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Cardiology

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. What are the different etiologies of dialted cardiomyopathy
In RA return (inspiration)
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
The aortic before pulmonic - inspiration increases diff
SV/ EDV

2. How do catecholamines increase contractility?
Increased SV
Maintain blood flow to organ over wide range of perfussion pressures
ANP
Increasing activity of Ca pump in SR

3. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Fick principle
RCA
Arteriolosclerosis in malignant hypertension
SA>AV>bundle of His>ventricles

4. What does an isoelectric ST segment indicate?
Ventricles are depolarized
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Stroke volume
Aortic disecction - intraluminal tear forming false lumen

5. which medications are used to maintain patency or close the ductus arteriosus?
Indomethacin closes - and pge keeps it open
Pulmonic stenosis and RBBB
LCX - I - aVL
Venodilators (nitrogylcerine)

6. What constitues the upstroke in pacemaker cells?
V fib
P02
Volatage gated Ca channels
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved

7. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
Ventricles are depolarized
Venodilators (nitrogylcerine)
Adult type aortic coarctation
Increase intracellular Na - resulting in increased Ca

8. What do patients die early from in rheumatic heart disease?
Pulsus parvus and tardus - weak - can lead to syncope
Early deaths from myocarditis
Fluid movement through capillaries
Hematocrit

9. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
Varicose veins - thromboembolism rare
During diastole
Polycythemia - hyperproteinemic states (multiple myeloma) - hereditary spherocytosis
TAPVR

10. Which murmur is heard in aortic stenosis?
Crescendo - decrescendo systolic ejection murmur following ejection click
Neg inotropy - HF - narcotic overdose
Increasing activity of Ca pump in SR
Pos inotropy - exercise

11. The 7 complications of MI

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12. Why is there edema after burns or during infection
HTN - bradycardia - and respiratory depression
RF
The plateau period
Inc Kf - capillary perm

13. What is the time frame for arrhythmia risk in the evolution of MI
The first 4 days
Chordae rupture - GN - suppurative pericarditis - emboli
Left heart failure
Apex and anterior interventricular septum

14. Churg Strauss - presentation and test
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Stable angina
Henoch - Schlonlein purpura
Cyclophosphamide and corticosteroids

15. How are sarcomeres added in concentric hypertrophy?
SA>AV>bundle of His>ventricles
In parallel
Inc interstitial osmotic pressure pulling fliud out of capillaries
Holosystolic - harsh sounding murmur - loudest over tricuspid area

16. When and why do you hear the S4 sound
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Dressler's - autoimmune
Turners
2-4 day - early coag necrosis on the first day

17. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Late systolic crescendo murmur with a midsystolic click
Non
Cyclophosphamide and corticosteroids
Persistant truncus arteriosus

18. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Henoch - Schlonlein purpura
CK- MB
ASD
Ventricular repolarization

19. What does the atria release in response to inc blood volume and atrial pressure
Aortic dilation - bicuspid aortic valve - RF -
LAD - V1 - V4
ANP
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

20. Why is contractility decreased in heart failure?
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Systolic dysfunction
Total anomalous pulmonary trunk venous return
Microscopic polyangiitis - like wegener's without granulomas

21. What happens in phase 3 of the cardiac ventricular action potential?
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels
Purkingee>atria>ventricles>AV node
Dressler's - autoimmune
LAD - V1- V2

22. fibrinous pericarditis several weeks post MI

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23. Given P = QR - what factors influence resistance?
Persistant truncus arteriosus
Pulmonary flow murmur and diastolic rumble
Proportional to viscosity and inversely proportional to the radius to the 4th power
Lymphangiosarcoma

24. Which area of the endocardium is especially vulnerable to infarction? Why?
Calcification in media of arteries esp radial and ulnar - does not obstruct blood flow - intima not involved
Glomus tumor
Subendocardial - fewer collaterals and higher pressure
Resting potential high K perm

25. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Inc blood volume
Hemorrhage
Troponin I
Mean arterial pressure

26. What is the characteristic pulse in aortic stenosis?
Aortic insuffic - late
Henoch - Schlonlein purpura
Early deaths from myocarditis
Pulsus parvus and tardus - weak - can lead to syncope

27. What happens with a decrease of extracellular Na
S. aureus
Rapid upstroke - voltage gated Na channels open
Decrease in activity of Na/Ca exhanger and increase in contractility
Dressler's - autoimmune

28. Which organ has ht highest blood flow per gram of tissue
At least 55%
Mitral valve prolapse
Kidney
Venodilators (nitrogylcerine)

29. What is the classic X ray finding for tet of fallot?
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Pulmonic stenosis and RBBB
Boot shaped heart
Anterosuperior displacement of the infundibular septum

30. stroke volume x HR =?
ASD
CO
Atherosclerosis
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve

31. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Total anomalous pulmonary trunk venous return
Fetal right to left - neonate left to right leading to RVH and failure
Inc Kf - capillary perm
ASD

32. In an inferior wall infarct - which artery is affected and which leads show Q waves
3rd degree block - pacemaker - Lyme disease
RCA - II - III - aVF
2-4 day - early coag necrosis on the first day
Hypertrophied cardiomyopathy

33. congenital heart defect in an infant with a diabetic mother?
Transposition of great vessels
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Viridans streptococci
Posterior descending (80% off the RCA - 20% off the circumflex)

34. In terms of starling forces - why does nephrotic syndrome or liver failure cause edems
Mechanican contraction of the ventricles
Kaposi's sarcoma
Dec plasma proteins
R to L shunt caused by stenoic pulmonic valve

35. bacterial endocarditis - previously normal valves - rapid onset - Which bacteria?
C - ANCA
S. aureus
Increase contractility
Inc venous return exaccerbates pulm vasc congestion

36. In an EKG - What is the p wave?
During diastole
In series
Atrial contraction
Group a beta hemolytic strep

37. In an EKG - What is the T wave?
If sodium channel
Ventricular repolarization
Buerger's disease
In parallel

38. When do you see extensive coagulative necrosis in an MI
2-4 day - early coag necrosis on the first day
Neg inotropy - HF - narcotic overdose
Hematocrit
Crescendo - decrescendo systolic ejection murmur following ejection click

39. Fatal arrhythmia
Neg inotropy - HF - narcotic overdose
V fib
During diastole
In parallel

40. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
LCX - I - aVL
Strawberry hemangioma
Yes
Diastolic

41. clinical signs of cardiac tamponade
Strawberry hemangioma
Left heart failure
Kussmaul's sign - cardiac tamponade - pulsus paradoxus
Hypotension - inc venous pressure - distant heart sounds - inc HR - pulsus paradoxus

42. What is the S1 sound?
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Inc central venous pressure - inc resistance to portal flow
Systolic dysfunction
Mitral and tricuspid closure

43. Which organ has the largest arteriovenous difference
ANP
Increased SV
LAD - V1- V2
Heart - 02 extraction is always around 100%

44. systolic - diastolic
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction
Decrease in activity of Na/Ca exhanger and increase in contractility
Pulse pressure
Tricuspid atresia - requires ASD and VSD

45. Which bacteria can cause endocarditis from prosthetic valves?
Arteriorles
Age related calcifications or bicuspid aortic valve
Decrease in activity of Na/Ca exhanger and increase in contractility
S. epidermidis

46. What kind of dysfunction ensues in restrictive cardiomyopathy
Increase in Pc
Inc central venous pressure - inc resistance to portal flow
RCA - II - III - aVF
Diastolic

47. What does autoregulation do?
Maintain blood flow to organ over wide range of perfussion pressures
Temporal arteritis
Left sided
Fluid movement through capillaries

48. What is the gold standard for dx of MI in the first 6 hours
Increase intracellular Na - resulting in increased Ca
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Ischemic heart dz - mitral valve prolapse - LV dilation
EKG

49. In terms of starling forces - why does heart failure cause edema?
S. bovis
Myxoma
Increase in Pc
Isovolumetric contraction

50. Do you see elevaged ASO titers in rheumatic heart disease
LAD > RCA > circumflex
Yes
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
Septal defects - PDA - pulm art stenosis