Cardio Flashcards Preview

Step 1 Flash Cards > Cardio > Flashcards

Flashcards in Cardio Deck (53):
1

QT prolonging meds

some risky meds can prolong QT
- sotalol, risperidone (antipsychotics), macrolides, chloroquine, protease inhibitors (-navir), quinidine (class 1a, also class III), thiazides

2

Romano-Ward Syndrome

congenital long QT syndrome
- AD, pure cardiac phenotype

3

Jervell and Lange-Nielsen syndrome

congenital long QT syndrome
- AR, sensorineural deafness

4

ANP/BNP mechanism of diuresis

causes vasodilation and decreased Na reabsorption in renal collecting tubule
- constricts efferent arterial and dilates afferent via cGMP

5

nesiritide

recombinant form of BNP for treatment of heart failure

6

Cushing reaction

- triad of HTN, bradycardia and resp depression
- mediated by baroreceptors
- increased ICP --> constricts arterioles --> cerebral ischemia and reflex sympathetic increase in perfusion pressure --> increased stretch, --> baro-receptor induced bradycardia

7

aortic arch baroreceptors

respond ONLY to increased BP

8

carotid baroreceptors

respond to increased and decreased BP

9

peripheral chemoreceptors

stimulated by dec PO2, inc PCO2, and dec pH

10

central chemoreceptors

stimualted by inc PCO2, dec pH only

11

Monckeberg (medial calcific sclerosis)

uncommon calcification in the media of the arteries, esp radial/ulnar
- usually benign "pipestem" arteries on xray
- does not obstruct blood flow, intima not involved

12

arteriolosclerosis

common - two types
- hyaline: thickening of small arteries in HTN or diabetes
- hyperplastic: "onion-skinning" in severe HTN, can cause acute renal failure with "flea bitten" appearance

13

atherosclerosis mechanism and location

- endothelial cell dysfunction --> macrophage and LDL accumulation --> foam cell formation --> fatty streaks --> smooth muscle cell migration (PDGF and FGF), proliferation and ECM deposition --> fibrous plaque --> complex atheromas
- abdominal aorta > coronary arter > pop >carotid

14

variant angina (Prinzmetal)

- angina at rest due to coronary vasospasm with transient ST elevation
- triggers: tobacco, cocaine, triptans
- treat with CCBs, nitrates, smoking cessation

15

coronary steal syndrome

- distal to coronary stenosis, vessels are maximally dilated at baseline, so the addition of vasodilator (dipyridamole, rgadenoson) dilates normal vessels and shunts to well perfused areas --> decreased flow and ischemia of the post-stenotic region

16

MI (0-4hr)

minimal change on light microscope
- complications include: arrhythmia, HF, cardiogenic shock and death

17

MI (4-12hr)

- light microscope: early coagulative necrosis, release of necrotic cell content into blood, edema, hemorrhage, wavy fibers
- complications include: arrhythmia, HF, cardiogenic shock, death

18

MI (12-24hr)

- light microscope: neutrophil migration starts. reperfusion injury may cause contraction bands (due to free radical damage), early coagulative necrosis
- complications include: arrhythmia, HF, cardiogenic shock, death

19

MI (1-3days)

- light microscope: extensive coagulative necrosis, tissue surrounding the infarct shows acute inflammation with neutrophils
- complications include: fibrinous pericarditis

20

MI (3 - 14 days)

- light microscope: macrophages, then granulation tissue at margins
- complications include: free wall rupture --> tamponade. papillary muscle rupture --> MR. intraventricular septal rupture due to macrophage-mediated structural degradation. LV pseudoaneurysm.

21

MI (2 weeks - several months)

- light microscope: contracted scar complete (collagen deposition)
- complications include: Dressler syndrome, HF, arrthymias, true ventricular aneurysm (dyskinesia)

22

leads with Q waves in inferior MI

II, III, avF
inFerior - RCA

23

leads with Q waves in lateral wall MI

I,avL
Lateral wall MI - LCX

24

Dressler syndrome

AI phenomenon resulting in fibrinous pericardiitis (several weeks post-MI)

25

causes of dilated cardiomyopathy

ABCCCD
Alcohol, wet beriberi, Coxsackie virus, Cocaine, Chagas disease, Doxorubicin

26

treatment for dilated cardiomyopathy

Na restriction, ACEi, beta blockers, diuretics, digoxin, ICD, heart transplant

27

treatment for HCM

beta blocker and non-dihydropyridine CCB
ICD in high risk patients
stop high-intensity athletics

28

medications that decrease mortality in CHF

ACEi, B blockers, ARBs and spironolactone

29

"heart failure cells"

hemosiderin laden macrophages in the lungs
- turn dark blue with Prussian blue staining

30

findings in bacterial endocarditis

FROM JANE
fever, roth spoits, osler nodes, murmur, janeway lesions, anemia, nail-bed hemorrhages, emboli

31

subacute v. acute v. culture neg endocarditis (which bug?)

acute - staph aureus
subacute - strep viridans
neg - coxiella burnetii and bartonella spp

32

IV drug abusers get endo with which bugs? prosthetic valves?

IV - s. aureus, pseudomonas, candida
prosthetics - s. epidermidis

33

rheumatic fever findings

- mitral > aortic >> tricuspid
- mitral valve regug --> stenosis
- Aschoff bodies, Anitschkow cells, increased ASO titers
- antibodies to M protein cross-react with self antigens

34

pulsus paradoxus

decrease in amplitude of SBP by >10mm Hg during inspiration
- seen in cardiac tamponade, asthma, OSA, pericarditis and croup

35

syphillitic heart disease

calcification of the aorta with atrophy --> dilation of the aorta and valve ring
leads to aneurysm, aortic insufficiency
"tree bark" appearance

36

rhabdomyomas

most frequent primary cardiac tumor in children (associated with tuberous sclerosis)

37

Kussmal sign

increased JVP on inspiration due to constrictive pericarditis, restrictive cardiomyopathies, right atrial or ventricular tumors

38

pyogenic granuloma

polypoid capillary hemangioma that can ulcerate and bleed
associated with trauma and pregnancy

39

cystic hygroma

cavernous lymphangioma of the neck, associated with Turner syndrome

40

glomus tumor

benign, painful, red-blue tumor under fingernails. arises from modified smooth muscle cells of the glomus body

41

bacillary angiomatosis

benign capillary skin papules found in AIDS patients caused by Bartonella

42

angiosarcoma

rare blood vessel malignancy typically in the head, neck and breasts.
Usually in the elderly in sun-exposed areas. Associated with radiation/arsenic exposure.
Aggressive, difficult to resect 2/2 delay in diagnosis.

43

lymphangiosarcoma

lymphatic malignancy associated with persistent lymphedema (eg post-radical mastectomy)

44

Kaposi's sarcoma

endothelial malignancy most commonly of the skin, but also mouth, GI tract, and resp tract
- associated with HHV8 and HIV

45

Temporal (giant cell) arteritis

large vessel vasculitis that affects elderly females (>50)
- unilat headache, jaw claudication, visual disturbances, associated with polymyalgia rheumatica
- most commonly affects branches of the carotid artery, focal granulomatous inflammation (segmental), inc ESR
- treat with high dose corticosteroids/temp art biopsy

46

takayasu arteritis

large vessel vasculitis, asian females <40, weak upper extrem pulses, fever, night sweats, arthritis, myalgias, skin nodules, ocular disturbances
- granulomatous thickening/narrowing of aortic arch and prox great vessels, ESR, treat with corticosteroids
- basically same path as TGCA, but aortic arch involvement instead of carotid

47

polyarteritis nodosa

med vessel vasculitis, young adults, hep B 30%, HTN, neuro dysfunction, cutaneous eruptions, renal damage, and non-spec symptoms
- SPARES the lungs
- immune complex, transmural inflamm, fibrinoid necrosis (pink walls), microaneurysms and spasm ("string of pearls")
- corticosteroids, cyclophosphamide

48

kawasaki disease

- asian kids < 4 years old
- fever, cervical lymphadenitis, conjunctival injection, changes in lips (strawberry tongue), hand/foot erythema, desquamating rash
- treat with IVIG/aspirin
- can develop coronary artery aneurysms

49

Buerger disease

-med vessel vasculitis in heavy smoking men < 40 (India, Japan, Israel)
- claudication and gangrene, raunauds, auto-amp of digits
- segmental thrombosing vasculitis that extends into continguous veins/nerves
- treat with smoking cessation

50

Wegener (granulomatosis with polyangiitis)

- small vessel vasculitis: URT (nasal septum, chronic sinusitis, OM, mastoiditis), LRT (hemoptysis, cough, dyspnea), renal (hematuria, RBC casts)
- triad: focal necrotizing vasculitis, necrotizing granulomas in lung/upper airway, necrotizing glomerulonephritis
- "WeCeners": C distribution of oropharynx, lungs and kindeys, C-ANCA, cyclophosphamide treatment

51

microscopic polyangiitis

- small vessel vasculitis involving lung, kidneys, skin with pauci-immune GN and palpable purpura
- similar to Wegener but.... no nasopharyngeal involvement, no granulomas, p-ANCA
- treat with cyclophosphamide and corticosteroids

52

Churg-Strauss Syndrome

-small vessel vasculitis
- adult onset asthma, sinusitis, palpable purpura, peripheral neuropathy
- can also involve heart, GI, kidneys
- similar to MPA but....granulomatous, asthma, eosinophilia
- MPO-ANCA/p-ANCA, inc IgE

53

Henoch-Schonlein Purpura

most commonly childhood vasculitis, follows URI
-triad: palpable purpura, arthragias, abdominal pain
- vasculitis 2/2 IgA complex deposition, associated with IgA nephropathy and can progress to acute GN
-usually self-limited