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Smart Decks > Cardio > Flashcards

Cardio Flashcards

1
Q

What are two key cells and chemical mediators in the pathogenesis of atherosclerosis?

A

Macrphages and platelets (and damaged endothelial cells) release PDGF → smooth mm. cell proliferation
Platelets also release TGF-β → smooth muscle cell migration and ECM deposition

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2
Q

In which vein is oxygen tension the lowest?

A

Coronary sinus – myocardium has the highest extraction of any organ

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3
Q

Which maternal blood types are associated with a risk of hemolytic disease of the newborn/erythroblastosis fetalis?

A

O only:

  • maternal blood types A or B when mismatched → IgM
  • maternal blood type O → IgG against surface antigens
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4
Q

What is the triad of Wiskott-Aldrich syndrome?

A

WATER: Wiskott-Aldrich: Thrombocytopenic purpura, Eczema, Recurrent infections

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5
Q

From which aortic arch is the ductus arteriosus derived?

A

6th

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6
Q

What kind of tissue process predisposes people to aneurisms?

A

Myxomatous change in the media of large arteries, as part of cystic medial degeneration. Occurs in young pts Marfan syndrome or older pts with HTN.

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7
Q

What are fatty streaks? Who gets them?

A

intimal lipid-filled foam cells derived from macrophages and smooth muscle cells that have engulfed lipoprotein (predominately LDL) which enters intima through injured, leaky endothelium. They can be seen in all children >10 y.o. and as young as <1 y.o., and not all progress to atherosclerotic plaques.

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8
Q

What types of hemoglobin is elevated in β-thalassemia minor and β-thalassemia intermedia?

A

HbF, HbA2

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9
Q

Explain the molecular defects in B-thalassemia

A

mutations → defective transcription, processing, and translation of β-globin mRNA → deficiency in β-globin chains required for normal hemoglobin synthesis

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10
Q

What congenital heart abnormality is commonly seen in down syndrome?

A

endocardial cushion defects

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11
Q

What percentage of coronary blood flow comes from systole vs. diastole?

A

30% systole

70% diastole

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12
Q

Describe the murmur associated with a PDA

A

continuous flow murmur (systolic and diastolic)

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13
Q

Describe the murmur associated with a VSD

A

low pitched holosystolic murmur that gets louder with handgrip (↑ afterload)

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14
Q

How might the lungs appear in a drug user who recently died of complications of tricuspid endocarditis?

A

wedge-shaped infarcts from septic embolization

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15
Q

Describe the coronary steal phenomenon

A
  1. coronary ischemia → maximal dilatation of vessels in affected area
  2. administering heart specific arteriole dilators (adenosine, dipyridamole) → dilation of arterioles in unaffected areas → stealing from ischemic area including reduction of collateral flow to affected area
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16
Q

Which classes of antiarrhythmics prolong the QT interval?

A

Class 1A and Class 3

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17
Q

What would you see on echocardiogram in transposition of the great vessels?

A

aorta lies anterior and to the right of the pulmonary artery

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18
Q

How does digoxin slow down HR?

A

stimulates vagus nerve

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19
Q

What indicates the severity of mitral stenosis?

A

↓ interval b/w S2 and the opening snap indicates ↑ severity

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20
Q

Put the following in order of conduction velocity: atria, ventricles, purkinje fibers, AV node

A 
Fastest  → slowest:
Purkinje
Atrial muscle
Ventricular muscle
AV node
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21
Q

What is an important step in the management of a patient with endocarditis caused by S. bovis?

A

examination for colon cancer

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22
Q

What is milrinone?

A

A phosphodiesterase inhibitor

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23
Q

What is the mechanism of action of phosphodiesterase inhibitors?

A

↑ cAMP → → ↑ contractility and vasodilation

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24
Q

What amino acid is used in the synthesis of NO?

A

Arginine

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25
Q

When does an S4 heart sound occur?

A

Just before S1

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26
Q

What can cause an S4 heart sound?

A

atrial contraction against ventricular wall with ↓ compliance

  1. Age-related stiffening (not as loud)
  2. Restrictive cardiomyopathy
  3. LV hypertrophy due to prolonged HTN
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27
Q

What are the actions of ANP?

A

peripheral vasodilation and increased urinary secretion of sodium and water

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28
Q

What congenital heart disease is associated with differential cyanosis?

A

PDA

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29
Q

What drugs are used for prevention of thrombosis in angina pectoralis?

A

Asprin

Clopridogrel

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30
Q

What are the two major causes of valvular aortic stenosis?

A
  1. calcified bicuspid or normal valve (most common in US)

2. rheumatic fever (most common worldwide)

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31
Q

Where can mitral valve prolapse be heard best? What does it sound like?

A

cardiac apex - midsystolic click with late systolic murmur

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32
Q

What is the most sensitive provocative test for Prinzmetal angina?

A

Ergonovine test (stimulates both α-adrenergic and 5-HT receptors; both → vasoconstriction)

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33
Q

Describe the mechanism of NO smooth muscle relaxation

A

NO → guanylyl cyclase → GTP converted to cGMP → ↓ intracellular Ca2+ → ↓ MLCK activity → MLC dephosphorylation → smooth muscle relaxation

34
Q

What conditions are associated with deletion of the long arm of chromosome 22?

A

facial (eg. cleft palate), cardiac (e.g. tetrology of fallot, interrupted aortic arch), or immunologic (e.g. T-cell deficiency, athymia); associated with DiGeorge syndrome

35
Q

Which antiarrythmic is associated with a prolonged QT interval w/out increased risk for torsade de pointes?

A

amiodarone

36
Q

Which two mechanisms lead to decreased Ca2+ intracellularly as the muscle begins to relax?

A
  1. Na+/Ca+ antiporter (3 Na in to cell / 2 Ca out of cell w/ no use of ATP)
  2. Ca2+ ATPase pumps Ca2+ into SR
37
Q

How does dilated cardiomyopathy present?

A

symptoms of L and R ventricular CHF

38
Q

What auscultation sound do you expect to hear in left ventricular systolic failure? How do you maximize the sound? What other heart condition could present this way?

A

S3 - accentuated by having patient lay in left lateral decubitus position; restrictive cardiomyopathy also presents this way

39
Q

What maneuvers accentuate auscultation of mitral valve prolapse and hypertrophic myopathy? Why?

A

straining phase of valsalva, standing position, and amyl nitrate inhalation (causes vasodilation); the maneuvers decrease venous return to heart

40
Q

What drug, when added to stable angina treatment regimen with β-blockers can have a severe additive negative chronotropic effect (→ bradycardia, hypotension, ↓ AV conduction, ↓ contractility)?

A

Non-dihydropyridine Ca2+ channel blockers (verapamil)

41
Q

What is Brain Natriuretic Peptide (BNP)?

A

a substance released from the ventricles during CHF → diuresis and vasodilation (like ANP which comes from atria; both upregulate cGMP)

42
Q

What are the 5 T’s of cyanotic congenital heart disease?

A 
Tetrology of Fallot
Tricuspid atresia
Transposition of the great vessels
Truncus arteriosus
Total anomalous pulmonary venous return
43
Q

A holosystolic murmur heard at the apex of the heart suggests:

A

mitral valve regurgitation

44
Q

What is a functional mitral regurgitation?

A

Acute LV dilation → separation of mitral leaflets (note that in addition to holosystolic murmur this will often give an S3 due to increased atrial volume)

45
Q

Where is aortic stenosis heard best?

A

aortic area in upper right chest

46
Q

What is the technical name for mitral valve prolapse? What product builds up?

A

myxomatous mitral valve degeneration; dermatan sulfate accumulates in the connective tissue

47
Q

Which auscultatory finding is the best indicator of severe mitral regurgitation?

A

presence of an audible S3 (indicates more blood has regurgitated during diastole → faster ejection into ventricle during systole)

48
Q

Does the intensity of its systolic murmur correlate with the severity of mitral valve regurgitation?

A

No, often larger opening is quieter

49
Q

Which kinds of beta receptors are present in vascular smooth muscle?

A

β2

50
Q

What disease can cause fibrous intimal thickening with endocardial plaques limited to the right side?

A

Carcinoid syndrome. Tumor secretes high amounts of 5-HT - limited to the right heart because lungs have MAO.

51
Q

What is the urinary product in carcinoid syndrome?

A

5-hydroxyindoleaacetic acid (5-HIAA; a serotonin metabolite)

52
Q

Which holosystolic murmur is exaggerated by inspiration?

A

tricuspid regurgitation

53
Q

What is nitroglycerine used for? What is the mechanism?

A

Rapid relief of stable angina symptoms; as a nitrate → venodilation → ↓ PREload

54
Q

What heart condition causes an involuntary head bob? Why?

A

aortic regurgitation due to widened pulse pressure

55
Q

What auscultatory finding often differs in patients with MVP caused by myxomatous degeneration vs. an MVP caused by papillary muscle dysfunction, ischemia, or dilated cardiomyopathy?

A

The midsystolic click is more often present with MVP caused by myxomatous degeneration

56
Q

What causes Janeway lesions? Are they painful?

A

septic microembolization from bacterial endocarditis; painless

57
Q

Are osler nodes painful?

A

yes

58
Q

What histologic heart finding is classic in rheumatic fever patients?

A

interstitial myocardial granulomas called Aschoff bodies
Slender macrophages called caterpillar cells
Multinucleated Aschoff giant cells (also Mø)

59
Q

What would chagas disease look like histologically in the heart?

A

intracellular trapanosomes w/ distension of individual mm. fibers

60
Q

What would diphtheria myocarditis look like?

A

interstitial infiltrate of macrophages (without distinct Aschoff body granulomas in RF)

61
Q

When you massage someone’s neck causing them ↓ BP, what are you stimulating? What nerve carries the afferent arc?

A

Carotid sinus baroreceptors → glossopharyngeal n. → solitary nucleus of medulla → vagus

62
Q

Where is ACE produced?

A

pulmonary endothelium

63
Q

Describe how HTN → LHF → RHF

A

LV concentric hypertrophy → ↓ LV diastolic compliance → ↑ filling P to maintain CO/SV → ↑ LA P → pulmonary venous congestion → ↑ hydrostatic P in lungs → capillary leak → pulmonary edema → alveolar collapse → ↓ ventilation → hypoxemia → reactive vasoconstriction/shunt → PAH → ↑ afterload → RHF

64
Q

What is the most common site of deceleration-related injury in the aorta?

A

the isthmus, where the ascending and descending aorta meet

65
Q

What is deposited by S. aureas that leads to heart valve vegetations?

A

fibrin and platelets

66
Q

What arteries are most commonly affected by atherosclerosis in order of prevalence?

A

abdominal aorta > coronary arteries > popliteal arteries > internal carotids > circle of Willis

67
Q

What does an AV shunt do to the pressure-volume curve in the heart?

A
  1. increases flow back to heart → EDV

2. reduces TPR → ↓ afterload

68
Q

What artery supplies the diaphragmatic surface of the heart (inferior wall of L ventricle)?

A

PDA (which is supplied by RCA in 80-90% of people)

69
Q

What drug is associated with atrialization of the RV (Ebstein’s anomaly)?

A

Lithium exposure in utero

70
Q

What does constrictive pericarditis look like on CT?

A

bright thick wall around heart > 4mm

71
Q

What antiarrhythmic drug exhibits the most use-dependence? What does this mean?

A

Class IC (e.g. flecainide, propafenone); QRS lengthens (i.e. effects of drug ↑) with ↑ HR

72
Q

What antiarrhythmic drug exhibits reverse use-dependence? What does this mean?

A

Class III (e.g. dofetilide); the slower the HR, the more the QT interval is prolonged

73
Q

How soon after initiation of total ischemia does it take for enough ATP to be lost so that myocytes stop contracting?

A

within 60 seconds

74
Q

What is the most common cause of coronary sinus dilation?

A

↑ right-sided pressure due to pulmonary hypertension; note that the coronary sinus communicates freely with RA so anything that dilates the RA → coronary sinus dilation

75
Q

How can the Fick principal be used to calculate CO?

A

CO = O2 consumption / arteriovenous O2 difference

76
Q

What is a normal maximum pressure in the RV and pulmonary artery?

A

25 mmHg

77
Q

What is a normal maximum pressure in the LV and aorta?

A

130 mmHg (systolic BP)

78
Q

What is a normal maximum pressure in the atria?

A

around 10 mmHg

79
Q

Is the minimum pressure in the pulmonary artery higher or lower than in the RV?

A

higher: RV minimum is about 4 and PA min is about 9

80
Q

What does ANCA stand for? Which vasculitities have MPO-ANCA?

A

Anti-neutrophil chemoplasmic antibody;

Churg-strauss and Microscopic polyangiitis

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