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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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1. In an EKG - What is the QRS complex?
V fib
Ventricular depolarization - nl < 120 msec
Hypertrophied cardiomyopathy
Varicose veins - thromboembolism rare

2. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
The plateau period
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
LCX - I - aVL
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

3. What is the most common cause of MI
Wolff - Parkinson white syndrome
Pulmonary flow murmur and diastolic rumble
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Acute thrombosis of coronary artery

4. What is associated with paradoxical spliting of S2
Aortic stenosis or LBBB
Babies
Cyclophosphamide and corticosteroids
Aortic dilation - bicuspid aortic valve - RF -

5. What is a normal EF
Apex and anterior interventricular septum
Aortic disecction - intraluminal tear forming false lumen
The first 4 days
At least 55%

6. What does an isoelectric ST segment indicate?
Stroke volume
Ventricles are depolarized
Atherosclerosis
Mechanican contraction of the ventricles

7. What constitues the upstroke in pacemaker cells?
Volatage gated Ca channels
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
The operating point of the heart
140/90

8. When does extracellular calcium enter the cardiac muscle cells during contraction?
Dilated cardiomyopathy
Inc RA pressure - due to filling against closed tricupsid valve
The plateau period
Temporal arteritis

9. 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
Increase intracellular Na - resulting in increased Ca
HTN - bradycardia - and respiratory depression
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

10. What supplies the posterior left ventricle?
RF
CFX
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
QRS complex

11. Which murmur is characteristic of mitral/tricuspid regurg?
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Can progess to V fib
Wolff - Parkinson white syndrome
Holosystoiic

12. stroke volume x HR =?
CO
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Holosystoiic
QRS complex

13. What causes ankle - sacral edema - jugular venous distention
Decreased
RV failure - in venous pressure
LAD > RCA > circumflex
Decrease in cAMP

14. tearing chest pain radiation to the back - associated with marfan
Vagus to medulla
Aortic disecction - intraluminal tear forming false lumen
Mitral>aortic>>tricuspid - high pressure valves affected most
Atrial contraction

15. Expiration causes an increase in which sided heart sounds
Left sided
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
...
Metastasis from melanoma or lymphoma

16. When and why is the S3 sound heard?
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Ventricular repolarization
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

17. What is the danger of torsades to pointes?
Can progess to V fib
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Inc TPR and LA return (expiration)

18. What happens in phase 2 of the cardiac ventricular action potential?
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Proportional to viscosity and inversely proportional to the radius to the 4th power
Strawberry hemangioma
Ischemic heart dz - mitral valve prolapse - LV dilation

19. list the coronary vessels most likely to be occluded
LAD > RCA > circumflex
MAP
Henoch - Schlonlein purpura
Tricuspid atresia - requires ASD and VSD

20. congenital heart defect with 22q11
Wolff - Parkinson white syndrome
S. aureus
Truncus - tet of fallot
Diastolic

21. What are the systolic heart sounds
CO
Hemorrhage
Aortic/pulmonic stenosis and mitral/tricuspid regurg
At least 55%

22. Which class of drugs decrease the murmur heard in aortic regurg?
Henoch - Schlonlein purpura
Vasodilators
Vasocxn - while other tissues it causes vasodilation
Kussmaul's sign - cardiac tamponade - pulsus paradoxus

23. absecnce of tricuspid valve - hypoplastic RV
Increase intracellular Na - resulting in increased Ca
Tricuspid atresia - requires ASD and VSD
RF
During HF from microhemorrhages from inc pulm cap pressure

24. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Fick principle
Mitral stenosis
If sodium channel
Septal defects - PDA - pulm art stenosis

25. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
ASD - VSD - AV septal defect (endocardial cushion defect)
Aortic stenosis or LBBB
LV failure - pulm venous distention transudation of fluid
140/90

26. what happens to capillaries in lymphatic blockage
Stroke volume
During diastole
Preload
Inc interstitial osmotic pressure pulling fliud out of capillaries

27. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Maintain blood flow to organ over wide range of perfussion pressures
Glossopharyngeal to soliary nucleus of medulla
Posterior descending (80% off the RCA - 20% off the circumflex)
LCX - V4- V6

28. Which sympathetic receptors raise MAP
Yes
Pulsus parvus and tardus - weak - can lead to syncope
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Hyperlipidemia

29. Which two mechanisms sense decrease MAP?
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Atrial contraction
Crescendo - decrescendo systolic ejection murmur following ejection click
Medullary vasomotor center senses baroreceptors and JGA

30. SV CAP means?
Unstable/crescendo angina
Heart - 02 extraction is always around 100%
EKG
Stroke volume affected by contractility - afterload - and preload

31. The 7 complications of MI

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32. Which area of the endocardium is especially vulnerable to infarction? Why?
Septal defects - PDA - pulm art stenosis
Subendocardial - fewer collaterals and higher pressure
Filling is incomplete and CO falls
Kids

33. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Volatage gated Ca channels
Purkingee>atria>ventricles>AV node
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Left heart failure

34. What are the 5 T's of cyanoitc babies
Mechanican contraction of the ventricles
Chordae rupture - GN - suppurative pericarditis - emboli
In series
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

35. fibrinous pericarditis several weeks post MI

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36. What does FAN MY SKIN On Wednesday stand for?
Postinfarction fibrinous pericarditis
SV/ EDV
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

37. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Vagus to medulla
Mechanican contraction of the ventricles
Fetal right to left - neonate left to right leading to RVH and failure
Dec P02 - inc PC02 and dec pH

38. Which bacteria can cause endocarditis from prosthetic valves?
Acute thrombosis of coronary artery
Holosystoiic
MAP
S. epidermidis

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. what percentage of HTN is secondary to renal disease?
Mitral and tricuspid closure
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
10%
The operating point of the heart

41. What causes the CO curve to shift upwards?
S. aureus
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Pos inotropy - exercise

42. Irregularly irregular ECG - no p waves: dx and treatment
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
V fib
Vasocxn - while other tissues it causes vasodilation

43. The carotid sinus transmits along which nerve?
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Vasodilators - (hydrAlAzine)
Glossopharyngeal to soliary nucleus of medulla
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

44. Churg Strauss - presentation and test
ASD
P02
Stable angina
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

45. What causes aortic stenosis
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Mitral and tricuspid closure
5-10 days - macs have degraded structural components
Age related calcifications or bicuspid aortic valve

46. Which enzymes are useful for diagnosing reinfarction
Mean arterial pressure
Proportional to viscosity and inversely proportional to the radius to the 4th power
CK- MB
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

47. What cardiac change occurs in pregnancy?
Increased SV
Boot shaped heart
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Holosystolic - harsh sounding murmur - loudest over tricuspid area

48. What are the four most common locations for atherosclerosis?
R to L shunt caused by stenoic pulmonic valve
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Pulsus parvus and tardus - weak - can lead to syncope
S. aureus

49. with what heart sounds do ASD usually present?
Dec plasma proteins
Pulmonary flow murmur and diastolic rumble
CO
EKG

50. clinical signs of cardiac tamponade
Changes in CO as a function of preload
Coarcation of aorta
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Stroke volume affected by contractility - afterload - and preload