Basics of cardiology Flashcards
(225 cards)
1
Q
What separates the right auricle from the right atrium?
A
Sulcus terminalis
Crista terminalis
2
Q
Name the structures which form the cardiac borders
A
Right border - right atrium
Left border - left ventricle, left atrial appendage
Anterior border - right ventricle
Posterior border - left atrium, left ventricle
Superior border - atria and great vessels
Inferior border - right ventricle
3
Q
Name the structures forming the right cardiac border
A
Right atrium
4
Q
Name the structures forming the left cardiac border
A
Left atrial appendage
Left ventricle
5
Q
Name the structures forming the anterior cardiac border
A
Right ventricle
6
Q
Name the structures forming the posterior cardiac border
A
Left atrium
Left ventricle
7
Q
Name the structures forming the inferior cardiac border
A
Right ventricle
8
Q
Name the structures forming the superior cardiac border
A
Atria
Great vessels
9
Q
Explain coronary arterial dominance
A
Describes the vessel which gives rise to the PDA
Right dominant ∼ 85% (RCA)
Left dominant ∼ 8% (LCX)
Co-dominant ∼ 7%
10
Q
When does coronary blood flow peak?
A
Early diastole
11
Q
Name the source of the left coronary artery
A
Left aortic sinus of ascending aorta
12
Q
Name the source of the right coronary artery
A
Right aortic sinus of ascending aorta
13
Q
Name the important branches of the left coronary artery
A
Left anterior descending artery (LADA)
Left circumflex artery
14
Q
Name the important branches of the right coronary artery
A
Right marginal artery
PDA
AV nodal artery
SA nodal artery
15
Q
Describe the course of the left anterior descending artery
A
Descends between right and left ventricles on anterior surface of heart in the anterior interventricular sulcus towards cardiac apex
16
Q
Which structures are supplied by the left anterior descending artery
A
> 50% of left atrium and ventricle Anterior aspect of the left ventricle Anterior ⅔ of the interventricular septum Anterolateral papillary muscle Cardiac apex
17
Q
Describe the course of the left circumflex artery
A
Courses left around the heart in the coronary sulcus towards the posterior aspect, ending before the posterior interventricular sulcus and gives off the left marginal artery
18
Q
Which arteries supply the anterolateral papillary muscle?
A
LADA
LCX
19
Q
Which structures are supplied by the left circumflex artery?
A
Posterolateral left atrium and ventricle
Anterolateral papillary muscle
SA node ∼ 40%
PDA ∼ 15%
20
Q
Describe the course of the right marginal artery
A
Courses along diaphragmatic border
21
Q
Which structures are supplied by the right marginal artery?
A
Lateral right ventricle
Cardiac apex
22
Q
Describe the course of the posterior descending artery
A
Descends between right and left ventricles on posterior surface of the heart in the posterior interventricular sulcus towards cardiac apex
23
Q
Which structures are supplied by the posterior descending artery?
A
Posterior ⅓ of the interventricular septum
Posteroinferior aspect of heart
Posteromedial papillary muscle
24
Q
Which structures are supplied by the AV nodal artery?
A
AV node
Bundle of His
25
Which structures are supplied by the SA nodal artery?
SA node
26
Which is the most commonly occluded coronary artery?
LAD
27
The occlusion of which coronary vessel will result in cardiac arrythmias?
Right coronary artery
28
Where do the lymphatics of the heart drain?
Anterior mediastinal nodes
| Tracheobronchial nodes
29
Discuss the innervation of the heart
Somatic nervous system - phrenic nerve
Sympathetic nervous system - cardiac plexus
Parasympathetic nervous system - vagus nerve
30
What is the visceral layer of serous pericardium?
Epicardium
31
What is the endocardium composed of?
Endothelium
Loose CT
Subendocardium
32
What is the subendocardium?
Loose connective tissue containing cardiac Purkinje cells, veins and nerves
33
What is the myocardium composed of?
Cardiomyocytes
Fibroblasts
Extracellular matrix
34
Which nerve is responsible for the sensory innervation of the pericardium?
Phrenic nerve
35
What germ layer gives rise to the heart?
Mesoderm
36
What do the endocardial cushions give rise to?
Atrial septum
Interventricular septum
Valves
37
What does the primitive atrium give rise to?
Trabeculated portions of atria
38
What does the primitive ventricle give rise to?
Trabeculated portions of ventricles
39
What does the primitive pulmonary vein give rise to?
Smooth portion of left atrium
40
What does the sinus venosus give rise to?
Right horn - smooth portion of right atrium
| Left horn - coronary sinus
41
What does the cardinal veins give rise to?
SVC
| IVC
42
What causes a defect in cardiac looping?
Defect in dynein arm of microtubules
43
What does a defect in cardiac looping result in?
Kartegener syndrome
44
How do you calculate EF?
SV/EDV
45
Name the 4 phases of the cardiac cycle
Isovolumetric contraction
Systolic ejection
Isovolumetric relaxation
Ventricular filling
46
During which phases of the cardiac cycle are all valves open?
None
47
During which phases of the cardiac cycle are all valves closed?
Isovolumetric contraction
| Isovolumetric relaxation
48
Define chronotropy relative to cardiac physiology
Any influence on the heart rate
49
Define dromotropy relative to cardiac physiology
Any influence on myocardial conductivity
50
Define inotropy relative to cardiac physiology
Any influence on myocardial contractility
51
Define lusitropy relative to cardiac physiology
Any influence on myocardial relaxation
52
Define bathmatropy relative to cardiac physiology
Any influence on myocardial excitability
53
Which equation describes the relationship between vascular resistance, the length and radius of the vessel, and the viscosity of blood?
Poisueille equation
54
Name factors that influence blood flow
Blood viscosity
Blood velocity
Lumen diameter
Blood vessel wall smoothness
55
What Reynold's number does laminar flow have?
Low
56
What Reynold's number does turbulent flow have?
High
57
How do you calculate MAP?
⅓ systolic pressure + ⅔ diastolic pressure
OR
CO x TPR
58
What is a normal pulse pressure?
30–40 mmHg
59
Name causes of a low pulse pressure
Advanced heart failure
Cardiac tamponade
Aortic stenosis
Shock
60
Name causes of a high pulse pressure
```
Exercise
Hypothyroidism
Aortic regurgitation
Anemia
OSA
```
61
What is the importance of Laplace's law?
Increased vessel thickness results in decreased wall tension
62
Differentiate vascular compliance from vascular elastance
Compliance - adapt to change in pressure
| Elastance - adapt to change in volume
63
What is the triad of symptoms in Cushing reflex?
Hypertension
Bradycardia
Respiratory depression
64
Explain the mechanism of Cushing reflex
↑ intracranial pressure → compensatory constriction of cerebral arterioles → ↓ cerebral perfusion → hypercapnia and acidosis → chemoreceptor mediated sympathetic response → ↑ blood pressure → stimulation of aortic arch baroreceptors → activation of the parasympathetic nervous system (vagus) → reflex bradycardia
65
What is the atrial reflex also known as?
Bainbridge reflex
66
What is the atrial reflex?
Atrial distension -> incr HR
67
What is the diuresis reflex also known as?
Gauer-Henry reflex
68
What is the diuresis reflex?
Incr BP -> decr ADH
69
Which chemoreceptors are more responsive to chronic hypoxia?
Peripheral > central
70
How does carotid massage act to reduce the heart rate?
Stimulating the carotid baroreceptors leads to an increased AV node refractory period
71
Where is central blood pressure regulation localized?
Solitary nucleus in the medulla oblongata
72
What are the afferent and efferent pathways of central blood pressure regulation?
```
Afferent
- glossopharyngeal nn (carotid)
- vagus nerve (aorta)
Efferent
- sympathetic
- parasympathetic
```
73
What causes the release of ANP from atrial cardiomyoctyes?
Increased volume
74
How is RAAS activated?
Release of renin from the juxtoglomerular cells
75
What is myogenic autoregulation?
Myocytes in the walls of arteries and arterioles react to changes in blood pressure to maintain constant blood flow in the blood vessels (incr BP -> vasoconstriction)
76
Which receptors does epinephrine have a greater affinity for: alpha 1 or beta 2?
Beta 2 receptors
77
How does epinephrine concentration affect adrenergic receptors?
Low concentration - greater effect on beta 2
| High concentration - stronger effect on alpha 1
78
What is the hypoxic pulmonary mechanism?
Hypoxia results in pulmonary vasoconstriction
79
Define hydrostatic pressure
The pressure exerted by any fluid on the wall of an enclosed space
80
Define osmotic pressure
The minimum pressure needed to prevent the flow of a solvent across a semi-permeable membrane
81
Define oncotic pressure
Intravascular osmotic pressure generated by proteins
82
What are the 4 Starling forces?
Capillary hydrostatic pressure
Interstitial hydrostatic pressure
Plasma oncotic pressure
Interstitial oncotic pressure
83
How do burns, infections and toxins cause edema?
They affect vessel permeability
84
At what point is the JVP elevated?
>4cm
85
How do you estimate the CVP?
JVP + 5cm
86
Which side should you assess the JVP and why?
Right side
| More direct path to SVC
87
What is the reference range of the CVP?
4-10 cm H20
88
What are signs of an elevated JVP?
Incr JVP
Kussmaul sign
Hepatojugular reflux
89
Name causes of elevated JVP
```
Right sided HF
Fluid overload
Tricuspid dysfunction
Pericardial effusion
Constrictive pericarditis
Cardiac tamponade
SVC syndrome
Pulmonary hypertension
```
90
Name the components of the JVP waveform
```
a wave
c wave
x descent
v wave
y descent
```
91
What is the mechanism behind the a wave of the JVP waveform?
Atrial contraction
92
What is the mechanism behind the c wave of the JVP waveform?
Tricuspid valve closure
93
What is the mechanism behind the v wave of the JVP waveform?
Venous refilling of right atrium
94
What is the mechanism behind the x descent of the JVP waveform?
Atrial relaxation
95
What is the mechanism behind the y descent of the JVP waveform?
Tricuspid valve opening
96
Name a cause of an absent a wave in the JVP waveform
Atrial fibrillation
97
Name a cause of a cv wave in the JVP waveform
Severe TR
98
Name a cause of an absent x descent in the JVP waveform
TR
| RHF
99
Name a cause of a prominent v wave in the JVP waveform
TR
| RHF
100
Name a cause of an absent y descent in the JVP waveform
TR
| Constrictive pericarditis
101
Name a cause of a prominent y descent in the JVP waveform
Cardiac tamponade
| TS
102
Which conditions can cause pulse bigeminus?
LHF
| Digoxin toxicity
103
What pulse rates can you get?
Tachycardia
| Bradycardia
104
What pulse rhythms can you get?
```
Regular
Regularly irregular
Irregularly irregular
Pulse deficit
Pulse bigeminus
```
105
What pulse volumes can you get?
```
Hyperkinetic
Hypokinetic
Pulsus paradoxus
Reverse pulsus paradoxus
Pulsus alternans
Dicrotic pulse
Pulsus bisfiriens
```
106
Name causes of bruits
```
AV fistulas
AV malformations
Aneurysms
Vascular stenosis
Hyperdynamic circulation
```
107
Where is De Musset sign seen?
AR
108
Name causes of an apex beat with a hyperdynamic impulse
High cardiac output
| Volume overload
109
Name causes of an apex beat with a heaving impulse
Pressure overload
110
Name causes of an apex beat with a hypodynamic impulse
```
MI
Obesity
Pericardial effusion
L pneumothorax
L pleural effusion
COPD
```
111
Name causes of an apex beat with a tapping impulse
Mitral stenosis
112
Name causes of an apex beat with a dyskinetic impulse
Left ventricular dysfunction
113
Name causes of a murmur at Erb's point
HOCM (systolic)
| AR, PR (diastolic)
114
Name causes of a murmur at the aortic area
AS
AR
Coarctation
115
Name causes of a murmur at the pulmonary area
PS
PR
ASD
116
Name causes of a murmur at the mitral area
MS
MR
Mitral valve prolapse
117
Name causes of a murmur at the tricuspid area
TS
TR
VSD
118
Which murmur also radiates to the carotid arteries?
Aortic stenosis
119
Name causes of a pathological 3rd heart sound
```
Chronic MR
AR
Heart failure
Dilated cardiomyopathy
Thyrotoxicosis
```
120
Name causes of a pathological 4th heart sound
Ventricular hypertrophy
| Ischemic heart disease
121
Which murmur radiates to the left axilla?
Mitral regurgitation
122
Which murmur radiates to the interscapular region?
Pulmonary stenosis
123
How do you remember where which murmur is?
Systolic = stenosis
| Therefore diastolic = regurgitation
124
Which maneuver increases the sound of mitral murmurs?
Left lateral position
125
Which maneuver increases the sound of aortic murmurs?
Sitting leaning forward
126
Which maneuver increases the sound of right sided murmurs?
Inspiration
127
Name the inferior ECG leads
II
III
aVF
128
Name the lateral ECG leads
I
aVL
V5
V6
129
Name the anteroseptal ECG leads
V1
V2
V3
V4
130
What is the P wave in the ECG?
Atrial depolarization
131
What is the PR interval in the ECG?
Depolarization from SA node -> atria -> AV node -> His-Purkinje system
132
What is the QRS complex in the ECG?
Ventricular depolarization
133
What is the ST segment in the ECG?
The duration between ventricular depolarization and repolarization
134
What is the T wave in the ECG?
Ventricular repolarization
135
What is the QT interval in the ECG?
Total time of ventricular depolarization and repolarization
136
Explain your approach to reading an ECG
1. Check patient information and standardisation
2. Lead II
3. aVR
4. R wave progression
5. ST segment
6. T wave
7. Lengths of PR, QT, QRS and R
137
How do you determine cardiac axis deviation?
```
Look at the QRS complex in lead I and aVF
Normal axis = I + aVF +
Left axis = I + aVF -
Right axis = I - aVF +
Extreme right axis = I - aVF -
```
138
What does P pulmonale signify?
Right atrial enlargement
139
What does P mitrale signify?
Left atrial enlargement
140
What should the duration of a PR interval be?
0.12s-0.2s
141
Name causes of a decreased PR interval
WPW
| Pre-excitation syndromes
142
Name causes of an increased PR interval
1st degree AV block
143
What is the cause of progressively lengthening PR interval until a QRS complex is dropped?
Mobitz type I (2nd degree AV block)
144
What is the cause of a constant PR interval with a constant QRS complex drop?
Mobitz type II (2nd degree AV block)
145
Name causes of an abnormally wide Q wave
```
Myocardial injury
Ventricular enlargement
Altered ventricular conduction
Acute PE
CHD
```
146
Name causes of a dominant R wave
```
RVH
RBBB
Posterior MI
HCM
WPW
```
147
Name causes of poor R wave progression/persistent S wave
```
RVH
Cardiac strain
LBBB
LAFB
WPW
```
148
What should new onset LBBB with concurrent angina be treated as?
Acute coronary syndrome
149
How do you remember V1 V6 M W shapes for LBBB vs RBBB?
WilliaM MorroW
150
Name causes of a LBBB
```
Cardiac
- coronary aa disease
- MI
- hypertension
- cardiomyopathy
Hyperkalemia
Digoxin toxicity
```
151
Name causes of a RBBB
```
Cardiac
- coronary aa disease
- MI
- mitral stenosis
Pulmonary
- pulmonary hypertension
- PE
- COPD
Brugada syndrome
```
152
Name causes of an ST elevation
```
Normal young healthy adult
STEMI
LBBB
Pericarditis
Perimyocarditis
PE
Brugada syndrome
Left ventricular aneurysm
```
153
Name causes of a downsloping/horizontal ST depression
Subendocardial MI
| Stress induced MI
154
Name causes of an upsloping ST depression
Normal in tachycardia
| MI if clinically ACS suspected
155
Name causes of a sagging ST depression
Digoxin
156
What is Brugada syndrome?
A rare, AD mutation of the cardiac voltage-gated Na channels that leads to abnormal cardiac conduction and sudden death
157
In which population group is Brugada syndrome found?
Asian men
158
What signs on an ECG indicate Brugada syndrome?
PseudoRBBB
| ST elevation in V1, V2, V3
159
How do you treat Brugada syndrome?
Implantable cardiac defibrillator
| Screen relatives
160
Name complications of Brugada syndrome
Atrial fibrillation
| Sudden death
161
Name causes of T wave inversion
```
Coronary aa disease
PE
BBB
Perimyocarditis
Digoxin
Ventricular hypertrophy
ICH
Wellens syndrome
```
162
Name causes of T wave flattening
Hypokalemia
Hypoglycemia
Hypothyroidism
MI
163
What is Wellens syndrome?
Severe proximal stenosis of the LAD resulting in unstable angina and deeply inverted/biphasic T waves on leads V2, V3
164
Name causes of a peaked T wave
Hyperkalemia
| Hypermagnesemia
165
Name causes of a hyperacute T wave
Early STEMI
| Prinzmetal angina
166
Name causes of a biphasic T wave with initial positive deflection
MI
| Wellens syndrome
167
Name causes of a biphasic T wave with initial negative deflection
Hypokalemia
168
Name causes of a prolonged QT interval
```
Congenital
- Romano Ward syndrome
- Jervell and Lange Nielsen syndrome
Acquired
- drugs
- electrolyte disturbance
- cardiac abnormalities
- arsenic poisoning
```
169
Name drugs that can cause a prolonged QT interval
Antiarrythmics
Antidepressants
Antipsychotics
Antihistamines (1st generation)
170
Which syndrome resulting in a prolonged QT interval is associated with sensorineural deafness?
Jervell and Lange-Nielsen syndrome
171
Name causes of a shortened QT interval
Hypercalcemia
Hyperkalemia
Digoxin
Congenital
172
What can cause a prominent U wave?
Hypokalemia
173
What ECG pattern is seen in pulmonary embolism?
S1Q3T3
174
What are the most relevant ECG findings in a STEMI?
```
Early stage
- Hyperacute T wave
- ST elevation
Intermediate stage
- Absent R wave
- T wave inversion
- Pathological Q wave
```
175
What are the most important clinical findings in a STEMI?
```
Acute, retrosternal pain
Dyspnea
N+V
Diaphoresis
Anxiety
Syncope
New S4
```
176
What are the most relevant ECG findings in an AV nodal re-entrant tachycardia?
Invisible P wave
| Narrow QRS complexes
177
What are the most important clinical findings in an AV nodal re-entrant tachycardia?
Palpitations
Dyspnoea
Dizziness
Diaphoresis
178
What are the most relevant ECG findings in an AV nodal reciprocating tachycardiaI?
```
Orthodromic
- narrow QRS
- p wave follows QRS
Antidromic
- wide QRS
- shortened PR
```
179
What are the most important clinical findings in an AV nodal reciprocating tachycardia?
Palpitations
Dyspnoea
Dizziness
Diaphoresis
180
What are the most relevant ECG findings in a multifocal atrial tachycardia?
Irregularly irregular
| 3 varying p wave morphologies
181
What are the most important clinical findings in a multifocal atrial tachycardia?
Palpitations
Dyspnoea
Dizziness
Diaphoresis
182
What are the most relevant ECG findings in a paroxysmal atrial tachycardia?
Unusual p wave before normal QRS
183
What are the most important clinical findings in a paroxysmal atrial tachycardia?
Palpitations
Dyspnoea
Dizziness
Diaphoresis
184
What are the most relevant ECG findings in a WPW?
Short PR
Delta wave
Widened QRS
185
What are the most important clinical findings in a WPW?
Palpitations
Dyspnoea
Dizziness
Diaphoresis
186
What are the most relevant ECG findings in a torsades de pointes?
Wide QRS complex
Dissociated P wave
Fusion complexes
Capture beat
187
What are the most important clinical findings in a torsades de pointes?
```
Often asx
Palpitations
Syncope
Angina
Dyspnea
Dizziness
Hypotension
Cardiac arrest
```
188
What are the most relevant ECG findings in an atrial fibrillation?
Irregularly irregular
Indiscernible P wave
Narrow QRS complex
189
What are the most important clinical findings in an atrial fibrillation?
Asx
Arrythmia symptoms
Tachycardia with regularly irregular pulse
Thromboembolic events
190
What are the most relevant ECG findings in atrial flutter?
Sawtooth P wave
| Narrow QRS
191
What are the most important clinical findings in atrial flutter?
Asx
Arrythmias symptoms
Tachycardia with regular pulse
192
What are the most relevant ECG findings in a ventricular fibrillation?
Indiscernible QRS
| Absent p wave
193
What are the most important clinical findings in a ventricular fibrillation?
```
Angina
Palpitatins
Dyspnea
LOC
Death
```
194
What are the most relevant ECG findings in a 1st degree AV block?
PR interval >200ms
195
What are the most important clinical findings in a 1st degree AV block?
```
Asx
Fatigue
Dizziness
Syncope
Palpitations
```
196
What are the most relevant ECG findings in a Mobitz type I?
Progressive PR interval lengthening followed by a beat drop
197
What are the most important clinical findings in a Mobitz type I?
```
Asx
Fatigue
Dizziness
Syncope
Palpitations
```
198
What are the most relevant ECG findings in a Mobitz type II?
Constant PR interval with a beat drop
199
What are the most important clinical findings in a Mobitz type II?
```
Asx
Fatigue
Dizziness
Syncope
Palpitations
```
200
What are the most relevant ECG findings in a 3rd degree AV block?
AV dissociation
201
What are the most important clinical findings in a 3rd degree AV block?
```
Asx
Fatigue
Dizziness
Syncope
Palpitations
```
202
What are the most relevant ECG findings in an acute pericarditis?
Saddle shaped ST elevation
Diffuse PR depression
T wave inversion
203
What are the most important clinical findings in an acute pericarditis?
```
Pleuritic chest pain
Low grade fever
Tachypnea
Dyspnea
Non-productive cough
Pericardial friction rub
```
204
What are the most relevant ECG findings in a cardiac tamponade?
Tachycardia
Low voltage QTS
Electrical alternans
205
What are the most important clinical findings in a cardiac tamponade?
```
Beck's triad
Pulsus paradoxus
Pallor
Cold sweats
Obstructive shock
Cardiac arrest
```
206
What are the most relevant ECG findings in a hypertrophic cardiomyopathy?
LVH signs
Nonspecific ST/T changes
Septal Q waves
207
What are the most important clinical findings in a hypertrophic cardiomyopathy?
```
Asx
Dyspnea
Chest pain
Syncope
Palpitations
Sudden cardiac death
```
208
What are the most relevant ECG findings in a restrictive cardiomyopathy?
Low voltage
| BBBs
209
What are the most important clinical findings in a restrictive cardiomyopathy?
```
Dyspnea
JVP distension
Peripheral edema
Ascites
Hepatomegaly
```
210
What are the most relevant ECG findings in a PE?
S1Q3T3
| New RBBB
211
What are the most important clinical findings in a PE?
```
Dyspnea
Tachypnea
Sudden pleuritic pain
Cough
Haemoptysis
Decr breath sounds
```
212
What are the most relevant ECG findings in a hypokalemia?
Flattened T wave
ST depression
U waves
213
What are the most important clinical findings in a hypokalemia?
```
Palpitations
Syncope
Muscle cramps
Muscle weakness
Decr DTR
N+V
Constipation
Polyuria
```
214
What are the most relevant ECG findings in a hyperkalemia?
Wide QRS
Peaked T wave
Flattened, wide P waves
215
What are the most important clinical findings in a hyperkalemia?
```
Muscle weakness
Paralysis
Paresthesia
Decr DTR
N+V
Diarrhea
```
216
What are the most relevant ECG findings in a hypocalcemia?
Prolonged QT interval
217
What are the most important clinical findings in a hypocalcemia?
```
Tetany
Spasms
Cramps
Paresthesia
Seizures
```
218
What are the most relevant ECG findings in a hypercalcemia?
Shortened QT interval
219
What are the most important clinical findings in a hypercalcemia?
```
Nephrolithiasis
Nephrocalcinosis
Bone pain
Arthalgia
Myalgia
N+V
Constipation
Anorexia
PUD
Pancreatitis
```
220
What are the most relevant ECG findings in a hypomagnesemia?
Prolonged PR
| Prolonged QT
221
What are the most important clinical findings in a hypomagnesemia?
```
Anorexia
N+V
Muscle weakness
Muscle cramps
Tremor
Ataxia
Nystagmus
Seizures
```
222
What are the most relevant ECG findings in a right atrial enlargement?
P pulmonale
223
What are the most relevant ECG findings in a left atrial enlargement?
P mitrale
224
What are the most relevant ECG findings in a LVH?
```
Sokolow-Lyon criteria
>3.5mV
- RV5
- RV6 + SV1
- SV2
```
225
What are the most relevant ECG findings in a RVH?
```
Sokolow-Lyon criteria
>1.05mV
- RV1
- RV2 + SV5
- SV6
Right axis deviation
```
