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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. In the evolution of an MI - when the risk for free wall rupture - tamponade - papillary muscle rupture - or interventricular septal rupture the hightest? Why?
R to L shunt caused by stenoic pulmonic valve
Preload
5-10 days - macs have degraded structural components
Chordae rupture - GN - suppurative pericarditis - emboli

2. The carotid sinus transmits along which nerve?
Troponin I
Pos inotropy - exercise
Fick principle
Glossopharyngeal to soliary nucleus of medulla

3. prolonged PR interval
1st degree AV blodck
Aortic dilation - bicuspid aortic valve - RF -
Posterior descending (80% off the RCA - 20% off the circumflex)
Persistant truncus arteriosus

4. What are aschoff bodies
Kids
ANP
ASD - VSD - AV septal defect (endocardial cushion defect)
Granuloma with giant cells

5. The 7 complications of MI

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6. In an anterolateral infarct - which artery is effected and which leads show Q waves
LCX - V4- V6
Changes in CO as a function of preload
Medullary vasomotor center senses baroreceptors and JGA
At least 55%

7. Unilateral headache - jaw claudication - impaired vision
Tempral arteritis - may cause irreversible blindness
HypoK and bradycardia
Fick principle
Angiosarcoma

8. what happens to capillaries in lymphatic blockage
Holosystoiic
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
Inc interstitial osmotic pressure pulling fliud out of capillaries
Squat. Compression of femoral arteries - inc TPR - dec

9. What is the association with wide S2 splitting?
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
Pulmonic stenosis and RBBB
Libman - sacks endocarditis
Venodilators (nitrogylcerine)

10. What channels do the the pacemaker cells lack?
Fast volatge gated Na channels
No
Torsades de pointes
Microscopic polyangiitis - like wegener's without granulomas

11. polypoid capillary hemangioma that can ulcerate and bleed
Systolic dysfunction
Pyogenic granuloma - associated with trauma and pregnancy
Increased efferent SANS and decreased efferent PANS
Fluid movement through capillaries

12. Which lab value indicates blood viscosity?
S. bovis
Ventricular repolarization
Varicose veins - thromboembolism rare
Hematocrit

13. Exercise - overtransfusiion and excitiment causes and increase in...?
C - ANCA
Preload
Sensironeural deafness - defects in sodium and potassium channels - jervell and lange - neilsen syndrome
Group a beta hemolytic strep

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

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15. In an inferior wall infarct - which artery is affected and which leads show Q waves
Hemoptysis - hematuria - perforation of nasal septum - chronic sinusitis - otitis media - mastoiditis - cough dyspnea
The first 4 days
RCA - II - III - aVF
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities

16. congenital heart defect with 22q11
Mitral valve prolapse
Stroke volume affected by contractility - afterload - and preload
Increased SV
Truncus - tet of fallot

17. What stimulates release of calcium from the SR?
Extracellular calcium - calcium induced calcium release
Septal defects - PDA - pulm art stenosis
LCX - V4- V6
Decreased

18. Which organ has ht highest blood flow per gram of tissue
Normal in children and pregs - assoc with inc filling pressures - early in diastole during rapid ventricular filling
Aortic/pulmonic regurg and mitral/tricuspid stenosis
Purkingee>atria>ventricles>AV node
Kidney

19. What murmur is heard with aortic regurg?
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Lymphangiosarcoma
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Atrial contraction

20. What is the classic X ray finding for tet of fallot?
Left heart failure
Increased SV
Boot shaped heart
140/90

21. What causes the CO curve to shift downwards?
If sodium channel
Changes in CO as a function of preload
Ventricles are depolarized
Neg inotropy - HF - narcotic overdose

22. list the coronary vessels most likely to be occluded
Decrease in cAMP
The operating point of the heart
Mean arterial pressure
LAD > RCA > circumflex

23. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
Aortic stenosis or LBBB
TAPVR
Pyogenic granuloma - associated with trauma and pregnancy
Tricuspid atresia - requires ASD and VSD

24. In an acute MI - are there any visible changes via LM in the first 2-4 hours
Aortic stenosis or LBBB
Fever - roth's spots - osler's nodes - murmur - janeway lesions - anemia - nail - bed hemorrhages - emboli
Conduction delay through AV node - nl < 200 msec
No

25. What happends in phase 1 of the ventricular cardiac action potential?
Aortic stenosis or LBBB
Cyclophosphamide and corticosteroids
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open
Vasocxn

26. Which organ has the largest arteriovenous difference
Myxoma
Heart - 02 extraction is always around 100%
S. epidermidis
Mitral>aortic>>tricuspid - high pressure valves affected most

27. fibrous plaques and atheromas in intima of arteries
Aortic stenosis or LBBB
S. epidermidis
Atherosclerosis
Squat. Compression of femoral arteries - inc TPR - dec

28. What are the complications of atherosclerosis?
Vasodilators
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
RCA
Can progess to V fib

29. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Varicose veins - thromboembolism rare
Henoch - Schlonlein purpura
Angiosarcoma
MI

30. 2/3 diastolic + 1/3 systolic
If sodium channel
RV failure - in venous pressure
MAP
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

31. disruption of the vasa vasorum of aorta - dilation of aorta and valve ring - tree bark appearance (calcifications on aortic root)
If sodium channel
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Septal defects - PDA - pulm art stenosis
Dilation

32. with what heart sounds do ASD usually present?
P02
Atherosclerosis
The plateau period
Pulmonary flow murmur and diastolic rumble

33. rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
Maintain blood flow to organ over wide range of perfussion pressures
Fick principle
LAD - V1 - V4
Polyarteritis nodosum

34. most common primary cardiac tumor in children - associated with tuberous sclerosis
Increase intracellular Na - resulting in increased Ca
Kawasaki
Granuloma with giant cells
Rhabdomyomas

35. What does prolonged QT predispose to?
Purkingee>atria>ventricles>AV node
LAD - V1- V2
Torsades de pointes
Viridans streptococci

36. What does FEVERSS stand for in rheumatic heart disease
Volatage gated Ca channels
10%
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)

37. Which two mechanisms sense decrease MAP?
Atrial contraction
Mitral valve prolapse
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Medullary vasomotor center senses baroreceptors and JGA

38. How does a patient with Tet of fallot learn to improve symptoms?
HypoK and bradycardia
Cherry hemangioma
Squat. Compression of femoral arteries - inc TPR - dec
Holosystolic - harsh sounding murmur - loudest over tricuspid area

39. What is the cushing triad?
Fetal right to left - neonate left to right leading to RVH and failure
HTN - bradycardia - and respiratory depression
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Increase intracellular Na - resulting in increased Ca

40. thrombosis w/o necrosis - ST elevation - worsening chest pain at rest or with minimal exertion
Unstable/crescendo angina
Neg inotropy - HF - narcotic overdose
Crescendo - decrescendo systolic ejection murmur following ejection click
Increased efferent SANS and decreased efferent PANS

41. EDV is also known as
Preload
V fib
Inc venous return exaccerbates pulm vasc congestion
Angiosarcoma

42. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
7 weeks
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Posterior descending (80% off the RCA - 20% off the circumflex)
Lower right - MC - upper right - AO - upper right AC - lower left MO

43. Which artery supplies the inferior portion of the left ventricle and posterior septum?
Extracellular calcium - calcium induced calcium release
Turners
Posterior descending (80% off the RCA - 20% off the circumflex)
Raynaud's

44. What are the different etiologies of dialted cardiomyopathy
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
V fib arrhythima
140/90
Cherry hemangioma

45. What are anitschkow's cells
Cherry hemangioma
Inc RA pressure - due to filling against closed tricupsid valve
Dec plasma proteins
Activated histiocytes

46. What causes the murmur heard in MR to enhance?
Vasodilators
Inc TPR and LA return (expiration)
R to L shunt caused by stenoic pulmonic valve
RV contraction (closed tricuspid valve bulding into atrium

47. congenital heart defect with congenital rubella
Gap junctions
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Truncus - tet of fallot
Septal defects - PDA - pulm art stenosis

48. What happens with a decrease of extracellular Na
Failure of LV to in CO during exercise
Buerger's disease
Decrease in activity of Na/Ca exhanger and increase in contractility
Infective endocarditis

49. What does an isoelectric ST segment indicate?
SV/ EDV
Ventricles are depolarized
Indomethacin closes - and pge keeps it open
ASD

50. Expiration causes an increase in which sided heart sounds
Aortic and pulmonary closing
LCX - V4- V6
Left sided
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa

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