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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!)


Digoxin toxicity

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.


Ethacrynic acid

Loop diuretic that inhibits the Na+/K+/2Cl- channel in the ascending loop of Henle (similar MOA to furosemide), NOT a sulfa drug.


Complications Post-MI

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


Familial hypercholesterolemia

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
3) Digoxin
4) Ivabradine


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)


Potassium-sparing diuretics

Throw bananas at TSA - Elevated potassium (hyperkalemia) with Triamterene, Spironolactone, and Amiloride


Medications that can cause hyperkalemia

1) Nonselective B-blockers
2) ACE inhibitors
3) ARBs
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)


Coronary steal

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


Pacemaker leads

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

(DHPRs, nitro)


Torsades de pointes is commonly associated with what drugs?

Drugs that prolong the QT interval
(Sotalol, quinidine, haloperidol, macrolides, FQs)


Kawasaki disease

Vasculitis of medium sized arteries with fever for >5 days, bilateral conjunctivitis, cervical lymphadenopathy, mucocutaneous involvement



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


Type IV Collagen

Basement membranes