Cardio Flashcards
(138 cards)
1
Q
AV fistula will cause what changes to TPR, CO, and venous return?
A
Deacrease TPR
Increase CO
Increase VR
2
Q
Cardiac Abnormalities of Turner’s (3)
A
Coarctation of Aorta
Bicuspid Aortic Valve
Aortic Dissection in Adulthood
3
Q
Name 3 Appetite Suppressants, and what can they cause
A
Secondary pulmonary hypertension
Fenfluramine, dexfluramine, Phentermine
4
Q
First Line Atrial fibrillation? (2 types)
Second line?
A
CCB (diltiazem), Cardioselective B-Blockers
Digoxin
5
Q
2 Mechanism of Digoxin?
A
1- Increase Contractility (block Na-K-ATPase on cardiac myocytes=> Incr. intracellular Ca2+)
2-Decr AV nodal conduction (Incr. Parasympathetic Tone)
6
Q
What is a Blowing Holosystolic murmur best heard over Apex?
A
MVRegurg.
7
Q
Janeway lesions are seen in what disease? What are they?
A
Bacterial Endocarditis.
-Microemboli fragments of infected intracardiac vegetations to cutaneous blood vessels
8
Q
Describe pulsus paradoxus and what is it associated with (4)
A
decrease in systolic Blood pressure (10mmHg) w/ inspiration
IN acute cardiac tamponade, constrictive pericarditis, severe obstructive lung disease (ASTHMA) and restrictive cardiomyopathy
9
Q
what receptor is activated for control of an Asthma exacerbation
A
b2 agonist => bronchial smooth m relaxation (via increased intracellular cAMP)
10
Q
S4 (hypertesion related) is due to?
A
increased stiffness of left ventricular wall
11
Q
Nitroglycerin dilates what portion of circulatory system? how does this treat angina
A
VENODILATES=> decr. preload
12
Q
(which valve problems)
1-Aortic valve calcification?
2-Aortic Vlave infecive endocarditis?
3- Rheumatic aortic heart Disease
A
Aortic Stenosis
Aortic Regurg.
Combined Sten + regurg
13
Q
Lidocaine (Class, specific for, replaced by)?
A
Class IB antiarrythmic
Ischemic myocardium (it binds rapidly deporalizing/depolarzed cells)
Amiodarone
14
Q
Dystrophic Calcification
A
hallmark of preceding cell injury and necrosis- can occur after trauma.
15
Q
Does coarctation of aorta cause cyanosis?
A
No. Not unless severe, if so pt dies without corrective surgery
16
Q
What usually causes acute rheumatic fever? Timing?
A
Group A Strep. 10d-6weeks before hand.
17
Q
What cells are typically found in rheumatic fever?
A
Aschoff giant cells within myocardium
18
Q
More common myocarditis- bacterial or viral?
A
Bacterial-GAS rheumatic carditis
19
Q
Sodium channel binding strength of class 1? (Prioritize class 1A1B1C)
A
1C>1A>1B. 1C most “use dependence”
20
Q
Myocyte contraction begins with depolarization of which type of channel?
A
Voltage-dependent ca2+channel
21
Q
How is calcium efflux prior to myocyte relaxation achieved?
A
Use of Ca2+-ATPase and Na+/Ca2+ exchange mechanism. Active process!
22
Q
Does prolongation of phase 3 of the cardiac action potential increase the QT Interval?
A
Yes, prolong thre QT Interval of the EKG.
23
Q
What portion of the EKG do b-blockers affect?
How about the cardiac conduction curve?
Do they change QRS complex?
A
Prolong the PR interval, decrease SA/AV Nodal activity.
Decrease phase four slope (not as prominent as PR changes).
No.
24
Q
What is the major factor for forward (thru aortic valve) : regurgitant (back thru mitral valve) volume ratio?
A
LV Afterload. Increase in Afterload decreases ratio, decrease in Afterload increases the ratio.
25
What type of myopathy will amyloidosis cause?
| What type of dysfunction will be seen?
Restrictive cardiomyopathy
| Diastolic dysfunction.
26
What are causes of restrictive caardiomyopathies? At least 3
Amyloidosis
Sarcoidosis
Metastatic cancer
Products of inborn metabolic errors
27
How do b-blockers decrease blood pressure?
B1 receptors on renal juxtaglomerular cells blocks renin release which does not allow angiotensinogen to become angiotensin 1.
=>no AT 2, no Aldosterone release, no increase blood pressure.
28
Can b-blockers blunt circulating catecholamines?
No. They have no direct effect.
29
Combination of which 2 cardio drugs can cause Negative chronotropic effects? What are these effects?
Virapamil/diltiazem & bBlockers (metoprolol)
| Severe bradycardia and hypotension.
30
Symptoms of acute mitral valve regurg v chronic MVR
Acute- pulmonary hypertension & pulmonary edema
| Chronic- atrial fibrillation and mural thromboembolism
31
When is LV free wall rupture post-transmural MI most likely to occur?
What is "protective" against this?
3-7days after the onset of an MI
| Previous MI, LV hypertrophy
32
What does strep. Viridians/ mutans require to form and endocarditis infection?
Is there another organism that can adhere to INTACT endothelium?
Preexisting endothelial damage leading to fibrin and platlet deposition/ aggregation.
Yes, staph. Aureus
33
Most serious complication of kawasakis?
Coronary artery aneurysms
34
Symptoms of kawasakis?
```
Persistent fever
Bilateral conjunctivitis
Lymphadenopathy
Strawberry tongue/mouth
Peripheral rash that moves to trunk
Peripheral edema and desquamation of fingertips.
```
35
Diastolic dysfunction seen in heart failure causes what changes to ventricular diastolic compliance and contractile performance?
What does this cause heart to do (technical terms)?
What is seen on PV curves?
Decrease compliance.
No change/ normal performance.
LEDP must increase to keep LEDV normal and EF is preserved as contractility does not change.
Bottom line of PV curve is elevated.
36
Brain/Atrial Natriuretic peptide des what to vasculature and water concentration and BloodPressure. Where is each sensed (brain/atrial)?
VasoDilates
Diuresis/Natriuresis
Decreasing Blood Pressure
ventricle/ Atrium
37
Increased Renal sympathetic nerve activity does what? What is are the cardiac effects? When might this be seen?
activates Renin-angiotensin-Ald system
Incr. BP
Heart Failure
38
When does fibrous/serofibrous pericarditis occur after a transmural Thrombosis? how often? SYMPTOMS?
2-4 days following thrombosis
10-20% of patients
Sharp/Pleuritic
39
what is Dressler's syndrome?
time frame?
features?
% ?
Autoimmune polyserositis from exposed antigens post-MI => diffuse inflammation
1week-few month
Fever, pleuritis, leukocytosis, pericardial friction rub, Xray with pleural effusion
40
How long after total ischemia is cardiac contractility lost?
At which time-point does reversible contractile dysfuntion become IRREVERSIBLE?
60 Sec/ 1 Min
| ~ >30 Min
41
Where is decreased femoral:brachial BP ratio seen?
Congenital coarctation of aorta
41
what is direction blood flow in TOF @ the VSD? where is O2 drop seen?
usually R-> Left due to pulmonic stenosis.
| O2 drop in LV
41
where do atherosclerotic plaques first develop in humans? (prioritize)
Large elastic arteries
| Abdominal aorta>coronary aorta> poplitieal arteries>internal carotids> circle of willis
41
CO equation (Not HR x SV)
CO= O2 consumption/ Ateriovenous O2 difference
41
what is the most common congenital heart disease?
VSD
41
What kind of VSD would cause increase in RV SpO2, with no corresponding increase in RA? what murmur accompanies this?
a small VSD,
| Holosystolic murmur heard best over left mid-sternal border
41
When is precordial continuous machine like murmur during systole/diastole seen?
Where is O2 change seen and what is it?
Patent Ductus Arteriosus
| Pulmonary Artery SpO2 increase
41
bifid carotid pulse with brisk upstroke seen when?
hypertrophic obstructive cardiomyopathy
41
Most common cardiac primary tumor of heart?
Histological findings of this tumor?
Releases which Interlukin causing what symptoms
Myxomas
pedunculated mass, composed of scattered cells within a mucopolysaccaride stroma
IL-6=> constitutional (fevers, weight loss)
41
when is fixed wide splitting of S2 seen?
Atrial Septal Defect pts.
41
Heart sound of Mitral Stenosis?
Opening Snap @ beg. of diastole with low pitched diastolic rumble murmur heard best at apex
41
When is precordial continuous machine like murmur during systole/diastole seen?
Where is O2 change seen and what is it?
Patent Ductus Arteriosus
| Pulmonary Artery SpO2 increase
41
Toxicities of Digoxin?
Treatments?
What to avoid?
Hyperkalemia (HYPOKALEMIA increases susceptibility to digoxin toxicity), Vfib/Vtach from AVnodal block ( incr. parasympathetics)
Management of Hyperkalemia w/ insulin etc, Digoxin specific Ab to bind dig in tissue/vascular space
Ca-gluconate
41
Ventricular Action Potential Phases correspond to what on EKG? exclude Phase 1
Phase 0- QRS
Phase 2- QT interval (+ phase 0- aka after QRS )
Phase 3- T wave (L&R V repolarization)
Phase 4- PR Interval (not exactly but changes can effect this interval)
pg 6-9 of becker physio
41
QT interval prolongation can be due to?
mutations to K+ currents through channel proteins.
41
second most common endocarditis organism in IV Drug users (1=Aureus)
P. Aeruginosa.
41
what drug is used to prevent doxirubicin cardiomyopathy?
Dexrazoxane= iron chelating agent that decreases formation of oxygen free radicals
41
What are Antracyclines and what are they associated with?
| Name 4 or what they end in?
chemotherapeutic agents assoc. with cardiotox.
| Daunorubicin, doxorubicin, epirubicin, idarubicin
41
Process of doxirubicin toxicity?
(early) sweling of sarcoplasmic reticulum => loss of cardiomyocytes "myofibrillar dropout" => CHF symptoms
41
Heart sound of Mitral Stenosis?
Opening Snap @ beg. of diastole with low pitched diastolic rumble murmur heard best at apex
41
where do atherosclerotic plaques first develop in humans? (prioritize)
Large elastic arteries
| Abdominal aorta>coronary aorta> poplitieal arteries>internal carotids> circle of willis
41
Artery assoc. with ST seg Elevation in leads II, III, aVF and sinus node dysfunction
Right Coronary Artery
41
what is the long term Rx of hypertension w/ CHF.
ACE inhibitors & B-blockers
41
Most common cardiac primary tumor of heart?
Histological findings of this tumor?
Releases which Interlukin causing what symptoms
Myxomas
pedunculated mass, composed of scattered cells within a mucopolysaccaride stroma
IL-6=> constitutional (fevers, weight loss)
41
Congenital Bicuspid Aorta will lead to what disorder and at what age?
Aortic Stenosis in patients 60's
41
CO equation (Not HR x SV)
CO= O2 consumption/ Ateriovenous O2 difference
67
What is Non-Bacterial Thrombotic Endocarditis due to? another name?
What is it associated with?
what does this MOA resemble?
result of hypercoaguable state leading to vegetations of bland thrombus without inflammation or valve damage; MARANTIC ENDOCARDITIS.
Cancers- mucinous adenocarcinoma of pancreas, adenocarcinoma of lung
Tumor assoc. release of procoagulants IN migratory thrombophebitis= Trousseau Syndrome.
68
Most common cause of death due to MI? when does this usually occur?
```
Heart Failure (Ventricular Failure)
2-10 days during in hospital phase
```
69
What is the most common cause of death due to MI during pre-hospital phase? MOA?
Ventricular Fibrillation
| Acute plaque change=> Acute myocardial ischemia => electrical instability=> lethal arrhythmia
70
What finding confirms the severity of Mitral Valve Regurgitation?
s3 gallop = indicates high regurgitant volume (MVR)
71
90% are cardiomyopathies are what type?
what percentage of these cardiomyopathies account for SCD?
Name 3
Dilated Cardiomyopathy
10-15%
Rheumatic Fever, SLE, polymositis
72
Name 4-5 Restrictive Cardiomyopathies
```
idiopathic/ Idiopathic Myocardial fibrosis
endomyocardial fibrosis
endocardial fibroelastosis
amyloidosis
hemochromatosis
```
73
Amyloidosis of the cardiac atria is done by which type? (name the others if possible)-thyroid, pancreas, brain, pituitary, systemic)
Atrial Natriuretic peptide
Thryroid: calcitonin
pancreatic islets: islet amyloid protein (amylin)
Cerebrum/Cerebral blood vessels: B-amyloid
Pituitary: Prolactin
systemic: Immune globin light chains!!!
74
Mechanism of ANP (Atrial Natriuretic Peptide) ?
Where + how it acts on each organ system (3) ?
ANP binds to NP-receptor on cell membranes
Activating guanylate cyclase and forming cyclicGMP
1) Kidney-dilates afferent arteriole=> INCR. GFR & excr. of sodium and water; DECR. Na+ reabsorption in Prox. Tubule/CT and inhibits renin secretion!
2) Adrenal Gland- restrics ALD secr=> sodium and water excretion by kidneys
3) Blood Vessels- Vasodilates & incr. capillary permeability
75
What maintenance is necessary for Nitrates and why?
Nitrate-free period every day is necessary to AVOID TOLERANCE to the drug.
76
What is the interaction between Nitrates & PDE inhibitors? main side effect?
Nitrates convert to NO with production of cGMP as second messenger (Incr. dilation).
PDE inhibitors block cGMP metabolism within cells.
HYPOTENSION
77
Use dependence explanation examples with Class 1 C and Class III anti-arrhythmics
Basically think of as direct (strong UD) v Indirect (reverse UD) correlation.
Class 1C are sodium channel blockers with Strong UD by prolonging QRS duration to greater extent at higher heart rates
Class III block repolarizing potassium currents = reverse UD (slower the HR the more the QT interval is prolonged)
78
which nitrate is 100% bioavailable when given orally
Isosorbide mononitrate
79
When given orally what type of metabolism do NO and Isosorbide Dinitrate
First Pass metabolism in the liver
80
How is sodium Nitroprusside delivered?
IV
81
```
What drugs (name 2) reduce the rate of spontaneous depolarization in cardiac pacemaker cells?
(decrease rate of atrial contraction)
```
Acetylcholine and Adenosine.
82
Golden yellow or brownish cytoplasmic granules could contain what 2 things? How can Prussian blue stain differentiate the 2?
Either Lipofuscin or Hemosiderin.
| Prussian blue turns blue-black in presence of Iron (hemosiderin)
83
How is Hemosiderin in alveolar macrophages indicitive of Left sided heart failure
indicates chronic elevation of pulmonary capillary hydrostatic pressure => LHF
84
Common causes of MVP?
sporadic myxomatous degeneration
Marfan sydrome
Ehlers-Danlos syndrome
85
Which bug is Cat+ Coagulase -
S. Epidermidis, S. Saprophitycus
86
DOC for S. Epidermidis
Vancomycin
87
What side effect in utero is seen by children of mothers taking lithium?
Ebsteins Anomaly- apical (apex) placement of Right heart Valves (tricuspid) => decreased volume of R. ventricle, atrialazation of R. Ventricle
88
What could occur if a pregnant female with bipolar disorder continues her drug regimen?
Lithium=> Epsteins anomaly in utero
89
What might cause EDV to increase?
| An increase in EDV does what to preload?
Fluid overload:
- renal failure
- CHF
- Fluid infusion
Increases
90
Murmur of Aortic Regurgitation?
| What physiologic finding is associated with this?
Bounding "Water-hammer" carotid pulsations (and femoral) accompanied with Head Bobbing
WIDE PULSE PRESSURE
PP= peakSysArtPr-EndDiast arterial Pressure
91
When is pulvus et Tardus seen?
Aortic Stenosis
92
Carcinoid syndrome Cardiac Complications?
| How can you detect this
Right sided endoardial fibrosis. leading to pulmonic stenosis or restrictive cardiomyopathy.
Plasma serotonin or Urinary excretion of 5-HT (serotonin) metabolite = 5-Hydroxyindoleactetic acid
93
Pacemaker cells Action potential phase descriptions:
Phase 4
Phase 0
Phase 3
P4- Sodium INFLUX
P0- Calcium INFLUX
P3- Potassium EFFLUX (outward current)
94
What is coronary steal and what can it lead to?
Bloodflow in ischemic areas is reduced due to arteriolar vasodilation in nonischemic areas
Hypoperfusion/worsening of ischemia
95
use aPTT to monitor what?
unfractionated heparin
96
```
microscopic changes after MI?
0-4hr
4-12 hr
12-24 hr
1-5 day
5-10days
10-14 days
2Wk-2Mo
```
0-4 =No change
4-12 =early coagulation necrosis, wavy fibers
12-24 =coagulation necrosis + Marginal Contraction band necrosis
1-5d =nuetrophilic infiltrate
5-10d= macrophage phagocytosis of dead cells
10-14d= granulation tissue and neovascularization
2-2mo= coagulation necrosis/scarformation
97
Dobutamine effects:
Increase HR, contractility, conduction velocity, myocardial oxygen consumption.
98
Does NO yield a increase or decreased HR?
Increased (reflex tachy)
99
Left ventricular outflow obstruction in hypertrophic cariomyopathy is usually created by what 2 things?
IVS
| Mitral Valve Cusps
100
Pericardial tamponade triad?
| name a cause of this
muffled heart sounds
elevated Jugular venous Pressure
HYPOTENSION
Ventr. Free wall rupture 3-7d post-MI.
101
Prinzmetal variant angina presentation=
Detecton?
Treatment?
episodic transient anginal chest pain in night hours with Holter monitor readings of ST-seg elevation
Ergonovine; ergot alkaloid=> coronary smasm => chest pain
Treatment: Nitrates/CCBs
102
Decrease Plaque stability traits:
Thin fibrous cap
Rich lipid core
active inlammation in atheroma
103
Treatment for B-Blocker overdose?
| MOA?
Glucagon; increases intracellular cAMP=> incr release of intracellular calcium during muscle contraction
104
5 age related changes to the heart?
Decr. apex to base dimensions
sigmoid shaped IVS
myocyte atrophy with interstitial fibrosis
accumulation of cytoplasmic lipofuscin pigment.
105
What effect does chronic anemia have on CO?
increases... also partial increase in venous return due to decreased blood viscosity
106
where is the ductus arteriousus derived from?
6th aortic arch
107
Sinus venosus forms what in adults?
smooth part of R atrium = sinus venarum
108
Bulbis cordis in adults?
smooth portions of L&R ventricles just before aortic and pulmonary arteries
109
primitive atria in adults?
rough portion of R&L atriums
110
what keeps a PDA open? closed?
PGE2
| Indomethacin
111
In reperfusion injury what enzyme leaks across a damaged Cell Membrane?
creatine kinase surge
112
which hypolipemic agent increases blood trigylceride levels
Bile acid-binding resins- Cholestyramine
113
What are first-line treatment drugs (name 2 ) for hypertriglyceridemia?
Fibric Acid derivivatives:
Gemfibrozil
fenofibrate
114
What is the MOA of Ezetimibe?
| use with what?
selectively inhibits the intestinal absorption of cholesterol from diet/bile acid.
REDUCING LDL.
use with statins
115
Niacin does what to HDL LDL and TRIGs
Primarily Decreases Triglycerides
ALSO INCR. HDL
mild LDL decrease
116
```
Side effects of Statin Therapy?
which other class of drugs share these effects
```
Hepatotoxicity
Myopathy (incr. creat. kinases)
Fibrates and Statins
117
What type of drug and which one specifically reduces overall mortality to CHF?
B-blockers
| Carvedilol
118
What type of drug is Cilostazol?
| What is it superior to for treatment of?
Phosphodiesterase inhibitor in pts with intermittent claudication
better than aspirin for Peripheral arterial disease.
119
When is Calcium gluconate indicated?
Severe Hypocalcemia
120
What type of drug is phentolamine?
| When might it be used?
a1 blocker
prevent tissue necrosis via Vasodilation ( EX: due to NE extravasastion/ vasoconstriction to infusion site)
121
What are the effects (using which receptors) of epinephrine on HR, SBP, DBP at low and high doses?
incr. HR (b1)
INCR. SBP (b1 + a1)
low dose = Decr. DBP (b2 > a1)
high dose= Incr. DBP (a1 > b2)
122
What could a mismatched V/Q defect of a perfusion defect not matched by ventilation defect indicate?
Blood flow is occluded to that segment of the lung
123
A matched V/Q defect (ventilation defect matches perfusion defect/ vice versa) indicates what?
lung collapse or consolidation.
124
cutaneous strawberry type capillary hemangiomas are benign or malignant tumors in babies?
How are they treated?
Benign
| Increase with age before eventually regressing by age 7
125
Receptors a1, a2, b1, b2
Change induced by Stimulation (IP3, cAMP, DAG)
clinical effect
a1- ^ IP3 - peripheral vasoConstriction
a2- v CAMP - v Release of NE & Insulin
b1- ^ cAMP - Increased contractility
b2- ^ cAMP - Bronchodilation, VasoDilation
126
Best indicator of MitralStenosis severity?
Time from s2 to Opening snap. Shorter the interval the longer the stenosis.
127
When would lymphangiosarcoma been seen? why?
typically 10 years post mastectomy
| due to chronic dilation of lymphatic channels
128
Dopamine
Low Dose
Med Dose
High Dose
low- stim D1 => vasodilate renal vasculature.
med- b1 agonist => increase cardiac contractility
high- a1 agonism=> decr. cardiac output with vasoconstriction (and increased afterload)
129
(3) a1-blockers are used for treatment of what 2 diseases together in older males? MOA of a1block in treatments?
BPH
Hypertension
Decrease TPR via arteriolar/venous sm. m relaxation
Relax sm. m of bladder neck/ prostate
130
First line in CAD/HYpertension + CHF?
cardioselective. b-Blockers
131
essential hypertension is first treated with?
Hydrochlorothiazide.
132
how does cholestyramine effect hepatic cholesterol synthesis and how?
INCREASES.
Binds bile acids in GI tract interfering with enterohepatic circulation of bile acids and resulting in the excretion of bile acids. Cholesterol is then sequestered for new bile acid production from liver.
133
Describe orthostatic hypotension mechanics?
systolic BP decr. of >20 or diastolic >10 from lying to standing up
less blood goes back to heart, decr. BP, Baroreceptor compensation => sympathetic increase to raise vascular resistance via a1 receptors!!!!
a1 receptor blockers cause Orthostatic hypotension because peripheral vasoconstriction is NOT maintained during hypoperfusion of standing up.
134
cystic medial degeneration can lead to ?
what can cause this?
which disease is this seen in?
Aortic dissection, anuerysms (large arteries)
Myxomatous Degeneration
Marfans
135
how does basal vascular tone change in response to:
1-Nitric oxide
2-Alpha adrenergic stim
3-beta adrenergic stim
Vasodilate
VasoConstrict
Vasodilate
136
what increases cardiac perfusion?
hypoxemia
| adenosine acculumation
137
LCX a. occlusion leads to ischemia where (anatomically) and with wich ST elevations ?
Transmural left ventricular wall ischemia
V5-V6
138
LAD a occlusion leads to ischemia where antatomically and in which leads?
anteroseptal transmural ischemia
V1-V4
