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*First Aid in Brainscape* > AAW - Cardio > Flashcards

AAW - Cardio Flashcards

1
Q

Patient presents with fever, loud 3 component heart sound,, diffuse ST segment elevations, and chest pain that worsens while lying down 5 weeks after an MI

What is the most likely diagnosis

A

dresslers syndrome, autoimmune post-myocardial infarction fibrinous pericarditis

the heart sound is a friction rub

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2
Q

Biopsy of the heart in a child with a murmur shows densely packed striated muscle

What is the most likely diagnosis

A

rhabdomyoma, most common primary cardiac tumor in kids, assc. with tuberous sclerosis

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3
Q

Histological examination of a myxoid tumor of the heart will show what

A

scattered mesenchymal cells in a prominent myxoid background

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4
Q

Turner syndrome

A

Cystic hygroma on the neck (obstruction of lymphatic drainage into the venous system)

Broad chest

high arched palate

short stature

gonadal dysgenesis

Coarctation of the aorta

(like putting a Turner kit on the aorta)

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5
Q

Methyldopa

A

First choice for treating hypertension in pregnant women

converted intraneuronally to alpha-methylnorepinephrine, and alpha-2 agonist

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6
Q

Tx for methemoglobinemia

A

Methylene blue

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7
Q

What does nitro do to your Left ventricular end systolic volume? Diastolic?

A

decreases both

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8
Q

Congenital defect assc with maternal rubella

A

PDA
cataracts
deafness

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9
Q

Congenital defect assc with maternal diabetes

A

transposition of the great vessels

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10
Q

fixed split s2

A

ASD

Sx can be absent or minimal until late in childhood

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11
Q

drug that causes nausia, vommiting, diarrhea, and blurry yellow vision

A

digoxin

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12
Q

what heart condition is assc with “ring-enhancing radiologic lesions” in the brain

A

infective endocarditis, usually s. aureus

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13
Q

what happens to your arterial diameter and PVR in anemia

A

arterial diameter increases to allow more blood to go to the heart

peripheral vascular resistance is decreased because the blood viscosity is lowered

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14
Q

pneumonic for cyanotic babies

A

the T defects (right to left shunts)

Tetralogy of fallot
Transposition
persistent Truncus ateriosus

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15
Q

Treatment for hypertension with BPH

A

alpha 1 blocker

-azosin

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16
Q

what causes AAA

A

atherosclerosis is by far most common

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17
Q

inflammatory condition that produces thoracic aortic aneurisms

A

takayasu arteritis

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18
Q

left horn of sinus venosus gives rise to

A

coronary sinus

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19
Q

right horn of sinus venosus gives rise to

A

smooth part of right atrium

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20
Q

right common cardinal vein and right anterior cardinal vein give rise to

A

superior vena cava

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21
Q

first functional organ in vertebrate embryos is the

A

heart.

beats by week 4

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22
Q

conditions that can cause paradoxical emboli (a venous thromboemboli that enters systemic arterial circulation)

A

ASD

patent foramen ovale

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23
Q

endocardial cushions of the AV canal form what

endocardial cushions of the outflow tract of the heart become what

A

mitral/tricuspid valves

aortic/pulmonary valves

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24
Q

ebstein anomaly

A

displaced valves due to lithium toxicity

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25
Q

why does fetal hemoglobin have a higher affinity for oxygen binding

A

it has alpha2gamma2 instead of alpha2beta2

alpha2gamma2 binds to 2,3 BPG less avidly.

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26
Q

what causes the foramen ovale to close when a baby is born

A

baby takes a breath, decreasing resistance in pulmonary arteries. This causes more blood to flow through them, resulting in more pressure in the left atrium than the right atrium, which pushes the valve shut

when shut, it is called the fossa ovalis

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27
Q

What causes the ductus arteriosus to close

A

increase in 02 from respiration and decrease in prostaglandins

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28
Q

umbilical vein becomes the

A

ligamentum teres hepatis (contained in falciform ligament)

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29
Q

umbilical arteries become the

A

medial umbilical ligaments

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30
Q

ductus arteriosus becomes the

A

ligamentum arteriosum

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31
Q

ductus venosus becomes the

A

ligamentum venosum

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32
Q

foramen ovale becomes the

A

fossa ovalis

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33
Q

allantois becomes the

A

urachus-median umbilical ligament

urachal cysts or sinuses can appear as remnants

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34
Q

notochord becomes the

A

nucleus pulposus of the intervertebral disc

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35
Q

SA and AV nodes are supplied by what artery

A

RCA

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36
Q

what most commonly gives rise to the posterior descending artery of the heart

A

right coronary in 85%

left coronary in 8%

mixture in 7%

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37
Q

enlargement of which area of the heart can cause dysphagia and/or hoarseness

A

left atrium (the most posterior part)

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38
Q

cardiac output in relation to O2 consumption

A

CO = O2 consumption / (arterial O2 content - venous O2 content)

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39
Q

two ways to calculate mean arterial pressure

A

MAP = CO x TPR
(think V=iR)

MAP = 2/3 diastolic + 1/3 systolic

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40
Q

what does hyperkalemia do to an EKG

A

tall, “tented” T waves that rise slowly is most characteristic

(the heart has to work harder to repolarize because it is not as easy to pump potassium outside the cell during repolarization)

can also cause abridged or absent ST segment

“hyper?, K pitch a tent”

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41
Q

what does hypercalcemia do to an EKG

A

shortened QT with abridged or absent ST segment

the T wave will not be as tall as the r wave, as seen in hyperkalemia

(also, BP will go up and the patient will likely vomit)

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42
Q

eosinophilic granulomatosis with polyangiitis is also known as

A

Churg-strauss

p-ANCA (directed at myeloperoxidase) with asthma, necrotising vasculitis, and eosinophilic granulomas

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43
Q

4 to 8 weeks after an MI, patient presents with dyspnea, bibasilar lung crackles, and arrhythmia

what are you thinking

A

ventricular aneurysm

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44
Q

2-7 days most MI patient presents with high pitched, holosystolic murmur and rapid onset of pulmonary edema

what are you thinking

A

papillary muscle rupture

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45
Q

what vasculitis causes coronary artery aneurysm

A

kawasaki disease

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46
Q

Loeffler endocarditis

A

restrictive heart disease that causes endomyocardial fibrosis with associated eosinophilia and myocyte necrosis

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47
Q

Someone not from the US has myocarditis and megacolon

what are you thinking

A

Chagas disease, caused by trypanasoma cruzi

usually they will be from central and south america

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48
Q

what type of cardiomyopathy does alcohol cause

A

dilated

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49
Q

what shows apple-green birefringence on a congo red stain and what can it do to the heart

A

amyloid deposit

cause restrictive cardiomyopathy

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50
Q

fibroelastosis

A

causes a think fibroelastic tissue buildup in the endocardium of young children

restrictive cardiomyopathy

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51
Q

hereditary hypertrophic cardiomyopathy

what type of patient is it usually seen in

what happens to the heart besides hypertrophy

what are the genetics

A

usually seen in young, athletic adults

hypertrophy of the interventricular septum and free wall of the left ventricle
subaortic stenosis
diastolic dysfunction
myocyte hypertrophy and disarray

autosomal dominant

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52
Q

decrescendo diastolic murmur is characteristic of

A

aortic regurgitation

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53
Q

diastolic rumble best heard at the left lateral decubitus position is characteristic of

A

mitral stenosis

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54
Q

holosystolic murmur radiating to the apex is characteristic of

A

chronic mitral regurgitation

55
Q

dihydropyridine calcium channel blockers

names
uses

A

amlodipine, nimodipine, nifedipine, felodipine (the dipines)

hypertension, angina (including prinzmetal), Raynaud

nimodipine is used for subarachnoid hemorrhage to prevent cerebral vasospasm

56
Q

non-dihydropyridine calcium channel blockers

names
uses

A

diltiazem, verapamil - slow SA and AV node conduction

hypertension, angina, atrial fib/flutter

heart: verapamil >diltiazem > the dihydropyridines

57
Q

terazosin

A

alpha-1 antagonist used for hypertension and benign prostatic hypertrophy

58
Q

pulsus paradoxus is characteristic of what heart condition(s)

A

cardiac tamponade

sometimes pericarditis

59
Q

kussmaul sign

A

an increase in venous blood pressure upon inspiration, usually indicative of right sided HF and pericarditis

60
Q

Class III antiarrhythmics

Mech
some SE

A

Block K channels, prolong repolarization

Used for afib, aflutter, Vtach (amiodarone and sotalol)

AIDS

Amiodarone - lots of SE including ARDS, hepatotox, hyper/hypothyroid, blue/grey skin deposits, cardiovascular effects, etc. has class I, II , III, and IV effects.

Ibutilide - torsades

Dofetilide

Sotalol - torsades, can cause Beta blockade

61
Q

esmolol

A

beta-1 selective beta blocker

ultra short acting

62
Q

lidocaine does what to the heart and what is it used for

A

class IB antiarrhythmic for Vtach

blocks sodium channels and shortens the action potential duration

63
Q

procainamide

A

class IA antiarrhythmic

64
Q

triad of cardiac tamponade sx

A

hypotension, JVD, muffled heart sounds

65
Q

isoproterenol

A

nonselective beta agonist

can be used for bradycardia

66
Q

overdosing on what common heart meds can cause a third degree heart block and bradycardia

A

betablockers

67
Q

biopsy a dead guys heart and you see focal fibrosis and subendocardial myocardial vacuolization

what are you thinking

A

he just had recurrent stable angina

68
Q

what normally predisposes people to aortic dissection

A

uncontrolled hypertension

69
Q

mexiletine

A

class IB antiarrhythmic used for vtach, esp in people who are iodine sensitive and cannot use amiodarone

shorten action potentials by blocking sodium channels

70
Q

what common heart meds may prevent some of the premonitory signs and symptoms of acute episodes of hypoglycemia

A

beta blockers

71
Q

alprostadil

A

PGE1 analog

can be used to maintain PDA

72
Q

libman-sacks endocarditis

A

wart-like vegetations on both sides of mitral and aortic valve, seen in SLE

(sometimes described as small, verrucous vegetations)

SLE commonly presents as rash, joint pain, and fever in females

73
Q

what does the moderator band do in the heart

A

it is in the right ventricle

carries purkinje fibers from the right bundle branch to the papillary muscle and causes it to contract at the very beginning of systole

74
Q

what happens to your end-diastolic volume if you have a PVC

A

it is lower than normal because the ventricle didn’t have time to fill completely

75
Q

person who was in the woods with joint pain and first degree heart block

what is name of the vector that infected them

A

Ixodes scapularis

aka deer tick

transmits lymes disease (borrelia burgdorferi)

76
Q

what common heart medication can cause dyslipidemia

A

metoprolol

77
Q

heart drug that causes cough and hyperkalemia

A

the -prils

ace inhibitors

78
Q

What heart drug can cause constipation, flushing, edema

A

diltiazem, the non-dihydropyridine calcium channel blocker

79
Q

what heart drugs have a first dose effect of profound onset of orthostatic hypotension?

A

the alpha-1 blockers like terazosin and prazosin

80
Q

mech of sildenafil

A

inhibits PDE5

PDE5 degrades cGMP

cGMP vasodilates and increases blood flow

81
Q

the medial umbilical folds used to be the

the median umbilical fold used to be the

A

umbilical arteries, they come off of the internal iliac arteries and deliver deoxy blood to the placenta

mediaN contains the urachus, a remnant of the allaNtois, which connects the bladder to the umbilicus

82
Q

L-myc genes assc with

A

small cell Lung cancer

Lung-mycancer

83
Q

PPARalpha activators

what do they do
SE

A

peroxisome proliferator-activated receptor alpha

AKA fibrates - used to raise HDL and lower triglycerides

they increase the expression of lipoprotein lipases.

Nuclear receptor proteins that act as transcription factors

SE: gallstones (increase the about of cholesterol in bile)

84
Q

histiology of a syphilitic aneurism

A

plasma cell lesion of the small blood vessels (the vasa vasorum) that supply the aorta and eventually obliterate the small vessel lumina

also you see wrinkling of the aorta and massive root dilatation

85
Q

what are you thinking if you see fibrinoid necrosis with a neutrophilic infiltration transmurally in an arterial wall

patient has fever, weight loss, malaise, headache, abdominal pain

A

polyarteritis nodosa

86
Q

cystic medial necrosis of the aorta is characteristic of what

A

marfans, a fibrillin-1 defect
phentol
can see focal fragmentation of elastic elements on histology

87
Q

phentolamine

mech
use

A

alpha adrenergic antagonist - nonselective

give to someone on an MAOI who just ate a bunch of tyramine

88
Q

what arrhythmics exhibit a negative inotropic effect and can exacerbate CHF

A

diltiazem and verapamil

they block Ca channels

the negative inotropic effect is generally compensated for by its afterload reduction or decreased systemic vascular resistance in patients who do not have heart failure or are not prone to developing this condition

also beta blockers

THIS IS IN CONTRAST WITH THE DIHYDROPYRIDINE CALCIUM CHANNEL BLOCKERS, WHICH CAN MILDLY INCREASE INOTROPY

89
Q

hydralazine

A

arteriodilator

decreases afterload

increased cGMP which leads to smooth muscle relaxation

SE can be SLE-like syndrome, reflex tachycardia, nausea, headache

90
Q

big artery that runs behind the knee cap

A

popliteal artery

it is the continuation of the femoral artery as the femoral artery exits the adductor hiatus

91
Q

weak upper extremity pulses in asian female

name
what do you see histologically
Tx

A

takayasu arteritis
granulomatous thickening and narrowing of aortic arch and proximal great vessels

treat with corticosteroids

92
Q

warfarin can cause what vitamin deficiency

A

b12

presents as neuropathy/anemia

93
Q

ST elevation in leads 2,3,aVF

what type of stemi

what do you give

A

inferior

you DON’T give nitro in an inferior STEMI because it can drop the BP (right coronary is involved)

give TPA

94
Q

most blood in the peritoneal sac drains where

A

RUQ, usually in the potential space between the liver and kidney (known as morison’s pouch)

95
Q

meds that prolong QT interval

A

Some Risky Meds Can Prolong QT:

Sotalol
Risperidone (antipsychotics)
Macrolides
Chloroquine
Protease inhibitors (-navir)
Quinidine (class Ia; also class III)
Thiazides
96
Q

disorders of myocardial repolarization due to ion channel defects (usually)

increased risk of sudden cardiac death due to torsades

which one is deafness assc with

A

Romano-ward syndrome - autosomal dominant, pure cardiac phenotype (no deafness)

jervell and lange-neilsen syndrome - autosomal recessive, sensorineural deafness

97
Q

patient has supraventricular tachycardia and

delta wave with shortened PR interval on ECG

A

wolff-parkinson-white syndrome

most common type of ventricular pre-excitation syndrome

abnormally fast conduction pathway from atria to ventricle, bypasses the rate-slowing AV node

98
Q

type II heartblock

type II mobitz heart block

A

type II heart block: PR intervals elongate until a PR interval occurs that is not succeeded by a QRS complex

type II mobitz: Dropped beats that are not preceded by a change in the length of the PR interval

99
Q

nesiritide

A

recombinant form of B-natriuretic peptide

can be used to treat heart failure

causes vasodilation and decreased Na reabsorption at the renal collecting tubule. Constricts efferent renal arterioles and dilates afferent arterioles

100
Q

hep b seropositivity in 30% of these vasculitis patients

A

polyarteritis nodosa

101
Q

asian kid

fever, cervical lymphadenitis, conjuctival injection, red lips/oral mucosa, hand-foot erythema

what is it
complications?
drugs?

A

kawasaki disease

may develop coronary arter aneurisms, thrombosis –> MI, rupture

gamma-globulin and high-dose aspirin

102
Q

c-ANCA vs p-ANCA

what enzymes do they target

A

c - anti-proteinase 3

p - antimyeloperoxidase (myeloperoxidase in NEUTROPHILS turns H2O2 into HClO (hypochlorous acid) which is what kills bacteria directly)

103
Q

which one of the ANCA vasculitis presents with neuropathy

A

Chrug-Strauss (asthma, sinusitis, palpable purpura, peripheral neuropathy

104
Q

A med is given that significantly lowers a persons LDL while significantly raising their HDL

what is the mechanism

A

niacin

reduces hepatic triglyceride and VLDL synthesis

105
Q

mech of beta blockers

A

inhibit the g-protein/cyclic adenosine monophosphate mechanism –> decreasesthe amount of cAMP and protein kinase A produced, decreasing the Na+ and Ca+ currents

106
Q

virus that cause cause CHF

A

coxsackie B

107
Q

treatment for infantile coarctation until surgery is performed

A

PGE1 to keep the ductus open

108
Q

a statin combined with what other type of medication can lead to rhabdomyolysis

A

a fibrate

109
Q

most common cause of slow onset infectious endocarditis in a previously damaged valve, no Hx of IV drug use.

A

strep virdans (50-60%)

110
Q

what mechanistically happens to the aorta in someone with marfans

A

cystic medial necrosis –> aortic incompetence and dissecting aortic aneurisms

111
Q

what drug is used for abolishing AV node arrhythmias by hyperpolarizing the cell by increasing K current

A

Adenosine

used for Dx and abolishment of AV node arrhythmia
extremely short duration of action (15 sec)

112
Q

what function tests should you check when a patient is on amiodarone?

A

pulmonary, liver, thyroid function tests

113
Q

what do you do if Vfib does not convert to sinus rhythm after cardioverting

A

epinephrine followed by amiodarone

114
Q

medication that is used to treat hypertension in a “patch”

mech?
SE?

A

clonidine, alpha 2 agonist

SE: dry mouth, sedation , sexual dysfunction. Sudden discontinuation can result in rebound hypertension

115
Q

Mechanism of fibrates

A

activate peroxisome proliferator-activated receptors (PPARs)

PPAR activation also increases lipoprotein lipase-mediated lipolysis and promotes rapid VLDL cholesterol turnover

116
Q

person eats a whole birthday cake and presents with elevated temp, BP, pulse, RR, disorientation, dilated pupils.

what depression med is she on

A

one of the MAOIs

tranylcypromine, phenelzine, isocarboxazid, selegiline

117
Q

alternations of the QRS height with each beat means what

A

cardiac tamponade

get pulsus paradoxus, hypotension, and elevated JVP that fails to decrease on inspiration (kussmaul’s sign)

118
Q

Sx of digoxin toxicity

antiarrhythmic that can cause this toxicity

A

atrial tachycardia (supraventricular tachycardia) with AV block

quinidine, verapamil, and amiodarone, decreases digoxin clearance and displaces digoxin from tissue-binding sites.

119
Q

what causes and increase in dromotropy, inotropy and chronotropy in the heart with regards to flow of ions

A

Dromo - increase of the conduction velocity, caused by increase influx of Ca into the AV node

ino - increased contractility caused be increased Ca influx into the myocytes

Chrono - increased heart rate, caused by increased Ca influx into the SA node

120
Q

what causes most autosomal dominant forms of hypertrophic cardiomyopathy

A

beta-myosin heavy chain mutation

aka the sarcomere gene myosin-binding protein C

121
Q

loop diuretic that is not sulfa-based

A

Ethacrynic acid

increased risk of ototox and is not usually a first line therapy for pulmonary edema

122
Q

causes of subacute endocarditis with previously damaged heart valves

A

virdans group strep (mutans, sanguinis, mitis, oralis)

123
Q

fever, weight loss, diffuse myalgias, abdominal pain

BP 168/92

areas of ulceration and mottled purple discoloration on lower extremities

hep b infections

what is it
what is the treatment

A

polyarteritis nodosa

fibrinoid necrosis of the medium sized muscular arteries

Tx: corticosteroids, cyclophosphamide for flares

124
Q

factor V leiden

A

production of mutant factor V (g->a point mutation -> Arg506Gln mutation) that is resistant to degradation by activated protein C. most common cause of inherited HYPERcoagulability in caucasians

DVT, cerebral vein thromboses, recurrent pregnancy loss

125
Q

phenoxybenzamine

A

irreversible alpha 1 and 2 blocker

used in pheochromocytoma to prevent catecholamine crisis

blocks alpha and can cause epi reversal

126
Q

small brown heart in an old guy

its a buildup of what

A

lipofuscin

yellow brown wear and tear pigment associated with normal aging

formed by oxidation and polymerization of autophagocytosed organellar membranes

127
Q

cholesterol of 700 in a teen

what disease
what inheritance pattern
what is the molecular defect

A

familial hypercholesterolemia

autosomal dominant

absent or defective LDL receptors

128
Q

pancreatitis, hepatosplenomegaly, eruptive/pruritic xanthomas. creamy layer in supernatant

what disease
what inheritance
what is the molecular defect

A

hyper-chylomicronemia (type 1 familial dyslipidemia)

autosomal recessive

lipoprotein lipase or apolipoprotein C-II deficiency

129
Q

hypertriglyceridemia and acute pancreatitis

what disease
what inheritance
what is the molecular defect

A

hyper-triglyceridemia (type IV familial dyslipidemia)

autosomal dominant

hepatic overproduction of VLDL

130
Q

jones criteria - what is the name of the rash

A

erythema MARGINATUM

131
Q

effects on lipid profile, mech, SE of:

Bile acid resins: cholestyramine, cholestipol, cholesevelam

A

LDL 2 arrows down
HDL slightly up
trig slightly up

prevent intestinal reabsorption of bile acids; liver must use cholesterol to make more

SE: decreased absorption of ADEK

132
Q

effects on lipid profile, mech, SE of:

ezetimibe

A

LDL 2 arrows down

prevents cholesterol absorption at small intestine brush border

diarrhea

133
Q

effects on lipid profile, mech, SE of:

fibrates: Gemfibrozil, bezafibrate, fenofibrate

A

LDL 1 arrow down
HDL 1 arrow up
trig three arrows down

activates PPAR-alpha to upregulate LPL –> increases TG clearance

causes myopathy (esp with statins) and cholesterol gall stones

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