M2 Cardiology Formatives Key Points

Question 1

Point on ECG Corresponding to Ventricle Ca+ Rise

Answer 1

QRS

Week 1

Question 2

Soft S1 Causes (4)

Answer 2

Leaflets Close Together

1) Long PR (1st Degree AV Block)
2) Severe Mitral Stenosis
3) Mitral Regurgitation
4) HTN (LVH)

Week 1

Question 3

Loud S1 Causes (3)

Answer 3

Leaflets Far Apart

1) Mild Mitral Stenosis
2) Short PR (Junctional Escape Rhythm)
3) High CO (Tachycardia for anemia/exercise)

Week 1

Question 4

Causes of Pathological S2 Splitting (3)

Answer 4

Fixed = ASD
Widened = RBBB + Pulmonic Stenosis
Paraxodical = LBBB + Aortic Stenosis 

Week 1

Question 5

S3 vs. S4 in CHF

Answer 5

S3 = Systolic Heart Failure 
S4 = Diastolic Heart Failure 

Week 1

Question 6

Long QT - Key Points (3)

Answer 6

1) Not Hypercalemia (Hypo)
2) Long Duration AP
3) Increase HR = Decrease Long QT

Week 1

Question 7

Isoprotenenol Keys (3)

Answer 7

1) Increase Chronotropy + Inotropy without Increase BP (decreases peripheral resistance
2) Not good for shock (no increase in BP)
3) Beta Selective

Week 1

Question 8

Alpha Blockers - Uses (4)

Answer 8

Resistant HTN
Pheochromocytoma
BPH
HTN Crisis

Week 1

Question 9

Phenylephrine Keys (2)

Answer 9

A1 Agonist - Used in Neurogenic Shock + Nasal De-congestion
Will Increase HTN/MI/Stroke

Week 1

Question 10

AE of Beta Blocker (4) vs. Alpha Blocker (2)

Answer 10

Alpha - Increased Ocular Pressure + Arrythmias
Beta - Bronchoconstriction + AV Block + HF + Sleep Issues

Week 1

Question 11

Elderly HTN (3) vs. Young HTN (3)

Answer 11

Elderly - Systolic with high pulse pressure + loss of vessel compliance
Young - Diastolic with low pulse pressure + increased risk of secondary cause

Week 1

Question 12

Hypovolemic Shock vs. Cardiogenic Shock vs. Septic - Swanz Ganz Changes

Answer 12

Hypovolumic - All Decrease (RA/RV + PA + Wedge)
Cardiogenic - All Increase (RA/RV + PA + Wedge)
Septic - No Change

Week 1

Question 13

Hydralazine - Key Points (3)

Answer 13

1) Vasodilator (NO Release)
2) Secondary/Resistant HTN in Africans
3) Pregnancy HTN with A-Methyldopa
4) SE = Headache + Symp Stim (Palpitation + High HR)

Week 1

Question 14

Adenosine - Key Points - Uses + Toxicity (4) + Contraindications (3)

Answer 14

1) First line for Supraventricular Tachycardia (Reentry + AVNRT + AVRT (Orthodontic) + Atrail Tachy)
2) Used with Vagal Massage + Valsalva
Toxicity = Chest Pain + Nausea + Flushing (Short-Lived) + Bronchspasm (Severe)
Contraindicated in Heart Transplant + Wide QRS + COPD

Week 2

Question 15

Steps for Supraventricular Tachycardia Treatment (4)

Answer 15

1) Vagal Massage + Valsalva
2) Adenosine
3) Class IV (Ca-Block) - Recurrent
4) Class II (B-Block) - Recurrent - AVNRT more than AVRT

Question 16

Treatment of Afib - #1 Option

Answer 16

1C - Flex

Question 17

Treatment of Post MI V-Tach - #1 Option

Answer 17

1B - Lidocaine - Reduced Abnormal Automaticity

Question 18

Treatment of Post MI V-Tach - 2/3/4 Option

Answer 18

1 = Lidocaine 
4 = Amilodine (III) + B-Block - Get Defibilator in!

Question 19

Torsades Drugs (3)

Answer 19

Levofloxan + IA + III (Less with Amilodine)

Question 20

Monomorphic V-Tach - Cause + 2 ECG Features

Answer 20

Reentry = #1 Cause
Normal Similar QRS with Regular Rate vs. Polymorphic (Caning QRS with Irregular Rate)

Week 2

Question 21

Reentry - V-Tach - Associated ECG + 3 Main Criteria + Result

Answer 21

ECG = Monomorphic with Regular Rate/QRS
3 Main Causes Criteria for Reentry 
1) Multiple Parallel Pathways 
2) Unidirection Conduction Block
3) Conduction time (CT) > Effective Refractory Period (ERP) 

Result = Unidirection block through a branch point with delay conduction that allows reentry formation

Week 2

Question 22

<24 Hours Post MI - Histopathology

Answer 22

Wavy fibers with edema - Then Coagulative Necrosis

Week 2

Question 23

Hypertrophic Cardiomyopathy - Histopathology

Answer 23

Myofiber Disarray (not in series)

Week 3

Question 24

Myocardial Demand Factors
Increase (3) + 4 Pathologies
Decrease (1) + 1 Pathology

Answer 24

Increase O2 Demand
Increase Ventricular Wall Stress + HR + Contracility
Pathology
Aortic Stenosis + HTN (High Pressure)
Mitral + Aortic Regurg (Increase LV FIlling + Radius)
All Decreased by Nitrates (Left Wall Stress + Volume Decreased by vasodilation)

Decrease O2 Demand
Increased Wall thinkness = Dereased O2 Demand
LVH = Less O2 Consumption

Week 2

Question 25

Nitrates - Specific Mechanism (3)

Answer 25

Decrease LV Wall Stress Decease LV Volume Increase Systemic Venous Reserve/Capacitance (Preload) Week 2

Question 26

Mitral and Aortic Stenosis - Most Common Causes

Answer 26

Mitral - Rhemuatic Fever Aortic - Age > 65 = Calcium Aortic - Age - 65-40 Bicuspid AV (or Rheumatic with fusion of the commisure) Week 2

Question 27

SLE Causes Drugs (2)

Answer 27

Procaimide + A-Methyldopa

Question 28

Toursades des Pointes - Pathophysiolgoy + Causes (4)

Answer 28

Triggered Activity - Early Afterdepolarizations Long QT Congential Long QT Hypokalemia Hypomagnesium Anti-Arrhythmia Drugs - IA + IC + III Week 2

Question 29

Infectious Endocarditis - Key Signs/Sympomts (8)

Answer 29

1) Murmur (Mitral or Aortic) 2) Patechiae 3) Nail BEd Hemorrhage 4) Rential Hemorrhage (Roth Spot) 5) Immune Mediated Vasculitis 6) Painless Palm Lesion - Janeway 7) Painful Finger Tip Nodes - Osler

Question 30

Hypoplastic Left Heart Syndrome - Key Points (5)

Answer 30

1) Slit Like Left Ventricle with Atretic Valves 2) PFO + ASD 3) Ventricular Septum Intact 4) PDA Keeps the patient alive (PFO brings blood back + PDA gets it to circulation) 5) Early Cyanosis

Question 31

Sudden Death - Think MI - 4-24 Hour Pathology

Answer 31

1) Contraction Band Coagulative Necrosis | Nuclei Out + "blurry" myocytes with internal white lines

Question 32

Acute Rhematic Fever - Presentation (2)

Answer 32

Aschoff Body = Big Circle with waves in middle of myocardium | Strep. Pydrimidans or Staph Aureus

Question 33

Acute Rheumatic Fever - Long Term Implications

Answer 33

1) Carditis - Long Term = Mitral Valve Most Likely 2) Aortic Valve = 2nd 3) Tricuspid in Staph

Question 34

Heart Failure - Always Look for Side - Left Alone vs. Right Alone vs. Both Chambers

Answer 34

DO IT

Question 35

Low EF Cardiomyopathy - Key Points

Answer 35

1) Dilated Cardiomyopathy - Look for S3 2) Both Chambers of the Heart 3) Most Common Lymphocyte Rich Inflitrate Dilated Cardiomyopathy = Coxsackie A/B 4) South America Carditis - Trypanzsoma = Protazoa 5) Alcohol and Pregancny can cause Dilated Cardiomyopathy

Question 36

Transposition of Great Arteries - Keys

Answer 36

1) Worses as PDA Closes (Cyanosis) | 2) Don't give imosaide - need to keep it open not close - Want to Elevate PGE

Question 37

Hypertrophic Cardiomyopathy - Murmur

Answer 37

Murmur results from obstruction of the ventricular outflow tract by the valve leaflet - Aortic Stenosis

Question 38

Pressure Volume - Systolic Failure

Answer 38

1) Increased Afterload/Decreased Contractility 2) Move Up and Right Decrease in ESPVR Curve Increase ESV and EDV Decrease EF and SV

Question 39

Pressure Volume - Diasolic Failure

Answer 39

``` Increased Preload Move Left and Smaller Increased EDPVR Decreased EDV Increased EDP ```

Question 40

Hypertropic Cardiomyopathy - Keys

Answer 40

1) Younger + cause of sudden death 2) Mitral Valve Prolapse - Less with less volume - Left Sternal Border Systolic Murmur 3) Young Patient with septal enlargement 4) Mutate Sarcomere proteins