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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. What happens in phase 2 of the cardiac ventricular action potential?
CK- MB
Transposition of great vessels
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

2. The cause of pulmonary edema - paroxysmal nocturnal dyspnea?
Increasing activity of Ca pump in SR
LV failure - pulm venous distention transudation of fluid
MAP
Increase intracellular Na - resulting in increased Ca

3. S3 - dilated heart on US - balloon appearance on CXR - eccentric hypertrophy
Lower right - MC - upper right - AO - upper right AC - lower left MO
Dilated cardiomyopathy
V fib
CO

4. What are common causes of mitral regurg?
Medullary vasomotor center senses baroreceptors and JGA
Late diastolic murmur following an opening snap
Failure of LV to in CO during exercise
Ischemic heart dz - mitral valve prolapse - LV dilation

5. When and why do you hear the S4 sound
Inc TPR and LA return (expiration)
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Hemorrhage
P02

6. What happens in phase 3 of the cardiac ventricular action potential?
2-4 day - early coag necrosis on the first day
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Cherry hemangioma
RCA - II - III - aVF

7. What is associated with paradoxical spliting of S2
Torsades de pointes
Aortic stenosis or LBBB
Decreases
Dilation

8. How are sarcomeres added in concentric hypertrophy?
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
No - no pressure gradient
Preload
In parallel

9. benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma - caused by bartonella henselae
SA and AV nodes
Infective endocarditis
Transfusion
...

10. polypoid capillary hemangioma that can ulcerate and bleed
Atherosclerosis
Transposition of great vessels
Pyogenic granuloma - associated with trauma and pregnancy
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

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

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12. When during cardiac nodal cells depolarize?
10%
During diastole
Tricuspid atresia - requires ASD and VSD
LCX - V4- V6

13. In an EKG - What is the QT interval?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
5-10 days - macs have degraded structural components
Left atrial pressure
Mechanican contraction of the ventricles

14. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
MAP
Hemorrhage
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Dec plasma proteins

15. How does digitatlis increase contractility?
Increase intracellular Na - resulting in increased Ca
Decrease in cAMP
In parallel
V fib

16. What causes the early cyanosis in Tet of Fallot?
RV contraction (closed tricuspid valve bulding into atrium
Inc RA pressure - due to filling against closed tricupsid valve
The aortic before pulmonic - inspiration increases diff
R to L shunt caused by stenoic pulmonic valve

17. retrosternal chest main with exertion - ST depression on ECG - likely due atherosclerosis
Resting potential high K perm
Aburpt halting of valve leaflets
Stroke volume
Stable angina

18. What does the starling curve show?
LAD
Strawberry hemangioma
Changes in CO as a function of preload
Transmural

19. wartiike - sterile vegetations occur on both sides of the valve - commonly causes mitral regurg. SLE causes it
Patent ductus arteriosus - congenital rubella or prematurity
Libman - sacks endocarditis
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Unstable/crescendo angina

20. What is the definition of HTN?
140/90
ASD - VSD - AV septal defect (endocardial cushion defect)
Increased efferent SANS and decreased efferent PANS
Coarcation of aorta

21. What causes the CO curve to shift downwards?
Decreases
Activated histiocytes
Neg inotropy - HF - narcotic overdose
Resting potential high K perm

22. What happens in phase 4 of the cardiac ventricular action potential?
Resting potential high K perm
Lymphangiosarcoma
CO
Kidney

23. fibrinous pericarditis several weeks post MI

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24. What are anitschkow's cells
Activated histiocytes
Dilated cardiomyopathy
Dressler's - autoimmune
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

25. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
HypoK and bradycardia
Myxoma
MI
Myxomatous degeneration - RF - chordae rupture

26. What does FROM JANE stand for in bacterial endocarditis?

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27. What stimulates release of calcium from the SR?
Non
The plateau period
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Extracellular calcium - calcium induced calcium release

28. What is the progression of atherosclerosis?
V fib
Atherosclerosis
At least 55%
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

29. What does an isoelectric ST segment indicate?
Black > white > asian
Kaposi's sarcoma
Maintain blood flow to organ over wide range of perfussion pressures
Ventricles are depolarized

30. What is the early and late lesion in rheumatic heart disease
During diastole
Transfusion
Raynaud's
Mitral valve prolapse

31. How does acidosis affect contractility?
Decreased
EKG
P02
5-10 days - macs have degraded structural components

32. What are the diastolic heart sounds?
Cystic hygroma
Aortic/pulmonic regurg and mitral/tricuspid stenosis
1st degree AV blodck
Strawberry hemangioma

33. Which bacteria causes rheumatic heart disease
Hyperlipidemia
Group a beta hemolytic strep
Pulmonary flow murmur and diastolic rumble
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

34. What 4 things drive myocardial 02 demand?
Black > white > asian
Unstable/crescendo angina
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Changes in CO as a function of preload

35. When and why is the S3 sound heard?
Early deaths from myocarditis
Left heart failure
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Increase contractility

36. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Kawasaki
Libman - sacks endocarditis
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD

37. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Wolff - Parkinson white syndrome
Venodilators (nitrogylcerine)
Cardiac tamponde
3rd degree block - pacemaker - Lyme disease

38. The cause of cardiac dilation?
Non
Medullary vasomotor center senses baroreceptors and JGA
Inc Kf - capillary perm
Greater ventricular EDV

39. What does hypoxia cause in the lung versus other tissues?
Hypertrophied cardiomyopathy
Vasocxn - while other tissues it causes vasodilation
Turners
Ischemic heart dz - mitral valve prolapse - LV dilation

40. What happens with a decrease of extracellular Na
...
Libman - sacks endocarditis
Decrease in activity of Na/Ca exhanger and increase in contractility
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

41. Right to left shunts are more common in babies or kids?
Medullary vasomotor center senses baroreceptors and JGA
Dilated cardiomyopathy
S. epidermidis
Babies

42. What causes the murmur heard in tricuspid regurg to enhance
In RA return (inspiration)
Vasodilators - (hydrAlAzine)
RF
C - ANCA

43. Irregularly irregular ECG - no p waves: dx and treatment
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Libman - sacks endocarditis
Stable angina
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

44. What channels do the the pacemaker cells lack?
LCX - V4- V6
Ventricles are depolarized
Fast volatge gated Na channels
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block

45. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
S. aureus
Gap junctions
Stroke volume affected by contractility - afterload - and preload
ANP

46. Chronic mitral stenosis can lead to what changes in size of the LA
Hemorrhage
Kidney
Dressler's - autoimmune
Dilation

47. What are the complications of atherosclerosis?
...
Proportional to viscosity and inversely proportional to the radius to the 4th power
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
The operating point of the heart

48. What causes orthopnea?
2-4 day - early coag necrosis on the first day
Metastasis from melanoma or lymphoma
Lymphangiosarcoma
Inc venous return exaccerbates pulm vasc congestion

49. congenital heart defect with marfan's
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Aortic insuffic - late
Stable angina

50. How are the sarcomeres added in eccentric hypertrophy?
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Unstable/crescendo angina
Vasocxn
In series