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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. The 7 complications of MI

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2. Which murmur is heard with VSD?
LAD > RCA > circumflex
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Fick principle
Inc venous return exaccerbates pulm vasc congestion

3. failure of truncus arteriosus to divide?
CO
Persistant truncus arteriosus
Aortic disecction - intraluminal tear forming false lumen
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's

4. How are the sarcomeres added in eccentric hypertrophy?
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
In series
Inc blood volume
Decreases

5. prolonged PR interval
Rapid upstroke - voltage gated Na channels open
Aortic stenosis or LBBB
C - ANCA
1st degree AV blodck

6. What causes aortic regurg
Boot shaped heart
The plateau period
Aortic dilation - bicuspid aortic valve - RF -
Mitral valve

7. On the cardiac cycle graph - on which corners do the opening and closing of the aortic and mitral valves occur?
Lower right - MC - upper right - AO - upper right AC - lower left MO
Metastasis from melanoma or lymphoma
Activated histiocytes
If sodium channel

8. When do you find hemosiderin laden macrophages in the lungs?
During HF from microhemorrhages from inc pulm cap pressure
ASD
Libman - sacks endocarditis
5-10 days - macs have degraded structural components

9. Which organ has the largest arteriovenous difference
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Heart - 02 extraction is always around 100%
Unstable/crescendo angina
Increased SV

10. decrease blood flow to the skin due to arteriolar vasospasm in cold temp - emotional stress - also in SLE and CREST

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11. What kind of infarct show ST depression
Increased SV
Inc TPR and LA return (expiration)
3rd degree syphillus - syphillit heart disease can lead to aortic valve incompetence
Subendocardial

12. congenital heart defect with marfan's
Black > white > asian
If sodium channel
Aortic insuffic - late
Rhabdomyomas

13. what percentage of HTN is secondary to renal disease?
Acute thrombosis of coronary artery
Atrial contraction
10%
Dilated cardiomyopathy

14. skin rash on buttocks and legs - arthralgia - intestinal hemorrhage - abdominal pain - melena. Follows URI - IgA immune complex - most common childhood systemic vasculitis
Age related calcifications or bicuspid aortic valve
Maintain blood flow to organ over wide range of perfussion pressures
Henoch - Schlonlein purpura
Angiosarcoma

15. segmental thrombosing vasculitis of small and medium vessels in smokers with intermittent claudication - superficial nodular phlebitis - raynaud's - gangrene and severe pain - autoamputation of digits is possible

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16. What do the carotid and aortic bodies respond to?
Varicose veins - thromboembolism rare
Inc TPR and LA return (expiration)
Dec P02 - inc PC02 and dec pH
Mitral and tricuspid closure

17. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Fever - Arthritis - Night sweats - Myalgia - SKIN nodules - Ocular disturbances - Weak pulses in upper extremities
Pulmonic stenosis and RBBB
Hemorrhage
Myxomatous degeneration - RF - chordae rupture

18. highly lethal malignancy of the liver - associated with vinyl chloride - arsenic - and thorosrast exposure
Kaposi's sarcoma
Pyogenic granuloma - associated with trauma and pregnancy
Angiosarcoma
Cherry hemangioma

19. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
No - no pressure gradient
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Late systolic crescendo murmur with a midsystolic click
Mitral and tricuspid closure

20. Which two mechanisms sense decrease MAP?
Medullary vasomotor center senses baroreceptors and JGA
Fetal right to left - neonate left to right leading to RVH and failure
Decrease in cAMP
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas

21. In an inferior wall infarct - which artery is affected and which leads show Q waves
RCA - II - III - aVF
Eisenmenger's syndrome
1st degree AV blodck
LCX - V4- V6

22. What does the U wave indicated?
Mitral stenosis
HypoK and bradycardia
Increase in Pc
Late systolic crescendo murmur with a midsystolic click

23. Which murmur is characteristic of mitral/tricuspid regurg?
Dec P02 - inc PC02 and dec pH
Holosystoiic
Mitral>aortic>>tricuspid - high pressure valves affected most
Postinfarction fibrinous pericarditis

24. What is the classic X ray finding for tet of fallot?
Boot shaped heart
At least 55%
Aortic disecction - intraluminal tear forming false lumen
RV contraction (closed tricuspid valve bulding into atrium

25. When does EF decrease
In HF
Conduction delay through AV node - nl < 200 msec
Eisenmenger's syndrome
Pos inotropy - exercise

26. What happends in phase 1 of the ventricular cardiac action potential?
No - no pressure gradient
Eisenmenger's syndrome
Dec P02 - inc PC02 and dec pH
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

27. Which area of the endocardium is especially vulnerable to infarction? Why?
Metastasis from melanoma or lymphoma
Fluid movement through capillaries
Changes in CO as a function of preload
Subendocardial - fewer collaterals and higher pressure

28. lymphatic malignancy associated with persistant lymphadema - post radical mastectomy
Hypertrophied cardiomyopathy
Lymphangiosarcoma
At least 55%
Increasing activity of Ca pump in SR

29. Which bacteria causes rheumatic heart disease
MAP
Mitral valve
Group a beta hemolytic strep
In parallel

30. What is the danger of torsades to pointes?
Dilation
Can progess to V fib
Unstable/crescendo angina
Liver

31. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
MI
Eccentric - concentric hypertrophy causes diastolic disfunction
Can progess to V fib
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

32. What causes the murmur heard in MR to enhance?
Arrhythmia - LV failure and pulm edema - cardiogenic shock - free wall rupture - aneurysm - postinfarcation fibrinous pericarditis - dressler's
During diastole
Inc TPR and LA return (expiration)
Sturge weber - vasculitis of caps

33. Central chemoreceptors do not respond directly to which parameter?
Aortic disecction - intraluminal tear forming false lumen
SV/ EDV
P02
Mitral valve

34. What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
Fetal right to left - neonate left to right leading to RVH and failure
HypoK and bradycardia
Torsades de pointes
Atherosclerosis

35. What does hypoxia cause in the lung versus other tissues?
LAD > RCA > circumflex
Postinfarction fibrinous pericarditis
Mitral valve
Vasocxn - while other tissues it causes vasodilation

36. p - anca

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37. acute - self limiting necrotizing vasculitis in children associated with fever - conjunctivitis - strawberry tongue - desquamatous skin rash - lymphadenitis - coronary sinus aneurysms. Seen in asians
Left sided
Kawasaki
Libman - sacks endocarditis
Holosystoiic

38. What is sudden cardiac death most commonly due to...
Tricuspid atresia - requires ASD and VSD
2nd degree AV block - mobitz type 1
V fib arrhythima
Myxomatous degeneration - RF - chordae rupture

39. Do dihydropyridine or non - dihyrdropyridine Ca channel blockers decrease contractility
Non
Failure of LV to in CO during exercise
Aortic stenosis or LBBB
RV failure - in venous pressure

40. What is the machine like murmur? What is the heart pathology and the predisposing causes
Patent ductus arteriosus - congenital rubella or prematurity
Fever - erythema marginatum - valvular damage - ESR - red hot joints - subQ nodules - St. vitus dance (chorea)
SA and AV nodes
Proportional to viscosity and inversely proportional to the radius to the 4th power

41. In normal S2 splitting - which valve closes first? What increases it?
Ventricles are depolarized
Stroke volume
Glossopharyngeal to soliary nucleus of medulla
The aortic before pulmonic - inspiration increases diff

42. How are cadiac myocytes eltrically coupled?
Aortic dilation - bicuspid aortic valve - RF -
During HF from microhemorrhages from inc pulm cap pressure
Gap junctions
Fast volatge gated Na channels

43. What causes the midsystolic click
Sudden tensing of chordae tendinae
Ventricular depolarization - nl < 120 msec
Aburpt halting of valve leaflets
Squat. Compression of femoral arteries - inc TPR - dec

44. What happens in phase 4 of the cardiac ventricular action potential?
During diastole
Stroke volume affected by contractility - afterload - and preload
140/90
Resting potential high K perm

45. What is the gold standard for dx of MI in the first 6 hours
Venodilators (nitrogylcerine)
EKG
If sodium channel
Decrease in cAMP

46. How does angiotensin II raise MAP
Dilation
Decrease in cAMP
In parallel
Vasocxn

47. What masks atrial repolarization?
Non
QRS complex
Varicose veins - thromboembolism rare
Black > white > asian

48. What causes ankle - sacral edema - jugular venous distention
Rhabdomyomas
RV failure - in venous pressure
Filling is incomplete and CO falls
Glossopharyngeal to soliary nucleus of medulla

49. What is the association with wide S2 splitting?
Subendocardial
Tetrology of fallot - pulmonary stenosis - RVH - overiding aorta - VSD
Inc blood volume
Pulmonic stenosis and RBBB

50. what conditions are associated with pulsus paradoxus
Increase contractility
Mitral and tricuspid closure
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Fluid movement through capillaries