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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. which heart valves are afected most in rheumatic heart diseease
Mitral>aortic>>tricuspid - high pressure valves affected most
Transposition of great vessels
S. epidermidis
Greater ventricular EDV

2. in the JVP - What is the a wave?
Patent ductus arteriosus - congenital rubella or prematurity
The operating point of the heart
Atrial contraction
Venodilators (nitrogylcerine)

3. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Persistant truncus arteriosus
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

4. If HR is too fast (V tach) what happens during diastole?
Greater ventricular EDV
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR
Heart - 02 extraction is always around 100%
Filling is incomplete and CO falls

5. Which bacteria causes rheumatic heart disease
Left atrial pressure
Holosystoiic
No
Group a beta hemolytic strep

6. which ethnic groups have higher association with HTN?
ASD
Black > white > asian
In RA return (inspiration)
Hematocrit

7. congenital heart defect with 22q11
Inc interstitial osmotic pressure pulling fliud out of capillaries
In parallel
Stroke volume
Truncus - tet of fallot

8. What is the cushing triad?
140/90
P02
Eisenmenger's syndrome
HTN - bradycardia - and respiratory depression

9. stroke volume x HR =?
CO
Cherry hemangioma
Proportional to viscosity and inversely proportional to the radius to the 4th power
Angiosarcoma

10. In an inferior wall infarct - which artery is affected and which leads show Q waves
RCA - II - III - aVF
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
S. bovis
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence

11. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Dec plasma proteins
Atherosclerosis
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
QRS complex

12. smaller vegetations - congenitally abnormal or diseased valves - sequela of dental procedures. Insidious onset
Septal defects - PDA - pulm art stenosis
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Pulsus parvus and tardus - weak - can lead to syncope
Viridans streptococci

13. In an anterior wall infarct - which artery is effected and which leads show Q waves
5-10 days - macs have degraded structural components
LAD - V1 - V4
Temporal arteritis
Left heart failure

14. diaphoresis - N/V - severe retrosternal pain - pain in left arm/jaw - SOB - fatigue - adrenergic symptoms
S. bovis
Hyperlipidemia
The operating point of the heart
MI

15. The cause of cardiac dilation?
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
MAP
Greater ventricular EDV
Glossopharyngeal to soliary nucleus of medulla

16. When during cardiac nodal cells depolarize?
Black > white > asian
During diastole
SA>AV>bundle of His>ventricles
ANP

17. most common primary cardiac tumor in adults - ball - valve obstruction in left atrium
Transposition of great vessels
Persistant truncus arteriosus
Myxoma
Aortic/pulmonic stenosis and mitral/tricuspid regurg

18. systolic - diastolic
5-10 days - macs have degraded structural components
Pulse pressure
Inc TPR and LA return (expiration)
Yes

19. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Left heart failure
Proportional to viscosity and inversely proportional to the radius to the 4th power
Varicose veins - thromboembolism rare
LCX - V4- V6

20. What is the most common cause of right heart failure
Left heart failure
Subendocardial
Squat. Compression of femoral arteries - inc TPR - dec
Ventricles are depolarized

21. CO x Total peripheral resistance
Increase - increase the chance the If are open
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Increase in Pc
Mean arterial pressure

22. When and why do you hear the S4 sound
Inc blood volume
Transmural
Vagus to medulla
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

23. What causes hepatomegaly?
LAD - V1- V2
2-4 day - early coag necrosis on the first day
Activated histiocytes
Inc central venous pressure - inc resistance to portal flow

24. Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
Postinfarction fibrinous pericarditis
Troponin I
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics
Pulse pressure

25. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
Glomus tumor
Decreased
TAPVR
Inc interstitial osmotic pressure pulling fliud out of capillaries

26. which medications are used to maintain patency or close the ductus arteriosus?
Unstable/crescendo angina
Indomethacin closes - and pge keeps it open
10%
MI

27. with what heart sounds do ASD usually present?
Sturge weber - vasculitis of caps
Changes in CO as a function of preload
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Pulmonary flow murmur and diastolic rumble

28. Expiration causes an increase in which sided heart sounds
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
...
Left sided
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

29. PCWP is an estimate of...
Left atrial pressure
LV failure - pulm venous distention transudation of fluid
Kids
Granuloma with giant cells

30. delta wave on ECG - accesory conduction pathway from atria to ventricles - reentry leading to supraventricular tachycardia
Patent ductus arteriosus - congenital rubella or prematurity
Vasodilators
Wolff - Parkinson white syndrome
Chordae rupture - GN - suppurative pericarditis - emboli

31. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Decreases
Temporal arteritis
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Metastasis from melanoma or lymphoma

32. How are cadiac myocytes eltrically coupled?
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Transmural
Gap junctions
The operating point of the heart

33. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
C - ANCA
PDA
Fetal right to left - neonate left to right leading to RVH and failure

34. What causes the murmur heard in MR to enhance?
Strawberry hemangioma
Hematocrit
Inc TPR and LA return (expiration)
Left sided

35. How are sarcomeres added in concentric hypertrophy?
No
Hemorrhage
In parallel
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

36. EDV is also known as
Preload
C - ANCA
Inc interstitial osmotic pressure pulling fliud out of capillaries
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling

37. How do beta blockers decrease contractility?
Right sided
Decrease in cAMP
Vasocxn
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia

38. What does FEVERSS stand for in rheumatic heart disease
No
No - no pressure gradient
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Myxoma

39. Churg Strauss - presentation and test
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Heart - 02 extraction is always around 100%
HTN - bradycardia - and respiratory depression
Granuloma with giant cells

40. Do you see elevaged ASO titers in rheumatic heart disease
Pos inotropy - exercise
Pyogenic granuloma - associated with trauma and pregnancy
Proportional to viscosity and inversely proportional to the radius to the 4th power
Yes

41. What cardiac change occurs in pregnancy?
Pulse pressure
Preload
Increased SV
Increasing activity of Ca pump in SR

42. In terms of starling forces - why does heart failure cause edema?
In series
Increase in Pc
The first 4 days
During diastole

43. What is the association with wide S2 splitting?
QRS complex
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Pulmonic stenosis and RBBB
Anterosuperior displacement of the infundibular septum

44. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Non
Boot shaped heart
Inc TPR and LA return (expiration)

45. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
CHF
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis
In HF
5-10 days - macs have degraded structural components

46. What is the definition of HTN?
140/90
Aortic disecction - intraluminal tear forming false lumen
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Late diastolic murmur following an opening snap

47. What murmur is heard with aortic regurg?
Decrease in cAMP
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
ASD - VSD - AV septal defect (endocardial cushion defect)
Sudden tensing of chordae tendinae

48. How does digitatlis increase contractility?
The aortic before pulmonic - inspiration increases diff
Takayasu's arteritis
Increase intracellular Na - resulting in increased Ca
Lower right - MC - upper right - AO - upper right AC - lower left MO

49. fibrous plaques and atheromas in intima of arteries
Anterosuperior displacement of the infundibular septum
Indomethacin closes - and pge keeps it open
Heart - 02 extraction is always around 100%
Atherosclerosis

50. most common heart tumor
Troponin I
Metastasis from melanoma or lymphoma
Apex and anterior interventricular septum
Extracellular calcium - calcium induced calcium release