Cardiology

Question 1

what layers does the pericardial sac consist of?

Answer 1

serous inner layer - visceral (inner) and parietal pericardium (fibrous outer)

Question 2

how much clear liquid lies between the layers of the heart?

Answer 2

40-50mL

Question 3

Which branches feed the LV?

Answer 3

PDA, Cx, LAD

Question 4

Which branch is also known as a widowmaker?

Answer 4

Left Anterior Descending (LAD)

Question 5

If a patient is having an inferior heart attack, which branch is this affecting?

Answer 5

PDA and leads 2&3

Question 6

If a patient is having an ANTERIOR heart attack, which branch is this affecting?

Answer 6

LAD, v1 and v2

Question 7

If a pt is having a LATERAL heart attack, which branch is this affecting?

Answer 7

Circumflex, L1

Question 8

What percentage does the PDA supply blood of LV arising from RCA and Cx?

Answer 8

80%;20%

Question 9

automaticity is another word for

Answer 9

pacemaker

Question 10

what are the pacemakers and conductors of the heart? which have a faster velocity, why?

Answer 10

Pacemakers- SA/AV node
Conductors- His and Purkinje
conductors are faster bc the AV node has a delay in order to fill the heart

Question 11

where is the electrical connection in the heart?

Answer 11

AV and His bundle

Question 12

The ____ distal the pacemaker is, the ______ the heart rate

Answer 12

distal, slower

Question 13

the p wave, QRS. and T wave measure…

Answer 13

P wave: atrial depolarization
Qrs: ventricular depolarization
T wave: atrial repolarization

Question 14

What needs to be maintained in the heart?

Answer 14

Cardiac OUTPUT

Question 15

What 3 parameters is the stroke volume dependent on?

Answer 15

preload, after load, contractility

Question 16

what do catecholamines and inotropic drugs do to the heart?

Answer 16

increase calcium thus increasing contractility

Question 17

are the nodal cells or the ventricular cells faster? Why?

Answer 17

phase 0 is faster so it spikes up in ventricular cells
-BUT depolarization is faster in phase 4 of the nodal (pacemaker) cells
…
“depolarization is faster but action potential is slower in nodal”

Question 18

how do myosin and actin interact to give rise to ____?

Answer 18

CONTRACTION;

there’s calcium release that binds to troponin C

Question 19

what two mechanisms consist of a Bradycardia

Answer 19

SA node and AV node block

Question 20

In Sick Sinus Syndrome, what does the ekg read?

Answer 20

a Sinus pause, and Junctional rhythm where the AV node takes over to generate a beat.
a missing p wave

Question 21

what are the 3 degrees of an AV block in Bradycardia?

Answer 21

1st- long AV conduction (lengthened PR interval > 0.22s) but still 1:1 AV conduction
2nd- not all atrial impulses are conducted to ventricles (missing QRS or random)
3rd- no association b/w atrial and ventricular activity

Question 22

Which degree in bradycardia is pathological and in need of a pacemaker?

Answer 22

MOBITZ II- constant PR interval, but QRS is skipped (dropped randomly)

Question 23

Which degree in bradycardia is in need of an organ donor?

Answer 23

3rd degree AV block

Question 24

LONG PR INTERVAL

Answer 24

1st degree AV block

Question 25

PR interval lengthens w/ each cycle until QRS is completely skipped

Answer 25

2nd - degree AV block : Wekebebach

Question 26

PR remains constant but QRS is skipped a. mobitz type 2 b. sick sinus syndrome c. wekebach d. 1st degree AV block

Answer 26

a.

Question 27

reasons why AV blocks can occur?

Answer 27

increasing age, vagal input, side effect of drugs

Question 28

Examples of congenital disorders

Answer 28

muscular dystrophy, lyme dz. Lupus, CAD, gout

Question 29

what are 3 ways tachycardia can occur?

Answer 29

inc automaticity, re-entry, and late/delayed

Question 30

a more rapid phase 4 depolarization can be due to: a. inc automaticity b. long QT syndrome c. wolf-parkinson d. reentry

Answer 30

a. increase automaticity = SA node firing faster, inc HR

Question 31

a long QT syndrome: a) inc automaticity b) triggered tachycardia c) supraventricular tachy d) delay repolarization

Answer 31

b. AND d

Question 32

what are some medications pts take and have polymorphic v tach (torsades de pointes) aka twisting of the points?

Answer 32

procainamide or quinidine and dig toxicity

Question 33

what leads to a prolonged plateau in Long QT syndrome?

Answer 33

reduced fxn of K channels

Question 34

what is the most common Reentry tachycardia and what is it indicated by on an ekg?

Answer 34

Wolf-Parkinson White- delta wave

Question 35

if there is a short PR and slurred upstroke to QRS on an ekg, this would be indicative of?

Answer 35

Delta Wave

Question 36

what occurs when an accessory pathway could block impulse due to refractory period

Answer 36

premature articular contraction (PAC) a form of reentry or Wolff-parkinson white

Question 37

if the QRS is wide, the tachycardia arises from..?

Answer 37

from ventricular tissue or is an SVT w WPW

Question 38

when p waves are occurring after QRS, this signifies

Answer 38

WPW reentry

Question 39

LV failure etiology (5)

Answer 39

volume overload, pressure overload, restricted filling, myocyte loss, decreased myocyte contractility

Question 40

pathophys of LV failure (3 changes)

Answer 40

hemodynamic changes, neuro-hormonal changes, cellular changes

Question 41

What are the two types of hemodynamic changes

Answer 41

HFrEF- decreased outside REDUCED | HFpEF- decreased filling PRESERVED

Question 42

what are the curve shifts in HFrEF and HFpEF?

Answer 42

HFrEF- contractility line decreases HFpEF-compliance (bottom) line increases (left up) *both decrease SV*

Question 43

what are 3 ways the heart tries to maintain CO during HFrEF? explain in shifting of curve as well

Answer 43

1. Inc prelooad- shift of a' to right 2. Inc release of catecholamines- - contractility line up c' 3. Hypertrophy and inc vent volume--- compliance line to right

Question 44

a decreased relaxation, decreased elastic recoil, or increased stiffness of the ventricle is indicative of _____. Examples include

Answer 44

HFpEF; | -HTN and Ischemia

Question 45

compensatory responses during neurohormonal changes in LV failure (4)

Answer 45

sympathetic system activation RAAS Vasopressin Cytokine release

Question 46

what are the two major groups in cytokine release of LV failure that help myocyte hypertrophy?

Answer 46

Interleukins (ILs) and tumor necrosis factor

Question 47

elevated _____ levels cause increase cardiac contractility and an inc HR to help maintain CO

Answer 47

epinephrine

Question 48

what causes the production of Angiotensin II?

Answer 48

low BP stimulating release of renin

Question 49

what helps maintain GFR despite a reduced CO?

Answer 49

angiotensin II and sympathetic activation

Question 50

angio II stimulates aldosterone syntethsis which leads to ____ and potassium ____ by kidneys

Answer 50

sodium resorption and potassium excretion

Question 51

vasopressin helps ____ of water in renal tubules

Answer 51

reabsorption

Question 52

excessive endothelia release may be responsible for _____ in pulmonary arteries

Answer 52

hypertension

Question 53

what two sarcoplasmic reticulum proteins have reduced levels of mRNA from failing hearts

Answer 53

phospholamban and Ca2+ATPase

Question 54

there is a downstream of B-1 receptors, uncoupling of the signal transduction pathway and up regulation of inhibitory G proteins leading to....

Answer 54

desensitization of B adregenic receptors as a result of chronic sympathetic activation

Question 55

alpha1 receptors are slightly increased in heart failure for induction of....

Answer 55

myocardial HYPERTROPHY-- to inc HR

Question 56

can cardiac proliferate during adult form?

Answer 56

no

Question 57

what is the function of myocytes that cannot proliferate, thus is a constant turnover producing large myocytes?

Answer 57

they do NOT contract normally and have decreased ATPase activity

Question 58

what causes holes in the myocardium?

Answer 58

myocyte loss via apoptosis (by TNF)

Question 59

what two things cause an inc in fibrous tissue in interstitial spaces of the heart?

Answer 59

collagen deposition | and endothelin release

Question 60

what sx occurs when there is a short blood supply to skeletal muscles?

Answer 60

fatigue

Question 61

what sx occurs when renal perfusion normalizes only at night?

Answer 61

nocturia

Question 62

what is a sx secondary to ischemia with CAD?

Answer 62

chest pain

Question 63

what are the 3 clinical presentations of a pt with RV failure?

Answer 63

SOB, pedal edema, abdominal pain

Question 64

What is the most common cause of RV failure?

Answer 64

LV failure bc of the inc afterload placed on RV

Question 65

* in cardiomyopathy, a thicker and reduced chamber size indicates: a) cardiac dilation b) physiological hypertrophy c) Idiopathic DCM d) pathological hypertrophy

Answer 65

d) pathological hypertrophy | slide 92

Question 66

*What is the most common cause of cardiomyopathy? which one requires cardiac transplants?

Answer 66

dilated cardiomyopathy--> idiopathic DCM`

Question 67

alcohol is a cause in which cardiomyopathy?

Answer 67

dilated

Question 68

a biventricular characteristic is seen in which cardiomyopathy?

Answer 68

dilated

Question 69

*what is the number one cause of sudden death in young athletes?

Answer 69

HOCM

Question 70

what area of the heart is most affected in HOCM and what does it block?

Answer 70

septum --> thickens up closing off the outflow of blood through the aorta

Question 71

*cells appearing as whorls are indicative of?

Answer 71

HOCM

Question 72

signs and symptoms of HOCM

Answer 72

dyspnea and Angina

Question 73

what is the rarest form of cardiomyopathy?

Answer 73

restrictive cardiomyopathy

Question 74

which type of cardiomyopathy has a filling problem thus heart can't relax?

Answer 74

restrictive cardiomyopathy

Question 75

which cardiomyopathy looks similar to normal heart?

Answer 75

restrictive cardiomyopathy

Question 76

define stenosis vs regurgitation

Answer 76

stenosis- narrow | regurgitation- leaky

Question 77

systole vs diastole murmurs

Answer 77

systole --> Mc Ao aortic stenosis or mitral regurgitation | diastole --> Mo Ac aortic regurgitation or mitral stenosis

Question 78

long latent period of slowly increasing obstruction before sx appear is seen in a) aortic regurgitation b) mitral stenosis c) aortic stenosis d) mitral regurgitation

Answer 78

c)

Question 79

what are the 3 cardinal symptoms of AS and the life expectancies of each one if left untreated?

Answer 79

chest pain--> 5 years, syncope--> 3 years, heart failure --> 2 years

Question 80

*comparison of carotid pulse and PMI in AS?

Answer 80

carotid pulse is decreased and delayed | pluses parvus & pulses tardus*

Question 81

You do an en echo on a pt's (age30-70) heart and find tissue inflammation and adhesion/fusing of commissures, which type of AS is this? a) congenital b) rheumatic c) degenerative d) glue

Answer 81

b) rheumatic slide 120* * congenital: partially fused, Abel flow--> fibrosis and calcification-> sx before 30y degenerative: inflexible leaflets, calcium deposits at bases, pt 70y

Question 82

if you see concentric hypertrophy and a prominent a wave, this indicative of

Answer 82

aortic stenosis | -causing LV hypertrophy; dependent on atrial kick

Question 83

in order to maintain the stroke volume in AS, what increases? think of the pressure/vol graph

Answer 83

LVED pressure increases, (preload to allow more blood out)

Question 84

The sound of AS is typically described as?

Answer 84

crescendo-decrescendo | quiet or silent S2 bc of hypertrophy

Question 85

what is the difference between HOCM and AS and how can this be tested?

Answer 85

decrease in preload in HOCM- valsalva maneuver--> HOCM murmur increase similarities: hypertrophy, crescendo-decrescendo sound * *slide 128

Question 86

What is the most common murmur sound in chronic AR?

Answer 86

Diastolic rumble --> Austin Flint murmur

Question 87

What signs are found in acute AR?

Answer 87

none bc it happens so fast

Question 88

Where does blood enter from in aortic regurgitation during diastole?

Answer 88

BOTH- the left atrium AND the aorta (leaking) thus increasing volume

Question 89

if you see eccentric hypertrophy, this is indicative of?

Answer 89

aortic regurgitation

Question 90

systemic diastolic BP inc or dec in Aortic regurgitation? | what about diastolic in the ventricle?

Answer 90

systemic diastolic pressure DECREASES because not squeezing enough blood out into the system*** - diastolic in ventricle increases because there is more blood in the ventricle * slide 131*

Question 91

no relaxation/contraction exists in a) aortic stenosis b) aortic regurgitation c) mitral stenosis d) mitral regurgitation

Answer 91

b ***

Question 92

pathophysiology with a mitral valve of 1 cm^2

Answer 92

c) mitral stenosis | * aortic stenosis AVA = < 0.8 cm

Question 93

a main pathophysiologic abnormality is elevated pulm pressure and RIGHT sided pressure a) aortic stenosis b) aortic regurgitation c) mitral stenosis d) mitral regurgitation

Answer 93

c) mitral stenosis

Question 94

**hoarseness or Ortner Syndrome during Mitral Stenosis is due to

Answer 94

LA enlargement impinging on recurrent laryngeal nerve

Question 95

What is heard during mitral regurgitation?

Answer 95

holosystolic pitched regurgitant murmur

Question 96

most common cause of mitral stenosis?

Answer 96

rheumatic

Question 97

most common cause of mitral regurgitation?

Answer 97

mitral valve prolapse, followed by CAD

Question 98

atrial v waves are present in which valvular heart disease?

Answer 98

mitral regurgitation | -reuptake of the blood from ventricle through mitral valve