Cardiology Flashcards
(208 cards)
1
Q
PR interval
A
0.12-0.20
2
Q
PR segment
A
0.05-0.12
3
Q
QRS complex
A
0.08-0.12
4
Q
QT interval
A
Less than or equal to 0.45 in males, 0.46 in females
5
Q
Corrected QT
A
Bazett’s formula: QT interval/square root of RR in seconds
6
Q
When to correct for QT
A
Tachycardia or bradycardia
7
Q
How to measure heart rate for regular rhythm
A
1500/number of small boxes from R-R
8
Q
1 small box: second/s
A
0.04
9
Q
5 small boxes (1 big box): second/s
A
0.2
10
Q
1 small box: mm
A
1
11
Q
5 small boxes (1 big box): mm
A
5
12
Q
Normal axis
A
-30 to 100
13
Q
Examples of LAD (4)
A
1) LVH
2) Inferior wall MI
3) Hyperkalemia
4) Normal variant
14
Q
Examples of RAD (6)
A
1) RVH
2) Anterolateral wall MI
3) Pulmonary embolism
4) Chronic lung disease
5) ASD, VSD
6) Normal variant in children and thin adults
15
Q
Leads for eyeballing of axis
A
1) Lead I
2) aVF
16
Q
Heart rate in sinus rhythm
A
60-100bpm
17
Q
Heart rate in junctional rhythm
A
40-60bpm
18
Q
Heart rate in idioventricular rhythm
A
15-40
19
Q
Anterior wall: Supplied by
A
LAD
20
Q
Anterior wall: Leads
A
v1-4
21
Q
Anteroseptal wall: Supplied by
A
LAD
22
Q
Anteroseptal wall: Leads
A
V1-2
23
Q
Anterolateral wall: Supplied by
A
LCX
24
Q
Anterolateral wall: Leads
A
V4-6
25
Lateral wall: Supplied by
LCX
26
Lateral wall: Leads
I, aVL
27
Inferior wall: Supplied by
RCA
28
Inferior wall: Leads
II, III, aVF
29
Vessels that comprise the largest total cross-sectional and surface area of circulation
Capillaries
30
T/F: Venules have autonomic innervation
T
31
Correponds to the distensibility of blood vessel
Capacitance/compliance
32
Artery vs vein: Greater capacitance
Vein
33
Most important determinant of pulse pressure
Stroke volume
34
Palpation mtd of BP measurement: Artery used
1) Brachial
| 2) Radial
35
Palpation mtd of BP measurement: Inflate the cuff ___ mmHg above the point where loss of pulse is noted
30
36
Auscultation mtd of BP measurement: Inflate cuff ___ mmHg above systolic pressure
30
37
Palpation mtd of BP measurement: Rate of decrease in pressure should be
2-3 mmHg/sec
38
Korotkoff phase: Onset of tapping
Phase 1
39
Korotkoff phase: Reappearance of tapping sound
Phase 3
40
Korotkoff phase: Disappearance of sound
Phase 5
41
Korotkoff phase: 10-15mmHg lower than previous phase during which a murmur may be heard after tap
Phase 2
42
Korotkoff phase: Muffling of heart sound
Phase 4
43
Normal BP difference of both arms
Less than 10 mmHg
44
UE vs LE: Higher BP
LE
45
BP is __mmHg higher in legs than arms
20
46
Orthostatic hypotension: Fall in SBP by __mmHg
20
47
Orthostatic hypotension: Fall in DBP by __mmHg
>10
48
Effect of inspiration to SBP
Decrease
49
Exaggerated fall in SBP with normal respiration
Pulsus paradoxus
50
mmHg fall in pulsus paradoxus
10mmHg or more
51
Slow rise in arterial pulse
Pulsus tardus
52
Pulsus tardus is seen in
Aortic stenosis
53
Non-cardiac causes of rapid rise in arterial pressure or bounding pulse (3)
1) Thyrotoxicosis
2) Pregnancy
3) Anemia
54
Cardiac causes of rapid rise in arterial pressure or bounding pulse (3)
1) PDA
2) AR
3) Coarctation of the aorta
55
Twice beating or double-peaked arterial pulse
Pulsus bisferiens
56
Condition: Pulsus bisferiens
AR
57
Single most common cause of heart failure
CAD
58
***Most common cause of pump failure hence CHF
Myocardial hypertrophy usually sec to htn
59
Measure of LV function
EF
60
Heart failure with depressed EF
Systolic failure
61
Heart failure with preserved EF
Diastolic failure
62
Treatment for systolic failure
Digoxin
63
Most common manifestation of left-sided heart failure
Pulmonary congestion and edema
64
Heart failure cells
Hemosiderin-laden macrophages
65
Most common cause of right-sided heart failure
Left-sided heart failure
66
Left vs right sided heart failure, etiology: Pulmonary emboli
Right
67
Left vs right sided heart failure, etiology: Any disease interfering with pulmonary ventilation
Right
68
Left vs right sided heart failure, etiology: Cystic fibrosis
Right
69
Left vs right sided heart failure, etiology: Ischemia
Left
70
Left vs right sided heart failure, etiology: Systemic htn
Left
71
Left vs right sided heart failure, etiology: Myocardial disease/cardiomyopathy
Left
72
Right-sided heart failure caused by pulmonary htn from intrinsic lung dse
Cor pulmonale
73
Right-sided heart failure results on __ in the liver
Chronic passive congestion
74
Histologic morphology of liver in right-sided heart failure
Centrilobular congestion and atrophy of central hepatocytes described as nutmeg liver
75
Functional capacity class: Ordinary physical activity does not cause undue fatigue
I
76
Functional capacity class: SLIGHT limitation. Ordinary physical activity results in fatigue.
II
77
Functional capacity class: MARKED limitation. Less than ordinary activity causes fatigue.
III
78
Functional capacity class: Symptoms present even at rest
IV
79
Cardinal symptoms of heart failure (2)
1) Fatigue
| 2) Shortness of breath
80
Periodic respiration or cyclic respiration
Cheyne-Stokes
81
Mgt of heart failure with depressed EF (less than 40%)
1) Screen and treat comorbidities
2) Stop smoking and limit alcohol
3) Avoid extremes of temp and heavy physical exertion
4) Diuretics
82
Most common sustained arrhythmia
Atrial fibrillation
83
Typical rate of afib
120-160bpm
84
Treatment for afib (2)
1) Rate controller
| 2) Anticoagulant
85
When to begin IV heparin in afib (2 conditions)
1) Duration >12hrs
| 2) Presence of risk factors for stroke in Afib
86
Risk factors for stroke in Afib (9)
1) History of stroke or TIA
2) Mitral stenosis
3) Htn
4) DM
5) Age >75
6) CHF
7) LV dysfunction
8) Marked left atrial enlargement (>5.0cm)
9) Spontaneous echo contrast
87
Membrane channel inhibited by Digoxin
Na/K ATPase pump
88
Electrolyte imbalances that worsen Digoxin toxicity
1) HypoK
| 2) Hypomag
89
Transient or concealed ST elevation in V1-V3 typically provoked with Na channel-blocking drugs
Brugada syndrome
90
Brugada syndrome: Provoking drugs
1) Ajmaline
2) Procainamide
3) Flecainide
91
Brugada syndrome: Gene mutation in 20% of patients
scn5a
92
Brugada syndrome: Most common in
Young males
93
Brugada syndrome: Responsible for ___ in southeast asian men
SUNDS
94
Brugada syndrome: Risk of developing
Polymorphic ventricular arrhythmia
95
Brugada syndrome: Predictors of adverse outcome
1) Spontaneous coved-type ST elevation in the right precordial leads
2) History of syncope
3) Aborted sudden cardiac death
96
Brugada syndrome: Treatment
Procainamide
97
***Most common type of heart disease among children
Congenital heart disease
98
Congenital heart disease develops at which week of gestation
3rd to 8th
99
Incidence of congenital heart disease
1% of livebirths
100
Congenital heart disease: L-R shunt (4)
1) ASD
2) VSD
3) PDA
4) AVSD (atrioventricular septal defect)
101
Most common congenital cardiac anomaly in adults
ASD
102
Male vs female: ASD
Female
103
Types of ASD (3)
1) Sinus venosus
2) Ostium primum
3) Ostium secundum
104
Most common form of ASD
Ostium secundum
105
Syndrome in which a mutation in tbx5 transcription factor causes ASD and VSD
Holt-Oram syndrome
106
S2 in ASD
Widely split
107
ECG change in ASD
rSr' pattern in the right precordial leads representing enlargement of RV outflow tract
108
Surgical repair of ASD should not be carried out in
1) Small defects
2) Trivial L-R shunts
3) Severe pulmonary vascular disease without a significant L-R shunt
109
Location of sinus venosus
High in the atrial septum near the entry of SVC
110
Sinus venosus ASD is frequently associated with
Anomalous pulmonary venous connection from the right lung to the SVC or right atrium
111
Location of ostium primum
Adjacent to the AV valves which may be deformed or regurgitant
112
Location of ostium secundum
Midseptal and involves fossa ovalis
113
Most common congenital cardiac anomaly overall
VSD
114
Congenital anomaly frequently associated with VSD
Tetralogy of Fallot
115
Isolated vs with association: VSD
With association
116
Single vs multiple: Opening/s in VSD
Single (MC single because MC is membranous; Trabecular or muscular VSD is characteristically "Swiss cheese" in appearance because of multiple openings)
117
Membranous vs infundibular: Opening in VSD
Membranous
118
Principal determinant of clinical manifestations, course, and feasibility of surgical repair of a given VSD
Pulmonary vascular bed
119
Large communication b/w 2 circulations and bidirectional or predominantly right-to-left shunts because of high resistance and obstructive pulmonary htn
Eisenmenger syndrome
120
Small shunt: Pulmonary-systemic flow ratio
Less than 1.5 to 2:1
121
Small shunt: Surgery
Surgery not recommended
122
Medium to large shunt: Pulmonary-systemic flow ratio
>1.5 or 2:1
123
Medium to large shunt: Surgery
Operative or transcatheter
124
Eisenmenger VSD: Management (3)
1) Pulmonary arterial vasodilators
2) Single lung transplantation with intracardiac defect repair
3) Total heart-lung transplantation
125
Therapeutic phlebotomy: Amount of blood removed
500
126
Therapeutic phlebotomy: Duration
45 mins
127
Therapeutic phlebotomy: Replacement of extracted volume
Isovolumetric replacement with isotonic saline
128
Outcome of R-L shunt (3)
1) Cyanosis
2) Clubbing
3) Erythrocytosis
129
Cause of erythrocytosis in R-L shunt
Chronic hypoxemia and EPO production
130
Compensated vs decompensated erythrocytosis: Therapeutic phlebotomy
Decompensated
131
Caveat of therapeutic phlebotomy
Limits O2 delivery
132
Isolated vs with association: PDA
Isolated
133
10% of PDA is associated with (3)
1) Pulmonary or aortic stenosis
2) Coarctation
3) VSD
134
PDA is associated with what gestational conditions
1) Prematurity (HMD)
| 2) Congenital rubella infection
135
Murmur associated with PDA
Machinery
136
Congenital heart diseases: R-L shunt
5 T's
1) Tetralogy
2) TOGV
3) Tricuspid atresia
4) Persistent Truncus
5) TAPVR
137
Most common cause of heart disease in children
RHD
138
RHD: Etiology
Immunologic hypersensitivity rxn to streptococcal antigens
139
RHD: Major criteria
1) Chorea
2) Carditis
3) Polyarthritis
4) Subcutaneous nodules
5) Erythema nodosum
140
RHD: Etiologic agent
GABHS
141
RHD: Foci of swollen eosinophilic collagen surr by lymphocytes, occ plasma cells, and plump macrophages (granuloma)
Aschoff bodies
142
RHD: Activated histiocytes/plump macrophages pathognomonic of RHD
Anitschkow's cells
143
RHD: Multinucleated giant cells seen in aschoff bodies
Aschoff cells
144
Most common clinical presentations of ARF (2)
1) Fever
| 2) Polyarthritis
145
Clinical features of RF (9)
FEVERSS PE
1) Fever
2) ESR elevation
3) Valvular damage
4) Erythema marginatum
5) Red hot joints (polyarthritis)
6) Subcutaneous nodules
7) St. Vitus dance (Chorea)
8) Polyarthralgia
9) ECG: Prolonged PR interval
146
Criteria for diagnosis of RF
Jones criteria
147
Jones criteria
Evidence of GABHS infection +
1) 2 major
2) 1 major + 2 minor
3) 2 minor for recurrence
148
Hallmark of rheumatic carditis
Valvular damage
149
RHD: Valve that is almost always affected
Mitral
150
T/F: Isolated aortic valve involvement is common in RHD
F
151
Rapid purposeless movements that affect particularly the head with a characteristic darting movement of the tongue
Sydenham's chorea
152
Evidence of GABHS infection is required for diagnosis of RF except
When discovered after a long latent period
153
Acute RF resolves in
3 months without treatment
154
Chronic RF is cxd persistence of symptoms for
More than 6 months
155
Polyarthritis in RF: Resolution
Within 2-4 weeks without permanent damage
156
Polyarthritis in RF: Symmetrical vs asymmetrical
Symmetrical
157
Polyarthritis in RF: Large vs small joints
Small
158
Polyarthritis in RF: Rare sequelae
Periarticular fibrosis called Jaccoud joint
159
Polyarthritis in RF: May be monoarticular with early use of what drug
NSAID
160
RF: Age of predilection
5-15 y/o
161
RF: Rare after what age
35 y/o
162
RF: Symptoms more common in females (2)
1) Mitral stenosis
| 2) Sydenham's chorea
163
RF: Major criteria most common in children
Carditis
164
RF: Major criteria most common in adults
Polyarthritis
165
RF: Major criteria that are very rare in adults (3)
1) Erythema nodosum
2) St. Vitus dance
3) Subcutaneous nodules
166
The ONLY manifestation of ARF with significant potential to cause long-term disability and/or death
Carditis
167
T/F: Carditis in RF is a PANCARDITIS
T
168
RF Chorea: Pathophy
Autoantibodies react with brain ganglioside
169
RF manifestation covered by clothing due to predilection for trunk and proximal aspects of limbs hence frequently missed by parents
Erythema marginatum
170
Erythema marginatum T/F: Pruritic
F
171
Erythema marginatum T/F: Painful
F
172
RF subcutaneous nodules resolve within
1-2 weeks
173
VSD: Defects in muscular septum
Multiple
174
VSD: Appearance of muscular defect
Swiss cheese
175
Components of TOF
PROVe
1) Pulmo stenosis
2) RVH
3) Overriding of aorta
4) VSD
176
T/F A fraction of VSDs close spontaneously
T
177
VSD: Timing of spontaneous closure
30-50% in the first 2 years of life
178
Congenital heart disease: Snowman or figure of 8
TAPVR
179
PDA: Permanent closure
8 weeks after birth
180
PDA: Inversely related to (2)
1) Gestational age
| 2) Birth weight
181
PDA: Attached to which portion of aorta
Descending
182
Classical rash of congenital rubella
Blueberry muffin rash
183
PDA: Mgt
Prostaglandin synthase inhibitors
1) Indomethacin
2) Ibuprofen
184
PDA: Drug associated with premature closure
Ibuprofen
185
Congenital heart disease: Boot-shaped heart
TOF
186
Most common cyanotic congenital anomaly
TOF
187
TOF: Prognosis is dependent on
Degree of pulmonary stenosis
188
TOF: Paroxysmal hypercyanotic attacks
Tet spells
189
TOF: Tet spells are due to
R-L flow across VSD due to overload from pulmo stenosis
190
TOF: Pharmacologic management
b-blocker
191
TOF: Physiologic management
Squatting or knee to chest position
192
TOF: Surgical management
Blalock-Tausig shunt
193
TOF: Best timing for Blalock-Tausig shunt
1st month
194
Most common aorticopulmonary anastomosis
Blalock-Tausig shunt
195
Anomalous in TOGV
Aorticopulmonary septum
196
TOGV: Risk factor
Diabetic mother
197
Congenital defect and associated cardiac disease: Down
ASD, VSD, AV septal defect (endocardial cushion defect)
198
Congenital defect and associated cardiac disease: Congenital rubella
PDA, pulmonary artery stenosis
199
Congenital defect and associated cardiac disease: Turner
Preductal coarctation of aorta
200
Congenital defect and associated cardiac disease: Marfan
Aortic insufficiency and dissection (late complication)
201
Congenital defect and associated cardiac disease: Infant of diabetic mother
TOGV
202
"Tree bark" aorta is seen in
Syphilitic heart disease
203
Most common PRIMARY cardiac tumor
Myxoma
204
90% of cardiac myxomas occur in
Atria, mostly left atrium
205
"Ball valve" obstruction of the left atrium
Cardiac myxoma
206
Most frequent primary cardiac tumor in children
Rhabdomyomas
207
Most common heart tumor
Metastasis
208
Most common tumours that metastasize to the heart
Melanoma, lymphoma
