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Flashcards in Cardio Deck (157):
1

MC cause of cardiomyopathy

Cocksackie B Virus

2

Digoxin: Mechanism

- Blocks Na/K ATPase which causes buildup of intracellular Ca → increased contractility
- Increases parasympathetic tone by acting on Vagus nerve → decreased rate of AV conduction

3

Digoxin: Toxicity

- Toxicity: yellow-green vision, arrhythmia (potentially fatal)
- Hyperkalemia in acute digoxin toxicity, but hypokalemia makes patient more susceptible to effects of digoxin

4

Endocarditis in IV drug users

Staph Aureus

5

Endocarditis w/ S. Bovis

Colon Cancer

6

Endocarditis w/ Prothetic Valves

S. epidermis (if 60 days)

7

Endocarditis after Dental Procedure

Viridans/Mutans

8

Chemoreceptors: Central vs Peripheral

- Central: (in medulla) senses high CO2
- Peripheral: (in carotid and aortic bodies) senses low O2, and also high O2

9

Chemoreceptors in COPD

Blunted response to pCO2 (hypercapnia)

10

Carotid Sinus

- Most of BP regulation (responsible for 80% of the response to hypotension)
- Fires more with HTN (increased stretch) and tachycardia
- Cut nerve connections → less signals → body thinks it is hypotensive → HTN + tachycardia

11

Carotid Sinus Massage

Causes parasympathetics to decrease the AV node conduction (by prolonging the refractory period)

12

Baroreceptors: Carotid vs Aortic

- Stretch increases signals
- Carotid: afferent is glossopharyngeal (hering’s nerve); Both increases and decreases in BP sensed
- Aortic: afferent is vagus; Only increases in BP sensed

13

VSD Murmur

Loud holosystolic murmur

14

ASD Murmur

Wide, fixed splitting of S2

15

Mitral Regurgitation Murmur

Holosystolic blowing murmur radiating to apex (aw/ Rheumatic fever)

16

Aortic Regurgitation Murmur and Signs

- Blowing diastolic murmur (decrescendo)
- Loudest in early diastole, end of expiration
- Quinke pulse, and head bobbing
- Wide/Increased pulse pressure

17

Delayed Closure of Pulmonic Valve Sound

Wide, fixed split S2

18

Mitral Valve Prolapse Murmur

Mid-systolic click with a regurgitation murmur following

19

Mitral Stenosis Murmur

Opening snap w/ diastolic rumble
(aw/ Rheumatic Heart Disease)

20

Aortic Stenosis Murmur

Crescendo-decrescendo (systolic)

21

Aortic Regurgitation Murmur

Decrescendo (diastolic)

22

Effect of Digoxin w/ Diuretic

Hypokalemia --> PVC (premature ventricular contractions)

23

Subendocardial infarction can be a result of _____

Prolonged hypotension

24

Dressler's Syndrome

Autoimmune pericarditis 2-10 wks post-MI

25

Senile Cardiac Amyloidosis

Transthyretin

26

Amyloid Light Chain (AL) vs Amyloid Associated (AA)

AL: primary/systemic
AA: secondary or autoimmune

27

Wedge Pressure

- Should equal left-ventricular end diastolic pressure
- If wedge is much higher, then indicates stenosis of mitral valve

28

Valve Affects w/ IV drug use

Tricuspid --> regurgitation

29

Mitral Stenosis

Right atrial pressure is much greater than left ventricular pressure near the end of diastole

30

Bicuspid Aortic Valve

Aortic stenosis w/ ejection click
- aw/ Turner's
- Calcifies due to wear and tear after age 60

31

Pressure Volume Loop: Contractility

Increased Slope

32

Pressure Volume Loop: Stroke Volume vs Preload

SV: Increased Width
Preload: Increased Width to the Right

33

Pressure Volume Loop: Arterial Pressure/BP

Increase height

34

Churg-Strauss

Vasculitis w/ eosinophilia
- aw/ atopic dermatitis and asthma
- granulomatous
- MPO and p-anca

35

Metoprolol + Thiazides cause ______

Dyslipidemia

36

Pathophysiology of Aortic Dissection

Medial change (cystic medial degeneration w/ intimal tear)
- smoking and high BP

37

Pathophysiology of Aneurysm

Intimal streak (atherosclerosis)
- MC abdominal
- Thoracic in Marfan's

38

Infective Endocarditis

o Fever, new murmur, janeway lesions, osler nodes, roth spots, and splinter hemorrhages

39

Endocarditis w/ Negative blood cultures

HACEK (difficult to grow)

40

____ can Infect Normal/Undamaged Valves

Staph aureus

41

Non-infective Endocarditis: Causes

- Hypercoagulable state associated vegetations
- Underlying adenocarcinoma
- Libman Sacks

42

Libman-Sacks:

Non-infective endocarditis (aw/ SLE): vegetations on surface and undersurface

43

Severity of a MR Holosystolic Murmur Indicated by ______

Presence of S3 gallop
- Accentuated on expiration

44

Dilated Cardiomyopathy: Sound and Causes

(S3 - Kan- kakee)
[turbulent blood flow into ventricles, heard during rapid filling]
- coxsackie B myocarditis, genetic mutation (in cytoskeletal proteins like dystrophin or mitochondrial enzymes of ox phos), alcohol, doxorubicin, pregnancy, hemochromatosis

45

Hemochromatosis: Defect

HFE defect (intestinal absorption)

46

Hypertrophic Cardiomyopathy: Sound and Cause

(S4)
[Heard immediately after atrial contraction as blood is forced into stiff ventricle]
- usually genetic cause (Genetic mutation in sarcomere proteins [disorganized])
- Syncope with exercise due to functional aortic stenosis due to hypertrophied ventricular septum
- LV obstruction due to anterior leaftlet of mitral valve and hypertrophied interventricular septum
- normal coronary arteries

47

Restrictive Cardiomyopathy: Effect and Causes

- Low QRS amplitude
- Decreased compliance
- Loffler syndrome, amyloidosis, or sarcoidosis

48

Loffler Syndrome

Endomyocardial fibrosis and eosinophilia that causes Restrictive Cardiomyopathy

49

Rhabdomyoma

MC primary tumor of heart in children
- aw/ Tuberous Sclerosis

50

Hyaline Arteriolosclerosis

From benign hypertension or diabetes

51

Hyperplastic arteriolosclerosis

From malignant hypertension
- onion skinning of arterioles

52

Buerger's Disease

Segmental vasculitis in Asian male smokers → claudication and gangrene/ulcers

53

Nitrates: Mechanism/Effects

Act primarily as venodilators to relieve stable angina by decreasing preload
- Can cause reflex tachycardia

54

Treat Nitrate-induced Reflex Tachycardia w/ _______

Beta blockers

55

Polyarteritis Nodosa

Transmural inflammation of arteries w/ fibrinoid necrosis
- Fever, malaise, melena, weight loss
- Hep B in 10-30%

56

Alpha-1 (3 effects)

- Vasoconstriction
- Dilates (mydriasis)
- Contracts sphincters of bladder and intestine

57

Beta-2 (6 effects)

- Relaxes uterus (inhibits contractions)
- Bronchodilation
- Ciliary muscle relaxation
- Increase aqueous humor
- Increase insulin release
- Vasodilation

58

Treat Hypertensive Emergency w/ ______

Nitroprusside or Fenoldopam
- Nitroprusside (equal effect on arteries and veins --> decreases preload and afterload)
- Fenoldopam (arterial dilation and natriuresis)

59

Pulsus Paradoxus Definition

Decrease by greater than 10 in systolic BP on inspiration) (eg. w/ cardiac tamponade)

60

Assessing Pulsus Paradoxus

- Inflate a cuff above systolic, slowly release and will only hear Korotkoff sounds on expiration, keep lowering and will hear it throughout
- Inspiration causes increased venous return → increased right heart volume (normally this should have little effect on left side) but in conditions impairing expansion into pericardial spaces (tamponade, restrictive pericarditis etc ) → increased RV pressure pushes IV septum towards left and blocks outflow → decreased systemic BP on inspiration

61

Treat B-Blocker Overdose w/ _______

Glucagon
- Raises HR and Contractility independent of adrenergic receptors
- Increases cAMP in cardiac myocytes

62

Conduction Velocity: Fast to Slow

Purkinje > Atrial muscle > ventricular muscles > AV node
- (park at ventura avenue)

63

Myocardium Stops Contracting at ____ of ischemia

1 min

64

Myocardial Damage Irreversible After _____

30 min (If ischemia resolves in less than 30, contractility will gradually return to normal (hrs-days))

65

Cardiac Output Equation

CO = O2 consumption / arteriovenous difference in O2 content
or
CO = SV*HR

66

Carcinoid Syndrome and Tumors

- Fibrous endocardial thickening in right side of heart because MAO in lung breaks down the serotonin and bradykinin before reaching left side
(Pulmonic stenosis and/or restrictive cardiomyopathy)
- 5-HIAA in urine
- Carcinoid Tumors: uniform nests or glands; minimal to no variation in cell size and shape
- MC in the ileum; frequently in appendix and rectum; derived from enterochromaffin cells
- No sx till it metastasizes

67

Jugular Venous Pulse Curve: a,c,x,v,y

a: R atrial contraction
c: R ventricle contraction → bulging of tricuspid
x: R atrial relaxation
v: Inflow of venous blood
y: Tricuspid opens → passive emptying of R atrium

68

Romano-Ward

QT prolongation (congenital): K+ channel mutation w/out deafness

69

Jervell-Lange-Neilson

QT prolongation (congenital): K+ channel mutation + deafness

70

Nitroprusside --> Cyanide Toxicity

Nitrites convert Fe2+ to Fe3+ Methemoglobin which binds cyanide tightly

71

Treating Cyanide Toxicity

- Amyl Nitrite followed by Thiosulfate to excrete it
- Can also use hydroxycobalamin

72

Adenosine: Mechanism and Side effects

- Very fast acting antiarrhythmic
-Slows AV node conduction to treat paroxysmal SVT
- Side effects: flushing, chest burning, hypotension

73

_____ Increases VSD Holosystolic Murmur

Handgrip → increases afterload

74

Systolic pressure gradient between the left ventricle and aorta is suggestive of _______

Left ventricular outflow (eg aortic stenosis)
- Would not be expected in dilated cardiomyopathy

75

Transient Reperfusion Arrhythmias

Caused by fibrinolytics (tPA) but they are usually benign

76

Paradoxical emboli

Can be facilitated by atrial left to right shunts (wide flixed split S2) during periods of transient shunt reversal (straining or coughing)

77

Calcium Efflux Prior to Relaxation in Myocardium

Accomplished through Ca2+ ATPase & Na/Ca Exchange

78

Saline Infusion in a Hypovolemic Patient will _______

Increase the intravascular volume → increased preload → increased SV and CO

79

Transudate in CHF

Will have low LDH content (low in protein)

80

In newborn, catheter through umbilical vein can reach right atrium via _______

Ductus venosus (which does not completely close for a week)

81

Coronary Sinus Dilation

Coronary sinus may become dilated due to pulmonary hypertension (which increases right sided heart pressure)

82

Common Cardinal Veins become:

SVC

83

_______ Regulates Contraction of Ventricles During AFib

AV node

84

Beta-1 (3 effects)

- Renin release
- Heart contractility
- HR increase

85

Muscarinic Receptor 1

CNS and enteric nervous system

86

Muscarinic Receptor 2

Decrease HR/atria contractility

87

Muscarinic Receptor 3

Increased gland secretions, bronchoconstriction, bladder contraction, gut peristalsis, accommodation

88

Dopamine 1 Receptor

Relaxes renal vasculature

89

Dopamine 2 Receptor

In brain

90

H1 Receptor

Allergy

91

H2 Receptor

Gastric Acid

92

V1 Receptor

Vascular constriction

93

V2 Receptor

ADH Effects

94

Distributive Shock

warm and dry with decreased wedge pressure and vasodilation

95

Cardiogenic Shock

cold and clammy, with high wedge pressure and vasoconstriction

96

Hypovolemic Shock

cold and clammy, with low wedge pressure and vasoconstriction

97

Ductus arteriosis derived from ____ Aortic Arch

6th

98

Sinus Venosus (Rt and Lft Horn) → _______

- Right horn: smooth R atrium
- Left horn: Coronary Sinus

99

Primitive Pulmonary Vein → ________

Smooth L atrium

100

Bulbus Cordis → _____

Smooth part/outflow tract of ventricles

101

Umbilical Vein → ______

Round ligament (ligamentum teres)

102

Umbilical Arteries → ______

Medial ligaments

103

Allantois → ______

Median Ligament

104

Preload Increases w/: ______, _______, & ________

- Increasing venous tone
- Increasing blood volume
- Inspiration

105

MSFP (Mean systemic pressure):

Fullness of vasculature with blood (changes with volume/venous tone); intercept with X axis

106

Right Sided Murmurs Increase w/

Inspiration (due to increased venous return)

107

S1

mitral and tricuspid close (just before contracting ventricles)

108

S2

aortic and pulmonary close (just before relaxing ventricles)

109

S3 Normal in:

pregnancy and children due to natural increased compliance
- (seen in dilated cardiomopathy but is pathologic)

110

Non-Pacemaker Cardiac Cell Depolarization

Rapid depol by Na in → then start to inactivate → Ca influx and K efflux create plateau → Ca channels close and K continues to efflux out causing repolarization

111

Pacemaker Cell Depolarization

4-0-3
Slow depolarization by funny channels (Na influx), spontaneous depol → Ca upstroke → Ca channel inactivated and K efflux to repolarize
- Sympathetic stimulation --> chance of funny channel being open so → increased HR

112

Ach and Adenosine

- Decrease rate of depolarization to lower HR (Act on Phase 4)
- Slope of phase 4 determines HR

113

Drugs to Avoid and Use in WPW

Avoid Digoxin, beta blockers, or CCBs
- Use IV amiodarone and procainamide

114

AV Block: 1st degree

Prolonged PR

115

AV Block: 2nd degree (Mobitz I)

Lengthening of PR till beat is dropped

116

AV Block: 2nd degree (Mobitz II)

Randomly dropped beat

117

AV Block: 3rd degree

Complete heart block, atria and ventricle beating independently

118

Adult-Type Coarctation: Increased risk of _______

Berry aneurysms and rupture of those aneurysms

119

Polymyalgia Rheumatica

aw/ Temporal Arteritis

120

Coronary Steal Syndrome

Ischemia can be worsened in areas distal to an occlusion with addition of a coronary vasodilator (eg adenosine or dipyradamole)

121

Endogenous substant that vasodilates and promotes diuresis

ANP/BNP
- mediates aldosterone escape

122

Vascular reaction to endothelial injury

Endothelial dysfunction stimulates PDGF and smooth muscle cells to proliferate in the intima instead of the media

123

Free wall ventricular rupture

Causes pericardial tamponade --> shortness of breath and profound hypotension

124

S3 can be heard with:

Dilated Cardiomyopathy or Restrictive

125

Expiring while in decubitus position, increases __________ heart sound

S3
- less air in lungs and heart closer to chest wall so it is easier to hear

126

Venous Return Curve Affected by:

hemorrhage (decreased)
fluid infusion (increased)

127

Cardiac Output Curve Affected by:

MI, narcotics (decreased)
Inotropes, Chronic anemia, catecholamines (increased)

128

Isolated Diastolic Heart Failure

Filling Problem, not systolic (eg. hypertrophic cardiomyopathy)
Ejection fraction will be preserved
End diastolic volume will be Normal, but decreased compliance will cause the End diastolic pressure to be increased

129

In LV failure, accumulation of fluid in lung interstitium causes ________ compliance

decreased

130

1st line for Atrial Fibrillation

Beta blockers and Ca Channel Blockers (Digoxin is 2nd line)

131

Transesophageal Echo

Left Atrium will be anterior
Descending Aorta will be posterior

132

Valsalva

Increases Vagal tone and can be used to abolish paroxysmal SVT tachycardia
- rectus abdominus is most important in increasing the intraabdominal and intrathoracic pressure

133

Long-term compensatory response to Aortic Regurg

Increased LV preload and Eccentric LV hypertrophy

134

Supine Hypotension Syndrome

Can be seen in pregnancy >20 weeks due to compression of the IVC by uterus reducing venous return and CO

135

Tricuspid Regurgitation

Holosystolic Murmur
Increases with Inspiration (because it is right sided) due to increased venous return

136

Normal Aging of Heart

Decreased LV chamber size, sigmoid-shaped ventricular septum, myocardial atrophy w/ increased collagen deposition, cytoplasmic lipofuscin accumulation in myocytes

137

Salicylate Poisoning

Respiratory Alkalosis and Metabolic Acidosis
pH slightly low

138

Aorta derived from _______ Aortic Arch

4th

139

Right Subclavian Artery derived from ________ Aortic Arch

4th

140

Third Aortic Arch Makes:

Common carotid and proximal internal carotid arteries

141

Second Aortic Arch makes:

Stapedial and Hyoid arteries

142

First Aortic Arch makes:

Maxillary Artery

143

PDA: keep open w/

PGE

144

PDA: close w/

PGE inhibitor (indomethacin) or NSAIDS (inhibits COX to prevent PG formation)

145

A1V1 =

A2V2

146

Chronic Aortic Stenosis w/ Afib

Can cause acute pulmonary edema/CHF because the hypertrophied LV depends greatly on atrial contraction to fill it. Loss of atrial contraction/kick due to afib can reduce preload and CO --> systemic hypotension and backup into LA and lungs

147

Cough Syncope

Increased intrathoracic pressure during a coughing episode decreases venous return --> transient decrease in CO and cerebral perfusion

148

IVC Obstruction

Symmetric bilateral lower extremity edema and often prominently visible abdominal wall collateral venous circulation

149

Cardiac Tamponade

- Electrical alternans means a big pericardial effusion (and usually cardiac tamponade)
- heart cannot fill properly, preload decreases
- hypotension and tachycardia
- fluid backup leads to elevated JVP (pulsus paradoxus)
- distant heart sounds

150

Effect of Lyme Disease on Heart

Carditis causing 3rd degree heart block

151

Isolated Systolic Hypertension

Commonly an age-related stiffening (decrease in compliance) of aorta

152

Aschoff Bodies

Interstitial myocardial granulomas
Typically found in acute rheumatic carditis
(caterpillar cells)

153

Abnormal migration of neural crest cells through primitive truncus arteriosus and bulbis cordis

Tetralogy of Fallot
Truncus Arteriosus
Transposition of Great Vessels

154

Most useful measure for assessing degree of Mitral Stenosis

A2 to opening snap time interval
(closure of aortic valve to opening of mitral)

155

Nitroglycerin vs Nitroprusside

Nitroglycerin: dilates veins --> decrease preload
Nitroprusside: dilates veins and arteries --> decrease both preload AND afterload

156

MC Cardiac Abnormality predisposing to Native Valve Bacterial Endocarditis

Mitral Valve Prolapse

157

Myxomatous changes in media of large arteries predisposes to development of: ________ and ________

aortic dissections and aortic aneurysms
(cystic medial degeneration)