Term
| What artery supplies the SA node |
|
Definition
|
|
Term
| What artery supplies the AV node |
|
Definition
|
|
Term
| What artery supplies the inferior wall |
|
Definition
Posterior Descending branch of Right coronary in 80-90% of people (right dominant)
10-20% of people have posterior descending branch of Circumflex |
|
|
Term
| What artery supplies the right ventricle |
|
Definition
| Acute marginal branch of the right coronary |
|
|
Term
| What artery supplies the posterior left ventricle |
|
Definition
|
|
Term
| What artery supplies the anterior wall? |
|
Definition
| Left anterior descending branch of the left main |
|
|
Term
| What chamber of the heart is most posterior? |
|
Definition
|
|
Term
What is mean arterial pressure equal to?
(two different formulas) |
|
Definition
MAP = COxTPR
MAP = 2/3diastolic+1/3 systolic |
|
|
Term
| What is the Fick Principle? |
|
Definition
| CO = O2 consumption/(arterial O2-venous O2) |
|
|
Term
Effect of each of the following on contractility:
Catecholamines
Intracellular calcium
Intracellular sodium
pH
Hypoxia |
|
Definition
Catecholamines: increase
INtracellular calcium INcreases
INtracellular sodium INcreases
LOW pH LOWers
LOW O2 LOWers |
|
|
Term
| What is a normal ejection fraction? |
|
Definition
|
|
Term
| Decrease in ejection fraction = systolic or diastolic HF? |
|
Definition
|
|
Term
| How does resistance to flow relate to viscosity, length, and vessel radius |
|
Definition
| Resistance = viscosity*length/(radius^4) |
|
|
Term
| At what point in the cardiac cycle is the heart consuming the most oxygen? |
|
Definition
| During isovolumetric contraction |
|
|
Term
|
Definition
Increased preload like in mitral regurg or CHF
Normal in kids and pregnant women |
|
|
Term
|
Definition
| Increased atrial pressure from pushing into stiff hypertrophied ventricle |
|
|
Term
| What is the order of the components of the jugular venous pulse? |
|
Definition
A wave
C wave
X descent
V wave
Y descent |
|
|
Term
| What does the A wave correspond to? |
|
Definition
|
|
Term
| What does the C wave correspond to? |
|
Definition
| Right ventricular contraction causing the tricuspid valve to bulge into the right atrium |
|
|
Term
| What does the X descent correspond to? |
|
Definition
| atrial relaxation and the downward displacement of tricuspid during ventricular contraction |
|
|
Term
| What does the Y descent correspond to? |
|
Definition
|
|
Term
| Conditions associated with wide splitting of the 2nd heart sound? |
|
Definition
|
|
Term
| Conditions associated with fixed splitting of the 2nd heart sound |
|
Definition
|
|
Term
| Conditions associated with paradoxical splitting of the 2nd heart sound? |
|
Definition
|
|
Term
| Name the 4 heart auscultation areas and their locations starting from the right most |
|
Definition
APT M
Aortic = Right parasternal 2nd intercostal space
Pulmonic = Left parasternal 2nd intercostal space
Tricuspid = Left parasternal 5th intercostal space
Mitral = Left mid clavicular 6th intercostal space |
|
|
Term
| What mumurs are heard best at the aortic area? |
|
Definition
SYSTOLIC
Aortic Stensosis
Flow Murmur
Aortic Valve Sclerosis |
|
|
Term
| What murmurs are heard best at the pulmonic area? |
|
Definition
SYSTOLIC
Pulmonic Stenosis
Flow murmur (e.g. ASD) |
|
|
Term
| What murmurs are heard best at the tricuspid area? |
|
Definition
SYSTOLIC
Tricuspid regurg
VSD
DIASTOLIC
Tricuspid stenosis
ASD |
|
|
Term
| What murmurs are heard best at the Mitral area? |
|
Definition
SYSTOLIC
Mitral regurg
DIASTOLIC
Mitral stenosis |
|
|
Term
| What murmurs are heard beast at the left sternal border? |
|
Definition
SYSTOLIC
Hypertrophic Cardiomyopathy
DIASTOLIC
Aortic regurg
Pulmonic regurg |
|
|
Term
| Holosytolic high pitched blowing |
|
Definition
| Mitral or Tricuspid regurgitation |
|
|
Term
| Crescendo-decrescendo systolic |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Immediate high pitched blowing diastolic |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Torsades de Pointes description and risk factors |
|
Definition
V-tach, shifting sinusoidal wave forms
Increasing QT interval increases risk |
|
|
Term
Congenital long QT syndromes
defect
association
other names |
|
Definition
Defects in cardiac sodium and potassium channels
may have sensorineural deafness
Jervell and Lange-Nielsen Syndrome |
|
|
Term
|
Definition
B-blockers
Calcium channel blockers
Digoxin |
|
|
Term
|
Definition
Class IA
Class IC
Class III
B-blockers |
|
|
Term
| Treating 3rd degree block |
|
Definition
|
|
Term
|
Definition
|
|
Term
Describe the A-fib tracing
Describe the A-flutter tracing |
|
Definition
A-Fib: no discrete P waves with irregularly spaced QRS complexes
A-flutter: identical back-back P waves (sawtooth) |
|
|
Term
| Describe the various heart block tracings |
|
Definition
1st degree: fixed, lengthened PR interval
2nd degree type1 (Wenckebach): progressive lengthening of PR interval until there is a dropped beat (P wave without QRS)
2nd degree type 2: Dropped beats not preceded by lengthening PR interval
3rd degree: No relation between P waves and QRS complexes |
|
|
Term
| What are the signals for ANP release and what does it do? |
|
Definition
Released in response to increased atrial pressure.
Vascular relaxation and increased GFR (dilate afferent arteriole, constrict efferent) |
|
|
Term
| Contrast the aortic and carotid barorceptors |
|
Definition
Carotid responds to any change in BP by proportionally adjusting it's firing rate on CN IX
Aortic responds only to increase in BP by increasing firing on CN X |
|
|
Term
| What is the Cushing reaction? |
|
Definition
| Increased ICP constricts arterioles leading to cerebral ischemia which increases systemic BP causing bradycardia. |
|
|
Term
| How does the heart increase it's O2 supply, why? |
|
Definition
| Vasodilation to increase blood flow since the organ is always extracting 100% of Oxygen delivered. |
|
|
Term
| Normal RA and RV pressure? |
|
Definition
|
|
Term
| Normal PA and PCWP pressure? |
|
Definition
|
|
Term
| Normal LV and Aortic arch pressure? |
|
Definition
LV = <130/10
Aorta = <130/90 |
|
|
Term
| What embryologic defect causes Persistent Truncus Arteriosus |
|
Definition
| Truncus arteriosus fails to divide into pulmonary trunk and aorta |
|
|
Term
| What embryologic defect causes tetrology of fallot? |
|
Definition
| Anterosuperior displacement of the infundibular septum |
|
|
Term
| What embryologic defect causes D-transposition of the great vessels? |
|
Definition
| Failure of the aorticopulmonary septum to spiral |
|
|
Term
|
Definition
Total anomalous pulmonary venous return
pulmonary veins drain into the right heart circulation
presents as blue baby with right to left shunt |
|
|
Term
| Most common congenital cardiac anomaly? |
|
Definition
|
|
Term
| Coarctation of the aorta presentation |
|
Definition
Infantile: PDA because coarctation proximal to it
Adult: kid with HTN in upper extremities and way pulses in lower, might see notching of ribs on X-ray due to collateral circulation. Coarcation is distal to ductus arterioles
Either can result in aortic regurg |
|
|
Term
|
Definition
machine like murmur
cyanosis of the toes but not fingers
Inititally a L to R shunt but eventually get Eisenmenger syndrome (R to L) |
|
|
Term
Congenital cardiac defects associated with:
DiGeorge |
|
Definition
Truncus Arteriosus
tetrology of Fallot
arch defects |
|
|
Term
Congenital cardiac defects associated with:
Down syndrome |
|
Definition
ASD
VSD
Inferior interatrial septal defects (endocardial cushion) |
|
|
Term
Congenital cardiac defects associated with:
Congenital Rubella |
|
Definition
Septal defects
PDA
Pulmonary artery stenosis |
|
|
Term
Congenital cardiac defects associated with:
Turner Syndrome |
|
Definition
| Preductal (infantile) coarctation of the Aorta |
|
|
Term
Congenital cardiac defects associated with:
Marfan's Syndrome |
|
Definition
Aortic insufficiency (adult complication)
Cystic medial necrosis leading to aortic dissection (adult complication) |
|
|
Term
Congenital cardiac defects associated with:
Gestational Diabetes |
|
Definition
| Transposition of the great vessels |
|
|
Term
| HTN is a risk factor for which diseases |
|
Definition
Atherosclerosis
LVH
Stroke
CHF
Renal Failure
Retinopathy
Aortic Dissection |
|
|
Term
Contrast the histology of
Monckeberg
Arteriosclerosis
Atherosclerosis |
|
Definition
Monckeberg = calcification of media usually in radial/ulnar arteries, no occlusion
Arterio = hyalinization of small arteries, onion skinning in malignant HTN
Athero = fibrous and atheromatous plaques in the intima |
|
|
Term
| What is the pathophysiology of developing an atheromatous plaque? |
|
Definition
Endothelial cell dysfunction leads to macrophages and LDL accumulation.
Macrophages become foam cells causing fatty streaks.
Smooth muscle cell migration (due to PDGF and TGF-B) leads to fibrous plaque formation and complex atheromas form. |
|
|
Term
What kind of vessels are affected by atherosclerosis?
What locations are most common? |
|
Definition
Elastic arteries and large/medium sized muscular arteries
Abdominal aorta > coronary > popliteal > carotid |
|
|
Term
| What ECG finding separates Prinzmetal angina from stable/unstable? |
|
Definition
| ST elevation in Prinzmetal, depression in the others |
|
|
Term
|
Definition
| Vasodilator aggravates ischemia by depriving shunting blood away from an area that is highly stenosed and towards a more healthy vessel |
|
|
Term
|
Definition
LAD > RCA > Circumflex
(anterior, inferior, posterior) |
|
|
Term
| Pathology of an MI 0-4 hours old? |
|
Definition
|
|
Term
| Pathology of an MI 4-12 hours old? |
|
Definition
Gross: white infarct, dark mottling; pale with tetrazolium stain
Microscope: early coagulative necrosis, edema, hemorrhage, wavy fibers |
|
|
Term
| Pathology of an MI 12-24 hours old? |
|
Definition
Gross: white infarct, dark mottling; pale with tetrazolium stain
Microscopic: Contraction bands. Release of necrotic cell content into blood, beginning of neutrophil emigration |
|
|
Term
| Pathology of an MI 2-4 days old? |
|
Definition
Gross: Hyperemia
Microscope: Extensive coagulative necrosis, tissue surrounding infarct shows acute inflammation, lots of neutrophils. |
|
|
Term
| Pathology of an MI 5-10 days old? |
|
Definition
Gross: Hyperemic border, central yellow/brown softening
Microscopic: Granulation tissue at the edges |
|
|
Term
| Pathology of an MI 7 weeks old? |
|
Definition
Gross: gray-white tissue with recanalized artery
Microscope: Contracted scar complete |
|
|
Term
| Which cardiac enzyme is positive first in an MI and when? |
|
Definition
|
|
Term
| What is special about CK-MB? |
|
Definition
| Good at diagnosing reinfarction on top of acute MI |
|
|
Term
| During an MI, what is the difference between ST elevation and depression? |
|
Definition
Elevation = transmural infarct
Depression = subendocardial infarct |
|
|
Term
Where is the infarct and what vessel is occluded?
V1-V4 |
|
Definition
|
|
Term
Where is the infarct and what vessel is occluded?
V1-V2 |
|
Definition
|
|
Term
Where is the infarct and what vessel is occluded?
V4-V6 |
|
Definition
Anterolateral Wall
Circumflex |
|
|
Term
Where is the infarct and what vessel is occluded?
1, aVL |
|
Definition
|
|
Term
Where is the infarct and what vessel is occluded?
2, 3, aVF |
|
Definition
Inferior wall
Right coronary |
|
|
Term
|
Definition
| autoimmune disease causing fibrinous pericarditis several weeks post MI |
|
|
Term
| Most common causes of dilated cardiomyopathy |
|
Definition
ABCCCD
Alcoholism
Beri beri (wet)
Coxsackie
Chagas
Cocaine
Doxirubicin |
|
|
Term
| Treating hypertrophic cardiomyopathy |
|
Definition
| Beta blockers and calcium channel blockers (non-dihydropyridine like verapamil) |
|
|
Term
|
Definition
| endomyocardial fibrosis (restrictive cardiomyopathy) with eosinophilic infiltrate |
|
|
Term
| CHF drugs that reduce mortality |
|
Definition
ACEi/ARBs
B blockers
Spironolactone |
|
|
Term
| CHF drugs that improve symptoms but don't improve mortality |
|
Definition
Thiazide/Loop diuretics
Nitrates |
|
|
Term
| What disease are hemosiderin filled macrophages in the lungs associated with? |
|
Definition
|
|
Term
| What are Roth's Spots and what are they a sign of? |
|
Definition
Round white spots on retina surround by hemorrhage
Bacterial endocarditis |
|
|
Term
| What are Osler's Nodes and what are they a sign of? |
|
Definition
Tender raised lesion on finger or toe pads
Bacterial Endocarditis |
|
|
Term
| What are Janeway lesions and what are they associated with? |
|
Definition
Small erythematous lesions on palm or sole
Bacterial endocarditis |
|
|
Term
| What are splinter hemorrhages associated with? |
|
Definition
|
|
Term
| What bacteria is associated with bacterial endocarditis of colon cancer? |
|
Definition
|
|
Term
| What bacteria is associated with endocarditis seen in prosthetic valves? |
|
Definition
|
|
Term
| Which bugs are more likely to be found in right sided bacterial endocarditis? |
|
Definition
S. Aureus
Pseudomonas
Candida |
|
|
Term
| Complications of bacterial endocarditis |
|
Definition
Chordae rupture
Glomerulonephritis
Suppurative pericarditis
Emboli |
|
|
Term
| What is the antibody target in acute rheumatic fever? |
|
Definition
|
|
Term
| Common causes of Serous pericarditis |
|
Definition
| noninfectious inflammatory diseases |
|
|
Term
| Conditions that cause Pulsus Paradoxus |
|
Definition
Cardiac Tamponade/Pericarditis
Asthma/Croup
Obstructive Sleep Apnea |
|
|
Term
Syphilitic heart disease findings
Underlying pathophys |
|
Definition
Ascending aorta/arch aneurysm
aortic insufficiency
tree bark appearance
disruption of the vasa vasorum of the aorta |
|
|
Term
What is Kussmaul's Sign?
What is it associated with? |
|
Definition
Increase in JVP on inspiration
Heart tumors |
|
|
Term
|
Definition
|
|
Term
| Most common location for primary heart tumor |
|
Definition
| Left atrium (90% in atrium) |
|
|
Term
Most common presentation for primary heart tumor
Most common radiology finding |
|
Definition
Multiple syncopal episodes
Ball-valve obstruction |
|
|
Term
| Difference between Raynaud's Disease vs. Raynaud's Phenomenon? |
|
Definition
| Phenomenon is when it is secondary to connective tissue disease |
|
|
Term
Giant cell arteritis
presentation |
|
Definition
| Old lady with headache, jaw claudication, and polymyalgia rheumatica |
|
|
Term
| Giant cell arteritis pathology |
|
Definition
| granulomas, increased ESR, palpable arteries |
|
|
Term
| Takayasu arteritis presentation |
|
Definition
Asian female under 40
weak upper extremity pulses, fever, night sweats, arthritis, myalgia, skin nodules, ocular disturbance |
|
|
Term
| Takaysu's arteritis pathology |
|
Definition
Granulomas in the aortic arch and proximal vessels
increased ESR |
|
|
Term
Polyarteritis Nodosa
presentation |
|
Definition
Young adults, often have HBV too
Fever, weight loss, abdominal pain, melena, HTN, CNS problems and CUTANEOUS ERUPTIONS |
|
|
Term
|
Definition
SPARES LUNGS
usually renal and visceral
Transmural fibrinoid necrosis with lesions of different ages
Multiple aneurysms and constrictions
immune complexes |
|
|
Term
|
Definition
Asian kids <4
fever, lymphadenitis, conjuctivitis, strawberry tongue, hand/foot erythema and desquamation |
|
|
Term
|
Definition
| be wary of coronary aneurysms |
|
|
Term
| Buerger's disease presentation |
|
Definition
Male smoker < 40
Claudication/gangrene and Raynaud's |
|
|
Term
|
Definition
Segmental thrombosin vasculitis
improves with smoking cessation |
|
|
Term
| Microscopic polyangiitis presentation |
|
Definition
palpable purpura
pauci-immune glomerulonephritis |
|
|
Term
| microscopic polyangitiis pathology |
|
Definition
|
|
Term
|
Definition
Nasal septum issues, sinusitis, otitis media and mastoiditis
hemoptysis, cough, dyspnea
hematuria with RBC casts |
|
|
Term
|
Definition
Granulomas
focal necrotizing vasculitis
c-ANCA
large nodular densities on x-ray |
|
|
Term
| Churg-Strauss presentation |
|
Definition
Asthma, wrist/foot drop
sinusitis, palpable purpura |
|
|
Term
|
Definition
eosinophilia and granulomas
p-ANCA |
|
|
Term
| Henoch-Schonlein presentation |
|
Definition
| kids who after a URI get palpable purpura on butt/legs, arthralgias, and GI pain/melena |
|
|
Term
| Henoch-Schonlein pathology |
|
Definition
IgA complexes, IgA nephropathy
Multiple GI lesions of the same age |
|
|
Term
| Sturge-Weber presentation |
|
Definition
| port-wine stain on face, seizures, early glaucoma, leptomeningieal angiomatosis |
|
|
Term
|
Definition
intracerebral AVMs
only affects very small vessels |
|
|
Term
|
Definition
| Benign capillary hemangioma in infants that regresses by age 5-8 |
|
|
Term
|
Definition
| Benign capillary hemangioma that appears in 20s or 30s, see more of them with age |
|
|
Term
|
Definition
Polypoid capillary hemangioma that ulcerates and bleeds
associated with trauma and pregnancy |
|
|
Term
|
Definition
Associated with Turner syndrome
cavernous lymphangioma in the neck |
|
|
Term
|
Definition
Benign, painful, reddish blue tumor under nail beds
Comes from muscular capillaries designed to shunt blood away when it's cold |
|
|
Term
|
Definition
Papules in AIDS patients infected with Bartonella Henselae (cat scratch fever)
looks like Kaposi's Sarcoma |
|
|
Term
|
Definition
| Liver cancer associated with vinyl chloride, arsenic and ThO2 (old x-ray contrast agent) |
|
|
Term
|
Definition
| lymphatic cancer associated with persistent lymphedema (e.g. post-mastectomy) |
|
|
Term
|
Definition
endothelial cancer in AIDS patients with HHV8 infection
looks like bacillary angiomatosis |
|
|
