Podcast
Questions and Answers
Which valve is located between the left atrium and the left ventricle?
Which valve is located between the left atrium and the left ventricle?
- Pulmonary valve
- Tricuspid valve
- Mitral valve (correct)
- Aortic valve
What is the primary function of the coronary arteries?
What is the primary function of the coronary arteries?
- To supply the heart muscle with oxygenated blood. (correct)
- To carry deoxygenated blood away from the heart.
- To regulate the heart's electrical activity.
- To provide structural support to the heart valves.
Which of the following correctly sequences the flow of deoxygenated blood through the heart?
Which of the following correctly sequences the flow of deoxygenated blood through the heart?
- Left atrium → Mitral valve → Left ventricle → Aortic valve
- Left atrium → Tricuspid valve → Left ventricle → Pulmonary valve
- Right atrium → Mitral valve → Right ventricle → Aortic valve
- Right atrium → Tricuspid valve → Right ventricle → Pulmonary valve (correct)
The sinoatrial (SA) node is typically supplied by which artery?
The sinoatrial (SA) node is typically supplied by which artery?
Which of the following cardiac conditions is characterized by fluid accumulation within the pericardial sac?
Which of the following cardiac conditions is characterized by fluid accumulation within the pericardial sac?
In right-dominant circulation, which artery typically gives rise to the posterior descending artery (PDA)?
In right-dominant circulation, which artery typically gives rise to the posterior descending artery (PDA)?
Which of the following best describes the location of the tricuspid valve?
Which of the following best describes the location of the tricuspid valve?
What is the function of the chordae tendineae and papillary muscles?
What is the function of the chordae tendineae and papillary muscles?
Which cardiac chamber is immediately posterior to the sternum, making it most vulnerable in penetrating chest trauma?
Which cardiac chamber is immediately posterior to the sternum, making it most vulnerable in penetrating chest trauma?
A patient presents with an acute myocardial infarction (MI) due to occlusion of the left anterior descending (LAD) artery. Which area of the heart is MOST likely to be affected?
A patient presents with an acute myocardial infarction (MI) due to occlusion of the left anterior descending (LAD) artery. Which area of the heart is MOST likely to be affected?
Which layer of the heart is most susceptible to damage from subacute bacterial endocarditis?
Which layer of the heart is most susceptible to damage from subacute bacterial endocarditis?
Which ECG finding is MOST suggestive of ischemia in the inferior wall of the left ventricle?
Which ECG finding is MOST suggestive of ischemia in the inferior wall of the left ventricle?
A patient with mitral valve stenosis is MOST likely to experience:
A patient with mitral valve stenosis is MOST likely to experience:
Which of the following is the MOST common cause of acquired mitral valve stenosis?
Which of the following is the MOST common cause of acquired mitral valve stenosis?
A patient is diagnosed with cardiac tamponade. Which of the following hemodynamic changes is MOST characteristic of this condition?
A patient is diagnosed with cardiac tamponade. Which of the following hemodynamic changes is MOST characteristic of this condition?
Which of the following structures is located in the anterior interventricular groove?
Which of the following structures is located in the anterior interventricular groove?
A 68-year-old male presents with chest pain and is found to have an occlusion of the circumflex artery. Which of the following electrocardiogram changes would MOST likely be seen in this patient?
A 68-year-old male presents with chest pain and is found to have an occlusion of the circumflex artery. Which of the following electrocardiogram changes would MOST likely be seen in this patient?
A 55-year-old male has a history of IV drug use and presents with fever, new heart murmur, and Roth spots on fundoscopic exam. Which cardiac structure is MOST likely affected?
A 55-year-old male has a history of IV drug use and presents with fever, new heart murmur, and Roth spots on fundoscopic exam. Which cardiac structure is MOST likely affected?
A 72-year-old woman presents to the emergency department. EKG shows ST elevation in II, III, and AVF with reciprocal changes in V1 and V2. Which coronary artery is MOST likely occluded?
A 72-year-old woman presents to the emergency department. EKG shows ST elevation in II, III, and AVF with reciprocal changes in V1 and V2. Which coronary artery is MOST likely occluded?
A 59-year-old male presents with sudden cardiac arrest. The patient is revived, and an angiogram shows a 99% occlusion of the proximal LAD artery. This lesion is most concerning because it can lead to extensive infarction of the anterior wall of the left ventricle. Considering the ventricular anatomy, and rapid cardiac arrest, what is MOST likely damaged in this scenario?
A 59-year-old male presents with sudden cardiac arrest. The patient is revived, and an angiogram shows a 99% occlusion of the proximal LAD artery. This lesion is most concerning because it can lead to extensive infarction of the anterior wall of the left ventricle. Considering the ventricular anatomy, and rapid cardiac arrest, what is MOST likely damaged in this scenario?
What hemodynamic change occurs within each cardiac chamber during the cardiac cycle?
What hemodynamic change occurs within each cardiac chamber during the cardiac cycle?
Which event causes passive closure of the mitral and tricuspid valves?
Which event causes passive closure of the mitral and tricuspid valves?
During which phase of the cardiac cycle do the aortic and pulmonic valves open, allowing for ventricular ejection?
During which phase of the cardiac cycle do the aortic and pulmonic valves open, allowing for ventricular ejection?
What causes the closure of the aortic and pulmonic valves?
What causes the closure of the aortic and pulmonic valves?
During which phase of diastole do the mitral and tricuspid valves open?
During which phase of diastole do the mitral and tricuspid valves open?
What is the effect of active isovolumetric contraction on ventricular filling during diastole?
What is the effect of active isovolumetric contraction on ventricular filling during diastole?
During a physical exam, what can be estimated to approximate right atrial pressure?
During a physical exam, what can be estimated to approximate right atrial pressure?
How is left atrial pressure measured?
How is left atrial pressure measured?
Invasive hemodynamic cardiac monitoring is indicated in a variety of conditions. Which of the following is NOT an indication for this type of monitoring?
Invasive hemodynamic cardiac monitoring is indicated in a variety of conditions. Which of the following is NOT an indication for this type of monitoring?
Which of the following factors affects cardiac performance by influencing the left ventricular diastolic volume?
Which of the following factors affects cardiac performance by influencing the left ventricular diastolic volume?
Which of the following directly affects afterload?
Which of the following directly affects afterload?
A patient's cardiac performance is noted to be independent of preload and afterload. Which of the following factors is MOST likely affecting this patient's cardiac performance?
A patient's cardiac performance is noted to be independent of preload and afterload. Which of the following factors is MOST likely affecting this patient's cardiac performance?
What is the formula to calculate Blood Pressure?
What is the formula to calculate Blood Pressure?
What two factors determine cardiac output?
What two factors determine cardiac output?
Which of the following conditions is MOST likely to cause hypotension due to systemic vasodilation?
Which of the following conditions is MOST likely to cause hypotension due to systemic vasodilation?
What does the cardiac index relate to?
What does the cardiac index relate to?
What is the normal Cardiac Index range?
What is the normal Cardiac Index range?
Ejection fraction is derived from which of the following calculations?
Ejection fraction is derived from which of the following calculations?
What two values are needed to calculate Stroke Volume?
What two values are needed to calculate Stroke Volume?
What is the normal Ejection Fraction?
What is the normal Ejection Fraction?
Which of the following best describes preload?
Which of the following best describes preload?
Which of the following actions will temporarily decrease preload?
Which of the following actions will temporarily decrease preload?
Which of the following medications causes a longer term decrease in preload?
Which of the following medications causes a longer term decrease in preload?
Which of the following will increase Preload?
Which of the following will increase Preload?
Within a normal heart, how does preload affect stroke volume?
Within a normal heart, how does preload affect stroke volume?
Which medication decreases afterload?
Which medication decreases afterload?
Which activity increases afterload?
Which activity increases afterload?
What term refers to the intrinsic strength of muscle fibers and is independent of preload and afterload?
What term refers to the intrinsic strength of muscle fibers and is independent of preload and afterload?
What class of drugs may directly increase Inotropy / Myocardial Contractility?
What class of drugs may directly increase Inotropy / Myocardial Contractility?
Which of the following pathophysiologic conditions may result in decreases in inotropy/myocardial contractility?
Which of the following pathophysiologic conditions may result in decreases in inotropy/myocardial contractility?
A patient is started on a new medication that decreases afterload. As a result of the decreased afterload, which of the following hemodynamic changes would be expected?
A patient is started on a new medication that decreases afterload. As a result of the decreased afterload, which of the following hemodynamic changes would be expected?
A patient is given a medication that increases their cardiac contractility. Which of the following is the MOST likely change to occur?
A patient is given a medication that increases their cardiac contractility. Which of the following is the MOST likely change to occur?
A 70-year-old male with a history of hypertension and heart failure presents to the emergency department with shortness of breath. His blood pressure is 180/110 mmHg, heart rate is 120 bpm, and oxygen saturation is 88% on room air. He is immediately started on intravenous nitroglycerin, which acts as a preload and afterload reducer. Which of the following hemodynamic changes is MOST likely to occur as a direct result of this intervention?
A 70-year-old male with a history of hypertension and heart failure presents to the emergency department with shortness of breath. His blood pressure is 180/110 mmHg, heart rate is 120 bpm, and oxygen saturation is 88% on room air. He is immediately started on intravenous nitroglycerin, which acts as a preload and afterload reducer. Which of the following hemodynamic changes is MOST likely to occur as a direct result of this intervention?
A patient is in cardiogenic shock following a massive myocardial infarction. His cardiac index is 1.8 L/min/m², pulmonary capillary wedge pressure is 25 mmHg, and systemic vascular resistance is 1800 dynes/sec/cm⁻⁵. Medical management includes the administration of an inotropic agent. Which of the following hemodynamic changes would be expected as a result of improved myocardial contractility?
A patient is in cardiogenic shock following a massive myocardial infarction. His cardiac index is 1.8 L/min/m², pulmonary capillary wedge pressure is 25 mmHg, and systemic vascular resistance is 1800 dynes/sec/cm⁻⁵. Medical management includes the administration of an inotropic agent. Which of the following hemodynamic changes would be expected as a result of improved myocardial contractility?
A researcher is studying the effects of a novel drug on cardiac function. They observe that the drug significantly increases the rate of myocardial relaxation during diastole without affecting heart rate, preload, or afterload. Which of the following cellular mechanisms is MOST likely enhanced by this drug?
A researcher is studying the effects of a novel drug on cardiac function. They observe that the drug significantly increases the rate of myocardial relaxation during diastole without affecting heart rate, preload, or afterload. Which of the following cellular mechanisms is MOST likely enhanced by this drug?
A 60-year-old male presents with a chief complaint of exertional chest pain. His ECG is normal. Which cardiac test would be MOST appropriate FIRST?
A 60-year-old male presents with a chief complaint of exertional chest pain. His ECG is normal. Which cardiac test would be MOST appropriate FIRST?
What is the MOST appropriate next step in a patient presenting to the emergency department with chest pain and a normal ECG, CXR, and serial troponins?
What is the MOST appropriate next step in a patient presenting to the emergency department with chest pain and a normal ECG, CXR, and serial troponins?
Which of the following cardiac imaging modalities is MOST suitable for estimating the ejection fraction in morbidly obese patients when echocardiography provides suboptimal images?
Which of the following cardiac imaging modalities is MOST suitable for estimating the ejection fraction in morbidly obese patients when echocardiography provides suboptimal images?
A patient is being evaluated for possible coronary artery disease. Their calcium score is 500. What is the interpretation of this result?
A patient is being evaluated for possible coronary artery disease. Their calcium score is 500. What is the interpretation of this result?
What is the MOST common indication for performing lower extremity venous doppler?
What is the MOST common indication for performing lower extremity venous doppler?
Which of the following is the MOST appropriate use of point-of-care ultrasound (POCUS) in the emergency department?
Which of the following is the MOST appropriate use of point-of-care ultrasound (POCUS) in the emergency department?
A patient with known coronary artery disease presents with increasing exertional chest pain. A coronary angiogram reveals severe stenosis in multiple vessels not amenable to PCI. Which of the following is the MOST appropriate next step in management?
A patient with known coronary artery disease presents with increasing exertional chest pain. A coronary angiogram reveals severe stenosis in multiple vessels not amenable to PCI. Which of the following is the MOST appropriate next step in management?
A patient is suspected to have orthostatic hypotension as the cause of his frequent syncopal episodes. Which cardiac test is MOST appropriate?
A patient is suspected to have orthostatic hypotension as the cause of his frequent syncopal episodes. Which cardiac test is MOST appropriate?
In a patient with suspected aortic dissection, which imaging modality offers the BEST combination of speed, accuracy, and availability in the acute setting?
In a patient with suspected aortic dissection, which imaging modality offers the BEST combination of speed, accuracy, and availability in the acute setting?
A 25-year-old patient with a history of palpitations and syncope has a normal ECG and echocardiogram. Which cardiac test is MOST indicated to evaluate for intermittent arrhythmias?
A 25-year-old patient with a history of palpitations and syncope has a normal ECG and echocardiogram. Which cardiac test is MOST indicated to evaluate for intermittent arrhythmias?
A 55-year-old male presents to the emergency department with chest pain. Which cardiac test is MOST appropriate?
A 55-year-old male presents to the emergency department with chest pain. Which cardiac test is MOST appropriate?
A 55-year-old female has a positive stress echocardiogram. What is the MOST appropriate next step in management?
A 55-year-old female has a positive stress echocardiogram. What is the MOST appropriate next step in management?
A 55-year-old male presents to the emergency department with shortness of breath. Which cardiac test is MOST appropriate as an initial assessment?
A 55-year-old male presents to the emergency department with shortness of breath. Which cardiac test is MOST appropriate as an initial assessment?
A 55-year-old male presents with shortness of breath, a 20 lb weight gain, jugular venous pressure elevated to the angle of the mandible, 3+ pitting edema, and a CXR showing cardiomegaly, Kerley B lines, and increased cephalization of the pulmonary vessels. What cardiac test is MOST likely indicated?
A 55-year-old male presents with shortness of breath, a 20 lb weight gain, jugular venous pressure elevated to the angle of the mandible, 3+ pitting edema, and a CXR showing cardiomegaly, Kerley B lines, and increased cephalization of the pulmonary vessels. What cardiac test is MOST likely indicated?
A 55-year-old male is found to have a new 3/6 systolic murmur on physical exam. Which cardiac test is MOST appropriate for initial evaluation?
A 55-year-old male is found to have a new 3/6 systolic murmur on physical exam. Which cardiac test is MOST appropriate for initial evaluation?
A 55-year-old male is found to have a pulsatile abdominal mass on physical exam. Which imaging study is MOST appropriate to confirm the diagnosis and assess the size of the mass?
A 55-year-old male is found to have a pulsatile abdominal mass on physical exam. Which imaging study is MOST appropriate to confirm the diagnosis and assess the size of the mass?
A 55-year-old diabetic male complains of calf pain with walking and has diminished dorsalis pedis and posterior tibial pulses on the left lower extremity. What is the MOST appropriate initial test?
A 55-year-old diabetic male complains of calf pain with walking and has diminished dorsalis pedis and posterior tibial pulses on the left lower extremity. What is the MOST appropriate initial test?
A 55-year-old male presents to the emergency department with chest pain. The initial ECG, CXR and serial troponins are normal. What is the MOST appropriate next test?
A 55-year-old male presents to the emergency department with chest pain. The initial ECG, CXR and serial troponins are normal. What is the MOST appropriate next test?
What cardiac test can be used as an adjunctive test to evaluate if patients should be placed on a statin for primary prevention?
What cardiac test can be used as an adjunctive test to evaluate if patients should be placed on a statin for primary prevention?
A 55-year-old female presents to the emergency department with palpitations. What test is MOST appropriate as an initial evaluation?
A 55-year-old female presents to the emergency department with palpitations. What test is MOST appropriate as an initial evaluation?
A 55-year-old female presents to the emergency department after an episode of syncope. ECG and echocardiogram are normal. What diagnostic test should be performed next?
A 55-year-old female presents to the emergency department after an episode of syncope. ECG and echocardiogram are normal. What diagnostic test should be performed next?
A 55-year-old male presents to the emergency department with chest pain after a motor vehicle accident. ECG, CXR, and troponins are normal. Which cardiac imaging is MOST appropriate to rule out significant cardiac injury?
A 55-year-old male presents to the emergency department with chest pain after a motor vehicle accident. ECG, CXR, and troponins are normal. Which cardiac imaging is MOST appropriate to rule out significant cardiac injury?
A 55-year-old male has new-onset swelling and pain of the right lower extremity. Dorsalis pedis and posterior tibial pulses are 2+. What initial imaging study is MOST appropriate?
A 55-year-old male has new-onset swelling and pain of the right lower extremity. Dorsalis pedis and posterior tibial pulses are 2+. What initial imaging study is MOST appropriate?
Which of the following ECG findings is MOST indicative of acute myocardial infarction?
Which of the following ECG findings is MOST indicative of acute myocardial infarction?
Which of the following conditions is an indication for performing a chest X-ray?
Which of the following conditions is an indication for performing a chest X-ray?
Which echocardiogram type provides the best visualization of the aorta?
Which echocardiogram type provides the best visualization of the aorta?
What is the MOST appropriate cardiac imaging for estimating ejection fraction in morbidly obese patients when echocardiography provides suboptimal images?
What is the MOST appropriate cardiac imaging for estimating ejection fraction in morbidly obese patients when echocardiography provides suboptimal images?
Which of the following cardiac imaging modalities is capable of detecting aortic aneurysms, aortic dissection, and pulmonary embolism?
Which of the following cardiac imaging modalities is capable of detecting aortic aneurysms, aortic dissection, and pulmonary embolism?
A patient with a coronary artery calcium (CAC) score of 500 is at what risk for a cardiovascular event in the next 10 years?
A patient with a coronary artery calcium (CAC) score of 500 is at what risk for a cardiovascular event in the next 10 years?
An Ankle-Brachial Index (ABI) greater than 1.4 indicates what condition?
An Ankle-Brachial Index (ABI) greater than 1.4 indicates what condition?
Which intervention is LEAST likely to be performed during a cardiac catheterization?
Which intervention is LEAST likely to be performed during a cardiac catheterization?
A patient has left main coronary artery stenosis. Which of the following is the MOST appropriate treatment strategy?
A patient has left main coronary artery stenosis. Which of the following is the MOST appropriate treatment strategy?
Which is a common indication for a electrophysiology (EP) study?
Which is a common indication for a electrophysiology (EP) study?
A 70-year-old male presents with exertional leg pain that is relieved by rest. His Ankle-Brachial Index (ABI) is 0.6. What is the MOST appropriate next step in management?
A 70-year-old male presents with exertional leg pain that is relieved by rest. His Ankle-Brachial Index (ABI) is 0.6. What is the MOST appropriate next step in management?
What is the purpose of tilt table testing?
What is the purpose of tilt table testing?
A patient is suspected of having a deep vein thrombosis (DVT) in their lower extremity. Which of the following is the MOST appropriate initial imaging study?
A patient is suspected of having a deep vein thrombosis (DVT) in their lower extremity. Which of the following is the MOST appropriate initial imaging study?
Which cardiac marker is typically elevated first after myocardial damage?
Which cardiac marker is typically elevated first after myocardial damage?
Which of the following criteria is MOST likely to prompt consideration for coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) in a patient with multivessel coronary artery disease?
Which of the following criteria is MOST likely to prompt consideration for coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI) in a patient with multivessel coronary artery disease?
Which of the following is MOST accurate regarding cardiac tamponade, as assessed via POCUS?
Which of the following is MOST accurate regarding cardiac tamponade, as assessed via POCUS?
What statement is MOST accurate regarding high-sensitivity troponin assays relative to standard troponin assays?
What statement is MOST accurate regarding high-sensitivity troponin assays relative to standard troponin assays?
Which of the following electrophysiological properties is LEAST affected by hyperkalemia?
Which of the following electrophysiological properties is LEAST affected by hyperkalemia?
A patient has a suspected aortic dissection, and CXR shows a widened mediastinum. What is the MOST likely next step?
A patient has a suspected aortic dissection, and CXR shows a widened mediastinum. What is the MOST likely next step?
What are the MOST common indications for ordering a lower extremity venous ultrasound?
What are the MOST common indications for ordering a lower extremity venous ultrasound?
Which of the following echocardiographic findings would be MOST specific for constrictive pericarditis?
Which of the following echocardiographic findings would be MOST specific for constrictive pericarditis?
A patient with exertional chest pain and a high pre-test probability of coronary artery disease undergoes a stress test with myocardial perfusion imaging. The images reveal a small, fixed defect in the inferior wall, unchanged from rest to stress. Which of the following is the MOST likely interpretation?
A patient with exertional chest pain and a high pre-test probability of coronary artery disease undergoes a stress test with myocardial perfusion imaging. The images reveal a small, fixed defect in the inferior wall, unchanged from rest to stress. Which of the following is the MOST likely interpretation?
Which of the following statements BEST encapsulates the utility of point-of-care ultrasound (POCUS) in the evaluation of a patient presenting with acute dyspnea?
Which of the following statements BEST encapsulates the utility of point-of-care ultrasound (POCUS) in the evaluation of a patient presenting with acute dyspnea?
A patient presents to the emergency department with suspected acute limb ischemia. Which of the following is the MOST appropriate initial diagnostic study?
A patient presents to the emergency department with suspected acute limb ischemia. Which of the following is the MOST appropriate initial diagnostic study?
A 62-year-old male with a history of coronary artery disease presents with exertional chest pain. His EKG shows ST depressions in leads V5 and V6. Which coronary artery is most likely involved?
A 62-year-old male with a history of coronary artery disease presents with exertional chest pain. His EKG shows ST depressions in leads V5 and V6. Which coronary artery is most likely involved?
A 48-year-old woman presents with acute chest pain and is diagnosed with pericardial tamponade. Which of the following best explains the pathophysiology?
A 48-year-old woman presents with acute chest pain and is diagnosed with pericardial tamponade. Which of the following best explains the pathophysiology?
A patient undergoes a right heart catheterization. The provider notes elevated right atrial pressure but normal pulmonary capillary wedge pressure. Which of the following is the most likely diagnosis?
A patient undergoes a right heart catheterization. The provider notes elevated right atrial pressure but normal pulmonary capillary wedge pressure. Which of the following is the most likely diagnosis?
Which of the following is the most accurate method to quantify left ventricular ejection fraction?
Which of the following is the most accurate method to quantify left ventricular ejection fraction?
A 70-year-old male with systolic heart failure has an ejection fraction of 30%. Which of the following best describes the pathophysiologic mechanism?
A 70-year-old male with systolic heart failure has an ejection fraction of 30%. Which of the following best describes the pathophysiologic mechanism?
A 36-year-old male with a history of vasovagal syncope presents for evaluation. Which of the following non-invasive tests would be most useful in reproducing symptoms?
A 36-year-old male with a history of vasovagal syncope presents for evaluation. Which of the following non-invasive tests would be most useful in reproducing symptoms?
Which of the following valvular events occurs at the beginning of ventricular systole?
Which of the following valvular events occurs at the beginning of ventricular systole?
A patient is undergoing invasive hemodynamic monitoring. The provider needs to indirectly measure left atrial pressure. Which of the following measurements should be used?
A patient is undergoing invasive hemodynamic monitoring. The provider needs to indirectly measure left atrial pressure. Which of the following measurements should be used?
Which of the following increases preload?
Which of the following increases preload?
A patient is found to have a wide mediastinum on chest X-ray following a motor vehicle accident. Which test is most appropriate to rule out aortic dissection?
A patient is found to have a wide mediastinum on chest X-ray following a motor vehicle accident. Which test is most appropriate to rule out aortic dissection?
A 45-year-old female is found to have a systolic murmur that radiates to the carotids. An echocardiogram shows a thickened and immobile aortic valve. Which of the following is the most likely long-term complication?
A 45-year-old female is found to have a systolic murmur that radiates to the carotids. An echocardiogram shows a thickened and immobile aortic valve. Which of the following is the most likely long-term complication?
A 66-year-old male presents with acute inferior wall myocardial infarction. Which coronary artery is most likely occluded?
A 66-year-old male presents with acute inferior wall myocardial infarction. Which coronary artery is most likely occluded?
Which coronary artery supplies the posteromedial papillary muscle of the mitral valve in a right-dominant heart?
Which coronary artery supplies the posteromedial papillary muscle of the mitral valve in a right-dominant heart?
A 55-year-old man presents in cardiogenic shock. Swan-Ganz catheterization reveals elevated right atrial pressure and elevated pulmonary capillary wedge pressure. What is the most likely explanation?
A 55-year-old man presents in cardiogenic shock. Swan-Ganz catheterization reveals elevated right atrial pressure and elevated pulmonary capillary wedge pressure. What is the most likely explanation?
Which of the following is the correct equation for blood pressure?
Which of the following is the correct equation for blood pressure?
A 29-year-old athlete with no medical history is found to have a high ejection fraction of 75% on echocardiogram. Which of the following best explains this finding?
A 29-year-old athlete with no medical history is found to have a high ejection fraction of 75% on echocardiogram. Which of the following best explains this finding?
A 64-year-old male presents with exertional dyspnea and fatigue. Echocardiogram reveals an EF of 35%. Which of the following medications is most likely to improve his inotropy?
A 64-year-old male presents with exertional dyspnea and fatigue. Echocardiogram reveals an EF of 35%. Which of the following medications is most likely to improve his inotropy?
Which of the following maneuvers would most effectively reduce preload in a patient with a suspected murmur?
Which of the following maneuvers would most effectively reduce preload in a patient with a suspected murmur?
Which test is most appropriate for evaluating for coronary artery disease in a patient with stable angina and normal resting EKG?
Which test is most appropriate for evaluating for coronary artery disease in a patient with stable angina and normal resting EKG?
A 60-year-old male has an EF of 60% and BP of 150/90. Which of the following best describes his afterload?
A 60-year-old male has an EF of 60% and BP of 150/90. Which of the following best describes his afterload?
Which of the following findings would most likely be seen in aortic regurgitation?
Which of the following findings would most likely be seen in aortic regurgitation?
A patient with acute pericarditis presents with chest pain relieved by sitting forward. Which of the following findings is most characteristic?
A patient with acute pericarditis presents with chest pain relieved by sitting forward. Which of the following findings is most characteristic?
A 38-year-old woman has fatigue and a holosystolic murmur heard best at the apex, radiating to the axilla. Which valvular abnormality is most likely?
A 38-year-old woman has fatigue and a holosystolic murmur heard best at the apex, radiating to the axilla. Which valvular abnormality is most likely?
Flashcards
Tricuspid Valve
Tricuspid Valve
The valve between the right atrium and right ventricle that prevents backflow of blood.
Mitral Valve
Mitral Valve
The valve between the left atrium and left ventricle, preventing backflow.
Pulmonary Valve
Pulmonary Valve
The valve that controls blood flow from the right ventricle into the pulmonary artery.
Aortic Valve
Aortic Valve
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Coronary Arteries
Coronary Arteries
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Left Anterior Descending (LAD)
Left Anterior Descending (LAD)
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Coronary Artery Dominance
Coronary Artery Dominance
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Endocardium
Endocardium
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Myocardium
Myocardium
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Epicardium
Epicardium
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Pericardium
Pericardium
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Cardiac Cycle
Cardiac Cycle
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Systole
Systole
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Diastole
Diastole
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Directly Measured Right Atrial Pressure
Directly Measured Right Atrial Pressure
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Central Venous Pressure (CVP)
Central Venous Pressure (CVP)
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Pulmonary Capillary Wedge Pressure
Pulmonary Capillary Wedge Pressure
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Invasive Hemodynamic Monitoring
Invasive Hemodynamic Monitoring
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Preload
Preload
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Afterload
Afterload
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Contractility
Contractility
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Blood Pressure (BP)
Blood Pressure (BP)
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Pulse Pressure (PP)
Pulse Pressure (PP)
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Systolic BP
Systolic BP
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Diastolic BP
Diastolic BP
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Cardiac Index
Cardiac Index
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Ejection Fraction (EF)
Ejection Fraction (EF)
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Stroke Volume (SV)
Stroke Volume (SV)
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Preload
Preload
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Temporary Decrease Preload
Temporary Decrease Preload
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Long Term to increase Preload
Long Term to increase Preload
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Afterload
Afterload
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Decrease Afterload Methods
Decrease Afterload Methods
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Temporary Increase Afterload
Temporary Increase Afterload
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Contractility
Contractility
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Increase inotropy Drugs
Increase inotropy Drugs
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Stroke Volume
Stroke Volume
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Electrocardiogram (ECG/EKG)
Electrocardiogram (ECG/EKG)
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Chest X-Ray (CXR)
Chest X-Ray (CXR)
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Echocardiogram
Echocardiogram
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Computed Tomography Angiography (CTA)
Computed Tomography Angiography (CTA)
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Coronary CT Calcium Score (CAC)
Coronary CT Calcium Score (CAC)
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Holter/Event Monitors
Holter/Event Monitors
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Ankle Brachial Index (ABI)
Ankle Brachial Index (ABI)
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Tilt Table Test
Tilt Table Test
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Stress Test
Stress Test
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Electrophysiology (EP) Study
Electrophysiology (EP) Study
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Electrocardiogram (ECG)
Electrocardiogram (ECG)
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Cardiac Enzymes/Biomarkers
Cardiac Enzymes/Biomarkers
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Echocardiogram Types
Echocardiogram Types
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Cardiac Imaging (CTA/MRI)
Cardiac Imaging (CTA/MRI)
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Stress Tests: Indications
Stress Tests: Indications
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Stress Test Types
Stress Test Types
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Cardiac Catheterization
Cardiac Catheterization
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CABG (Coronary Artery Bypass Graft)
CABG (Coronary Artery Bypass Graft)
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CABG: Indications
CABG: Indications
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Valve Repair/Replacement
Valve Repair/Replacement
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Heart Monitors: Indications
Heart Monitors: Indications
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Abdominal Ultrasound/CT scan: Indications
Abdominal Ultrasound/CT scan: Indications
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Lower Extremity Ultrasound
Lower Extremity Ultrasound
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Tilt Table Test: Indications
Tilt Table Test: Indications
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POINT OF CARE ULTRASOUND (POCUS)
POINT OF CARE ULTRASOUND (POCUS)
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CXR for Cardiac Disease
CXR for Cardiac Disease
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Lower Extremity Angiography
Lower Extremity Angiography
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MUGA Scan
MUGA Scan
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Left Circumflex Artery
Left Circumflex Artery
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Pericardial Tamponade Pathophysiology
Pericardial Tamponade Pathophysiology
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Pulmonary Hypertension
Pulmonary Hypertension
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Echocardiogram (EF)
Echocardiogram (EF)
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Systolic Heart Failure Mechanism
Systolic Heart Failure Mechanism
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Tilt Table Test Use
Tilt Table Test Use
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Mitral and Tricuspid Valve Closure
Mitral and Tricuspid Valve Closure
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Pulmonary Capillary Wedge Pressure (PCWP)
Pulmonary Capillary Wedge Pressure (PCWP)
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Squatting Effect on Preload
Squatting Effect on Preload
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CT Angiogram (CTA)
CT Angiogram (CTA)
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Study Notes
Cardiac Anatomy, Physiology, and Testing
- ST depressions in leads V5 and V6 on an EKG indicate the need to assess the Left circumflex artery.
- V5/V6 corresponds to the lateral wall that is supplied by the circumflex artery.
- EKG findings include:
- V1-V4 indicating Anterior (LAD).
- II, III, aVF indicating Inferior (RCA) involvement.
- V5-V6, I, aVL indicating Lateral (Circumflex) involvement.
- Pericardial tamponade is caused by impaired diastolic filling due to external compression.
- Tamponade increases diastolic filling, decreases stroke volume (SV), which leads to hypotension.
- Beck's Triad indicates hypotension, JVD, and muffled heart sounds.
- Right atrial pressure (RA) being elevated but pulmonary capillary wedge pressure (PCWP) being normal indicates pulmonary hypertension.
- In this case the cause stems from after the RA but before the LA.
- PCWP equates to LA pressure, while RA pressure equates to CVP.
- A discrepancy between these indicates a pulmonary cause.
- Echocardiogram is the most accurate method to quantify left ventricular ejection fraction.
- MUGA scans are a gold standard for EF.
- EF is calculated as (SV/EDV) x 100, normal is > 60%.
- Used in heart failure assessment.
- Systolic heart failure with an ejection fraction of 30% is best described as decreased myocardial contractility.
- HFrEF equals reduced inotropy, SV decreases which in turn decreases EF.
- SV is calculated as EDV - ESV.
- EF is calculated as (SV/EDV) × 100.
- EF < 40% indicates systolic dysfunction.
- A tilt table test is useful for reproducing symptoms in a vasovagal syncope evaluation.
- Syncope from autonomic dysregulation evaluates with tilt, monitors BP and HR response.
- Orthostasis is a typical finding.
Valvular Events and Hemodynamics
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Closure of mitral and tricuspid valves occurs at the beginning of ventricular systole and creates the S1 sound.
- Start of systole equates to AV valves closing.
- AV valves includes mitral and tricuspid.
- Semilunar valves include aortic and pulmonic.
- S1 is the sound of AV closure and S2 is the sound of semilunar closures.
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Pulmonary capillary wedge pressure should be used to indirectly measure left atrial pressure during invasive hemodynamic monitoring.
- LA pressure equals PCWP via swan-ganz/ right heart cath during which, the balloon occludes the small PA branch.
- It reflects downstream LA pressure.
-
Squatting increases preload.
- Increased venous return corresponds with increased preload.
- Preload is the LV diastolic volume.
- Increased preload increases SV (Starling).
- Preload is decreased by standing, nitrates, and diuretics.
-
CT angiogram is most appropriate to rule out aortic dissection in a patient with a wide mediastinum on chest X-ray following a motor vehicle accident.
- Wide mediastinum + trauma are indicators of suspect dissection, which CTA is the gold standard.
- CTA detects dissection, aneurysm, and PE.
- The "Triple Rule-Out" study can be ordered.
-
Left ventricular hypertrophy is the most likely long-term complication of aortic stenosis that will present as a systolic murmur that radiates to the carotids.
- Aortic stenosis causes pressure overload causing LV hypertrophy.
- Signs of Aortic stenosis include a harsh systolic murmur that radiates to carotids, crescendo-decrescendo being present.
- High LV pressure causes the muscle to thicken.
-
Right coronary artery occlusion is most likely the cause in acute inferior wall myocardial infarction.
- Inferior wall = II, III, aVF = RCA territory.
- Anterior = V1-V4 (LAD).
- Lateral = I, aVL, V5-V6 (Circumflex).
- Inferior = II, III, aVF (RCA).
-
Right coronary artery supplies the posteromedial papillary muscle of the mitral valve in a right-dominant heart.
- Posteromedial papillary has a single supply of RCA if right dominant.
- Anterolateral has dual supply (LAD + diagonal/circumflex).
- Posteromedial single supply causes increase risk prone to infarct.
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Left ventricular failure is the most likely explanation in a patient presenting in cardiogenic shock with elevated right atrial pressure and elevated pulmonary capillary wedge pressure.
- RA and PCWP increase, blood back up from failing LV.
- Cardiogenic shock equates to pump failure, where backflow increases the LA pressure which in turn increases PA/RA pressures.
- Wedge pressure equals LA.
-
BP = CO × PVR is the correct equation for blood pressure, where CO = SV × HR.
- Systolic BP is related to cardiac output and volume.
- Diastolic BP is related to peripheral resistance.
- Pulse pressure is calculated as SBP – DBP.
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Increased myocardial contractility explains a high ejection fraction of 75% on echocardiogram in a 29-year-old athlete with no medical history.
- Increased inotropy increases SV, normal EDV causing EF to rise.
- Inotropy increases SV at same preload.
- Normal EF >60%.
-
Dobutamine is most likely to improve inotropy in a 64-year-old male presenting with exertional dyspnea and fatigue and EF of 35%.
- Dobutamine is a positive inotrope increasing contractility.
- Inotropy is muscle strength.
- Dobutamine, milrinone, and digoxin are inotropes which are helpful in systolic heart failure (EF+).
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Standing up quickly would most effectively reduce preload in a patient with a suspected murmur.
- Standing decreases venous return in turn decreasing preload.
- Decreased preload is related to standing, nitrates, diuretics.
- Increased preload = squatting, IV fluids, supine which is useful in murmur eval.
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Exercise stress test is most appropriate for evaluating for coronary artery disease in a patient with stable angina and normal resting EKG.
- Slides list stress testing as key diagnostic for angina if there is a normal baseline EKG?
- If there is an abnormal baseline use nuclear (echo stress), while CAC is for asymptomatic screening.
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Aortic impedance best describes afterload.
- Afterload is the resistance LV must pump against.
- Afterload is ≈ arterial BP, where increase afterload increases SV.
- Arterial vasodilators decrease afterload (e.g. hydralazine).
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Widened pulse pressure is most likely to be seen in aortic regurgitation.
- Aortic valve incompetence equates to backflow which causes a wide PP.
- Early diastolic murmur (LUSB) is also present.
- Findings include bounding pulses, where SBP goes up and DBP goes down.
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Diffuse ST elevation is the most characteristic finding, in a patient with acute pericarditis presenting with chest pain relieved by sitting forward.
- Pain increases with supine position, decreases on sitting forward.
- Pericardial friction rub and PR depression is also observed.
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Mitral regurgitation is the most likely valvular abnormality in a 38-year-old woman with fatigue and a holosystolic murmur heard best at the apex, radiating to the axilla.
- Radiates to axilla and volume overload causes LA dilation.
- Can cause A-fib.
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