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Flashcards in Cardiology Deck (84)
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1

In the cardiac cycle, isovolumetric relaxation is a brief period when volume in ventricle ________ as ventricles ______, pressure ____ and AV valves & semilunar valves are ______

does not change
relax
drops
closed

2

List the minor criterias for Rheumatic Fever

Fever
Arthralgia (joint pain w/o swelling)
Increased : ESR, CRP
ECG showing heart block (prolonged PR interval)

3

Describe conduction system of HT

SA Node - cluster of autorhthymic cells in right atrium begins HT activity that spreads to both atria, excitation spreads to AV node
AV node transmits signal to AV bundle of His
AV bundle divides into right & left bundle branches & purkinje fibers

4

The classic sign of pericarditis is a _________. The classic presentation is ___________. Pericarditis can be misdiagnosed as ____ and vice versa

friction rub

sharp/stabbing chest pain radiating to the back and relieved by sitting up forward and worsened by lying down

myocardial infarction

5

IHD risk increases according to what factors?

age, smoking, hypercholesterolemia, diabetes, hypertension, family history or IHD

6

Explain the presence of troponin in blood when there is myocardial infarction

Troponin is released from actin/myosin complex when cardiac muscle dies

7

Reactive (Dressler’s) pericarditis is due to the following cause:

Auto-immune response to myocardial antigens released after myocardial infarction

8

Clinical presentations of LHF are _____________

SOB, orthopnea, paroxysmal nocturnal dyspnea, easy fatigue-ability, exercise intolerance

9

Describe the difference between chest pain that is ischemic in nature vs. pain that is pericardial in nature.

Ischemic pain is a heaving, squeezing pain

Pericardial pain is a stabbing pain, worse in supine position

10

Buerger's disease is AKA ___________. It is strongly associated with use of ________

Thromboangiitis Obliterans

tobacco products

11

List common treatments for Rheumatic Fever

- anti-inflammatory medications such as aspirin or corticosteroids

- antibiotics for patients with positive strep throat culture

12

T/F AF can produce embolic stroke

True

13

The most common congenital heart defect is _________. This condition results in ________ due to mixing of oxygenated and deoxygenated blood in the ______ via the ventricular septal defect and through the over-riding aorta. This is known as a _______ shunt

Tetralogy of Fallot

low oxygenated blood

left ventricle

right-to-left

14

Pulse pressure is calculated as ____?

Difference between the systolic pressure and the diastolic pressure (SP-DP).

15

Atherosclerosis is commonly promoted by ________

It is characterized by the formation of ______, eventually leading to _______

sustained hypertension, high level of LDL, low level of HDL in blood plasma

multiple plaques within the arteries (atheromas)

ischemia

16

Myocarditis is __________. It often resembles heart attack except that ______________. It is often caused by _____ reaction, triggered by _________. Left untreated, it has the potential to develop into _________ cardiomyopathy

inflammation of heart muscle (myocardium)

coronary arteries are not blocked

auto-immune

prior recent infection with streptococcus bacteria or Coxsackie virus

dilated

17

Rheumatic Fever is believed to be caused by _________ and can involve organs/tissues including __________. It is responsible for many cases of damaged _______

antibody cross-reactivity with streptococcal antigens

joints, skin, heart, brain

heart valves

18

Abnormal blood flow in congenital heart defects such as patent foramen ovale or patent ductus arteriosis start off as a _______ shunt but then reverse after a few decades.

left-to-right

19

List and describe layers of the heart from exterior to interior

epicardium - visceral layer of serous pericardium
myocardium - cardiac muscle layer
endocardium - chamber lining & valves

20

List risk factors associated with aneurysm development

diabetes

obesity,

hypertension

tobacco use

alcoholism

copper deficiency

Adult Polycystic Kidney Disease

21

The phase in the cardiac cycle when the mitral valve is closed and the aortic valve is open is the _______

systolic ejection phase

22

Define Orthopnea. What cardiovascular disorder does its presence indicate?

shortness of breath in the supine position

Left CHF

23

Rheumatic Fever (RF) may develop after a ______ infection.

Group A Beta-hemolytic streptococcal infection

24

In cardiac output, what can influence the Preload?

amount of stretching of cardiac muscle

25

________hypertension indicates that the high blood pressure is a result of another condition. List the possible causes.

Secondary

1) anatomical cause - coarctation of aorta
2) renal causes - renal artery stenosis, adult polycystic KD disease
3) adrenal causes - Cushing's syndrome, Cushing's diease, pheochromocytoma
4) neurogenic / thyroid causes

26

In the normal cardiac cycle, the End diastolic volume (EDV) is about ___ml while the End systolic volume (ESV) is about ___ ml. The stroke volume is defined as ______

130 ml
60ml
EDV - ESV

27

T/F AF is most common in the elderly

True

28

1st degree conduction block shows an extended ____ interval in ECG

P-R

29

What are risk factors for atherosclerosis?

- males, age, family history, HTN, High total cholesterol, and LDL with low HDL, smoking, diabetes mellitus

30

List the types of IHD

Stable Angina Pectoris

Unstable Angina Pectoris

Prinzmetal Angina

Myocardial Infarction

Sudden Cardiac Death Syndrome

31

Describe systemic blood circulation

left ventricle pumps oxygenated blood into aorta
aorta branches into many arteries that travel to organs
arteries branch into arterioles in tissue
arterioles branch into capillaries
deoxygenated blood begins return into venules
venules merge into veins and return to right atrium

32

How can Rheumetic Fever be prevented?

- long term antibiotic (e.g. long acting penicillin monthly for 5 years)

- in case of carditis, antibiotic treatment for up to 40 years

-screening of school-aged children for sore throat

33

Describe the difference between Stable and Unstable Angina Pectoris

Stable Angina Pectoris is ischemic chest pain upon exertion of predictable amount for not more than 15-20 minutes. Unstable Angina Pectoris is ischemic chest pain for not more than 15-20 minutes, occuring either with exertion or at rest

34

What is the difference 1st, 2nd degree conduction block?

Rhythm is still sinus but the propagation is delayed from atria to the ventricles

35

In cardiac output, what can influence contractility?

autonomic nerves, hormones, CA2+ or K+

36

Hypertrophic cardiomyopathy is caused by __________ leading to _________

genetic factors

thickening of heart muscle

37

The three types of cardiomyopathy are ________. Describe the effect each has on preload and cardiac output./stroke volume

dilated cardiomyopathy - increased preload, reduced cardiac output

hypertrophic cardiomyopathy - decreased preload, reduced cardiac output

restrictive cardiomyopathy - decreased preload, reduced cardiac output

38

The most frequent site of aneurysm is in the __________. Most non-intracraneal aneurysms arise distal to the origin of the renal arteries at the __________ Aneurysms can also occur in the _______aorta and in the deep vessels of the legs, e.g. ______

anterior cerebral artery from the circle of Willis

infrarenal abdominal aorta

thoracic

popliteal vessels

39

List the 4 Anomalies/Defects of Tetralogy of Fallot

Pulmonary stenosis - in PA

RVH [right ventricular hypertrophy]

VSD [ventricular septal defect]

Overriding Aorta (dextra-position)

40

Restrictive cardiomyopathy is caused by _________ and leads to __________

depositions of various agents due to inflammatory response

stiffening of ventricle walls

41

Ischemic pain is often described as _________ while pericardial pain is often described as ____________

heavy, stone-like crashing pain

sharp, stabbing pain radiating to the back and relieved by sitting up forward and worsened by lying down

42

Describe septic shock

bacterial toxins caused dilation of peripheral arterioles

43

In an electrocardiogram, the P wave denotes _____ while the QRS complex denotes ________

atrial depolarization
ventricular depolarization

44

Define pulmonary embolism and where it comes from.

Blood clot that obstructs the pulmonary arteries in the lung. They come from the pulmonary artery.

45

Pericarditis is _________. It can be classified according to ___________________

inflammation

composition of inflammatory exudate, duration, causative factor

46

The _______ muscles attach to the atrioventricular valves via the __________ and contract to prevent inversion or prolapse of these valves

papillary
chordae tendineae

47

(T/F) Atherosclerosis is a form of arteriosclerosis

T

48

What is the major cause of pulmonary embolism?

List risk factors of pulmonary embolism.

*DVT (deep vein thrombosis)

4 F's (fat forty female fertile)

Cancer

Prolonged immobility

CHF

MI

Stroke

Fracture of long bone/hip

Major Surgery

Blood disorders - e.g. renal cell carcinoma, polycythemia rubra vera

49

In the cardiac cycle, ventricular systole is the period when ________

ventricles pump blood into pulmonary trunk / ascending aorta

50

Endocarditis is an inflammation of _____. The most common structures involved are __________. It is characterized by prototypic lesion aka __________, which is a mass of _________. This mass has the potential to cause ___________

endocardium - inner layer of the heart

the heart valves

the vegetation

platelets, fibrin, microcolonies of microbes, scant inflammatory cells

embolic stroke

51

An aneurysm is ____________ caused by _________

localized, blood-filled dilation of a blood vessel

disease or weakening of the vessel wall

52

List general clinical features of shock

hypotension

tachycardia

altered mental status

decreased urinary output

cool, clammy skin

53

Cardiac output = ______


Stroke volume (SV) * Heart Rate (HR)

54

Arteriosclerosis is a general term describing ________.
Atherosclerosis is a hardening of an artery due to _________.

any hardening of medium or large arteries

an atheromatous plaque

55

Cardiac reserve = _____
In the average person, cardiac reserve is _____
In atheletes, cardiac reserve is _______

maximum output / output at rest

4-5

7-8

56

Cardiomyopathy is very commonly accompanied by what condition? As a result, it may lead to what other conditions?

arterial hypertension

end-stage CHF, sudden cardiac arrest

57

List and define influences on Stroke Volume

Preload - affect of stretching

Contractility - force of contraction

Afterload - amount of pressure created by blood resisting flow

58

In cardiac output, what can influence afterload?

arterial blood pressure in diastole

Peripheral vascular resistance

59

Clinical features of systemic hypertension include _______

asymptomatic in mild to moderate HTN, late stage HTN is associated with headache, somnolence, confusion, visual disturbances, nausea, vomiting

60

Pericarditis is a common complication of ________ but can also be caused by ______________

myocardial infarction

microbial infection, trauma to heart, malignancy, medications

61

Describe pulmonary blood circulation

right side of HT pumps deoxygenated blood to LU
right ventricle pumps blood to pulmonary trunk
pulmonary trunk branches into pulmonary arteries
pulmonary arteries carry blood to LU for exchange of gases
oxygenated blood returns to HT in pulmonary veins

62

Heart rate is regulated by what part of brain stem? Which nervous system?

cardiovascular center in medulla oblongata

ANS

63

Ischemic heart disease aka __________ is characterized by ________, usually due to ___________

myocardial ischemia

reduced blood supply to the heart muscle

coronary artery disease

64

90-95% of hypertension is ________ hypertension. Its etiology is _________

essential aka primary

idiopathic

65

In the cardiac cycle, isovolumetric contraction is the period when _____

atria, ventricles are all in contraction and AV/SL valves are closed

66

Describe pathogenesis of systemic hypertension

Kidney receives less blood supply per unit of time and activates secretion of renin --> angiotensin I --> angiotensin II --> aldosterone --> ADH --> increased osmolarity and blood volume along with increased vascular resistance/pressure

67

List the phases of the cardiac cycle

Isovolumetric relaxation
Ventricular filling
Atrial systole
Isovolumetric contraction
Ventricular systole

68

The most common cause of secondary systemic arterial hypertension is:

Kidney disease

69

Lung edema is an expected complication of ____.

Left CHF

70

What are the major types of shock? What are their etiologies?

Hypovolemic - blood/fluid loss

Cardiogenic - cardiac tamponade, thrombosis, MI, carditis, CHF

Distributive - dilation of peripheral arterioles

71

Clinical presentations of RHF are _____________

peripheral edema, nocturia, ascites, hepatomegaly, jaundice, portal hypertension

72

What are of the most common complications of MI?

Arrhythmias (more specifically VF) and HF.

73

About 40% of cases of dilated cardiomyopathy are ______ in nature. Other causes of dilated cardiomyopathy include ____________

familial

pregnancy, alcoholism, toxic, metabolic, or infectious agents

74

Confirmation of MI diagnosis requires ____________

1) ECG

2) cardiac enzymes blood level elevation: troponin, creatine kinase B

3) clinical presentation

75

The most common cause of left CHF is _______
The most common cause of right CHF is _______

Arterial hypertension

Left CHF

76

The most common etiology of ectopic arrhythmia is _______

hypoxia

77

SA node fires spontaneously ____ times per minute
AV node fires at ______ times per minute

60-100
40-60

78

The duration of ischemic pain is _______ while duration of myocardial infarction pain is _________

20 minutes
several hours

79

Diagnosis of IHD is based on _________

clinical presentations, ECG, blood tests of MI markers, ultrasound, chest X-ray studies

80

Ectopic pacemakers are _____ and can be caused by stimulants including _____

extra beats forming at other sites of the HT

caffeine, nicotine

81

Major diagnostic criteria for Rheumatic Fever are:

Migratory polyarthritis - large joints, starts at legs and migrating up (wind)

Carditis

Subcutaneous nodules - loc: back of wrist, outside elbow, front of knees

Erythema marginatum - rash on trunk, arms

Sydenham's chorea (St. Vitus' Dance) - neurological presentation (pop and lock) occurs late

82

The first heard sound ("lub") is associated with the ____

closing of the AV valves

(Tricuspid and Mitral Valves)

83

Buerger's disease presents with _____________. The main symptom is ___________ which occurs in episodes upon exertion (aka ____________) due to severe obstruction with ischemia.The only proven treatment for Beurger's disease is ________

inflammation and thrombosis of arteries and veins of the hands and feet.

pain in the affected areas

claudication

smoking cessation

84

In the cardiac cycle, ventricular filling is the period when _____

blood flows from full atria into ventricle

diastasis - blood trickles into ventricle

atrial systole - pumps final 20-25ml blood into ventricle