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Cardiology
FA review round 3
| Question | Answer |
|---|---|
| Which adrenergic receptor is stimulated by NE? | Beta-1 |
| What is the effect of NE stimulating B-1 adrenergic receptor? | Increased Ca2+ influx into the cell |
| What is the result on myocytes when B-1 stimulation by NE, causes more Calcium to enter the cell? | Increases myocyte contractility |
| What parameter is increased by NE B-1 stimulation on a myocyte, among heart rate, contractility, and velocity? | Increased myocyte contractility |
| What is a cause for increased heart rate? | Increase firing rate of SA node due to increased inward Na+ current during phase 4 of nodal AP |
| Which channels are involved in AV nodal conduction velocity? | Voltage-gated Ca2+ channels |
| Which phase of the nodal action potential establishes the automaticity of the pacemaker cells? | Phase 4 |
| How the Phase 4 of the Nodal action potential established? | Influx of Na+ ions into the myocytes that causes the "funny" current, or If. |
| What are common risk factors of S. viridans-induced infective endocarditis? | Pre Existing valve disease, HF, IV drug use, poor dentition, hemodialysis, male sex, and implantable devices such as catheters |
| What is Eisenmenger syndrome? | Untreated Left to right shunt, which permanently reverses into Right-to-Left shunt, leading to cyanosis and hypoxemia |
| Which cholesterol type is increased by the use of Niacin? | HDL |
| What are the most common adverse effects of Niacin? | Flushing and increased risk of gout |
| Flushing and increased risk for gout, are adverse effects associated with which antihyperlipidemic drug? | Niacin |
| What is the main result or targeted purpose of Niacin as an antihyperlipidemic drug? | Reduced hepatic triglycerides and VLDL cholesterol levels |
| What are some clinical characteristics of Pericarditis? | Chest pain relieved by leaning forward, a pericardial rub, and a diffuse ST-segment elevations on ECG |
| What is the most significant ECG finding of Pericarditis? | Diffuse ST-segment elevations |
| What are the most common causes of acute pericarditi? | Viral infection, which is often due to Coxsackie B virus |
| Which virus sthe most often causative pathogen of pericarditis? | Coxsackie B virus |
| What is Granulomatous Chronic arteritis? | Inflammation of the large vessels and commonly the temporal artery and surrounding vessels |
| What are the most common symptoms and signs of GCA? | Unilateral headache, jaw claudication, and/or transient loss of vision |
| What muscular condition is strongly associated to GCA? | Polymyalgia rheumatica |
| How is Polymyalgia Rheumatica clinically presented? | Shoulder, neck, and hip pain and stiffness, especially in the morning |
| What is Variant Angina? | Coronary artery spaces, which causes intermittent chest pain |
| What is the severe consequence of Systemic infection? | Distributive shock with hypotension |
| What are the effects of Distributive shock on hemodynamic parameters? | Decreased - Systemic vascular resistance Increased - Cardiac output Variable = CVP and and PCWP |
| What is the effect of non-selective Beta blockers on heart rate, contractility, and Renin release? | All are decreased |
| Is the use of atenolol, cause a increase or decrease in contractility? | Decrease |
| What is a common cause of MR in post-MI patients? | Papillary muscle rupture |
| How ar the aultation findings of MR described? | Decrescendo murmur obscuring the S1, best heard at the apex of the heart |
| Which heart chamber is enlarged by Mitral regurgitation? | Left atrium |
| Why is the Left Atrium enlarged in patients with MR? | Due to blood entering the left atrium during systole |
| Mitral regurgitation. Systolic or diastolic murmur? | Systolic murmur |
| How is AV Nodal Reentrant Tachycardia manifested on the ECG? | Tachycardia with narrow QRS complex without P waves or with inverted P waves. |
| What is the cause of AVNRT? | Reentry circuit at the AV node |
| What cardiac rhythm or arrhythmia is due to reentry circuit at the AV node? | AV Nodal Reentry Tachycardia (AVNRT) |
| What are some hemodynamic effects of Mitral Stenosis? | Diastolic murmur and elevated left atrial pressure |
| What chamber pressure is most notably elevated in MS? | Left atrial pressure |
| What is the MCC of MS? | Rheumatic heart disease |
| What causes Rheumatic heart disease? | Antibody cross-reactivity between the bacterial antigen and the mitral valve |
| What is molecular mimicry? | One of the leading mechanisms by which infectious or chemical agents may induce autoimmunity |
| What condition is known to produce disease by the principle of "molecular mimicry"? | Rheumatic heart disease |
| What are the main two mediators for vasodilation? | Nitric oxide and Adenosine |
| Increase in NO and Adenosine would indicate --> | Artery vasodilation |
| Hypertension is a common cause for which two cardiac conditions? | Left ventricular hypertrophy and non-systolic heart failure |
| What is a common cause for non-systolic heart failure? | Hypertension |
| What murmur is diagnosed by a mid systolic crescendo-decrescendo at the base of the heart? | Aortic stenosis |
| What is the feature regarding pulse in AS? | Weak pulses with delayed peaks |
| What is pulsus parvus et tardus? | Weak pulses with delayed peaks |
| What condition is associated with Pulsus parvus et tardus? | Aortic stenosis |
| How do fibrates decrease Triglyceride levels? | Upregulating lipoprotein lipase though increased PPAR-gamma activity |
| How do fibrastes help elevate HDL levels? | Increasing Apolipoproteins A-I and A-II |
| What are the factors that cause benign or innocent heart murmurs? | Turbulent blood flow in the pulmonary outflow tract of the right ventricle |
| Which heart chamber is most associated with the pathogenesis of benign heart murmurs? | Right ventricle |
| What is often caused by turbulent blood flow in the pulmonary outflow tract of the RV? | Benign or innocent murmurs |
| What are 3 common causes of chronic aortic regurgitation? | Valve calcification, dilated aortic root, and rheumatic heart disease |
| What are the changes in pressure and size of the heart chambers in a person with long-standing aortic regurgitation? | Ventricular dilation and eventually a rise in LV end-diastolic pressure |
| What are the physical consequences of chronic AR? | Pulmonary edema and signs of systolic heart failure |
| What are the common complications of long-stand varicose veins? | Chronic venous insufficiency and stasis dermatitis |
| What is a underlying condition that can lead to Stasis dermatitis? | Varicose veins |
| What type of medications are the first line of treatment for patients with an MI? | Beta blockers |
| Why are beta blocker contraindicated in patients addicted to cocaine? | Unopposed alpha-receptor effects and vascular smooth muscle contraction |
| Is beta-blockers + cocaine associated with Vascular SM contraction or dilation? | Vascular smooth muscle contraction |
| What are 3 actions known to increase Preload? | 1. Abrupt squatting 2. Passive leg raising 3. Volume expansion |
| Does abrupt standing increase or decrease preload/or afterload? | Increase preload |
| What is the right combination of passive leg raising and sudden standing, among decrease/increase and preload/afterload? | Increase preload |
| What heart sound is accentuated with an increase in preload? | S3 |
| What is a S3 heart sound? | Diastolic heart sound heard in the states of volume overload and/or ventricular enlargement |
| Which type of heart failure, systolic or diastolic, is associated with S3? | Systolic heart failure |
| Which vasculitis is strongly associated with Hepatitis B infection? | PAN |
| What infectious pathogen is associated with development of PAN? | Hepatitis B virus infection |
| What type of hypersensitivity is PAN? | Type III hypersensitivity |
| Which organ is spared in PAN from illness or symptoms? | Lungs |
| What are the physical effects on the heart due to Rheumatic Heart disease? | Murmur and Left Atrial enlargement |
| What pathogen is the most common cause of Rheumatic Heart disease? | Group A B-hemolytic streptococcal throat infection |
| What is the auscultation description mitral stenosis? | Opening snap with mid-diastolic rumble |
| What common complications of bacterial endocarditis? | Septic emboli that are lodged in the brain, spleen, kidney, and gut |
| Which leads are affected with ST-segment elevation in a Left Circumflex artery infarct? | Leads I, aVL, V5, and V6. |
| Which artery is suspected to be occluded by ST-elevation of leads I, aVL, V5, and V6? | Left Circumflex artery |
| What are the main mediators of coronary artery vasodilation? | Nitric oxide and Adenosine |
| What is the typical presentation of Aortic dissection? | Sudden-onset of chest pain and back, and widened mediastinum on X-ray of the chest |
| What is the most common association of Aortic dissection? | Severe hypertension |
| What are some common causes of Non-systolic heart failure? | Long-standing, uncontrolled hypertension or aortic stenosis |
| What are complication seen in a person with diastolic heart dysfunction? | Pulmonary hypertension and dyspnea due to passive transmission of the elevated left heart filling pressure proximally into the pulmonary circulation |
| What are two main causes of Aortic stenosis in patient with Turner syndrome? | Bicuspid aortic valve, and coartation of aorta |
| What medication may be used to prevent the flushing adverse effects of Niacin therapy? | Aspirin |
| Does Digoxin toxicity cause hyperkalemia or hypokalemia? | Hyperkalemia |
| What causes hyperkalemia adversity due to Digoxin therapy? | Inhibition of the Na+/K+ ATPase |
| What is a common antiarrhythmic that may cause AV block, especially a 3 AV block? | Verapamil |
| Why is Verapamil often the cause of a 3 AVB? | Its MOA decrease Ca2+ conduction during phase 0 of the nodal action potential, leading to a delay atrial depolarization rate, which case uncoordinated firing of AV and SA nodes |
| Which nodal action potential phase is affected by Verapamil? | Phase 0 |
| Which ion is blocked by Verapamil? | Calcium |
| What are the hemodynamic effects due to Digoxin? | Increase ejection fraction and decrease in heart rate |
| What are the most common toxicity effects of Digoxin? | Visual disturbances, nausea, vomiting, diarrhea, and arrhythmias |
| List of first line anti-hypertensives: | Thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers |
| Which first line antihypertensive are know to worsen hyperlipidemias? | Thiazide diuretics |
| What is the pharmacodynamic effect produced by competitive inhibitors as per described in a Lineweaver-Burk plot? | Increase in Km and maintained of Vmax, leading to a steeper slop but the same y-intercept. |
| Does the y-intercept increase, decrease, or remains the same in a Lineweaver-Burk plot when comparing a drug with a competitive inhibitor? | y-intercept remain the same |
| What are auscultation findings of Aortic Stenosis? | Mid-to-late peaking systolic murmur at the RUSB |
| What action is known to DECREASE the intensity of Aortic Stenosis murmur? | Valsalva maneuver |
| Which heart murmur is known to systolic and with a mid-to-late auscultative description? | Aortic stenosis |
| What is the mode of action of Sildenafil? | PDE-5 inhibitor that prevents metabolism of cGMP |
| Is cGMP serum concentration increased or decreased with PDE-5 inhibitors (Sildenafil)? | Increased |
| What is the structural consequence of Hypertrophic cardiomyopathy? | Left Ventricular (LV) hypertrophy, leading to an increase oxygen demand which may lead to chest pain |
| What chamber hypertrophy causes increase oxygen demand in HCM? | Left ventricle |
| What does "ARVC" stand for? | Arrhythmogenic Right Ventricular Cardiomyopathy |
| What is the underlying mechanism of ARVC? | Myocardial cell apoptosis of the RV, leading to fibrofatty replacement and eventual thinning , dilation, and predisposition to fatal arrhythmias |
| Which heart chamber is affected in ARVC? | Right ventricle |
| Which condition is characterized by myocardial cell apoptosis of the right ventricle, which then is replaced by fibrofatty tissue? | ARVC |
| What is the cause of Osler nodes in PSGN? | Immune complex deposition in the tissues |
| What does an abnormal S3 indicate? | Ventricular volume overload associated with systolic heart failure or high-output states (thyrotoxicosis, anemia) |
| What are the main characterizes of a PDA? | Wide pulse pressure and a continuous machine-like murmur |
| Which TORCHES infection associated with PDA development in neonate? | Rubella |
| What are the most significant physical features of congenial rubella? | PDA, deafness, blindness, and cardiac abnormalities |
| What is the structure of Rubella virus? | Positive single-stranded virus of the genus Rubivirus |
| What are the main factors of Eisenmenger syndrome? | Cyanosis and hypoxemia |
| What is the most common and severe complication of Infective Endocarditis? | Septic emboli that may lodge in the brain, spleen, kidney, and gut. |
| What is the main pathogenesis of TOGV? | Left ventricle to empty into the pulmonary artery, and with the right ventricle emptying into the aorta |
| What is the typical CXR description of the heart in Transposition of the Great vessels? | "egg on a string" |
| What concurrent heart defect is associated with TOGV? | VSD |
| Auscultation description of Pulmonary regurgitation: | Diastolic, decrescendo murmur best heard at the left second intercoastal space along the sternal border |
| How long after initial MI event, can a Lateral Free wall Left ventricular rupture, can occur? | Within 2 weeks |
| What is the most significant development after Lateral free wall LV rupture after MI? | Cardiac tamponade |
| Which type of medication should be avoided if possible in patients with bilateral RAS? | ACE inhibitors and ARBs |
| Bilateral RAS patients are mainly depending on which enzyme to maintain GFR and overall renal function? | AT II |
| What is the featured heart rate of Cardiac Tamponade? | Pulsus paradoxus |
| What condition is most associated with Pulsus paradoxus? | Cardiac tamponade |
| What are adverse effects of Hydralazine? | Reflex tachycardia, leading to increased myocardial oxygen demand and angina in CAD patients |
| Which protein (enzyme) is upregulated by Fibrates to decrease TG levels? | Increased PPAR-alpha activity |
| How is lipoprotein lipase upregulated by fibrates? | Increased PPAR-alpha activity |
| What causes V-FIB? | Abnormal reentrant circuits within damaged myocardium |
| What causes a Tension pneumothorax? | One-way trapped valve and no capability of escape for air trapped the pleural space |
| What are common signs of Tension pneumothorax? | Hypotension, tachycardia, and mediastinal shift away from the affected side |
| What is most immediate after an MI, Lateral free ventricular rupture or papillary muscle rupture? | Papillary muscle rupture |
| What are the main consequences on heart dynamics in a patient with chronic Aortic regurgitation? | Ventricular dilation and eventually rise in LVED pressure |
| Holosystolic murmur obscuring S1 and best heard at the apex | Mitral regurgitation |
| What represents the start in the LV Volume Vs Pressure loop? | Mitral valve opening |
Created by:
rakomi
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