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Cardiology

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Answer 50 questions in 15 minutes.
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1. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Eisenmenger's syndrome
CHF
ASD
Troponin I

2. What does FEVERSS stand for in rheumatic heart disease
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
RCA - II - III - aVF
Increase - increase the chance the If are open
Persistant truncus arteriosus

3. Rank the pacemakers cells
Kids
SA>AV>bundle of His>ventricles
Granuloma with giant cells
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

4. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Acute thrombosis of coronary artery
C - ANCA
Decreases
Sturge weber - vasculitis of caps

5. How are the sarcomeres added in eccentric hypertrophy?
In series
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Subendocardial
Medullary vasomotor center senses baroreceptors and JGA

6. How does aldosterone raise MAP
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Inc RA pressure - due to filling against closed tricupsid valve
Inc blood volume

7. absecnce of tricuspid valve - hypoplastic RV
Tricuspid atresia - requires ASD and VSD
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
HTN - bradycardia - and respiratory depression
Vasocxn

8. What is the characteristic pulse in aortic stenosis?
Pulsus parvus and tardus - weak - can lead to syncope
Non
Postinfarction fibrinous pericarditis
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

9. Why is there edema after burns or during infection
Increased SV
Inc Kf - capillary perm
Acute thrombosis of coronary artery
Lymphangiosarcoma

10. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
During diastole
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Dilated cardiomyopathy
Fluid movement through capillaries

11. What is the time frame for arrhythmia risk in the evolution of MI
The first 4 days
2-4 day - early coag necrosis on the first day
LAD - V1- V2
RCA

12. What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
Gap junctions
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Resting potential high K perm
ANP

13. Wegener's tx
Cyclophosphamide and corticosteroids
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical
CO
Takayasu's arteritis

14. What is the machine like murmur? What is the heart pathology and the predisposing causes
Unstable/crescendo angina
Inc interstitial osmotic pressure pulling fliud out of capillaries
S. aureus
Patent ductus arteriosus - congenital rubella or prematurity

15. benign - painful - red - blue tumor under fingernails from smooth muscle cells
Isovolumetric contraction
140/90
Glomus tumor
Pyogenic granuloma - associated with trauma and pregnancy

16. What are common causes of mitral regurg?
Maintain blood flow to organ over wide range of perfussion pressures
Ischemic heart dz - mitral valve prolapse - LV dilation
Myxoma
Vasodilators

17. PCWP > LV diastolic pressure
At least 55%
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
No
Mitral stenosis

18. What are the 5 T's of cyanoitc babies
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Strawberry hemangioma
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

19. What is the classic X ray finding for tet of fallot?
LAD
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Atrial contraction
Boot shaped heart

20. What is the early and late lesion in rheumatic heart disease
Systolic dysfunction
3rd degree block - pacemaker - Lyme disease
Decreases
Mitral valve prolapse

21. What causes the murmur heard in tricuspid regurg to enhance
Ischemic heart dz - mitral valve prolapse - LV dilation
Transmural
In RA return (inspiration)
Inc blood volume

22. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Stable angina
Unstable/crescendo angina
Henoch - Schlonlein purpura
Sturge weber - vasculitis of caps

23. Which class of drugs decreases afterload?
SA>AV>bundle of His>ventricles
Boot shaped heart
Cherry hemangioma
Vasodilators - (hydrAlAzine)

24. What causes tet of fallot?
LCX - I - aVL
Anterosuperior displacement of the infundibular septum
Acute thrombosis of coronary artery
S. aureus

25. Which organ has ht highest blood flow per gram of tissue
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Inc TPR and LA return (expiration)
Kidney
Ventricles are depolarized

26. Endothelial malignancy of the skin assocated with HHV-8 and HIV

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27. What causes the early cyanosis in Tet of Fallot?
R to L shunt caused by stenoic pulmonic valve
Preload
During diastole
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

28. CO x Total peripheral resistance
Varicose veins - thromboembolism rare
2nd degree AV block - mobitz type 1
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Mean arterial pressure

29. in the JVP - What is the c wave?
Fast volatge gated Na channels
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
RV contraction (closed tricuspid valve bulding into atrium

30. Fatal arrhythmia
V fib
RV failure - in venous pressure
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Filling is incomplete and CO falls

31. Left to right shunts are more common in babies or kids?
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Kids
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Aortic dilation - bicuspid aortic valve - RF -

32. 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
Unstable/crescendo angina
Pos inotropy - exercise
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)

33. what conditions are associated with pulsus paradoxus
S. bovis
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Holosystoiic
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup

34. When does EF decrease
In HF
Decreases
Vasodilators
Volatage gated Ca channels

35. When is the scar completely formed in an MI?
7 weeks
Angiosarcoma
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Afterload (proportional to peripheral resistance)

36. Which bacteria causes endocarditis in the presence of colon cancer
Isovolumetric contraction
Left heart failure
S. bovis
Increase - increase the chance the If are open

37. What causes the ejection click in the Cres - decres murmur?
Fast volatge gated Na channels
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Aburpt halting of valve leaflets

38. Hyperplastic onion skinning
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Holosystoiic
Crescendo - decrescendo systolic ejection murmur following ejection click
Arteriolosclerosis in malignant hypertension

39. What is indicated when CO and venous return are equal?
LAD - V1- V2
Increase - increase the chance the If are open
The operating point of the heart
2-4 day - early coag necrosis on the first day

40. In an EKG - What is the PR interval?
Can progess to V fib
Mitral stenosis
QRS complex
Conduction delay through AV node - nl < 200 msec

41. What masks atrial repolarization?
During diastole
Heart - 02 extraction is always around 100%
QRS complex
Inc TPR and LA return (expiration)

42. Which murmur is heard with mitral prolapse?
Atrial contraction
Vasodilators - (hydrAlAzine)
During HF from microhemorrhages from inc pulm cap pressure
Late systolic crescendo murmur with a midsystolic click

43. What is the difference between adult and infantile type aortic coarctation?
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
During HF from microhemorrhages from inc pulm cap pressure
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
CK- MB

44. In an anteroseptal infarct - which artery is effected - and which leads show Q waves?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Patent ductus arteriosus - congenital rubella or prematurity
Fick principle
LAD - V1- V2

45. Which valve is most commonly involved in bacterial endocarditis?
RCA
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus
Mitral valve
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis

46. PROVe
V fib arrhythima
Subendocardial - fewer collaterals and higher pressure
Fast volatge gated Na channels
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

47. with what heart sounds do ASD usually present?
3rd degree block - pacemaker - Lyme disease
Pulmonary flow murmur and diastolic rumble
PDA
Increased SV

48. What causes the CO curve to shift upwards?
Pos inotropy - exercise
Dilation
RV contraction (closed tricuspid valve bulding into atrium
Fick principle

49. What does T wave inversion indicated?
No - no pressure gradient
...
MI
Troponin I

50. Do you see elevaged ASO titers in rheumatic heart disease
Vasocxn
Angiosarcoma
Turners
Yes

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