Cardiology

Phisiology

100

Phase of cardiac cycle when aortic and mitral valves are closed

isovolumetric contraction

200

Mechanism of S1 and S2 heart sounds

Closure of mitral and tricuspid valves
Closure of aortic and pulmonic valves

300

Main factor which determines diastolic blood pressure 

PVR

400

Increasing afterload (such as with hypertension or aortic stenosis) has this effect on stroke volume, assuming contractility and preload remain constant

decrease

500

This region of the myocardium is the most susceptible to ischemia because it experiences the highest wall stress, is compressed during systole, and is farthest from coronary blood supply

subendocardial layer 

Pathophysiology

100

This event causes STEMI/NSTEMI and unstable angina

plaque rupture

200

This type of hypertrophy results from pressure overload (e.g., hypertension, aortic stenosis) and involves sarcomeres added in parallel

Concentric

300

Mechanism of S3 sound

Rapid passive filling of a very compliant or volume-overloaded ventricle during early diastole (right after S2)

400

Which signs are caused by wide pulse pressure in aortic regurgitation?

Musset head bobbing

Quincke capillary pulsations in nail beds 

Traube "pistol-shot” sounds over femoral artery 

500

Pulsus paradoxus mechanism

• Inspiration → ↑ venous return to RV

• RV cannot expand outward (fluid-filled pericardium restricts)

• RV pushes interventricular septum leftward → ↓ LV filling

• ↓ LV stroke volume → marked fall in systolic BP (>10 mmHg) = pulsus paradoxus

Auscultation

100

A congenital heart disease (CHD) that causes a continuous “machinery-like” murmur

Patent Ductus Arteriosus (PDA)

200

This low-frequency heart sound, always pathologic in adults, occurs just before S1 due to atrial contraction against a stiff ventricle

S4

300

Classic finding in ASD

wide, fixed splitting of S2

400

Classic auscultation finding in hypertrophic cardiomyopathy

Harsh crescendo–decrescendo systolic murmur, best heard at the left sternal border, that increases with Valsalva or standing and decreases with squatting or handgrip.

500

The murmur decreases with handgrip but increases with squatting. Name the condition

Aortic stenosis

Conditions

100

Sharp chest pain which is relived by leaning forward

Acute pericarditis

200

Classic clinical triad for cardiac tamponade

Hypotension – due to ↓ stroke volume.

Jugular venous distension (JVD) – due to impaired venous return.

Muffled or distant heart sounds – due to fluid around the heart.

300

This valve is most commonly affected in infective endocarditis due to IV drug use

Tricuspid

400

Septic shock changes of CVP PCWP CO SVR

CVP ↓, PCWP ↓, CO ↑, SVR ↓

500

A post-menopausal woman develops acute chest pain after severe emotional stress. Her ECG shows ST-segment elevation and troponins are mildly elevated, but coronary angiography is normal. Echocardiography reveals apical ballooning of the left ventricle. Name the condition

Takotsubo

Drugs

100

Mechanism of action of nitrates in angina

venodilation -> decreased venous return ->  decreased preload -> decreased O2 demand 

200

Drug which causes prolonged QT but has low probability of causing torsades

Amiodarone

300

antiarrhythmic drug which can cause LSE-like syndrome 

Procainamide

400

5 classes of drugs which have proven mortality benefit in CHF

• ACE inhibitors (or ARBs) – ↓ afterload, ↓ preload, inhibit maladaptive remodeling.

• ARNI (angiotensin receptor–neprilysin inhibitor, e.g., sacubitril/valsartan) – improves outcomes beyond ACEi/ARB alone.

• Beta blockers (specific ones: carvedilol, metoprolol succinate, bisoprolol) – improve EF and survival.

• Mineralocorticoid receptor antagonists (MRAs) – spironolactone, eplerenone; ↓ mortality in HFrEF.

• SGLT2 inhibitors (dapagliflozin, empagliflozin) – now proven to reduce mortality and hospitalization in HFrEF (even without diabetes).

500

Sacubitril-Valsartan mechanism of action

Neprilisin inhibitor -> increased ANP BNP -> increased natriuresis, decreased aldosterone, vasodilation