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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. The 7 complications of MI

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2. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Increase intracellular Na - resulting in increased Ca
Glomus tumor
Increase contractility

3. What happens in phase 2 of the cardiac ventricular action potential?
Late diastolic murmur following an opening snap
Ventricular repolarization
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
5-10 days - macs have degraded structural components

4. What are the systolic heart sounds
Proportional to viscosity and inversely proportional to the radius to the 4th power
Hematocrit
Mitral valve prolapse
Aortic/pulmonic stenosis and mitral/tricuspid regurg

5. What does FAN MY SKIN On Wednesday stand for?
Buerger's disease
Eisenmenger's syndrome
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Diastolic

6. What is association with fixed S2 splitting - does not increase with inspiration
Atrial contraction
In parallel
Pulse pressure
ASD

7. What are common causes of mitral regurg?
Temporal arteritis
Ischemic heart dz - mitral valve prolapse - LV dilation
Crescendo - decrescendo systolic ejection murmur following ejection click
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

8. What causes ankle - sacral edema - jugular venous distention
RV failure - in venous pressure
CK- MB
Mechanican contraction of the ventricles
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea

9. Which two mechanisms sense decrease MAP?
Medullary vasomotor center senses baroreceptors and JGA
LCX - V4- V6
Volatage gated Ca channels
During diastole

10. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Holosystoiic
Libman - sacks endocarditis
LCX - V4- V6

11. What happens with a decrease of extracellular Na
Decrease in activity of Na/Ca exhanger and increase in contractility
Eisenmenger's syndrome
Changes in CO as a function of preload
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

12. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Neg inotropy - HF - narcotic overdose
LV failure - pulm venous distention transudation of fluid
Myxomatous degeneration - RF - chordae rupture
Dec P02 - inc PC02 and dec pH

13. What is the gold standard for dx of MI in the first 6 hours
RCA - II - III - aVF
Systolic dysfunction
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
EKG

14. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Dec plasma proteins
Libman - sacks endocarditis
Eccentric - concentric hypertrophy causes diastolic disfunction
Neg inotropy - HF - narcotic overdose

15. What channels do the the pacemaker cells lack?
Dilation
Sturge weber - vasculitis of caps
Fast volatge gated Na channels
Non

16. Where is the most posterior portion of the heart and What can it cause?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Acute thrombosis of coronary artery
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida

17. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Truncus - tet of fallot
Stable angina
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

18. What does the U wave indicated?
EKG
Unstable/crescendo angina
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
HypoK and bradycardia

19. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
Conduction delay through AV node - nl < 200 msec
S. bovis
Lower right - MC - upper right - AO - upper right AC - lower left MO
Aburpt halting of valve leaflets

20. Do you see elevaged ASO titers in rheumatic heart disease
Yes
Anterosuperior displacement of the infundibular septum
Viridans streptococci
Fick principle

21. What is the association with wide S2 splitting?
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Non
No
Pulmonic stenosis and RBBB

22. What causes the cushing reflex and why
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
CFX
LCX - I - aVL

23. What is the S2 sound?
Fetal right to left - neonate left to right leading to RVH and failure
Aortic and pulmonary closing
Indomethacin closes - and pge keeps it open
Decrease in activity of Na/Ca exhanger and increase in contractility

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

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25. The cause of dyspnea on exertion?
Failure of LV to in CO during exercise
Kidney
LV failure - pulm venous distention transudation of fluid
Mitral valve prolapse

26. Which organ gets the largest share of systemic cardiac output
Pos inotropy - exercise
Rapid upstroke - voltage gated Na channels open
Liver
Subendocardial

27. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
S. aureus
Aortic and pulmonary closing
Pulsus parvus and tardus - weak - can lead to syncope
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

28. What are the four most common locations for atherosclerosis?
Angiosarcoma
Eisenmenger's syndrome
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Increase intracellular Na - resulting in increased Ca

29. What do the starling forces determine
RF
In parallel
Pulmonary flow murmur and diastolic rumble
Fluid movement through capillaries

30. What is the cushing triad?
HTN - bradycardia - and respiratory depression
During HF from microhemorrhages from inc pulm cap pressure
Truncus - tet of fallot
Inc interstitial osmotic pressure pulling fliud out of capillaries

31. In normal S2 splitting - which valve closes first? What increases it?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
The aortic before pulmonic - inspiration increases diff
Systolic dysfunction
Aortic insuffic - late

32. What stimulates release of calcium from the SR?
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Patent ductus arteriosus - congenital rubella or prematurity
Sturge weber - vasculitis of caps
Extracellular calcium - calcium induced calcium release

33. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Decreased
Posterior descending (80% off the RCA - 20% off the circumflex)
LAD - V1 - V4
Decrease in cAMP

34. Central chemoreceptors do not respond directly to which parameter?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
P02
Late systolic crescendo murmur with a midsystolic click
Liver

35. congenital heart defect withdown syndrome
Activated histiocytes
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
ASD - VSD - AV septal defect (endocardial cushion defect)
Can progess to V fib

36. Expiration causes an increase in which sided heart sounds
LAD - V1- V2
Angiosarcoma
Left sided
Metastasis from melanoma or lymphoma

37. In an EKG - What is the QT interval?
Afterload (proportional to peripheral resistance)
Mechanican contraction of the ventricles
Rapid upstroke - voltage gated Na channels open
2-4 day - early coag necrosis on the first day

38. When is the scar completely formed in an MI?
7 weeks
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
During diastole
Greater ventricular EDV

39. segmental thrombosing vasculitis of small and medium vessels in smokers with intermittent claudication - superficial nodular phlebitis - raynaud's - gangrene and severe pain - autoamputation of digits is possible

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40. in the JVP - What is the v wave?
Yes
Inc RA pressure - due to filling against closed tricupsid valve
The aortic before pulmonic - inspiration increases diff
Vagus to medulla

41. What causes orthopnea?
Cardiac tamponde
Mean arterial pressure
Inc venous return exaccerbates pulm vasc congestion
Aortic/pulmonic regurg and mitral/tricuspid stenosis

42. What murmur is heard with aortic regurg?
Decreased
Age related calcifications or bicuspid aortic valve
Aortic insuffic - late
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure

43. What causes the murmur heard in MR to enhance?
Hemorrhage
Inc TPR and LA return (expiration)
Temporal arteritis
Fast volatge gated Na channels

44. what percentage of HTN is secondary to renal disease?
Aortic and pulmonary closing
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
ASD - VSD - AV septal defect (endocardial cushion defect)
10%

45. How do beta blockers decrease contractility?
Decrease in cAMP
Decrease in activity of Na/Ca exhanger and increase in contractility
Transmural
LAD - V1 - V4

46. Which organ has ht highest blood flow per gram of tissue
Decreases
PDA
Kawasaki
Kidney

47. What causes aortic regurg
Tricuspid atresia - requires ASD and VSD
Age related calcifications or bicuspid aortic valve
Sturge weber - vasculitis of caps
Aortic dilation - bicuspid aortic valve - RF -

48. in the JVP - What is the c wave?
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
LCX - I - aVL
The first 4 days
RV contraction (closed tricuspid valve bulding into atrium

49. congenital heart defect with turner's
Gap junctions
LV failure - pulm venous distention transudation of fluid
Coarcation of aorta
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn

50. What can cause mitral prolapse?
Vasocxn
10%
Myxomatous degeneration - RF - chordae rupture
LCX - V4- V6