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Cardiology Q's
Question Which artery supplies the SA and AV nodes? Answer RCA. RCA occlusion is ST elev. and inc. AVF II and III. Bradycardia d/t no blood to the SA node. Leads to ARRYTHMIA.

Which artery supplies the inferior portion of the left ventricle and Posterior descending (80% off the RCA, posterior septum? 20% off the circumflex) Where does coronary artery occlusion occur most commonly? What does the LAD supply? When do coronary arteries fill? LAD apex and anterior interventricular septumST inc. and V1+ V2 for septum. V3+ V4 for ant. wall during diastole

The LA, can cause dysphagia because of Where is the most posterior portion of the heart and what can it compression of the esophageal nerve or hoarseness by compressing the the cause? recurrent laryngeal nerve What supplies the posterior left ventricle? stroke volume x HR rate of 02 consumption/ arterial 02 - venous 02 ccontent CO x Total peripheral resistance 2/3 diastolic + 1/3 systolic systolic - diastolic EDV - ESV SV CAP means? How do catecholamines increase contractility? What does increasing intracellular Ca do? What happens with a decrease of extracellular Na How does digitatlis increase contractility? How do beta blockers decrease contractility? Why is contractility decreased in heart failure? How does acidosis affect contractility? Do dihydropyridine or non-dihyrdropyridine Ca channel blockers decrease contractility What cardiac change occurs in pregnancy? What 4 things drive myocardial 02 demand? CFX. V5 + V6 inc. ? CO mean arterial pressure MAP pulse pressure stroke volume Stroke volume affected by contractility, afterload, and preload Increasing activity of Ca pump in SR increase contractility decrease in activity of Na/Ca exhanger and increase in contractility Increase intracellular Na, resulting in increased Ca decrease in cAMP systolic dysfunction decreased Non increased SV inc afterload, inc contractility, inc heart rate, inc heart size (inc wall tension)
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If HR is too fast (V tach) what happens during diastole? EDV is also known as MAP is also known as Which class of drugs decrease preload Which class of drugs decreases afterload? Exercise, overtransfusiion and excitiment causes and increase in...? What does the starling curve show? When does EF decrease What is the formula for EF? What is a normal EF Given P Which vessels account for the most total peripheral resistance Which lab value indicates blood viscosity? In what disease states is blood viscosity increased?

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filling is incomplete and CO falls Preload Afterload (proportional to peripheral resistance) venodilators (nitrogylcerine) Vasodilators, (hydrAlAzine) Preload changes in CO as a function of preload in HF SV/ EDV at least 55% QR, what factors influence resistance? arteriorles hematocrit polycythemia, hyperproteinemic states (multiple myeloma), hereditary spherocytosis

In the cardiac and vascular function curves, in what instance is hemorrhage the vascular curve shifted to the left? In the cardiac and vascular function curves, in what instance is transfusion the vascular curve shifted to the right? What is indicated when CO and venous return are equal? What causes the CO curve to shift upwards? what causes the CO curve to shift downwards? In the cardiac cycle, which period has the highest 02 consumption? On the cardiac cycle graph, on which corners do the opening and closing of the aortic and mitral valves occur? What is the S1 sound? What is the S2 sound? When and why is the S3 sound heard? The operating point of the heart pos inotropy, exercise neg inotropy, HF, narcotic overdose isovolumetric contraction lower right, MC, upper right, AO, upper right AC, lower left MO mitral and tricuspid closure Aortic and pulmonary closing normal in children and pregs, assoc with inc filling pressures, early in diastole during rapid ventricular filling late in diastole, high atrial pressure, pushing against a stiff LV wall, associated with ventricular hypertrophy atrial contraction RV contraction (closed tricuspid valve bulding into atrium inc RA pressure, due to filling against closed tricupsid valve
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When and why do you hear the S4 sound in the JVP, what is the a wave? in the JVP, what is the c wave? in the JVP, what is the v wave?

YKS In normal S2 splitting, which valve closes first? What increases the aortic before pulmonic, inspiration it? increases diff

What is the association with wide S2 splitting? What is association with fixed S2 splitting, does not increase with inspiration What is associated with paradoxical spliting of S2 with what heart sounds do ASD usually present? Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason? Inspiration causes an increase in which sided heart sounds? Expiration causes an increase in which sided heart sounds What are the systolic heart sounds What are the diastolic heart sounds? Which murmur is characteristic of mitral/tricuspid regurg? What are common causes of mitral regurg? What causes the murmur heard in MR to enhance? What causes the murmur heard in tricuspid regurg to enhance Which murmur is heard in aortic stenosis? What causes the ejection click in the Cres-decres murmur? What is the characteristic pulse in aortic stenosis? What causes aortic stenosis Which murmur is heard with VSD? Which murmur is heard with mitral prolapse? what causes the midsystolic click What does mitral prolapse predeispose to? What can cause mitral prolapse? What murmur is heard with aortic regurg? What causes aortic regurg Which class of drugs decrease the murmur heard in aortic regurg? Which murmur do you hear in mitral stenosis?

pulmonic stenosis and RBBB ASD Aortic stenosis or LBBB pulmonary flow murmur and diastolic rumble No, no pressure gradient Right sided Left sided aortic/pulmonic stenosis and mitral/tricuspid regurg aortic/pulmonic regurg and mitral/tricuspid stenosis holosystoiic ischemic heart dz, mitral valve prolapse, LV dilation inc TPR and LA return (expiration) in RA return (inspiration) crescendo-decrescendo systolic ejection murmur following ejection click aburpt halting of valve leaflets pulsus parvus and tardus, weak, can lead to syncope age related calcifications or bicuspid aortic valve holosystolic, harsh sounding murmur, loudest over tricuspid area late systolic crescendo murmur with a midsystolic click sudden tensing of chordae tendinae infective endocarditis myxomatous degeneration, RF, chordae rupture immediate high pitched blowing diasystolic murmur with a wide pulse pressure aortic dilation, bicuspid aortic valve, RF, Vasodilators late diastolic murmur following an opening snap
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YKS Chronic mitral stenosis can lead to what changes in size of the dilation LA

Mitral stenosis is most often secondary to which condition?

RF

What is the machine like murmur? What is the heart pathology patent ductus arteriosus, congenital rubella and the predisposing causes or prematurity When does extracellular calcium enter the cardiac muscle cells the plateau period during contraction? What stimulates release of calcium from the SR? When during cardiac nodal cells depolarize? How are cadiac myocytes eltrically coupled? What happens in phase 0 of the cardiac ventricular action potential? What happends in phase 1 of the ventricular cardiac action potential? What happens in phase 2 of the cardiac ventricular action potential? What happens in phase 3 of the cardiac ventricular action potential? What happens in phase 4 of the cardiac ventricular action potential? Where are pacemaker cells? What channels do the the pacemaker cells lack? What constitues the upstroke in pacemaker cells? What is the result of not have fast sodium channels in pacemaker cells? Which channel accounts for automaticity of the SA and AV nodes? What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine? What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and In an EKG, what is the p wave? In an EKG, what is the PR interval? In an EKG, what is the QRS complex? In an EKG, what is the QT interval? In an EKG, what is the T wave? What does T wave inversion indicated? What masks atrial repolarization? extracellular calcium, calcium induced calcium release during diastole gap junctions rapid upstroke, voltage gated Na channels open initial repol, inactivation of of voltage gated Na channels, voltage gated K channels begin to open plateau, influx of calcium through voltage gated ca channels, ca release from SR and contraction rapid repol, massive K influx, opening of voltage gated slow K channels and closure of Ca channels resting potential high K perm SA and AV nodes fast volatge gated Na channels volatage gated Ca channels slow conduction velocity, used by AV node prolongs transmission from atria to ventrical If sodium channel decreases increase, increase the chance the If are open atrial contraction conduction delay through AV node, nl < 200 msec ventricular depolarization, nl < 120 msec mechanican contraction of the ventricles Ventricular repolarization MI QRS complex
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What doesYKS isoelectric ST segment indicate? an What does the U wave indicated? What does prolonged QT predispose to? What is the danger of torsades to pointes? What other sign is often present with congenital long QT syndrome, why? Rank the following by speed of conduction, av node, atria, purkinjee, ventricles Rank the pacemakers cells

ventricles are depolarized hypoK and bradycardia torsades de pointes can progess to V fib sensironeural deafness, defects in sodium and potassium channels, jervell and langeneilsen syndrome purkingee>atria>ventricles>AV node SA>AV>bundle of His>ventricles

delta wave on ECG, accesory conduction pathway from atria to Wolff-Parkinson white syndrome ventricles, reentry leading to supraventricular tachycardia Irregularly irregular ECG, no p waves: dx and treatment sawtooth wave prolonged PR interval progressive lengthening of PR until beat is dropped, a p wave not followed by QRS no change in PR interval followed by dropped beat A fib, beta block or ca channel block, warfarin, thromboembolism prophylaxis atrial fiutter, identical back to back atrial depol's, convert to sinus, cal IA, IC or III antiarrhythmics 1st degree AV blodck 2nd degree AV block, mobitz type 1 2nd degree AV block, mobitz type 2, may progess to 3rd degree block

no relation between p waves and QRS intervals, treatment and 3rd degree block, pacemaker, Lyme disease predisposing factor Fatal arrhythmia What does the atria release in response to inc blood volume and atrial pressure Which two mechanisms sense decrease MAP? Which sympathetic receptors raise MAP How does angiotensin II raise MAP How does aldosterone raise MAP The aortic arch receptors transmit along which nerve? The carotid sinus transmits along which nerve? decrease stretch in baroreceptors leads to what response? What do the carotid and aortic bodies respond to? Central chemoreceptors do not respond directly to which parameter? What is the cushing triad? V fib ANP medullary vasomotor center senses baroreceptors and JGA beta 1 inc HR and cont, alpha 1 venocxn, alpha 1 arteriolar vascxn vasocxn inc blood volume vagus to medulla glossopharyngeal to soliary nucleus of medulla increased efferent SANS and decreased efferent PANS dec P02, inc PC02 and dec pH P02 HTN, bradycardia, and respiratory depression
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What causes the cushing reflex and why Which organ gets the largest share of systemic cardiac output Which organ has ht highest blood flow per gram of tissue Which organ has the largest arteriovenous difference PCWP > LV diastolic pressure PCWP is an estimate of What does hypoxia cause in the lung versus other tissues? What does autoregulation do? What do the starling forces determine In terms of starling forces, why does heart failure cause edema? In terms of starling forces, why does nephrotic syndrome or liver failure cause edems Why is there edema after burns or during infection what happens to capillaries in lymphatic blockage What are the 5 T's of cyanoitc babies what does TAPVR stand for Right to left shunts are more common in babies or kids? Left to right shunts are more common in babies or kids? failure of truncus arteriosus to divide? absecnce of tricuspid valve, hypoplastic RV pulmonary veins drain into right heart circulation (SVC, coronary sinus) L to R shunt becomes R to L due to increase pulm pressures from original congenital heart defect PROVe What causes the early cyanosis in Tet of Fallot? What is the classic X ray finding for tet of fallot? What causes tet of fallot? How does a patient with Tet of fallot learn to improve symptoms? What other congenital abnormality is necessary for life for a

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inc ICP, cerebral ischemia, inc SANS tone (HTN) and reflex bradycardia Liver Kidney Heart, 02 extraction is always around 100% mitral stenosis Left atrial pressure vasocxn, while other tissues it causes vasodilation maintain blood flow to organ over wide range of perfussion pressures fluid movement through capillaries increase in Pc dec plasma proteins inc Kf, capillary perm inc interstitial osmotic pressure pulling fliud out of capillaries tetralogy of fallot, transposition of great vessels, truncus arteriosus, tricuspid atresia, TAPVR total anomalous pulmonary trunk venous return babies kids persistant truncus arteriosus tricuspid atresia, requires ASD and VSD TAPVR Eisenmenger's syndrome tetrology of fallot - pulmonary stenosis, RVH, overiding aorta, VSD R to L shunt caused by stenoic pulmonic valve boot shaped heart anterosuperior displacement of the infundibular septum squat. Compression of femoral arteries, inc TPR, dec shunt, VSD, PDA or patent foramen ovale, due to failure of the aorticopulmonary
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YKS patient with transposition of the great vesses?

septum to spiral adult type aortic coarctation infantile is proximal to ductus arteriosus and adult is distal. Infantile IN and aDult is Distal to Ductus turners PDA

Weak pulses, notching of the ribs on xray, HTN in upper extremeties and weak peripheral pulses what is the difference between adult and infantile type aortic coarctation? What other syndrom is associated with infantile aortic coarctation machine murmer

What is the difference between the fetal and neonatal direction fetal right to left, neonate left to right leading of blood flow in a patent ductus arteriosus to RVH and failure which medications are used to maintain patency or close the ductus arteriosus? congenital heart defect with 22q11 congenital heart defect withdown syndrome congenital heart defect with congenital rubella congenital heart defect with turner's congenital heart defect with marfan's congenital heart defect in an infant with a diabetic mother? What is the definition of HTN? which ethnic groups have higher association with HTN? what percentage of HTN is secondary to renal disease? What does HTN predispose to? What are tendinous xanthoma, atheromas, and corneal arcus signs of? Hyperplastic onion skinning fibrous plaques and atheromas in intima of arteries moncekberg disease of elastic arteries and large and medium sized muscular arteries What is the progression of atherosclerosis? indomethacin closes, and pge keeps it open truncus, tet of fallot ASD, VSD, AV septal defect (endocardial cushion defect) septal defects, PDA, pulm art stenosis coarcation of aorta aortic insuffic, late transposition of great vessels 140/90 black > white > asian 10% atherosclerosis, LVH, stroke, CHF, renal failure, retinopathy, aortic dissection hyperlipidemia arteriolosclerosis in malignant hypertension atherosclerosis calcification in media of arteries esp radial and ulnar, does not obstruct blood flow, intima not involved atherosclerosis endothelial cell dysfxn, mac and LDL accum, foam cell, fatty streaks, smooth muscle cell migration, fibrous plaque, comlex atheromas aneurysms, ischemia, infarcts, peripheral vasc dz, thromboemboli abdominal aorta>coronary artery>popliteal artery>carotid artery ACoPCa
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what are the complications of atherosclerosis? what are the four most common locations for atherosclerosis?

tearing chest pain radiation to the back, associated with marfan retrosternal chest main with exertion, ST depression on ECG, likely due atherosclerosis coronary artery spasm, ST elevation

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aortic disecction, intraluminal tear forming false lumen stable angina prinzmetal angina

thrombosis w/o necrosis, ST elevation, worsening chest pain at unstable/crescendo angina rest or with minimal exertion What is the most common cause of MI What is sudden cardiac death most commonly due to list the coronary vessels most likely to be occluded diaphoresis, N/V, severe retrosternal pain, pain in left arm/jaw, SOB, fatigue, adrenergic symptoms acute thrombosis of coronary artery v fib arrhythima LAD > RCA > circumflex MI

What is the time frame for arrhythmia risk in the evolution of MI the first 4 days In an acute MI, are there any visible changes via LM in the first no 2-4 hours In the evolution of an MI, when the risk for free wall rupture, tamponade, papillary muscle rupture, or interventricular septal rupture the hightest? Why? When do you see extensive coagulative necrosis in an MI When is the scar completely formed in an MI? Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI? What is the gold standard for dx of MI in the first 6 hours Which enzymes are useful for diagnosing reinfarction Which kind of infarct show ST elevation, and/or pathologic Q waves What kind of infarct show ST depression Which area of the endocardium is especially vulnerable to infarction? Why? In an anterior wall infarct, which artery is effected and which leads show Q waves In an anteroseptal infarct, which artery is effected, and which leads show Q waves? In an anterolateral infarct, which artery is effected and which leads show Q waves 5-10 days, macs have degraded structural components 2-4 day, early coag necrosis on the first day 7 weeks troponin I EKG CK-MB transmural subendocardial subendocardial, fewer collaterals and higher pressure LAD, V1 -V4 LAD, V1-V2 LCX, V4-V6

In a lateral wall infarct, which artery is effected, and which leads LCX, I, aVL show Q waves? In an inferior wall infarct, which artery is affected and which leads show Q waves, The 7 complications of MI RCA, II, III, aVF arrhythmia, LV failure and pulm edema, cardiogenic shock, free wall rupture, aneurysm, postinfarcation fibrinous pericarditis, dressler's
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YKS friction rub, 3-5 days post MI

postinfarction fibrinous pericarditis dressler's, autoimmune

fibrinous pericarditis several weeks post MI

S3, dilated heart on US, balloon appearance on CXR, eccentric dilated cardiomyopathy hypertrophy What are the different etiologies of dialted cardiomyopathy How are the sarcomeres added in eccentric hypertrophy? sudden death in young atheletes, S4, apical impulses, outflow obstruction How are sarcomeres added in concentric hypertrophy? Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction Restrictive cardiomyopathy causes What kind of dysfunction ensues in restrictive cardiomyopathy dyspnea, fatigue, edema and rales, multiple causes The cause of dyspnea on exertion? The cause of cardiac dilation? The cause of pulmonary edema, paroxysmal nocturnal dyspnea? When do you find hemosiderin laden macrophages in the lungs? what causes orthopnea? what causes hepatomegaly? What causes ankle, sacral edema, jugular venous distention What is the most common cause of right heart failure What does FROM JANE stand for in bacterial endocarditis? Which valve is most commonly involved in bacterial endocarditis? EtOh, wet Beriberi, Coxsackie B, cocaine, chagas, doxorubicin, hemochromatosis, peripartum cardiomyopathy in series hypertrophied cardiomyopathy in parallel eccentric, concentric hypertrophy causes diastolic disfunction sarcoid, amyloid, postradiation fibrosis, endocardial fibroelastosis, Loffler, hemochromatosis diastolic CHF failure of LV to in CO during exercise greater ventricular EDV LV failure, pulm venous distention transudation of fluid during HF from microhemorrhages from inc pulm cap pressure inc venous return exaccerbates pulm vasc congestion inc central venous pressure, inc resistance to portal flow RV failure, in venous pressure left heart failure fever, roth's spots, osler's nodes, murmur, janeway lesions, anemia, nail-bed hemorrhages, emboli mitral valve

Which valve is commonly involved in bacterial endocarditis from tricuspid, don't tri drugs, S. aureus, IV drug use and which bacteria are most common? pseudomonas, candida bacterial endocarditis, previously normal valves, rapid onset, which bacteria? s. aureus

smaller vegetations, congenitally abnormal or diseased valves, viridans streptococci sequela of dental procedures. Insidious onset Which bacteria causes endocarditis in the presence of colon cancer s. bovis
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YKS which bacteria can cause endocarditis from prosthetic valves?

s. epidermidis chordae rupture, GN, suppurative pericarditis, emboli libman-sacks endocarditis group a beta hemolytic strep early deaths from myocarditis mitral>aortic>>tricuspid, high pressure valves affected most mitral valve prolapse granuloma with giant cells activated histiocytes yes fever, erythema marginatum, valvular damage, ESR, red hot joints, subQ nodules, St. vitus dance (chorea)

What are the complications from bacterial endocarditis? wartiike, sterile vegetations occur on both sides of the valve, commonly causes mitral regurg. SLE causes it Which bacteria causes rheumatic heart disease what do patients die early from in rheumatic heart disease? which heart valves are afected most in rheumatic heart diseease what is the early and late lesion in rheumatic heart disease What are aschoff bodies what are anitschkow's cells Do you see elevaged ASO titers in rheumatic heart disease What does FEVERSS stand for in rheumatic heart disease

Equilibration of diastolic pressures in all 4 chambers, decreased cardiac tamponde CO from compression of heart by fluid in pericardium exaggerated decrease in pulse during inspiration. clinical signs of cardiac tamponade what conditions are associated with pulsus paradoxus disruption of the vasa vasorum of aorta, dilation of aorta and valve ring, tree bark appearance (calcifications on aortic root) most common primary cardiac tumor in adults, ball-valve obstruction in left atrium most common primary cardiac tumor in children, associated with tuberous sclerosis most common heart tumor dilated tortous veins due to chronically inc venous pressure, poor wound healing, varicose ulcers decrease blood flow to the skin due to arteriolar vasospasm in cold temp, emotional stress, also in SLE and CREST necrotizing granulomas in lung and upper airways, nectrotizing GN, small vessel vasculitis Wegener's presentation serum marker for wegener's Wegener's tx kussmaul's sign, cardiac tamponade, pulsus paradoxus hypotension, inc venous pressure, distant heart sounds, inc HR, pulsus paradoxus cardiac tamponade, asthma, obstructive sleep apnea, pericarditis and croup 3rd degree syphillus, syphillit heart disease can lead to aortic valve incompetence myxoma rhabdomyomas metastasis from melanoma or lymphoma varicose veins, thromboembolism rare raynaud's Wegener's hemoptysis, hematuria, perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis, cough dyspnea c-ANCA cyclophosphamide and corticosteroids microscopic polyangiitis, like wegener's
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p-anca

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without granulomas granulomatous vasculitis with eosinophilia. Asthma, sinusitis, skin lesions and periphereal neuropathy (wrist/foot drop) heart, GI, kidneys sturge weber, vasculitis of caps Henoch-Schlonlein purpura

Churg Strauss, presentation and test port wine stains on face, intracerebral AVM, siezures, early onset glaucoma, congenital skin rash on buttocks and legs, arthralgia, intestinal hemorrhage, abdominal pain, melena. Follows URI, IgA immune complex, most common childhood systemic vasculitis

segmental thrombosing vasculitis of small and medium vessels in smokers with intermittent claudication, superficial nodular Buerger's disease phlebitis, raynaud's, gangrene and severe pain, autoamputation of digits is possible acute, self limiting necrotizing vasculitis in children associated with fever, conjunctivitis, strawberry tongue, desquamatous skin kawasaki rash, lymphadenitis, coronary sinus aneurysms. Seen in asians immune mediated transmural vasculitis with fibrinoid necrosis, small and medium vessels, renal and viscera, not pulm arteries, polyarteritis nodosum hep B seropos in 30% of pts, pulseless disease, granulomatous thickening of the aortic arch and/or proximal great vessels - elev ESR, asian females > 40 what does FAN MY SKIN On Wednesday stand for? Unilateral headache, jaw claudication, impaired vision, Most common vasculitis affecting medium and large arteries benign cap hemangioma of infancy, spont regresses bening capillary hemangioma of elderly, does not regress polypoid capillary hemangioma that can ulcerate and bleed cavernous lymphangioma of the neck, associated with turner's benign, painful, red-blue tumor under fingernails from smooth muscle cells benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma, caused by bartonella henselae highly lethal malignancy of the liver, associated with vinyl chloride, arsenic, and thorosrast exposure lymphatic malignancy associated with persistant lymphadema, post radical mastectomy endothelial malignancy of the skin assocated with HHV-8 and HIV takayasu's arteritis Fever, Arthritis, Night sweats, Myalgia, SKIN nodules, Ocular disturbances, Weak pulses in upper extremities tempral arteritis, may cause irreversible blindness Temporal arteritis strawberry hemangioma cherry hemangioma pyogenic granuloma, associated with trauma and pregnancy cystic hygroma glomus tumor ... angiosarcoma lymphangiosarcoma kaposi's sarcoma

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