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NPLEX I - RaeForReal > Cardio > Flashcards

Cardio Flashcards

1
Q

____ is the most posterior part of the heart

A

LA is the most posterior part of the heart

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2
Q

Enlargement of the LA (e.g, in mitral stenosis) can lead to compression of the ___________ or ___________.

A

Enlargement of the LA (e.g, in mitral stenosis) can lead to compression of the esophagus (dysphasia) or left recurrent laryngeal nerve (causing hoarseness/Ortner syndrome)

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3
Q

_____ is the most anterior part of the heart, most commonly injured in trauma

A

RV is the most anterior part of the heart, most commonly injured in trauma

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4
Q

Pericardium layers (out to inner)

A

Fibrous pericardium
Parietal layer of serous membrane
(Pericardial cavity)
Visceral layer of serous membrane

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5
Q

The pericardium is innervated by the

A

Phrenic nerve

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6
Q

____ and its branches supply anterior 2/3 of IVS, anterolateral papillary muscle, and anterior surface of LV.

A

LAD

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7
Q

____ supplies AV node, posterior 1/3 of IVS and posterior 2/3 walls of ventricles

A

PDA

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8
Q

_____ supplies SA node

A

RCA

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9
Q

Coronary blood flow peaks in (early/late) (systole/diastole)

A

Early diastole

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10
Q

LCA branches and what they supply

A

LAD - Supplies anterior 2/3 of IVS, anterior surface of LV
LCX - Supplies LA and posterior walls of LV

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11
Q

RCA branches and what they supply

A

Right Marginal Artery - RV
PDA - Posterior 1/3 IVS, posterior 2/3 ventricular walls

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12
Q

Most common origin of PDA

A

RCA - Right-dominant circulation

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13
Q

Coronary arteries are in what layer of the heart wall

A

Epicardium

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14
Q

Nitroglycerine (increases/decreases) preload

A

Decreases

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15
Q

Preload approximated by ____

A

Ventricular EDV

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16
Q

After load approximated by _____

A

MAP

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17
Q

SV = EDV - ?

A

SV = EDV - ESV

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18
Q

CO = ? x ?

A

CO = SV x HR

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19
Q

In early stages of exercise, CO maintained by increased ____ and ______

A

HR and SV

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20
Q

In later stages, CO maintained by increased _____ only

A

HR

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21
Q

MAP = CO x ?

A

TPR

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22
Q

What is one part of the heart with no contractile muscle filaments?

A

SA Node

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23
Q

What is the pacemaker of the heart?

A

SA Node

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24
Q

Why does the AV node delay the conduction signal from atria and ventricles?

A

To allow time for atria to empty blood into the ventricles prior to contraction.

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25
Q

How does the AV node delay the conduction signal from atria and ventricles?

A

Fewer gap junctions between cells in AV node and bundle.

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26
Q

If the pacemaker is located anywhere other than the SA node, it is called an

A

Ectopic pacemaker

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27
Q

ACh increases permeability of membrane to ___ ions > increases membrane negativity > hyperpolarization (less excitable tissue) > slowed HR

A

K

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28
Q

What is the P wave

A

Atrial contraction / Depolarization of atria

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29
Q

What is the QRS complex

A

Ventricular contraction / Depolarization of ventricle

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30
Q

What is the T wave

A

Ventricular repolarization

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31
Q

What is the most common cardiac congenital defect?

A

Interventricular septal defect

SXS: Holosystolic murmur or CHF, increase risk of endocarditis

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32
Q

What 4 abnormalities form the Tetralogy of Fallot?

A

VSD
Aorta overriding the VSD
Pulmonic stenosis
RVH

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33
Q

What condition may a bicuspid aortic valve lead to later in life?

A

Aortic stenosis

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34
Q

What is the S1 sound

A

Closure of tri/mi valves

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35
Q

What is the S2 sound?

A

Closure of aortic/pulmonic valves

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36
Q

S1 to S2 =

A

Systole

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37
Q

S2 to S1 =

A

Diastole

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38
Q

RCA + LCA fill during (systole/diastole)

A

Diastole

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39
Q

Which is larger, R or L coronary artery?
What part of the heart do they feed?

A

R is larger - Supplies R and posterior L ventricles

L carries less blood, but divides and feeds the anterior and lateral portions of the L ventricle

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40
Q

What conditions are caused by Subendocardial ischemia? Subendocardial nfarction?

A

Ischemia - Stable and unstable angina
Infarction - NSTEMI

(ST depression and T wave inversion)

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41
Q

What conditions are caused by transmural ischemia? Transmural infarction?

A

Ischemia: Vasospastic angina
Infarction: STEMI

(ST elevation, hyper acute T waves, pathologic Q waves)

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42
Q

LA blood supply comes from

A

Pulmonary veins

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43
Q

RA blood supply comes from

A

SVC, IVC, coronary sinus

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44
Q

Largest decrease in pressure occurs at these vessels

A

Arterials

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45
Q

Binding sites:
LDL
HDL
Chylomicron

A

LDL - B100
HDL - A1
Chylomicron - E

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46
Q

(Heme/Non-heme) iron requires transferrin

A

Non-heme iron

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47
Q

What are the functions of:
Ferritin
Transferrin
Lactoferrin

A

Ferritin - Can enter plasma
Transferrin - Plasma binding protein
Lactoferrin - Sequestering agents in blood, used when infection is active to keep iron from bacteria

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48
Q

Effects of excess calcium on the heart

A

Spastic contractions

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49
Q

Effects of excess potassium (K) on the heart

A

Dilated and slower contractions

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50
Q

What virulent organism is known for infecting structurally abnormal heart valves?

A

Strep Viridans

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51
Q

Oval retinal microhemorrhages with a pale center (seen in bacterial endocarditis) are known as _____

A

Roth spots

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52
Q

What nerve is responsible for slowing the heart’s conduction rate?

A

Vagus nerve

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53
Q

The foramen ovale is found where in a fetus?

A

Between RA and LA

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54
Q

Which of the following factors would shift the hemoglobin oxygen saturation curve to the right?
- Hypothermia
- Exercise
- Decreased 2,3-bisphosphoglycerate
- Higher pH

A

Exercise

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55
Q

What would you hear during auscultation of tetralogy of fallot?

A

Pulmonary stenosis
(Midsystolic murmur at L upper sternal border

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56
Q

During fetal development, when does the foramen ovale close?

A

Immediately after birth

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57
Q

What directly originates from the aortic arch?

A

Brachiocephalic trunk
Left common carotid artery
Left subclavian artery

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58
Q

Middle cardiac vein branches into what?

A

Coronary sinus

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59
Q

Ventricular depolarization is seen as ______ on an ECG

A

QRS complex

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60
Q

Foramen ovale usually closes immediately after birth due to ______

A

Increased LA pressure

61
Q

(T or F) Elastic arteries have a tunica intima, media, and externa, but NO internal elastic lamina

A

True

62
Q

The ______ is the most posterior part of the heart. Enlargement can cause compression of the esophagus, causing dysphagia OR compression of the L laryngeal nerve causing Ortner Syndrome

A

LA

63
Q

The _____ is the most anterior part of the heart, most commonly injured in trauma.

A

RV

64
Q

The pericardium is innervated by the

A

Phrenic nerve

65
Q

Which phase of the cardiac cycle?
P wave
QRS complex
QTI
T wave
U

A

P wave - Atrial depolarization
QRS complex - Ventricular depolarization
QTI - Ventricular depolarization/contraction/repolarization (long QTI = Torsades de Pointes)
T wave - Ventricular repolarization
U - Hypokalemia

66
Q

Receptors in aortic arch transmit via ______ nerve > solitary nucleus in medulla in response to BP changes

A

Vagus nerve

67
Q

Carotid sinus transmits via ________ nerve > solitary nucleus in medulla in response to BP changes

A

Glossopharyngeal nerve

68
Q

Explain the functions of the chemoreceptors

A

Peripheral: ↓pO2 > Carotid and Aortic bodies > ↑pCO2 and ↓pH

Central: Changes in pH and pCO2 of CSF (don’t directly respond to pCO2)

69
Q

What organ gets the largest amount of blood flow?
What organ gets the highest amount of tissue perfusion?

A

Liver
Kidneys

70
Q

Diastolic BP is highest in the (vessel)

A

Aorta

71
Q

HTN due to renal disease is associated with increased sympathetic activity and overstimulation of the ________ system

A

Renin-angiotensin-aldosterone

72
Q

______ is the most important risk factor for stroke

A

HTN

73
Q

A diastolic BP of _____ is diagnostic of HTN

A

> 80mmHg

74
Q

The ductus arteriosus connects the ______ to the ______

A

Pulmonary artery to the proximal descending aorta

75
Q

Why does edema develop in pts with CHF?

A
  • Increased aldosterone thus increased sodium and water retention.
  • Reduced cardiac output triggers renal responses to try and compensate and maintain adequate blood flow.
76
Q

Common cause of viral cardiomyopathy that could result in CHF

A

Coxsackievirus

77
Q

Right sided HF sxs

A

Dependent edema
JVD
Hepatosplenomegaly

78
Q

What are risk factors for abdominal aortic aneurysm?

A

History of smoking, marfan syndrome, FHx

79
Q

Which of the following is NOT a branch of the abdominal aorta?
a. Inferior epigastric artery
b. Superior mesenteric artery
c. Left renal artery
d. Celiac artery

A

a. Inferior epigastric artery

80
Q

Which portion of the primitive cardiac tube generates the ascending aorta?

A

Truncus arteriosus

81
Q

What layers of the blood vessel are involved in aortic dissection?

A

Tunica media, intimia, and adventitia

82
Q

In the synthesis of cholesterol, what is the key regulating enzyme?

A

HMG-CoA reductase

83
Q

The membranous interventricular septum is normally formed by the ____

A

Endocardial cushions

84
Q

After birth, the umbilical vein becomes the ______

A

Ligamentum teres

85
Q

Umbilical arteries carry (oxygenated/deoxygenated) blood

A

Deoxygenated

86
Q

Cardiac muscle is striated. Describe the I bands and A bands

A

I - no thick filaments
A bands - single thick filament

87
Q

What type of vein can form a venous plexus?

A

Venules

88
Q

(T or F) The pulmonary veins are valveless

A

True

89
Q

What conditions are Right-to-Left shunts?

A

Truncus arteriosus
Transposition of great vessels
Tetralogy of Fallot

90
Q

What is Cor Pulmonale

A

Isolated right HF due to pulmonary cause

91
Q

Stable and Unstable angina show up on an EKG as ST (elevation/depression)

A

ST Depression

92
Q

STEMI shows up on an EKG as ST (elevation/depression)

A

ST Elevation

93
Q

NSTEMI shows up on EKG as ST (elevation/depression)

A

ST Depression

94
Q

Aortic Stenosis is a (systolic/diastolic) murmur, where as Aortic Regurgitation is a (systolic/diastolic) murmur

A

Aortic Stenosis - Systolic (ASS)
Aortic Regurgitation - Diastolic (DAR)

95
Q

What are some etiologies of Mitral Regurgitation?

A

Rheumatic fever, infective endocarditis

96
Q

What murmur has a MSC (mid systolic click)

A

Mitral Valve Prolapse

97
Q

Which murmurs are due to pressure overload?

A

Aortic stenosis, mitral stenosis

98
Q

Which murmurs are due to volume overload?

A

Mitral valve prolapse, aortic regurgitation

99
Q

What is the most common valve disease?

A

Mitral valve prolapse

100
Q

What can cause mitral stenosis?

A

Rheumatic heart disease

101
Q

Rheumatic heart disease, caused by group A strep, is a immune mediated type __ hypersensitivity

A

2

102
Q

What cells are associated with rheumatic heart disease?

A

Aschoff bodies

103
Q

What is the JONES criteria?

A

Dx Rheumatic Heart Disease:

Joint (migratory polyarthritis)
Carditis
Nodules in skin (subcutaneous)
Erythema marginatum
Sydenham chorea

104
Q

What is the most common cardiomyopathy?

A

Dilated

105
Q

Systolic or Diastolic dysfunction?
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Restrictive Cardiomyopathy

A

Systolic
Diastolic
Diastolic

106
Q

HHV-6, CMV, lyme, lack of B1, post-partum, hypothyroid, chemo, alcohol are all causes of which cardiomyopathy?

A

Dilated Cardiomyopathy

107
Q

What are the heart sounds for each?
Dilated Cardiomyopathy
Hypertrophic Cardiomyopathy
Restrictive Cardiomyopathy

A

S3
S4
S3

108
Q

Which cardiomyopathy causes sudden death in young athletes?

A

Hypertrophic (obstructive) cardiomyopathy

109
Q

What is a major cause of SCD in adults > 40 YO

A

Myocarditis

110
Q

What is cardiac tamponade

A

Compression of the heart by fluid, causes decreased CO

111
Q

What are the EKG and CXR findings in pericardial effusions?

A

Alternans on EKG
Water bottle appearance on CXR

112
Q

Pleuritic chest pain and friction rub can be a sign of what condition

A

Pericarditis

113
Q

What is the most common cardiac congenital anomaly? (Hint: valves)

A

Bicuspid aortic valve

114
Q

Patent ductus arteriosus (PDA) causes this type of murmur

A

Continuous machine-like murmur (loudest at S2)

115
Q

What is the most common congenital defect?

A

Interventricular septal defects

116
Q

Interventricular septal defects put pts at risk of what condition

A

Endocarditis

117
Q

What is the most common cause of early childhood cyanosis?

A

TOF - Tetralogy of fallot

118
Q

“Tet spells” occur in what condition?

A

Tetralogy of fallot - Often caused by crying, fever, exercise. Better with squatting.

119
Q

RVH appears on a CXR as _____

A

Boot shaped heart

120
Q

Name the 4 types of shock

A
  1. Hypovolemic Shock: Hemorrhage, dehydration, burns
  2. Cardiogenic Shock: Acute MI, HF, valvular dysfunction, arrhythmia
  3. Obstructive Shock: Cardiac tamponade, PE, tension pneumothorax
  4. Distributive Shock: Sepsis, anaphylaxis, CNS injury
121
Q

Aneurysm vs dissection

A

Aneurysm - Localized pathologic dilation of vessel lumen
Dissection - Longitudinal intimal tear forming a false lumen (double barrel shape)

122
Q

Arteriosclerosis vs atherosclerosis

A

Arteriosclerosis: Thickening and loss of elasticity of arterial walls
Atherosclerosis: Intimal thickening and lipid deposition

123
Q

(T or F) Arteriosclerosis of the coronary artery (CAD) is the #1 killer of M + F in the US

A

False - Atherosclerosis

124
Q

Familial hypercholesterolemia is (AD/AR), and is due to absent or defective LDL receptors, or defective ApoB-100

A

AD

125
Q

Familial hypercholesterolemia cholesterol levels:
Heterozygotes:
Homozygotes:

A

Heterozygotes: ~300 mg/dL
Homozygotes: (Rare) >700 mg/dL

126
Q

Giant Cell Arteritis (Temporal arteritis) causes elevated IL-?

A

IL-6

127
Q

40-50% of pts with Giant Cell Arteritis also have this condition

A

Polymyalgia rheumatica

128
Q

Giant Cell Arteritis can lead to ______

A

Blindness (ophthalmic artery occlusion)

129
Q

Peripheral Arterial Disease can lead to these sxs

A

Claudication (muscle pain lower limb)
Atypical leg pain
Arterial ulcers

130
Q

Peripheral Arterial Disease is screened with these diagnostic tests (2)

A

Buerger test, and ankle brachial index

131
Q

Inherited thrombophilia can cause a pulmonary embolism, and is caused by these mutations/deficiencies (3)

A

Factor V Leiden mutation
Protein C deficiency
Protein S deficiency

132
Q

What is the diagnostic criteria for PEs

A

Well’s Criteria for PE

133
Q

DVT diagnostic criteria

A

Leg swelling, pain, warmth, redness
Unilateral pitting edema in leg

D-dimer: Rule OUT DVT
Well’s Criteria for DVT

134
Q

Hemangiomas are vascular birthmarks made of extra blood vessels in the skin, and are (benign/malignant)

A

Benign

135
Q

What causes Kaposi Sarcoma

A

HHV-8, HIV

136
Q

Complications of Kaposi Sarcoma

A

Pericardial effusion
Cardiac tamponade

137
Q

What valve is most often affected by bacterial endocarditis

A

Mitral (or tricuspid with IV drug use)

138
Q

Acute bacterial endocarditis is caused by this bacteria

A

Staph aureus (high virulence), large vegetations on normal valves, rapid onset, RARE.

139
Q

Subacute bacterial endocarditis is caused by this bacteria

A

Strep viridans (low virulence), small vegetations on abnormal or diseased valves. Sequelae of dental procedures.

140
Q

Bacterial endocarditis characteristics and diagnostic criteria

A

FROM JANE
Fever
Roth spots
Osler nodes
Murmur
Janeway lesions
Anemia
Nail-bed hemorrhage
Emboli

Modified Duke Criteria

141
Q

Chagas disease is the leading cause of ____ worldwide, and is caused by Trypanosoma cruzi

A

Infectious myocarditis

142
Q

Lyme disease can lead to these cardiac conditions

A

AV-block
Carditis

143
Q

AV-block
Carditis

A

Vasculitis

144
Q

Dengue fever can lead to these cardiovascular conditions

A

Hypotension, pleural effusions, bradycardia

145
Q

Viral myocarditis can lead to arrhythmias, HF, and sudden death. It is caused by these viruses

A

Adenovirus, coxsackie B, parvovirus B19, HIV, HHV-6

146
Q

Afib on EKG

A

No discrete P waves

147
Q

No discrete P waves

A

Sawtooth

148
Q

Beck triad is made up of what 3 sxs, and is a sign of what cardiac condition?

A

Cardiac tamponade
1. Hypotension
2. Distended neck veins
3. Distant heart sounds

NPLEX I - RaeForReal (16 decks)

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