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Circulation Part 2 > First Aid Review > Flashcards

First Aid Review Flashcards

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
Q

An absent y descent is seen in _

A

An absent y descent is seen in cardiac tamponade

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26
Q
A

Aortic stenosis

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27
Q
A

Aortic regurgitation
* There is no true isovolumetric phase (mitral is open when it should not be)

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28
Q
A

Mitral regurgitation
* There is no true isovolumetric phase

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29
Q
A

Mitral stenosis

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30
Q

Aortic stenosis:
ESV
EDV

A

Aortic stenosis:
ESV increased
EDV unchanged

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31
Q

Mitral regurgitation
ESV
EDV

A

Mital regurgitation
ESV decreased (less resistance during systole)
EDV increased (due to extra volume from RA regurg)

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32
Q

Mitral stenosis
ESV
EDV

A

Mitral stenosis
ESV decreased
EDV decreased

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33
Q

Aortic regurgitation
ESV
EDV

A

Aortic regurgitation
ESV unchanged
EDV increased

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34
Q

Stenosis will _ stroke volume, while regurgitation will _ stroke volume

A

Stenosis will decrease stroke volume, while regurgitation will increase stroke volume

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35
Q

Wide splitting of the S2 occurs in conditions that delay _

A

Wide splitting of the S2 occurs in conditions that delay pulmonic valve closure/ RV emptying

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36
Q

Two conditions in which we might see wide splitting of S2:

A

Two conditions in which we might see wide splitting of S2:
1. Pulmonic stenosis
2. Right bundle branch block

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37
Q

Fixed splitting means that S2 is split during _ and _

A

Fixed splitting means that S2 is split during inspiration and expiration

38
Q

We hear fixed splitting of S2 during _

A

We hear fixed splitting of S2 during ASD
* The L –> R shunt causes extra blood in RV and delay in pulmonic valve closure

39
Q

Paradoxical splitting is heard in conditions that _

A

Paradoxical splitting is heard in conditions that delay aortic valve closure
* Expiration will cause the louder split

40
Q

ASD can be heard over _ area

A

ASD can be heard over pulmonic area
* Think of the extra blood traveling through pulmonic valve

41
Q

Mitral valve prolapse is best heard in _ area

A

Mitral valve prolapse is best heard in mitral area

42
Q

VSD is best heard in _ area

A

VSD is best heard in tricuspid area
* Think of the extra blood traveling L –> R

43
Q

Three murmurs that are best heard over Erb’s point

A

Three murmurs that are best heard over Erb’s point
1. Aortic regurgitation
2. Pulmonic regurgitation
3. HOCM

44
Q

Crescendo-decrescendo murmur heard during systole over the left sternal boarder: _

A

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
Q

The two murmurs that will sound louder with decreased preload include _ and _

A

The two murmurs that will sound louder with decreased preload include HOCM and mitral valve prolapse

46
Q

Hand grip will cause HOCM and mitral valve prolapse to sound (quieter/louder)

A

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
Q

LV pressure greater than aortic pressure during systole describes _

A

LV pressure greater than aortic pressure during systole describes aortic stenosis

48
Q

Murmur that radiates to the carotids:

A

Murmur that radiates to the carotids: aortic stenosis

49
Q

Holosystolic “blowing” murmur

A

Holosystolic “blowing” murmur: mitral or tricuspid regurgitation

50
Q

Murmur that is “loudest at apex and radiates to the axilla”

A

Murmur that is “loudest at apex and radiates to the axilla”: mitral regurgitation

51
Q

Late systolic crescendo murmur with midsystolic click

A

Late systolic crescendo murmur with midsystolic click: mitral valve prolapse

52
Q

The midsystolic click in MVP is the sound of _

A

The midsystolic click in MVP is the sound of sudden tensing of chordae tendineae

53
Q

Carotid pulse is weak with a delayed peak

A

Carotid pulse is weak with a delayed peak: aortic stenosis
* Called pulsus parvus et tardus

54
Q

60+ year old patient presents with syncope, angina, dyspnea with a murmur

A

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
Q

Holosystolic “harsh-sounding murmur”

A

Holosystolic “harsh-sounding murmur”: VSD
* Loudest at the tricuspid area

56
Q

Caused by myxomatous degeneration

A

Caused by myxomatous degeneration: mitral valve prolapse
* Associated with connective tissue disease: Marfan, Ehlers-Danlos
* Also associated with rheumatic fever

57
Q

Head bobbing:

A

Head bobbing: aortic regurgitation

58
Q

Patient has a pulse of 150/50

A

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
Q

Opening snap:

A

Opening snap: mitral stenosis

60
Q

Left atrium has a higher pressure than left ventricle during diastole describes _

A

Left atrium has a higher pressure than left ventricle during diastole describes mitral stenosis

61
Q

Continuous machine like murmur

A

Continuous machine like murmur: PDA

62
Q

PDA is best heard in _ area

A

PDA is best heard in infraclavicular area

63
Q

PDA is loudest at (S1/S2)

A

PDA is loudest at S2

64
Q

“irregularly, irregular rhythm”

A

“irregularly, irregular rhythm” atrial fibrillation
* No P waves
* Irregularly spaced QRS waves

65
Q

Erratic rhythm with no identifiable waves

A

Erratic rhythm with no identifiable waves: ventricular fibrillation

66
Q

“egg on a string” on chest xray

A

“egg on a string” on chest xray: transposition of great vessels

67
Q

Tetralogy of fallot is caused by _

A

Tetralogy of fallot is caused by anterosuperior displacement of the infundibular septum

68
Q

Normal PR interval

A

120-200 ms

69
Q

Normal QRS complex width

A

< 100 ms

70
Q

WPW involves an abnormal accessory pathway called the bundle of kent that is (faster/ slower) than the AV node

A

WPW involves an abnormal accessory pathway called the bundle of kent that is faster than the AV node –> pre-excitation

71
Q

Most common risk factors of atrial fibrillation are _ and _

A

Most common risk factors of atrial fibrillation are hypertension and coronary artery disease

72
Q

How do ANP and BNP work?

A

Released from atria and ventricles in response to high blood volume and pressure –>
Acts via cGMP –> vasodilation and also decreased Na+ reabsorption

73
Q

Progression of atherosclerosis

A
  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
Q

Cardiac troponin rises after _ hours, peaks at _ , and decreases after _

A

Cardiac troponin rises after 4 hours, peaks at 24 hours , and decreases after 7-10 days

75
Q

CK-MB rises after _ , peaks at _ , and decreases after _

A

CK-MB rises after 6-12 hours , peaks at 24 hours , and decreases after 48 hours

76
Q

Cardiac arrhythmias post MI are significant bc _

A

Cardiac arrhythmias post MI are important cause of death before reaching the hospital and within 24 hours post-MI

77
Q

Pericarditis usually develops _ days after MI

A

Pericarditis usually develops 1-3 days after MI
* Involves a friction rub

78
Q

Papillary muscle ruptures occur within _ days post MI

A

Papillary muscle ruptures occur within 3-7 days post MI

79
Q

IV septal ruptures occur _ days post-MI

A

IV septal ruptures occur 3-5 days post-MI

80
Q

Papillary muscle tears are most common in posteromedial papillary muscle and can result in _

A

Papillary muscle tears are most common in posteromedial papillary muscle and can result in severe mitral regurgitation

81
Q

Ventricular pseudoaneurysm formation is most likely _ day post-MI

A

Ventricular pseudoaneurysm formation is most likely 3-14 days post-MI

82
Q

Ventricular free wall rupture is most common _ days post-MI

A

Ventricular free wall rupture is most common 2-14 days post-MI –> cardiac tamponade

83
Q

The most common type of cardiomyopathy is _

A

The most common type of cardiomyopathy is dilated cardiomyopathy

84
Q

Dilated cardiomyopathy (90% of cases) is often idiopathic or familial due to a mutation in _

A

Dilated cardiomyopathy (90% of cases) is often idiopathic or familial due to a mutation in TTN gene encoding sarcomeric protein titin

85
Q

Etiologies of dilated cardiomyopathy

A

Alcohol
Beriberi
Chagas
Cocaine
Coxsackie B
Doxorubicin

Others: hemochromatosis, sarcoidosis, peripartum

86
Q

Hypertrophic obstructive cardiomyopathy is usually caused by mutation in genes encoding _ or _

A

Hypertrophic obstructive cardiomyopathy is usually caused by mutation in genes encoding beta myosin heavy chain or myosin binding protein C

87
Q

“HF cells” in the lungs (pulmonary edema)

A

Hemosiderin-laden macrophages

88
Q

ECG findings with cardiac tamponade

A

Low voltage QRS and electrical alterans due to “swinging” movement of the heart within fluid

89
Q

Three common pathogens associated with IVDU induced IE

A
  1. Staph aureus
  2. Pseudomonas
  3. Candida
90
Q

Most myxomas occur in the _

A

Most myxomas occur in the left atrium

Circulation Part 2 (15 decks)

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