Podcast
Questions and Answers
Which of the following conditions can cause an isolated low diffusion capacity (DLCO)?
Which of the following conditions can cause an isolated low diffusion capacity (DLCO)?
A patient with COPD will always have a low FEV1/FVC ratio.
A patient with COPD will always have a low FEV1/FVC ratio.
True (A)
What is the primary difference between asthma and COPD in terms of reversibility of airflow obstruction?
What is the primary difference between asthma and COPD in terms of reversibility of airflow obstruction?
Asthma is generally reversible with bronchodilators, while COPD is not.
A low DLCO with normal lung volumes suggests a[n] ___________ cause of the diffusion impairment, while a low DLCO with reduced lung volumes indicates a[n] ___________ cause.
A low DLCO with normal lung volumes suggests a[n] ___________ cause of the diffusion impairment, while a low DLCO with reduced lung volumes indicates a[n] ___________ cause.
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What is the first line treatment for pericarditis?
What is the first line treatment for pericarditis?
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The ECG changes in stage 3 of pericarditis show T wave inversions.
The ECG changes in stage 3 of pericarditis show T wave inversions.
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What symptoms are associated with fluid overload in constrictive pericarditis?
What symptoms are associated with fluid overload in constrictive pericarditis?
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A pericardial _____ is an excess of fluid in the pericardial sac.
A pericardial _____ is an excess of fluid in the pericardial sac.
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Which of the following is NOT a symptom of pericardial effusion?
Which of the following is NOT a symptom of pericardial effusion?
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Prednisone is a first-line treatment for constrictive pericarditis.
Prednisone is a first-line treatment for constrictive pericarditis.
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Name one imaging technique used to confirm pericardial effusion.
Name one imaging technique used to confirm pericardial effusion.
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Match the following terms with their definitions:
Match the following terms with their definitions:
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What is the primary function of ACE inhibitors?
What is the primary function of ACE inhibitors?
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Which medication is used for acute treatment of supraventricular tachycardia (SVT)?
Which medication is used for acute treatment of supraventricular tachycardia (SVT)?
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SGLT2 inhibitors have no effect on patients without diabetes.
SGLT2 inhibitors have no effect on patients without diabetes.
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A permanent pacemaker is indicated only for bradycardia due to 3rd degree complete block.
A permanent pacemaker is indicated only for bradycardia due to 3rd degree complete block.
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What is the primary risk associated with using β-blockers in patients over 60 years old?
What is the primary risk associated with using β-blockers in patients over 60 years old?
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What is the formula used to calculate stroke volume (SV)?
What is the formula used to calculate stroke volume (SV)?
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The median survival for heart transplant patients is approximately ___ years.
The median survival for heart transplant patients is approximately ___ years.
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In assessing heart failure, the __________ condition has the worst prognosis.
In assessing heart failure, the __________ condition has the worst prognosis.
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Match the treatment with its mechanism or effect:
Match the treatment with its mechanism or effect:
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Which of the following is NOT a treatment method for atrial fibrillation?
Which of the following is NOT a treatment method for atrial fibrillation?
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Which of the following is true about heart failure treatments?
Which of the following is true about heart failure treatments?
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Match the heart failure medication classes with their primary function:
Match the heart failure medication classes with their primary function:
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Ventricular assist devices (VADs) are a long-term solution for heart failure patients.
Ventricular assist devices (VADs) are a long-term solution for heart failure patients.
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What does EF stand for in the context of heart function?
What does EF stand for in the context of heart function?
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What lifestyle change is recommended for all patients with hypertension?
What lifestyle change is recommended for all patients with hypertension?
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Name one medication option for thromboembolic events in atrial fibrillation.
Name one medication option for thromboembolic events in atrial fibrillation.
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Which of the following is NOT considered a 'resistance vessel'?
Which of the following is NOT considered a 'resistance vessel'?
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Aortic regurgitation is characterized by a high-pitched, blowing, decrescendo early diastolic murmur.
Aortic regurgitation is characterized by a high-pitched, blowing, decrescendo early diastolic murmur.
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What is the primary cause of mitral stenosis?
What is the primary cause of mitral stenosis?
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The presence of an S3 heart sound indicates ______ ventricular volume overload.
The presence of an S3 heart sound indicates ______ ventricular volume overload.
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Match the following signs with their corresponding clinical condition:
Match the following signs with their corresponding clinical condition:
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Which of the following is a common symptom of both aortic stenosis and aortic regurgitation?
Which of the following is a common symptom of both aortic stenosis and aortic regurgitation?
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Beta blockers are a treatment option for both mitral regurgitation and mitral stenosis.
Beta blockers are a treatment option for both mitral regurgitation and mitral stenosis.
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What is the recommended treatment for acute severe aortic regurgitation?
What is the recommended treatment for acute severe aortic regurgitation?
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Pericarditis is an inflammation of the ______
Pericarditis is an inflammation of the ______
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Which of the following statements best describes the pathophysiology of aortic stenosis?
Which of the following statements best describes the pathophysiology of aortic stenosis?
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What is the primary cause of infective endocarditis?
What is the primary cause of infective endocarditis?
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A true aneurysm involves only the outer layer of the blood vessel.
A true aneurysm involves only the outer layer of the blood vessel.
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What is the first-line treatment for a STEMI?
What is the first-line treatment for a STEMI?
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In the management of limb ischemia, smoking cessation is the most important ________.
In the management of limb ischemia, smoking cessation is the most important ________.
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Match the clinical signs with their associated conditions:
Match the clinical signs with their associated conditions:
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What is the most common location for an abdominal aortic aneurysm?
What is the most common location for an abdominal aortic aneurysm?
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Pulsus paradoxus is a sign commonly associated with cardiac arrest.
Pulsus paradoxus is a sign commonly associated with cardiac arrest.
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List two indications for surgical repair of infrarenal AAA.
List two indications for surgical repair of infrarenal AAA.
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In the treatment of myocardial infarction, _____ is administered to reduce platelet aggregation.
In the treatment of myocardial infarction, _____ is administered to reduce platelet aggregation.
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Which of the following describes a pseudoaneurysm?
Which of the following describes a pseudoaneurysm?
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Anticoagulation is the initial treatment for thrombotic limb ischemia.
Anticoagulation is the initial treatment for thrombotic limb ischemia.
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What is one common risk factor for chronic limb ischemia?
What is one common risk factor for chronic limb ischemia?
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In the context of infective endocarditis, _____ criteria are used for diagnosis.
In the context of infective endocarditis, _____ criteria are used for diagnosis.
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Match each treatment with the corresponding condition:
Match each treatment with the corresponding condition:
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Which of the following conditions is NOT associated with isolated low DLCO?
Which of the following conditions is NOT associated with isolated low DLCO?
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A patient with asthma typically has normal TLC and RV values.
A patient with asthma typically has normal TLC and RV values.
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Name one medication category that should be avoided in asthma patients.
Name one medication category that should be avoided in asthma patients.
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A low DLCO with normal lung volumes suggests a[n] __________ cause of the diffusion impairment.
A low DLCO with normal lung volumes suggests a[n] __________ cause of the diffusion impairment.
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Match the conditions with their corresponding pulmonary function test results:
Match the conditions with their corresponding pulmonary function test results:
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Study Notes
Cardiology Review Notes (Weeks 1-3)
- This review supplements, not replaces, student notes.
- Review focuses on high-yield topics and key points.
- The presentation's opinions are the presenter's own.
General Tips/Advice/Reassurances
- The practical exams are fair.
- Complete the weekly quizzes and ECG quizzes.
- Understand the drugs, not just memorize them.
Cardiovascular Basics
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Vessels:
- Arteries: High pressure, distensible (less so with age). Control microvascular flow. Resistance vessels (large pressure change), thin walls.
- Arterioles: Control microvascular flow, resistance vessels, slow flow due to large cross-sectional area, thin walls.
- Capillaries: Low pressure, capacitance vessels (distensible), thin walls.
- Plasma skimming: Blood from larger vessels enters at 40%. Flow profile develops a parabolic shape. High shear in center, low velocity near walls. Cells move rapidly through areas of low shear.
Ew, Math
- Cardiac output (blood/min) = Heart rate (beat/min) x Stroke volume (blood/beat)
- Ejection fraction = Stroke volume/End diastolic volume
- Mean arterial pressure = (2/3 x Diastolic BP) + (1/3 x Systolic BP) ≈ 93mmHg
- Compliance = change in volume/change in pressure
- Poiseulle Equation: Flow (Q) = πPr4/8ηl
Heart Basics
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Phases of the cardiac action potential:
- Phase 0 (Depolarization): Voltage-gated Na+ channels open.
- Phase 1 (Initial repolarization): Voltage-gated Na+ channels close, voltage-gated K+ channels begin to open.
- Phase 2 (Plateau): Voltage-gated Ca2+ channels open, K+ efflux continues, myocytes contract.
- Phase 3 (Rapid repolarization): Voltage-gated Ca2+ channels close, slow voltage-gated K+ channels open.
- Phase 4 (Resting potential): High K+ permeability.
- Systole vs diastole, Isovolumteric contraction and relaxation, Electrical activity before mechanical activity.
- Systolic and diastolic heart failure (different graphs showing pressure/volume relationships)
Drugs
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ACE Inhibitors (-pril): Indications: Hypertension, heart failure, MI. ADRs: Hypotension, worsening kidney function, cough, angioedema. Contraindications: Allergy, pregnancy.
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ARBs (-sartan): Indications: Hypertension, heart failure, MI. ADRs: Hypotension, worsening kidney function, cough, angioedema. Contraindications: Allergy, pregnancy.
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MRA (Spironolactone/Eplerenone): Indications: Hypertension (supplement), ascites in cirrhosis. ADRs: Gynecomastia, hyperkalemia. Contraindications: Allergy, pregnancy.
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Digoxin: Mechanism: Inhibits Na+/K+ ATPase -> increased Ca2+ -> increased contractility. Indications: Atrial fibrillation (AF) (rate control). ADRs: Arrhythmias, emesis, nausea, visual or CNS problems.
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Nitrates: Mechanism: Increase cGMP, vasodilation (arterial, venous, coronary). Indications: MI, angina, coronary spasm, MI with PE. ADRs: Headache, hypotension, reflex tachycardia, withdrawal syndrome.
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Calcium Channel Blockers:
- Dihydropyridines (-dipine): Mechanism: Vasodilators, decrease BP, vasodilate coronary arteries, no effect on contractility or SA node. Indications: Hypertension. ADRs: Headache, low BP, edema.
- Non-dihydropyridines (Verapamil, Diltiazem): Mechanism: Vasodilators, less potent than dihydropyridines, decrease myocardial contractility & sinus rate (slow SA node), increase refractory period of AV node. Indications: Atrial fibrillation (AF), Supraventricular tachycardia (SVT). ADRs: Bradycardia, worsening CO, edema.
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Beta-Blockers: Classification (nonselective, cardioselective, 3rd generation). Indications (angina, MI, hypertension, HFrEF, AF). ADRs (bronchospasm, bradycardia, worsening HF). Contraindications (severe reactive airway disease).
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Cholinergic Neurons & Receptors (parasympathetic): Cholinergic neurons: all skeletal muscles, preganglionic neurons (including to the adrenal gland), postganglionic neurons, some neurons in brain. Cholinergic receptors: Nicotinic (skeletal muscles, brain ganglia), Muscarinic (PSNS postganglionic neuron targets, sweat glands, brain)..
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Anticholinesterase Inhibitors: Mechanism: Target both nicotinic and muscarinic receptors. Indications: Myasthenia gravis.
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Antimuscarinics (Atropine): Mechanism: Target muscarinic receptors only. Indications: Bradycardia antidote, Surgical anesthetic.
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Neuromuscular blockers: Mechanism: Target muscarinic receptors specific to the NMJ. Indications: Surgical anesthetic.
Heart Sounds
- Know the descriptions of each heart sound, including its location, timing, character, and associated conditions.
Aortic Stenosis/Regurgitation.
- Pathophysiology: High pressures causing LV hypertrophy and increased O2 demand.
- Signs: Crescendo-decrescendo systolic ejection murmur, pulsus parvus et tardus. Low S2.
- Symptoms: Syncope, angina, dyspnea, sudden onset severe dyspnea, pulmonary edema.
- Treatment: Valve replacement (bioprosthetic or mechanical).
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Aortic Regurgitation
- High-pitched blowing decrescendo early diastolic murmur.
- Widened pulse pressure.
- S3 (sign of volume overload)
Mitral Stenosis/Regurgitation
- Mitral Stenosis
- Pathophysiology: Impaired flow from LA to LV
- Signs: Decrescendo diastolic murmur, Afib, Opening snap, Loud S1.
- Symptoms: Asymptomatic, or HF in years. LHF (PND, orthopnea). RHF (Edema, portal HTN).
- Tx: Beta blockers, anticoagulants, diuretics, Percutaneous mitral balloon valvuloplasty.
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Mitral Regurgitation
- Decrescendo systolic murmur.
- Maybe S3.
- Afib in chronic.
- LHF: PND, orthopnea.
- RHF: Edema, portal HTN.
- CO: Fatigue, dyspnea
- Tx: Beta blockers, anticoagulants, diuretics. Surgical mitral valve repair.
Pericarditis, Constrictive Pericarditis, Pericardial Effusion, Tamponade
- Pericarditis • Inflammation of pericardium, often viral, could be post MI • Typical symptom: pleuritic chest pain, improves leaning forward • Signs: Pericardial friction rub, ECG changes (diffuse ST elevation, PR depression, or other patterns) • Workup: Echo to rule out pleural effusion, other tests
- Constrictive Pericarditis • Thickening and rigidity of pericardium, typically resulting from acute pericarditis. • Symptoms: Fluid overload, elevated JVP, Ascites, Peripheral edema, reduced cardiac output, exertional dyspnea. • Signs: Tachycardia, Pulsus paradoxus, Pericardial knock (sudden cessation of ventricular filling) • Workup: Echo (increased pericardial thickness, abnormal ventricular filling)
- Pericardial effusion: Too much pericardial fluid • Symptoms: Orthopnea, retrosternal pain and hypotension • Signs: Muffled heart sounds, distended neck veins, tachycardia, pulsus paradoxus, obstructive shock, cardiac arrest
- Pericardial Tamponade: A severe form of pericardial effusion where pressure on the heart is significantly increased.
- Workup : Echo, POCUS, CXR (increased silhouette).
- Treatment: Unstable: pericardiocentesis. Stable: conservative measures or pericardiocentesis.
Infective Endocarditis
- Pathophysiology and Symptoms: S. aureus most commonly, transient bacteremia on damaged valve causing colonization → platelets aggregate to form a biofilm. Constitutional symptoms(fever), Tricuspid regurgitation, heart failure.
- Workup: Duke's criteria (CBC, 3x blood cultures, urine culture, ECG, CXR, ECHO)
- Treatment: Antibiotics (typically IV vancomycin), some indications for surgery.
Tests for the Heart and Myocardial Infarction (MI)
- Risk Tiers (asym/low, moderate, high) related to testing.
- Stress tests: Treadmill, pharmacologic (persantine, adenosine, dobutamine).
- Pathophysiology: Plaque rupture with thrombus (STEMI - complete occlusion) or Non-occlusive (NSTEMI).
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Ischemic (Type 1), mismatch (Type 2).
- Signs: EKG changes (ST elevation/depression) and other markers
- Types: STEMI, NSTEMI.
- Management: Acute: Cardiac monitor, EKG, large-bore IVs, oxygen, ASA, nitroglycerin (SL), morphine. PCI (if appropriate). Otherwise, thrombolytics.
- Complications: Mitral regurgitation, Arrhythmias, pericarditis, mural/septal rupture and tamponade. Mural thrombus.
CABG (Coronary Artery Bypass Graft)
- Coronary artery order of importance: LAD > circumflex > RCA.
- Coronary artery occlusion order: Left main coronary stenosis, Left main equivalent, Triple vessel, Double vessel
- Procedures using internal thoracic artery, radial artery, saphenous vein.
Aneurysms
- True involve all three layers of vessel wall.
- Saccular (saclike) and Fusiform (bulging).
- Pseudo aneuyrsims = walled off.
- Indications for repair: size (infrarenal AAA ≥ 5.5 cm men, 5cm women). Rapid growth rate (> 1 cm/year).
- Thoracic (6-6.5 cm)
- Popliteal (3-4 cm MC).
Dissection
- Pathophysiology Blood leaks into vessel wall, creating a false lumen.
- Signs: Tearing chest pain radiating to the back.
- Treatment: Fixing the tear.
Vascular Pathology
- Generally asymptomatic
- Never regress
- Treatment is prophylactic to prevent complications.
- Complications often include
- Rupture
- Embolism
- Thrombosis
- Screening with abdominal ultrasound in people at high risk.
Risk of Rupture Increases with Aneurysm Size... except for saccular (mycotic) & pseudoaneurysms. Management includes Aggressive anti-atherosclerotic management, Stenting, or graft (open repair).
Limb Ischemia
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Acute: Embolic (catastrophic, white leg, complete sensory loss, often from cardiac source) or Thrombotic (progressive, hx of claudication).
- Symptoms: Asx, Pain, pulses are absent, paresthesia (decreased fine touch), pallor.
- Tx: Anticoagulation, oxygen, IV hydration, analgesia, endovascular options.
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Chronic: Intermittent claudication (functional, distal → proximal, often) or Critical limb ischemia (limb threatening, pain at rest, tissue loss, gangrene).
- Tx: Medical management (ABCDEs, antiplt, statins, BP), exercise, smoking cessation. Surgical bypass/percutaneous revascularization (for severe ischemia).
ECGs and Arrhythmias
- Location Matters: ECG leads correspond to specific areas of the heart.
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Rate: Calculate using number of large boxes between QRS complexes (300/box count) or counting QRS complexes over ten seconds and multiplying by 6.
- Normal: 60-100 beats per minute.
- Tachycardia:= >100 bpm
- Bradycardia: < 60 bpm.
- Rhythm: Regular or irregular. Narrow or wide QRS complexes. Present P waves. Evidence of AV block or retrograde P waves (Junctional).
Determining Normal Heart Axis
- Based on the positive/negative nature of leads I and aVF on an ECG.
AV Block
- 1st degree: PR interval > 0.20 seconds.
- 2nd degree Type 1 (Wenckebach): PR interval progressively lengthens until a QRS is dropped.
- 2nd degree Type 2: PR constant, but some QRS are dropped randomly.
- 3rd degree (complete): AV dissocation, no relationship between P and QRS
Bundle Branch Blocks
- RBBB & LBBB. QRS is widened beyond 0.12 seconds. Characteristic EKG morphology in limb leads.
Cardiac Arrhythmias, Narrow & Broad QRS
- Tachycardia (narrow QRS): Sinus tachycardia (Sympathetic stimulation), Atrial fibrillation (multiple foci, irregular rhythm), Atrial flutter (single reentrant circuit, sawtooth pattern).
- Tachycardia (broad QRS): Ventricular tachycardia (Autonomic focus or re-entrant circuit in ventricles; regular rhythm), Supraventricular tachycardia (narrow QRS, often with abnormal P waves, irregular rhythm).
- Ventricular fibrillation: Disordered impulses, rapid irregular wide QRS.
Treatments for Bradycardia/Tachycardia
- Bradycardia: Atropine, isoproterenol, Temporary pacing, permanent pacemaker (chronic).
-
Tachycardia
- SVT: Vagal maneuvers, adenosine, verapamil, diltiazem, cardioversion, procainamide, ibutilide.
- VT: Adenosine, lidocaine, procainamide, amiodarone, Cardioversion (often).
- AF (Atrial Fibrillation): ASA, clopidogrel, apixaban, rivaroxaban, dabigatran, BB, CCB, Digoxin, DC cardioversion(<48hrs). General principles for all: Identify the type, assess stability, treat accordingly.
Heart Failure
- Chronic progressive disease where the heart can't meet the body's oxygen demands.
- Compensated: Asymptomatic, has compensatory responses (enlarged heart, increase HR)
- Decompensated: Symptomatic, requires treatment/hospitalization.
- Systolic (HFrEF) and Diastolic (HFpEF): Left-sided (low EF, enlarged ventricles), Right-sided (pulmonary hypertension, fluid back-up), Biventricular (both sides).
- Causes: Ischemic heart disease, Cardiomyopathy (primary or secondary), Valvular heart disease, hypertension.
- Symptoms: Fatigue, reduced exercise tolerance, dyspnea, orthopnea, PND, edema (peripheral/pulmonary), ascites, elevated JVP, hepatomegaly, anorexia, and GI distress.
- Diagnosis: Clinical history, PE, vital signs, weight, volume status, CXR, EKG, Lab studies (CBC, electrolytes, BNP), echocardiogram for ventricular function.
- Treatment with medications (digoxin, loop diuretics, ACEis, ARBs, ARNi, other inotropes...).
Cardiomyopathy (3 Major Types)
- Dilated: Ventricular chamber enlargement and systolic dysfunction with normal LV wall thickness (due to various causes-viral, genetic conditions, etc.)
- Hypertrophic: Thickening of the ventricular walls (often genetic causes) and can lead to dilation of mitral/tricuspid annuli.
- Restrictive: Large atria, high amyloid deposit (often presents with diastolic dysfunction).
Classification of Heart Failure (NYHA, ACC/AHA)
- The various clinical classifications of Heart failure based on Functional capacity.
Assessment of Heart Failure
• Clinical history and physical exam (vital signs, weight, volume status, CXR, ECG, BNP, echocardiogram, additional testing like exercise tests).
Treatment for Heart Failure
- Diuretics (loops, thiazides), inotropes (digoxin, milrinone/dobutamine), ACE/ARBs, beta-blockers, and MRA.
- Early to late stage management as well as hospitalizations.
- Consider other options like implantable cardioverter defibrillators or Ventricular assist devices in end-stage HF.
Hypertension (HTN)
-
Treatment: Lowering blood pressure to reduce associated CV risk. This includes lifestyle changes (diet, exercise) and medications.
- Appropriate Medications: Diuretics (thiazides), ACE inhibitors, ARBs, beta-blockers, DHP CCBs.
- Management: Lifestyle changes (weight loss, diet, exercise, stress reduction) and antihypertensive medications based on patient risk group (High/Moderate/Low-risk) associated with thresholds and targets.
Pediatric Heart Disease
- Fetal Circulation: Ductus venosus, ductus arteriosus, foramen ovale.
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Congenital Heart Disease: Categories of lesions based on shunt involvement and blood flow characteristics (acyanotic/pink, cyanotic/blue).
- Valves lesions (bicuspid aorta, aortic stenosis/regurgitation, mitral stenosis/regurgitation)
- Pediatric Murmurs: Classification of heart murmurs in children, separating innocent murmurs from significant heart disease (e.g., ASD, VSD, etc.
- Kawasaki Disease: Acute, systemic vasculitis with coronary artery aneurysm risk.
Respiratory Week 1
- Lung Volumes: TLC, VC, IRV, EVR, RV, FRC are defined (and depicted diagrammatically to show their relationship).
- Pulmonary Function Tests (PFT): How they're conducted and the values measured (FEV1, FVC, FEV1/FVC ratio, TLC, RV, and DLCO). Use these tests to determine if a patient has obstructive, restrictive, or isolated diffusion abnormalities.
- Interpreting PFT Results: Obstructive, restrictive, and isolated defects.
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Description
Test your knowledge on pulmonary and cardiac conditions with this quiz. Explore various conditions such as COPD, pericarditis, and related symptoms and diagnostic methods. This quiz will help reinforce key concepts essential for understanding respiratory and cardiovascular pathophysiology.
