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
ASD - VSD - AV septal defect (endocardial cushion defect)
Gap junctions
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

42. clinical signs of cardiac tamponade
Increased SV
Greater ventricular EDV
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
MI

43. Rank the pacemakers cells
Torsades de pointes
Inc TPR and LA return (expiration)
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
SA>AV>bundle of His>ventricles

44. Which artery supplies the SA and AV nodes?
Subendocardial - fewer collaterals and higher pressure
Increased efferent SANS and decreased efferent PANS
RCA
CO

45. What constitues the upstroke in pacemaker cells?
Cyclophosphamide and corticosteroids
Volatage gated Ca channels
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Increase intracellular Na - resulting in increased Ca

46. Which kind of infarct show ST elevation - and/or pathologic Q waves
The plateau period
Right sided
Maintain blood flow to organ over wide range of perfussion pressures
Transmural

47. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
No - no pressure gradient
CO
Decreases
Non

48. EDV is also known as
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Preload
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

49. Wegener's tx
Atrial contraction
CK- MB
Cyclophosphamide and corticosteroids
Ventricular depolarization - nl < 120 msec

50. 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
Viridans streptococci
Ischemic heart dz - mitral valve prolapse - LV dilation
MI

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