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Cardiology

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Answer 50 questions in 15 minutes.
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1. In an anterior wall infarct - which artery is effected and which leads show Q waves
LAD - V1 - V4
CHF
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Mitral stenosis

2. Which organ gets the largest share of systemic cardiac output
Liver
140/90
Vagus to medulla
Increase intracellular Na - resulting in increased Ca

3. Why is there edema after burns or during infection
Inc Kf - capillary perm
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Dilation
QRS complex

4. What causes the CO curve to shift upwards?
Pos inotropy - exercise
Cardiac tamponde
Volatage gated Ca channels
Aortic and pulmonary closing

5. What does an isoelectric ST segment indicate?
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Ventricles are depolarized
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

6. Which class of drugs decrease the murmur heard in aortic regurg?
Vasodilators
Acute thrombosis of coronary artery
Cyclophosphamide and corticosteroids
LAD - V1- V2

7. Which valve is commonly involved in bacterial endocarditis from IV drug use and Which bacteria are most common?

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8. How does angiotensin II raise MAP
Inc Kf - capillary perm
Infective endocarditis
Vasocxn
R to L shunt caused by stenoic pulmonic valve

9. SV CAP means?
Stroke volume affected by contractility - afterload - and preload
Afterload (proportional to peripheral resistance)
Kidney
Preload

10. which ethnic groups have higher association with HTN?
R to L shunt caused by stenoic pulmonic valve
Black > white > asian
Aortic dilation - bicuspid aortic valve - RF -
Aortic stenosis or LBBB

11. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the right?
Stable angina
Dec P02 - inc PC02 and dec pH
Transfusion
Aortic/pulmonic stenosis and mitral/tricuspid regurg

12. What does HTN predispose to?
Holosystoiic
ASD - VSD - AV septal defect (endocardial cushion defect)
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Activated histiocytes

13. What happens in phase 2 of the cardiac ventricular action potential?
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Glomus tumor
Raynaud's

14. What does increasing intracellular Ca do?
Indomethacin closes - and pge keeps it open
S. aureus
Increase contractility
Inc Kf - capillary perm

15. what conditions are associated with pulsus paradoxus
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Atherosclerosis

16. What causes ankle - sacral edema - jugular venous distention
RV failure - in venous pressure
CK- MB
Mean arterial pressure
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

17. What is the S1 sound?
Inc central venous pressure - inc resistance to portal flow
CK- MB
Mitral and tricuspid closure
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

18. congenital heart defect in an infant with a diabetic mother?
Transposition of great vessels
Inc afterload - inc contractility - inc heart rate - inc heart size (inc wall tension)
Neg inotropy - HF - narcotic overdose
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

19. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Extracellular calcium - calcium induced calcium release
Fetal right to left - neonate left to right leading to RVH and failure
Kawasaki
In RA return (inspiration)

20. which heart valves are afected most in rheumatic heart diseease
Mitral>aortic>>tricuspid - high pressure valves affected most
Mean arterial pressure
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Vasocxn

21. What are anitschkow's cells
Vasodilators - (hydrAlAzine)
Activated histiocytes
Resting potential high K perm
Babies

22. Rank the following by speed of conduction - av node - atria - purkinjee - ventricles
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Purkingee>atria>ventricles>AV node
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
Dec plasma proteins

23. What does the LAD supply?
Apex and anterior interventricular septum
Stroke volume affected by contractility - afterload - and preload
Anterosuperior displacement of the infundibular septum
Wolff - Parkinson white syndrome

24. What happends in phase 1 of the ventricular cardiac action potential?
Purkingee>atria>ventricles>AV node
Turners
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
RCA

25. What does the U wave indicated?
HypoK and bradycardia
Eccentric - concentric hypertrophy causes diastolic disfunction
During HF from microhemorrhages from inc pulm cap pressure
Slow conduction velocity - used by AV node prolongs transmission from atria to ventrical

26. What does T wave inversion indicated?
MI
R to L shunt caused by stenoic pulmonic valve
RV contraction (closed tricuspid valve bulding into atrium
Polyarteritis nodosum

27. If HR is too fast (V tach) what happens during diastole?
Filling is incomplete and CO falls
Aortic/pulmonic regurg and mitral/tricuspid stenosis
LAD - V1 - V4
Septal defects - PDA - pulm art stenosis

28. How do beta blockers decrease contractility?
Total anomalous pulmonary trunk venous return
Decrease in cAMP
In HF
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys

29. Which murmur is heard with VSD?
Can progess to V fib
CFX
Holosystolic - harsh sounding murmur - loudest over tricuspid area
P02

30. with what heart sounds do ASD usually present?
Pulmonary flow murmur and diastolic rumble
Polyarteritis nodosum
Dec plasma proteins
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli

31. Which bacteria causes rheumatic heart disease
Aortic and pulmonary closing
Inc blood volume
Group a beta hemolytic strep
Pulse pressure

32. In normal S2 splitting - which valve closes first? What increases it?
Greater ventricular EDV
The aortic before pulmonic - inspiration increases diff
Beta 1 inc HR and cont - alpha 1 venocxn - alpha 1 arteriolar vascxn
During diastole

33. in the JVP - What is the a wave?
Atrial contraction
Takayasu's arteritis
Fetal right to left - neonate left to right leading to RVH and failure
Vagus to medulla

34. In an EKG - What is the PR interval?
Conduction delay through AV node - nl < 200 msec
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
Cystic hygroma
HTN - bradycardia - and respiratory depression

35. What is the machine like murmur? What is the heart pathology and the predisposing causes
Truncus - tet of fallot
Sturge weber - vasculitis of caps
Vagus to medulla
Patent ductus arteriosus - congenital rubella or prematurity

36. Restrictive cardiomyopathy causes
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
At least 55%
Polyarteritis nodosum
During diastole

37. What are common causes of mitral regurg?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Kaposi's sarcoma
Fast volatge gated Na channels
Ischemic heart dz - mitral valve prolapse - LV dilation

38. What other sign is often present with congenital long QT syndrome - why?
Ventricles are depolarized
Mitral and tricuspid closure
Aortic and pulmonary closing
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome

39. sudden death in young atheletes - S4 - apical impulses - outflow obstruction
3rd degree block - pacemaker - Lyme disease
Vagus to medulla
Hypertrophied cardiomyopathy
Atherosclerosis

40. What causes aortic regurg
Inc central venous pressure - inc resistance to portal flow
Activated histiocytes
Aortic dilation - bicuspid aortic valve - RF -
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy

41. what happens to capillaries in lymphatic blockage
Inc interstitial osmotic pressure pulling fliud out of capillaries
Takayasu's arteritis
Increased efferent SANS and decreased efferent PANS
Henoch - Schlonlein purpura

42. What is the association with wide S2 splitting?
LAD > RCA > circumflex
Rapid upstroke - voltage gated Na channels open
Increase contractility
Pulmonic stenosis and RBBB

43. polypoid capillary hemangioma that can ulcerate and bleed
Pyogenic granuloma - associated with trauma and pregnancy
ANP
Changes in CO as a function of preload
Neg inotropy - HF - narcotic overdose

44. What are the different etiologies of dialted cardiomyopathy
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
ASD - VSD - AV septal defect (endocardial cushion defect)
Transposition of great vessels
Coarcation of aorta

45. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Systolic dysfunction
No
Buerger's disease
Can progess to V fib

46. When do you find hemosiderin laden macrophages in the lungs?
Left atrial pressure
During HF from microhemorrhages from inc pulm cap pressure
Vagus to medulla
Fluid movement through capillaries

47. Chronic mitral stenosis can lead to what changes in size of the LA
Pulse pressure
Mean arterial pressure
Dilation
Persistant truncus arteriosus

48. L to R shunt becomes R to L due to increase pulm pressures from original congenital heart defect

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49. What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
Microscopic polyangiitis - like wegener's without granulomas
Decreases
Takayasu's arteritis
Raynaud's

50. What is sudden cardiac death most commonly due to...
Vasocxn - while other tissues it causes vasodilation
Chordae rupture - GN - suppurative pericarditis - emboli
V fib arrhythima
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

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