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Today > 0120 - Cardiac 2/3 > Flashcards

0120 - Cardiac 2/3 Flashcards

1
Q

Right to left shunts?

A

Truncus arteriosus, Transposition, Tricuspid atresia, Tetralogy of Fallot, Total anomalous pulmonary venous return (TAPVR)

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2
Q

Tetralogy of Fallot

A

Abnormal anterior and cephalic displacement of infundibular portion of inter ventricular septum: VSD, pulmonic stenosis, overriding aorta (receiving blood flow from both ventricles), and RV hypertrophy. “Tet” spells following exertion b/c systemic VASOdilation -> increased right to left shunt. Associated with diGeorge.

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3
Q

Transposition of great vessels

A

Aorta is ANT and leaves RV while pulmonary artery is POSTerior and leaves LV. Requires shunt to support life. Failure of aorticopulmonary septum to spiral. Most common cause of cyanosis in NEONATE period. Associated with diabetic mother.

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4
Q

VSD

A

Left to right shunt. Asymptomatic at birth. Most self resolve but large lesion -> LV overload and HF

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5
Q

ASD

A

Wide, fixed split S2 (2/2 constant P2 late). Usu. septum secundum. NOT patent foramen ovale b/c septa are missing not unfused.

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6
Q

Patent ductus arteriosus

A

Indomethicin closes, PGE2 keeps open. Machine-like continuous murmur.

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7
Q

Eisenmenger syndrome

A

An uncorrected Left-to-right shunt can cause pulmonary vasculature to be remodeled and increased resistance eventually leading to a REVERSAL to a R-L shunt -> cyanosis (clubbing, and polycythemia)

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8
Q

TAPVR

A

Total anomalous pulmonary venous return. Pulmonary veins drain into Right heart circulation. Associated with ASD +/- PDA.

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9
Q

Coarctation of the aorta

A

Infantile type is PRE-ductal (before ductus arteriosus) and is associated with XO Turner’s. PGE2 to prevent closure. Adult type is post-ductal (after ligamentem arteriosum), associated with rib notching (collateral circulation), HTN of UPPER limbs and weak pulses in lower extremities

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10
Q

Truncus arteriosus

A

No septation. Often associated with a VSD. Seen in diGeorge

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11
Q

Congenital rubella is associated with what cardiac defects?

A

Septal, PDA, pulmonary artery stenosis

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12
Q

Turner syndrom is associated with what cardiac defects?

A

Bicuspid valve, coarctation of the aorta

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13
Q

Monckeberg arteriosclerosis

A

Medial calcific sclerosis. Calcification of then media NOT intima of blood vessels. Usu. benign. X-rays of radial or ulnar arteries.

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14
Q

What type of people would you expect to get an abdominal aortic aneurysm vs. a thoracic aortic aneurysm?

A

Abdominal - 50’s smoker. Thoracic - Marfan syndrome, tertiary syphilis. Associated with cystic medial degeneration in the older population

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15
Q

Aortic dissection Sanford type A vs. B?

A

A involves ascending aorta (+/- descending) while B does not.

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16
Q

Prinzmetal angina

A

2/2 to coronary spasm. Triggers include tobacco, cocaine, triptans. Tx = CCB, nitrates, smoking sessation

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17
Q

MI days 3-14: what do I need to know?

A

Macrophages doing their thing. Granulation tissue. Hyperemic border with central yellow-brown softening on gross. Free wall rupture, papillary muscle rupture, IV septal rupture (macrophage-mediated structural degradation). LV pseudoaneurysm = mural thrombus plugs hole = a time bomb

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18
Q

How long after occlusion does it take for histological or gross changes to occur in a MI?

A

FOUR hours. Coincedentally (or not), it takes four hours for troponin I to start rising (most specific cardiac marker)

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19
Q

Why use CK-MB?

A

Found in myocardium and skeletal muscle (less specific). BUT, it goes back to normal after 48 hours (troponins rise for 7-10 days). Therefore , it’s used for diagnosing re-infarction

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20
Q

Anteroseptal vs. Anterolateral leads?

A

V1-V2 vs. V4-V6

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21
Q

Dressler syndrome

A

autoimmune, takes several weeks to months (true ventricular aneurysm timeline)

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22
Q

Etios of dilated cardiomyopathy

A

Alcohol, wet Beriberi, Coxsackie B myocarditis, chronic Cocaine, Chagas, Doxorubicin toxicitiy, hemochromatosis, peripartum cardiomyopathy. Idiopathic and congenital.

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23
Q

Hypertrophic cardiomyopathy

A

LV ONLY. Most are familial and AD (Beta-myosin heavy chain mutation) although rarely associated with Fridreich ataxia. Can syncopize if septum to close to mitralm leaflet. Diastolic dysfunction. S4. Myofibrillar disarray and fibrosis. Tx = Cessation of high-intesnsity, Beta-block or non-di CCB.

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24
Q

Explain night symptoms of HF?

A

Orthopnea and PND are due to increased venous return 2/2 to the gradual reabsorption of pooled blood toward the lungs.

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25
Q

Physical signs of bacterial endocarditis

A

Fever, new murmur, Roth spots, Osler nodes, Janeway lesions, splinter hemorrhages on nail bed

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26
Q

Acute vs. subacute etios of endocarditis?

A

Acute - Staph aureus. Subacute - Viridians strep.

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27
Q

Culture negative bacterial endocarditis?

A

Coxiella burnetii, Bartonella. Or 2/2 malignancy, hpercoagulable state, lupus

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28
Q

Rheumatic fever histo findings

A

Aschoff bodies (granuloma with giant cells), Anitschkow cells (enlarged macrophages w/ ovoid nucleus).

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29
Q

Fibrinous vs. serous pericarditis?

A

Fibrinous is usu. Dressler, uremia, radiation. Serous is usually viral or inflammatory/auto-immune

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30
Q

Findings in cardiac tamponade

A

Beck’s triad (hypotension, distended neck veins, distant hear sounds). Tachy. Pulsus paradoxes, Kussmaul sign (rise of JVP on inspiration), ECG electrical alternans

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31
Q

Pathogenesis of syphilitic heart disease

A

In tertiary syphilis, disruption of the vasa vasorum of the aorta -> atrophy of wall and dilation. “Tree bark” aorta. Aneurysm.

32
Q

Myxoma vs. rhabdomyoma

A

Myxoma - most common primary. LA. Associated with syncopal episodes associated with obstruction of valve. Rhabdo - mostly in children (i.e. tuberous sclerosis)

33
Q

Cherry vs. strawberry hemangiomas?

A

Strawberries are for kids! Regress by 5-8. Cherries are for old people. Don’t regress.

34
Q

Pyogenic granuloma

A

Hemangioma that can ulcerate and bleed. Associated with trauma and pregnancy.

35
Q

Glomus tumor

A

Benign, PAINful, red-blue tumor under fingernails. From mod SMC’s of glomus body (temp. regulation)

36
Q

Bacillary angiomatosis

A

Like Kaposi, associated with AIDS. But looks uglier and caused by Bartonella henselae.

37
Q

Angiosarcoma

A

Rare blood vessel malignanty of the H&N and breast. Eldelry, sun-exposed. Radiation and arsenic. Agressive

38
Q

Lymphangiosarcoma

A

Lymphatic malignancy associated with too much lymph (e.g. post-mastectomy)

39
Q

Large vessel vasculitis

A

Temporal (Giant cell) and Takayasu

40
Q

Medium-vessel vasculitides

A

Polyarteritis nodosa, Kawasaki disease, Buerger disease

41
Q

Small-vessel vasculitides

A

Granulomatosis with polyangiitis, microscopic polyangiitis, Churg-Strauss syndrome, Henoch-Schonlein purpura

42
Q

Temporal arteritis

A

Elderly women with unilateral HA and jaw claudication. Treat with corticosteroids before temporal a. biopsy to prevent irreversible blindness 2/2 opthalmic artery occlusion. Associated with polymyalgia rheumatic. Path - focal granulomatous inflammation.

43
Q

Takayasu arteritis

A

Asian women < 40. “Pulseless disease.” Weak upper extremity PULSE, fever, night sweats, arthritis, myalgias, skin nodules, ocular. Path - granulomatous thickening and narrowing of aortic arch and great vessels. Tx = steroids

44
Q

Polyarteritis nodosa

A

Young adults with abdominal pain, melena, HTN, neuro, cut. eruptions, renal damage w/ Hep B seropositivity in 30%. IC-mediated. Transmural inflammation of wall w/ fibrinoid necrosis. MICROaneurysms. Renal and visceral vessels. Tx = steroids, cyclophosphomide

45
Q

Kawasaki disease

A

Asian children < 4 w/ fever, cervical nymphs, RED (conjuctiva, strawberry tongue, hand-foot), desquamating rash. Comps include coronary artery aneurysm -> MI,rupture. Tx = IVIG and ASA

46
Q

Buerger disease

A

Smoking men < 40 w/ claudication that can lead to gangrene and autoamputation.

47
Q

Granulomatosis with polyangitis

A

Perf’d nasal septum, chronic sinusitis, hemoptysis, cough, hematuria. Necrotizing vascultisi, granulomas of lung, glomerulonephritis. PR3-ANCA/c-ANCA. Tx - cyclophosamide, corticosteroids.

48
Q

Microscopic polyangitis

A

Kidney, lung, skin. Hemoptysis, cough, hematuria. NO granulomas. MPO-ANCA/p-ANCA. Tx = cyclophosphamide, corticosteroids

49
Q

Churg-Strauss

A

Asthma, sinusitis, palpable purpura, peripheral neuropathy. Granulomatous, necrotizing vasculitis with EOSinophilia. MPO-ANCA/p-ANCA.

50
Q

Henoch-Schonlein purpura

A

IgA complex deposition often following a URI. Palpable purport, arthralgia, GI.

51
Q

Dihydropyridine CCBs?

A

Amlodopine, nimodipine, nifedipine. HTN, angina, Raynauds. Nimodipine in particular used to decrease vasospasm following SAH.

52
Q

Non-dihydropyridine CCB’s?

A

Verapamil, Diltiazem. Used for HTN, angina, AFIB/FLUTTER.

53
Q

Vascular smooth muscle vs. heart effects by CCBs?

A

For smooth muscle: amlodopine = nifedipine > dilt > verp. For heart, Verapamil > dilt > amlodopine = nifedipine.

54
Q

CCB toxicities?

A

Cardiac depression, AV block, peripheral edema, flusshing, dizziness, hyperprolactinemia, constiation

55
Q

Hydralazine mech and use?

A

Increases cyclic GMP -> vasodilating arterioles > veins. Used fo rsevere HTN, CHF. 1st line for pregnancy with methyldopa. Often administered with Beta-blockers to prevent reflex tachy. B/c of reflex tachy, contra’d in angina/CAD

56
Q

Nitroprusside

A

Increases cGMP via direct NO release. But releases cyanide. Used for hypertensive emergencies.

57
Q

Fenoldopam

A

A D1 receptor agonist -> coronary, peropheral, renal, splanchnic vasodilation.

58
Q

Nitrates

A

Venodilation > arteriolardilation via increased cGMP. Decreased preload is mechanism as anti-anginal.

59
Q

Bile acid resins

A

Cholestyramine, colestipol, colesevelam. Prevents intestinal reabsorption of bile forcing the liver to use more cholesterol. Decreases LDL. GI discomfort, decreased absorption of fat-soluble vitamins. Cholesterol gallstones.

60
Q

Cholesterol absorption blockers

A

Ezetimibe. Only affects LDL (lowers)

61
Q

Niacin mech and side effecst

A

Inhibits lipolysis in adipose tissue and reduces hepatic VLDL synthesis. SE include flushing (dec. by aspirin), hyperglycemia, and hyperuricemia.

62
Q

Fibrates

A

Upregulate lipoprotein lipase to increase triglyceride clearance. Activates PPAR-alpha to induce HDL synthesis. Best TG lowering drug. Myositis (inc. with statins), hepatotoxicity, cholesterol gallstones (inc. with resins)

63
Q

Important digoxin pharmacokinetics

A

Urinary excretion. 75% bio. 20-40% protein bound. t1/2 of 40 hours.

64
Q

Digoxin mech?

A

Inhibits Na/K ATPase -> indirect inhibition of Na/Ca exchanger -> increased Ca intracellular -> positive isotropy. Also stimulates vagus nerve -> bradycardia.

65
Q

Digoxin Tox and Tx?

A

Cholinergic tox, increased PR, decreased QT, ST scooping, TWI, arrhythmia, AV block. HyperKalemia. Renal failure, hypokalemia, verapamil, amiodarone, quinidine all predispose. Tx = fix K+ slowly, pacer, anti-digoxin Fab-fragments, Mg2+

66
Q

Class IV antiarrhythmics

A

Non-dihydropyridine CCBs = verapamil and diltiazem. Decrease conduction velocity, increase effective refractory period, increase PR. Slowed rise of AP, prolonged depolarization. Used for nodal arrhythmias and rate control in AFib.

67
Q

Class III anti-arrhythmic names

A

Amiodarone (all class effects), Ibutilide, Dofetilide, Sotalol. AIDS is Potassium on Three.

68
Q

Class III anti-arrhythmics mechanism and usage

A

K+ channel blocker -> markedly prolong depolarization. Increased AP duration, increased refractory period. Increased QT. Used for Afib, A-flutter, ventriclear tachy

69
Q

Amiodarone toxicities

A

pulmonary fibrosis, hepatotoxicity, hypothyroidism/ hyperthyroidism, corneal depositis, skin deposits (blue/gray), neurological, constipation, brady, heart block, CHF. Therefore, must check PFTs, LFTs, TFTs.

70
Q

Class II antiarrhythmics mechanism and usage

A

Decreased cAMP -> dec. nodal activity. Decrease the phase 4 depolarization slope AND prolong repoarlization. Used for SVTs, rate control

71
Q

Class II antiarrhythmics tox

A

Impotence, exacerbate COPD/asthma, brady, AV block, CNS. Metoprolol can cause DLD. Propanolol can exacerbate vasopasm. Contra’d in COCAINE (b/c of risk of unopposed alpha-adrenergic receptor). Tx with glucagon.

72
Q

Class IA antiarrhythmics mech and usage

A

Quinidine, Procainamide, Disopyramide. Na+ channel bicker that decreases rate of depolarization -> inc. AP duration, inc. refractory, inc. QT. Used of atrial and ventricular arrhythmias.

73
Q

Class IB mech and usage

A

Lidocaine, Mexiletine. Decreased AP duration. Preferentially affects ischemic or depolarized tissue. Used for acute ventricular arrhythmias (post-MI), digitalis-induced.

74
Q

Class IC mech and usage

A

Flecainide, Propafenone. Significantly prolongs refractory period in AV node. Used for SVTs, AFib.

75
Q

Adenosine mech

A

K+ out of cells -> hyper polarizing and decreased Ca2+ current. Used to abolish and dx SVTs. Flushing, hypotension, CP. Blocked by theophylline and caffeine.

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