Flashcards in Cardiac Questions Deck (39):
What pigment accumulates normally in the elderly heart?
Lipofuscin - a brown and granular benign pigment that accumulates with age due to LIPID PEROXIDATION
Common findings in Marfan syndrome
Marfan's syndrome is a connective tissue disease due to fibrillin gene mutation on chromosome 15. It causes aortic involvement, including dilation of the aortic root (aortic regurg), aortic dissection, and mitral valve prolapse.
Other symptoms include ectopia lentis (displaced lens), increased arm span, arachnodactylyl, scoliosis, dural ectasia.
Carcinoid tumor symptoms and cause
Carcinoid tumors cause flushing, water diarrhea, and right-sided valvular dysfunction. These can be detected by elevated Serotonin levels, or 5-HIAA (5-hydroxyindolecetic acid) levels.
IV drug use or Carcinoid syndrome are the most common causes of right-sided valvular pathology
Aortic arch derivatives
1st - Maxillary (1 is Max)
2nd - Stapedial and hyoid arteries (Second = Stapedial)
3rd- Common Carotid artery and internal carotid artery (C is the 3rd letter of the alphabet)
4th - L aortic arch, right subclavian artery (4 = limbs = systemic)
6th - Pulmonary arteries and ductus arteriosus
(Count down from the maxillary!)
Symptoms include N/V/D, blue-yellow vision, SVT, AV-block.
Causes include renal failure, hypokalemia (U waves on EKG), quinidine, verapamil, and amiodarone.
Antidote is anti-digoxin Fab fragments (Dig-fab) with Mg+2 and K+ supplements.
Loop diuretic that inhibits the Na+/K+/2Cl- channel in the ascending loop of Henle (similar MOA to furosemide), NOT a sulfa drug.
1) Rupture of ventricular free wall - cardiac tamponade (hypotension, elevated JVP). Typically presents 3-14 days post-MI
2) Interventricular septum rupture - cyanosis due to shunting.
3) Fibrinous pericarditis - asymptomatic, presents 1-3d post-MI
4) Cardiac arrhythmias - arrhythmia present within 24 hours of MI
5) Rupture of papillary muscle - new-onset murmur with mitral regurgitation and heart failure
Physiology of B-blocker in CAD
B-blocker reduces the heart rate, thus lengthening the duration of diastole, and allowing for increased coronary filling
Very high LDL levels due to AD defects in the LDL receptor
Drugs causing lupus-like syndrome
Lupus-like syndrome (Drug-induced lupus) can be cased by sulfa drugs, procainimide, hydralazine, isoniazid, propylthiouracil, phenytoin, and etanercept.
Biggest complication associated with aortic dissection
Pericardial tamponade (rupture into the pericardial space)
Aortic dissection complications also include pleural or peritoneal ruptures leading to hemorrhage shock
Common side effect of treatment with doxorubicin
Cardiomyopathy (dilation of all four chambers, and often presents with decreased EF, narrow pulse pressure, JVD, as well as S3 heart sound)
Increased venous return to the heart causes which reflexive rate response?
Increased stroke volume is caused by increased venous return, and therefore to keep the same CO, the rate decreases.
CO = HR x SV
Murmur characteristic of mitral valve stenosis
A mid-diastolic murmur best heard at the apex
(Mitral stenosis commonly associated with post-strep infection => JONES criteria)
Heart rate modulating agents in patients with chronic heart failure
1) Beta blockers
2) NDHPR CCB's
Mechanism of action of Ivabradine
Ivabradine slows heart rate with no effect on contractility or relaxation - Selectively inhibits funny sodium channels (If) thereby prolonging the slow depolarization phase (phase 4)
Throw bananas at TSA - Elevated potassium (hyperkalemia) with Triamterene, Spironolactone, and Amiloride
Medications that can cause hyperkalemia
1) Nonselective B-blockers
2) ACE inhibitors
4) Potassium-sparing diurectics
5) Cardiac glycosides (digoxin, milrenone, niseritide)
Digoxin use for rate control
Digoxin can be used for rate control in atrial fibrillation by decreasing AV nodal conduction through increased parasympathetic tone.
It also has a positive inotropic effect (use in heart failure)
A phenomenon in which blood flow in ischemic areas is reduced due to arteriolar vasodilation in nonischemic areas - this can lead to hypoperfusion and worsen existing ischemia
Adenosine and dipyridamole selectively vasodilate coronary vessels
Pacemakers with 2-3 leads are often placed in the right atrium and right ventricle, and then the left ventricle. The left ventricular lead is placed in the coronary sinus (which resides in the atrioventricular groove) on the posterior aspect of the heart.
Pulsus paradoxus and causes
Pulsus paradoxus refers to an exaggerated drop (>10mmHg) in systolic blood pressure during inspiration.
This is seen in cardiac tamponade, severe asthma, COPD, and constrictive pericarditis (due to inability of heart to accommodate to the RV volume expansion during inspiration)
What cardiac abnormality is most commonly associated with Turner syndrome?
Bicuspid aortic valve
(Can occur alongside aortic coarctation)
Thromboangiitis obliterans (Buerger's disease)
SMOKING - Segmental thrombosing vasculitis of medium and small arteries, especially tibial and radial
Acute/chronic inflammation with thrombosis of the lumen which can extend into contiguous veins and nerves
Types of aortic dissection
Stanford type A => Aortic dissections with any part of the ASCENDING AORTA
Stanford Type B => Aortic dissections involving the DESCENDING AORTA (usually near the origin of the LEFT SUBCLAVIAN ARTERY)
Cardiac changes that occur during exercise
1) Decreased Systemic vascular resistence (due to arteriolar vasodilation in active skeletal muscles)
2) Increased cardiac contractility and heart rate
3) Increased cardiac output
3) Resting muscle and splanchnic vasoconstriction
Bottom line: Guts constrict, skeletal muscle dilates
Post-MI complication time course
1) ACUTE = Right ventricular failure
2) 3-5 Days = Papillary muscle rupture (mitral regurgitation), interventricular septum rupture (new holosystolic murmur)
3) 5-14 days = Free wall rupture (pericardial tamponade)
Effects of Nitroprusside on the cardiac cycle
Nitroprusside is a short-acting venous and arterial vasodilator that decreases BOTH PRELOAD AND AFTERLOAD, but maintains stroke volume
Location and blood supply of AV node
AV node is located in the posteroinferior part of the the interatrial septum with blood supply from the RCA
Medications to avoid in HOCM
Medications that decrease venous or systemic vascular resistance
Torsades de pointes is commonly associated with what drugs?
Drugs that prolong the QT interval
(Sotalol, quinidine, haloperidol, macrolides, FQs)
Vasculitis of medium sized arteries with fever for >5 days, bilateral conjunctivitis, cervical lymphadenopathy, mucocutaneous involvement
Associated with CORONARY ARTERY ANEURYSMS
What is the blood supply to the inferior wall of the left ventricle?
Posterior descending artery
(PDA derives from the RCA in 90% of individuals)
ACE Inhibitor effects on the kidney
ACE Inhibitors reduce AT II production, and therefore decrease EFFERENT arteriolar resistance and SVR, causing a reduction in GFR => ACEI's promote efferent arteriolar dilation
Peripheral artery disease medical treatment
Symptomatic management includes graded exercise programs and CILOSTAZOL => PDE5 inhibitor that blocks platelet aggregation and acts as a direct arterial vasodilator
Patients should also receive an antiplatelet agent such as aspirin or clopidogrel for secondary prevention
Type I Collagen
Dermis, bone, tendons, ligaments, dentin, cornea, blood vessels, scar tissue
(Found in the heart post-MI after healing)
Type II Collagen
Cartilage, vitreous humor, and nucleus pulposus
Type III Collagen
Skin, lungs, intestines, blood vessels, bone marrow, lymphatics, granulation tissue