Medicine Study Set: Block Exam 2 Terms & Definitions

Which cardiomyopathy is characterized by dilation + systolic dysfunction and accounts for 90% of all cardiomyopathies?

Dilated

3 multiple choice options

Which cardiomyopathy is a disease of the heart muscle that causes impaired filling of the ventricle along with either normal or reduced metric diastolic volume?

Restrictive

1 multiple choice option

Which cardiomyopathy is the development of a hypertrophied, nondilated L ventricle that occurs without another predisposing condition?

Hypertrophic

3 multiple choice options

A 60-year-old man presents to his cardiologist for worsening SOB and fatigue with minimal exertion. He began developing symptoms a few months prior to presentation. His SOB is most significant with exertion and he notes having swollen feet. His medical history includes HTN, hyperlipidemia, and alcohol use disorder. He currently takes HCTZ and atorvastatin. On physical exam, an S3 heart sound and a systolic regurgitant murmur is auscultated. An echo shows markedly dilated ventricles with a reduced EF. What is the most likely diagnosis?

dilated cardiomyopathy

3 multiple choice options

What is the first line tx for a pt with dilated cardiomyopathy?

ACE-I

2 multiple choice options

Hypertrophic obstructive cardiomyopathy may be caused by an autosomal dominant genetic disorder via a mutation in which chromosome?

chromosome 14

3 multiple choice options

Which cardiomyopathy causes subaortic outflow obstruction due to asymmetrical septal hypertrophy, and systolic anterior motion of the mitral valve?

HOCM

2 multiple choice options

Where is HOCM best heard?

harsh systolic murmur at LSB

1 multiple choice option

what is the 1st line tx for HOCM?

B-blockers

3 multiple choice options

When auscultating a pt you suspect has HOCM, valsalva and standing can __________ LV volume, worsening the murmur.

decrease

1 multiple choice option

When auscultating a pt you suspect has HOCM, squatting and leg raises can _________ LV volume, decreasing the murmur.

increase

1 multiple choice option

A 40-year-old woman presents to her PCP with DOE and exercise tolerance. She states that her symptoms seem to be worsening overtime. Her medical history includes breast cancer. A year prior to presentation, she had completed multiple rounds of chemo for breast cancer. An echo is obtained. What is the most likely dx?

restrictive cardiomyopathy

2 multiple choice options

What respiratory presentation may be observed in a pt with R sided restrictive cardiomyopathy?

Kussmaul's sign

Which cardiomyopathy has the poorest prognosis and highest rate of SCD?

restrictive cardiomyopathy

2 multiple choice options

Murmurs lasting throughout systole are referred to as

pansystolic/holosystolic

Insufficiency/regurgitation/incompetent

Incomplete closure of the valve

2 multiple choice options

Prolapse

Involves the mitral valve

2 multiple choice options

The point on the precordium farthest outwards (laterally) and downwards (inferiorly) from the sternum at which the cardiac impulse can be felt is known as the

PMI/apical impulse

Right sided murmurs generally ____________ with inspiration

Increase

2 multiple choice options

Left sided murmurs are usually ____________ during expiration.

Louder

1 multiple choice option

Most murmurs decrease in length and intensity with the exception of two murmurs:

-systolic murmur of HCM

-murmur of MVP

Grade I murmur

Just audible in a quiet room

3 multiple choice options

Grade 2 murmur

Quiet

3 multiple choice options

Grade 3 murmur (MC)

Loud, no thrill

3 multiple choice options

Grade 4 murmur

Loud, with thrill

3 multiple choice options

Grade 5 murmur

Very loud with thrill

2 multiple choice options

Grade 6 murmur

Audible without stethoscope

3 multiple choice options

Harsh/rumble = stenosis → overload of pressure

-aortic stenosis

-mitral stenosis

Blowing = regurgitation → volume overload

-aortic regurgitation

-mitral regurgitation

Increase in venous return → increases intensity of murmurs except:

↓ HCM

↓ ejection click MVP

supine

squat

leg elevation/raise

Decrease in venous return → decreases intensity of murmurs except:

↑ HCM

↑ ejection click MVP

standing

valsalva

Right side sounds like left side

TR & MR

AS & PS

AR & PR

Murmur radiation to the axilla is indicative of

mitral regurgitation

1 multiple choice option

Murmur radiation to the carotids is indicative of

aortic stenosis

1 multiple choice option

An incomplete closure which causes leakage back into the R atrium is known as

tricuspid insufficiency (regurg)

Tricuspid regurg

soft

holosystolic

high-pitched

L mid-sternal border

increases:

-squatting

-full inspiration

2 multiple choice options

diseases associated with tricuspid insufficiency

-HF

-pulmonary HTN

-rheumatic fever

-endocarditis

A narrowing through the tricuspid valve is known as

tricuspid stenosis

Tricuspid stenosis

Mid-diastolic

opening snap

LLSB

increases:

-full insp

-squatting

-lying supine

-leg raise

2 multiple choice options

What disease is most commonly associated with tricuspid stenosis?

Rheumatic heart disease

1 multiple choice option

True or False. Patients with mechanical/bioprosthetic valves must have warfarin.

True

1 multiple choice option

Which valvular disease causes retrograde flow from pulmonary artery through valve into R ventricle?

pulmonic insufficiency (regurg)

What is the most common cause of pulmonic insufficiency (regurg)?

tetralogy of fallot

1 multiple choice option

Pulmonic insufficiency murmur (regurg) due to pulmonary HTN

-Graham-steel murmur

-early diastolic murmur

2nd LICS

increases:

-full insp

-sitting upright

-squatting

2 multiple choice options

Pulmonic insufficiency murmur (regurg) NOT due to pulmonary HTN

pansystolic

rough

low pitch

parasternal 4th ICS

increased:

-inspiration

-exercise

-leg raise

1 multiple choice option

Restriction through pulmonic valve to pulmonary arterial vasculature

pulmonic stenosis

Which condition is most commonly associated with pulmonic stenosis?

congenital rubella syndrome

Pulmonic stenosis

harsh

midsystolic

crescendo-decrescendo

systolic ejection click

L upper sternal border

increases:

full inspiration

What is the preferred tx for pulmonic stenosis?

balloon valvuloplasty

Incomplete closure of valve leading to regurgitation of blood back into L atrium and is characterized by wide splitting of S2

Mitral insufficiency (regurg)

Chronic sx of mitral regurg

dysnea

fatigue

A-fib

Acute sx of mitral regurg

pulmonary edema

hypotension

Mitral regurg

pansystolic

blowing

apex

increases:

-L lateral position

-expiration

-squatting

-leg raise

-hand grip**

1 multiple choice option

Incomplete closure of valve; valve bulges back into atrium

Mitral valve prolapse

Mitral Valve prolapse

mid-late systolic ejection click

apex

valsalva/standing/inspiration

↳earlier click + longer murmur

lying supine/squatting/leg raise/hand grip

↳delayed click

Sx mitral valve prolapse management:

valvuloplasty

valve replacement

b-blockers

Obstruction of flow from L atrium to L ventricle. Thickening, and mobility of mitral leaflets, including pressure in L atrium. Fluid backs up into pulmonary vasculature.

mitral stenosis

What is almost always the cause of mitral stenosis?

rheumatic heart disease

What is the MC sx of mitral stenosis?

DOE

Mitral stenosis

mid-diastolic rumble

prominent loud S1 w/ opening snap

apex

increases:

-L lateral decubitus position

-full exhalation

-squatting/leg raise

-lying supine

1 multiple choice option

Which valvular condition is characterized by a leaky aortic valve which causes blood flow in the reverse direction during ventricular diastole?

aortic insufficiency (regurg)

What is the most common cause of aortic insufficiency?

bicuspid aortic valve (congenital)

Aortic insufficiency (regurg) is characterized by:

-wide pulse pressure

-corrigan pulse

What peripheral signs may be observed in a pt with aortic insufficiency?

-Hills sign

-Quincke Pulse

-de Musset's sign:

Hill's sign

Popliteal artery systolic pressure > brachial artery by 60 mmHg (most sensitive for aortic regurg/aortic insufficiency)

2 multiple choice options

Quincke pulse

Systolic pulsations seen upon light compression of nail bed

2 multiple choice options

de Musset's sign

head bob w/ each ventricular contraction

2 multiple choice options

Aortic insufficiency (regurg)

diastolic (decrescendo)

blowing

L upper sternal border

increases:

-hand grip,

-sitting while leaning forward and expiration

Which valvular condition is characterized by the narrowing of the aortic valve, and obstructs blood from heart to the aorta?

aortic stenosis

What are the most common causes of aortic stenosis?

-bicuspid valve

-calcific disease

-degenerative process

-rheumatic heart disease (post strep infection)***

What is the MC sx of aortic stenosis

angina

3 multiple choice options

A pt presents to your clinic with a narrow pulse pressure, LV heave, and a murmur in the R upper SB. What is the most likely dx?

aortic stenosis

Aortic stenosis

systolic crescendo-decrescendo

2nd RICS

Increase:

-sitting, leaning forward

-squatting

-lying supine

-leg raise

-expiration

What might one find on an EKG for a pt with aortic stenosis?

LBBB

3 multiple choice options

What is the only effective tx for aortic stenosis?

aortic valve replacement

A pt is considered hypotensive when their BP is

< 90/60

2 multiple choice options

Which 3 criteria must a pt meet in order to be considered hypotensive?

-symptomatic

-drop in systolic

-increased HR

What are the 5 most common causes of hypotension?

-emotional stress/fear

-dehydration/heat

-blood donation

-internal bleeding

The _____________ nervous system acts to raise BP by increasing heart rate and constricting arterioles.

sympathetic

1 multiple choice option

The _____________ nervous system lowers BP by decreasing HR and relaxing arterioles to increase vessel diameter.

parasympathetic

1 multiple choice option

For most individuals, a healthy BP lies from 90/50 to 135/90. A small drop in BP, even as little as 20 mmHg, can result in:

transient hypotension

Which type of shock occurs when the heart is unable to pump as much blood as the body needs, and can happen even if there hasn't been an MI?

cardiogenic

Which 3 classes of meds should be given to a pt with cardiogenic shock?

-antiarrhthymics

-blood thinners/antiplatelets

-vasopressors/inotropes

Which 3 goal directed treatments should be considered for pts in cardiogenic shock?

-ECMO

-IABP

-PCADs

A transient loss of consciousness due to a sudden drop in HR and BP is known as

vasovagal syncope

What are the 3 P's of vasovagal syncope?

Posture

Provoking

Prodromal

Vasovagal syncope criteria:

↑ 30 bpm HR

or

↓ more than 20 mmHg systolic

True or False. A Vasovagal reaction is an exaggeration of an adaptive response meant to assist in hemostasis in times of trauma.

True

1 multiple choice option

Hypotension + vasovagal LOC occurs with:

↑ lower body negative pressure

↳induces fall in HR + CO

Workup for syncope includes:

-EKG

-24 hr Holter monitor

-Echo

-Tilt table testing

Which blood circulation disorder is characterized by ↑ HR from horizontal to standing of at least 30 bpm and 40 bpm in adolescents during the first 10 mins of standing?

POTS

True or False. POTS is the least common form of orthostatic intolerance in young people.

False

1 multiple choice option

True or False. Although there is no known cure for POTS, the condition can be managed in most patients with diet exercise, and medication.

True

1 multiple choice option

Which congenital heart disease shunts blood R → L and typically results in less than normal O2 levels delivered to the body?

cyanotic

1 multiple choice option

Which congenital heart disease shunts blood L → R and results in O2 levels remaining normal?

acyanotic

1 multiple choice option

APGAR Score

a scale of 1-10 to evaluate a newborn infant's physical status at 1 and 5 minutes after birth

Appearance (skin color)

Pulse

Grimace

Activity

Respiration

True or False. L → R shunts can progress to R → L shunts as they worsen.

True

1 multiple choice option

Acyanotic defects that cause shunting: (↑ pulmonary blood flow)

-Atrial septal defect

-Ventricular septal defect

-Patent ductus arteriosus

-AV canal

Acyanotic defects that don't cause shunting: (obstruction to blood flow from ventricles)

-coarctation

-aortic stenosis

-pulmonic stenosis

Cyanotic defects (↓ pulmonary blood flow)

-tetralogy of fallot

-tricuspid artresia