Cardio

Question 1

IC: Sindrome que resulta de ___ ventricular; sobrecarga de ____ ou ____; combinados ou ____

Answer 1

disfuncao; volume; pressao; isolados

Question 2

Heart output proportional to its:

Answer 2

Filling volume

Question 3

Heart output inversely proportional to:

Answer 3

Resistance against wich it pumps

Question 4

Systemic oxigen transport is calculated as…

Answer 4

Product of cardiac output and systemic o2 content

Question 5

Cardiac output is calculated as…

Answer 5

Product of heart rate and stroke volume

Question 6

Stroke volume dependes on…

Answer 6

PRE-load; AFTER-load; contractility

Question 7

High-output heart hailure is…

Answer 7

Mantained or increased cardiac output with decreased systemic O2 content or increased demands

Question 8

Increased sympathetic tone increases secretion of…

Answer 8

epinephrine and noradrenaline; in turn this increases cardiac output

Question 9

Wich receptors increases HR and myocardical contractility?

Answer 9

B-adrenergic receptors

Question 10

A-adrenergic receptors causes vaso____

Answer 10

constriction

Question 11

Chronic exposure to catecholamines leads to…

Answer 11

a decrease in B-adrenergic receptors; Downeregulation

Question 12

Edema is very frequent in infants with HF (T/F)

Answer 12

False; generally absent; may be passed off as normal weight gain

Question 13

Many children may pressent abdominal symptoms of HF (T/F)

Answer 13

True; abd pain;nausea; anorexia can be quite common

Question 14

Cardiomegaly is invariably noted in HF (T/F)

Answer 14

True

Measured on a PA chest x-ray

0.42-0.50 NV

Question 15

Common rhythm in HF

Answer 15

Gallop (S3)

Question 16

Holosystolic murmur might signal

Answer 16

advanced dilation; mitral and/or tricuspid regurgitation

Question 17

Large left to right shunts may have ______ at the X-ray

Answer 17

Exaggeration of the pulmonary arterial vessels

Question 18

Fluffy perihialr purmonary markings indicate:

Answer 18

Venous congestion

Question 19

Standard technique for assessing ventricular function:

Answer 19

Ecocardiography

Question 20

Ventricular function can be quantitated by meassuring: (USG)(2)

Answer 20

Fractional shortening and ejection fraction

Question 21

Fractional shortening:

Answer 21

[(End-Diastolic - End-Systolic)/End-Diastolic]*100; Normal 28-42

Question 22

Normal Ejection fraction:

Answer 22

55-65%

Question 23

Usefulness of magnetic resonance angiography in HF: (5)

Answer 23

Quantifying L&R V function; volume; mass; coronary anatomy; valvular regurgitatino

Question 24

Hyponatremia in HF is often the result of…

Answer 24

renal water retention

Question 25

Increased ventricular tension causes the release of…

Answer 25

B-type natriuretic peptide; it might indicate HF or volume overload

Question 26

Pulmonary embolism or hypertension can cause BNP release (T/F)

Answer 26

TRUE

Question 27

Noncardiac causes of elevated BNP (10)

Answer 27

Isquemic or hemorragic brain lesion; renal; liver; paraneo; COPD; Sepsis; Burns; Anemia; Metabolic and hormonal abnormalities

Question 28

Possitive pressure ventilation may be required in:

Answer 28

Pulmonary edema; reduces o2 consuption by eliminating work of breathing

Question 29

Infants with HF fail to trhive due to:

Answer 29

increased metabolic demands and decreased caloric intake

Question 30

Caloric density above 0.8cal/ml may cause:

Answer 30

Diarreia or renal overload

Question 31

Gastroesophageal reflux may appear in…

Answer 31

Cardiac enlargement

Question 32

Low sodium formulas for infants are routinely used (TF)

Answer 32

False; there preparations are often poorly tolerated and may cause hyponatremia

Question 33

First mode of therapy for congestive HF

Answer 33

Diuretics

Question 34

Most commonly used diuretic in pediatric HF

Answer 34

Furosemide

Question 35

Diuretic that inhibits reabsorption of Na and CL in the "distal" tubules and the "loop"

Answer 35

Furosemide

Question 36

Diuretic that inhibits aldosterone

Answer 36

Spironolactone; enhances K retention; 2mg/kg/24h BID

Question 37

Diuretic with favorable effect on cardiac fibrosis

Answer 37

Spironolactone

Question 38

Children with cardiomyopathy may benefit more from ___load reducers

Answer 38

"AFTER"load; ACEI and ARB's

Question 39

Children with mitral or aortic insufficiency may benefit more from ___load reducers

Answer 39

"AFTER"load; ACEI and ARB's

Question 40

Adults with dilated cardiomyopathy in use of ACEI have reduced:

Answer 40

Mortality and morbidity; may have effects on cardiac remodeling

Question 41

Main effect of nitroprusside

Answer 41

Peripheral arterial vasodilation and afterload reduction; some venodilation

Question 42

High doses of nitroprusside may cause intoxication due to:

Answer 42

Thiocyanate poisoning; Cyanide is a byproduct of hepatic metabolization

Question 43

ACEIs may cause ___kalemia

Answer 43

"HYPER"

Question 44

Digoxin may reduce death among infants with _____ heart disease

Answer 44

Single-ventricle.

Question 45

Dopamine is a "predominantly _____ receptor agonist

Answer 45

B-adrenergic; it also has A-adrenergic effect at "higher" doses >15µ/kg/min

Question 46

Dopamine is more arrhytmogenic than pure B-agonists like Isoproterenol (T/F)

Answer 46

False; its also less chronotropic

Question 47

Fenoldopam is a ____ receptor agonist

Answer 47

Dopamine DA1; increases renal blood flow and urine output

Question 48

Dobutamine is a derivative of ____

Answer 48

Dopamine

Question 49

Main effects of Dobutamine (2)

Answer 49

Inotropic effect and moderate reduction in peripheral vascular resistance

Question 50

Isoproterenol is a pure _____ receptor agonist

Answer 50

B-adrenergic; marked chronotropic effect; effective in patients with slow HR. Often used after heart transplants.

Question 51

Epinephrine is a ____ receptor agonist

Answer 51

Mixed A-B adrenergic; usually reserver for patientes with cardiogenic shock and low BP

Question 52

Epinephrine increases afterload by:

Answer 52

increasing systemic vascular resistance; also increases risk of arrhytmia

Question 53

Milrinone is a ______ Inhibitor

Answer 53

Phosphodiesterase

Question 54

Milrinone is useful in patients with _____ cardiac output

Answer 54

Low; used mostly after open heart surgery

Question 55

Milirinone has ___tropic effect and ____ vasodilatory effects

Answer 55

"INO"; peripheral

Question 56

Carvelidol is a ____ receptor bloquer

Answer 56

A-B adrenergic; metoprolol is B-adrenergic selective

Question 57

B-blockers should be adminestered in acute fase of HF (T/F)

Answer 57

False; increases mortality

Question 58

Ivabradine lowers HR without _______ miocardial _____

Answer 58

Lowering; contractility

Question 59

Leading cause of sudden death in severe cardiomyopathy

Answer 59

Arrhytmias

Question 60

Main causes of cardiogenic shock (8)

Answer 60

Cardiac dysfunction before or after surgery; septicemia; severe burns; anaphylaxis; cardiomyopathy; infarction; CNS disorders

Question 61

Cardiogenic shock is characterized by:

Answer 61

low cardiac output that results in inadequate tissue perfusion

Question 62

Hight HR may reduce cardiac output by:

Answer 62

decreasing time for diastolic filling and increasing myocardial o2 demand

Question 63

Use of digoxin should be ____ during acute low cardiac output states

Answer 63

"Avoided"

Question 64

Milrinone combined with a B-adrenergic agonists has a _____ effect

Answer 64

synergistic

Question 65

Most common short term modality to support circulatory failure in children

Answer 65

ECMO

Question 66

Tools for preload meassurement(4)

Answer 66

CVP; PCWP; Left Atrial Pressure; Cardiac chamber size (USG)

Question 67

Parameters that measure contractility (4)

Answer 67

Cardiac output; BP; fractional shortening or EF (USG) mixed venous sato2

Question 68

Parameters that measure afterload (3)

Answer 68

BP; periferal perfusion; SVR (calculated from cardiac output and meanBP)