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Cardiology

FA review Round 1 2020

QuestionAnswer
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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