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cardio 1 Flashcards

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1
Q

causes of viral myocarditis

A

parvovirus B19, HHV-6, HIV, and adenovirus.

picorna (coxsackie)

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2
Q

signs of MI but no cardio markers elevated

A

unstable angina

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3
Q

which beta blockers from the selective type has an effect on B2 rec too

A

labetolol

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4
Q

pulsus parodoxus

A

seen in cardiac tamponade or constrictive pericarditis

decrease in pressure on deep insp

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5
Q

pulsus parvus et tardus

A

aortic stenosis

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6
Q

he patient’s history of pharyngitis 2 weeks ago and the palpable non-blanching skin lesions with arthritis and abdominal pain are classic signs of

A

HSP

small cell vasculitis

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7
Q

blood brain barrier composed of

A

Composed of three layers: pedicles (foot processes of astrocytes), a basal membrane, and capillary endothelial cells bound by tight junctions.

damage to tight junctions can lead to edema

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8
Q

what is the function of PDGF in atherosclerosis

A

binds to tyrosine kinase receptors and stimulates the transition of cells from the G1 phase to the S phase. PDGF is released at atherosclerotic lesion sites by platelets and macrophages and stimulates proliferation and migration of smooth muscles cells in the tunica intima,

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9
Q

how is the thrombus formed after atheroma

A

matrix metalloproteinases is thought to be responsible for breaking down the fibrous cap of an atheroma. Matrix metalloproteinases, which are secreted by inflammatory cells in the atheroma (e.g., macrophages), weaken the fibrous cap by breaking down the extracellular matrix. Subsequently, minor stress can rupture the fibrous cap and expose the atheroma’s highly thrombogenic lipid core. It is this event that then causes the acute, total obstruction of the vessel and subsequent myocardial infarction.

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10
Q

bronchial artery originates

A

from internal thoracic arteries
branch of thoracic aorta
LEFT originates directly from thoracic aorta

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11
Q

what happens in ischemic muscle

dysfunction of sarcoplasmic ca channel

A

production of lactid acid due to anaerobic resp
inc in H+…. this gets throw out and Na+ is absp in
Na brings water along —– cell swelling

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12
Q

idarucizumab

A

dabigatran reversal
direct thrombin inhibitor
used fro —- venous thromboembolism and a fib

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13
Q

drug prescribed in anaphylactic shock

how does it affect the pacemaker action potential

A

catecholamines
increase Na and ca influx in PHASE 4
adenosine also works on PHASE 4 —- increases the K conductance —– decreases HR

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14
Q

what phase determines Heart rate

A

PHASE 4

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15
Q

Nonbacterial verrucous thrombi on the undersurface of the mitral valve are suggestive of

A

licman sack

SLE

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16
Q

subacute endocarditis

A

strept viridians
opt res, alpha hemolytic…

staph epidermis … venous catethers

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17
Q

infective endocarditis

A

most common staph aureus

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18
Q

damage to which artery in cervial esophagus dissection

A

The inferior thyroid artery originates from the thyrocervical trunk (left) or subclavian artery (right). It supplies the cervical portion of the esophagu

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19
Q

freidrich ataxia

A

deg of lateral corticospinal tract ( spastic paralysis)
deg of spinocerebellar tract ( ataxia)
dorsal columns (dec vib sense proprioception)
common cause of death —– HF
Autosomal recessive

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20
Q

fredreich ataxia gene

A

fraxatin ch 9

mitochondrial dysfunction

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21
Q

most common consequence of pt with right sided IE

A

pulomary embolism

Bacterial colonization of the heart valves can lead to the formation of thrombi and subsequent bacterial emboli.

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22
Q

he patient’s early-onset coronary heart disease and marfanoid habitus (tall and thin stature with increased arm span, arachnodactyly) in combination with a history of deep vein thromboses (DVTs) and learning disability raise concern

A

homocystinuria

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23
Q

Fever, pleuritic chest pain, pericardial friction rub (high-pitched scratching sound), and a pericardial and unilateral pleural effusion occurring 3 weeks after an MI

A

dressler

immune complex-mediated damage (type III hypersensitivity reaction) to the pericardium.

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24
Q

nitrate tolerance

A

Development of tolerance is a typical side-effect of chronic nitrate therapy. The mechanism underlying nitrate tolerance is not completely understood but is thought to involve decreased sensitivity of the vascular endothelium to nitrates. The most effective strategy to prevent this is intermittent therapy with nitrate-free intervals of at least 8 hours, which would be accomplished by avoiding isosorbide dinitrate at night.

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25
free wall rupure after mi
within 2 weeks can lead to cardiac tamponade previous MI is protective
26
time line for ventricular anneurysm post MI
few weeks to months
27
interventricular septal rupture
due to macrophages | 3-5 days
28
pt under treatment for afib and heart failure attempts suicide abd pain, hyperkalemia, blurry vision
digoxin toxicity cholinergic = diarrhea vomiting nausea yellow vision hyperkalemia
29
BBlockers overdose
verdose would likely cause hypotension, bradycardia, bronchospasm, and hypoglycemia
30
woman has a pruritic, red-brown rash over the medial ankles, varicose veins, and bilateral lower extremity edema. Her occupation likely requires her to stand for prolonged periods. These findings suggest
stasis dermatitis due to chronic venous insuff | Dermal deposition of hemosiderin is a key feature of stasis dermatitis.
31
differentiate ulcers caused bby PAD
they are well demarcated painful claudication, hair loss on the leg, or nail changes.
32
pt undergoes cardiac catheterization and 2 weeks later returns with low urinary output high creatinine levels mottle purple discoloration of feet and ischemic changes on big toe
cholestrol embolization syndrome skin description is livedo reticularis due to vessel spasm very high Cr due to AKI txt stop anticoag therapy and begin statins
33
physiological effect of sotalol
BB with K channel blocking ability | decreased conduction through AV node
34
how do BB lead to decrease in AV node conduction
blocking b1 rec leads to DECREASED sympathetic tone ----- decrease in HR K+ blocking effect of sotalol .... increased myocyte AP duration due to delayed efflux of K+.------ increased ERP and prolonged QT slow av cond is eveident by increase PR interval on ecg
35
prolonged repolarization caused in which classes of antiarrythmic drugs
2 and 4 2- BB 4- calcium cb both act on pacemaker action potention
36
which class of antiarythmics works by decreased conduction in cardiac myocytes and purkinje fiber
Decreased conduction in cardiac myocytes and Purkinje fibers is the mechanism by which sodium channel blockers (class I antiarrhythmics) function.
37
mechanism of fibrates
increase LPL activity --- breaks down TG also INCREASE ppar ALPHA (not gamma) activity---- actually it is the activation of this that increases LPL activity also increases HDL prodcution leads to gall stone risk Fibrates are associated with an increased risk of cholesterol gallstones because they inhibit the cytochrome p450 enzyme cholesterol 7-α hydroxylase (↑ cholesterol and ↓ bile acid concentration in bile).
38
role of PPAR GAMMA
transcription factor that increases the sensitivity to insulin GLITAZONES side effects include = weight gain, edema, risk of fracture
39
how does glucagon work in BB toxicity
Glucagon increases intracellular cAMP by activating adenylate cyclase, which improves cardiac contractility and heart rate while bypassing the beta receptors. It also improves hypoglycemia.
40
similarities and diff between digoxin and BB toxicities
BOTH CAUSE HYPOTENSION AND BRADYCARDIA bb- wheezes or brnochospasm , hypoglycemia digoxin -- abdominal problems, blurry vision yellow vision
41
most common heart malformation in down syndrom
AVSD | atrioventricular septal defects
42
Recurrent episodes of pain, swelling, and erythema in various locations in a patient with a history of pancreatic cancer are suggestive of
migratory thrombophlebitis | trosseau
43
which vein courses medial to the medial condyle of the femur
Great saphenous vein
44
most common vein involved in migratory thrombophlebitis
GSV saphenous also popliteal vein can be involved but remember its location is in the popliteal fossa not medial to the medial femural condyle
45
right broncial artery catheter route after entering the femoral artery
thoracic aorta-----right posterior intercostal artery ----- right bronchial artery
46
left bronchial arteries originate from
directly thoracic aorta
47
internal thoracic artery
supplies the anterior post chest wall | originates from subclavian artery
48
right bronchial arteries orginate from
interCOSTAL arteries whch are branches of the thoracic aorta
49
abnormal placement of infundibular septum leads to whcih congenital heart disease
TOF
50
absent fusion of septum primum and septum secundum
PFO
51
Elevated pulmonary artery pressure in a 6 hours old new born raises suspicion for what is the txt for this condition
PPHN persistent pulmonary HTN of newborn inhaled NO, increases CGMP by ACTIVATING guanyl cyclase and causes vessel dialation without really affecting the systemic resistence
52
after NO treatment in a baby with PPHN the baby develops tachypnea with blue grey discoloration of lips toes and nails why is this>
NO treatment can cause oxidation of Fe 2+ to fe 3+ .... oxidized state of iron cannot carry o2 METHEMOGLOBIN basically side effects of inhaled NO in neonates include platelet dysfunction, pulmonary edema, and the formation of peroxynitrites.
53
inhibits mitochondrial cytochrome c oxidase
Cyanide poisoning treated with METHEMOGLOBIN iron in oxidized state can bind to cyanide and treat the condiiton
54
african american with isolated HTN DOC
clorthiadone thiazide block nacl at DCT
55
african pt HTN with metabolic syndrome
dihydropyridine CCB
56
an artery that travels along the external branch of superior laryngeal nerve
superior thyroid artery which is a direct branch of the ECA
57
indications for a high risk of DVT
recent surgery within 4 weeks swelling of area malignancy
58
pt presents with DVT lost 7 kg smoked 1 pack for 25 yeasr edema of forearm with overlying erythema and a tender cord like structure duplex shows thrombosis of left basilic and external jugular veins whats the diagnosis? how to confirm?
history of thrombosis and superficial migratory thrombophlebitis --- migratory thrombophlebitis raises suspicion for a hypercoagulable state must do CT abdomen to confirm trosseau syndrome due to pancreatic cancer
59
a drug that prevents voltage gate dependent calcium entry into myocytes used for trating A FIB can have a side effect like?
gingival hyperplasia nondehydropryridine like verapamil ---- rate control 1. slow down AV conduction 2. reduces ventricular rate
60
tinnitus can be a SE of which antiarrythmic drug
quinidine I A | cinchonism prolong qt and hypoT
61
old pt microscopin exam of heart shows brown perinuclear inclusions and isolated deposits of abnormally folded natriuretic peptide
most likely lipoduscin deposits that result from lysosomal oxidation
62
what are the heart findings in advance age
sigmoid shaped intraventricular septum increased myocyte size with reduced numbers deposition of normal transthyretin protein in ventricles
63
amyloid proteins appear
eosinophilic glassy homogenous deposits
64
old woman collapses while walking briskly grade 3 ejection systolic murmur intensity decreases with hand grip mannv
think aortic stenosis | dystrophic calicfication of valve
65
what is dystrophic calcification
localized calcification in abnormal /damaged tissue in patients with normal calium levels
66
which murmurs increase with handgrip test
AR MR VSD
67
granulomatous nodules on mitral valve are assoc with
RHD
68
dabigatran mechanism and indications
direct thrombin inhibitor | prophylaxis of thromboembolism
69
drug indicated in PAD that inhibits platelet aggreg and cuases vasodialation too
cilostazol | PDE 3 inhibitor--- increases cAMP
70
pt has 10 month history of crampy left lower extremity pain that is exacerbated while walking and releived by rest smokes 1 pack for 40 yeasr dry and hairless skin over left foot
PAD | intimal plaque in post tibial artery
71
systemic hyperplastic arteriosclerosis
small vessel disease in the setting of sever hypertension (180/120) onion skin due to the intimal response
72
a drug is prescribed to increase contractility selectively inhibits an isoenzyme that is responsible for the degradation of cyclic adenosine monophosphate what is this drug? and SE?
milrinone PDE 3 inhibitor inhibits myosin light chain kinase (cannot phosphorylate myosin) ----- leads to muscle relaxation so SE would be hypotension
73
which condition with chorea (repetitive movemnts) and psychiaric complications leads to early dementia
huntington
74
what are aschoff bodies composed of
necrotic debris, t cells, plasma cells, and cardiac histiocytes
75
old pt dies and autopsy done ventricles are normal microscopic image is shown yellow brown perinuclear inclusions
normal aging | lipofuscin due to oxidation of phospholipid molecules
76
deposition of wild type transthyretin is seen in?
senile amyloidis | PLUS CARDIOMEGALY AND VENTRICULAR THICKENING
77
yellow brown perinuclear inclusions VS brown sarcoplasmic perinuclear granules
1 seen in normal aging due to oxidation of phospholipid molecules 2 seen in hemochromatosis
78
aortic stenosis due to metastatic calcification can be caused due to which conditions
primary hyperthyroidism sarcoidosis multiple myeloma CKD
79
splenic infarcts causes include a fib and intravascular hemolysis how will you differentiate between both
so in intravascular hemolysis other signs like anemia, hyperbilirubinema and increase LDH can be seen also shcitocytes on smear in a fib pt may have increase LDH but not other anemic symptoms
80
formation of giant cells in the tunica media
giant cell arteritis
81
what breaks down the fibrous cap of the atheroma
metalloproteinases secreted by inflammatory cells
82
what is characteristic of Myxomatous degeneration of mitral valve in MVP
derman sulfate | deposition of glycosaminoglycans
83
65 years old patient has wide pulse pressure and hypertension 165/79 what can be the cause
age>60 means decreased complianvce of arteries | ISOLATED SYSTOLIC HYPT
84
the handgrip mnnvr increases murmurs of which heart defects
MR AR and VSD
85
drugs that cause torsade pointes
``` ABCDE anti IA arrythmatics (quinidine procainamide dysopyradmide) anti IIIA (sotalol ibutilide) antibiotics antipscycotics antidepressant antiemetics ```
86
which anti III arythmatic does not lead to torsade pointes but still has long QT has a SE
amiodarone
87
dyspnea with a high pitched blowing diastolic murmur at right upper sternal border suggests?
aortic regurgitation
88
what conditon can aortic dissection lead to?
if the dissection reaches the aortic valve ring it can cause regurgitation
89
dipyridamole
PDE3 inhibitor | causes coronary vasodialation via activation of A2A rec
90
pt with chest pain is given dipyridamole/ regadenoson and then comes back with ST depression and twave depression what is the underlying mechanism
coronary steal syndrome | coronary vasodialation causes blood to be shunted towards the healthier heart making the situation worse
91
young female with BP of 185/125 papilledema and severe headaches flank bruit
Fibromuscular dysplasia | DO CT or ultrasonography

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