Cardiovascular Flashcards Preview

Uworld Journal > Cardiovascular > Flashcards

Flashcards in Cardiovascular Deck (86):
1

Failure to thrive + respiratory distress + machine-like murmur + palpable thrill over L infraclavicular border

Patent Ductus Arteriosus

2

Two main causes of cyanosis at birth

Transposition of the great arteries
Tetralogy of Fallot

3

Definition: Permissiveness

When one hormone allows another to exert its maximal effect.

4

First step in the pathogenesis of Coronary Artery Atherosclerosis?

Endothelial cell injury

5

Main difference - Skeletal muscle vs Cardiac/Smooth muscle

Skeletal muscle does not require external calcium for contraction. Cardiac and Smooth muscle undergo calcium-induced calcium release.

6

Mid-systolic click in murmur?

Mitral valve prolapse

7

Holosystolic murmur? (2)

-Mitral/Tricuspid regurgitation
-Ventral Septal Defect

8

Bounding femoral and carotid pulses + head bobbing + murmur

Aortic regurgitation

9

Congenital cardiac defect(s) associated with diabetic mothers (1)

Transposition of great vessels

10

Congenital cardiac defect(s) associated with Marfan Syndrome (4)

-Mitral Valve Prolapse
-Thoracic aortic aneurysm
-Thoracic aortic dissection
-Aortic regurgitation

11

Congenital cardiac defect(s) associated with Turner Syndrome (2)

-Aortic coarctation
-Bicuspid aortic valve

12

Congenital cardiac defect(s) associated with DiGeorge Syndrome (3)

-Tetralogy of Fallot
-Interrupted aortic arch
-Truncus arteriosus

13

Congenital cardiac defect(s) associated with Freidrich ataxia (1)

Hypertrophic cardiomyopathy

14

Congenital cardiac defect(s) associated with Fetal Alcohol Syndrome (4)

-Ventral Septal Defect
-Atrial Septal Defect
-Patent Ductus Arteriosus
-Tetralogy of Fallot

15

Cells involved in producing atheromas?

Endothelial cells
Leukocytes
Vascular smooth muscle cells

16

Types of vegetations found in subacute endocarditis?

Fibrin + platelets (thrombotic vegetations)

17

Flat facies, epicanthal folds, oblique palpebral fissures, single palmar crease, endocardial cushion defect =

Down syndrome (trisomy 21 via chromosomal nondisjunction)

18

Mechanism of diphtheria AB exotoxin

Active subunit A transfers a ribose from NAD onto histadine on Elongaton Factor 2. The ribosylation of EF-2 inhibits protein synthesis.

19

Myofibrillar dysarrray on light microscopy

Hypertrophic Cardiomyopathy

20

Lipofuscin - definition, where it is found

Product of lipid peroxidation, yellow-brown pigment. Accumulates in aging cells (heart, liver).

21

What parameter is most similar between the systemic and pulmonary circuits?

Blood flow per minute

22

Fracture of the pterion results in laceration of _ and formation of _ hematoma?

-Middle meningial artery
-Epidural hematoma

23

Wide fixed splitting of S2 is caused by?

Atrial Septal Defect

24

The significant increase in blood oxygen saturation between two right sided vessels/chambers indicates =

L->R shunt (most likely a VSD)

25

Pericardial friction rub 3 days after an acute MI is caused by =

fibrinous pericarditis as a reaction to transmural necrosis

26

Pericardial friction rub several weeks after an acute MI is caused by =

fibrinous pericarditis caused by an autoimmune reaction against the pericardium

27

10 yo + clubbing + cyanosis in toes only + exertional dyspnea and fatigue + no regular checkups + equal extremity pulses + no murmur =

Large PDA

differential cyanosis

28

Where is O2 extraction the highest?

Myocardium

29

63 yo male + progressive exertional dyspnea + orthopnea + hypertension + elevated JVP + pitting edema

Is his Ang II level elevated or decreased?

Ang II will be elevated

CHF -> decreased CO -> decreased RBF -> (+) JG apparatus -> renin -> Ang II + Aldo + ADH -> aberrant salt and fluid retention and vasoconstriction -> elevated BP

30

Right sided varicocele indicates occlusion of _

IVC - usually due to a renal malignancy that has spread to the right renal vein and then thrombosed into the IVC

31

Which holosystolic murmur increases intensity upon inspiration =

increases VR to the right heart

-Tricuspid regurgitation

32

Which murmur increases intensity on standing or doing a valsalva maneuver?

decreases VR

-Hypertrophic cardiomyopathy
-Mitral valve prolapse

33

Which murmur increases intensity on squatting ?

increases VR

-Aortic stenosis

34

Which murmur increases intensity on hand grip?

increases afterload

-Aortic regurgitation
-Mitral regurgitation
-VSD

35

2 most susceptible locations for atherosclerotic disease

-Lower abodminal aorta
-Coronary arteries

36

Traumatic aortic rupture from a MVA affects where on the aorta?

aortic isthmus - it is held by the ligamentum arteriosum and therefore is relatively immobile

37

Hypotension + elevated JVD + diminished heart sounds + no pulse on inspiration =

Cardiac tamponade

Beck's triad = hypotension + distended neck veins + distant heart sounds

no pulse on inspiration = Pulsus paradoxus

38

Cardiac sinus massage mechanism =

Increased firing of carotid sinus -> increased afferent (IX) firing -> medulla -> increased efferent (X) firing -> parasympathetic stimulation to the heart -> decreased AV node conduction -> terminates tachycardia

39

Ebstein's anomaly

ASD + no tricuspid valve

seen in lithium teratogenicity

40

beta-blocker effect on ECG =

slow AV conduction + prolongs AV nodal delay -> prolongs PR interval

41

Mechanism of ventricular free wall rupture leading to sudden death

rupture -> hemopericardium -> cardiac tamponade -> hypotension + shock -> pulseless activity -> death

42

earliest microscopic change seen in ischemic stroke in the brain =

in the heart =

@12 hours - red neurons

@4 hours - wavy myofibrils

43

JVP waveform:
- a wave =
- c wave =
-x descent =
- v wave =
-y descent =

-a wave = Atrial contraction
-c wave = RV contraction, tricuspid valve bulges into the atrium
-x descent = atrial relaXation
-v wave = atrial pressure increases as there is filling against a closed tricuspid valve
-y descent = RA emptying into RV

44

S4 or S3 in children - normal or pathological

S4 in children - always pathological
S3 in children - normal

45

ECG with delta wave + widened QRS + shortened PR interval =

Wolff-Parkinson White syndrome - ventricular pre-excitation syndrome, bypasses the rate-slowing AV node

46

Cherry hemangioma - population? progression?

-benign
-capillary hemangioma of the elderly
-does not regress

47

Strawberry hemangioma - population? progression?

-benin
-capillary hemagioma of infancy
-grows rapidly and then regresses spontaneously by 5-8 yo

48

Differences (1) and Similarities (4) between Temporal arteritis and Takayasu arteritis

Differences =
-location
Temporal arteritis - temporal artery
Takayasu arteritis - aortic arch + proximal great vessels

Similarities =
-large vessel vasculitis
-increased ESR
-granulomatous inflammation
-treatment - corticosteroids

49

"immune complex deposition-mediated transmural inflammationn of the arterial wall with fibrinoid necrosis" - what type of vasculitis?

Polyarteritis nodosa

50

"segmental thrombosing vasculitis of medium sized arteries" - what type of vasculitis?

Buerger disease. Also known as: thromboangiitis obliterans.

51

Biventricular pacemakers put leads to pace 3 locations

-RA
-RV
-RA -> coronary sinus (atrioventricular groove) -> lateral venous tributary -> LV

52

Thick band of atrial muscle that separates the smooth sinus venosus from the Right atrial appendage and atrium proper + site of origin of atrial pectinate muscle =

Crista terminalis

53

L/R atrial appendage =

Small sac-like structure in the atria that is susceptible to thrombus formation

54

Migratory thrombophlebitis indicates =

Visceral cancer (adenocarcinoma of the pancreas, colon or lung)

Trousseau syndrome - paraneoplastic hypercoagulability

55

Most common cause of death post-common femoral artery catheterization =

Retroperitoneal hemorrhage -> shock

56

-Painful thromboses
-Stasis dermatitis
-Skin ulceration
-Poor wound healing
-Superficial infections

These are complications of _

varicose veins

57

MI involving the RCA resulting in damage to the inferior wall may present as

Abdominal discomfort

58

Deep, broad Q waves on ECG indicates

prior/old MI

59

ANP - What triggers its release? What does it do?

Released when: increased atrial pressure, increased blood volume in heart

Actions: vasodilation, decreased sodium reabsorbed at the CD

60

Anemia causes increased or decreased CO?

Increased CO due to the reduced O2 carrying capacity of RBCs, more blood needs to be shunted past tissues to ensure appropriate oxygen delivery

61

2 vessels used for bypass surgery:

-Internal mammary artery
-Saphenous vein

62

Systolic murmurs and Diastolic murmurs

Systolic: AS, MR, TR, MVP, VSD

Diastolic: AR, MS

63

AV shunt hemodynamic changes (preload, afterload, SV)

-Because the AV shunt moves from the arteral system straight to the venous system, blood flow is much faster and at a higher volume returning to the heart -> increased preload

-Becauses the AV shunt bypasses the arterioles, there is a decrease in TPR -> decreased afterload

-Increased preload + Decreased afterload = Increased SV

64

Ortner Syndrome =

Mitral stenosis -> LA dilation -> impinges on the L recurrent laryngeal nerve -> hoarseness

65

Murmurs that decrease on squatting (2)

-Hypertrophic cardiomyopathy
-Mitral valve prolapse (mid-systolic click is closer to S1)

66

Buerger disease treatment =

Smoking cessation

67

Serious complication of Kawasaki disease =

Coronary artery aneurysm

68

Penetrating injury at the left sternal border at 4th and 2nd intercostal spaces:

@4th intercostal space (T4) = RV

@2nd intercostal space (T2) = pulmonary trunk

69

Dyslipidemia: associated with obesity and insulin resistance and increased VLDL in circulation

Type IV - familial hypertriglyceridemia
-Hepatic overproduction of VLDL
-AD

70

Dyslipidemia: premature peripheral vascular disease + tuberoeruptive and palmar xanthomas

Type III - familial dysbetalipoproteinemia
-Defective ApoE -> increased chylomicrons and VLDL remnants in circulation

71

Dyslipidemia: tendon xanthomas + xanthelasmas + corneal arcus

Type II - familial hypercholesterolemia
-AD
-Defective LDL receptor -> increased LDL and cholesterol in circulation
-Also presents with premature CAD in the family - MI before age of 20

72

Dyslipidemia: creamy supernatant + acute pancreatitis + eruptive skin xanthomas + AR

Type I - familial chylomicronemia
-Defective LPL -> increased in chylomicrons in circulation

73

“Polymorphic QRS complexes that change in amplitude and cycle length”

Torsades de Pointes

Always will have a prolonged QT as well - distinguishes TdP from other polymorphic ventricular tachycardias

74

Cardiac tissue conduction speeds

(Fastest) Purkinje > Atria > Ventricles > AV node (Slowest)

Park At Venture Avenue

75

Phenomenon where blood flow is diverted away from ischemic areas due to vasodilator action in nonischemic areas

Coronary steal syndrome - leads to hypoperfusion and worsening of existing ischemia

Concept used during stress testing to identify cardiac “lesions”

76

1 week old boy with an uncomplicated pregnancy and birth now has a harsh holosystolic murmur heard at the L mid to lower sternal border. His exam prior to leaving the hospital after birth had no cardiac findings. What is this new murmur?

-Small VSD - no symptoms/cyanosis, audible around age 4-10 days when PVR lowers enough to allow a L->R shunt
-Small VSDs close spontaneously

-A large VSD would have presented with failure to thrive right away and requires surgical intervention

77

Leukocytoclastic vasculitis

Microscopic polyangitis - segmental fibrinoid necrosis of small vessels

78

Portal vein = _ + _

Superior mesenteric vein + Splenic vein

79

Bicuspid aortic valve predisposes to an increased risk for developing _

premature aortic stenosis (~50 yo)

Normal aging stenosis of the aortic valve becomes symptomatic ~65 yo

80

Irregularly irregular rhythm - describe P waves, QRS, and R-R

-Absent P waves
-Narrow QRS
-Varying R-R interval

81

Nitrates cause increase/decrease in HR?

The hypotension caused by venodilation results in reflex tachycardia (increased HR)

82

Where is the great saphenous vein accessed to use in grafting?

inferolateral to the pubic tubercule
-travels up the leg medially
-the small saphenous vein is lateral

83

Middle meningial artery comes off of _ artery

External carotid -> maxillary artery -> middle meningial artery

84

pathology of an AAA

Chronic transmural inflammation of the aortic wall -> degradation of elastin and collagen -> wall weakening -> aneurysm

85

pathology of intermittent claudication

atheroscloerosis (lipid filled intimal plaque)

86

polyarteritis nodosa spares what arteries?

pulmonary arteries