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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. When and why do you hear the S4 sound
Inc interstitial osmotic pressure pulling fliud out of capillaries
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Ventricular depolarization - nl < 120 msec

2. failure of truncus arteriosus to divide?
Aortic and pulmonary closing
Vasocxn - while other tissues it causes vasodilation
Inc RA pressure - due to filling against closed tricupsid valve
Persistant truncus arteriosus

3. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Sudden tensing of chordae tendinae
Aortic disecction - intraluminal tear forming false lumen
PDA
Wolff - Parkinson white syndrome

4. coronary artery spasm - ST elevation
Crescendo - decrescendo systolic ejection murmur following ejection click
Posterior descending (80% off the RCA - 20% off the circumflex)
5-10 days - macs have degraded structural components
Prinzmetal angina

5. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
LV failure - pulm venous distention transudation of fluid
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Granuloma with giant cells
Mechanican contraction of the ventricles

6. What do the carotid and aortic bodies respond to?
Dec P02 - inc PC02 and dec pH
Maintain blood flow to organ over wide range of perfussion pressures
Mitral>aortic>>tricuspid - high pressure valves affected most
Left heart failure

7. Where are pacemaker cells?
Conduction delay through AV node - nl < 200 msec
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
SA and AV nodes
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

8. Churg Strauss - presentation and test
Eccentric - concentric hypertrophy causes diastolic disfunction
Increased SV
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
TAPVR

9. What does prolonged QT predispose to?
Sturge weber - vasculitis of caps
Vagus to medulla
Torsades de pointes
Pulsus parvus and tardus - weak - can lead to syncope

10. What causes the early cyanosis in Tet of Fallot?
Activated histiocytes
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
R to L shunt caused by stenoic pulmonic valve
Left sided

11. 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
C - ANCA
Decrease in activity of Na/Ca exhanger and increase in contractility
Increasing activity of Ca pump in SR

12. What channels do the the pacemaker cells lack?
Rapid upstroke - voltage gated Na channels open
Dressler's - autoimmune
Fast volatge gated Na channels
10%

13. What cardiac change occurs in pregnancy?
Increased SV
Buerger's disease
Transposition of great vessels
Filling is incomplete and CO falls

14. Why is contractility decreased in heart failure?
Vasocxn - while other tissues it causes vasodilation
Libman - sacks endocarditis
Mitral valve prolapse
Systolic dysfunction

15. What are common causes of mitral regurg?
Arteriorles
P02
Ischemic heart dz - mitral valve prolapse - LV dilation
HypoK and bradycardia

16. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Ventricles are depolarized
Unstable/crescendo angina
Black > white > asian
Inc venous return exaccerbates pulm vasc congestion

17. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
ASD - VSD - AV septal defect (endocardial cushion defect)
RV failure - in venous pressure
Decreases
Sturge weber - vasculitis of caps

18. Rank the pacemakers cells
Kaposi's sarcoma
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
LAD
SA>AV>bundle of His>ventricles

19. PCWP > LV diastolic pressure
Mitral stenosis
Varicose veins - thromboembolism rare
Mitral>aortic>>tricuspid - high pressure valves affected most
Ventricles are depolarized

20. no change in PR interval followed by dropped beat
Glomus tumor
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Inc RA pressure - due to filling against closed tricupsid valve
Inc interstitial osmotic pressure pulling fliud out of capillaries

21. In the cardiac cycle - which period has the highest 02 consumption?
Isovolumetric contraction
Aburpt halting of valve leaflets
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Torsades de pointes

22. Which organ gets the largest share of systemic cardiac output
Liver
S. bovis
The first 4 days
S. aureus

23. What are the systolic heart sounds
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
C - ANCA

24. Which area of the endocardium is especially vulnerable to infarction? Why?
Angiosarcoma
Raynaud's
Subendocardial - fewer collaterals and higher pressure
HypoK and bradycardia

25. decrease stretch in baroreceptors leads to what response?
In RA return (inspiration)
Increased efferent SANS and decreased efferent PANS
No - no pressure gradient
Troponin I

26. What happens in phase 0 of the cardiac ventricular action potential?
Rapid upstroke - voltage gated Na channels open
Atrial contraction
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
Hyperlipidemia

27. What does TAPVR stand for
Volatage gated Ca channels
Venodilators (nitrogylcerine)
Transposition of great vessels
Total anomalous pulmonary trunk venous return

28. Fatal arrhythmia
V fib
Indomethacin closes - and pge keeps it open
Anterosuperior displacement of the infundibular septum
3rd degree block - pacemaker - Lyme disease

29. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Purkingee>atria>ventricles>AV node
Takayasu's arteritis
Posterior descending (80% off the RCA - 20% off the circumflex)
Babies

30. Which murmur do you hear in mitral stenosis?
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Late diastolic murmur following an opening snap
LCX - V4- V6

31. What are the different etiologies of dialted cardiomyopathy
Dilation
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Preload
No - no pressure gradient

32. Inspiration causes an increase in which sided heart sounds?
Right sided
Polyarteritis nodosum
Indomethacin closes - and pge keeps it open
SV/ EDV

33. 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
Fast volatge gated Na channels
Fick principle
Holosystoiic

34. How does a patient with Tet of fallot learn to improve symptoms?
Dilation
Squat. Compression of femoral arteries - inc TPR - dec
Dilated cardiomyopathy
Dec P02 - inc PC02 and dec pH

35. EDV - ESV
Dressler's - autoimmune
Crescendo - decrescendo systolic ejection murmur following ejection click
Aortic dilation - bicuspid aortic valve - RF -
Stroke volume

36. What are anitschkow's cells
Activated histiocytes
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Right sided
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis

37. congenital heart defect with marfan's
Aortic insuffic - late
Cardiac tamponde
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Glossopharyngeal to soliary nucleus of medulla

38. Most common vasculitis affecting medium and large arteries
Vasodilators - (hydrAlAzine)
Lymphangiosarcoma
Wolff - Parkinson white syndrome
Temporal arteritis

39. What other sign is often present with congenital long QT syndrome - why?
Anterosuperior displacement of the infundibular septum
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
2nd degree AV block - mobitz type 1
Kidney

40. Which class of drugs decreases afterload?
Vasodilators - (hydrAlAzine)
5-10 days - macs have degraded structural components
Pyogenic granuloma - associated with trauma and pregnancy
Increase intracellular Na - resulting in increased Ca

41. What does hypoxia cause in the lung versus other tissues?
Polyarteritis nodosum
Vasocxn - while other tissues it causes vasodilation
Late systolic crescendo murmur with a midsystolic click
Can progess to V fib

42. In an inferior wall infarct - which artery is affected and which leads show Q waves
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Strawberry hemangioma
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
RCA - II - III - aVF

43. What are the 5 T's of cyanoitc babies
Holosystoiic
Mitral valve
Subendocardial
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

44. What are aschoff bodies
Gap junctions
Hyperlipidemia
Granuloma with giant cells
Libman - sacks endocarditis

45. immune mediated transmural vasculitis with fibrinoid necrosis - small and medium vessels - renal and viscera - not pulm arteries - hep B seropos in 30% of pts
Polyarteritis nodosum
ASD - VSD - AV septal defect (endocardial cushion defect)
Hemorrhage
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

46. What constitues the upstroke in pacemaker cells?
Inc RA pressure - due to filling against closed tricupsid valve
Volatage gated Ca channels
Varicose veins - thromboembolism rare
Aortic dilation - bicuspid aortic valve - RF -

47. In what disease states is blood viscosity increased?
Infective endocarditis
Rapid upstroke - voltage gated Na channels open
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Proportional to viscosity and inversely proportional to the radius to the 4th power

48. sawtooth wave

49. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
7 weeks
Mitral stenosis
Indomethacin closes - and pge keeps it open
Henoch - Schlonlein purpura

50. CO x Total peripheral resistance
Atrial contraction
Troponin I
Mean arterial pressure
Systolic dysfunction