Boards and Beyond- Cardio Flashcards
1
Q
Which valve problem?
Turner syndrome or aortic coarctation
A
Bicupsid aortic valve
Early stenosis
Aortic regurg
2
Q
which blood vessel has the highest velocity? Lowest?
A
Highest: Large arteries
Lowest: Capillaries
3
Q
_______________ ischemia occurs with flow obstruction but some distal blood flow.
A
Subendocardial ischemia
4
Q
Kussmaul’s sign
A
Inspiration causes rise in JVP
*Classic sign of restrictive heart disease
5
Q
Complications of Ischemia weeks later
A
Dressler’s syndrome
Aneurysm
LV Thrombus/ stroke
6
Q
Loud S3 heart sound. Disease?
A
Rapid ventricular filling (such as mitral incompetence or congestive heart failure)
7
Q
3 main ways to decrease conduction in AV node
A
Carotid massage
Vagal maneuvers
Adenosine
8
Q
What conditions decrease oncotic pressure?
A
Nephrotic syndrome
Liver failure
9
Q
Rhythm signs of restrictive heart disease
A
- Arrythmias (sudden death)
- AV block
10
Q
Symptoms of atrial fibrillation
A
Palpitations, fatigue, dyspnea
11
Q
Which baroreceptor only senses elevated BP?
A
Aortic arch
12
Q
which genetic disorders has conotruncal anomalies?
A
DiGeorge syndrome
- Outflow tract anomalies
- Truncus arteriosus
- Conus arteriousus
13
Q
CO calculation
A
SV X HR
14
Q
Neprilysin inhibitors
A
Sacubitril
15
Q
Side effects of neprilysin inhibitors
A
Hypotension
Hyperkalemia
Angioedema
16
Q
Which heart problem?
Healthy, young athelete, syncope
A
HCM
17
Q
Carvallo’s sign
A
Right -sided murmurs increase with inspiration
Left sided murmurs increase with exhalation
18
Q
Which drugs are implicated in causing coronary steal?
A
Adenosine
Persantine
Regadenoson
19
Q
Mg blocks influx of _____ into cells.
A
Ca
20
Q
________ (acute/chronic) regurgitation may cause shock.
A
Acute
21
Q
_____________ inhibits sarcoplasmic reticulum Ca2+ ATPase. What effect does this have?
A
Phospholamban; prevents Ca2+ uptake by SERCA and prevents relaxation
22
Q
When is a S3 heard?
A
- Acute heart failure
- Young patients
- Pregnant women
23
Q
Alprostadil
A
- Prostaglandin E1
- Maintains patency of ductus arteriosus
- Delivers blood to lungs
24
Q
Therapies for systolic HF
A
Drugs: ACE-inhibitors, beta blockers, aldosterone antagonists
Defibrillators
Bi-ventricular pacemakers
25
Type of shock?
Low CO
High cardiac pressures
High SVR
Cardiogenic
26
How is prinzmetal angina treated?
* Quit smoking
* Calcium channel blockers, nitrates
* Avoid propranolol
27
Key control variables for autoregulation in kidneys
BP
NaCl feedback
28
In systolic heart failure, ejection fraction is \_\_\_\_\_\_\_\_\_\_\_. In diastolic heart failure, ejection fraction is \_\_\_\_\_\_\_\_\_.
Reduced; normal
29
In what condition can you see a prolonged PR interval?
Primary AV block
30
Infundibulum develps from \_\_\_\_\_\_.
Bulbus cordis
\*infundibulum is a funnel leading to pulm valve
31
Dystrophic calcification of coronary arteries is the result of \_\_\_\_\_\_\_\_\_\_\_\_.
Chronic inflammation
32
Truncus arteriosus gives rise to what structures
Aorta
Pulm artery
33
How is prinzmetal angina diagnosed?
* Intracoronary ergonovine
* Acts on smooth muscle serotonergic receptors
* Vasospasm visualized on angiogram
* Intracoronary acetylcholine
* Acts on endothelial muscarinic receptors
* Endothelial dysfunction leads to vasoconstriction
34
ACE inhibitors
Captopril
Enalapril
Lisinopril
Ramipril
35
Side effects of loop diuretics
Hypokalemia
Volume deplettion
* Renal failure
* hypotension
36
Venous return is blood returned to the \_\_\_\_\_\_\_\_\_\_\_\_\_.
Left ventricle
37
In which conditions are u waves seen?
Hypokalemia
38
Systolic crescendo-decrescendo murmur
Aortic stenosis
39
Class _______ antiarrhythmic drugs block K channels.
III
40
Conditions with right axis deviation
Right bundle branch block
Right ventricular hypertrophy
41
Structures effected by central cyanosis
Lips
Nail beds
Conjunctivae
\*Warm extremities
42
normal QRS axis
Between -30 and +90
43
which blood vessel has the highest area? Lowest?
Highest: Capillaries
Lowest: Large arteries
44
Why are headaches an adverse of nitrates?
Meningeal vasodilation
45
For left axis deviation, lead ____ is negative.
II
46
Three major classes of calcium antagonists
* Dihydropyridines (nifedipine)
* Phenylalkylamines (Verapamil)
* Benzothiazepines (Diltiazem)
47
Causes of pulmonic regurg
**Repaired tetralogy of fallot**
Endocarditis
Rheumatic heart disease
48
If you notice a wide QRS and V1 is facing downward. What is the prognosis?
LBBB
49
Conginetal heart defects seen in fetal alcohol syndrome
ASD
VSD
Tetralogy of Fallot
50
Inotropes
Milrinone
Dobutamine
Dopamine
Epinephrine
51
What venous pressure tracing is seen in tricupsid stenosis?
Large a wave
52
All forms of HF have a low CO except\_\_\_\_\_\_\_\_.
High output heart failure
53
When do systolic murmurs occur?
Between S1- S2
54
Decreased S2 heart sound. Disease?
Aortic stenosis
55
Key control variables for autoregulation in brain
CO2
pH
56
Class \_\_\_\_antiarrhytmic drugs block Na channels
I
57
Which valve problem?
Young female, otherwise healthy
MVP
58
Typical symptoms of cardiac ischemia
Chest pain
Dyspnea
Diaphoresis
59
Symptoms of coarctation of the aorta are caused by closure of the \_\_\_\_\_\_\_\_\_\_\_.
Ductus arteriosus
60
In which cases is emergent cardioversion performed regardless of possible thrombus?
Hypotension and shock
61
White infarcts
* Occlusion of arterial supply to a solid organ
* Common in heart, kidneys, spleen
* Limited blood seepage from healthy tissue
* Tissue becomes pale
62
WHat drugs is used during cardioversion
Ibutilide
63
Lysosomal storage disease
Deficiency of a-galatosidase A
Accumulation of ceramide trihexoside
Fabry disease
64
ST elevation if lead avR. Which artery is occluded?
Left coronary
65
Class IB antiarrhythmics
Lidocaine
Mexiletine
66
What viruses are associated with nonischemic cardiomyopathy
**Coxsackie**
Influenza
Adenovirus
67
Chemical cardioversion
* Administration of antiarrhythmic medication
68
How should a NSTEMI be treated?
Aspirin
B-blockers
Heparin
Angioplasty (non-emergent)
69
how are the murmurs heard in aortic stenosis and hypertrophic cardiomyopathy differentiated?
Valsalva
* Decreases venous return/preload
* Increase HCM murmur
* Decrease Aortic stenosis murmur
70
Key control variables for autoregulation in skeletal muscle
Lactate
Adenosine
K+
71
Excess fluid movement out of capillaries results in \_\_\_\_\_\_\_\_\_\_\_.
Edema
72
In which conditions do we see a cannon a wave?
Complete heart block
PAC/PVC
Ventricular tachycardia
73
Rank calcium channel blockers based on vascular smooth mucscle effects (greatest to least)
Nifedipine\>Diltiazem\> Verapamil
74
Maternal _________ can lead to Ebstein's anomaly.
Lithium
75
General symptoms of endocarditits
Fever, chills, sweats, petechiae
76
AV block seen in Lyme disease improves with \_\_\_\_\_\_\_\_\_.
Antibiotics
77
Neprilysin inhibitors should not be administered with \_\_\_\_\_\_.
ACE inhibitors
\*Same side effects
78
HF leas to the activation of what two physiological systems
* Sympathetic nervous system
* Renin-angiotensin-aldosterone system
79
What conditions increase capillary permeability (Kf)?
Toxins
Infections
Burns
80
Types of Shock
Cardiogenic
Hypovolemic
Distributive
Obstructive
81
Prolonged Qt conditions
Hypocalcemia
Drugs
LQTS (Long QT syndrome)
82
Culture negative endocarditis
Coxiella burnetii
Bartonella
83
Diastolic murmur. Disease?
Turbulence during ventricular filling (mitral stenosis or aortic regurgitation
84
Results of K Channel blockage on EKG
Prolong Qt
85
Key control variables for autoregulation in heart
CO2
Adenosine
NO
86
Most common manifestation of chronic Q fever
Endocarditis
87
How is acute heart failure treated?
Most: Daily diuretic
Some: Daily long acting nitrate (often oral isosorbide mononitrate)
Rare: Chronic IV infusion inotrope, heart transplant, left ventricular assist device (LVAD)
88
How does digoxin supress AV node conduction?
Increased vagal tone
* can be used to decrease heart rate
89
Where are aortic regurgitations heard?
Left sternal border
90
familial cuases of nonischemic cardiomyopathy
Mutations
* Sacromere proteins
* Beta myosin heavy chain
* Alpha myosin heavy chain
* Troponin
91
Symptoms of acute heart failure
Congested/swollen
Pulm edema
Pitting edema
Increased JVP
92
Valvular atrial fibrillation is associated with \_\_\_\_\_\_\_\_\_\_\_.
Rheumatic heart disease
\*Usually mitral stenosis
**NOTE:** Non-valvular fibrillation is NOT associated with rheumatic disease
93
B blocker used to treat glaucoma
Timolol
94
Loop diurectics
Furosemide
Bumetanide
Torsemide
Ethacrynic Acid
95
Phase 0 of myocyte AP
* Nearby myocytes raise membrane potential via gap junctions
* Rising potential opens fast Na Channels
* Threshold potential reached (about -70mV)
* Large Na+ currents leads to rapid depolarization
* Membrane potential overshoots (\>0mV)
* Fast Na+channels close
96
a2 agonist
Clonidine
Methyldopa
97
Side effects of RAAS drugs
Hyperkalemia (due to decreased aldosterone)
Renal failure (due to decreased GFR)
98
Mechanism by which viridians strep causes endocarditits
* Bacteria synthesize dextran
* Dextran adheres to fibrin
* Fibrin found with endothelial damage
99
Which valve problem?
IV drug abuser
Tricupsid regurgitation
100
Results of Na Channel blockage on EKG
Prolonged QRS
101
Acute exacerbations of HF
* Infection/trauma/ surgery
* Ischemia
* NSAIDS
* Dietary indiscretion
* Poor medication compliance
102
How is dressler's syndrome treated?
NSAIDs or steroids
103
Class IV antiarrhythmics
Ca channel blockers
104
When afterload ____________ (falls/rises), stroke volume and CO increase.
Falls
105
How is stable angina usually treated?
Revascularization
106
Cuases of heart block
Drugs
* Beta blockers, calcium channel blockers
* Digoxin
High vagal tone
* Athletes
Fibrosis and sclerosis of conduction system
107
Which layer of the heart is infiltrated by eosinophils?
Endomyocardium
108
Which antiarrythymics prolong Qt?
Class Ia, III drugs
109
\_\_\_\_\_\_\_\_\_ (fast/slow) HR shortens diastole.
Fast
110
Supravalvular aortic stenosi
Narrowing of ascending aorta above aortic valve
111
Severe disease findings in aortic stenosis
* Late peaking murmur
* Soft/ quiet S2
* Stiff valve can't slam shut
* Pulsus parvus et tardus
* Weak and small carotid pulses
* Delayed carotid upstroke
112
Which organs are great autoregulators?
Heart
Brain
Kidneys
Lungs
Skeletal muscle
113
S3 and S4 are heard during \_\_\_\_\_\_.
Diastole
114
Forms of nitrates
* Nitroglycerin Tablets/ Spray
* Take during angina attack, before exercise
* Isosorbide Dinitrate
* Isosorbide Mononitrate
* Topical nitroglycerin
115
Which volumes are effected by an increase in afterload?
* Increased ESV
* Decreased SV
* Decreased EF
116
Side effects of ranolazine
Constipation
Dizziness
Headache
117
Secundum type of ASD
* Defects at site of foramen ovale/ ostium secundum
* Poor growth of secundum septum
* Or excessive absorption of primum septum
* Often isolated defect
118
What two classes of drugs affect pacemaker AP?
* Calcium channel blockers
* Slow rate sinus depolarization (slow HR)
* Slow AV node conduction
* Beta blockers
* Slows phase 4
* Makes it longer to reach threshold
* Decreases HR
* Prolong repolarization
* Slow AV node conduction
119
Why does the LVEF increase during exercise?
More vigorous contraction causes the **ESV to decrease**. There is more preload but less filling time at fast heart rates.
120
Which valve problem?
Immigrant or pregnant
Mitral stenosis
121
In which cases can the recurrent laryngeal nerve be compressed?
Aortic dissection
Massive LA enlargement
122
What factors cause a decrease in preload?
* Remove volume
* Raise heart rate
* Rool blood in veins
123
Phospholamban is phosphorylated by \_\_\_\_\_\_\_\_\_\_\_\_. What effect does this have?
Beta adrenergic stimulation; this causes phospholamban to stop inhibiting SERCA. SERCA takes up calcium. Muscle relaxes.
124
Which factor drives smooth muscle proliferation in the intima of arteries?
PDGF (Platelet derived growth factor)
125
Cause of NSTEMI
* Atherosclerotic plaque rupture
* Thrombus formation
* Subtotal vessel occlusion
126
What venous pressure tracing is seen in tricupsid regurgitation?
Giant v wave
127
Mechanism of action of digoxin
Inhibits the Na-K pump, increases calcium in myocytes
128
Side effects of class Ib drugs
* CNS stimulation
* Tremor, agitation
* CVS side effects
* Bradycardia, heart block, hypotension
129
What is the effect on the arterioles of stenotic vessels in angina?
Arterioles are maximally dilated to maintain flow
\*Arterioles are not maximally dilated in normal vessels.
130
* Sacromeres added in parallel
* Left ventricular mass increased
* Wall thickness increased
Concentric hypertrophy
131
Phase 1 of myocyte AP
* Membrane potential is positive
* K+ channels open
* Outward flow of K+ returns membrane to approximately 0 mV
132
most common cause of paroxysmal supraventricular tachycardia
Atrioventricular nodal rentrant tachycardia
\*More common in young women and requires dual AV nodal pathways
133
What does a LVEDP pressure considerably greater than PCWP indicate?
There is a pressure gradient across the mitral valve, indicating stenosis
134
Nitroprusside can cause _______ toxicity with prolonged use.
Cyanide
135
How is stable angina diagnosed?
Cardiac stress test, which increases demand for O2
136
How does cushing's syndrome cuase HTN?
Cortisol increases vascular sensitivity to adrenergic agonists
137
How does the kidney regulate high BP?
Decreases salt/ water retention
138
Common sites of red infarcts
Lungs
Small intestines
\*Places with dual blood supply
139
What leads to a patent foramen ovale?
Septum primum and secundum fail to fuse
140
Organ that receives 100% of CO
Lung
141
Short Qt conditions
Hypercalcemia
142
Types of systolic clicks. When are they heard?
* Ejection click
* Early in systole
* Before carotid pulse
* Non-ejection click
* Late in systole
* After carotid pulse
143
EKG changes in NSTEMI
St depressions
T-wave inversions
144
Tamponade EKG
Sinus tachycardia
Prominent x decent
Blunted y descent
145
Type of shock?
High CO
Low SVR
Distributive
146
Inotropes are only for ________ heart failure.
Systolic
147
Which drugs can cause long qt syndrome?
Antiarrhythmic drugs
Levofloxacin
Haldol
148
Severe hypertension whithout end organ damage?
Hypertensive Urgency
149
What conditions decrease viscocity?
Anemia
150
In which conditions do we see a giant v wave?
Tricupsid regurgitation
151
Complications of treating a STEMI with B-blockers
Bradycardia and AV block can develop
152
Results of rupture of posteromedial papillary muscles in mitral valve
Severe mitral regurgitation
Acute heart failure
153
Classic causes of cardiogenic shock
Large MI
Advanced heart failure
154
Angiotensin Receptor blockers
Candesartan
Irbesartan
Valsartan
155
Complications of Ischemia in first 4 days
Arrhythmia
156
On what phase of myocyte AP do verapamil/ diltiazem work?
Phase 2
157
Digoxin benefits in HF
Increased CO
Improved symptoms and quality of life
158
What EKG change is an early sign of ischemia?
Hyperacute T waves
\*Seen before ST elevations
159
Class II antiarrhythmics
Beta blocks
160
Of the a1 blckers which is "uroselective"?
Tamsulosin (less hpotensive effect)
161
Automaticity
Pacemakers do not require stimulation to initiate action potential. Capable of sel-initiated depolarization
162
Main regulator of contractility
Sympathetic nervous system
163
Clinical feautures of pericarditis
* Chest pain
* Fever
* Leukocytosis
* Elevated ESR
164
Digoxin Toxicity
GI
neurologic
visual changes
cardiac arrhythmias
165
Normal PR interval
120-200ms
166
Atherosclerosis Complications
* Ischemia
* Plaque Rupture
* Thombi
* Emboli
* Hemorrhage into plaque
* Aneurysm
167
All forms of heart failure lead to decrease in \_\_\_\_\_\_\_\_\_
CO
168
Valsalva manuever
* Patient bears down as if moving bowels
* Increased thoracic pressure
* Aortic pressure rises
* Decreased heart rate and AV conduction
169
IVC comes from \_\_\_\_\_\_\_\_\_\_
Posterior veins
170
Main use for Class Ib drugs?
Ischemic ventricular tachycardia
* Fast heart rates
* Depolarized Na channels
171
What are two main steps of atheroma growth?
1. Fatty streaks
2. Atherosclerotic plaque
* Intima thickens
* Lipids accumulate
172
Symptoms of hypercalcemia
Confusion
Consitipation
173
Complications of Ischemia in first 5-10 days
Free wall rupture
Tamponade
Papillary muscle rupture
VSD
174
Possible triggers of atrial fibrillation
* Binge drinking
* Increased catecholamines
175
Lung findings of HF
* Rales
* Fluid filled alveoli "pop" open with inspiration
* X-ray: Congestion
176
Fatty streaks
* Macrophages filled with lipids
* Form line along vessel lumen
* Do not impair blood flow
177
Clinical features of tamponade
Distant heart sounds
Dyspnea
elevated JVP
Hypotension
178
Key side effect of nifedipine
* Edema
* Increases capillary hydrostatic pressure
* Pre-capillary arteriolar vasodilation
179
Type of shock?
Low CO
Low cardiac pressures
High SVR
Hypovolemic
180
Common location of ventricular pseudoaneurysm
Inferior wall
181
LVEDP
Pressure in the left ventricle when filled
182
Causes of mitral regurg
Mitral valve prolapse
Ischemia
Left ventricular dilation
Hypertrophic cardiomyopathy
Endocarditis
Rheumatic heart disease
183
Causes of congenital long qt syndrome
Abnormal K/Na channels
184
Preload
* Amount of blood loaded into left ventricle
* How much stretch is on fibers prior to contraction
185
Bacterial endocarditis complications
* May form abscess beneath valve annulus
* Persistent fever, bacteremia often indicates abscess
* Aortic valve abscess can lead to heart block
186
3 causes of holosystolic murmurs
Mitral regurgitation
Tricupsid regurgitation
VSD
187
Symptoms of hypocalcemia
Tetany
Numbness
Spasms
188
Murmur heard in VSD. Where is it heard?
Harsh, holsystolic mumur in tricupsid area
189
Atrial fibrillation treatment
* Control Heart rate (slow AV node conduction)
* Beta blockers
* Calcium channel blockers
* Digoxin
* Control heart rhythm
* Cardioversion
* Anticoagulation
190
EKG findings of pericarditis
Diffuse ST elevation
PR depression
191
PV loop: Isovolumic contraction disrupted
Mitral regurgitation
192
Results in an irregularly, irregular pulse
Atrial fibrillation
193
prophylaxis for endocarditis
Amoxicillin
Clindamycin
194
WPW syndrome
* Causes "pre-excitation"
* Ventricular depolarization before AV nodal impulse
195
What do the different waves represent on venous pressure tracings?
* a wave= Atrial contraction
* v wave= Venous filling
* c wave= tricupsid valve
* x descent= atrial relaxation
* y descent= emptying of the atrium
196
Treatment for ventricular tachycardia?
Emergent electrical cardioversion
197
Absent a wave
No organized atrial contraction
198
Organ that receives highest blood flow by weight
Kidneys
199
only available oral inotrope
Digoxin
200
Escape Rhythm
* Heart block: Lower pacemaker depolarizes ventricles
* Rate of lower pacemaker determines symptoms
* Very slow: Dizziness, syncope, hypotension
* Less slow: Fatigue, exercise intolerance
201
Clinical features of primary aldosteronism
Resistant HTN
Hypokalemia
Normal volume status on physical exam
202
paradoxical S2 splitting
Delayed closure of aortic valve
203
What conditions increase interstitial osmotic pressure?
Lymphatic blockage
204
What maneuvers cause a decrease in afterload?
Amyl Nitrate- vasodilator
205
What molecules are produced by skeletal muscles during exercise that cause vasodilation?
Adenosine
Lactate
Potassium
206
Class III drugs bind best in ______ state.
Resting
\*More binding at slow rates
207
Side effects of a1 blockers
Postural hypotension
208
Atrioventricular nodal rentract tachycardia (AVNRT) treatment
* many patients need no therapy
* Beta blockers, verapamil/ diltiazem
* Surgical ablation of slow pathway
209
Enteroccoccus endocarditis is associated with....
Manipulation of the GI/GU tract
* Abdominal surgery
* Urinary catheter
* TURP for treatment of BPH
210
Afterload
Factors resisting flow out of left ventricle
211
How do ACE inhibitors precipitate renal failure?
* Normal GFR depends on angiotension II
* ATII causes efferent arteriole vasoconstriciton, which maintains GFR
212
Channels prominent in phase 3 of pacemaker action potential
Delayed rectifier K+ channels open, return cell to -60 mV
213
In what cases, do you see eccentric hypertrophy?
* Volume overload of LV
* Aortic regurgitation
* Mitral regurgitation
* Cardiomyopathy
214
How is mean arterial pressure calculated?
Diastolic BP + 1/3(Systolic-Diastolic)
215
Eventual result of L-transposition of great arteries
Eventually right ventricle fails
216
Side effects of methyldopa
Hemolytic anemia
217
Normal QRS
\<120 ms
218
Two cardiac effects of digoxin
* Increases contractility
* Used in systolic heart failure with decreased LVEF
* Slows AV node conduction
* Used in atrial fibrillation to slow ventricular rate
219
Early filling sound. S3 or S4?
S3
220
Calcium channel blockers
Verapamil
Diltiazem
221
Side effects of clonidine
Rebound hypertension
Sedation
222
Complications interventricular septal rupture
Loud, holosystolic murmur
Hypotension
RHF (increases JVP, edema)
223
Side effects of potassium-sparing diuretics
* Hyperkalemia
* Gynecomastia in men (not eplerenone)
* Amenorrhea in women
224
What endocrine problem can lead to atrial fibrillation?
Hyperthyroidism
225
How is Wall tension calculated?
Tension= (P x r)/(2h)
h= wall thickness
226
When is a s4 heard?
Stiff left ventricle
* Long-standing HTN
* Hypertrophic cardiomyopathy
* Diastolic heart failure
227
Late filling sound. S3 or S4?
S4
228
Restrictive heart disease leads to severe ________ dysfunction.
Diastolic
229
Heart failure
Impaired ability of the heart to pump blood. Hallmark: low CO
230
Risk factors for coronary artery disease
* prior coronary disease
* Coronary risk equivalents
* Diabetes
* Peripheral artery disease
* CKD
231
Prolonged QRS interval
Right bundle branch block
Left bundle branch block
232
Class I drugs bind best in the _________ state. These drugs are said to exhibit ________ dependence.
open/inactive; use
\*Class1 drugs work best at a fast HR
233
least effect on AP of class 1 drugs
Ib
234
Causes of 1st degree AV block
* Beta blockers
* Calcium channel blockers
* Well-trained athletes
235
How is obstructive shock treated?
resolve obstruction
236
Quinidine
Class Ia
Oral
Can decrease recurrence rate of atrial fibrillation
Associated with increased mortality
237
Causes of obstructive shock
Tamponade
Tension pneumothorax
Massive PE
238
Large a wave
Increased atrial contraction pressure
239
Electrical cardioversion
* Deliver "synchronized" shock at time of QRS
* Adminster anesthesia
* Deliever electrical shock to chest
* All myocytes depolarize
* Usually sinus node first to repolarize/depolarize
240
How is distributive shock treated?
Vasopressors
* Phenyephrine
* Epinephrine
* Norepinephrine
241
\_\_\_\_\_\_\_\_\_\_\_\_ is caused by untreated, rapid atrial fibrillation.
Cardiomyopathy
242
Cold skin indicates what type of shock
Cardiogenic and hypovolemic
243
Phase 2 of myocyte AP
* L- type Ca2+ channels open, leading to inward Ca2+ current
* Contraction trigger: excitation-contraction coupling
* K+ leaks out (down gradient)
* Delayed rectifier K+ channels
* Plateau of membrane charge
244
Class Ia antiarrythmic
Quinidine
procainamide
245
Determinants of CO
* Preload
* Afterload
* Contractility
* HR
246
If leads ____ and _________ are both positive, axis is normal.
I; II
247
Weak peripheral pulses. Disease?
Aortic stenosis
248
Common sites of white infarct
Heart, kidneys, spleen
249
Causes of distributive shock
Sepsis
Anaphylaxis
Neurogenic
250
Ivabradine
* Selective sinus node inhibitor
* Inhibits funny current
* Used in patients on max-dose beta blocker with increased HR
251
Carotid massage
* Examiner presses on neck near carotd sinus
* Strech of baroreceptors
* CNS response as if high BP
* Increased vagal tone
* Decrease in AV node conduction
252
What conditions can cause high viscocity?
Polycythemia
Multiple myeloma
Spherocytosis
253
What is the relationship between anticoagulant administration and cardioversion?
If symptoms have lasted more than 48 hrs, a possible thrombus could have formed. Before conducting cardioversion, antiagulatants should be given for 3 weeks. Anticoagulants should be given 4 wks after cardioversion as well
254
Which maneuvers increase preload/venous return?
leg raise
Squatting
255
Which class I antiarrhythmic?
Increase QRS and QT
Increase AP and ERP
Ia
256
LVEDV
Volume of blood in the left ventricle when filled
257
Heaves. Disease?
Left ventricular hypertrophy or right ventricular hypertrophy
258
Continous, "machine-like" murmur
Patent ductus arteriosis
259
Abnormal heart sounds associated with heart failure
* S3 (associated with high left atrial pressure)
* S4 (associated with stiff left ventricle)
* Displaced apical impulse- enlarged heart
260
What effect does exercise have on pulse pressure?
Increase in PP
* SBP rises
* DBP decreases slightly or stays normal
261
Potential causes of high output heart failure
Severe anemia
Thyroid disease
Beriberi
AV fistulas (post- surgical)
262
What venous pressure tracing is seen in atral fibrillation?
Absent a wave
263
Low flow symptoms
Cool extremities
Cachexia
Confusion
264
\_\_\_\_\_\_\_\_\_\_\_ is life-threatening in WPW.
Atrial fibrillation
265
What maneuvers cause an increase in afterload?
Hand grip-clench fist
266
What are the 3 main situations that lead to a red infarct?
* Blockage of venous drainage
* Tissues with dual circulation
* Flow re-establoshed to necrotic area
267
Causes of diastolic murmurs
Aortic regurgitation
Mitral stenosis
Pulmonic regurgitation
Tricupsid stenosis
268
Liddle syndrome
Genetic disorder
Increased activity of epithelial sodium channels
Low aldosterone levels
269
Types of Aortic dissection
Type A
* Involves ascending aorta and/or arch
* Surgically
Type B
* Descending aorta
* Can be treated medically
270
When do diastolic murmur occur?
Between S2-S1
271
For right axis deviation, lead _________ is negative.
I
272
Venous return should be equal to the \_\_\_\_\_\_\_\_\_\_.
CO
273
Major effect of a vagotomy
Decreases acid production in stomach
274
Organ that receives largest O2 content from blood
Heart
275
medical therapy for ischemia
* Increase O2 supply
* Dilate coronary arteries
* Increase diastole
* Decrease O2 demand
* Decrease HR
* Decrease contractility
* Decrease afterload
* Decrease preload
276
Role of vasa vasorum
Supplies blood to medial layer in thick vessels
277
What are the two ways the an ASD can form?
Septum secundum too short
Septu primum excessively reabsorbed
278
* Filling completed
* Contraction beginning
EDV
279
What factors increase afterload?
* Raise in mean blood pressure
* Obstruct outflow of left ventricle
* Aortic stenosis
* Hypertrophic cardiomyopathy
280
Why are weak lower extremity pulses associated with coarctation of the aorta?
* Low BP in lower extremities
* Increase renin release
* Salt/water retention
* Vasoconstriction
* Weak pulse
281
In what condition can you see a short PR interval?
Wolff-Parkinson White Syndrome
282
Special complications of an inferior MI
* Right ventricular infarction
* Loss of RV contractility
* Elevated JVP
* Decreased preload to left ventricle
* Hpotension
* Sinus bradycardia and heart block
* Vagal stimulation from inferior wall ischemia
283
What is the primary determinant of systolic BP?
CO
284
Supravalvular aortic stenosis is seen in ___________ syndome.
Williams
285
Phases of valsalva maneuver
Phase I
* Increased thoracic pressure
* Decreased venous return (compression of veins-\> increased RA pressure)
* Transient rise in aortic pressure
* Decrease in heart rate and AV node conduction
Phase II
* Decreased preload, leads to decreased CO
* Increased HR and AV node conduction
286
SVC comes from _______ and \_\_\_\_\_\_\_\_\_\_.
R common cardinal vein and R anterior cardinal vein
287
How is hypovolemic shock treated?
Blood transfusions
IV fluids
288
Neprilysin
Degrades ANP/BNP
\*Also degrades bradykinin
289
In which conditions, do we see a large a wave?
Tricupsid stenosis
Right heart failure/ Pulm HTN
290
Bilbus cordis gives rise to what structures
Smooth LV/RV
291
\_\_\_\_\_\_\_\_\_\_\_ in a patient on mexiletine indicates toxicity.
Tremor
292
Causes of bundle branch blocks
* Slowly progressive fibrosis/sclerosis
* LBBB: Prior MI, cardiomyopathy
* RBBB: Right heart failure
\*More common in older patients
293
Stent complications
* Restenosis
* Slow, steady growth of scar tissue over stent
* Thrombosis
294
a1 blockers
Tamsulosin
Alfuzosin
Doxazosin
Terazosin
295
What is the key regulatory protein of lusitropy?
Phospholamban
296
Causes of T wave inversions
* Raised intracranial pressure
* Resolving pericarditis
* Bundle branch blocks
* Ventricular hypertrophy
297
Phase 4 of myocyte AP
* Resting potential: about -85 mV
* Constant outward leak of K+
* "Inward rectifier channels"
* Na + and Ca2+ channels are closed
298
There are no signs of volume overload with renal artery stenosis. Why?
Normal kidney compensates
299
Hydralazine
* Direct arteriolar vasodilator
* Rarely used for hypertension
* Combined with nitrates for HF
* Safe in pregnancy
* Causes drug induced lupus
300
Viridans strep causes __________ endocarditis.
Subacute
301
Anterior ST elevation in V1-V4. Artery?
LAD
302
Subtotal occlusion of the coronary artery can result in..
Unstable angina
Non ST elevation myocardial infarction
303
Classic imaging findings in restrictive heart disease
Normal left ventricular function/size
Bi-atrial enlargement
304
Which type of cardiomyopathy is often seen in systolic heart failure?
Dilated cardiomyopathy (eccentric hypertrophy)
305
How can the risk of recurrent events be reduced after coronary artery disease?
* Aspirin
* Statins
* B-blockers
* Used in patients with prior infarction (STEMI/NSTEMI)
306
Complications of papillary muscle rupture
* Acute mitral regurgitation (holosystolic murmur)
* HF
* Respiratory distress
307
Requirement for endocarditis diagnosis
2 major
1 major 3 minor
5 minor
308
Older patients and hypertensive patients have a/an ___________ (decreased/increased) pulse pressure
Increased
309
Pheochromocytoma diagnosis
Catecholamine breakdown products
* Metanephrines
* Vanillylmandelic acid (VMA)
310
Lateral wall of the heart is supplied by \_\_\_\_\_\_\_\_\_\_.
Left cicumlflex artery
311
Ejection fraction calculation
SV/ EDV
312
Primitive ventricle gives rise to what structure
Trabeculated LV/RV
313
Warm skin indicates what type of shock
Distributive
314
a ___________ aortic valve in seen in 60% of coarctation cases.
Bicupsid
315
Cannon a wave
Atria against closed tricupsid valve
316
\_\_\_\_\_\_\_\_ sometimes used for diagnosis in dyspnea. High levels suggest HF.
BNP (brain natriurectic peptide), released by ventricles
317
Which drugs are associated with Drug induced Lupus
Isonozaid
Hydralazine
Procainamide
\*Anti-histone antibodies
318
Primitive atrium gives rise to what structure
Trabeculated atria
319
How does digoxin increase contractility?
* Inhibits Na-K- ATPase
* Na trapped inside of cell
* Less Na exchange for Ca
* More Ca inside of cell
320
Adenosine effects are blocked by ______ and \_\_\_\_\_\_\_\_\_\_.
Theophylline; caffeine
321
Index of contractility
Ejection fraction
322
Organ that receives largest systemic blood flow
Liver
323
Physiological S2 splitting
Increased venous return delauys P2 by 40-60 ms
\*Single to split inspiration
324
Treatment of STEMI
* Emergency angioplasty
* Should be done \<90 mins
* Thrombolysis
* Should be done \<30 mins
325
procainamide
Class Ia
IV
Slows conduction in accessory pathways (WPW)
used in arrhythmias associated with bypass tracts
326
Clinical features of constrictive pericarditis
Dyspnea
Prominent right heart failure
327
What EKG effect can be seen with ranolazine use?
QT prolongation
328
In which types of CAD do you see subendocardial ischemia?
Stable angina, undtable angina, NSTEMI
329
Which parts of the heart receive blood supply from the LAD?
Anterior wall
Anterior septum
Apex
330
Pheochromocytoma symptoms
Palpitations
Headache
Episodic sweating
331
Which valve problem?
Marfan's
MVP
332
Side effects of adenosine
* Skin flusing, hypotension
* Dyspnea, chest pain
333
how can fibrinous pericarditis be distinguished from Dressler's syndrome?
* Occurs days after MI
* Not autoimmune
334
What effect do beta blockers have on the graph for pacemaker cells?
Decrease the slope of phase 4
Prolong repolarization (phase 3)
335
What factors increase contractility?Decrease?
Increase: Exercise, Inotropes
Decrease: MI, HF
336
Complications of treating STEMI with nitrates
Hypotension
337
Potassium sparing diuretics
Spironolactone
Eplerenone
338
Sinus p waves are upright in which leads?
II, III, and F
339
Clinical feautures of restrictive heart disease
Dyspnea
Prominent right heart failure
340
Mechanism of action of loop diuretics
Inhibit Na-K-Cl pump in ascending loop of Henle, result in salt-water excretion, which relieves congestion
341
Endocardial cusion defects are common in \_\_\_\_\_\_\_\_\_\_.
Down syndrome
342
How is cardiogenic shock treated?
Inotropes
* Milrinone
* Dobutamine
343
Causes of Torsade de Pointes
Antiarrhytmic drugs
Hypokalemia
Hypomagnesemia
Hypocalcemia (rare)
344
Low flow symptoms are seen in ________ (systolic/ diastolic) heart failure only.
Systolic
345
Which maneuvers decrease preload/venous return?
Valsalva
Standing
346
How do nitrates relieve angina?
Cause pool of blood in veins, which lowers preload and leads to less work for the heart
347
Symptoms of left heart failure
* Dyspnea especially on exertion
* Paroxysmal nocturnal dyspnea
* Orthopnea
348
When is alprostadil a useful drug?
Useful when poor RV to pulm artery flow
* Tetralogy of Fallot
* Pulmonary atresia
349
Which type of Step bovis has the strongest association with colon cancer?
S. gallolyticus
350
Which volumes increase with an increase in preload?
* EDV
* SV
* EF (slightly)
351
Where is the murmur heard in mitral regurgitation?
Holosystolic murmur heard best at the apex (at the 5th intercostal space, mid-clavicular line)
352
Major indications for revascularization
Angina
MI
Systolic dysfunction
353
What venous pressure tracing is seen in AV dissociation?
Cannon a wave
354
Cause of STEMI
* Atherosclerotic plaque rupture
* Thombus formation
* Complete vessel occlusion
355
which blood vessel has the highest change in pressure? Lowest?
Highest: Arterioles
Lowest: Veins
356
Why does an ASD result in a wide, fixed splitting of S2?
Increased volume in RA/RV delays closure of the pulmonic valve
357
Rank calcium channel blockers based on HR/contractility effects (greatest to least)
Verapamil\> Diltiazem\> Nifedipine
358
What part of the brain senses signals from baroreceptors?
Nucleus Solitarius
359
Why is S4 not heard in atrial fibrillation?
You need the atria to contract to hear this sound
360
Classic causes of concentric hypertrophy
Hypertension
Aortic stenosis
361
Drugs used to treat STEMI
* Aspirin
* Heparin
* B-blockers
* Nitrates
* Clopidogrel
* Eptifibatide
* Bivalirudin
362
Risk factors for atrial fibrillation
* \>80 yrs
* More common in women
* HTN, CAD
* Heart failure, valvular disease
363
* Emptying completed
* Relaxation beginning
ESV
364
Verapamil/diltiazem actions
* Negative inotropes
* Reduced HR/ contractility
* Can precipitae acute heart failure if LVEF is very low
365
What factors decrease afterload?
* Lower the mean blood pressure
* Treat aortic valve disease, hypertrophic cardiomyopathy
366
Key control variables for autoregulation in lungs
Hypoxia-\>Vasoconstriction
367
Poor R wave progression seen in ___________ ischemia.
Anterior
368
Atrial fibrillation eliminates ventricular \_\_\_\_\_\_\_\_\_.
Prefilling, which leads to a decrease in preload.
\*Can lead to low CO and hypotension, especially in preload dependent patients.
369
Coronary arteries are perfused during ________ (diastole/systole).
Diastole
370
How digoxin toxicity treated?
* Digibind
371
Nonselective b blockers
Propanolol
Timiolol
Nadolol
372
In which conditions are peaked T waves seen?
Hyperkalemia
Early ischemia (hyperacute)
373
Amiodarone aslso hase effects of which class of drugs?
I, II, and IV antiarrythmics
374
Patent ductus arteriosus becomes the \_\_\_\_\_\_\_\_\_\_\_.
Ligamentum arteriosum
375
Class Ic antiarrhythmics
Flecainide
Propafenone
376
Major determinant of systolic BP
SV
377
In the body, which compartments are used to calculate the change in pressure?
Arterial pressure-right atrial pressure
378
Which three beta blockers are useful in chronic systolic HF?
Metoprolol
Carvediol
Bisoproplol
379
What conditions increase capillary pressure?
Heart failure
380
Clinical features of HCM
HF, angina, sudden cardiac death, syncope, mitral regurg
381
EKG in WPW
Delta Wave
Short PR
382
Which baroreceptor senses elevated and low BP?
Carotid sinus
383
Result of severed CN X on heart?
* Vagotomy
* Unopposed sympathetic cardiac stimulation
* Increase in heart
384
Causes of tamponade
Cancer
Uremia
Pericarditis
Trauma
385
Which Beta blockers should be used to treat angina? Which should not?
Use: B1 selective drugs (Metoprolol, atenolol)
Don't use: partial agonist (Pindolol, acebutolol)
386
Slowest conduction is through \_\_\_\_\_\_\_\_\_\_. Fastest conduction is through \_\_\_\_\_\_.
AV node; Purkinje fibers
Purkinje\>Atria\>Ventricles\> AV node
387
Minor criteria for endocarditits
Fever
Risk factors
Roth spots, Osler node, Janeway lesions, splinter
388
Conditions with left axis deviation
Left bundle branch block
Ventricular rhythm
389
Casues of Systolic murmurs
* Aotic stenosis
* Mitral regurgitation
* Pulmonic stenosis
* Tricuspid regurgitation
* Hypertrophic cardiomyopathy
* Ventricular septal defect
390
How does a decrease O2 effect the work of the heart?
Heart starved for O2-\>Reduce O2 demand-\>Low output-\>Need to increase work
391
magnesium is used in the acute management of \_\_\_\_\_\_\_\_\_. By what mechanism?
Torsade de pointes. Mg blocks influx of Ca into cells. Ca influx leads to early after depolarizations
392
What factors provide evidence of a hypertensive emergency?
* Neurologic impairment
* Retinal hemorrhages, encephalopathy
* Renal impairment
* Acute renal failure
* Hematuria, proteinuria
* Cardiac ischemia
393
Which class I antiarrhythmic?
Increased QRS
+/- QT
+/- AP
Ic
394
explain how epinephrine acts at different doses
Low dose: beta 1 and beta 2 agonis
High dose: alpha agonist
395
Baroreceptors sense \_\_\_\_\_\_\_\_\_\_\_.
Stetch
396
Symptoms of Mobitz II
Dizziness, syncope
397
PV loop: Isovolumic Relaxation disrupted
Aortic regurgitation
398
\_\_\_\_\_\_\_\_\_ is the most commonly injured cardiac chamber in penetrating chest trauma.
RV
399
Diastolic rumbling murmur, preceded by opening snap
Mitral stenosis
\*time to opening snap associated with severity. Higher left atrial pressure, leads to a decreased time to opening snap
400
which blood vessel has the highest resistance? Lowest?
Highest: Arterioles
Lowest: Veins
401
Complications of coarctation of the aorta
Heart failure
Aortic rupture/dissection
Endocarditis/endarteritis
402
sinus venosus gives rise to what structure
Right horn: RA
Left horn: Coronary sinus
403
Why is there a widened pulse pressure in patent ductus arteries
* Loss of volume in arterial tree through PDA
* Low diastolic pressure, leads to increased pulse pressure
404
Which type of hypertrophy is often seen in systolic heart failure?
Concentric
405
How can radiation cause restrive heart disease?
May cause inflammation
Fibroblast recruitment
Extracellular matrix deposition
Collagens and fibronectin
406
Major causes of restrictive heart disease
Amyloidosis
Sarcoidosis
Fabry disease
Hemochromotosis
Post-radiation fibrosis
Pericarditis
Loeffler's syndrome
Endocardial fibroelastosis
407
Hepatojugular reflux
* Pressure on abdomen raises JVP
* With failing RV, increase is greater
408
Endocardial cushions give rise to what structures
Atrial septum
Ventricular septum
AV valves
Semilunar valves
409
Primum type of ASD
* Defect at site of ostium primum
* Failure of primum septum to fuse with endocardial cushions
* Located near AV valves
* Often occurs with other defects
410
In which types of CAD do you see transmural ischemia?
STEMI
411
How do viruses cause cardiomyopathy?
Virus enters myocytes causes myocarditis which leads to cardiomyopathy
412
Decresendo blowing diastolic murmur
Aortic regurgitation
413
Aorticopulmonary septum formed from ___________ and fuses with \_\_\_\_\_\_\_\_\_.
Neural crest cells; Interventricular septum
414
Risk factors for aortic dissection
Aortic damage
* HTN
* Atherosclerosis
* Thoracic aneurysm
Abnormal collagen
* Marfan syndrome
* Ehler's Danlos
Others
* Bicupsid aortic valve
* Turner Syndrome
* Tertiary syphilis
415
explain how dopamine acts at different doses
Low dose: dopamine agonist
Medium dose: beta 1 agonist
High dose: alpha agonist
416
How do cyclosprine and tacrolimus cause hypertension?
* Calcineurin inhibitors
* Renal vasoconstriction
* Salt/water retention
417
Sings and symptoms of HF
* Low flow signs
* Loss of appetitie
* Cachexia
* Confusion
* Cool extremities
* "Narrow pulse pressure"
* Seen only with low CO
418
Which antihypertensive drugs cause orthostatic hypotension?
A-1 blokers
ACE inhibitors (especially in patients on diuretics)
419
Pulse pressure is _________ (directly/indirectly) related compliance.
Indirectly
420
Class Ib drugs, bind Na channels in the _______ state.
Depolarized
**NOTE:** These drugs alsor rapidly unbind, so are more effective in fast heart rates
421
Abdominal pain with isolated increase in ________ could be MI.
AST
422
Main roles of calcium channel blockers
Vasodilators
Negative chronotropes/inotropes
423
Nesiritide
Recombinant BNP, vasodilator, decreases afterload and increases CO
424
Adverse effects of Nitrates
Heachache
Flushing
Hypotension
Angina
425
Milrinone
* PDE3 INHIBITOR
* PD3 breaks down cAMP in myocytes
* INhibition leads to an increase in cAMP, which increase contraction
* Vascular smooth muscle increase in cAMP leads to dilation
426
Which class I antiarrhythmic?
+/- QRS
Decreased QT
Decreased AP
Decreased ERP
Class 1b
427
Nitrates can be used to treat ischemia in what two ways?
* Venous dilation
* Lowers preload
* Arterial dilation
* Increase coronary perfusion, hence O2 supply
**NOTE:** In patients with severe CAD, sympathetic activation can cause a reflex effect, which increases contractility. Administering beta blocker Ca channel blockers blunt this effect.
428
Carcinoid heart disease
* Caused by carcinoid tumors of intestines
* Secrete serotonin
* Fibrous deposits tricupsid/pulmonic valves
* leads to stenosis and regurg
429
What phase of myocyte AP do class III antiarrhythmic drugs work?
3
430
What factors cause an increase in preload?
* Add volume
* Slow heart rate
* Constrict veins
431
Aliskiren
Renin inhibitor
Reduces ATI levels
432
What volumes/ pressure are effected in systolic heart failure?
* Decreased contractility
* Decreased cardiac output
* Decreased SV
* Drastic increase in ESV
* Increase in EDV
* Increase in LVEDP
433
What drugs are used to prevent stent thrombosis
Aspirin
Clopidogrel
Prasugrel
Ticagrelor
\*After 1 year stent no longer exposed to blod and most patients take aspirin only
434
Metolazone
* Thiazide-like diuretic
* Inhibits Na-Cl reabsorption distal tubule
*
435
What factors increase contractility?
* Sympathetic nervous system activity
* Increased calcium
* Exercise, stress
* Sympathomimetic drugs
* Digoxin
* Inhibits Na-K pump, increases calcium in myocytes
436
EKG abnormalitiy with SVT
Retrograde P waves
437
side effects of amiodarone
Hyper and hypothyroidism
Increased liver function tests
Photosensitivity
Blue-grey discoloration
Corneal deposits
Pulmonary fibrosis
438
Atrial fibrillation ablation
Electrically isolation of pulm vein creates small scar in LA, preventing conduction in that area
439
Constrictive pericarditis venous curve signs
Rapid y descent
440
Result of carotid occlusion
Increase in HR and BP, due to an interpretation of a decrease in BP
441
Beta blockers used to treat portal hypertension
Nadolol
Propranolol
442
Side effects of metolazone
additional fluid
K+ loss
443
Thiazide diuretics
Hydrochlorothiazide
Chlorthalidone
Metolazone
444
If you notice a wide QRS and V1 is facing upward. What is the prognosis?
RBBB
445
Digoxin should not be used in people with...
CKD
Hypokalemia
446
Electrical causes of paradoxical splitting
Delayed LV activation
* LBBB
* RV pacing
447
Treatment for primary aldosteronism
Spironolactone
Epleronone
\*Aldosterone antagonists
448
3 types of AV blocks
* Type 1
* Prolongation of PR interval only
* All p waves conducted
* Type 2
* Some p waves conducted, some not
* Progressive PR prolongation (Mobitz Type 1)
* Two sub types: Mobitz 1 and Mobitz 2
* RR intervals NOT regular
* Type III
* No impulse conduction from atria to ventricles
* Regular RR intervals
449
Most common site of aortic rupture
Isthmus
450
How is cardiomyopathy caused by tachycardia-mediated?
* Constant, rapid heart rate for weeks/months
* Leads to depression of LV systolic function
\*Reversible with slower heart rate
451
another name for a systolic crescendo-decrescendo murmur
Ejection murmur
452
WPW treatment
Ablation of accessory pathyway
453
Phase 3 of myocyte AP
* Ca 2+ channels inactivated
* Persistent outflow of K+
* Resting potential back to -85 mV
454
\_\_\_\_\_\_\_\_\_\_\_\_ aneurysms occur in about 10% of patients with coarctation.
Intracranial
455
Ebstein's anomaly
* Apical displacement of TV leads to small RV
* Severe tricupsid regurg
* Can leads to right heart failure
456
Causes of loud P2
Pulmonary HTN
457
Which defects can cause central cyanosis early in life
Tetralogy of fallot
transposition of great vessels
Truncus arteriosus
Tricusid atresa
Total anomalous pulm venous return
458
Major determinant of diastolic BP
total peripheral resistance
459
Two main causes of AV blocks. compare the two
* AV node disease
* Less dangerous
* Conduction imprives with exertion
* HIS- purkinje disease
* More dangerous
* Usually does not improve with exertion
* Often progresses to complete heart block
* Often requires a pacemaker
460
Major sites of atherosclerosis
Abdominal aorta
Coronary arteries
Popliteal arteries
Internal carotid
Circle of Willis
461
Histology of HCM
Myocyte disarray
Hypertrophy
Interstitial fibrosis
462
\_\_\_\_\_\_\_\_\_\_\_\_\_ is the most common cause of sudden death in adults.
Coronary artery disease
\*In younger patients , its hypertrophic cardiomyopathy
463
Class III antiarrhythmics
Amiodarone
Sotalol
Dofetilide
Ibutilide
464
Mobitz II
* Block usually in the HIS-purkinje system
* Often seen with bundle branch block
465
Channels prominent in phase 4 of pacemaker action potential
Funny current
* Spontaneous flow of Na+
466
Major criteria for endocarditits
Positive blood cultures
Vegetation on echocardiogram
467
EKG abnormality seen in atrial fibrillation
No p waves
468
What factors are modified by baroreceptor response?
* HR/ contractility
* Arterial tone
* Venous tone
* Renal renin release
469
Pericarditis treatment
NSAIDS
Steroids
Colchicine
470
How should HTN as a rsult on cyclosporine and tacrolimus be treated?
Diltiazem (allows lower amount of cyclosporine to be used)
471
\_\_\_\_\_\_\_\_\_\_\_\_\_ refractory period determines HR.
AV node
472
What murmurs can be heard at the left upper sternal border?
Pulmonic murmurs
patent ductus arteriosus
473
Lateral ST elevation in -\> I,L,V5,V6.Artery?
Left circumflex artery
474
\_\_\_\_\_\_\_\_\_\_ ischemia occurs with complete % flow obstructions.
Transmural
475
Where are baroreceptors located?
* Aortic arch
* Carotid sinus
* Kidneys
476
Causes of persistent S2 splitting
RBBB or Pulmonary Hypertension
477
Nifedipine function
* Vasodilator
* Lower blood pressure
* Reduce afterload
* Dilate coronary arteries
* May cause reflex tachycardia
478
Vagal manuevers
* Valsalva
* Breath holding
* Coughing
* Deep respirations
* Gagging
* Swallowing
479
Mechanical causes of paradoxical splitting
Delayed LV outflow
* LV systolic failure
* Aortic stenosis
* Hypertrophic cardiomyopathy
480
Result of severed CN IX
Increase in HR and BP, due to an interpretation of a decreased BP
481
Most common cause of systolic heart failure
MI
482
B1 selective antagonist
Atenolol
Metoprolo
Esmolol
483
Inferior ST elevation in II, III, F. Artery?
Posterior descending artery
484
SA and AV nodes supplied by the \_\_\_\_\_\_\_\_\_\_.
RCA
485
Lusitropy
Myocardial relaxation
486
Valvular atrial fibrillation has a very high risk of \_\_\_\_\_\_\_\_\_.
Thrombus
487
Symptoms of AV blocks
* Bradycardia
* Fatique, dizziness, syncope
\*Symptomatic AV block often treated with a pacemaker
488
Types of Cardioversion
* Electrical
* Chemical
* Spontaneous
489
Which drugs block L-type Ca channels?
Verapamil/ Diltiazem
490
Arteriolar Rarefaction
Loss of arterioles
Arterioles close off and get resorbed
491
Symptoms of chronic heart failure
Euvolemic
Clear lungs
no pitting edema
JVP flat
492
In which conditions do we seen an absent a wave?
Atrial fibrillation
493
Pompe disease
Glycogen storage disease
Acid alpha-glucosidase deficiency
Enlared muscles, hypotonia
Cardiac enlargement
494
How does the cardiac tissue extract more O2 during exercise?
Coronary vasodilation, which leads to an increased blood flow.
**NOTE:** Cardiac tissues cannot extract more O2 from RBCs as they already extract the maximum amount
495
Coronary steal is induced by \_\_\_\_\_\_\_\_\_.
Drugs
496
Symptoms of paroxysmal supraentricular tachycardia
* Sudden onset palpitations
* Chest discomfort
* Rarely syncope
497
bundle branch blocks interfere with detection of \_\_\_\_\_\_\_\_.
Ischemia
498
Result of carotid massage
* Decreased HR and BP due to interpretation of increased BP
499
What factors decrease contractility?
* Sympathetic system blocking drugs
* Beta blockers
* Calcium channel clockers
* Heart failure
500
Verapamil side effects
Constipation
Hyperprolactinemia
Gingival hyperplasia (seen in all types of calcium channel blockers)
501
What volumes/ pressure are effected in diastolic heart failure?
* Decrease in LV compliance
* Decrease in lusitropy (rate of myocardial relaxation)
* Decreased CO
* Decreased SV
* Decreased EDV
* Increase in LVEDP
502
Key control variables for autoregulation in skin
Sympathetic stimulation
503
SV calculation
EDV-ESV
504
Channels prominent in phase 0 of pacemaker action potential
L-type Ca2+ channels open, which depolarizes the cell
505
General mechanism of action of class II and IV antiarrhythmic
Slow sinus and AV node conduction
506
Pulse Pressure calculation
Systolic- Diastolic
507
Most murmurs increase with more preload except ________ and \_\_\_\_\_\_\_\_.
Hypertrophic cardiomyopathy; mitral valve prolapse
508
Key exam finding of renal artery stenosis
Renal bruit
509
Murmurs Grading
I- barely audible on listening carefully
II- faint but easily audible
III- loud and easily audible, no thrill
IV- loud murmur with a thrill
V- heard with scope barely touching chest
VI- audible with scope not touching the chest
510
STEMI "special" subtypes
* Left main
* ST-elevation aVR
* Diffuse ST depressions
* Posterior
* Anterior ST depressions with standard leads
* ST-elevation in posterior leads (V7-V9)
511
Mechanism of action of Ranolazine
* Inhibits late sodium current
* Reduces calcium overload
* Reduces wall tension and O2 demand
512
True or False. Stable Angina is a thrombotic problem.
False
\*Stable coronary atherosclerotic plaque with no plaque rupture/ thrombus
513
Classic signs of restrictive heart disease caused by amyloidosis and Fabry's disease
Low voltage on EKG
