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Cardio Flashcards

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1
Q

Cause of patent truncus arteriosus

A

failure of neural crest cells to form aorticopulmonary septum

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2
Q

Improper separation of aorticopulmonary septum

A

transposition of the great vessels

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3
Q

Drug for closure of PDA

A

indomethacin

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4
Q

Drug to maintain ductus arteriosus

A

PGE1 and PGE2

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5
Q

Cause of hoarseness/dysphagia with heart pathology

A

dilated L atrium

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6
Q

Drug class to decrease preload on heart

A

nitroglycerin (venodilators)

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7
Q

Drug class to decrease afterload on heart

A

hydralazine (vasodilators)

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8
Q

S3 heart sound

A

rapid filling (mitral regurg)/tensing of chorade tendiae
early diastole
“Kentucky”

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9
Q

S4 heart sound

A

L atrium pushing against stiff LV wall
late diastole
“Tennessee”

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10
Q

Wide S2 splitting

A

delay of RV emtpying

RBBB/pulmonic stenosis

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11
Q

Fixed S2 splitting

A

seen in ASD

increased RA and RV volumes

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12
Q

Paradoxical splitting of S2

A

delayed LV emtpying
seen in aortic stenosis/LBBB
during expiration

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13
Q

Sound for mitral/tricuspid regurg

A

holosystolic blowing murmur

assc with rheumatic fever/endocarditis

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14
Q

Sound for Aortic stenosis

A

crescendo-descrescendo systolic following ejection click

radiates to carotids

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15
Q

Sound for VSD

A

holosystolic machine like murmur

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16
Q

Sound for MVP

A

late systolic descrendo murmur

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17
Q

Sound for aoritc regurg

A

high pitched blowing diastolic decrescendo murmur

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18
Q

Sound for mitral stenosis

A

delayed rumbling in late diastole

secondary to rheumatic fever

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19
Q

Sound for PDA

A

continuous machine like murmur

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20
Q

Phases of ventricular AP

A

0-Na+ upstroke
1-K+ open,Na+ close
2-Ca2+ influx/K+ efflux balance (plateau)
3-K+ massive efflux repolarizes
4-high K+ permeability (flat hyperpolarized stage)

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21
Q

Phases of pacemaker AP

A

0-Ca2+ upstroke (Na+ closed, slow conductivity)
2-no plateau
3-Ca2+ inactivated/K+ efflux repolarizes
4-slow depolarization from spontaneous Na+ channels (I funny channels)

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22
Q

Normal PR interval

A

less than 200ms

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23
Q

Normal AV node delay

A

100ms

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24
Q

EKG with only irregular narrow QRS complexes

A

Atrial fibrillation

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25
EKG with back to back atrial waves with QRS complexes at regular intervals
Atrial flutter | sawtooth pattern
26
Progressively lengthening PR interval with a dropped QRS complex at the end
2nd degree heart block type I | Wenckebach
27
PR interval over 200ms in length
1st degree heart block
28
Dropped QRS complexes with no PR interval change
2nd degree heart block type II
29
Independent atrial and ventricular depolarizations
3rd degree heart block
30
V1-wide rSR' complex | I/V6-slurred S wave
R bundle branch block
31
V1-negative deflection with notching | I/V6-rSR' complex
L bundle branch block
32
V1/V2 (-) deflection V5/V6 (+) deflection added together over 35mm
L ventricular hypertrophy must be over 40 see T wave discordance/asymmetric T wave
33
R axis deviation (I deflected downward) R/S > 1 on V1 Deep S wave on V6
R ventricular hypertrophy
34
Role of atrial natiuretic peptide
decrease blood volume vascular relaxation and decreased Na+ resorption constrict afferent, dilate efferent renal arterioles
35
QT prolongation resulting in polymorphic V tach
Torsades de pointes
36
Bypass of AV node and bundle of His
Wolff-Parkinson-White syndrome no Q wave delta wave with no PR segment atria fire directly to ventricles
37
Brain center for BP maintenance
solitary nucleus aortic arch/CN X carotid sinus/CN IX
38
HTN bradycardia respiratory depression
Cushing rxn | increased ICP causes ischemia, increasing BP, which in turn results in bradycardia
39
Chemoreceptors for BP
Carotid/aortic bodies measure decreased oxygen/increased CO2/decreased pH Central measures pH and CO2
40
Hypoxia in the lungs impact
Causes vasoconstriction | other tissues vasodilate in response to decreased O2
41
Pulmonary vascular hypertrophy/PAH cyanosis/clubbing late in disease L to R shunts
Eisenmenger's syndrome | increased pulmonary resistance causes shunt to switch to R to L shunt
42
VSD RVH overriding aorta pulmonic valve stenosis
Tetralogy of Fallot PROVe early cyanosis squatting improves cyanosis
43
Early death | failure of aorticopulmonary septum to spiral
D transposition of the great vessels | need shunt to live allowing mix of blood
44
Rib notching HTN in upper extremities weak lower extremity pulses
Coarctation of the aorta adult type past ligamentum arteriosum
45
Cyanosis in lower extremities | goes away with indomethacin
patent ductus arteriosus stays open with PGE1/2 machine like murmur L to R shunt/LVH
46
22q11 syndrome assc with heart
Truncus arteriosus | Tetralogy of Fallot
47
Diabetic mother assc with heart
Transposition of the great vessels
48
Down syndrome assc with heart
ASD VSD AV septal defect
49
Xanthomas in Achilles corneal deposits ischemia of small vessels
Hyperlipidemia
50
Radial/ulnar artery calcification | pipstem arteries
Moenckeberg arteriosclerosis calicification of media no flow obstruction
51
Hyaline deposition in small arteries
Hyaline Arteriolosclerosis assc with essential HTN or diabetes mellitus
52
Onion skinning of small vessels
Hyperplastic Arteriolosclerosis assc with malignant HTN
53
Plaques on intima of arteries
atherosclerosis
54
Process of atherosclerosis
``` LDL accumulation foam cell formation fatty streaks/smooth m. cell migration extracellular matrix deposition plaques form ```
55
Male smoker age 55 HTN pulsatile mass in abd
Abd aortic aneurysm | assc with atherosclerosis
56
Pt sexually active hypotension in extremities also has Marfan's syndrome
Thoracic aortic aneurysm | assc with HTN/cystic medial necrosis (Marfan's)/tertiary syphilis
57
Mediastinal widening diminished heart sounds tearing chest pain
Aortic dissection | assc with Marfan's
58
4-12 hrs post MI
coagulative necrosis | wavy fibers
59
12-24 hrs post MI
contraction bands from reperfusion | neutrophil migration
60
24-72 hrs post MI
extensive coagulative necrosis acute inflammation around infarct risk of fibrinous pericarditis
61
3-14 days post MI
macrophage migration granulationx tissue at infarct margins risk of free wall rupture (due to macrophages)
62
2 weeks post MI
contracted scar
63
Dx for reinfarct of an MI
CK-MB | rises and falls within 48 hours
64
S3 heart sound dilated heart on echo alcoholic
Dilated cardiomyopathy assc with EtOH/Beriberi/Coxsackie B/cocaine/Chaga's disease/hemachromatosis also can be X-linked (eccentric hypertrophy from sarcomeres added in series)
65
``` Normal heart size S4 heart sound systolic murmur syncope young athlete ```
Hypertrophic cardiomyopathy outflow obstruction of mitral valve leaflet Beta-myosin heavy chain mutation sarcomeres added in parallel (haphazard myocytes) assc with Friedriech's ataxia
66
Causes of restrictive cardiomyopathy
``` amyloidosis (Congo red stain) sarcoidosis Loeffler's syndrome (eosinophilia/fibrosis) hemachromatosis results in loss of heart compliance ```
67
Pt has systemic lupus | eosinphilic/granular verucae on heart valves
Libman Sacks endocarditis | vegetations on both sides of valves
68
IV drug user rapid onset splinter hemorrhages tricuspid valve stenosis
Acute Bacterial endocarditis (S. aureus) lg vegetations on previously normal valves assc with IV drug use R sided heart valves
69
``` Vegetations on damaged heart valves Roth spots (on retina) Osler nodes (on fingers) Janeway lesions (on palms) ```
Subacute bacterial endocarditis (viridans strep) | assc with dental procedures
70
Assc of endocarditis with prosthetic valves
S. epidermidis
71
Endocarditis with colon cancer pts
Strep bovis
72
Baterial endocarditis sx (5)
``` Roth spots (retina hemorrhage) Olser's nodes (painful papules on fingers) Janeway lesions (emboli to palms/soles) Splinter hemorrhages of nails emboli ```
73
Mitral valve regurg Granuloma with giant cells activated histiocytes increased ASO titer
``` Rheumatic fever beta-hemolytic strep post pharyngitis mitral/aortic valves most affected mitral regurg, then stenosis late Aschoff bodies (giant cells) Anitschkows cells (activated histiocytes) type II HS rxn, anti-M protein ```
74
Jones criteria
``` For rheumatic fever Joints-migratory arthralgia Heart-myocarditis Nodules sub q Erythema marginatum Sydenham's chorea ```
75
Pericarditis causes
Fibrinous-uremia/radiation/friction rubs seen Serous-viral/RA/lupus Suppurative/purulent-pneumococcus/strep
76
JVD hypotension systolic BP more than 10 mmHP greater on inspiration
``` Cardiac tamponade pulsus paradoxus (inspiration increased intrathoracic pressure, increasing BP) ```
77
Tree bark aorta calcification at aortic root aortic insufficiency
Tertiary syphilis disruption of vasa vasorum in aorta an cause aneurysm
78
L atrium obstruction syncope 40 y/o male
Myxomas | ball valve obstruction in atria
79
Spider cells pt also has Tuberous sclerosis 4 year old male
Rhabdomyoma
80
Increased JVD with inspiration
Kussmaul's sign | from restrictive cardiac pathology
81
Unilateral headaches on L 73 y/o female Lost sight out of L eye
Temporal (giant cell) arteritis ophthalmic artery occlusion granulomatous inflammation assc with polymyalgia rheumatica
82
Asian 51 y/o female weak upper extremity pulses ocular problems skin nodules
Takayasu's arteritis pulseless disease granulomatous thickening of aortic arch/great vessels
83
``` 23 y/o male Pt has Hep B cutaneous eruptions at different stages HTN renal damage ```
Polyarteritis nodosa renal involvement, no pulmonary immune complex mediated Fibrinoid necrosis
84
``` 2 y/o Asian male recovering from Chicken pox strawberry tongue erythema of hands/feet cervical lymphadenitis ```
Kawasaki disease follows viral infection can develop coronary aneurysms MI/rupture
85
Male smoker 52 y/o intermittent claudication autoamputation of 2 fingers Raynaud's phenomenon seen
Buerger's disease (thromboangiitis obliterans) segmental thrombosing vasculitis autoamputation of digits tx with smoking cessation
86
Lung and kidney damage palpable purpura (+) for p-ANCA
Microscopic polyangiitis necrotizing vasculitis pauci-immune GN no granulomas
87
Chronic sinusitis/otitis media hemoptysis hematuria
``` Wegener's granulomatosis lung and kidney involvement granulomas present (+) c-ANCA focal necrotizing vasculitis ```
88
``` Has allergies sinusitis palpable purpura wrist drop hematuria eosinophilia of vesels ```
``` Churg-Strauss syndrome highly allergic people (+) p-ANCA peripheral neuropathy pauci-immune GN granulomatous ```
89
``` 6 y/o recovering from strep throat palpable purpura on buttocks arthralgia melena GI lesions of same stage ```
Henoch-Schoenlein purpura childhood systemic vasculitis IgA complex deposition assc with IgA nephropathy
90
Female pt with 1 X chromosome mass on the neck 3 y/o
Cystic hygroma assc with Turner syndrome cavernous lymphangiomas of neck
91
AIDS pt skin papules pt owns a cat
Bacillary angiomatosis benign capillary skin papules Bartonella henselae infections mistaken for Kaposi's
92
Pt has mastectomy for breast cancer 5 years ago | has chronic edema of R arm and R chest
Lymphangiosarcoma | assc with post radical mastectomy and persistent lymphedema
93
Mouth/skin/GI/respiratory tract purple lesions | pt has AIDS
Kaposi's sarcoma | assc with HHV-8 and HIV
94
Nevus flammus on face seizures at early age glaucoma 6 y/o
Sturge-Weber disease capillary sized blood vessels ipsilateral leptomeningeal angiomatosis (AVM)
95
Lesion under the finger nail extremely painful red/blue color
Glomus tumor benign modified smooth m. cells of glomus body
96
HTN tx for diabetics
ACEI's | nephroprotective
97
Essential HTN tx
thiazides
98
MOA of CCB's
block L-type calcium channels
99
Cardiac and peripheral CCB's
Cardiac-verapamil/diltiazem | Peripheral-amlodipine/nifedipine
100
Given with beta blockers to prevent reflex tachycardia
Hydralazine peripheral (arterial) vasodilator can cause lupus like syndrome
101
Can cause CN toxicity | decreased preload
nitroprusside | releases NO, vasodilates via cGMP increase
102
Drug for tx of HTN with renal insufficiency
Fenoldopam | D1 agonist that vasodilates renal and other arterioles
103
Contraindicated Beta blockers in angina tx
Pindolo/acebutolol | they are partial beta agonists
104
Impact of HMG-Coa reductase inhibitors
very lg decrease in LDL decrease in TG increase in HDL
105
Impact of Niacin on cholesterol
lg decrease in LDL lg increase in HDL decrease in TG
106
Impact of bile acid resins on cholesterol
lg decrease in LDL | slight increase in HDL and TG
107
Impact of ezetimibe on cholesterol
lg decrease in LDL | blocks cholesterol absorption
108
Impact of fibrates on cholesterol (gemifibrozil/fenofibrate)
very lg decrease in TG decrease in LDL increase in HDL
109
Risk with use of statins
rhabdomyolysis | hepatotoxicity
110
Risk with use of niacin
hyperuricemia
111
Risk of bile acid resins/fibrates
cholesterol gallstones
112
Role of ApoE
on IDL's and chylomicrons | uptake of remnants by liver
113
Role of ApoA1
``` activates LCAT (free cholesterol to esterified) on HDL ```
114
Role of ApoCII
``` LPL cofactor (frees FA's) on chylomicron/VLDL/HDL ```
115
Role of ApoB48
chylomicron secretion by GI tract | on chylomicrons
116
Role of ApoB100
binds LDL receptor | on VLDL/IDL/LDL
117
MOA of digoxin
inhibit Na+/K+ ATPase, increasing Ca2+ conc (via decreased secondary Ca2+/Na+ transport) Also stimulates vagus n.
118
Side effects of digoxin
blurry yellow vision hyperkalemia AV block
119
Phosphodiesterase inhibitors for antiplatelet effects
Cilostazol | dipyridamole
120
Thienopyridines and MOA
clopidogrel/prasugrel/ticlopidine | inhibit ADP platelet aggregation
121
Risk with thienopyridines
thombotic thrombocytopenic purpura
122
Tx of warfarin overdose
Vit K | fresh frozen plasma
123
Tx for heparin overdose
protamine sulfate
124
Side effects of class 1A antiarrhythmics
quinidine-cinchonism (tinnitus) procainamide-lupus like syndrome disopyramide- anticholinergic all can cause Torsades de pointes
125
Use of Class 1A antiarrhythmics
reentry tachycardias | increase effective refractory period/QT interval
126
Use of Class 1B antiarrhythmics
acute ventricular arrhythmias and digitalis induced arrhythmias decreased AP duration
127
Use of Class 1C antiarrhythmics
V tach going to V fib/intractable SVT | no effect on AP duration/prolongs refractory period
128
Class 1C antiarrhythmic drugs
flecainide/propafenone | propafenone does not cause Torsades
129
Class 1B antiarrhythmics
lidocaine/mexiletine/tocainide/phenytoin | side effect of CNS depression
130
Class II antiarrhythmics
beta blockers decrease SA and AV nodal activity (via cAMP decrease) increase PR interval
131
Class III antiarrhythmics
K+ channel blockers amiodarone/ibutilide/dofetilide/sotalol can cause Torsades increase AP duration and QT interval
132
Side effects of amiodarone
pulmonary fibrosis hepatotoxicity hyper/hypothyroid (iodine structure) corneal deposits
133
Class IV antiarrhythmics
CCB's (verapamil/diltiazem) decrease conduction velocity increase PR interval for SVT
134
MOA of adenosine
increased K+ out of cells hyperpolarizes the cell for SVT does not work with caffeine/theophylline
135
Mg2+ tx for cardiac
Torsades de pointes | digoxin toxicity
136
Given with beta blockers to prevent reflex tachycardia
Hydralazine peripheral (arterial) vasodilator can cause lupus like syndrome
137
Cardiac and peripheral CCB's
Cardiac-verapamil/diltiazem | Peripheral-amlodipine/nifedipine
138
MOA of CCB's
block L-type calcium channels
139
Essential HTN tx
thiazides
140
HTN tx for diabetics
ACEI's | nephroprotective
141
Lesion under the finger nail extremely painful red/blue color
Glomus tumor benign modified smooth m. cells of glomus body
142
Nevus flammus on face seizures at early age glaucoma 6 y/o
Sturge-Weber disease capillary sized blood vessels ipsilateral leptomeningeal angiomatosis (AVM)
143
Mouth/skin/GI/respiratory tract purple lesions | pt has AIDS
Kaposi's sarcoma | assc with HHV-8 and HIV
144
Pt has mastectomy for breast cancer 5 years ago | has chronic edema of R arm and R chest
Lymphangiosarcoma | assc with post radical mastectomy and persistent lymphedema
145
AIDS pt skin papules pt owns a cat
Bacillary angiomatosis benign capillary skin papules Bartonella henselae infections mistaken for Kaposi's
146
Female pt with 1 X chromosome mass on the neck 3 y/o
Cystic hygroma assc with Turner syndrome cavernous lymphangiomas of neck
147
``` 6 y/o recovering from strep throat palpable purpura on buttocks arthralgia melena GI lesions of same stage ```
Henoch-Schoenlein purpura childhood systemic vasculitis IgA complex deposition assc with IgA nephropathy
148
``` Has allergies sinusitis palpable purpura wrist drop hematuria eosinophilia of vesels ```
``` Churg-Strauss syndrome highly allergic people (+) p-ANCA peripheral neuropathy pauci-immune GN granulomatous ```
149
Chronic sinusitis/otitis media hemoptysis hematuria
``` Wegener's granulomatosis lung and kidney involvement granulomas present (+) c-ANCA focal necrotizing vasculitis ```
150
Lung and kidney damage palpable purpura (+) for p-ANCA
Microscopic polyangiitis necrotizing vasculitis pauci-immune GN no granulomas
151
Male smoker 52 y/o intermittent claudication autoamputation of 2 fingers Raynaud's phenomenon seen
Buerger's disease (thromboangiitis obliterans) segmental thrombosing vasculitis autoamputation of digits tx with smoking cessation
152
``` 2 y/o Asian male recovering from Chicken pox strawberry tongue erythema of hands/feet cervical lymphadenitis ```
Kawasaki disease follows viral infection can develop coronary aneurysms MI/rupture
153
``` 23 y/o male Pt has Hep B cutaneous eruptions at different stages HTN renal damage ```
Polyarteritis nodosa renal involvement, no pulmonary immune complex mediated Fibrinoid necrosis

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