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Step 1 (Steffanie) > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What are the 4 abnormalities that characterize Tetrology of Fallot

A
  1. VSD
  2. Overriding aorta over the right and left ventricles
  3. Right ventricular outflow tract obstruction
  4. Right ventricular hypertrophy
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2
Q

What is the embryologic mechanism that causes TOF?

A

Deviation of the infundibular septum

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3
Q

What forms most of the inferior surface of the heart? Which vessel supplies this area?

A

Inferior wall of the left ventricle. Supplied by the posterior descending artery, which derives from the right coronary artery in 85-90% of people (right dominant)

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4
Q

What is the pathogenesis of an abdominal aortic aneurysm?

A

oxidative stress, vascular smooth muscle apoptosis, and chronic transmural inflammation of the aorta.

Inflammatory cells release matrix metalloproteinases and elastases that degrade extracellular matrix components leading to weakening and progressive expansion of the aortic wall

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5
Q

First aortic arch

A

Regresses almost completely, gives rise to a portion of the maxillary artery

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6
Q

Third aortic arch

A

Forms the common and proximal internal carotid arteries

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7
Q

Fourth aortic arch

A

Part of the true aortic arch and subclavian arteries

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8
Q

Sixth aortic arch

A

Pulmonary arteries and the ductus arteriosus

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9
Q

Describe the murmur of aortic stenosis

A

Systolic ejection type, crescendo-decrescendo. Starts after the first heart sound and typically ends before the A2 component of the 2nd heart sound.

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10
Q

The intensity of the murmur of aortic stenosis is proportional to what?

A

The magnitude of the left ventricle to aorta pressure gradient during systole

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11
Q

Murmur of mitral valve stenosis

A

Opening snap following by a diastolic rumbling murmur best heard over the apex

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12
Q

What is the physiologic cause of a PFO?

A

Incomplete fusion of the septum primum and septum secundum

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13
Q

What causes ASD?

A

Aplasia of the septum primum or septum secundum during development

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14
Q

Mechanism of fibrates

A

They lower triglycerides by activating PPAR-alpha, which leads to decreased hepatic VLDL production and increased LPL activity

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15
Q

Rerpurfusion injury occurs secondary to what processes?

A

Oxygen free radical generation, mitochondrial damage, and inflammation

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16
Q

What genetic disorder is associated with coarctation of the aorta?

A

Turner Syndrome (45, XO)

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17
Q

Where do type A aortic dissections usually originate?

A

Ascending aorta, usually originates in the sinotubular junction

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18
Q

Where do type B aortic dissections usually originate?

A

Usually near the origin of the left subclavian artery

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19
Q

Cardiac auscultation for mitral stenosis

A

Loud first heart sound, an early diastolic opening snap after the second heart sound, and a low pitched diastolic rumble beast heard at the cardiac apex

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20
Q

What physical exam findings can be seen in patients with aortic regurgitation?

A

Bounding peripheral pulses and head bobbing with each heartbeat

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21
Q

How does atrial fibrillation present on ECG?

A

Absent P waves, irregularly irregular R-R intervals, and narrow QRS complexes

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22
Q

What mediates phase 0 depolarization in cardiac pacemaker cells?

A

Inward influx of calcium

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23
Q

What are the findings associated with cardiac tamponade?

A

Hypotension, elevated JVP, muffled heart sounds. Pulsus paradoxus. Echo shows pericardial fluid accumulation with late diastolic collapse of right atrium.

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24
Q

What is pulsus paradoxus?

A

Exaggerated drop in systolic BP (>10) during inspiration

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25
Q

When does dystrophic calcification occur?

A

In damaged or necrotic tissue in the setting of normal calcium levels

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26
Q

What causes an S3 sound?

A

Increased LA pressure

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27
Q

Janeway lesions

A

Nontender, macular, erythematous lesions typically located on the palms and soles of pts with acute infective endocarditis. Result of septic embolization from valvular vegitations

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28
Q

Flecainide

A

Class 1c antiarrhythmic used to treat supraventricular tachycardias such as those caused by atrial fibrillation. Block inward sodium current by binding fast sodium channels responsible for phase 0 depolarization. Exhibit use dependence - more intense effects at increased heart rate

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29
Q

Which congenital syndromes are associated with QT prolongation

A

Romano-Ward Syndrome (aut. dominant, no deafness) and Jervell and Lange-Nielsen Syndrome (aut. recessive, neurosensory deafness)

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30
Q

Why are patients with coarctation of the aorta at increased risk for ruptured intrancranial aneurysms?

A

Because of increased incidence of congenital berry aneurysms of the Circle of Willis as well as aortic arch HTN

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31
Q

Trousseau syndrome

A

Migratory superficial thrombophlebitis. Indication of visceral cancer (adenocarcinomas of pancreas, colon, lung)

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32
Q

Which bacteria can cause endocarditis in patients with pre-existing valvular lesions

A

Viridans streptococci

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33
Q

Which bacteria can cause endocarditis in intact valves?

A

Staph aureus

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34
Q

Hibernating myocardium

A

Presence of LV systolic dysfunction due to reduced coronary blood flow at rest that is partially or completely reversible by coronary revascularization

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35
Q

Name the class III antiarrhythmics

A

Amiodarone, sotalol, dofetilide

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36
Q

Mechanism of class III antiarrhythmics

A

Block potassium channels and inhibit the outward potassium currents during phase 3 of the cardiac action potential, thereby prolonging repolarization and total action potential duration

37
Q

Type I collagen

A

Most prevalant colalgen in the human body and primary collagen in mature scars

38
Q

How is carotid massage useful for termination of paroxysmal supraventricular tachycardia?

A

Leads to an increase in parasympathetic tone causing temporary inhibition of sinoatrial node activity, slowing of conduction through the AV node, and prolongation of the AV node refractory period

39
Q

What forms the majority of the posterior surface of the heart and is adjacent to the esophagus?

A

Left atrium

40
Q

What lies posterior to the esophagus and left atrium?

A

Descending thoracic aorta

41
Q

Mechanism of carotid sinus massage

A

Increases vagal parasympathetic tone, which slows conduction through the AV node and prolongs AV node refractory period

42
Q

Histology showing “areas of myocardium infiltrated by an amorphous and acellular pink material” indicates

A

Cardiac amyloidosis

43
Q

What complication can occur 5-14 days after an initial MI?

A

Left ventricular free wall rupture

44
Q

Biopsy findings in giant cell temporal arteritis

A

Granulomatous inflammation of the media

45
Q

Takayasu arteritis presentation

A

Predominantly in females under 40. May have low BP and pulses in UE as compared to LE and cold or numb fingers. Typically affects the aortic arch

46
Q

What is nitric oxide synthesized from?

A

Arginine, NADPH, and oxygen.

47
Q

Conversion of angiotensin I to angiotensin II

A

Occurs in small vessels of the lungs via endothelial bound angiotensin converting enzyme

48
Q

Failure of what embryologic process leads to transposition of the great arteries?

A

Spiraling. There is linear rather than spiral development of the aorticopulmonary septum in utero

49
Q

Describe the location of the aorta in TGA

A

Aorta is anterior, inferior, and to the right of the pulmonary artery

50
Q

What causes progressive eccentric hypertrophy of the LV?

A

Chronic volume overload

51
Q

What complication can varicose veins cause?

A

Venous stasis dermatitis

52
Q

Flow equation

A

Flow (Q) = P1-P2 x r^4/(viscosity)(length)

53
Q

What medications prolong the QT interval?

A

Certain antiarrhythmics (sotalol, quinidine), antipsychotics (haloperidol), and antibiotics (macrolides, fluoroquinolones)

54
Q

What is pathognomonic for acute rheumatic fever on myocardial biopsy?

A

Interstitial myocardial granuloma, or Aschoff body

55
Q

Presentation of acute rheumatic fever

A

Pancarditis causing nonspecific fever, fatigue, anorexia, tachycardia, tachypnea, hypotension.

56
Q

Lethargy, confusion, nausea, decreased appetite, vomiting , vision problems, arrhythmias, hyperkalemia. Signs of toxicity of what medication?

A

Digoxin

57
Q

Hormone sensitive lipase

A

Found in adipose tissue. Drives breakdown of stored triglycerides into free fatty acids and glycerol. In times of starvation, it provides substrates for hepatic gluconeogensis and ketone body formation

58
Q

early systolic, high frequency click over the right 2nd interspace

A

Bicuspid aortic valve

59
Q

Right-sided face and arm swelling and engorgement of subcutaneous veins on the same side of the neck

A

obstructed right brachiocephalic vein

60
Q

ST elevations in leads I and aVL

A

Occlusion of the left circumflex artery

61
Q

What supplies the lateral aspect of the left ventricle?

A

Left circumflex artery

62
Q

What is the most common heart defect in patients with Down Syndrome?

A

Complete AV canal defect - comprised of ASD, VSD, and a common AV valve

63
Q

Cannulation above the inguinal ligament can lead to what complication?

A

Retroperitoneal hemorrhage

64
Q

How long does it take for loss of cardiomyocyte contractility after onset of total ischemia?

A

60 seconds

65
Q

What are the most important factors involved in coronary blood flow autoregulation?

A

Adenosine and nitric oxide (NO)

66
Q

What are the most heavily involved vessels in humans with atherosclerotic plaques?

A

The abdominal aorta > coronary arteries > popliteal artery > internal carotid arteries > circle of Willis

67
Q

What are common complications of varicose veins?

A

Edema, stasis dermatitis, skin ulcerations, poor wound healing, and infections

68
Q

How is suspected carcinoid syndrome diagnosed?

A

Elevated 24-hour urinary 5-HIAA level

69
Q

What are the heart findings associated with carcinoid syndrome?

A

Pathognomonic plaque-like deposits of fibrous tissue occur most commonly on the endocardium, leading to tricuspid regurgitation, pulmonic valvulopathy, and right sided heart failure

70
Q

How does hyperplastic arteriosclerosis present?

A

Onion-like concentric thickening of the walls of arterioles

71
Q

What are the findings associted with a large PDA complicated by Eisenmenger syndrome?

A

Differential clubbing and cyanosis without blood pressure or pulse discrepancy

72
Q

What mediates calcium efflux from cardiac cells prior to relaxation?

A

Na+/Ca2+ exchange pump and sarcoplasmic reticulum Ca2+-ATPase pump

73
Q

Which cells in an atherosclerotic plaque are capable of synthesizing collagen and matrix components?

A

Vascular smooth muscle cells (VSMCs)

74
Q

Low pitched, holocystolic murmur at the left sternal border. Accentuates with handgrip maneuver.

A

Ventricular septal defect (VSD)

75
Q

Blood supply to posteromedial papillary muscle

A

Supplied solely by the posterior descending artery

76
Q

Best ausculatory indicator of the degree of mitral stenosis

A

Interval from S2 (A2 component) to opening snap

77
Q

Hypotension with pulsus paradoxus, elevated JVP, and muffled heart sounds

A

Beck’s triad. Presentation of cardiac tamponade

78
Q

Development of an atherosclerotic plaque

A

Activated macrophages, platelets, and endothelial cells release growth factors that stimulate recruitment of smooth muscle cells from the arterial wall media and their subsequent proliferation in the intima

79
Q

What causes dynamic left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy?

A

Due to abnormal systolic anterior motion of the anterior leaflet of the mitral valve toward a hypertrophied interventricular septum

80
Q

Concentric hypertrophy

A

Uniform thickening of the ventricular wall and narrowing of the ventricular cavity due to increased afterload (chronic HTN, aortic stenosis)

81
Q

Eccentric hypertrophy

A

Reduced ventricular wall thickness with an associated increase in chamber size due to volume overload

82
Q

Lipofuscin

A

Product of lipid peroxidation, accumulating in aging cells. Yellow-brown, finely granular perinuclear pigment

83
Q

Harsh, crescendo-decrescendo systolic ejection murmur heard best in the right intercostal space with radiation to the carotids

A

Aortic stenosis

84
Q

The ductus arteriousus is derived from which aortic arch?

A

6th

85
Q

Episodic, transient attacks of coronary vasospasm producing temporary transmural myocardial ischemia with ST-segment elevation

A

Prinzmetal (variant) angina

86
Q

Triggers for prinzmetal angina

A

Cigarette smoking, cocaine/amphetamines, and dihydroergotamines/triptans

87
Q

Treatment for prinzmetal angina

A

Tobacco/drug cessation and vasodilator therapy (nitrates, calcium channel blockers)

88
Q

Where are the structures located that mediate the pupillary light reflex

A

Upper midbrain

89
Q

What are the neural structures that mediate the direct and consensual pupillary light reflex

A

Optic nerve, pretectal nuclei, Edinger-Westphal nuclei, oculomotor nerve

Step 1 (Steffanie) (21 decks)

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