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Cardiology
FA review
| Question | Answer |
|---|---|
| What is an Paradoxical emboli? | DVT combined with a sign of stroke |
| What are the most common causes of a Paradoxical emboli? | ADS or a PFO |
| Auscultation of an ASD | Wide and fixed S2 |
| What is the effect of ACE inhibitors on AT II and renin? | Decrease levels of AT II and increase release of Renin |
| What is the most classical presentation of Infective endocarditis? | Fever and a new heart murmur |
| What is the MC left-sided complication of Infective endocarditis? | Septic emboli that can be lodged in the brain, spleen, kidney, and gut. |
| What is caused, anatomically, by Hypertrophic cardiomyopathy? | Asymmetric septal hypertrophy and at times leads to outflow obstruction, leading to dyspnea, dizziness, and syncope |
| What reduces the intensity of an HCM murmur? | Decreased Left Ventricle size and volume, which maneuvers such as squatting, by reducing the venous return |
| Squatting, leads to a decrease in what blood circulation parameter? | Venous return |
| Squatting increases or decreases venous return to the heart? | Decreases venous return |
| What is caused by non-selective Beta blockers? | Decrease in HR, contractility and renin release |
| Is renin release increased or decreased by the use of nonselective beta blockers? | Decrease renin release |
| What are the classic auscultation findings of Aortic Stenosis? | Mid-to-late peaking systolic murmur at the right upper sternal border that decreases with Valsalva maneuver. |
| What maneuver is known to decrease intensity of AS? | Valsalva maneuver |
| What is a useful and common diagnostic use for BNP levels? | To rule out non-cardiac causes of dyspnea |
| What is BNP? | Sensitive marker for congestive heart failure an in released by the ventricles in response to high volume or pressure |
| What causes the ventricles to release or secrete BNP? | High volume or pressure |
| Is BNP released by the ventricles or atria? | Ventricles |
| What causes an AV block? | Defects in the AV node and the inability to transmit impulses from the atria to the ventricles via the AV node |
| What is the associated relationship of impulses from the atria and those from the ventricles? | Impulses by the atria and ventricles, are dissociated, leading to bradycardia |
| On which phase of the nodal action potential does Verapamil work on? | Phase 0 |
| What is a unwanted result of Verapamil? | Delaying atrial depolarization rates, leading to uncoordinated firing of AV and SA nodes, leading to AV block |
| MOA of Verapamil: | Decreased Ca2+ conditions during phase 0 of the Nodal Action potential |
| Is atrial depolarization or atrial repolarization, delayed by Calcium channel blockers? | Atrial depolarization |
| What is the MC drug to safely treat acute hypertension in pregnancy? | Hydralazine |
| What is the most common adverse effect of Hydralazine? | Reflex tachycardia |
| How is Reflex tachycardia due to Hydralazine use prevented? | Concurrent use of B-blocker |
| Which is the common beta blocker used to prevent hydralazine-induced reflex tachycardia? | Labetalol |
| Which cardiomyopathy is seen with systolic dysfunction? | Dilated cardiomyopathy |
| Which abnormal heart sound is associated with DCM? | S3 |
| What is the MCC of DCM? | Ischemic cardiomyopathy resulting from coronary artery disease. |
| How does NE increase myocyte contractility? | Via B1-adrenergic receptor stimulation, leading to increased Ca2+ influx into the cardiomyocytes. |
| What causes Aortic Stenosis (AS) in Turner syndrome? | Bicuspid aortic valve, and/or coartation of the aorta |
| What is caused by Coarctation of the aorta? | Difference in blood pressure in legs and arms |
| What causes the difference in blood pressure between legs and arms in a patient with Turner syndrome? | Coarctation of the aorta |
| Which ECG leads show ST-segment elevation or Q waves in MI of the Right Coronary artery? | Leads II, III, and aVF |
| Which artery irrigates the inferior part of the heart? | Right coronary artery |
| What are the most common manifestations of Congestive HF? | Pulmonary and peripheral edema and jugular venous distension |
| How does RAAS response to HF? | Increase renal sodium retention and AT II-mediated vasoconstriction |
| How long after initial MI is neutrophilic infiltration seen microscopically? | 1 to 3 days after onset of MI |
| What is the histological finding after 0-4 hours onset of MI? | Wavy fibers |
| How soon is early coagulative necrosis seen after initial MI? | 4-24 hours |
| What type of drugs are given to patients to prepare them for Percutaneous coronary intervention? | P2Y12 receptor blockers |
| What are two common P2Y12 receptors blockers? | Prasugrel and Ticagrelor |
| How do P2Y12 receptor blocker work? | Inhibit ADP binding to P2Y12 receptor |
| What does blocking the P2Y12 receptor cause that aid in preparing patients for percutaneous coronary intervention? | Blocking both PLATELET AGGREGATION and the expression of glycoprotein IIb/IIIa receptors |
| Which two receptors are blocked by Prasugrel and Ticagrelor? | P2Y12 receptors and GpIIb/IIIa receptors |
| What does the y-decent on the Jugular venous tracing represent? | Rapid emptying of the right atrium after the Tricuspid valve opens |
| To which heart sound does the y-descent of JV tracing correspond? | S3 |
| Which jugular venous tracing trace represent the rapid emptying of the RA after the tricuspid valve opens? | y-descent |
| What are the 4 more common causes of Aortic regurgitation? | 1. Rheumatic heart disease 2. Congenital bicuspid aortic valve 3. Calcific valve disease 4. Aortic root dilation |
| What does AR demonstrate on the Pressure-Volume cardiac loop? | Increased EDV and increased SV |
| Is stroke volume increased or decreased with AR? | Increased |
| Which leads represent LAD MI on ECG? | V1 - V6 |
| Which leads represent inferior MI (RCA)? | II, III, and aVF |
| Which lead would best represent Lateral MI? | aVL and I |
| Which artery is causing the MI, if it is best represented by leads avL and I on ECG? | Left circumflex artery |
| How is Thoracic Aortic dissection represented clinically? | Chest and/or back pain, diminished or asymmetric pulses or BP, or aortic regurgitation, depend on the level of the dissection |
| Which heart sound is absent in AS auscultation? | S2 |
| Does diastolic or systolic heart failure represented with a preserved ejection fraction? | Diastolic dysfunction |
| What are some common complication of Aortic stenosis? | Diastolic heart failure, AFIB, and pulmonary hypertension |
| What is the most common clue or key factor to suspect coronary artery disease in a patient? | Hx of previous MI or angina |
| Which heart murmur is associated with a high-pitched opening snpa during diastole? | Mitral Stenosis |
| Opening snap ---> Murmur? | Mitral Stenosis |
| Description of auscultation findings of MS: | Sharp, high-pitched opening snap during diastole, followed by a harsh, rumbling murmur |
| What is the MCC of Mitral Stenosis? | Rheumatic heart disease |
| What is the MCC of Rheumatic heart disease leading to MS? | Untreated group A streptococcal pharyngitis |
| Is Rheumatic heart disease associated with untreated streptococcal pharyngitis or impetigo? | Pharyngitis |
| What bacteria is known to potentially cause right- or left-sided valvular disease? | Strep viridans |
| What are some risk factor of S. viridian endocarditis? | Preexisting valvular disease, HF, injectable drug use, poor dentition, hemodialysis, implantable devices such as valves and catheters, age > 60, and male sex |
| What murmur is best heard at the left second intercostal space along the sternal border, and increases intensity with inspiration? | Pulmonary regurgitation |
| Where is PR best auculated or heard? | Left second intercoastal space along the sternal border |
| Pulmonary regurgitation is a diastolic or systolic murmur? | Diastolic |
| What does the time after S2 and before S1 represent? | Diastole |
| How is Restrictive cardiomyopathy clinically presented? | Non-systolic heart failure, a normal ejection fraction, and low volvate on ECG. |
| What is the most common cause of Restrictive Cardiomyopathy? | Myocardial fibrosis |
| What are the main findings of Pericarditis? | Cardiac tamponade, including hypertension, increased JVP, distant heart sounds, and pulsus paradoxus |
| Which blood pressure phenomenon is associated with Pericarditis and Cardiac tamponade? | Pulsus paradoxus |
| What is the most specific ECG finding of Cardiac tamponade? | Electrical alternans and low QRS voltage |
| Electrical alternans is associated with which heart condition? | Cardiac tamponade |
| Fixed and split S2 with systolic murmur | ASD |
| What is a severe complication of an ASD? | Allow for venous thromboembolism to enter left side of heart and subsequently the systemic circulation, leading to strokes |
| Class IB sodium channel blocker | Lidocaine |
| Which phase does lidocaine work on? | Phase 0 |
| What type of arrhythmias are treated with Class IB Sodium channel inhibitors? | Acute ventricular arrhythmias, especially after a MI |
| What is Pericarditis? | Pleuritic chest pain that is relieved when the patients leans forward |
| Which autoimmune disease is often associated with Pericarditis? | SLE |
| How is Pericarditis seen in ECG? | Diffuse ST elevations |
| What kind of sound is produced by VSDs? | Harsh or blowing holosystolic murmur best herad a the left sternal border |
| Why is Digoxin used to treat heart failure? | Increases cardiac contractility |
| What are manifestations of Digoxin toxicity? | Nausea, vomiting, and visual changes |
| What protein is directly inhibited by Digoxin? | Na+/K+ ATPase |
| Which ion intracellular concentration is directly increased by Digoxin? | Sodium |
| What causes an AV block? | Defects in the AV node and an inability to transit impulses from the atria to the ventricles via the AV node |
| Mitral regurgitation is associated with a: | Holosystolic murmur that is best heard at the cardicat apex |
| What causes MR? | Increase in LA pressure during systole due to regurgitation of blood from the LV into the LA through an insufficient mitral valve |
| Is MR occurs during systole or diastole? | Systole |
| Back of blood from LV to LA, leading to an increase in LA pressure. Dx? | Mitral regurgitation |
| What causes AFIB? | Aberrant electrical activity within the pulmonary veins |
| Abnormal electrical activity in the pulmonary vein leads to development of: | AFIB |
| What adrenergic receptors are stimulated by Epinephrine? | alpha-1, beta-1, and beta-2 |
| Common hormone release in response to stress and adminitete as a drug for septic shock? | Epinephrine |
| What are some common physical findings of Infective endocarditis? | Osler nodes, splinter hemorrhages, and postinfectious glomerulonephritis with hematuria and proteinuria |
| What cause Osler nodes? | Immune complex deposition in the tissues |
| How is Aortic regurgitation represented or changed in the LV Pressure-Volume loop? | Increased EDV and Increased SV (stroke volume) |
| Phosphodiesterase-3 inhibitor | Milrinone |
| What is MOA of Milrinone? | Inhibiting PDE-3, leading to increase intracellular cAMP levels in cardiomyocytes and vascular smooth muscle. |
| Which enzyme is inhibited by Milrinone? | PDE-3 |
| What is the effect of increased cAMP in myocardial cells? | Increased cardiac contractility |
| What is the effect of increased cAMP in vascular smooth muscle cells? | Decreased peripheral vascular resistance |
| Common PDE-3 inhibitor increases cardiac contractility and reduce systemic blood pressure? | Milrinone |
| How is diastolic heart failure defined? | Congestive heart failure with a normal LV ejection fraction |
| What is the result in non-systolic heart failure? | Impaired LV filling and high ventricular pressures, leading to increased LA and PCWP, leading to dyspnea |
| How long after initial MI, is an ventricular free wall rupture expected? | First 2 weeks |
| What is caused by a Ventricular free wall rupture after in MI? | Hemorrhage into the pericardial sac, leading to hemopericardium and cardiac tamponade |
| What are some common risk factors for Infective endocarditis? | Drug use, dialysis, and dental procedures |
| How is Wolff-Parkinson-White syndrome characterized? | AV reentrant tachycardia with a resting EFC showing short PR, long QRS, and delta waves |
| AV reentrant tachycardia + delta waves. Dx? | Wolff-Parkinson-White syndrome |
| What causes Wolff Parkinson White syndrome? | Reentry using an abnormal accessory conduction pathway through the bundle of Kent |
| Holosystolic murmur best heard at the cardiac apex | Mitral regurgitation |
| Why is left atrial pressure elevated in MIR? | Due to regurgitation of blood from LV into LA through an insufficient Mitral valve |
| Does MR's Left atrial pressure increase occurs during systole or diastole? | Systole |
| Aortic stenosis is responsible for causing the following: | 1. Prolonged ventricular systole 2. High pressures 3. Ventricular hypertrophy |
| Is AS seen with Ventricular or Atrial hypertrophy? | Ventricular hypertrophy |
| How is Pulmonary edema clinically characterized? | Bilateral crackles and dyspnea |
| What change in starling forces cause cardiogenic pulmonary edema? | Increase in capillary fluid hydrostatic pressure |
| What leads to the Increase Capillary hydrostatic pressure seen in cardiogenic pulmonary edema? | Left ventricular systolic or diastolic dysfunction that cause fluid to move from the capillaries into the alveoli |
| In simple terms, a person with CHF develops, pulmonary edema as fluid: | Travels from the capillaries to the alveoli due to systolic or diastolic dysfunction |
| What are some of the produced effects of Non-Selective Beta blockers? | 1. Decreased Heart Rate 2. Decreased Contractility 3. Decreased renin release |
| Which three factors are DECREASED by the use of non-selective beta blockers? | Heart rate, contractility, and renin release |
| What may cause MR in a patient with recent Hx of MI? | Papillary muscle rupture |
| Is MR a crescendo or decrescendo murmur? | Decrescendo |
| What heart chamber is enlarged by acute MR development? | Left atrium |
| What causes LA enlargement in acute MR? | Blood entering the Left Atrium during systole |
| Which chamber pressure is increased in both MS and MR? | Elevated atrial pressure |
| What is the most common cause of MS? | Rheumatic heart disease |
| What is the cause of Rheumatic heart disease? | Antibody cross-reaction between the bacterial antigen and mitral valve (molecular mimicry) |
| What condition is associated molecular mimicry? | Rheumatic heart disease |
| What is an adverse effect of Hydrazine in a person with CAD? | Increased myocardial demand and angina |
| Angina and reflex tachycardia are common adverse effects of which drug? | Hydralazine |
| How do Beta-blockers work? | Slow HR by decreasing the activity of the funny current (If) by reducing cAMP in SA nodal cells |
| Which current is affected by beta blockers? | Funny current in SA node cells |
| Beta blockers decrease or increase cAMP in SA nodal cells? | Decrease cAMP in SA nodal cells |
| Which type of beta blockers are contraindicated to COPD patients? | Non-selective Beta blockers |
| COPD patient should be treated with selective or nonselective beta blockers? | Selective Beta blockers |
| What are the consequences of uncorrected PDA? | Reversal of the Right-to-Left shunt, leading to cyanosis and hypoxemia |
| What is Eisenmenger syndrome? | Reversal to a right-to-left shunt, leading to cyanosis and hypoxemia |
| Which cardiomyopathy is due to asymmetric septal hypertrophy? | Hypertrophic cardiomyopathy |
| What type of maneuver leads to a reduced hypertrophic cardiomyopathy murmur? | Squatting, which increases venous return |
| What is the effect on venous return due to Squatting? | Increases venous return |
| What is the most common cause of aortic dissection? | Severe hypertension |
| How are the retinal hemorrhages in infective endocarditis called? | Roth spots |
| What is a common bacterial cause of IE? | Viridans streptococci |
| What is the most common toxicity of Niacin? | Flushing |
| How is niacin toxicity induced flushing commonly prevented? | Pretreatment with aspirin |
Created by:
rakomi
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