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Cardio - Missed Uworld Questions
Terms in this set (185)
What is the most common cause of an irregularly irregular rhythm?
A-fib = absence of of P-waves
What is represented on the first peak wave of Jugular Venous tracing?
A=Right atrial contraction
What disease is identified with slowly progressive dyspnea, peripheral edema and ascites?
S3 gallop, II/IV holosytolic murmur of apex. Disappears after treatment with diuretics and vasodilators?
Functional mitral regurgitation
-Dilation of the left ventricle in response to increase preload
-eliminated with preload and afterload reduction
What best explains the heart rate lowering effects of Digoxin?
Increased parasympathetic tone
-used to control A-fib by inhibition of Na+/K+ ATPase
In the event of an interruption of blood flow secondary to arterial occlusions, which of the following organs is LEAST vulnerable to infarction?
What triggers Prinzmental angina?
Left sided heart failure causes Pulmonary HTN thru?
Vasoconstriction due to pulmonary venous congestion
Carotid sinus massage leads to?
Increased parasympathetic tone causing temporary inhibition of sino-atrial node activity
(Prolonged AV node refractory period)
The greatest difference oxygen consumption of various organs is between Aorta and which blood vessel?
-Myocardium have the highest oxygen extraction
Digoxin lowers heart rate thru which mechanism?
Decreased AV nodal conduction by increased parasympathetic (vagal) tone
-inhibition of Na-K ATPase pump
-Positive inotropic effect for heart failure patients
What would be most suggestive of combine disease involving both of the mitral and aortic valves?
Increased left ventricular diastolic pressure
-Diastolic pressure in the left ventricle is usually near normal or even decreased with severe mitral stenosis
How does metoprolol lower blood pressure?
Decreased level of circulating renin
-Beta blockers inhibit release of renin from renal juxtaglomerular cells through antagonism of Beta-1 receptors on these cells
57 y/o caucasian male with muscle pain, fatigue and dark urine is significant for stable agina. Medication inclue metoprolol, atorvastatin and asprin. What medication is increasing causing these symtpoms?
=Statin induced myopathy and rhabdomyoylsis
What medication would be most helpful in lowering blood pressure without worsening his ECG abnormalities?
Dihydropyridines calcium channel blockers (Nifedipine)
-peripheral arteries cause vasodilations
Milirone drug mechanism?
Phosphodiesterase-3 inhibitor leads to increased cAMP = vasodilation
-promotes intracellular calcium influx and increases cardiac contractility
-Helps in heart failure
A heart with scarring and enlargement of the left ventricle. What type of collagen is simillar to scar formation?
-Type I collagen
-Tendon, bone, blood vessels
1st aortic arch derivatives?
2nd aortic arch derivatives ?
3rd aortic arch derivatives?
-Common carotid artery
-Prox. internal carotid artery
4th aortic arch derivatives?
-True aortic arch
6th aortic arch derivatives?
What is the chi-squared test used for?
-Test for the association between 2 categorical variable
-Patients are divided into 2 groups based on exposure
-Outcome in a 2 x 2 table
What is the cause Jervell and Lange-Nielsen syndrome?
mutation in genes that encode voltage-gated potassium channels
How does Jervell and Lange-Nielsen syndrome present?
-Bilateral sensorineural hearing loss
-Congenital long QT syndrome
-Predisposes to ventricular arrhythmias
-Sudden cardiac death
Which part of the heart makes up a majority of posterior surface?
Doppler ultrasound evaluation of the left vertebral artery reveals retrograde (caudal) flow instead of normal anterograde. What artery is most likely occluded?
-Subclavian steal syndrome
What is the pathophysiology of subclavian steal syndrome?
Severe stenosis of the proximal subclavian artery which leads to reversal in blood flow from the contralateral vertebral artery to the ipsilateral vertebral artery
The autopsy of a 78 y/o caucasian male shows myocardial cells shows intracytoplasmic granules that are tinged yellowish-brown. What caused?
-Lipofuscin is the product of lipid peroxidation, accumulating in aging cells
-especially in patients with malnutrition and cachexia
ACh and adenosine reduce the rate of?
Reduce rate of spontaneous depolarization in cardiac pacemaker cells by prolonging phase 4
What is the pathway of pulmonary artery catheter?
R. atrium-->R. ventricle-->Pulmonary artery-->Pulmonary artery wedge
What causes valvular inflammatin and scarring in streptococcus disease?
-vegitations are caused by bacterial colonization and growth on a sterile fibrin-platelet nidus that forms on damaged/disrupted endothelial surface on valvular apparatus
S3 heart sound is associated with?
Increased left ventricular end-systolic volume
-occurs in patients with left ventricular systolic failure
Woman presents with severe mitral regurgitation and rupture of posteriormedial papillary muscle. Compromised blood flow thru which vessel is the cause?
Posterior descending artery
What is the best position to listen to an S3 heart sound?
S3 is early diastole
-Best heard with bell at cardiac apex with patient in the left lateral decubitus position at the end of expiration
What is the cause of Vancomycin Resistance Enterococcus?
D-lactate, D-alanine replacement in peptidoglycan synthesis
-Prevents binding D-ala, D-ala from vancomycin
What is the side effect of taking an ACE inhibitor & Amiloride?
-ACE inhibitor reduces aldosterone and causes increased K retention
-Amiloride - K+ sparing diuretic
A patient comes in with a DVT then has a stroke with a paradoxical embolism. What would be heard during auscultation of the patient's heart?
Wide and fixed splitting of S2
-shunt reversal with atrial left to right shunt
A trial were patients are started on selective direct relaxation of the smooth muscle of arterioles for HTN treatment. What is a possible adverse effect?
Sodium and fluid retention
-Direct arteriole vasodilator lower BP but trigger reflex sympathetic activation and stimulate the renin-angiotensin-aldosterone axis.
What causes Janeway lesions?
Erythematous lesions on the palms and soles caused by infective endocarditis. Septic emboliztion from valvular vegetations
(Microemboli to skin vessels)
Left dominant circulation with a normal left main coronary artery. Small thrombus detaches and obstructs the artery supply to the AV node. Which of the following arteries caused by an MI?
Left Circumflex artery
What artery would damage the AV node in Right dominant circulation?
Right coronary artery
Pulmonary artery occlusion pressures is measured by occluding the pulmonary artery branch. The pressure closely corresponds to what atrial chamber?
Left atrial and left ventricular end-diastolic pressure
Abscence of myocardial necrosis and scarring despite vessel occlusion, what feature of the plaque allows this to happen?
Slow growth rate
-slow growing rate allows for compensation by the development of arterial collateral circulation around the point of occlusion
ASD causes left to right shunt and can cause irreversible damage to what organ?
-Eismenger syndrome = late onset reversal of L-->R
-due to pulmonary vascular sclerosis from chronic pulmonary HTN
What causes dystrophic calcification of cardiac valves?
Necrotic tissue in the setting of normal calcium levels
What diseases cause pulsus paradoxus?
(decrease in systolic BP > 10 mm hg with inspiration)
Most common - Cardiac tamponade
What is the treatment for asthma and COPD patient with pulsus paradoxus?
Beta-adrenergic agonist - cause bronchial smooth muscle relaxation via increased cAMP
What is the murmur heard with PDA?
continuous murmur heard best in the left infraclavicular region with maximal intensity at S2
23 y/o with recurrent nosebleed and spider-like lesions on his oral and nasal mucosa, face and arms. What is the diagnosis?
Osler-Weber-Rendu syndrome (Heriditary hemorrhagic telangiectasia)
What happens with the rupture of telangiectasias?
Epistaxis, GI bleeding or hematuria
What is the mechanism of Fenofibrates?
reducing hepatic VLDL production
-lower TG levels by activating Peroxisome proliferator-activated receptor alpha (PPAR-alpha)
What the typical findings of myxoma?
-mid diastolic rumbling murmur (at apex)
-dyspnea & syncope
-large pedunculated mass in left atrium
What is the histological presentation myxoma?
-scattered cells with mucopolyaccharide strome
-abrnomal blood vessels
What drugs have been shown to improve long term survival in patients with heart failure due to left ventricular systolic dysfunction?
-Beta blockers (Carvediol, Metoprolol)
Patients with chronic aortic stenosis and concentric left ventricular hypertrophy what contributes significantly to left ventricular filling?
Loss of atrial contraction due to A-fib can?
-Reduce left ventricular preload
-Reduce Cardiac output
How does A-fib contribute to acute pulomonary edema?
Decreased forward filling of the left ventricle can cause back up of blood in left atrium and pulmonary veins = pulmonary edema
What is the etiology of constrictive pericaridits?
-Idiopathic or viral
What is the pathogensis of constrictive pericarditis?
Thickened, rigid pericardium forms a concompliant casing surrounding the heart
-limits ventricular expansion during diastolic filling
Patient presents with increased JVP, kussmaul sign, pulsus paradoxus and pericardial knock. Diagnosis?
What is the purpose of carotid massage?
leads to increased parasympathetic tone causing temporary inhibition of SA node, which slows conduction thru AV node and prolongation of the AV node refractory period
Thiamine defiency - Dry Bierberi
sysmetical peripheral neuropathy of distal extremities
-resulting sensory and motor impairments
Thiamine deficiency - Wet Bierberi
-high out put congestive heart failure
Consolidation in the right middle lobe can obscure the x-ray silhouette of the?
Right heart boarder
What is the result of a chronic AV shunt?
-Increase Cardiac Output b/c of increased sympathetic stimulation to the heart
-Increased Venous Return
Why does a chronic AV shunt cause the venous curve to shift to the right?
The circulating blood volume is increased through renal retention of fluids and because venous pooling is reduced by the increased sympathetic tone
What are the compensatory mechanisms for decreased cardiac output?
-Increased sympathetic output
both raise AFTERLOAD
What is the issue with increasing afterload in heart failure patients?
Exacerbate heart failure by making it more difficult for the failing heart to pump blood to the tissues
Patient presents with left sided heart failure. What would you expect to see INCREASED in this patient?
What are the features of 4th heart sound?
-Atrial gallop sound (before S1)
-Heard immediately after atrial contraction phase as blood is forced into stiff ventricle
What are the abnormal/associated conditions with a 4th heart sound?
What patients is it normal to hear a 4th heart sound?
-healthy older adults
What are the features of a 3rd heart sound?
-Ventricular gallop sound (Heard after S2)
-heard during rapid filling of ventricles
-tubulent blood flow to ventricles due to increased volume
When is it normal to hear a 3rd heart sound?
What are abnormal/associated conditions of 3rd heart sound?
What are some causes of reduced ventricular compliance causing an abnormal S4 heart sound?
-Hypertensive heart disease
What is the cause of the abnormal S4 heart sound?
Sudden rise in end-diastolic pressure following atrial contraction
Why is skeletal muscle resistant to calcium channel blockers?
Calcium release by the SR is triggered by mechanical interaction between L-type and RyR calcium channels
-little dependence on extracellular calcium influx
What is the most frequent mechanism of sudden cardiac death in the first 48 hours after acute MI?
-related to electrical instability in the ischemic myocardium
What are the major symptoms of Digoxin toxicity?
-GI & Neuro
What is lab sign to look out for with digoxin toxicity?
-caused by inhibition of Na-K-ATPase pumps
What is the most suggestive of combined disease involving the mitral and aortic valves rather than exclusive mitral involvement?
Increased left ventricular diastolic pressure
-diastolic pressure in the left ventricle is usually near normal or even decreased with severe mitral stenosis
What durgs cause an increase risk for internal GI bleed?
GI mucosal injury and bleeding are the most common side effects of asprin
What is the MOA of asprin?
Due primarily to COX-1 inhibition, which results in impaired prostaglandin-dependent GI mucosal defense and decreased platelet aggregation
Combination of JVD, hypotension and muffled heart sounds is highly suggestive of?
Tachycardia and pulsus paradoxus are also associated?
Simultaneous development of stroke, intestinal or foot ischemia and renal infaraction should raise suspicion for?
Which drug given in combination with lisinopril causes hyperkalemia?
Amiloride (K+ sparing diuretics )
What is the most severe side-effect of Doxorubicin?
What murmur is heard the loudest at 3/4 intercostal spaces while the patient is sitting up and leaning forward with the breath held in end expiration?
Which sodium (Na) channel blockers cause prolonged length of the action potential?
Which soidum (Na) channel blockers cause inhibition of phase 0 depolarization?
What drug causes increase HR, increase Contractility, leading to increase in myocardial oxygen consumption?
Dobutamine = Beta-1 predominant
What drug makes it more effective in treating tachyarrhythmias, but can also cause prolonged QRS duration (a proarrhythmic effect) at higher heart rates?
Flecanide - Class 1C Sodium channel blockers
Chronic aortic regurgitation leads to?
-Increased wall stress = eccentric hypertrophy
How does the body maintain CO with chronic aortic regurgitation?
Gradual increase in left ventricular chamber size leads to increased in total left ventricular stroke volume
Increased contractility results in?
Shift up in pressure and left in volume curve
Pre-treatment _______ eliminates the Beta effects of epinephrine (vasodilation and tachycardia) and leaves only the alpha effects?
Propranolol + Epinephrine
-Increased diastolic blood pressure (vasoconstriction)
-Lowers heart rate
Combined use of Non-dihydropyridine Ca channel blockers and Beta blockers can have what effect?
Additive negative chronotropic effects causing severe bradycardia and hypotension
Lateral stab wound to the anterior chest wall at the intercostal space along the mid-clavicular line. What is most likley damaged?
What are the causes of systolic heart failure?
-Ischemic Heart Disease
What is the mechanism causing heart failure in Ischemic Heart disease?
Decreased ventricular contraction force
Where do potassium sparing diruetics act in the nephron?
-Na channel blocker
-Aldosterone receptor antagonists
Late distal tubule and cortical collecting duct
What is S3 associated with?
Increased left ventricular end-systolic volume
-occurs in left ventricular systolic failure
What arteries in the body are most at risk for atherosclerosis?
-Lower abdominal aorta
Spronolactone/eplerenone should not be used in what patients?
-Hyperkalemia or Renal Failure
Patient has family history of premature sudden death and a systolic murmur that accentuates with standing from a supine position. Diagnosis?
What is coronary steal?
blood flow to ischemic areas is reduced due to arteriolar vasodilation in nonischemic areas
What are the side effects of coronary steal?
hypoperfusion and worsening of existing edema
What drugs can cause coronary steal syndrome?
Adenosine & dipyridamole = selective vasodilators
Brain infarcts appear as bilateral wedge shaped strips of necrosis over the cerebral convexity, parallel and adjacent to the longitidunal cerebral fissure.
Ischemic-hypoxic encephalopathy (Watershed infarcts)
What is a cause of global cerebral ischemia?
Cardiogenic shock or hypotension
What drug has very little risk of developing Torsades de pointes?
What drug used to treat A-fib is likely to cause Torsades?
Sotalol (class III)
-causes QT interval prolongation
-has beta blocking effects
What medications are a common cause of orthostatic hypotension?
Alpha-1 adrenergic antagonists
How do beta blockers affect ECGs?
Slow AV node conduction = prolonged PR interval (time between atrial and ventricular depolarization)
Phosphodiesterase inhibitor that inhibits platelet aggregation and acts as a direct arterial vasodilator
What is the most likely to increase during chlorthalidone therapy?
What is the major side effect of amlodipine?
Peripheral edema (lower extremities)
Atenolol has what effect on vascular smooth muscles [cAMP]
No significant change
Tissue necrosis associated with NE infusion is best prevented by local injection of?
Phentolamine (alpha-1 blocker)
This drug increases peripheral vascular resistance and systolic blood pressure. It also decreases pulse presssure and heart rate.
Phenylephrine (selective alpha-1 adrenergic receptor agonist)
Decrease hepatic VLDL production
What is the best treatment for TCA antidepressant overdose?
Patient presents with constipation, new onset 2nd degree AV block and syncope in the setting of new medication for A-fib
Diltiazem (non-dyhdro Ca channel blocker)
What is the blood supply to the Pterion?
Maxillary artery --> Middle Mengial Artery
What amino acid is involved in the synthesis of NO?
Arginine + NO synthase
Selevtively inhibits the funny sodium channels prolonging depolarization of phase 4
What is the effect of slowing depolarization of phase 4 in SA node?
Slows down SA node firing rate
-negative chronotropic effect with no effect on cardiac contractility (ionotropy) or relaxation (lusitropy)
S4 heart is caused by?
Decreased left ventricular compliace
What diseases are associated with S4 heart sound?
Left Ventricular Hypertrophy
What is the major proliferative stimuli for the cellular components of atherosclerotic plaques?
PDGF - promotes migration of SMC from the media into the intima = increased smooth muscle
presents as onion like concentric thickening of the walls of arterioles as a results of laminated SMC and reduplicated basement membranes
What is a complication of Hyperplastic arteriosclerosis?
Renal artery stenosis leading to HTN emergency
Clubbing and cyanosis without blood pressure or pulsce discrepancy is suggestive of?
Large PDA complicated with Esenmenger syndrome (R-->L)
Obstruction of what blood vessel results in symptoms to SVC syndrome but only on 1 side of the body?
atherosclerotic plaque obstruction greater than 75% of the coronary artery lumen, no thrombus
Cardiac tissues conduction velocity (fastest to slowest)
Purkinje-->Atrial muscle-->ventricular muscle-->AV node
What composes most of the hearts anterior surface?
Patient presents with fever, headache, jaw claudication, visual distrubances and has history of polymyalgia rheumatica?
Giant Cell Arteritis
What are the diagnostic test for Giant Cell Arteritis?
-Elevated ESR & C-reactive protein
What is seen on temporal biopsy in Giant Cell Arteritis?
-Elastic lamina fragmentation
-Multinucleated Giant cells
What is the treatment for Giant Cell Arteritis?
Flulike symptoms, fever and new systolic murmur suggests?
What is a complication of Infective Endocariditis?
Diffuse proliferation glomerulonephritis secondary to circulating immune complex deposition can result in acute renal insufficiency
V-wave on BP/Time curve is indicative of?
Coaraction of Aorta in 22 year old man is assocaited with what other disease?
Berry Aneurysms - HTN associated subarachnoid hemorrhage
What blood vessel supplies Broca & Wernicke's area?
17 year old boy presents with skin rash after staring oral penicillin therapy. Skin has several violaceous, raised, nonblanchable lesions distributed over both lower extremities
cutaneous small vessel vasculitis associated with Penicillins and palpable purpura over the lower extremities
What is decreased during peak stress during exercise compared to at rest?
Total systemic vascular resistance
-modest increased in mean blood pressure
-vasodilation in skeletal muscles decreases more
Cardinal veins give rise to?
Pulmonary Artery Catheter - pressure 25/2
Pulmonary Artery Catheter - pressure 25/10
ST elevation in leads I and aVL
Left Circumflex Artery
ST elevation in II, III, aVF
Right Coronary Artery
Where does the vertebral artery branch from?
Continuous murmur heard best in the left infraclavicular region with maximal intensity at S2
Arsenic, thorostat, polyvinyl chloride cause tumor cells to express CD31
Holosystolic murmur best heard at the apex and radiates to axilla
Holosystolic murmur best heard at the left 2nd and 3rd intercostal spaces. Murmur increases with inspiration
Holosystolic murmur best heard at 3rd and 4th intercostal spaces. Murmur is usually loud and accompanied by a thrill
Increase in systemic venous return, resulting in increased heart volumes
What heart condition causes pulsus paradoxus?
What receptors are targeted in COPD treatment?
Beta-2 antagonist cause cAMP accumulation in smooth muscle causing bronchial smooth muscle dilation
Key finding in diastolic heart failure?
Increased left ventricular end-diastolic pressure
-Normal ventricular ejection fraction
Hand grip = increased afterload
AR, MR, VSD
S3 in an older adult suggests?
When is an S3 heart sound best heard?
At the end of expiration
Patient presents with recurrent nosebleeds and mucosal telangiectasias
Symptoms associated with hypertrophic cardiomyopathy are associated with?
Mitral valve leaflet and IV septum causing outflow obstruction
What is the most common cause of age related changes causing HTN
What is heard during auscultation in Cardiac Tamponade = pericardial effusion
Drop in pulse amplitude during respiration = pulsus paradoxus
Becks Triad of Cardiac Tamponade
-Muffled heart sounds
What is seen 12 days after MI
Granulation tissue with neovascularization
Left ventricular systolic dysfunction due to reduced coronary blood flow at rest that is partially or completely reversible by coronary artery revascularization
-fibrous deposits in right sided endocardium
Carcinoid syndrome = elevated 5-1AA in urine
Wolf-Parkinson White syndrome
AV conduction tract bypassing the AV node
Platelet rich thrombin on the edges of the mitral valve is associated with?
Nonbacterial Thrombotic Endocarditis (NBTE) - assoc with advanced malignancy
What is the underlying cause of AAA?
Chronic Transmural Inflammation
What maneuver causes an increase intensity of a LVOT obstruction in hypertrophic cardiomyopathy?
Sudden standing = decreases preload
Causes increase risk of seizure and tachyarrhythmias
-pump in charcoal
Patient presents with L and R decompensated heart failure after viral infection. Most likely cause?
Dilated Cardiomyopathy from Viral Myocarditis
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