Term
| What 3 structures are contained in the carotid sheath? |
|
Definition
| "VAN" 1. Internal Jugular Vein (lateral) 2. Common Carotid Artery (medial) 3. Vagus Nerve (posterior) |
|
|
Term
| Where do coronary artery occlusions most commonly occur? Where does this supply? |
|
Definition
| Left Anterior Descending (LAD), supplied the anterior interventricular septum |
|
|
Term
| What are the 2 equations for Mean Arterial Pressure? |
|
Definition
| MAP = (1/3)systolic pressure + (2/3)diastolic pressure......... MAP = CO x TPR |
|
|
Term
| What is Fick's Principle equation for Cardiac Output? |
|
Definition
| CO = (rate of O2 consumption)/(change in arterial O2 content) |
|
|
Term
| What 3 factors affect stroke volume? |
|
Definition
| "CAP"...Contractility, Afterload, and Preload |
|
|
Term
| What is the equation for ejection fraction? |
|
Definition
| EF = (SV/EDV) = (EDV-ESV)/EDV |
|
|
Term
| What is a "normal" ejection fraction value? |
|
Definition
|
|
Term
| Name 3 things that can increase viscosity... |
|
Definition
1. polycythemia
2. hyperproteinemic states (MM)
3. hereditary spherocytosis |
|
|
Term
| Resistance is inversely proportional to the ______ to the 4th power? |
|
Definition
|
|
Term
| Under what conditions is an S3 sound considered "normal"? |
|
Definition
| in children and pregnant women |
|
|
Term
| Name 4 conditions that can result in an S3 heart sound |
|
Definition
1. Dilated cardiomyopathy
2. Left-->Rt shunt
3. CHF
4. Mitral regurgitation |
|
|
Term
| Name 5 conditions that can result in an S4 heart sound |
|
Definition
1. Left Ventricular Hypertrophy
2. HOCM
3. Aortic stenosis
4. MI
5. chronic HTN |
|
|
Term
| What gives rise to the jugular venous A, C, and V waves? |
|
Definition
A = atrial contraction
C = rt ventircular contrxn (tricuspid valve bulging into atrium)
V = increased atrial pressure due to filling against closed tricuspid valve (atrial filling) |
|
|
Term
| What are 2 situations that lead to Wide Splitting? |
|
Definition
1. Pulmonic stenosis
2. Rt Bundle Branch Block |
|
|
Term
| In what situation is Fixed Splitting found? |
|
Definition
|
|
Term
| In what 2 situations is Paradoxical Splitting seen? |
|
Definition
1. Aortic Stenosis
2. Left Bundle Branch block |
|
|
Term
| With what type of congenital heart defect would increasing afterload be beneficial? |
|
Definition
| Anything w/ a Rt-->Left shunt (Truncus Arteriosis, Tetralogy of Fallot, Transposition of Great Vessels) |
|
|
Term
| When does isovolumetric contraction take place? |
|
Definition
| the period b/w when the mitral valve closes and the aortic valve opens |
|
|
Term
| Ventricular Action Potential: What re the main electrolytes involved in phases 0-4? |
|
Definition
0 : Na+ channels open
1 : Na+ channels close
2 : Ca2+ channels open
3 : Ca2+ channels close, K+ channels open
4 : Resting potential, high K+ permeability |
|
|
Term
| What phase of the pacemaker potential determines heart rate? |
|
Definition
| The slope of Phase 4 (Na+) |
|
|
Term
| Pacemaker action potential: What electrolyte is responsible for each phase? |
|
Definition
0 : upstroke, Ca2+
NO PHASE 1, NO 2 plateau
3 : Ca2+ channels close, K+ channels open
4 : Na+ channels |
|
|
Term
| What does the P wave on ECG indicate? |
|
Definition
|
|
Term
| What does the PR interval on an ECG indicate? What length is considered normal? |
|
Definition
| Conduction delay through AV node; normal is <200msec (<1 big box) |
|
|
Term
| What does the QRS complex on an ECG indicate? What is considered normal? |
|
Definition
| Ventricular depolarization, <120msec |
|
|
Term
| A narrowed QRS indicates pathology in what part of the heart? |
|
Definition
| Above the AV node (ie. Supraventricular) |
|
|
Term
| What does a peaked T wave indicate? A U wave? |
|
Definition
Peak T wave : hypErkalemia
U wave : hypOkalemia |
|
|
Term
| Toursade de pointes is at risk for progressing into what? |
|
Definition
|
|
Term
| What do you treat Toursade de pointes with? |
|
Definition
|
|
Term
| ** Name the 6 classes of drugs that can prolong QT... |
|
Definition
| "Big crazy moquitos w/ AIDS and 2 arrhythmias" ... Macrolides, Haloperidol/Risperidone, Chloroquine/mefloquine, Protease inhibitors, 1A antiarrhythmics, and K+ channel blockers |
|
|
Term
| What drug do you use to treat most SVT's, but NOT WPW? |
|
Definition
|
|
Term
| In what situation do you see delta waves on ECG? |
|
Definition
| WPW (exciting the ventricles prematurely) |
|
|
Term
| What 2 drugs can you use to treat WPW with? |
|
Definition
| "AP"...Amiodarone and Procainamide |
|
|
Term
| How does it affect the Starling forces and cause edema? Liver failure, nephrotic syndrome |
|
Definition
| Decreased plasma proteins (decreased colloid plasma oncotic pressure) |
|
|
Term
| How does it affect the Starling forces and cause edema? Lymphatic blockage |
|
Definition
| Icreases interstitial fluid colloid osmotic pressure (more protein in the interstitium) |
|
|
Term
| How does it affect the Starling forces and cause edema? Infections, toxins, burns |
|
Definition
| increases capillary permeability |
|
|
Term
| How does it affect the Starling forces and cause edema? Heart failure |
|
Definition
| Increased capillary pressure (capillaries are congested f/ the venous end) |
|
|
Term
| Does lymphatic blockage produce pitting or non-pitting edema? |
|
Definition
|
|
Term
|
Definition
| P waves become progressively more spread out until a beat is dropped (dropped QRS)...Predictable dropped beat |
|
|
Term
| What Mobitz is described by a dropped QRS WITHOUT warning? |
|
Definition
|
|
Term
| What is the MOA of the antiarrhythmic classes 1-4? |
|
Definition
| "Nice BabyBoys Keep Clean" I : Na+ channel blockers II : Beta-blockers III : K+ channel blockers IV : Ca+ channel blockers |
|
|
Term
| What has caused the associated HTN? paroxysms of increased sympathetic tone: anxiety, palpitations, disphoresis |
|
Definition
|
|
Term
| What has caused the associated HTN? age of onset between 20 and 50 |
|
Definition
|
|
Term
| What has caused the associated HTN? Elevated creatinine and abnormal urinalysis |
|
Definition
|
|
Term
| What has caused the associated HTN? Abdominal bruit |
|
Definition
|
|
Term
| What has caused the associated HTN? BP in arms > BP in legs |
|
Definition
|
|
Term
| What has caused the associated HTN? Tachycardia, heat intolerance, diarrhea |
|
Definition
|
|
Term
| What has caused the associated HTN? hyperkalemia |
|
Definition
|
|
Term
| What has caused the associated HTN? abrupt onset in a pt younger than 20 or older than 50, and depressed serum K+ levels |
|
Definition
| Hyperaldosteronemia (ie. renal A stenosis) |
|
|
Term
| What has caused the associated HTN? Normal urinalysis and normal serium K+ levels |
|
Definition
|
|
Term
| What has caused the associated HTN? Young individual w/ acute onset tachycardia |
|
Definition
| think stimulants...cocaine, amphetamines |
|
|
Term
| What has caused the associated HTN? hypOkalemia |
|
Definition
|
|
Term
| Which anti-HTN drug/drug class causes the following SE? first dose orthostatic hypOtension |
|
Definition
| Alpha-blockers ("--osin", ie. prazosin) |
|
|
Term
| Which anti-HTN drug/drug class causes the following SE? ototoxicity (esp. w/ aminoglycosides) |
|
Definition
|
|
Term
| Which anti-HTN drug/drug class causes the following SE? Hypertrichosis |
|
Definition
|
|
Term
| Which anti-HTN drug/drug class causes the following SE? Cyanide toxicity |
|
Definition
|
|
Term
| Which anti-HTN drug/drug class causes the following SE? dry mouth, sedation, severe rebound HTN |
|
Definition
|
|
Term
| Which anti-HTN drug/drug class causes the following SE? bradycardia, IMPOTENCE, asthma exacerbation |
|
Definition
|
|
Term
| Which anti-HTN drug/drug class causes the following SE? Reflex tachycardia |
|
Definition
|
|
Term
| Which anti-HTN drug/drug class causes the following SE? cough |
|
Definition
|
|
Term
| Which anti-HTN drug/drug class causes the following SE? Avoid in pts w/ sulfa allergies |
|
Definition
| Loop and thiazide diuretics |
|
|
Term
| Which anti-HTN drug/drug class causes the following SE? Possible angioedema |
|
Definition
|
|
Term
| Which anti-HTN drug/drug class causes the following SE? Drug-induced Lupus |
|
Definition
|
|
Term
| Which anti-HTN drug/drug class causes the following SE? HypErcalcemia, hypOkalemia |
|
Definition
|
|
Term
| Name 4 antihypertensives that are safe to use in pregnancy |
|
Definition
"Lower's Htn in Nice Mamas"
Labetalol, Hydralazine, Nifedipine, and Methyldopa |
|
|
Term
| Which lipid-lowering agent? SE: facial flushing |
|
Definition
|
|
Term
| Which lipid-lowering agent? SE: elevated LFTs and myositis |
|
Definition
|
|
Term
| Which lipid-lowering agent? SE: GI discomfort, bad taste |
|
Definition
| bile acid resins (cholestyramine, colestipol, etc) |
|
|
Term
| Which lipid-lowering agent? best effect on HDL |
|
Definition
| niacin (increases the NICE cholesterol) |
|
|
Term
| Which lipid-lowering agent? Best effects on triglycerides/VLDL |
|
Definition
| fibrates (alternative = omega3-FA) |
|
|
Term
| Which lipid-lowering agent? Best effect on LDL/cholesterol |
|
Definition
|
|
Term
| Which lipid-lowering agent? Binds C.diff toxin |
|
Definition
|
|
Term
| A 50yo man is started on lipid-lowering medication. Upon his first dose, he develops a rash, pruritis, and diarrhea. What drug is he taking? |
|
Definition
|
|
Term
| How can the flushing rxn cause by niacin be prevented? |
|
Definition
|
|
Term
| An abdominal aortic aneurysm is most likely a consequence of what process? |
|
Definition
|
|
Term
| What are the 5 deadly causes of acute chest pain? |
|
Definition
| MI, PE, Aortic dissection, unstable angina, and tension pneumothorax |
|
|
Term
| In the evolution of an MI, when does the following occur? contraction bands become visible |
|
Definition
|
|
Term
| In the evolution of an MI, when does the following occur? Early coagulative necrosis |
|
Definition
|
|
Term
| In the evolution of an MI, when does the following occur? hyperemia and high risk for arrhythmias |
|
Definition
|
|
Term
| In the evolution of an MI, when does the following occur? Tissue is yellow-brown and soft |
|
Definition
|
|
Term
| What are the 4 major risks 5-10 days after an MI? |
|
Definition
| 1. Free wall rupture 2. tamponade 3. papillary muscle rupture 4. interventricular septal rupture |
|
|
Term
| What will you hear on physical exam that indicates a papillary rupture? |
|
Definition
|
|
Term
| In the evolution of an MI, when does the following occur? Increased for ventricular aneurysms |
|
Definition
| after 10 days (scar tissue can't contract, so it begins to bulge out) |
|
|
Term
| Most likely cause of the chest pain? ST segment elevation only during brief episodes of chest pain |
|
Definition
|
|
Term
| Most likely cause of the chest pain? Rapid onset of sharp chest pain that radiates to the scapula |
|
Definition
|
|
Term
| Most likely cause of the chest pain? Rapid onset sharp pain in a 20yo and assoc w/ dyspnea |
|
Definition
|
|
Term
| Most likely cause of the chest pain? sharp pain lasting hrs-days and is somewhat relieved by sitting forward |
|
Definition
|
|
Term
| Most likely cause of the chest pain? Moat common cause of noncardiac chest pain |
|
Definition
|
|
Term
| Most likely cause of the chest pain? Acute onset dyspnea, tachycardia, and confusion in a hospitalized patient |
|
Definition
|
|
Term
| Most common cause of myocarditis in the U.S.? Followed by what? |
|
Definition
| Most common: Coxsackie B virus Followed by: Echovirus and Influenza |
|
|
Term
| What artery perfuses the anterior wall of the heart? What are the corresponding ECG leads? |
|
Definition
Left Anterior Descending (LAD)
Leads: V1->V5 |
|
|
Term
| What artery perfuses the inferior wall of the heart? What are the corresponding ECG leads? |
|
Definition
Right coronary artery
Leads: II, III, aVF |
|
|
Term
| What do you treat atrial fibrillation with? What do you use for prophylaxis? |
|
Definition
| Treat A-fib with beta-blockers or Ca2+ channel blockers. Prophylaxis = Warfarin |
|
|
Term
| Which 2 beta blockers can exacerbate the pain in a patient w/ angina? |
|
Definition
| Acebutolol and Pindolol (they have intrinsic sympathomimetic activity) |
|
|
Term
| What is Beck's triad for cardiac tamponade? (+1) |
|
Definition
1. hypOtension
2. JVD
3. muffled heart sounds
....also PULSUS PARADOXUS |
|
|
Term
| What vasculitis that affects small and medium arteries has a 30% association with Hepatitis B? |
|
Definition
| Polyarteritis Nodosa (PAN) "peter PAN flies like a B" |
|
|
Term
| If a patient presents with low hematocrit, will the diameters of theit small arteries be increased or decreased? |
|
Definition
| The diameters will be increased in an attempt to maximize the blood flow to the heart |
|
|
Term
| When does the coronary artery fill (systole or diastole)? |
|
Definition
|
|
Term
| Endomyocardial fibrosis w/ prominent eosinophial infiltrate = ? |
|
Definition
| Loffler's Syndrome (restrictive cardiomyopathy, tropical climates) |
|
|
Term
| With the administration of nitroglycerin, what happens to the EDV and ESV of the left ventricle? |
|
Definition
|
|
Term
| What is the most specific physical sign of left sided heart failure? |
|
Definition
|
|
Term
| What murmur? Crescendo-decrescendo systolic murmur best heard in the 2nd-3rd RIGHT interspace close to the sternum |
|
Definition
|
|
Term
| What murmur? EARLY diastolic decrescendo murmur heard best along the left side of the sternum |
|
Definition
|
|
Term
| What murmur? LATE diastolic decrescendo murmur heard best along the left side of the sternum |
|
Definition
|
|
Term
| What murmur? Pansystolic (aka holosystolic) murmur best heard at the apex and often radiates to the left axilla |
|
Definition
|
|
Term
| What murmur? Late systolic murmur usually preceded by a mid-systolic click |
|
Definition
|
|
Term
| What murmur? Crescendo-decrescendo systolic murmur best heard in the 2nd-3rd LEFT interspace close to the sternum |
|
Definition
|
|
Term
| What murmur? Pansystolic (aka holosystolic) murmur best heard along the left lower sternal border and generally radiates to the right lower sternal border |
|
Definition
|
|
Term
| What murmur? Rumbling late diastolic murmur with an opening snap |
|
Definition
|
|
Term
| What murmur? Pansystolic (aka holosystolic) murmur best heard at the 4th-6th left intercostal space |
|
Definition
|
|
Term
| What murmur? Continuous machine-like murmur (in systole and diastole) |
|
Definition
|
|
Term
| What murmur? High-pitched diastolic murmur with a widened pulse pressure |
|
Definition
|
|
Term
| Name 3 common causes of aortic stenosis |
|
Definition
1. Senile calcifications
2. Congenital bicuspid valve (sxs after 40)
3. Chronic rheumatic valve dz |
|
|
Term
| Which murmurs are best heard in the left lateral decubis position? |
|
Definition
|
|
Term
| Name 4 signs of Left-sided Heart failure |
|
Definition
1. Dyspnea on exertion
2. Cardiac dilation (S3)
3. Pulmonary edema, paroxysmal nocturnal dyspnea
4. Orthopnea |
|
|
Term
| Name 3 common signs of right sided heart failure |
|
Definition
1. Hepatomegaly (nutmeg liver)
2. Ankle, sacral edema
3. JVD |
|
|
Term
| What is the pneumonic for treating acute heart failure? What does it stand for? |
|
Definition
| "LMNOP"...Lasix, Morphine, Nitrates, Oxygen, pressers/positioning |
|
|
Term
| What is the most common site/valve of bacterial endocarditis? |
|
Definition
|
|
Term
| What is the most common site for bacterial endocarditis in IV drug users? |
|
Definition
| Tricuspid valve (drug abusers "TRI" new things) |
|
|
Term
| What happens to Systemic vasular resistance and cardiac output in hypOvolemic shock? |
|
Definition
|
|
Term
| What happens to Systemic vasular resistance and cardiac output in heart failure? |
|
Definition
CO: Decreases (primary problem)
SVR: increases |
|
|
Term
| What happens to Systemic vasular resistance and cardiac output in sepsis/anaphylaxis? |
|
Definition
SVR: decreases (primary activity)
CO: increases |
|
|
Term
| What happens to Systemic vasular resistance and cardiac output in neurogenic shock? (ie. spinal cord injury) |
|
Definition
|
|
Term
| What is the diagnostis criteria for Rheumatic Fever? (ie. JONES major criteria) |
|
Definition
"JONES"
1. Joints (migratory polyarthritis)
2. O "heart shape"...Pancarditis
3. Nodules (subcutaneous)
4. Erythema marginatum (serpiginous skin rash)
5. Sydenham's chorea |
|
|
Term
| What is Kussmaul's sign and why does it occur? What is it indicative of? |
|
Definition
| Kussmaul's sign is JVD with inspiration and it occurs bc of decreased capacity of the RIGHT ventricle. Often indicates PERICARDITIS |
|
|
Term
| What is Pulsus Paradoxis and why does it occur? What is it indicative of? |
|
Definition
| Pulsus Paradoxis is a decrease in systolic BP by more than 10mmHg w/ inspiration and occurs bc of decreased capacity of the LEFT ventricle. It is often indicative of Cardiac Tamponade |
|
|
Term
| Most likely dx? An IV drug user presents w/ chest pain, tachycardia, and tachypnea |
|
Definition
| Bacterial endocarditis of the tricuspid valve leading to pulmonary emboli |
|
|
Term
| Most likely dx? A patient in a MVA presents w/ chest pain, dyspnea, tachycardia, and tachypnea |
|
Definition
|
|
Term
| Most likely dx? Post-op pt presents w/ chest pain, dyspnea, tachycardia, and tachypnea |
|
Definition
|
|
Term
| A young girl w/ congenital valve dz is given penicillin prophylactically. In the ER bacterial endocarditis is diagnosed; what do you treat her with? |
|
Definition
| Vancomycin (DOC for empiric tx of endocarditis) |
|
|
Term
| Under what circumstance are you likely to see pulsus paradoxus? |
|
Definition
|
|
Term
| What heart pathology? diffuse myocardial inflammation w/ necrosis and mononuclear cells |
|
Definition
|
|
Term
| What heart pathology? focal myocardial inflammation w/ multinucleate giant cells |
|
Definition
| Rheumatic fever (Aschoff bodies) |
|
|
Term
| What heart pathology? Fever + IVDA + new heart murmur |
|
Definition
| bacterial endocarditis of the tricuspid valve |
|
|
Term
| What heart pathology? chest pain and course rubbing heart sounds in pt w/ Cr of 5 |
|
Definition
|
|
Term
| What heart pathology? Tree-barking of the aorta |
|
Definition
|
|
Term
| What heart pathology? Child w/ fever, joint pain, cutaneous nodules 4 wks after a throat infxn |
|
Definition
|
|
Term
| What heart pathology? ST elevation in ALL leads |
|
Definition
|
|
Term
| What heart pathology? Disordered growth of myocytes |
|
Definition
|
|
Term
| What heart pathology? ECG shows Electrical Alernans |
|
Definition
| Cardiac tamponade (think about it, currents are sloshing around in pericardial fluid) |
|
|
Term
| What vasculitis? Weak pulses in upper extremity |
|
Definition
|
|
Term
| What vasculitis? necrotizing granulomas of lung and necrotizing glomerulonephritis |
|
Definition
|
|
Term
| What vasculitis? necrotizing immune complex inflammation of visceral/renal vessels |
|
Definition
|
|
Term
| What vasculitis? Young male smokers |
|
Definition
|
|
Term
| What vasculitis? Young Asian women |
|
Definition
|
|
Term
| What vasculitis? Young Asthmatics |
|
Definition
|
|
Term
| What vasculitis? infants and young children; involved coronary arteries |
|
Definition
|
|
Term
| What vasculitis? Most common vasculitis |
|
Definition
|
|
Term
| What vasculitis? Associated w/ Hep B infxn? |
|
Definition
| Polyarteritis Nodosa (PAN) |
|
|
Term
| What vasculitis? Unilateral headache, jaw claudication |
|
Definition
|
|
Term
| What vasculitis? Perforation of nasal septum |
|
Definition
|
|
Term
| Which vascular tumor? benign raised RED lesion about the size of a mole in older pts |
|
Definition
|
|
Term
| Which vascular tumor? raised, red area present at birth, increases in size initially then regresses over month to years |
|
Definition
|
|
Term
| Which vascular tumor? Lesion caused by lymphoangiogenic growth factors in an infected HIV pt |
|
Definition
|
|
Term
| Which vascular tumor? polyploid red lesion found in pregnancy or after trauma |
|
Definition
| pyogenic granuloma (bleed easily if ruptured) |
|
|
Term
| Which vascular tumor? benign, painful red-blue tumor under the fingernails |
|
Definition
|
|
Term
| Which vascular tumor? Cavernous lymphangioma associated w/ Turner's Syndrome |
|
Definition
|
|
Term
| Which vascular tumor? Skin papule in AIDS pts caused by bartonella |
|
Definition
|
|
Term
| What syndrome consists of endomyocardial bibrosis w/ a prominent eosinophilc infiltrate (often in tropical climates)? |
|
Definition
|
|
Term
| Name 4 causes of restrictive cardiomyopathy |
|
Definition
1. amyloidosis
2. hemochromatosis
3. sarcoidosis
4. Loffler's Syndrome |
|
|
Term
| What are the 2 most common complications after an MI? |
|
Definition
1. Arrhythmias (2-4 days)
2. Left sided heart failure |
|
|
Term
| Name the 4 most common locations of atherosclerosis |
|
Definition
1. abdominal aorta
2. popliteal
3. coronaries
4. carotids |
|
|
Term
| An adult pt w/ a hx of HTN presents w/ a sudden sharp, tearing pain radiating to the back. What would you expect to see on CXR? |
|
Definition
| Widened mediastinum (aortic dissection) |
|
|
Term
| A 25 yo pregnant woman in her 3rd trimester has a normal BP when standing and sitting. When supine, her BP drops to 90/50. What is the dx? |
|
Definition
| Compression of the Inferior Vena Cava |
|
|
Term
| Between which 2 layers lies the pericardial space into which blood fills in cardiac tamponade? |
|
Definition
| B/w the epicardium (visceral cardium) and the parietal pericardium |
|
|
