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Cardiology
UWORLD Round 2 2021 Part 2
| Question | Answer |
|---|---|
| What causes the decrease in pulmonary vascular resistance immediately after birth? | Oxygenation and ventilation of the lungs |
| What causes the increased vascular resistance in blood circulation immediately after birth? | Removal of the placenta from circulation |
| What is the result of the removal of the placenta from fetal circulation to blood circulation immediately after birth? | Increased vascular resistance |
| What is the result of the increase vascular resistance in neonate immediately after birth? | Reverse flow across the Ductus Arteriosus , to Left-to-Right |
| What are the immediate blood circulation hemodynamic changes seen immediately after birth? | 1. Reduced pulmonary vascular resistance 2. Increased systemic vascular resistance |
| Immediately after birth, which heart chamber becomes solely response for the total cardiac output? | Left ventricle |
| During fetal circulation which heart chambers are responsible for cardiac output? | Right and Left ventricles |
| What is Marfan syndrome? | Connective tissue disorder in which defective fibrillin-1 decreases tissue integrity and increase expression of Transforming growth factor-beta |
| Which is the defective protein in Marfan syndrom3? | Fibrillin-1 |
| Which growth factor is seen in increased expression in Marfan syndrome? | Transforming growth factor-beta (TGF-B) |
| Which genetical condition is associated with increased expression of TGF-B? | Marfan syndrome |
| What are the cardiac effects seen with Marfan syndrome? | 1. Myxomatous degeneration 2. Prolapse of the mitral valve 3. Association with regurgitation |
| How is the regurgitation seen in Marfan syndrome characterized in auscultation description? | Midsystolic click and mid-to-late systolic murmur |
| Is the murmur seen with Marfan syndrome, a diastolic or systolic murmur? | Systolic murmur |
| What is the type of degeneration seen in the heart anatomy of a patient with Marfan syndrome? | Myxomatous degeneration |
| What type of ventricular hypertrophy, eccentric or concentric is seen with Aortic regurgitation (AR)? | Eccentric hypertrophy |
| What is the result of eccentric hypertrophy in AR? | Dilated cavity with relative thin ventricular walls dueto addition of myocardial fibers in series |
| What type of cardiac muscle hypertrophy is due to Volume overload? | Eccentric hypertrophy |
| What are some conditions that lead to or are associated to Eccentric ventricular hypertrophy? | 1. Aortic and Mitral Regurgitation 2. Ischemic heart disease 3. Dilated cardiomyopathy |
| Mitral regurgitation will cause an Volume overload or Pressure overload problem to the heart? | Volume overload |
| Which hypertrophy of the heart muscle is due to increase myofibril in SERIES? | Eccentric hypertrophy |
| What are the two types of pathological overall conditions that lead to either concentric or eccentric ventricular hypertrophy? | Pressure overload and Volume overload |
| What are pathologies or condition that produce Concentric hypertrophy? | 1. Chronic hypertension 2. Aortic stenosis |
| What murmur is known to cause Concentric left ventricular hypertrophy? | Aortic stenosis |
| A person with a long history of uncontrolled hypertension, will more likely develop concentric or eccentric ventricular hypertrophy? | Concentric hypertrophy |
| How are cardiac myofibrils added in Concentric hypertrophy, parallel or series? | Parallel |
| Which muscle is often affected by ischemia after an MI that leads to development of a new Mitral Regurgitation murmur? | Papillary muscle |
| Ischemia to the Papillary muscle after an MI is associated with the development of what valvular condition? | Mitral regurgitation |
| Mitral regurgitation is a systolic or diastolic murmur? | Systolic murmur |
| What are the main causes of Mitral regurgitation? | 1. Leaflets -- Impaired coaptation 2. Chordae tendineae rupture 3. Papillary muscles rupture or displacement 4. Mitral annulus calcification or enlargement |
| What are the main causes of MR due to Leaflet impairment? | Rheumatic fever, Endocarditis, and Myxomatous degeneration |
| What can cause MR due to Papillary muscle rupture? | Papillary muscle infarct (MI) |
| What are the the main causes of MR due to Mitral annulus etiology? | Calcification due to advance age and Enlargement due to LV dilation |
| What can cause MR due to displacement of the Papillary muscles? | LV ischemic/infarct and LV dilation |
| What conditions are associated with Chordae tendinae rupture? | Rheumatic fever, Endocarditis, and Myxomatous degeneration |
| Where do most myxomas are located? | Left atrium |
| What is a myxoma? | The most common primary cardiac neoplasm, and most commonly located at the left atrium |
| What are possible effects caused by a Atrial myxoma? | 1. Position-dependent obstruction leading to mid-diastolic murmur and symptoms of decrease CO (dyspnea and syncope) |
| What are the MC symptoms of decreased Cardiac Output (CO)? | Dyspnea and Syncope |
| What is the histology of a Atrial Myxoma? | Scattered cells within a mucopolysaccharide stroma and blood vessels with hemorrhage |
| What is another name for Stress Cardiomyopathy? | Takotsubo cardiomyopathy |
| What is Takotsubo cardiomyopathy? | Stress induced cardiomyopathy characterized by Hypokinesis of the mid and apical segments and hyperkinesis of the basal segments of the Left Ventricle, resulting in systolic dysfuntion |
| Does Takotsubo cardiomyopathy result in systolic or diastolic dysfunction? | Systolic dysfunction |
| What is the main feature of the apical and mid segment of the LV in Takotsubo cardiomyopathy? | Hypokinesis |
| What is the disntnuigin feature of the basal segment of LV in Stress-induced cardiomyopathy? | Hyperkinesis |
| What causes Takotsubo cardiomyopathy? | Surge of catecholamines in the setting o f physical or emotional stress |
| What is the most common presentation of Stress-induced cardiomyopathy? | Mostly affects postmenopausal women and resolve on its own after several weeks |
| A person that experiences a strong emotional event, may develop which characteristic type of systolic dysfunction cardiomyopathY? | Takotsubo cardiomyopathy |
| A surge of what substance(s) is seen in the pathogenesis of Takotsubo cardiomyopathy? | Catecholamines |
| Which neurohormonal mechanisms are activated in acute heart failure? | SNS and RAAS pathway |
| What is secreted by the activated SNS in heart failure? | Norepinephrine |
| What is the purpose of the increased activity of the SNS and RAAS pathway in HF? | Increase volume retention and peripheral resistance to maintain organ perfusion |
| What is the long-term effect of the continuous upregulated activity of RAAS pathway and SNS in acute heart failure? | Increased hemodynamic stress and cardiac remodeling leading to decompensated heart failure |
| Asymptomatic LV systolic dysfunction is a common stage of: | Acute heart failure |
| What is the differential cyanosis seen with Persistent Pulmonary hypertension of the neonates? | Postductal < Preductal oxygen saturation |
| What does higher preductal oxygen saturation than postductal mean in terms of blood flow? | Suggests right-to-left shunting across the PDA |
| Which murmur is associated with Persistent Pulmonary Hypertension of the Newborn (PPHN)? | PDA |
| What are some characteristic of PPHN? | Underlying pulmonary disorder with respiratory distress and strong femoral pulses |
| What is the most common antihypertensive used for Malignant hypertension? | Labetalol |
| What type of cardiac drug is Labetalol? | Non-selective B-blocker, that blocks B-1, B-2, and a-1 receptors |
| What receptors are blocked by Labetalol? | B-1, B-2, and a-1 |
| How does Labetalol cause Peripheral vasodilation? | a-1 blockade overweighs B-2 receptor blockade to cause peripheral vasodilation with decreased venous return and lower systemic vascular resistance |
| Is venous return increased or decreased with the use of Labetalol? | Decreased venous return |
| What is the result of the balanced vasodilation caused by Labelatol? | Reduction of blood pressure without changing the stroke volume (SV) |
| What is the effect of blocking B-1 receptor with Labetalol? | Override of the "expected" Baroreceptor-mediated increased in HR, resulting in an overall decrease in HR |
| What hypertensive drug is known to cause override of the Baroreceptor-mediated reflex tachycardia? | Labetalol |
| What are the most common dose-dependent sympathomimetics? | Dopamine and Epinephrine |
| What is the effect on receptor activity (decreasing order) or low dose dopamine? | D1 > B1 > a1 |
| High doses of Dopamine will have strongest effect on which adrenergic receptor? | a-1 receptor |
| Unlike dopamine, epinephrine only has renal effects when it is used in __________ doses. | High dose |
| Which vasculature is most affected by the situation of D1 receptors with Dopamine in a low dose? | Renal and mesenteric vasculature |
| What is the effect on afterload in high-dose dopamine? | Increase afterload with result in decreased cardiac output |
| What is another way to refer Aldosterone antagonists? | Mineralocorticoid receptor antagonists |
| What are two commonly used Aldosterone antagonists? | Spironolactone and Eplerenone |
| Which types of patients have better survival rates with the use of Aldosterone antagonists? | Congestive Heart failure and those with reduced LV ejection fraction |
| Which conditions are contraindicated for the use of Spironolactone (aldosterone antagonists)? | Hyperkalemia and/or renal failure |
| Which enzyme mediates most of the collagen deposition and fibrosis following a myocardial infarct? | AT II |
| Why are ACE inhibitors beneficial in the treatment post-MI? | Reduce the deleterious cardiac remodeling driven by AT II, thus minimizing LV dilation and helping conserve contractile function |
| What type of hypertrophy is often seen after an MI, in the remodelling process? | Eccentric hypertrophy of the Left ventricle |
| What is the result of LV eccentric hypertrophy, LV dilation or LV constriction? | LV dilation |
| LV dilation due to eccentric hypertrophy causes: | Worsening of the heart contractile dysfunction |
| What is a permissive hormone? | Hormone has no effect on physiological process by itself, but allow another hormone to exert maximal effect on the process |
| What is a commonly tested (USMLE) permissive hormone? | Cortisol |
| On which hormones does Cortisol act as an permissive hormone most commonly? | Catecholamines and Glucagon |
| What is the effect of Cortisol permissive action on Catecholamines? | Potentiate vasoconstriction and bronchodilation |
| What can be used exogenously to increase the release of glucose from the liver? | Cortisol |
| What causes PPHN of Newborn? | Failure of Pulmonary Vascular resistance to decrease after birth |
| What is the main treatment for PPHN of the newborn? | Nitric oxide (NO) |
| How does Nitric Oxide (NO) treats PPHN in a newborn? | Increases cGMP in smooth muscle cells, causing pulmonary vasodilation and decrease pulmonary vascular resistance (PVR) |
| What is the Carotid sinus? | Dilation of the internal carotid artery located just above the bifurcation of the Common Carotid Artery |
| Where is the Carotid sinus located? | Just above the bifurcation of the Common Carotid artery |
| Which cranial nerves are involved in the Carotid Sinus Reflex? | Glossopharyngeal nerve (CN IX) and Vagus nerve (CN X) |
| What cranial nerve is associated with the Afferent limb of the Carotid sinus reflex? | Glossopharyngeal nerve |
| What cranial nerve is associated with the Efferent limb of the Carotid sinus reflex? | Vagus nerve |
| The efferent limb of the Carotid Sinus reflex carries the _________________ impulses via the ____________ nerve. | Parasympathetic; Vagus nerve |
| What is a common result of progressive decrease advanced age-related aortic compliance? | Primary hypertension |
| What are some changes in hemodynamics in a person with advice age and primary hypertension? | 1. Increase in pulse pressure 2. Slight decrease in diastolic pressure 3. Isolated systolic hypertension |
| What common elderly-associated condition is found with Isolated Systolic Hypertension? | Primary hypertension |
| Does diastolic or systolic pressure decrease in primary HTN, especially in the elderly? | Diastolic pressure (slight decrease) |
| Is pulse pressure increased or decreased in patients with Primary hypertension? | Increased pulse pressure |
Created by:
rakomi
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