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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
P02
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Strawberry hemangioma

2. in the JVP - What is the c wave?
The first 4 days
RV contraction (closed tricuspid valve bulding into atrium
Pulsus parvus and tardus - weak - can lead to syncope
Cardiac tamponde

3. dilated tortous veins due to chronically inc venous pressure - poor wound healing - varicose ulcers
Vasocxn
Preload
Varicose veins - thromboembolism rare
Transposition of great vessels

4. What is the time frame for arrhythmia risk in the evolution of MI
Decrease in cAMP
The first 4 days
Dec plasma proteins
Systolic dysfunction

5. Expiration causes an increase in which sided heart sounds
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy
Left sided
Late systolic crescendo murmur with a midsystolic click
Increased SV

6. Which channel accounts for automaticity of the SA and AV nodes?
Lower right - MC - upper right - AO - upper right AC - lower left MO
MI
If sodium channel
Increasing activity of Ca pump in SR

7. Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
Holosystolic - harsh sounding murmur - loudest over tricuspid area
No - no pressure gradient
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Granuloma with giant cells

8. Restrictive cardiomyopathy causes
Preload
Black > white > asian
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Rapid repol - massive K influx - opening of voltage gated slow K channels and closure of Ca channels

9. systolic - diastolic
Postinfarction fibrinous pericarditis
Stroke volume
V fib
Pulse pressure

10. When is the scar completely formed in an MI?
Resting potential high K perm
MI
Holosystolic - harsh sounding murmur - loudest over tricuspid area
7 weeks

11. Which murmur is heard with VSD?
The aortic before pulmonic - inspiration increases diff
Holosystolic - harsh sounding murmur - loudest over tricuspid area
Mitral stenosis
CHF

12. what happens to capillaries in lymphatic blockage
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Inc interstitial osmotic pressure pulling fliud out of capillaries
S. bovis
Late in diastole - high atrial pressure - pushing against a stiff LV wall - associated with ventricular hypertrophy

13. which heart valves are afected most in rheumatic heart diseease
Mitral>aortic>>tricuspid - high pressure valves affected most
Angiosarcoma
QRS complex
Late systolic crescendo murmur with a midsystolic click

14. What causes the ejection click in the Cres - decres murmur?
Right sided
Aburpt halting of valve leaflets
Neg inotropy - HF - narcotic overdose
Varicose veins - thromboembolism rare

15. In an EKG - What is the p wave?
Pulmonary flow murmur and diastolic rumble
Atrial contraction
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Plateau - influx of calcium through voltage gated ca channels - ca release from SR and contraction

16. In an EKG - What is the QT interval?
Microscopic polyangiitis - like wegener's without granulomas
Mechanican contraction of the ventricles
Tricuspid - don't tri drugs - S. aureus - pseudomonas - candida
Truncus - tet of fallot

17. Which organ has the largest arteriovenous difference
3rd degree block - pacemaker - Lyme disease
Heart - 02 extraction is always around 100%
Babies
Medullary vasomotor center senses baroreceptors and JGA

18. Central chemoreceptors do not respond directly to which parameter?
Fetal right to left - neonate left to right leading to RVH and failure
Infective endocarditis
P02
3rd degree block - pacemaker - Lyme disease

19. What is indicated when CO and venous return are equal?
Aortic stenosis or LBBB
Sarcoid - amyloid - postradiation fibrosis - endocardial fibroelastosis - Loffler - hemochromatosis
Acute thrombosis of coronary artery
The operating point of the heart

20. What happends in phase 1 of the ventricular cardiac action potential?
Inc ICP - cerebral ischemia - inc SANS tone (HTN) and reflex bradycardia
Buerger's disease
Dec P02 - inc PC02 and dec pH
Initial repol - inactivation of of voltage gated Na channels - voltage gated K channels begin to open

21. What is a normal EF
Vasodilators
The first 4 days
At least 55%
Fetal right to left - neonate left to right leading to RVH and failure

22. Which valve is most commonly involved in bacterial endocarditis?
Decreases
Mitral valve
Inc Kf - capillary perm
During HF from microhemorrhages from inc pulm cap pressure

23. MAP is also known as
LCX - I - aVL
Afterload (proportional to peripheral resistance)
Non
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral

24. What is the characteristic pulse in aortic stenosis?
V fib arrhythima
S. epidermidis
Increased efferent SANS and decreased efferent PANS
Pulsus parvus and tardus - weak - can lead to syncope

25. What murmur is heard with aortic regurg?
Immediate high pitched blowing diasystolic murmur with a wide pulse pressure
Cyclophosphamide and corticosteroids
Aortic/pulmonic stenosis and mitral/tricuspid regurg
Lower right - MC - upper right - AO - upper right AC - lower left MO

26. Rank the pacemakers cells
Dilation
SA>AV>bundle of His>ventricles
Aneurysms - ischemia - infarcts - peripheral vasc dz - thromboemboli
Hypertrophied cardiomyopathy

27. 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
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
MAP

28. What are the diastolic heart sounds?
Abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
Mitral>aortic>>tricuspid - high pressure valves affected most
Libman - sacks endocarditis
Aortic/pulmonic regurg and mitral/tricuspid stenosis

29. How does digitatlis increase contractility?
Increase intracellular Na - resulting in increased Ca
Tricuspid atresia - requires ASD and VSD
5-10 days - macs have degraded structural components
Inc Kf - capillary perm

30. The cause of dyspnea on exertion?
Kaposi's sarcoma
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Afterload (proportional to peripheral resistance)
Failure of LV to in CO during exercise

31. Which bacteria can cause endocarditis from prosthetic valves?
S. epidermidis
Tempral arteritis - may cause irreversible blindness
Increase in Pc
In RA return (inspiration)

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

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33. Which kind of infarct show ST elevation - and/or pathologic Q waves
Aortic insuffic - late
Transmural
S. epidermidis
Atrial fiutter - identical back to back atrial depol's - convert to sinus - cal IA - IC or III antiarrhythmics

34. How are cadiac myocytes eltrically coupled?
Aortic dilation - bicuspid aortic valve - RF -
Age related calcifications or bicuspid aortic valve
Gap junctions
Yes

35. In the cardiac and vascular function curves - In what instance is the vascular curve shifted to the left?
Pulmonary flow murmur and diastolic rumble
Hemorrhage
Crescendo - decrescendo systolic ejection murmur following ejection click
EKG

36. pulmonary veins drain into right heart circulation (SVC - coronary sinus)
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus
Endothelial cell dysfxn - mac and LDL accum - foam cell - fatty streaks - smooth muscle cell migration - fibrous plaque - comlex atheromas
TAPVR
Neg inotropy - HF - narcotic overdose

37. What does HTN predispose to?
Acute thrombosis of coronary artery
Atherosclerosis - LVH - stroke - CHF - renal failure - retinopathy - aortic dissection
Fetal right to left - neonate left to right leading to RVH and failure
Aortic/pulmonic regurg and mitral/tricuspid stenosis

38. When do you find hemosiderin laden macrophages in the lungs?
Metastasis from melanoma or lymphoma
During HF from microhemorrhages from inc pulm cap pressure
SA and AV nodes
C - ANCA

39. Weak pulses - notching of the ribs on xray - HTN in upper extremeties and weak peripheral pulses
V fib arrhythima
Adult type aortic coarctation
Cyclophosphamide and corticosteroids
A fib - beta block or ca channel block - warfarin - thromboembolism prophylaxis

40. What stimulates release of calcium from the SR?
Tricuspid atresia - requires ASD and VSD
Extracellular calcium - calcium induced calcium release
Left heart failure
Cyclophosphamide and corticosteroids

41. How does a patient with Tet of fallot learn to improve symptoms?
The LA - can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
In parallel
LAD
Squat. Compression of femoral arteries - inc TPR - dec

42. no change in PR interval followed by dropped beat
Pulse pressure
2nd degree AV block - mobitz type 2 - may progess to 3rd degree block
Cardiac tamponade - asthma - obstructive sleep apnea - pericarditis and croup
Mitral valve prolapse

43. Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
Eccentric - concentric hypertrophy causes diastolic disfunction
Unstable/crescendo angina
EtOh - wet Beriberi - Coxsackie B - cocaine - chagas - doxorubicin - hemochromatosis - peripartum cardiomyopathy
Left atrial pressure

44. Churg Strauss - presentation and test
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Henoch - Schlonlein purpura
Left heart failure
Proportional to viscosity and inversely proportional to the radius to the 4th power

45. What causes the midsystolic click
Shunt - VSD - PDA or patent foramen ovale - due to failure of the aorticopulmonary septum to spiral
Sudden tensing of chordae tendinae
Systolic dysfunction
Left atrial pressure

46. bening capillary hemangioma of elderly - does not regress
LCX - V4- V6
Venodilators (nitrogylcerine)
Mitral and tricuspid closure
Cherry hemangioma

47. What is the machine like murmur? What is the heart pathology and the predisposing causes
Venodilators (nitrogylcerine)
Patent ductus arteriosus - congenital rubella or prematurity
Chordae rupture - GN - suppurative pericarditis - emboli
Infantile is proximal to ductus arteriosus and adult is distal. Infantile In and aDult is Distal to Ductus

48. If HR is too fast (V tach) what happens during diastole?
Granulomatous vasculitis with eosinophilia. Asthma - sinusitis - skin lesions and periphereal neuropathy (wrist/foot drop) heart - GI - kidneys
Transmural
Filling is incomplete and CO falls
Tetralogy of fallot - transposition of great vessels - truncus arteriosus - tricuspid atresia - TAPVR

49. port wine stains on face - intracerebral AVM - siezures - early onset glaucoma - congenital
Myxomatous degeneration - RF - chordae rupture
Cherry hemangioma
Sturge weber - vasculitis of caps
Non

50. In a lateral wall infarct - which artery is effected - and which leads show Q waves?
Crescendo - decrescendo systolic ejection murmur following ejection click
EKG
LCX - I - aVL
Tricuspid atresia - requires ASD and VSD