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Flashcards in Cardiology Deck (208):
1

PR interval

0.12-0.20

2

PR segment

0.05-0.12

3

QRS complex

0.08-0.12

4

QT interval

Less than or equal to 0.45 in males, 0.46 in females

5

Corrected QT

Bazett's formula: QT interval/square root of RR in seconds

6

When to correct for QT

Tachycardia or bradycardia

7

How to measure heart rate for regular rhythm

1500/number of small boxes from R-R

8

1 small box: second/s

0.04

9

5 small boxes (1 big box): second/s

0.2

10

1 small box: mm

1

11

5 small boxes (1 big box): mm

5

12

Normal axis

-30 to 100

13

Examples of LAD (4)

1) LVH
2) Inferior wall MI
3) Hyperkalemia
4) Normal variant

14

Examples of RAD (6)

1) RVH
2) Anterolateral wall MI
3) Pulmonary embolism
4) Chronic lung disease
5) ASD, VSD
6) Normal variant in children and thin adults

15

Leads for eyeballing of axis

1) Lead I
2) aVF

16

Heart rate in sinus rhythm

60-100bpm

17

Heart rate in junctional rhythm

40-60bpm

18

Heart rate in idioventricular rhythm

15-40

19

Anterior wall: Supplied by

LAD

20

Anterior wall: Leads

v1-4

21

Anteroseptal wall: Supplied by

LAD

22

Anteroseptal wall: Leads

V1-2

23

Anterolateral wall: Supplied by

LCX

24

Anterolateral wall: Leads

V4-6

25

Lateral wall: Supplied by

LCX

26

Lateral wall: Leads

I, aVL

27

Inferior wall: Supplied by

RCA

28

Inferior wall: Leads

II, III, aVF

29

Vessels that comprise the largest total cross-sectional and surface area of circulation

Capillaries

30

T/F: Venules have autonomic innervation

T

31

Correponds to the distensibility of blood vessel

Capacitance/compliance

32

Artery vs vein: Greater capacitance

Vein

33

Most important determinant of pulse pressure

Stroke volume

34

Palpation mtd of BP measurement: Artery used

1) Brachial
2) Radial

35

Palpation mtd of BP measurement: Inflate the cuff ___ mmHg above the point where loss of pulse is noted

30

36

Auscultation mtd of BP measurement: Inflate cuff ___ mmHg above systolic pressure

30

37

Palpation mtd of BP measurement: Rate of decrease in pressure should be

2-3 mmHg/sec

38

Korotkoff phase: Onset of tapping

Phase 1

39

Korotkoff phase: Reappearance of tapping sound

Phase 3

40

Korotkoff phase: Disappearance of sound

Phase 5

41

Korotkoff phase: 10-15mmHg lower than previous phase during which a murmur may be heard after tap

Phase 2

42

Korotkoff phase: Muffling of heart sound

Phase 4

43

Normal BP difference of both arms

Less than 10 mmHg

44

UE vs LE: Higher BP

LE

45

BP is __mmHg higher in legs than arms

20

46

Orthostatic hypotension: Fall in SBP by __mmHg

20

47

Orthostatic hypotension: Fall in DBP by __mmHg

>10

48

Effect of inspiration to SBP

Decrease

49

Exaggerated fall in SBP with normal respiration

Pulsus paradoxus

50

mmHg fall in pulsus paradoxus

10mmHg or more

51

Slow rise in arterial pulse

Pulsus tardus

52

Pulsus tardus is seen in

Aortic stenosis

53

Non-cardiac causes of rapid rise in arterial pressure or bounding pulse (3)

1) Thyrotoxicosis
2) Pregnancy
3) Anemia

54

Cardiac causes of rapid rise in arterial pressure or bounding pulse (3)

1) PDA
2) AR
3) Coarctation of the aorta

55

Twice beating or double-peaked arterial pulse

Pulsus bisferiens

56

Condition: Pulsus bisferiens

AR

57

Single most common cause of heart failure

CAD

58

***Most common cause of pump failure hence CHF

Myocardial hypertrophy usually sec to htn

59

Measure of LV function

EF

60

Heart failure with depressed EF

Systolic failure

61

Heart failure with preserved EF

Diastolic failure

62

Treatment for systolic failure

Digoxin

63

Most common manifestation of left-sided heart failure

Pulmonary congestion and edema

64

Heart failure cells

Hemosiderin-laden macrophages

65

Most common cause of right-sided heart failure

Left-sided heart failure

66

Left vs right sided heart failure, etiology: Pulmonary emboli

Right

67

Left vs right sided heart failure, etiology: Any disease interfering with pulmonary ventilation

Right

68

Left vs right sided heart failure, etiology: Cystic fibrosis

Right

69

Left vs right sided heart failure, etiology: Ischemia

Left

70

Left vs right sided heart failure, etiology: Systemic htn

Left

71

Left vs right sided heart failure, etiology: Myocardial disease/cardiomyopathy

Left

72

Right-sided heart failure caused by pulmonary htn from intrinsic lung dse

Cor pulmonale

73

Right-sided heart failure results on __ in the liver

Chronic passive congestion

74

Histologic morphology of liver in right-sided heart failure

Centrilobular congestion and atrophy of central hepatocytes described as nutmeg liver

75

Functional capacity class: Ordinary physical activity does not cause undue fatigue

I

76

Functional capacity class: SLIGHT limitation. Ordinary physical activity results in fatigue.

II

77

Functional capacity class: MARKED limitation. Less than ordinary activity causes fatigue.

III

78

Functional capacity class: Symptoms present even at rest

IV

79

Cardinal symptoms of heart failure (2)

1) Fatigue
2) Shortness of breath

80

Periodic respiration or cyclic respiration

Cheyne-Stokes

81

Mgt of heart failure with depressed EF (less than 40%)

1) Screen and treat comorbidities
2) Stop smoking and limit alcohol
3) Avoid extremes of temp and heavy physical exertion
4) Diuretics

82

Most common sustained arrhythmia

Atrial fibrillation

83

Typical rate of afib

120-160bpm

84

Treatment for afib (2)

1) Rate controller
2) Anticoagulant

85

When to begin IV heparin in afib (2 conditions)

1) Duration >12hrs
2) Presence of risk factors for stroke in Afib

86

Risk factors for stroke in Afib (9)

1) History of stroke or TIA
2) Mitral stenosis
3) Htn
4) DM
5) Age >75
6) CHF
7) LV dysfunction
8) Marked left atrial enlargement (>5.0cm)
9) Spontaneous echo contrast

87

Membrane channel inhibited by Digoxin

Na/K ATPase pump

88

Electrolyte imbalances that worsen Digoxin toxicity

1) HypoK
2) Hypomag

89

Transient or concealed ST elevation in V1-V3 typically provoked with Na channel-blocking drugs

Brugada syndrome

90

Brugada syndrome: Provoking drugs

1) Ajmaline
2) Procainamide
3) Flecainide

91

Brugada syndrome: Gene mutation in 20% of patients

scn5a

92

Brugada syndrome: Most common in

Young males

93

Brugada syndrome: Responsible for ___ in southeast asian men

SUNDS

94

Brugada syndrome: Risk of developing

Polymorphic ventricular arrhythmia

95

Brugada syndrome: Predictors of adverse outcome

1) Spontaneous coved-type ST elevation in the right precordial leads
2) History of syncope
3) Aborted sudden cardiac death

96

Brugada syndrome: Treatment

Procainamide

97

***Most common type of heart disease among children

Congenital heart disease

98

Congenital heart disease develops at which week of gestation

3rd to 8th

99

Incidence of congenital heart disease

1% of livebirths

100

Congenital heart disease: L-R shunt (4)

1) ASD
2) VSD
3) PDA
4) AVSD (atrioventricular septal defect)

101

Most common congenital cardiac anomaly in adults

ASD

102

Male vs female: ASD

Female

103

Types of ASD (3)

1) Sinus venosus
2) Ostium primum
3) Ostium secundum

104

Most common form of ASD

Ostium secundum

105

Syndrome in which a mutation in tbx5 transcription factor causes ASD and VSD

Holt-Oram syndrome

106

S2 in ASD

Widely split

107

ECG change in ASD

rSr' pattern in the right precordial leads representing enlargement of RV outflow tract

108

Surgical repair of ASD should not be carried out in

1) Small defects
2) Trivial L-R shunts
3) Severe pulmonary vascular disease without a significant L-R shunt

109

Location of sinus venosus

High in the atrial septum near the entry of SVC

110

Sinus venosus ASD is frequently associated with

Anomalous pulmonary venous connection from the right lung to the SVC or right atrium

111

Location of ostium primum

Adjacent to the AV valves which may be deformed or regurgitant

112

Location of ostium secundum

Midseptal and involves fossa ovalis

113

Most common congenital cardiac anomaly overall

VSD

114

Congenital anomaly frequently associated with VSD

Tetralogy of Fallot

115

Isolated vs with association: VSD

With association

116

Single vs multiple: Opening/s in VSD

Single (MC single because MC is membranous; Trabecular or muscular VSD is characteristically "Swiss cheese" in appearance because of multiple openings)

117

Membranous vs infundibular: Opening in VSD

Membranous

118

Principal determinant of clinical manifestations, course, and feasibility of surgical repair of a given VSD

Pulmonary vascular bed

119

Large communication b/w 2 circulations and bidirectional or predominantly right-to-left shunts because of high resistance and obstructive pulmonary htn

Eisenmenger syndrome

120

Small shunt: Pulmonary-systemic flow ratio

Less than 1.5 to 2:1

121

Small shunt: Surgery

Surgery not recommended

122

Medium to large shunt: Pulmonary-systemic flow ratio

>1.5 or 2:1

123

Medium to large shunt: Surgery

Operative or transcatheter

124

Eisenmenger VSD: Management (3)

1) Pulmonary arterial vasodilators
2) Single lung transplantation with intracardiac defect repair
3) Total heart-lung transplantation

125

Therapeutic phlebotomy: Amount of blood removed

500

126

Therapeutic phlebotomy: Duration

45 mins

127

Therapeutic phlebotomy: Replacement of extracted volume

Isovolumetric replacement with isotonic saline

128

Outcome of R-L shunt (3)

1) Cyanosis
2) Clubbing
3) Erythrocytosis

129

Cause of erythrocytosis in R-L shunt

Chronic hypoxemia and EPO production

130

Compensated vs decompensated erythrocytosis: Therapeutic phlebotomy

Decompensated

131

Caveat of therapeutic phlebotomy

Limits O2 delivery

132

Isolated vs with association: PDA

Isolated

133

10% of PDA is associated with (3)

1) Pulmonary or aortic stenosis
2) Coarctation
3) VSD

134

PDA is associated with what gestational conditions

1) Prematurity (HMD)
2) Congenital rubella infection

135

Murmur associated with PDA

Machinery

136

Congenital heart diseases: R-L shunt

5 T's
1) Tetralogy
2) TOGV
3) Tricuspid atresia
4) Persistent Truncus
5) TAPVR

137

Most common cause of heart disease in children

RHD

138

RHD: Etiology

Immunologic hypersensitivity rxn to streptococcal antigens

139

RHD: Major criteria

1) Chorea
2) Carditis
3) Polyarthritis
4) Subcutaneous nodules
5) Erythema nodosum

140

RHD: Etiologic agent

GABHS

141

RHD: Foci of swollen eosinophilic collagen surr by lymphocytes, occ plasma cells, and plump macrophages (granuloma)

Aschoff bodies

142

RHD: Activated histiocytes/plump macrophages pathognomonic of RHD

Anitschkow's cells

143

RHD: Multinucleated giant cells seen in aschoff bodies

Aschoff cells

144

Most common clinical presentations of ARF (2)

1) Fever
2) Polyarthritis

145

Clinical features of RF (9)

FEVERSS PE
1) Fever
2) ESR elevation
3) Valvular damage
4) Erythema marginatum
5) Red hot joints (polyarthritis)
6) Subcutaneous nodules
7) St. Vitus dance (Chorea)
8) Polyarthralgia
9) ECG: Prolonged PR interval

146

Criteria for diagnosis of RF

Jones criteria

147

Jones criteria

Evidence of GABHS infection +
1) 2 major
2) 1 major + 2 minor
3) 2 minor for recurrence

148

Hallmark of rheumatic carditis

Valvular damage

149

RHD: Valve that is almost always affected

Mitral

150

T/F: Isolated aortic valve involvement is common in RHD

F

151

Rapid purposeless movements that affect particularly the head with a characteristic darting movement of the tongue

Sydenham's chorea

152

Evidence of GABHS infection is required for diagnosis of RF except

When discovered after a long latent period

153

Acute RF resolves in

3 months without treatment

154

Chronic RF is cxd persistence of symptoms for

More than 6 months

155

Polyarthritis in RF: Resolution

Within 2-4 weeks without permanent damage

156

Polyarthritis in RF: Symmetrical vs asymmetrical

Symmetrical

157

Polyarthritis in RF: Large vs small joints

Small

158

Polyarthritis in RF: Rare sequelae

Periarticular fibrosis called Jaccoud joint

159

Polyarthritis in RF: May be monoarticular with early use of what drug

NSAID

160

RF: Age of predilection

5-15 y/o

161

RF: Rare after what age

35 y/o

162

RF: Symptoms more common in females (2)

1) Mitral stenosis
2) Sydenham's chorea

163

RF: Major criteria most common in children

Carditis

164

RF: Major criteria most common in adults

Polyarthritis

165

RF: Major criteria that are very rare in adults (3)

1) Erythema nodosum
2) St. Vitus dance
3) Subcutaneous nodules

166

The ONLY manifestation of ARF with significant potential to cause long-term disability and/or death

Carditis

167

T/F: Carditis in RF is a PANCARDITIS

T

168

RF Chorea: Pathophy

Autoantibodies react with brain ganglioside

169

RF manifestation covered by clothing due to predilection for trunk and proximal aspects of limbs hence frequently missed by parents

Erythema marginatum

170

Erythema marginatum T/F: Pruritic

F

171

Erythema marginatum T/F: Painful

F

172

RF subcutaneous nodules resolve within

1-2 weeks

173

VSD: Defects in muscular septum

Multiple

174

VSD: Appearance of muscular defect

Swiss cheese

175

Components of TOF

PROVe
1) Pulmo stenosis
2) RVH
3) Overriding of aorta
4) VSD

176

T/F A fraction of VSDs close spontaneously

T

177

VSD: Timing of spontaneous closure

30-50% in the first 2 years of life

178

Congenital heart disease: Snowman or figure of 8

TAPVR

179

PDA: Permanent closure

8 weeks after birth

180

PDA: Inversely related to (2)

1) Gestational age
2) Birth weight

181

PDA: Attached to which portion of aorta

Descending

182

Classical rash of congenital rubella

Blueberry muffin rash

183

PDA: Mgt

Prostaglandin synthase inhibitors
1) Indomethacin
2) Ibuprofen

184

PDA: Drug associated with premature closure

Ibuprofen

185

Congenital heart disease: Boot-shaped heart

TOF

186

Most common cyanotic congenital anomaly

TOF

187

TOF: Prognosis is dependent on

Degree of pulmonary stenosis

188

TOF: Paroxysmal hypercyanotic attacks

Tet spells

189

TOF: Tet spells are due to

R-L flow across VSD due to overload from pulmo stenosis

190

TOF: Pharmacologic management

b-blocker

191

TOF: Physiologic management

Squatting or knee to chest position

192

TOF: Surgical management

Blalock-Tausig shunt

193

TOF: Best timing for Blalock-Tausig shunt

1st month

194

Most common aorticopulmonary anastomosis

Blalock-Tausig shunt

195

Anomalous in TOGV

Aorticopulmonary septum

196

TOGV: Risk factor

Diabetic mother

197

Congenital defect and associated cardiac disease: Down

ASD, VSD, AV septal defect (endocardial cushion defect)

198

Congenital defect and associated cardiac disease: Congenital rubella

PDA, pulmonary artery stenosis

199

Congenital defect and associated cardiac disease: Turner

Preductal coarctation of aorta

200

Congenital defect and associated cardiac disease: Marfan

Aortic insufficiency and dissection (late complication)

201

Congenital defect and associated cardiac disease: Infant of diabetic mother

TOGV

202

"Tree bark" aorta is seen in

Syphilitic heart disease

203

Most common PRIMARY cardiac tumor

Myxoma

204

90% of cardiac myxomas occur in

Atria, mostly left atrium

205

"Ball valve" obstruction of the left atrium

Cardiac myxoma

206

Most frequent primary cardiac tumor in children

Rhabdomyomas

207

Most common heart tumor

Metastasis

208

Most common tumours that metastasize to the heart

Melanoma, lymphoma