Newman Questions Flashcards
(138 cards)
1
Q
Two determinants of O2 demand
A
Heart Rate, Systolic BP
2
Q
2 Categories of Pressure Overload
A
Systemic HTN, Outflow Obstruction (Aortic Stenosis, Asymmetric Septal Hypertrophy)
3
Q
2 categories of Volume overload
A
Regurgitant Valves, High-Output States (Anemia, Hyperthyroidism)
4
Q
2 Major Humoral Manifestations of Renin-Angiotensin
A
Most potent vasoconstrictor in body; Aldosterone secreted by adrenals
5
Q
3 Causes of Aortic Regurgitation
A
Ischemia, Infection, Dissection
6
Q
3 Causes of Volume Overload
A
Regurgitation, Anemia, Hyperthyroidism
7
Q
3 Drugs associated with delayed after-depolarizations
A
Procainamide, Quinidine, Digoxin
8
Q
3 Major Clinical Manifestations of RV HF
A
SOB, Elevated JVP, Hepatojugular Reflex
9
Q
4 Clinical Manifestations of LV Failure
A
SOB/Orthopnea/PND; Fatigue/Confusion; Nocturia; Chest Pain
10
Q
4 Neurohumoral changes with CHF
A
Increased sympathetic (NE), Renin release, Vasopressin, Cytokines (IL-1, Enodthelin)
11
Q
5 Causes of Acute Pericarditis
A
Infection (TB, Viral); CT Disease; Malignancies; Thyroid Dz; metabolic
12
Q
5 Common Causes of CHF
A
Volume Overload, Pressure Overload, Loss of Muscle, Loss of Contractility, Restricted Filling
13
Q
5 complications of MI
A
HF, Arrhythmia, Shock, Bradycardia, Nausea/Vomiting
14
Q
5 main etiologies of LV Failure
A
Volume/Pressure Overload, Restricted Filling, Myocyte Loss, Decreased Contractility
15
Q
Afterload is the pressure that
A
the LV needs to overcome for aortic valve to open
16
Q
Angina Pectoris is characterized by
A
> 5 mins; Pressing, tightness
17
Q
Angina, Syncope, HF
A
Aortic Stenosis
18
Q
Anterior Leads
A
V1-V6
19
Q
Auscultation of STEMI
A
S4 may be present
20
Q
AV block can be seen in some congenital disorders:
A
MD, Tuberous Sclerosis, Maternal SLE
21
Q
Blowing systolic murmur
A
Mitral Regurgitation
22
Q
Bundle Branch Block leads to what on ECG
A
Widening of QRS Complex
23
Q
Cardiac Adaptation to Regurgitation
A
Eccentric Hypertrophy (Dilatation): Cardiac fibers multiply in series –> Output increased (sterling’s law)
24
Q
Cardiac Adaptation to Stenosis
A
Concentric Hypertrophy, Normal Volume and Size
25
Cardiac exam findings in LV Failure
Displaced, Sustained PMI, S3, S4
26
Causes of Mitral Prolapse
Infection, Infarction, Myxomatous Degeneration, CT disorder
27
Changes of Calcium function in LV HF
Delivery of Ca to contractile apparatus and reuptake of Ca by SR are slowed
28
Changes to beta-adrenergic receptor in LV HF
Densensitization
29
Changes to myosin and troponin in LV HF
Re-expression of fetal and neonatal forms of myosin and troponin
30
Changes to Systolic Isovolumetric curve in LV Diastolic Dysfunction
None
31
channels disrupted in prolonged QT
(Ca and/or) K
32
Clearing throat murmur in systole
Aortic Stenosis
33
Contractility of Myocytes in LV Diastolic Dysfunction
Preserved
34
Cytokines released in CHF lead to
IL-1 --> Myocyte hypertrophy; Endothelin --> HTN in pulmonary arteries, mycoyte growth, collagen deposition
35
Decrease in PR interval means
WPW
36
ECG in WPW
Short PR, Delta Wave
37
Echo for MI vs Pericarditis
Segments not contracting vs Effusion
38
Ejection Fraction =
SV / EDV
39
EKG Features of Ischemia
Inverted T Wave, ST Depression
40
Elevated Atrial Pressures indicate
Preload is adequate but ventricular function is decreased, or fluid is accumulating in venous system
41
Elevated RR, HR, Cold Clammy Skin, Pulsus Alternans, Displacement of PMI, Lung Rales, S3, S4 audible
Left Heart Failure
42
First Degree AV Block
Abnormally long conduction time (PR > 0.22s)
43
First thing to do with Pericardial Effusion
Palpate pulse and watch breathing
44
Giant V Wave
Acute Mitral Regurgitation
45
Giant V Wave =
Mitral Valve Prolapse
46
Height of QRS is usually
2 boxes
47
Hemodynamic changes in Aortic Regurg
Increased Preload, Increased SV
48
Hemodynamic changes in Diastolic Dysfunction
Diastolic PV curve shifts left, Increase in LV EDP
49
Hemodynamic changes in systolic dysfunction
Isovolumic Systolic Pressure curve shifts down; SV and CO reduced
50
Hemodynamics in acute regurgitation
Pressure in LA markedly elevated
51
High QRS on ECG indicates
Ventricular Hypertrophy
52
How do CO2, O2, Acidity, and Temp affect Automaticity
CO2, Acidity, and Temp increase, O2 decreases
53
How do we determine severity of Mitral Stenosis
LV vs Pulmonary Capillary Wedge pressure (should be identical)
54
How do you distinguish between Aortic Regurgitation and Stenosis
Regurg produces diastolic murmur, wide pulse pressures, brisk pulse
55
How do you dx Pericardial Tamponade
Pulsus Paradoxis: Upon inhalation, pulse disappears
56
How does heart respond reduced SV in LV Systolic Dysfunction
Increased return of blood (preload), Increased release of catecholamines, Cardiac Muscle Hypertrophy
57
How does K+ affect automaticity
Decreased K+ --> Increased automaticity
58
How quickly can V Fib lead to SCD
Few seconds
59
How to increase murmur in HOCM
Valsalva or standing --> Decrease IV volume --> Murmur increases
60
If QRS is wide, what is abnormal
Ventricular activation
61
Increase in NE during HF can lead to
increased preload and afterload, which can worsen HF
62
Increase in PR interval means
Heart Block
63
Increased SV, Brisk Arterial Pulse, Whooshing decrescendo murmur after S2
SV, Pulse, Mumur in Aortic Regurg
64
Inferior Leads
II, III, aVF
65
Is S3 present in Systolic or Diastolic Dysfunction
Can be present in either
66
Key finding in acute regurgitation
Loud murmur without hypertrophy
67
Key to clinical assessment of Valve Stenosis
Pressure difference on either side of valve
68
LA pressure in Acute vs Chronic Regurgitation
Elevated in Acute, Normal in Chronic
69
Long QT results from
Reduced function of K channels -> Prolonged plateau period
70
Loud S1
Mitral Stenosis
71
Loud S1 (snaps shut), Diastolic Rumble
Mitral Stenosis
72
LV Diastolic Dysfunction is caused by any disease that
Causes decreased relaxation, decreased elastic recoil, or increased stiffness of ventricle
73
May be responsible for Pulmonary HTN, Myocyte Growth, and deposition of interstitial collagen
Role of Endothelin in HF
74
Midsystolic Click
Mitral Valve Prolapse
75
Morphological Changes in Aortic Regurg
Ventricular Dilation (Eccentric Hypertrophy)
76
Morphological Changes in Aortic Stenosis
Concentric Hypertrophy
77
Morphological Changes in Mitral Regurgitation
If chronic, LV and LA Dilation; Not in acute
78
Most common cause of mitral regurgitation
Mitral Prolapse
79
Most common cause of stroke
A Fib
80
Most common finding
Displaced Apical Impulse (PMI)
81
Most potent vasoconstrictor
AngII
82
Most prolonged QT is caused by
drugs
83
Mumur in Aortic Regurgitation
Decrescendo following S2
84
Mumur of Aortic Stenosis
Clearing throat in systole
85
Murmur for Mitral Regurgitation
Holosystolic Blowing Murmur
86
Murmurs for Mitral Stenosis
Opening Snap, Diastolic Rumble
87
Murmurs, Sounds in Mitral Stenosis
Loud S1 (snaps shut), Diastolic Rumble
88
Narrow QRS means
Arrhythmia originating at or above AV node
89
NE released in CHF leads to
Increased Preload and Afterload
90
Normal JVP
2mmHg
91
Opening Snap, Diastolic Rumble
Murmurs for Mitral Stenosis
92
Physical findings in Mitral Stenosis
RHF: JVD, Ascites, Edema
93
Pressures in Constrictive Pericarditis
All diastolic pressures in heart equal
94
Principal Physical Findings in Constrictive Pericarditis
Pulsatile Neck Veins; Systemic Congestion; No Pulsus Paradoxis
95
Prolonged QRS could be
(1) Ventricular Escape Rhythm; (2) Bundle branch block
96
Pulmonary edema with no enlargement of chambers
Mitral Valve Prolapse
97
QRS 6 boxes high on V6
Ventricular Hypertrophy
98
QRS should be less than
0.12 seconds
99
Range for QTc
0.38-0.42
100
Renin released in CHF leads to
AngII --> Aldosterone, Vasoconstriction --> Increased afterload, reduction in CO
101
Result of Endothelin release in CHF
HTN in pulmonary arteries, Myocyte growth, Collagen deposition
102
Result of IL-1 release in CHF
Myocyte Hypertrophy
103
Role of Endothelin in HF
May be responsible for Pulmonary HTN, Myocyte Growth, and deposition of interstitial collagen
104
Role of IL's in HF
May accelerate myocyte hypertrophy
105
Role of TNF in HF
May play role in hypertrophy and myocyte death
106
S4 is best heard at
PMI
107
S4 occurs concomitantly w/
Atrial Contraction
108
Sawtooth pattern on EKG
A Flutter
109
Second Degree AV Block
Some, but not all, atrial impulses are conducted to ventricles
110
Sign in Acute Mitral Regurgitation
Giant V Wave
111
Signs in Aortic Stenosis
Throat-clearing (C-D) murmur, Pulsus Tardus, Pulsus Parvus
112
Sinus tachycardia accompanying MI may be indicative of
Cardiogenic Shock
113
Skin findings in Left Ventricular Failure?
Pale, Cold, Sweaty
114
SV, Pulse, Mumur in Aortic Regurg
Increased SV, Brisk Arterial Pulse, Whooshing decrescendo murmur after S2
115
Symptoms of Aortic Stenosis
Syncope, Angina, HF
116
Systolic LV dysfunction reduces
SV (decreased CO)
117
Throat-clearing (C-D) murmur, Pulsus Tardus, Pulsus Parvus
Signs in Aortic Stenosis
118
Triad of Aortic Stenosis
Angina, Syncope, HF
119
Type of HF w/ Pulsus Alternans possible
LV HF
120
Valve disease associated with Stable Angina
Aortic Stenosis
121
Vicious circle:
Continued hyperactivity of Renin-Angiotensin system leading to severe vasoconstriction, increased afterload, and further reduction in CO and GFR
122
Weak and Delayed Arterial Pulse
Aortic Stenosis
123
What causes nocturia in LHF
Decreased renal perfusion gets better at night
124
What causes ventricular dilation in Aortic Regurg
Increased Preload
125
What is characteristic of Aortic Stenosis
Weak Arterial Pulse (parvus)
126
What is mechanism behind Torsades de Points
Delayed Depolarizations
127
What is probably the most common cause of LV Failure
MI
128
What is the Hepatojugular Reflex
Pressing on liver for 5 seconds causes increase in JVP
129
What on ECG indicates ventricular hypertrophy
High QRS
130
What usually causes acute mitral regurgitation
Infection, Ischemia
131
When Apical Impulse (PMI) is displaced =
LV Volume is Increased as compensatory mechanism of HF
132
When Apical Impulse (PMI) is sustained =
Suggests increased LV volume or mass
133
When bundle branches are disease, EKG change:
QRS becomes wide
134
Where is S3 best heard
Apex
135
Which type of heart failure presents with abdominal pain
Right
136
Why do patients with Left Sided Failure have Orthopnea
Now operating on steep portion of Diastolic Pressure-Volume Curve = Any increase in blood return leads to marked elevations in ventricular pressures
137
Width of QRS is usually
3 little boxes
138
Workup of Stable Angina
Stress Test, Echo, Coronary Angiogram
