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Circulation Part 2 > First Aid Review > Flashcards

First Aid Review Flashcards

(90 cards)

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1
Q

A patient who presents with dysphagia and hoarseness may have an enlargement of _ which compresses the _ and _

A

A patient who presents with dysphagia and hoarseness may have an enlargement of left atrium which compresses the esophagus and left recurrent laryngeal nerve
* Ex: mitral stenosis

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2
Q

The LAD supplies three areas:

A

The LAD supplies
1. Anterior 2/3 of IV septum
2. Anterolateral papillary muscle
3. Anterior surface of the left ventricle

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3
Q

The most commonly occluded coronary artery is _

A

The most commonly occluded coronary artery is LAD

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4
Q

The PDA supplies 4 areas:

A

The PDA supplies 4 areas:
1. AV node
2. Posterior 2/3 IV septum
3. Posterior ventricles
4. Posteromedial papillary muscle

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5
Q

Coronary blood flow peaks during _

A

Coronary blood flow peaks during early diastole

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6
Q

The RCA supplies 2 areas:

A

The RCA supplies:
1. SA node
2. Right ventricle

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7
Q

An infarct in the _ coronary artery tends to cause bradycardia or heart block

A

An infarct in the right coronary artery tends to cause bradycardia or heart block
* Due to its supply of the SA node
* This would be an inferior MI

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8
Q

Hydralazine is a drug that is administered during _ because of its _ effects

A

Hydralazine is a drug that is administered during hypertensive crisis because of its arterial vasodilating effects

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9
Q

Myocardial oxygen demand is determined by 4 factors:

A

Myocardial oxygen demand is determined by 4 factors:
1. Contractility
2. Afterload
3. Heart rate
4. Wall tension (radius)

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10
Q

Pulse pressure (PP) = ?

A

PP = SBP - DBP

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11
Q

When does the aortic valve open and close?

A
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12
Q

S1 is loudest in the _ area

A

S1 is loudest in the mitral area

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13
Q

S2 is loudest in the _ area

A

S2 is loudest in the left upper sternal border

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14
Q

S3 is heard in (early/ late) diastole

A

S3 is heard in early diastole
* It is heard during the rapid ventricular filling phase
* Common in dilated ventricles
* Pathologies: mitral regurgitation, aortic regurgitation, systolic heart failure

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15
Q

S3 can be normal in _ individuals

A

S3 can be normal in children, young adults, athletes, pregnant women

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16
Q

S4 is heard during (early/late) diastole

A

S4 is heard during late diastole
* Associated with the atrial kick
* Atria kicks into a noncompliant ventricle
* Associated with hypertrophy

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17
Q

JVP waveform: the a wave represents _

A

JVP waveform: the a wave represents atrial contraction

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18
Q

An absent a wave:

A

An absent a wave: atrial fibrillation

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19
Q

JVP waveform: the c wave represents _

A

JVP waveform: the c wave represents right ventricle contracting (Tricuspid bulging into atrium)
* C = cusp

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20
Q

The x descent represents _

A

The x descent represents rapid ventricular ejection phase when tricuspid is closed

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21
Q

The x descent is absent in _

A

The x descent is absent in tricuspid regurgitation

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22
Q

The v wave represents _

A

The v wave represents atrial filling

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23
Q

y descent represents _

A

y descent represents right atrium emptying into right ventricle

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24
Q

Prominent or steep y descent is seen in _

A

Prominent or steep y descent is seen in constrictive pericarditis
* Recall that we want to fill during early diastole!

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25
An absent y descent is seen in _
An absent y descent is seen in **cardiac tamponade**
26
Aortic stenosis
27
Aortic regurgitation * There is no true isovolumetric phase (mitral is open when it should not be)
28
Mitral regurgitation * There is no true isovolumetric phase
29
Mitral stenosis
30
Aortic stenosis: ESV EDV
Aortic stenosis: ESV **increased** EDV **unchanged**
31
Mitral regurgitation ESV EDV
Mital regurgitation ESV **decreased** (less resistance during systole) EDV **increased** (due to extra volume from RA regurg)
32
Mitral stenosis ESV EDV
Mitral stenosis ESV **decreased** EDV **decreased**
33
Aortic regurgitation ESV EDV
Aortic regurgitation ESV **unchanged** EDV **increased**
34
Stenosis will _ stroke volume, while regurgitation will _ stroke volume
Stenosis will **decrease** stroke volume, while regurgitation will **increase** stroke volume
35
Wide splitting of the S2 occurs in conditions that delay _
Wide splitting of the S2 occurs in conditions that delay **pulmonic valve closure/ RV emptying**
36
Two conditions in which we might see wide splitting of S2:
Two conditions in which we might see wide splitting of S2: 1. **Pulmonic stenosis** 2. **Right bundle branch block**
37
Fixed splitting means that S2 is split during _ and _
Fixed splitting means that S2 is split during **inspiration** and **expiration**
38
We hear fixed splitting of S2 during _
We hear fixed splitting of S2 during **ASD** * The L --> R shunt causes extra blood in RV and delay in pulmonic valve closure
39
Paradoxical splitting is heard in conditions that _
Paradoxical splitting is heard in conditions that **delay aortic valve closure** * Expiration will cause the louder split
40
ASD can be heard over _ area
ASD can be heard over **pulmonic area** * Think of the extra blood traveling through pulmonic valve
41
Mitral valve prolapse is best heard in _ area
Mitral valve prolapse is best heard in **mitral** area
42
VSD is best heard in _ area
VSD is best heard in **tricuspid** area * Think of the extra blood traveling L --> R
43
Three murmurs that are best heard over Erb's point
Three murmurs that are best heard over Erb's point 1. **Aortic regurgitation** 2. **Pulmonic regurgitation** 3. **HOCM**
44
Crescendo-decrescendo murmur heard during systole over the left sternal boarder: _
Crescendo-decrescendo murmur heard during systole over the left sternal boarder: **HOCM** * Recall that HOCM and aortic stenosis sound the same * Aortic stenosis will be heard over aortic area * Also HOCM is louder with low preload (standing)
45
The two murmurs that will sound louder with *decreased preload* include _ and _
The two murmurs that will sound louder with *decreased preload* include **HOCM** and **mitral valve prolapse**
46
Hand grip will cause HOCM and mitral valve prolapse to sound (quieter/louder)
Hand grip will cause HOCM and mitral valve prolapse to sound **quieter** * Hand grip --> increases afterload --> keeps more blood in the ventricle --> makes these murmurs sound quieter
47
LV pressure greater than aortic pressure during systole describes _
LV pressure greater than aortic pressure during systole describes **aortic stenosis**
48
Murmur that radiates to the carotids:
Murmur that radiates to the carotids: **aortic stenosis**
49
Holosystolic "blowing" murmur
Holosystolic "blowing" murmur: **mitral or tricuspid regurgitation**
50
Murmur that is "loudest at apex and radiates to the axilla"
Murmur that is "loudest at apex and radiates to the axilla": **mitral regurgitation**
51
Late systolic crescendo murmur with midsystolic click
Late systolic crescendo murmur with midsystolic click: **mitral valve prolapse**
52
The midsystolic click in MVP is the sound of _
The midsystolic click in MVP is the sound of **sudden tensing of chordae tendineae**
53
Carotid pulse is weak with a delayed peak
Carotid pulse is weak with a delayed peak: **aortic stenosis** * Called *pulsus parvus et tardus*
54
60+ year old patient presents with syncope, angina, dyspnea with a murmur
60+ year old patient presents with syncope, angina, dyspnea with a murmur: **aortic stenosis** * SAD: three cardinal signs of aortic stenosis * Very common in older adults * Due to age-related calcification * In younger patients often due to bicuspid aortic valve
55
Holosystolic "harsh-sounding murmur"
Holosystolic "harsh-sounding murmur": **VSD** * Loudest at the tricuspid area
56
Caused by myxomatous degeneration
Caused by myxomatous degeneration: **mitral valve prolapse** * Associated with connective tissue disease: Marfan, Ehlers-Danlos * Also associated with rheumatic fever
57
Head bobbing:
Head bobbing: **aortic regurgitation**
58
Patient has a pulse of 150/50
Patient has a pulse of 150/50 --> *wide pulse pressure* --> **aortic regurgitation** * Aortic valve open when it shouldn't be --> open during diastole --> blood from aorta goes to LV --> leaves the systemic pressure very low during diastole --> wide pulse pressure
59
Opening snap:
Opening snap: **mitral stenosis**
60
Left atrium has a higher pressure than left ventricle during diastole describes _
Left atrium has a higher pressure than left ventricle during diastole describes **mitral stenosis**
61
Continuous machine like murmur
Continuous machine like murmur: **PDA**
62
PDA is best heard in _ area
PDA is best heard in **infraclavicular area**
63
PDA is loudest at (S1/S2)
PDA is loudest at **S2**
64
"irregularly, irregular rhythm"
"irregularly, irregular rhythm" **atrial fibrillation** * No P waves * Irregularly spaced QRS waves
65
Erratic rhythm with no identifiable waves
Erratic rhythm with no identifiable waves: **ventricular fibrillation**
66
"egg on a string" on chest xray
"egg on a string" on chest xray: **transposition of great vessels**
67
Tetralogy of fallot is caused by _
Tetralogy of fallot is caused by **anterosuperior displacement of the infundibular septum**
68
Normal PR interval
120-200 ms
69
Normal QRS complex width
< 100 ms
70
WPW involves an abnormal accessory pathway called the bundle of kent that is (faster/ slower) than the AV node
WPW involves an abnormal accessory pathway called the bundle of kent that is **faster** than the AV node --> pre-excitation
71
Most common risk factors of atrial fibrillation are _ and _
Most common risk factors of atrial fibrillation are **hypertension** and **coronary artery disease**
72
How do ANP and BNP work?
Released from atria and ventricles in response to high blood volume and pressure --> Acts via **cGMP --> vasodilation** and also **decreased Na+ reabsorption**
73
Progression of atherosclerosis
1. Endothelial cell dysfunction 2. Macrophage and LDL accumulation 3. Foam cell formation 4. Fatty streaks 5. Smooth muscle cell migration (PDGF, FGF) 6. Proliferation 7. ECM deposition 8. Fibrous plaque 9. Complex atheromas 10. Calcification
74
Cardiac troponin rises after _ hours, peaks at _ , and decreases after _
Cardiac troponin rises after **4 hours**, peaks at **24 hours** , and decreases after **7-10 days**
75
CK-MB rises after _ , peaks at _ , and decreases after _
CK-MB rises after **6-12 hours** , peaks at **24 hours** , and decreases after **48 hours**
76
Cardiac arrhythmias post MI are significant bc _
Cardiac arrhythmias post MI are **important cause of death before reaching the hospital** and **within 24 hours post-MI**
77
Pericarditis usually develops _ days after MI
Pericarditis usually develops **1-3 days** after MI * Involves a friction rub
78
Papillary muscle ruptures occur within _ days post MI
Papillary muscle ruptures occur within **3-7 days** post MI
79
IV septal ruptures occur _ days post-MI
IV septal ruptures occur **3-5 days** post-MI
80
Papillary muscle tears are most common in posteromedial papillary muscle and can result in _
Papillary muscle tears are most common in posteromedial papillary muscle and can result in **severe mitral regurgitation**
81
Ventricular pseudoaneurysm formation is most likely _ day post-MI
Ventricular pseudoaneurysm formation is most likely **3-14 days** post-MI
82
Ventricular free wall rupture is most common _ days post-MI
Ventricular free wall rupture is most common **2-14 days** post-MI --> cardiac tamponade
83
The most common type of cardiomyopathy is _
The most common type of cardiomyopathy is **dilated cardiomyopathy**
84
Dilated cardiomyopathy (90% of cases) is often idiopathic or familial due to a mutation in _
Dilated cardiomyopathy (90% of cases) is often idiopathic or familial due to a mutation in ***TTN*** **gene encoding sarcomeric protein titin**
85
Etiologies of dilated cardiomyopathy
Alcohol Beriberi Chagas Cocaine Coxsackie B Doxorubicin Others: hemochromatosis, sarcoidosis, peripartum
86
Hypertrophic obstructive cardiomyopathy is usually caused by mutation in genes encoding _ or _
Hypertrophic obstructive cardiomyopathy is usually caused by mutation in genes encoding **beta myosin heavy chain** or **myosin binding protein C**
87
"HF cells" in the lungs (pulmonary edema)
Hemosiderin-laden macrophages
88
ECG findings with cardiac tamponade
Low voltage QRS and electrical alterans due to "swinging" movement of the heart within fluid
89
Three common pathogens associated with IVDU induced IE
1. Staph aureus 2. Pseudomonas 3. Candida
90
Most myxomas occur in the _
Most myxomas occur in the **left atrium**

Circulation Part 2 (15 decks)

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