p.9
Diagnostic Procedures in Cardiology
What is a notable feature of cardiac catheterization in constrictive pericarditis?
Equalization of diastolic pressure.
What are common causes of pericarditis due to neoplastic disease?
Carcinoma of Lung and Breast, Malignant Melanoma, and Hematologic conditions like Lymphoma and Leukemia.
p.14
Diagnostic Procedures in Cardiology
What is the goal for initiating PCI in STEMI patients?
Within 120 minutes of first medical contact.
What happens to the ST segments in Stage 2 of acute pericarditis?
ST segments return to normal after several days.
What is the characteristic pain associated with acute pericarditis?
Worsened by lying supine, relieved by sitting up and leaning forward.
p.3
Diagnostic Procedures in Cardiology
What is the major noninvasive marker of increased cardiovascular morbidity/mortality?
Left Ventricular Hypertrophy (LVH) in ECG.
p.3
Diagnostic Procedures in Cardiology
What indicates myocardial ischemia during stress testing?
New regional wall motion abnormalities and reduced systolic wall thickening in echocardiography.
What are the primary goals of pharmacologic therapy for HFrEF?
Improvement in symptoms and prolongation of patient survival.
p.3
Diagnostic Procedures in Cardiology
What is the most widely used test for the diagnosis of Ischemic Heart Disease (IHD)?
12-lead ECG before, during, and after exercise, usually on a treadmill.
What marks the end of isovolumetric ventricular relaxation?
Closure of the aortic and pulmonic valves.
p.12
Cardiovascular Diseases
What is the most common cause of myocardial ischemia?
Atherosclerotic disease of an epicardial coronary artery.
Which anti-arrhythmic drug class shortens the action potential?
Class IC, which binds to both activated and inactivated sodium channels.
p.7
Heart Failure Concepts
What are the cardinal symptoms of heart failure?
Fatigue and shortness of breath.
p.11
Congenital Heart Diseases
What condition is associated with a continuous machine-like murmur and needs indomethacin to close?
Patent Ductus Arteriosus (PDA).
What is ARNI and what does it consist of?
ARNI (LCZ696) is an ARB (valsartan) combined with an endopeptidase inhibitor (sacubitril).
p.1
Cardiac Physiology Equations
How is pulse pressure calculated?
Pulse Pressure = Systolic BP minus Diastolic BP.
p.7
Heart Failure Concepts
What are the primary causes of heart failure (HF) in men and women in industrialized countries?
Coronary Artery Disease (CAD) and Hypertension, responsible for 60-75% of cases.
Name three beta blockers proven to improve survival in HFrEF.
Carvedilol, bisoprolol, and metoprolol succinate.
p.3
Diagnostic Procedures in Cardiology
What is the diagnostic test of choice for assessing small lesions in the heart?
Transesophageal echocardiography.
p.1
Cardiac Physiology Equations
What is the equation for blood pressure?
Blood Pressure = Cardiac Output x Total Peripheral Resistance (TPR).
p.2
Cardiac Physiology Equations
What does a positive Jv indicate?
Net fluid movement out of the capillary (filtration).
p.3
Diagnostic Procedures in Cardiology
What constitutes Virchow's Triad?
Endothelial injury, hypercoagulability, and venous stasis.
Which phase of the cardiac cycle is the longest?
Reduced ventricular filling (diastasis).
What medications are used to treat hypertension in HFpEF?
ARBs, ACE inhibitors, calcium channel blockers, and beta blockers.
p.12
Cardiovascular Diseases
What are the risk factors for ischemic heart disease (IHD)?
Obesity, insulin resistance, and type 2 diabetes mellitus.
p.11
Congenital Heart Diseases
What is the most common congenital anomaly recognized at birth?
Ventricular Septal Defect (VSD).
What are the main therapeutic agents for Prinzmetal angina?
Nitrates and Calcium Channel Blockers.
p.11
Congenital Heart Diseases
What is the characteristic CXR finding for Transposition of the Great Arteries (TGA)?
Egg-shaped silhouette or egg-on-its-side appearance.
What is the time frame for reversible damage in the myocardium due to total occlusion?
20 minutes in the absence of collaterals.
What occurs during Phase 0 of the cardiac action potential?
Depolarization due to rapid Na+ influx.
p.14
Diagnostic Procedures in Cardiology
What is the overarching goal of STEMI management?
Minimize the time from first medical contact to initiation of reperfusion therapy.
What role does digoxin play in HFrEF treatment?
Digoxin is used to improve symptoms and control heart rate.
p.11
Cardiovascular Diseases
What is the most common primary cardiac tumor in adults?
Myxomas (90% are sporadic).
p.12
Cardiovascular Diseases
What is the major site of atherosclerotic disease?
Epicardial coronary arteries.
p.7
Heart Failure Concepts
What is the cornerstone of pharmacotherapy for heart failure with reduced ejection fraction?
RAAS blockers and Beta Blockers.
p.5
Cardiovascular Diseases
What is the effect of beta-blockers in hypertension?
Decreases the workload of the heart.
p.5
Cardiovascular Diseases
What is commonly used to acutely manage severe hypertension in preeclampsia?
IV labetalol or hydralazine.
What is the most reliable treatment for symptomatic AV conduction system disease?
Temporary or permanent artificial pacing.
What is the final stage of ECG evolution in acute pericarditis?
The ECG returns to normal weeks or months after the onset.
What occurs during rapid ventricular ejection?
Ventricular pressure reaches its maximum value.
What combination is used in HFrEF treatment involving hydralazine?
Hydralazine plus nitrate.
What is a major contraindication for using nitrates?
Recent use of phosphodiesterase type 5 inhibitors like sildenafil or vardenafil (within 24 hours) or tadalafil (within 48 hours).
p.1
Cardiac Physiology Equations
What is the formula for capacitance?
Capacitance = Volume/Pressure.
p.15
Cardiac Physiology Equations
What is the primary mechanism for rapid buffering of acute fluctuations in blood pressure?
Arterial baroreflex mediated by stretch-sensitive sensory nerve endings.
p.11
Congenital Heart Diseases
What is the characteristic CXR finding for Tetralogy of Fallot?
Boot-shaped heart (Coeur en Sabot).
p.15
Congenital Heart Diseases
What is the most common congenital cardiovascular cause of hypertension?
Coarctation of the aorta (CoA).
p.16
Cardiovascular Diseases
What is the pathology of Giant Cell Arteritis?
Focal granulomatous lesions involving the entire arterial wall.
p.15
Diagnostic Procedures in Cardiology
What tests document a history of antecedent GABHS infection in Rheumatic Fever?
Anti-streptolysin O (ASO) and anti-DNase B (ADB) titers.
p.16
Diagnostic Procedures in Cardiology
What is the most important initial screening test for pulmonary hypertension?
Echocardiogram with bubble study.
p.14
Cardiovascular Diseases
What is the primary cause of out-of-hospital deaths from STEMI?
Ventricular Fibrillation.
What are RAAS inhibitors and name two types used in HFrEF treatment?
RAAS inhibitors include ACE inhibitors (ACEis) and Angiotensin II receptor blockers (ARBs).
p.3
Diagnostic Procedures in Cardiology
What is the main method for clinical assessment of diastolic function?
Echocardiography, particularly assessing left atrial size.
What is the classic echocardiogram finding in hypertrophic cardiomyopathy?
Systolic anterior motion (SAM) of the mitral valve.
p.1
Cardiac Physiology Equations
What does Mean Arterial Pressure (MAP) represent?
MAP = Diastole + ½ Pulse Pressure.
p.7
Heart Failure Concepts
What is the single most important bedside measurement to estimate volume status in heart failure?
Jugular venous pressure (JVP), with the internal jugular vein preferred.
p.11
Congenital Heart Diseases
What is the most common form of cyanotic congenital heart disease?
Tetralogy of Fallot (TOF).
p.7
Heart Failure Concepts
What is orthopnea?
Dyspnea occurring in the recumbent position, relieved by sitting upright.
p.13
Cardiovascular Diseases
How may the pain of STEMI radiate?
As high as the occipital area but not below the umbilicus.
p.13
Heart Failure Concepts
What is a common consequence of myocardial rupture post-MI?
Occurs in patients with previous myocardial infarction.
What is the main characteristic of Phase 2 in the cardiac action potential?
Plateau phase, where K+ efflux is balanced by Ca2+ influx.
What is the characteristic ST segment change in Stage 1 of acute pericarditis?
Widespread elevation of the ST segments, often with upward concavity, involving two or three standard limb leads and V2-V6.
What is a significant clue to the presence of cardiac tamponade?
A paradoxical pulse (Pulsus Paradoxus) consisting of a greater than normal (10 mmHg) inspiratory decline in systolic arterial pressure.
What happens to ventricular pressure during reduced ventricular ejection?
Ventricular pressure begins to decrease.
p.3
Diagnostic Procedures in Cardiology
How is ejection fraction assessed?
By subtracting end-systolic volume from end-diastolic volume and dividing by end-diastolic volume.
p.2
High-Yield Terms in Cardiovascular Examination
What is the Abdominojugular Reflex?
A sustained rise of >3 cm in JVP during firm abdominal pressure.
p.2
High-Yield Terms in Cardiovascular Examination
What is the Gallavardin Effect?
Transmission of the murmur of aortic stenosis downward to the apex.
p.13
Cardiovascular Diseases
In which patient population is the proportion of painless STEMIs greater?
Patients with diabetes mellitus and in the elderly.
p.15
Cardiovascular Diseases
What infection typically precedes Rheumatic Fever?
Streptococcal pharyngitis.
p.7
Valvular Heart Diseases
What is the most common congenital heart valve defect?
Bicuspid Aortic Valve Disease.
What is the significance of a pericardial friction rub?
Heard in acute pericarditis, typically at end-expiration with the patient upright and leaning forward.
p.10
Heart Failure Concepts
What is the basic physiologic abnormality in chronic constrictive pericarditis?
Inability of ventricles to fill because of limitations imposed by the rigid, thickened pericardium.
What drugs should be avoided in patients with STEMI?
Glucocorticoids and nonsteroidal anti-inflammatory agents.
p.11
Cardiovascular Diseases
What is the most common primary site from which cardiac metastases originate?
Carcinoma of the breast and lung.
p.3
Diagnostic Procedures in Cardiology
What is the gold standard in assessing the anatomy and physiology of the heart?
Diagnostic cardiac catheterization and coronary angiography.
p.16
Cardiovascular Diseases
What is the most common pathologic condition associated with atherosclerosis?
Degenerative aortic aneurysms.
p.14
Cardiovascular Diseases
What is the most common complication of angioplasty?
Restenosis, or re-narrowing of the dilated coronary stenosis.
What is the main cause of sudden death in the young related to cardiomyopathy?
Hypertrophic Cardiomyopathy (HCM).
What is the mnemonic for Class IA anti-arrhythmic drugs?
Quiapo Police Department.
What is Tako-tsubo cardiomyopathy also known as?
Stress-induced cardiomyopathy or 'Broken-Heart' Syndrome.
p.16
Cardiovascular Diseases
What describes the pain of aortic dissection?
Sudden onset of very severe, tearing pain associated with diaphoresis.
p.2
High-Yield Terms in Cardiovascular Examination
What does the Traube Sign indicate?
A booming 'pistol-shot' sound over the femoral arteries in aortic regurgitation.
p.16
Cardiovascular Diseases
What is the initial lesion of syphilitic aortitis?
Obliterative endarteritis of the vasa vasorum, especially in the adventitia.
p.13
Diagnostic Procedures in Cardiology
What diagnostic test can aid in management when the ECG is not diagnostic of STEMI?
Echocardiography showing early detection of wall motion abnormalities.
p.16
Diagnostic Procedures in Cardiology
What is the gold standard for diagnosis and assessment of pulmonary hypertension severity?
Invasive hemodynamic monitoring.
What are the most common clinical signs of pump failure?
Pulmonary rales and S3 and S4 gallop sounds.
What is a key feature of restrictive cardiomyopathy?
Endomyocardial scarring resulting in restriction of ventricular filling.
What is the main focus of pharmacologic therapy for HFpEF?
Management of symptoms and associated conditions.
What is the clinical use of Class IA anti-arrhythmic drugs?
Used for atrial fibrillation, atrial flutter, ventricular tachycardia, and post-ischemic arrhythmias.
What histologic changes are associated with hypertrophic cardiomyopathy?
Misaligned and disarrayed myofibrils and myocytes; fibrosis and microvascular disease.
p.2
High-Yield Terms in Cardiovascular Examination
What characterizes a Corrigan Pulse?
A rapidly rising 'water-hammer' pulse seen in aortic regurgitation.
p.7
Heart Failure Concepts
What is LCZ696 classified as?
An angiotensin receptor-neprilysin inhibitor (ARNI).
What manifestations may occur within the first hour of STEMI in patients with anterior infarction?
Tachycardia and/or hypertension.
What is the difference between non-sustained and sustained VT?
Non-sustained VT terminates on its own, while sustained VT persists for >30 seconds.
Which diuretics are commonly used in the treatment of HFrEF?
Diuretics are used to manage fluid overload.
What is a common clinical characteristic of dilated cardiomyopathy?
Left ventricular enlargement resulting in impaired systolic function.
What triggers the opening of the mitral valve during rapid ventricular filling?
When ventricular pressure becomes less than atrial pressure.
What are common first symptoms of hypertrophic cardiomyopathy?
Exertional intolerance; may have chest pain.
p.11
Cardiovascular Diseases
What are the most common cardiac tumors in infants and children?
Rhabdomyomas and fibromas.
p.1
Cardiac Physiology Equations
What does Poiseuille's Law describe?
Resistance (R) = (8nL) / (πr^4), where n is viscosity, L is length, and r is radius.
What is the effect of amiodarone in terms of drug classes?
Amiodarone has class I, II, III, and IV effects.
p.12
Heart Failure Concepts
What is the primary approach to managing metabolic syndrome?
Weight reduction (caloric restriction).
p.16
Cardiovascular Diseases
Where is the usual location of aortic dissection pain?
Right lateral wall of the ascending aorta.
p.5
Cardiovascular Diseases
What is notorious for causing drug-induced cough?
ACE inhibitors, due to increased bradykinin.
p.5
Cardiovascular Diseases
What is the use of alpha-1 antagonists in hypertension?
Used for hypertension with benign prostatic hyperplasia (BPH).
p.7
Valvular Heart Diseases
What are the three cardinal symptoms of aortic stenosis (AS)?
Syncope, Angina pectoris, Exertional dyspnea.
p.2
Cardiac Physiology Equations
What does the Starling Equation describe?
Fluid movement across capillary membranes.
What is the time frame for peripartum cardiomyopathy?
Last trimester or within the first 6 months after pregnancy.
p.2
Cardiac Physiology Equations
What does a negative Jv indicate?
Net fluid movement into the capillary (absorption).
What are the common Class IA anti-arrhythmic drugs?
Quinidine, Procainamide, Disopyramide.
p.7
Heart Failure Concepts
What causes dyspnea in heart failure?
Pulmonary congestion with accumulation of interstitial or intra-alveolar fluid.
p.2
High-Yield Terms in Cardiovascular Examination
What is the Quincke Pulse?
Capillary pulsations manifesting as alternate flushing and paling of the skin.
p.15
Heart Failure Concepts
What lifestyle modifications can help manage hypertension?
Maintain BMI <25 kg/m², reduce sodium intake, eat a diet rich in fruits and vegetables, limit alcohol, and engage in regular aerobic activity.
p.15
Cardiovascular Diseases
What type of hypersensitivity mechanism is involved in Rheumatic Fever?
Type II hypersensitivity.
What is the principal goal of fibrinolysis in STEMI?
Prompt restoration of full coronary arterial patency.
p.3
Diagnostic Procedures in Cardiology
What is an independent risk factor for Ischemic Heart Disease (IHD)?
Elevated level of high-sensitivity C-reactive protein (CRP).
p.3
Diagnostic Procedures in Cardiology
What are the three principal features of cardiac tamponade (Beck Triad)?
Hypotension, soft/absent heart sounds, and jugular venous distention with prominent x-descent.
p.13
Cardiovascular Diseases
What is the diagnostic hallmark of Prinzmetal variant angina?
Transient coronary spasm.
p.2
High-Yield Terms in Cardiovascular Examination
What is the Graham Steell Murmur?
A high-pitched, decrescendo diastolic murmur associated with pulmonary hypertension.
p.7
Heart Failure Concepts
What is paroxysmal nocturnal dyspnea?
Acute and severe shortness of breath that awakens the patient from sleep.
p.13
Cardiovascular Diseases
What distinguishes pericarditis from STEMI?
Radiation of discomfort to the trapezius.
What is the physiological basis for the QRS complex in an ECG?
Ventricular depolarization.
p.2
High-Yield Terms in Cardiovascular Examination
What does the Broadbent Sign indicate?
Reduced apical pulse that may retract in systole in constrictive pericarditis.
What characterizes Mobitz Type II?
No prolongation of PR interval before a dropped QRS complex.
What is the mechanism of action for Class IA anti-arrhythmic drugs?
Binds to activated sodium channels and blocks the flow of sodium ions into the cardiac myocyte, prolonging the action potential.
p.16
Cardiovascular Diseases
Where are 90% of syphilitic aneurysms located?
Ascending aorta or aortic arch.
p.14
Heart Failure Concepts
What should patients be encouraged to do during the first 1-2 weeks post-STEMI?
Increase activity by walking about the house and outdoors in good weather.
p.2
High-Yield Terms in Cardiovascular Examination
What is the Carvallo Sign associated with?
Blowing holosystolic murmur of Tricuspid Regurgitation.
p.15
Diagnostic Procedures in Cardiology
What ABI cut-off is diagnostic of PAD?
ABI <0.90 associated with >50% stenosis in at least one major lower limb vessel.
p.5
Cardiovascular Diseases
What is the primary action of diuretics in hypertension?
Causes sodium excretion and reduction in blood volume.
p.15
High-Yield Terms in Cardiovascular Examination
What is another name for Streptococcus pyogenes?
Group A Beta-Hemolytic Strep (GABHS).
p.5
Cardiovascular Diseases
Which drugs block the AT1 receptor of angiotensin II?
Angiotensin II Receptor Blockers (ARBs).
p.7
Valvular Heart Diseases
What is the most prominent complaint in chronic severe mitral regurgitation (MR)?
Fatigue, exertional dyspnea, and orthopnea.
p.15
Cardiovascular Diseases
What are the most common clinical features of Rheumatic Fever?
Polyarthritis (60-75%) and carditis (50-60%).
p.15
Cardiovascular Diseases
What is the classic symptom of Peripheral Artery Disease (PAD)?
Intermittent Claudication.
p.11
Congenital Heart Diseases
What congenital heart condition is associated with Turner Syndrome?
Coarctation of the Aorta (CoA).
What is the recommended pressure for graduated compression stockings in chronic venous disease?
20-30 mmHg for simple varicose veins; 30-40 mmHg for manifestations of venous insufficiency.
p.16
Cardiovascular Diseases
What type of aneurysms are associated with Takayasu's arteritis?
Aneurysms of the aortic arch and descending thoracic aorta.
p.16
Diagnostic Procedures in Cardiology
What findings on a chest X-ray suggest a thoracic aortic aneurysm?
Widened mediastinum and aneurysm displacement or compression of the trachea or left main stem bronchus.
p.5
Cardiovascular Diseases
Which calcium channel blockers exert more effect on the vessels?
Dihydropyridines (e.g., Nifedipine, Felodipine, Amlodipine).
What does the T Wave indicate in an ECG?
Ventricular repolarization.
p.12
Cardiovascular Diseases
Where do atherosclerotic plaques commonly develop?
At branch points in the epicardial arteries.
p.13
Cardiovascular Diseases
What pathologic consequence of atherosclerotic plaque leads to STEMI?
Atherosclerotic plaque disruption exposing its contents to the blood, favoring thrombogenesis.
p.15
Cardiovascular Diseases
What are Aschoff Bodies?
Granulomas with giant cells (Anitschkow cells) found in Rheumatic Fever.
p.2
High-Yield Terms in Cardiovascular Examination
What does the Becker Sign reveal?
Retinal arterial pulsations visible in aortic regurgitation.
p.2
High-Yield Terms in Cardiovascular Examination
What is the Duroziez Sign?
A to-and-fro murmur audible when lightly compressing the femoral artery.
p.13
Diagnostic Procedures in Cardiology
What are the preferred biochemical markers for myocardial infarction?
Cardiac-Specific Troponin T and Cardiac-Specific Troponin I.
p.15
Cardiovascular Diseases
What are the signs and symptoms of Rheumatic Fever?
Polyarthritis, Carditis, Subcutaneous Nodules, Erythema Marginatum, Syndenham Chorea.
What defines Chronotropic Incompetence?
Failure to increase heart rate during exercise, unable to achieve >100 beats/min.
What characterizes Mobitz Type I?
Prolongation of PR interval before a dropped QRS complex.
p.7
Valvular Heart Diseases
What is a common finding in tricuspid regurgitation?
Giant C-V wave in jugular venous pulses.
What do beta-adrenoceptor blocking agents do in patients with STEMI?
Abolish ventricular ectopic activity and prevent ventricular fibrillation.
