Cardio Flashcards
(53 cards)
1
Q
QT prolonging meds
A
some risky meds can prolong QT - sotalol, risperidone (antipsychotics), macrolides, chloroquine, protease inhibitors (-navir), quinidine (class 1a, also class III), thiazides
2
Q
Romano-Ward Syndrome
A
congenital long QT syndrome
- AD, pure cardiac phenotype
3
Q
Jervell and Lange-Nielsen syndrome
A
congenital long QT syndrome
- AR, sensorineural deafness
4
Q
ANP/BNP mechanism of diuresis
A
causes vasodilation and decreased Na reabsorption in renal collecting tubule
- constricts efferent arterial and dilates afferent via cGMP
5
Q
nesiritide
A
recombinant form of BNP for treatment of heart failure
6
Q
Cushing reaction
A
- 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
Q
aortic arch baroreceptors
A
respond ONLY to increased BP
8
Q
carotid baroreceptors
A
respond to increased and decreased BP
9
Q
peripheral chemoreceptors
A
stimulated by dec PO2, inc PCO2, and dec pH
10
Q
central chemoreceptors
A
stimualted by inc PCO2, dec pH only
11
Q
Monckeberg (medial calcific sclerosis)
A
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
Q
arteriolosclerosis
A
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
Q
atherosclerosis mechanism and location
A
- 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
Q
variant angina (Prinzmetal)
A
- angina at rest due to coronary vasospasm with transient ST elevation
- triggers: tobacco, cocaine, triptans
- treat with CCBs, nitrates, smoking cessation
15
Q
coronary steal syndrome
A
- 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
Q
MI (0-4hr)
A
minimal change on light microscope
- complications include: arrhythmia, HF, cardiogenic shock and death
17
Q
MI (4-12hr)
A
- light microscope: early coagulative necrosis, release of necrotic cell content into blood, edema, hemorrhage, wavy fibers
- complications include: arrhythmia, HF, cardiogenic shock, death
18
Q
MI (12-24hr)
A
- 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
Q
MI (1-3days)
A
- light microscope: extensive coagulative necrosis, tissue surrounding the infarct shows acute inflammation with neutrophils
- complications include: fibrinous pericarditis
20
Q
MI (3 - 14 days)
A
- 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
Q
MI (2 weeks - several months)
A
- light microscope: contracted scar complete (collagen deposition)
- complications include: Dressler syndrome, HF, arrthymias, true ventricular aneurysm (dyskinesia)
22
Q
leads with Q waves in inferior MI
A
II, III, avF
inFerior - RCA
23
Q
leads with Q waves in lateral wall MI
A
I,avL
Lateral wall MI - LCX
24
Q
Dressler syndrome
A
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
