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Cardiology
FA review Round 1 2020
| Question | Answer |
|---|---|
| What is the pathogen that causes Endocarditis in IV users? | Staph aureus |
| Which valve is most commonly affected by Endocarditis in IV users? | Tricuspid valve |
| What are the EKG changes produced by Hyperkalemia? | 1. Peaked T-waves 2. PR prolongation |
| What medications cause hyperkalemia? | K+- sparing diuretics and ACE-inhibitors |
| What is the most reliable study type? | Randomized Control study |
| At which location does an abdominal aortic aneurysm appear? | Below the Renal arteries |
| What risk factors are strongly associated with Abdominal Aortic aneurysm? | Smoking and Hyperlipidemia |
| What is the typical clinical presentation of AAA? | Visibly, palpating abdominal mass, with or without midline abdominal bruit |
| What is the most posterior part of the heart anatomically? | Left atrium |
| On a clockwise diagram, which hours would approximately indicate the Left atrium on a CT scan? | Between 3 and 5 |
| What are some characteristic cardiac symptoms? | Chest pain, nausea, diaphoresis, and edema |
| What GI condition is often mistaken by a cardiac condition? | GERD |
| A person with Chest pain and Hx of hyperlipidemia and MI, and obese, is very likely to develop: | Acute Coronary Syndrome |
| MOA of Verapamil | Decrease Calcium conduction during Phase 0 of the nodal action potential, delaying atrial depolarization rates |
| On which phase of of the nodal AP does Verapamil work on? | Phase 0 |
| What is the result of the delay caused by Verapamil on Phase 0 of the SA node AP? | Uncoordinated firing of AV and SA nodes leading to complex dissociation and AV block |
| What is an important adverse effect of Verapamil? | AV block |
| Verapamil is a non-dihydropyridine or a dihydropyridine Calcium channel blocker? | Non-dihydropyridine |
| List of Adverse effects associated with Non-dihydropyridine calcium channel blockers? | Gingival hyperplasia, cardiac depression, AV block, hyperprolactinemia, and constipation |
| What is an specific adverse effect of Verapamil? | Hyperprolactinemia |
| What is the most common adverse effect of all calcium channel blockers? | Gingival hyperplasia |
| What broken down by ACE? | Bradykinin |
| Which condition has strict contraindication of use of ACE inhibitors? | Hereditary angioedema |
| What are key clinical features of Hereditary angioedema? | Random episodes of swelling which are self resolved. Often associated with diarrhea, abdominal pain |
| Self-resolving swelling episodes seen in father and son. Dx? | Hereditary angioedema |
| What is the cause of Hereditary angioedema? | Dysfunction of C1 Esterase inhibitor |
| Which product elevation or lack of breakdown can lead to exacerbation of angioedema? | Bradykinin |
| How long after an MI does a Left Ventricular Wall rupture usually occurs? | 5-10 days |
| What are the consequences of L-Ventricular Wall rupture after an MI? | Blood spill into the Pericardium, resulting in TAMPONADE |
| What are clinical features of ventricular wall rupture after an MI? | Chest pain, sudden onset of severe hypotension and unresponsiveness (loss of conscious) |
| Which is more common Left or Right Ventricular Wall rupture? | Left |
| How long after an MI does a Papillary Muscle rupture usually happens? | 4-7 days after MI |
| Which takes longer to occur, Papillary Muscle rupture or Ventricular Wall rupture, after an MI? | Ventricular Wall rupture |
| Which is associated with development of Mitral regurgitation, Papillary Muscle rupture or Ventricular Wall rupture? | Papillary Muscle rupture |
| Which of the following two, is associated with development of Tamponade, Papillary wall rupture or Ventricular wall rupture? | Ventricular Wall rupture |
| What class of antiarrhythmic is Lidocaine? | Class IB sodium channel blocker |
| On which phase does Lidocaine work on? | Phase 0 |
| What is the main result or effect of Lidocaine on AP? | Decreased AP duration |
| When is Lidocaine best used? | Acute Ventricular arrhythmias especially after a MI and digitalis-induced arrhythmias |
| Which arrhythmias are best treated with Lidocaine (class iB antiarrhythmics)? | 1. Acute ventricular arrhythmias 2. Digitalis-induced arrhythmias |
| Which ions go INTO the myocyte during the Action potential? | Sodium and Calcium |
| Which clinical features are associated with Abdominal Aortic aneurysm rupture? | Pulsatile mass above the umbilicus, back and abdominal pain, and hypertension |
| Which risk factors are associated with AAA? | Hx of smoking, increased age, male sex, and family Hx |
| What are the two main hemodynamic changes of Septic shock due to sepsis? | 1. Severe decrease in Systemic vascular resistance (SVR) 2. Increase in CO |
| Which two hemodynamic measures correlate with each other in all types of Shock? | CVP and PCWP |
| If the CVP goes down, which other hemodynamic measure will also go down? | PCWP |
| What causes the low SVR in Distributive shock due to sepsis? | Release of inflammatory mediators which cause vasodilation |
| Definition of Shock: | Inadequate organ perfusion and delivery of nutrients for normal tissue and cellular function |
| What are the 4 types of Shock? | 1. Hypovolemic 2. Cardiogenic 3. Obstructive 4. Distributive |
| What are the common causes of Hypovolemic shock? | Hemorrhage, dehydration, and burns |
| What are the common causes of Cardiogenic shock? | Acute MI Valvular dysfunction Arrhythmia |
| What are the MCC of Obstructive shock? | Cardiac tamponade, Pulmonary embolism Tension pneumothorax |
| What type of injuries or causes lead to a distributed type of shock? | 1. Sepsis and anaphylaxis 2. CNS injury |
| A person with a Cardiac tamponade, will develop which type of shock most likely? | Obstructive |
| Acute MI or a valvular dysfunction will lead to a _______________ shock. | Cardiogenic |
| A person involved in a car accident,that has lost immense amounts of blood will go into _________________ shock. | Hypovolemic |
| If the vignette indicates a fever and other signs of infection, which type of shock is most likely to be developed? | Distributive |
| Which types of shock develop cold and clammy skin? | Hypovolemic, Cardiogenic ,and Obstructive |
| How is the skin in a Distributive shock? | Warm and dry |
| Which hemodynamic measure or result distinguishes between a distributive shock due to CNS injury or Sepsis/anaphylaxis? | Septic and anaphylactic shock, will have increased CO, while CNS injury shock, has a decrease CO. |
| Which what is the most likely cause of a Distributive shock with severely decrease SVR and Decreased CO? | CNS injury |
| A decrease in SVR represents a decrease in afterload or preload? | Afterload |
| What is the main decrease seen in Cardiogenic and Obstructive shocks? | Large decrease in Cardiac output |
| Which shock is the only type ose a decrease in SVR? | Distributive |
| It is safe to say that if the PCWP is increased the CVP will be __________. | Increased |
| Which murmur is associated with an Opening Snap? | Mitral stenosis |
| What causes an Opening snap? | Due to Mitral valve opening when the atrial pressure exceeds ventricular pressure |
| On the Pressure-Volume loop, where is the Opening snap located? | Just after Mitral valve opening, located in the bottom left corner. |
| Which sound is located in the right upper corner of the Pressure-Volume loop? | S2 |
| On which corner would the ejection click sound located on the Pressure-Volume loop? | Upper Right corner |
| Which murmur is associated with an ejection click? | Aortic stenosis |
| In the bottom part (line) of the Pressure volume loop, how are the sounds distributed along the line? | Opening snap (OS) ---> S3 --->S4 ----> S1 |
| Which sound is seen in the Lower right hand corner? | S1 |
| Anatomically where would a Hypertrophic cardiomyopathy is better auscultated (heard)? | Left sternal border |
| What are some auscultation findings of HCM? | S4 gallop and Systolic ejection murmur |
| What condition is associated with syncope or dizziness in young patients, with a family member with the same condition? | Hypertrophic Cardiomyopathy |
| What are the treatments for HCM? | 1. Beta-blockers 2. Non-dihydropyridine Ca2+-channels blockers |
| What are the two main non-dihydropyridine? | Verapamil and Diltiazem |
| How is Hypertension defined or diagnosed? | Persistent BP > 130/80 mmHg |
| A person with non-consistent high blood pressure measures, should be treated with? | Supportive care and monitoring, medication is only when hypertension is permanent |
| What combination of lowering cholesterol drugs work best to decrease LDL cholesterol? | Statin + Ezetimibe |
| What is the MOA of Ezetimibe? | Inhibits absorption of cholesterol at brush border of small intestine by inhibiting Niemann-Pick C1-like1 protein |
| Which protein is inhibited by Ezetimibe? | Niemann-Pick C1-like1 protein |
| Where does Ezetimibe work? | Brush border of small intestine |
| What is the MCC of Restrictive cardiomyopathy? | Cardiac amyloidosis |
| How does amyloidosis (cardiac) cause Restrictive cardiomyopathy? | Amyloid infiltration of myocardial wall, leads to a decrease in ventricular compliance, S4 gallop, and diastolic dysfunction symptoms in a setting of anormal ejection fraction |
| Is restrictive cardiomyopathy due to a diastolic or systolic dysfunction? | Diastolic dysfunction |
| Is Restrictive cardiomyopathy seen with a decreased, normal or increased Ejection fraction? | Normal |
| What is the normal Ejection Fraction? | 55% - 70% |
| What are common symptoms of diastolic dysfunction? | Dyspnea (SOB), fatigue, JVD, pulmonary congestion, and peripheral edema |
| What are affected or poorly developed in DiGeorge syndrome, 3rd and 4th branchial pouches or arches? | Pouches |
| What condition is seen with Equalization of End-diastolic aortic and Left Ventricular pressures? | Acute Aortic regurgitation (AR) |
| What is the MCC of acute AR? | Aortic dissection |
| What leads to the equalization pressures of the ED aortic pressure and L-ventricular pressure? | The rise in Left-ventricular EDV occurs to rapidly for the left ventricular compensation to occur |
| Which condition is often treated with Adenosine? | PSVT |
| PSVT is treated with: | High-dose IV bolus of Adenosine |
| What is a common AV node antiarrhythmic : | Adenosine |
| Why is Adenosine used to treat PSVT? | Slows conduction through the AV node via cellular hyperpolarization |
| What maternal condition is often associated with development of Transposition of the Great vessels? | Diabetes |
| What fails in embryology that leads to Transposition of the Great vessels? | Aorticopulmonary septum fails to spinal during development, and the systemic pulmonary circular are completely separate, preventing proper oxygenation of the blood |
| Why are B-blockers completely contraindicated in persons on cocaine? | Unopposed Vascular smooth muscle contraction |
| What type of medication is completely contraindicated in patients with a cocaine addiction? | B-blockers |
| Beta blocker + Cocaine ---> | Unopposed vascular smooth muscle contraction leading to increase in BP and further coronary artery ischemia |
| What is the 1st line of Treatment for Pulmonary edema? | Diuresis is a loop diuretic |
| Pulmonary edema is a sign of Right of Left heart failure? | Left |
| What are important histological findings in Pulmonary edema due to Heart failure? | Hemosiderin-laden macrophages (HF cells) in the lungs |
| What causes pulmonary edema in Left sided heart failure? | Increase in pulmonary venous pressure leading to pulmonary venous distension and transudation of fluid |
| What is the most common cardiac glycoside? | Digoxin |
| What is the MOA of Digoxin? | Direct inhibition of the Na+/K+-ATPase pump, disrupting the Na+ gradient across the cellular membrane, and lead to indirecti inhibition to the Na+/Ca2+ antiporter |
| What is the indirect mechanism of action of Digoxin? | Inhibition of Na+/Ca2+ antiporter |
| What is the result of the indirect inhibition of Na+/Ca2+ antiporter by Digoxin? | Increase in Ca2+ has a positive inotropic effect on the heart |
| Which type of individuals tend to develop Subacute bacterial endocarditis the most often? | Individuals with a pre-existing valvular disease |
| What is the most common pathogen that causes Subacute bacterial endocarditis? | Viridans streptococci |
| What is the structural composition of S. viridans? | Gram (+), Optochin-resistant, and alpha-hemolytic cocci |
| Gram (+), optochin-resistant, and alpha-hemolytic cocci. Bacteria? | Viridans streptococci |
| What ions are in charge of Phase 4 of the pacemaker action potential? | Na+ and K+ |
| What happens during phase 4 of the Pacemaker AP? | Channels opening leading to increased conductance of Na+ and K+ |
| What is the common name for Phase 4 current of the Pacemaker AP? | Funny current |
| Atrial pacemaker phase 0 is due to: | Influx of Calcium channels |
| What is the main adverse effect of Fibrates when co-administered with a Statin? | Rhabdomyolysis |
| Which fibrate is best known to cause rhabdomyolysis as it is co-administered with a statin? | Gemfibrozil |
| What is a common consequence of Rhabdomyolysis? | Acute kidney injury |
| What is a very common therapy given to patients with CHF? | Digoxin |
| Why is digoxin toxicity a common concern? | Due to its narrow therapeutic index |
| What are adverse effects associated with Digoxin? | 1. Blurry and yellow vision 2. Hyperkalemia, 3. Nausea and Vomiting 4. ECG abnormalities |
| What is the treatment for Digoxin toxicity? | 1. Normalizatio of electrolytes 2. Administration of Lidocaine 3. Digoxin immune Fab 4. Magnesium (Mg2+) |
| What is a dangerous complication of Aortic dissection? | Cardiac tamponade |
| What are symptoms associated with Aortic dissection? | 1. Tearing chest pain radiating to the back 2. Asymmetric pulses |
| What condition is known to have asymmetric pulses? | Aortic dissection |
| Patient presents with tearing chest pain and alternating or different pulses in both upper extremities. Dx? | Aortic dissection |
| What is Incomplete penetrance? | Accounts for genotypes that do not always express a phenotype |
| What is the mode of action of Milrinone? | Increase intracellular cAMP levels in cardiac muscle and vascular smooth muscle |
| On which muscles does Milrinone act upon? | Cardiac muscle and vascular smooth muscle |
| What intracellular levels are increased with the use of Milrinone? | Intracellular cAMP levels |
| How does increased levels of intracellular cAMP act on cardiac muscle? | Increased cardiac contractility |
| How does Milrinone cause an increase in cardiac contractility? | Increased levels of intracellular cAMP |
| What is the effect on vascular smooth muscle by increased intracellular cAMP levels? | Decreased peripheral vascular resistance |
| What are actions and therapies associated with decreased mortality due to cardiovascular events? | 1. Aerobic exercise 2. Weight loss 3. High-intensity statin therapy |
| What is an key adverse effect of Hydralazine? | Reflex tachycardia |
| What is the result of Reflex Tachycardia due to Hydralazine therapy? | Increased myocardial demand and angina |
| What is the most common use for Hydralazine? | Severe tachycardia |
| When is Hydralazine highly contraindicated? | In patients with Coronary Artery disease |
| What is the MOA of Hydralazine? | Increase cGMP leading to smooth muscle relaxation |
| What is increased by Hydralazine, cAMP or cGMP? | cGMP |
| What is more dilated with hydralazine, veins or arteries? | Arteries |
| What are adverse effects of Hydralazine? | Fluid retention, angina, and drug-induced lupus, as well as reflex tachycardia |
| What causes the angina in patients treated hypertension with Hydralazine? | Reflex tachycardia produces a higher myocardial oxygen demand leading to angina |
| What is an important autoimmune adverse effect of Hydralazine? | Drug-induced lupus |
| How is Incidence calculated? | Number of NEW CASES = ------------------------------------------ Number of people at risk |
| What defines "people at risk"? | Subtracting the number of people who already have the disease, as they are no longer at risk of contracting it |
| How is stable PSVT treated initially? | Carotid massage or Valsalva maneuver |
| What is the second line of treatment of stable PSVT? | Adenosine |
| What is used to treat unstable PSVT? | Adenosine |
| If the PSVT is stable, instead of using Adenosine as initial treatment, what is the best course of action? | Carotid massage or Valsalva maneuver |
| What is the effect of Norepinephrine in the heart hemodynamics? | Increases venous return to the heart, leadin to an increase in stroke volume |
| How doe NE increase stroke volume? | Increasing the venous return to the heart |
| What is the result of NE increased venous return of blood to the heart, and subsequent increase in SV? | Reflex decrease in heart rate |
| What is decreased as reaction of NE effect on stroke volume increases? | Reflex decrease in heart rate |
| What is the effect of reflex decrease in heart rate due to Norepinephrine? | Reflex bradycardia |
| What catecholamine is known to cause Reflex bradycardia? | Norepinephrine |
| What are the forms of Compensatory Neurohormonal mechanisms of CHF? | 1. Increased sympathetic output by CNS 2. Increased secretion of ADH 3. Increased activation of the RAAS |
| What happens as RAAS is activated? | Produce an increased in the level of AT II and Aldosterone, which both function to increase sodium reabsorption in the kidneys |
| Which artery is occluded or obstructed in Subclavian Steal syndrome? | Subclavian artery |
| At which site is the occlusion of the Subclavian artery leading to Subclavian Steal syndrome? | Subclavian artery proximal to the vertebral artery |
| Proximal to which artery is the Subclavian artery occluded in Subclavian Steal syndrome? | Vertebral artery |
| What is the Subclavian Steal syndrome? | Vascular disorder in which occlusion or stenosis of the subclavian artery proximal to the vertebral artery origin causes altered vascular haemodynamics |
| What is the blood flow effects presented in Subclavian Steal syndrome? | Retrograde blood flow in the ipsilateral vertebral artery toward the upper arm, distal to the subclavian artery narrowing, where decreased blood pressure had been established |
| What condition involves retrograde blood flow from the Subclavian artery to the upper extremity due to stenosis of the proximal part of the Vertebral artery? | Subclavian Steal syndrome |
| Aberrant accessory pathway leading to decreased ventricular filling during diastole. Dx? | Wolff-Parkinson-White syndrome |
| Which part of the cardiac cycle, systole or diastole, is affected in Wolff-Parkinson-White syndrome? | Diastole |
| The aberrant accessory pathway seen in WPW syndrome, leads to: | Decreased ventricular filling during diastole |
| Which autoimmune condition is associated with Libman-Sacks endocarditis? | Systemic Lupus Erythematosus |
| How is Libman-Sacks endocarditis presented? | Small, verrucous vegetations of the mitral valve, causing mitral regurgitation |
| Description of vegetations in mitral valve in Libman-Sacks endocarditis? | Small and verrucous |
| What cardiac valve is most affected by Libman-Sacks endocarditis? | Mitral valve |
| Which murmur is most commonly generated by Libman-Sacks endocarditis? | Mitral regurgitation |
| What it he Umbilical cord made of? | 2 Umbilical arteries and 1 Umbilical vein |
| What embryological tissue is made of 2 arteries and 1 vein wrapped around a cord? | Umbilical cord |
| What is the role of the Umbilical arteries? | Return deoxygenated blood from fetal internal iliac arteries to placenta |
| What is the role of the Umbilical vein? | Supplies oxygenated blood from the placenta to the fetus |
| How is the umbilical vein drained? | Drains IVC via the liver or via ductus venosus |
| Umbilical arteries carry oxygenated or deoxygenated blood? | Deoxygenated |
| What is the clinical use of Clonidine? | Antihypertensive acting as agonist of the presynaptic alpha-2 receptors in the CNS |
| What are some clinical uses and mode of action of Clonidine? | 1. Inhibition sympathetic outflow 2. Decrease in peripheral resistance 3. Decrease in renal vascular resistance 4. Decrease in Heart rate and Blood pressure |
Created by:
rakomi
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