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Flashcards in Cardio Deck (487):
1

How is dilated cardiomyopathy manifested?

Systolic disfunction

2

How do ACE inhibitors produce angioedema?

Due to bradykinin accumulation

3

Early findings of reumathic fever

Migratory arhthritis
Pancarditis
Syndenham chorea

4

Late findings of rheumatic fever

Mitral regurgitation/ stenosis
Aortic valve less frequently involved

5

Which is the most common cause of nephritic syndrome in children worldwide?

Post streptococcal glomeruloneohritis

6

How is restrictive cardiomyopathy manifested?

With diastolic disfunction

7

What leaks in case of cell wall damage caused by ischemia of heart, brain or skeletal muscle cells?

Creatinine kinase

8

How is mitral stenosis heard?

Opening snap being heard after the S2 heart sound

9

Most common cause of mitral stenosis

Prior rheumatic fever

10

Low pitched murmur heard best at the sternal border with accentuation during handgrip exercise

Ventricular septal defect

11

Mid systolic pulmonary ejection murmur which results from increased flow across the pulmonic valve

Atrial septal defect

12

What does hand maneuver increase?

Afterload

13

How does systolic ejection murmur of hypertrophic cardiomyopathy decrease?

With maneuvers that increase afterload

14

Which maneuver decreases preload?

Valsalva maneuver

15

Which maneuver accentuates the systolic ejection murmur of hypertrophic cardiomyopathy?

Valsalva maneuver

16

Which maneuver accentuates aortic regurgitation murmur?

Maneuvers that accentuate afterload such as handgrip exercise

17

What is paradoxical embolism?

They originate in the systemic venous circulation and enter the systemic arterial circulation via intracardiac or intrapulmonary shunt

18

In whom can paradoxical embolism happen?

Patients with patent foramen ova,e , atrial septal defects, ventricular septal defects or Large AVMs

19

Wide and fixed splitting (no change with respiration) of the second heart sound S2

Atrial septal defects with left to right shunting

20

Early disstolic decrescendo murmur

Aortic regurgitation

21

Systolic ejection murmur that increases in intensity with standing

Hypertrophic cardiomyopathy

22

Diastolic murmur with presystolic accentuation

Mitral or tricuspid valve stenosis

23

What causes the diastolic murmur with presystolic accentuation in mitral or tricuspid valve stenosis?

due to atrial contraction

24

Which is a sign of delayed closure of the tricuspid valve?

Wide splitting of S1 that is accentuated by inspiration

25

What is associated to liver angiosarcoma?

With exposure to carcinogens such as arsenic, thorotrast and polyvinyl chloride

26

What does hepatic angiosarcoma express?

Tumor cell express CD 31 an endothelial cell marker

27

When does acute rheumatic fever occur after group A streptococcal pharyngitis?

10 day to 6 weeks after

28

Which group of age are most often affected by acute rheumatic fever?

Children between 5 and 15 years old

29

Which are the main clinical manifestations of Acute rheumatic arthritis fever?

Acute migratory poly arthritis and pancarditis

30

Signs of acute pancarditis

Weak heart sounds, tachycardia, pericardial friction rubs, and arrhythmia

31

What causes death in patients with acute reumathic fever?

Heart failure due to severe myocarditis

32

How long does mitral stenosis take to develop in case of Acute rheumatic fever?

Years or decades

33

On the ECG what correspond to phase 0 of ventricular myocyte action potential?

QRS complex corresponding to ventricular depolarization

34

Which drugs have shown slow progression of heart failure and reduce mortality in CHF?

Beta blockers and carvedilol i. Particular

35

How do beta blockers help in CHF?

Decrease cardiac work by slowing the ventricular rate and decreasing afterload

36

Refers to a conclusion that there is no difference between the groups studied when a difference truly exists

Beta error

37

Results from the inaccurate recall of past exposure by subjects

Recall bias

38

What is the main purpose to avoid observer bias?

The main purpose of blinding is to prevent patient or researcher expectancy from interfering with an outcome

39

How does digoxin primarily acts?

By inducing stimulation of the AV node of the vagus nerve causing slowing of conduction through the AV node

40

Possible findings of digitalis toxicity

Fatigue, blurry vision, changes in color perception, nausea and vomiting , diarrhea, abdominal pain, headache, dizziness, confusion and delirium
Bradycardia
Eventual ventricular tachycardia or ventricular fibrilation

41

Which electrolyte is mainly affected in digitalis intoxication? What could be seen?

K+
Seen as high serum levels of potassium

42

What is needed to treat digitalis toxicity?

Oral activated charcoal as a GI decontaminant
Management Of serum potassium levels by the use of insulin, kayexalate or hemodialysis
Digoxin specific antibody fragments

43

What should be avoided in digitalis intoxication?

Calcium gluconate

44

Which cardiac manifestations does digoxin intoxication might show?

AV block and ventricular tachycardia

45

After MI when can we see ruptured of ventricular free wall?

Generally occurs 3-7 days after the onset of total ischemis

46

Clinical manifestations of ruptured of ventricular wall

Profound hypotension and shortness of breath
On physical examination the heart sounds are muffled and the jugular venous pressure is elevated

47

Why can rupture of ventricular wall cause death?

Due to hemopericardium and cardiac tamponade

48

Most common cause of death in a patient hospitalized for a MI

Ventricular failure (cardiogenic shock) which is a 2/3 of death cause

49

In MI what causes weakening of ventricular walls?

After coagulative necrosis and neutrophil infiltration
May cause ventricular ruptured

50

Most common cause of subungual splinter hemorrhages

Microemboli from valvular vegetations of bacterial endocarditis

51

What could be found in case of bacterial endocarditis?

Regurgitation murmur

52

What are the Janeway lesions?

Septic embolization from infected cardiac wall vegetations
Localized in palms and soles

53

What compose Janeway lesions?

Bacteria, neutrophils, necrotic material ams subcutaneous hemorrhage

54

Which is the most common necrosis variant after MI?

Coagulative necrosis

55

When does coagulative necrosis develops?

After irreversible ischemic injury

56

Cellular changes in coagulative necrosis

Tissue architecture is preserved
Cells become anucleated with eosinophilic cytoplasm
Leukocytes eventually infiltrate necrotic tissue and digest cellular debris

57

When is liquefactive necrosis seen?

With focal bacterial infections that stimulate massive leukocyte recruitment

58

Where does liquefactive necrosis occur?

Central nervous infarcts

59

Where do we see fat necrosis?

Seen in acute pancreatitis

60

Morphology of fat necrosis

Saponification (chalky white deposits)

61

When is the saponification formed?

When fatty acids combine with calcium

62

When does caseous necrosis occur?

Most commonly with tuberculosis infection

63

What is the result of complete muscle ischemia for >30 minutes in MI?

Progressive cardiomyocyte death and coagulative necrosis

64

Yellow brown finely granular found in heart and liver cells

Lipid peroxidation

65

When are lipid peroxidation granules seen?

Seen in heart and liver aging or cachectic, malnourished patients

66

How are hemosiderin granules seen?

Brown pigments granules seen in iron overload

67

Dark brown to black pigmented granules

Melanin

68

Clear vacuoles within cytoplasm

Glycogen

69

Is a form of protein accumulation, typically appearing as glassy, homogenous pink deposit

Hyaline deposit

70

Which is the product of lipid peroxidation?

Lipofuscin, seen accumulated in aging cells (specially in patients with malnutrition and cachexia)

71

Percentage of total perfusion through the myocardium capillaries of the LV occurs during systole

10%, while the majority of left ventricular flow occurs during diastole

72

Which is the effect of nitric oxide within the vascular smooth muscle cell?

NO stimulates guanylate cyclase to convert GTP into cyclic guanosine monophosohate (cGMP)

73

What is the final effect of increased cGMP by Nitric oxide?

Decreased intracellular calcium concentration which leads to decreased activity of myosin light chain kinase and finally myosin light chain dephosphorylation and smooth muscle relaxation

74

In muscle what is the effect of muscle phosphorylation?

Contraction

75

What is the effect of chronic arteriovenous shunt?

Increase cardiac output because of increased sympathetic stimulation to the heart, decreased peripheral resistance and increase venous return

76

Drugs that inhibit cGMP degradation leading to its accumulation, which produce muscle relaxation

PDE Inhibitors (sildenafil, tadalafil, vardenafil)

77

How is atrial septal defect heard?

Fixed splitting of the second herat sound

78

When does S4 sound could be heard?

Occurs at the end of diastole just before S1

79

Associated with a mid systolic click and a mid to late systolic murmur

Mitral valve prolapse

80

What is associated to S4?

Due to decreased left ventricular compliance and is often associated with restrictive cardiomyopathy and left ventricular hypertrophy

81

When left anterior descending artery alone is occluded, which is the preferred vessel for bypass grafting?

Internal mammary (thoracic) artery

82

When multiple coronary arteries require vascularization, which is the preferred vessel to use?

Saphenous vein graft

83

Which is the longest vein in the body?

Great saphenous vein

84

Who forms the femoral triangle?

Inguinal ligament superiorly, sartorius muscle laterally, and adductor longus medially

85

Where are the majority of peripheral artery aneurysm formed?

In the popliteal artery

86

Adult derivative of first aortic arch

Part of maxillary artery

87

Adult derivative of second aortic arch

Hyoid artery
Stapedial artery

88

Adult derivative of third aortic arch

Common carotid artery
Proximal internal carotid artery

89

Adult derivative of fourt aortic arch

On left aortic arch
On right proximal right subclavian

90

Adult derivative of sixth aortic arch

Proximal pulmonary arteries
On left ductus arteriosus

91

From which structure does ductus arteriosus derivates?

From sixth aortic arch

92

What is the effect of carotid sinus massage?

Increases baroreceptor firing, and thus increases parasympathetic influence on the heart and vessels, and ultimately prolongs the AV node refractory period which stops AV re entrant tachycardias

93

Typically a re entrant circuit in the AV node

Paroxysmal supraventricular tachycardia seen in patients with no other disease

94

How is paroxysmal commonly manage?

With adenosine in the hospital setting, but vagal maneuvers such as carotid sinus massage and Valsalva can also be used

95

How is orthosthatic hypotension defined?

As a fall of >22 mm in systolic or > 10 mm in diastolic pressure when assuming upright posture

96

Who prevents cerebral hypoperfusion upon standing

a1 adrenergic receptors stimuli

97

Which is the most striking finding of pericarditis?

Pericardial friction rub

98

Chest pain sharp and pleuritic, and characteristically decreases when the patient sits up and leans forward

Acute pericarditis

99

Most common variant of pericarditis

Fibrinous or serofibrinous

100

Common causes of pericarditis

Myocardial infarction , rheumatic fever, uremia, viral infection

101

Paradoxical increase in the jugular venous pressure with inspiration

Kussmaul's sign

102

When is kussmaul's sign often found?

In chronic constrictive pericarditis

103

Differential diagnosis of kussmaul's sign

Restrictive cardiomyopathy, severe right sided heart failure, tricuspid stenosis and cardiac tamponade

104

Drop in systolic blood pressure of 10 mmHg or more during inspiration

Pulsus paradoxus

105

When is Pulsus paradoxus found?

Cor pulmonale, constrictive (chronic) pericardial disease, and cardiac tamponade

106

Brief, high frequency, precordial sound heard in early diastole (shortly after S2)

Pericardial knock in patients with constrictive (chronic) pericarditis

107

What are fenfluramine, dexfenfluramine and phentermine?

Appetite suppressants

108

What is a secondary effect of appetite suppressants used for more tha 3 months?

Pulmonary hypertension

109

Pathologies associated to cerebral aneurysm?

Autosomal dominant polycystic kidney disease
Ehlers Danlos syndrome

110

What do pulmonary embolism patients develop?

Ventilation/perfusion (V/Q) mismatch

111

What is the result of pulmonary embolism?

Hypoxemia, causing subsequently hyperventilation and Respiratory ALKALOSIS

112

Increased pH and reduced PaCO2

Respiratory alkalosis

113

Increased pH and reduced PaCO2 + low PaO2

Acute Pulmonary embolism

114

pH of 7.30 and low HCO3-

Metabolic acidosis

115

pH of 7.32 and PaCO2 high, high HCO3-

Respiratory acidosis, with renal compensation

116

pH 7.47, low PaCO2 , low HCO3-

Respiratory alkalosis with partial renal compensation

117

PH 7.48 and high HCO3-

Metabolic alkalosis

118

Which is the first change in coronary artery atherosclerosis?

Endothelial cell injury

119

Inhibits platelet aggregation and also works as direct arterial vasodilator

Cilostazol

120

Clinical use for Cilostazol

In the treatment for intermittent claudication

121

Direct thrombin inhibitor

Argatroban

122

When is abciximab used?

Prior to percutaneous coronary intervention

123

Phosphodiesterase inhibitor used in patients with intermittent claudication

Cilostazol

124

Decreased femoral to brachial blood pressure ratio

Congenital coarctation of the aorta

125

Which enzyme is deficient in Ehlers Danlos syndrome?

Procollagen peptidase

126

Which is the effect of procollagen peptidase?

Transforms the procollagen into insoluble tropocollagen

127

How do macrophage reduce plaque stability of the intima?

By secreting metalloproteinases, which degrade collagen

128

Direct pathway of how HDL delivers cholesterol

Delivers cholesterol esters directly to the liver via a scavenger receptor (SCARB1)

129

Indirect pathway of how HDL delivers cholesterol

HDL transfer cholesterol to LDL and VLDL by cholesteryl ester transfer protein

130

Which are the most effective lipid lowering drugs for oreventing cardiovascular effects?

HMG CoA reductase inhibitors

131

When aren't thiazides recommended?

For diabetic, gout or hypercalcemia
They can also cause hyponatremia

132

When are ACE inhibitors the drug of choice in hypertensive patients?

When diabetic and hypertension

133

In case of extravasation of NE what is recommended?

Infiltration of sodium chloride solution containing phentolamine mesylate
Must be given within 12 hours

134

What is phentolamine?

alpha receptor blocker

135

When is calcium gluconate used?

In severe hypocalcemia

136

What characterizes abdominal aortic aneurysm?

Transmural inflammation of the aortic wall

137

Cardiac action potential conduction where is the slowest

AV node

138

Cardiac action potential conduction where is the fastest

Purkinje system

139

Rate of each system id action potential

SA node 1.1m/sec
AV node .05 m/sec
His-Purkinje 2.2 m/sec
Purkinje- ventricles .3 m/sec

140

Adult onset asthma, eosinophilia, history of allergy, mono or poly neuropathy, migratory/ transient pulmonary infiltrates, and paranasal sinus abnormalities + pANCA

Churg Strauss syndrome

141

Which enzyme may be elevated in Sarcoidosis?

Angiotensin converting enzyme

142

Circulating autoantibodies against alpha 3 chain of collagen IV, which damage alveolar and glomerular basement membranes

Pulmonary goodpasture syndrome

143

Antibodies found in Scleroderma

Antibodies to Scl 70, a soluble nuclear antigen, and or anti centromere antibody

144

What is characteristic of Aspergillus fumigatus?

Eosinophilia and elevated IgE and IgG antibodies to Aspergillus fumigatus

145

What leaks in case of cell wall damage caused by ischemia of heart, brain or skeletal muscle cells?

Creatinine kinase

146

How is mitral stenosis heard?

Opening snap being heard after the S2 heart sound

147

Most common cause of mitral stenosis

Prior rheumatic fever

148

Low pitched murmur heard best at the sternal border with accentuation during handgrip exercise

Ventricular septal defect

149

Mid systolic pulmonary ejection murmur which results from increased flow across the pulmonic valve

Atrial septal defect

150

What does hand maneuver increase?

Afterload

151

How does systolic ejection murmur of hypertrophic cardiomyopathy decrease?

With maneuvers that increase afterload

152

Which maneuver decreases preload?

Valsalva maneuver

153

Which maneuver accentuates the systolic ejection murmur of hypertrophic cardiomyopathy?

Valsalva maneuver

154

Which maneuver accentuates aortic regurgitation murmur?

Maneuvers that accentuate afterload such as handgrip exercise

155

What is paradoxical embolism?

They originate in the systemic venous circulation and enter the systemic arterial circulation via intracardiac or intrapulmonary shunt

156

In whom can paradoxical embolism happen?

Patients with patent foramen ova,e , atrial septal defects, ventricular septal defects or Large AVMs

157

Wide and fixed splitting (no change with respiration) of the second heart sound S2

Atrial septal defects with left to right shunting

158

Early disstolic decrescendo murmur

Aortic regurgitation

159

Systolic ejection murmur that increases in intensity with standing

Hypertrophic cardiomyopathy

160

Diastolic murmur with presystolic accentuation

Mitral or tricuspid valve stenosis

161

What causes the diastolic murmur with presystolic accentuation in mitral or tricuspid valve stenosis?

due to atrial contraction

162

Which is a sign of delayed closure of the tricuspid valve?

Wide splitting of S1 that is accentuated by inspiration

163

What is associated to liver angiosarcoma?

With exposure to carcinogens such as arsenic, thorotrast and polyvinyl chloride

164

What does hepatic angiosarcoma express?

Tumor cell express CD 31 an endothelial cell marker

165

When does acute rheumatic fever occur after group A streptococcal pharyngitis?

10 day to 6 weeks after

166

Which group of age are most often affected by acute rheumatic fever?

Children between 5 and 15 years old

167

Which are the main clinical manifestations of Acute rheumatic arthritis fever?

Acute migratory poly arthritis and pancarditis

168

Signs of acute pancarditis

Weak heart sounds, tachycardia, pericardial friction rubs, and arrhythmia

169

What causes death in patients with acute reumathic fever?

Heart failure due to severe myocarditis

170

How long does mitral stenosis take to develop in case of Acute rheumatic fever?

Years or decades

171

On the ECG what correspond to phase 0 of ventricular myocyte action potential?

QRS complex corresponding to ventricular depolarization

172

Which drugs have shown slow progression of heart failure and reduce mortality in CHF?

Beta blockers and carvedilol i. Particular

173

How do beta blockers help in CHF?

Decrease cardiac work by slowing the ventricular rate and decreasing afterload

174

Refers to a conclusion that there is no difference between the groups studied when a difference truly exists

Beta error

175

Results from the inaccurate recall of past exposure by subjects

Recall bias

176

What is the main purpose to avoid observer bias?

The main purpose of blinding is to prevent patient or researcher expectancy from interfering with an outcome

177

How does digoxin primarily acts?

By inducing stimulation of the AV node of the vagus nerve causing slowing of conduction through the AV node

178

Possible findings of digitalis toxicity

Fatigue, blurry vision, changes in color perception, nausea and vomiting , diarrhea, abdominal pain, headache, dizziness, confusion and delirium
Bradycardia
Eventual ventricular tachycardia or ventricular fibrilation

179

Which electrolyte is mainly affected in digitalis intoxication? What could be seen?

K+
Seen as high serum levels of potassium

180

What is needed to treat digitalis toxicity?

Oral activated charcoal as a GI decontaminant
Management Of serum potassium levels by the use of insulin, kayexalate or hemodialysis
Digoxin specific antibody fragments

181

What should be avoided in digitalis intoxication?

Calcium gluconate

182

Which cardiac manifestations does digoxin intoxication might show?

AV block and ventricular tachycardia

183

After MI when can we see ruptured of ventricular free wall?

Generally occurs 3-7 days after the onset of total ischemis

184

Clinical manifestations of ruptured of ventricular wall

Profound hypotension and shortness of breath
On physical examination the heart sounds are muffled and the jugular venous pressure is elevated

185

Why can rupture of ventricular wall cause death?

Due to hemopericardium and cardiac tamponade

186

Most common cause of death in a patient hospitalized for a MI

Ventricular failure (cardiogenic shock) which is a 2/3 of death cause

187

In MI what causes weakening of ventricular walls?

After coagulative necrosis and neutrophil infiltration
May cause ventricular ruptured

188

Most common cause of subungual splinter hemorrhages

Microemboli from valvular vegetations of bacterial endocarditis

189

What could be found in case of bacterial endocarditis?

Regurgitation murmur

190

What are the Janeway lesions?

Septic embolization from infected cardiac wall vegetations
Localized in palms and soles

191

What compose Janeway lesions?

Bacteria, neutrophils, necrotic material ams subcutaneous hemorrhage

192

Which is the most common necrosis variant after MI?

Coagulative necrosis

193

When does coagulative necrosis develops?

After irreversible ischemic injury

194

Cellular changes in coagulative necrosis

Tissue architecture is preserved
Cells become anucleated with eosinophilic cytoplasm
Leukocytes eventually infiltrate necrotic tissue and digest cellular debris

195

When is liquefactive necrosis seen?

With focal bacterial infections that stimulate massive leukocyte recruitment

196

Where does liquefactive necrosis occur?

Central nervous infarcts

197

Where do we see fat necrosis?

Seen in acute pancreatitis

198

Morphology of fat necrosis

Saponification (chalky white deposits)

199

When is the saponification formed?

When fatty acids combine with calcium

200

When does caseous necrosis occur?

Most commonly with tuberculosis infection

201

What is the result of complete muscle ischemia for >30 minutes in MI?

Progressive cardiomyocyte death and coagulative necrosis

202

Who mediates vasodilation stimuli of vascular endothelium?

Acetylcholine, bradykinin, serotonin, substance P and shear forces

203

What is the effect of Acetylcholine, bradykinin, serotonin, substance P and shear forces in endothelium?

Increase in cytosolic calcium levels

204

Once calcium is elevated in endothelial cells what is activated?

Endothelial nitric oxide synthase

205

Which is the precursor of nitric oxide once stimulated by endothelial nitric oxide synthase?

Arginine
NADPH
O2

206

What is activated by nitric oxide?

Guanylyl cyclase and increases formation of cyclic G,P

207

What is the effect of high levels of cyclic GMP?

Activate protein kinase G, which causes a reduction in cytosolic calcium levels and relaxation of smooth muscle cells

208

Which is the most common cause of death in patients suffering from myocardial infarction?

Ventricular fibrilation

209

Which are the most lethal arrhythmias in patients with acute myocardial infarction?

Ventricular tachycardia and ventricular fibrillation

210

Clinical findings of ruptured of the intraventricular septum

Hypotension, bi ventricular failure and a new murmur

211

When does significant mural thrombosis occur after myocardial infarction?

Until three to seven days after the onset of infarction

212

What is used to treat hypertensive heart failure?

Nitroprusside

213

What is the effect of nitroprusside?

Decreases preload and afterload
Doesn't affect contractility

214

Short acting balanced venous and arterial vasodilator that decreases both preload and afterload

Nitroprusside

215

Hereditary hemorrhagic telangiectasia

Osler Weber Rendu syndrome

216

Mode of inheritance of Osler Weber Rendu syndrome

Autosomal dominant

217

Better-known as encephalotrigrminal angiomatosis

Sturge Weber syndrome

218

Findings of Sturge Weber syndrome

Presence of continuous facial angiomas as well as leptomeningeal angiomas
Mental retardation, seizures, hemiplegia coma and skull radio opacity

219

When you see "tram track " image on skull radiography what should you suspect?

Sturge Weber syndrome

220

Capillary hemangioblastomas in retina and/or cerebellum as well as congenital cysts and/or neoplasm in the kidney liver and pancreas

Von Hippel Lindau

221

What should be suspected when seeing cortical and subependymal hamartomas?

Tuberous sclerosis

222

How is cardiac output affected when doing exercise?

Increase from a resting rate of 5 L per minute to approximately 20 L per minute during Maxima exertion

223

What is the effect of sympathetic stimulation to the venous system?

Causes contraction, increasing venous return to the heart

224

What is the effect of sympathetic in arterioles?

Contraction in arterioles in all tissues except that actively working muscles, effectively shunting blood toward exercising muscle

225

When doing exercise how much is the pressure increased by sympathetic nervous system?

Typically increases only 20-40 mmHg during full body exercise

226

When doing exercise which are local vasodilators?

Adenosine, potassium ions, ATP, CO2 and lactate

227

Percentage of total cardiac output for renal bloodflow?

25%

228

Elevation of the peak v wave pressure and an earlier upswing than would normally be seen

Mitral regurgitation

229

Most common cause of right heart failure

Secondary to left heart failure

230

Effects of increased Angiotensin II

Sodium retention (direct effect)
Aldosterone production
Vasoconstriction

231

In congestive heart failure how does it affects pressure?

Decreased renal flow causing increased renin which leads to increased arteriolar resistance
So... Increased pressure

232

In the kidney what is activated by decreased GFR?

Macula densa increasing renin

233

If heard in adults typically is a sign of left ventricular failure

S3

234

When is S3 heart sound heard?

Forceful, rapid filling of a ventricle that has normal or elevated compliance
Normal or even decreased filling rates when ventricular compliance is low
Blood flowing into Overfilled ventricle with high end systolic volume

235

When does bulging of intraventricular septum occurs?

In cardiac tamponade

236

Which finding is common in cardiac tamponade?

Pulsus paradoxus

237

Blowing, holsystolic murmur heard over the cardiac apex with radiation to the axilla

Mitral regurgitation

238

How is aortic regurgitation heard?

Early diastolic murmur

239

What may ascending aortic aneurysm develop?

Aortic regurgitation

240

Mid systolic ejection murmur best heard over the right second intercostal space with radiation to the neck

A bicuspid aortic valve
Aortic stenosis

241

Opening snap at the beginning of diastole with a low pitched, mid diastolic rumbling murmur heard best at the cardiac apex

Mitral stenosis

242

In MI what is seen in 0-4 hours

No visible changes

243

In MI what is seen in 4-12 hours

Wavy fibers with narrow, elongated myocytes

244

In MI what is seen in 12- 24 hours

Coagulation necrosis (loss of nuclei & striations)
Prominent neutrophilic infiltration

245

In MI what is seen in 1-3 days

Disintegration of dead neutrophils and myofibers,
Macrophages infiltration a border areas

246

In MI what is seen in 7-10 days

Robust phagocytosis of dead cells by macrophages,
beginning formation of granulation tissue at margins

247

In MI what is seen in 10-14 days

Well-developed granulation tissue with neovascularization

248

In MI what is seen in 2 weeks to 2 months

Progressive collagen deposition and scar formation

249

Major changes in chronic ischemic heart disease

Subendocardial vacuolization

250

Normal morphological changes in the aging heart include

Decrease in left ventricular chamber apex to base dimension, development of a sigmoid shape ventricular septum, myocardium atrophy with increased collagen deposition, and accumulation of cytoplasmic lipofuscin pigment within cardiomyocytes

251

What is the problem of using around the clock nitrates?

Results in development of tolerance to nitrates

252

Mineralocorticoid receptor antagonist

Spironolactone
Eplerenone

253

Potassium sparing diuretics

Spironolactone
Eplerenone

254

Which drugs Block the deleterious effect of aldosterone on the heart, causing regression of myocardial fibrosis and improvement in ventricular remodeling

Mineralocorticoid receptor antagonists
Spironolactone
Eplerenone

255

Which drugs are recommended in heart failure therapy?

Mineralocorticoid receptor antagonist
ACE inhibitors
Beta blockers

256

When are mineralocorticoid receptor antagonist contraindicated?

In patients with hyperkalemia or renal failure

257

Most common side effects of mineralocorticoid receptor antagonists

Hyperkalemia and Gynecomastia

258

Which is the first line of treatment in atrial fibrillation?

Calcium channel blockers
Diltiazem
Verapamil

259

Which is the fsecond line of treatment in atrial fibrillation?

Digoxin

260

How does digoxin decreases rate of AV conduction?

Through increased parasympathetic tone throughout its action on the vagus nerve

261

How can Digoxin lead to ventricular tachycardia and dead?

By increasing intracellular calcium

262

When is clinically recommended the use of adenosin?

In paroxysmal supraventricular tachycardia

263

Between the arrhythmic drugs that cause torsades de points, with which one is less common to see this?

Amiodarone

264

Nonselective betta antagonist

Propanolol

265

Nonspecific alpha 1 and Alpha 2 Blocker with no beta effect

Phentolamine

266

Nonselective beta adrenergic agonist that stimulates both beta receptors on muscular smooth muscle and cardiac receptors

Isoprotenerol

267

Most common cause of atrial stenosis

Senile calcific aortic valve

268

At what age is common to see senile calcification of aortic valve

7th decade of life

269

Dominant Cardiac defect in DiGeorge syndrome

Tetralogy of Fallot and aortic arch anomalies

270

What is mutated in Friedreich ataxia?

Frataxin

271

What is frataxin?

A mitochondrial protein important in iron homeostasis and respiratory function

272

Spinocerebellar degeneration with predominantly spinal ataxia

Friedreich ataxia

273

Progression of Friedreich ataxia

Initial loss of sensory neurons in the dorsal root ganglia, with accompanying gait ataxia

274

How does Marfan syndrome causes dissecting aortic aneurysm?

With cystic medial necrosis of the aorta

275

Where is the mutation in Marfan syndrome?

In the gene that encodes fibrillin 1

276

Heart defects associated to Down syndrome

Ostium primum ASD, regurgitant AV valves

277

Which heart defect is seen in Friedreich ataxia

Hypertrophic cardiomyopathy

278

Heart defect in tuberous sclerosis

Valvular obstruction due to cardiac rhabdomyomas

279

Which syndrome is related to cause berry aneurysms?

Ehler Danlos syndrome

280

What its associated to hyperplastic arteriosclerosis of renal arterioles?

Malignant hypertension

281

It results from concentric lamellar reduplication of the intimal smooth muscle cells

Hyperplastic arterolosclerosis

282

Findings on hyperplastic arteriolosclerosis

Concentric lamellar reduplication of the intima smooth muscle cells "onion skinning"

283

Which structure composes most of the hearts anterior surface?

Right ventricle

284

It is defined as a drop in arterial blood pressure during inspiration of over 10 mmHg

Pulsus paradoxus

285

When does pulsus alternans occur?

Inpatients with left ventricular dysfunction

286

It is defined as a beat to beat variation in the magnitude of the lse upressure in the presence of a regular cardiac rythm

Pulsus alternans

287

Refers to a pulse with two distinct peaks, one during systole and the other during diastole

Dicrotic pulse

288

When does dicrotic pulse is found?

Severe systolic dysfunction

289

Refers to the pulse palpated in patients with aortic stenosis

Pulsus parvus et tardus

290

In patients with hypertensive heart disease what causes pulmonary hypertension?

Vasoconstriction due to pulmonary venous congestion

291

What should migratory thrombophlebitis make you think?

Cancer, leading to hypercoagulable state

292

How does adenocarcinoma produce hypercoagulability?

Because they produce thromboplastin like substance

293

What is Trousseau's syndrome?

Migratory superficial thromboplebitis

294

In the coronaries Vasculature who is responsible of dilation of large arteries and Pre arteriolar vessels?

Nitric oxide

295

From whom is adenosine product?

ATP metabolism

296

In the coronary system where does adenosine work?

In the small coronary arteries

297

Which diseases can cause myocardial fibrosis?

Dermatomyocitis, muscular dystrophy, sarcoidosis, and scleroderma

298

Most common causative organism of acute infective endocarditis

Staphylococcus aureus

299

How is the valvular vegetation caused by S. Aureus formed?

Following bacterial binding, tissue factor expression results in platelet and fibrin deposition and the formation of a valvular vegetation

300

Giant cell (temporal) arteritis

Takayasu arteritis

301

Which is the most specific symptom of Giant cell arteritis?

Jaw claudication

302

In Giant cell arteritis what does temporal artery biopsy demonstrates?

Granulomatous inflammation of the media

303

These bacterias are able to adhere to the surface of tooth enameland heat valves

Viridians streptococci: S. Mutans and S. Sanguis

304

What characteristic of streptococcus viridians let adhere to the surface of tooth enamel and heart valves and multiply in those locations?

Due to their ability to produce insoluble extra cellular polysaccharides (dextrans) using sucrose as a substrate

305

Immune response caused by post streptococcal glomeruloneohritis

Type III (immune complex mediated)

306

What is the result of post streptococcus glomerulonephritis?

Inflammation, renal dysfunction, hematuris and nephritic range protein

307

From which the disease is migratory polyarthritis characteristic?

Rheumatic fever

308

Agents that may cause anterior uveitis

Herpes viruses, syphillis, and Lyme disease
Inflammatory conditions such as the HLA B27 related diseases and sarcoid

309

Most common cause of coronary sinus dilation

Elevated right sided heart pressure secondary to pulmonary artery hypertension

310

Most common cause of fatigue and new onset Cardiac murmur in a young adult

Bacterial endocarditis

311

Which Renal complication may be seen in patients with bacterial endocarditis?

Acute proliferative glomerulonephritis secondary to two collating immune complexes and there is Angelo and/or subepithelial deposition in the glomeruli

312

Tumor associated release of procoagulants responsible for Trombophlebitis

Trosseau syndrome

313

Humoral hypercalcemia of malignancy, The most common cause of hypercalcemia in hospitalized patients

Due to production of a parathyroid hormone like substance by tumors

314

Autoimmune paraneoplastic myasthenic syndrome that affects the presynaptic calcium channels

Lambert Eaton syndrome

315

What is the result of Lambert Eaton syndrome?

Decreased presynaptic acetylcholine release

316

With what is lambert eaton syndrome associated?

With oat cell carcinoma of the ling

317

Laboratory findings for systemic lupus erythematosus

Hemolytic anemia, thrombocytopenia and leukopenia
Hypocomplementemia (c3 & c4)
ANA and Anti dsDNA & anti SM
Proteinuria and elevated creatinine

318

Sensitive antibodies present in systemic lupus erythematosus

ANA

319

Sensitive antibodies present in systemic lupus erythematosus

Anti dsDNA & anti SM

320

Cardiovascular manifestations in SLE

Pericardial effusion, verrucous (Libman- Sacks) endocarditis and increased risk of coronary artery disease

321

In which patients does aortic dissection occurs?

With long-standing hypertension and those with Marfan and Ehlers Danlos syndrome

322

It presents would abrupt onset, Severe, tearing chest pain that radiates to the back

Aortic dissection

323

Distended neck veins, hypotension, Diminished heart sounds and pulsus paradoxus

Cardiac tamponade

324

It presents with dyspnea, Malaise, and findings associated with right ventricular failure

Pulmonary hypertension

325

Most common cardiovascular manifestation associated with SLE

Pericarditis

326

It presents with sharp pleuritic chest pain that is relieved by sitting up and leaning forward

Pericarditis

327

When do we consider that an ischemic injury becomes irreversible for contractility in myocardial infarction?

If it last more than 30 minutes

328

After MI, how long does the myocyte last in order to lose all ATP?

60 seconds

329

In MI, who Maintains vasodilation in coronaries the first 30 minutes?

Adenosine

330

Aschoff bodies

Interstitial myocardial granulomas typically found in acute rheumatic arthritis

331

Plump macrophages with abundant cytoplasm and central , round to ovoid nuclei with central , slender chromatin ribbons are called...

Anitschkow cells (caterpillar cells)

332

Characteristics of diastolic heart failure

Normal left ventricle her ejection fraction
End diastolic volume with increase left ventricular filling pressure

333

How is left ventricular diastolic pressure determined?

By the blood volume in the left ventricle cavity and compliance of the left ventricle

334

Cause of Diastolic dysfunction

Decreased in ventricular compliance

335

Cause of systolic dysfunction

Decreased in myocardial contractility

336

Characteristics of systolic heart failure

Reduced left ventricular ejection fraction, along with progressive chamber dilation with increased left ventricular volume and elevated left ventricular end diastolic pressure

337

How is Atrial regurgitation best heard?

At the left sternal border, with the patient leaning forward and at end expiration

338

What does jugular venous distention mean?

Elevation or the central venous pressure in the superior vena cava

339

Acute onset central venous pressure elevation with hypotension and tachycardia

Cardiac tamponade
Pneumothorax

340

Central venous pressure elevation

>15 cm H2O

341

Hypotension, distended neck veins, and distant or muffled hearts sounds on auscultation

Beck triad

342

Beck triad + tachycardia

Cardiac tamponade

343

In congestive heart failure, what does loss of a palpable pulse during inspiration means?

Is most likely due to an inspiratory fall in systolic blood pressure

344

Pulsus paradoxus + acute onset hypotension + tachycardia + JVD=

Cardiac tamponade

345

Characterized by pleuritic chest pain pain and a pericadial friction rub

Acute fibrinous pericarditis

346

The only class 3 antiarrhythmic with beta adrenergic blocking abilities

Sotalol

347

Class III antiarrhythmic

Amiodarone, ibutilide, dofelitide, sotalol

348

Possible side effect of class 3 antiarrhythmics

QT prolongation

349

How do beta blockers decrease heart rate and cardiac contractility?

By slowing AV nodal conduction and the phase 4 depolarization of cardiac pacemaker

350

Clinical use for beta blockers

As myocardium protective agents following myocardial infarction or in congestive heart failure resulting from systolic dysfunction, and as anti hypertensive

351

Slow the phase 0 depolarization of cardiac pacemaker cells and phase 2 of the myocyte action

Calcium channel blockers

352

Which Viral agent cause dilated myocardiopathy?

Coxsackie B

353

Dilation of all four chambers of the heart, systolic dysfunction, and myocardial failure

Dilated cardiomyopathy

354

Situations when thiazide diuretics are not recommended in patients with essential hypertension as a an initial treatment

In patients with CHF and diabetics

355

When are ACE inhibitors the recommended first line of treatment in patients with essential hypertension?

When the patients are diabetics or have CHF

356

Eiocosanoid, arachidonic acid derived substances with paracrine properties

Prostacyclin

357

What is the effect prostacyclin related to platelet aggregation?

Inhibits platelet aggregation and adhesion
And also vasodilates, increases vascular permeability and stimulates leukocyte chemotaxis

358

Clinical use for prostacyclin

Pulmonary Hypertension, Peripheral vascular disease and Raynaud syndrome

359

It's action is to convert kininogen into bradykinin

Kallikrein

360

Which clothing factors are in inhibited by Protein C?

Va and VIIIa

361

Phosphodiesterase isoenzyme 3 inhibitor

Milrinone

362

Which is the effect of cyclic AMP in the heart?

Increases the conductance of the calcium channel in the sarcoplasmic reticulum, and as a result re calcium can enter the cell and strengthen the force of contraction

363

What is the effect of phosphodiesterase isoenzyme 3 in the heart?

Metabolizes cyclic AMP, so decreases calcium in the heart, with decreased contractility as a result

364

Which is the effect of cAMP in vascular smooth muscle?

Cause vasodilation

365

What is the effect of milrinone?

Increase contractility but induces vasodilation

366

When do we see tubular obstruction with urate Crystals?

During tumor lysis

367

Classic clinical presentation of tubular obstruction with urate Crystals

Acute renal failure during chemotherapy for a malignancy

368

What does cystic dilation of the collecting duct make you suspect of?

Autosomal dominant polycystic kidney disease (ADPKD)

369

Classic presentation of Autosomal dominant polycystic kidney disease (ADPKD)

A patient in his 40s or 50s with a family history of renal disease who presents with flank pain, hematuria and hypertension

370

What should you suspect when you see signs of renal failure and toe gangrene or livedo reticularis following an invasive vascular procedure?

Atheroembolic renal disease

371

Which vessels are affected in polyarteritis nodosa?

Medium to small sized arteries in any organ

372

Segmental, transmural, necrotizing inflammation of medium to small sized arteries in any organ

Polyarteritis nodosa

373

Which arteries are spare in polyarteritis nodosa?

Pulmonary arteries

374

What does persistent lymphedema predisposes to?

Lymphangiosarcoma

375

Typical scenario of lymphangiosarcoma

Approximately 10 years following radical Mastectomy for breast cancer

376

With which pathology are cystic hygromas associated?

Turner syndrome

377

In what do cystic hygromas differ to cavernous hemangiomas?

Only by the absence of luminal blood cells

378

What causes congenital QT prolongation?

Due to decreased outward K+ currents

379

When does dynamic left ventricular outflow obstruction happens?

Hypertrophic obstructive cardiomyopathy

380

Alternative name for Buerger disease

Thromboangitis obliterans

381

Which vessels are mainly affected in thrombangitis obliterans?

Vasculitis of medium and small sized arteries, principally tibial and radial arteries

382

What can thrombosed arteries of Buerger diaseas lead to?

Can often extend into contiguous veins and nerves

383

When is Buerger's disease commonly seen?

In heavy cigarette smokers, with onset before age 35

384

When can onion like concentric thickening of arteriolar walls be seen?

A condition that can result from malignant hypertension

385

How does malignant hypertension defined?

Diastolic pressure >120-130 mmHg

386

From which vasculitis is Granulomatous inflammation of the media characteristic?

Temporal (giant cell) arteritis

387

Most common form of systemic vasculitis in adults

Temporal (giant cell) arteritis

388

Which vessels are mainly affected by Temporal (giant cell) arteritis?

Medium to smaller branches of carotid artery, especially the temporal arteries

389

Transmural inflammation of the arterial wall with fibrinoid necrosis

Characteristic of polyarteritis nodosa

390

Heavy cigarette smoker with onset before age 35 and associated with hypersensitivity reaction to intradermal injection of tobacco extract

Thromboangitis obliterans (Buerger's disease)

391

When myocardial infarction occurs in the setting of normal coronary arteries, what should be suspected?

Hypercoagulability with acute thrombosis, or coronary vasospasm

392

Differential diagnosis for mitral valve thickening with vegetations

Infectious endocarditis, rheumatic valvulitis, Libman Sacks endocarditis

393

Pathologies associated to Libman Sacks endocarditis

SLE, and non bacterial thrombotic endocarditis

394

How does SLE affects coronary arteries?

Via arteritis and/or thrombosis

395

How does SLE produce thrombosis?

Due to hypercoagulable antiphospholipid antibody syndrome, present in 10-30%

396

What does bleeding time indicates?

Platelet function

397

What does aPTT indicate?

Intrinsic coagulation system

398

What does PT indicates?

Extrinsic coagulation pathway

399

What is the result of factor VIII deficiency?

Classic X linked hemophilia A

400

Which factor is deficient in hemophilia C?

Factor XI

401

Autosomal recessive disorder of factor XI deficiency

Hemophilia C

402

Which factor is Hageman factor?

Factor XII

403

Carrier molecule for factor VII and mediator of platelet adhesion to the endothelium

Von Willebrand factor

404

Niacin's main side effect

Cutaneous (flushing, warmth, itching)

405

Who mediates cutaneous effects of Niacin?

Prostaglandins

406

Which drug induces red man syndrome? And who mediates it?

Vancomycin by histamine release

407

Reduces pain by decreasing the level of substance P in the peripheral nervous system

Capsaicin

408

Which drug should be initiated promptly in patients with temporal arteritis?

Prednisone

409

Which lab is altered in patients with temporal arteritis?

Erythrocyte sedimentation rate (ESR)

410

How should patients with granulomatosis with polyangiitis be treated?

With cyclophosphamide and prednisone

411

How should patients with Goodpasture syndrome be treated?

Immediate plasmapheresis, along with immunosuppressive therapy

412

Granulomatosis with polyangiitis syndrome

Wegner's syndrome

413

Most common vasculitis associated with MI

Kawasaki's disease

414

Long extremities , scoliosis, pectus excavatum, ectopia lentis, and Aortic root disease

Marfan syndrome

415

Most common cardiac abnormalities

Mitral valve prolapse
Cystic medial degeneration of the aorta

416

In Marfan syndrome patients what is the risk of cystic medial degeneration of the aorta?

Aneurysm dilation

417

Which is the most common cause of death in patients with Marfan syndrome?

Aortic dissection

418

Second most common cause of death in Marfan syndrome

Cardiac failure secondary to mitral valve prolapse and/aortic regurgitation

419

Where are beta 1 receptors found?

Cardiac tissue and on renal juxtaglomerular cells

420

Another effect of metoprolol

Blocks catecholamine induced renin release by the kidney

421

Which veins form brachiocephalic vein?

Right subclavian vein and right internal jugular vein

422

What is Ortner syndrome?

Mitral stenosis can cause left atrial dilation sufficient to impinge on the left recurrent laryngeal nerve

423

Which is the only structure of the intrinsic muscles of the larynx that isn't innervated by left recurrent?

Cricothyroid

424

What is the result of paresis of vocal cord muscles innervated by recurrent laryngeal?

Hoarness

425

Cause of left recurrent laryngeal nerve impingement

Left atrial enlargment

426

Most common cause of left ventricle diastolic dysfunction

Hypertensive heart disease due to chronic hypertension

427

From which situations is crescendo decrescendo systolic murmur characteristic of?

Aortic or pulmonic stenosis

428

Chronic inflammatory disease of the axial skeleton characterized by pain and stiffness of the spine, sacroiliitis and increased risk of aortic regurgitation

Ankylosing spondylitis

429

Characteristic sound of mitral regurgitation associated to chordal rupture

Holosystolic decrescendo murmur

430

Medications that cause Drug induced lupus erythematosus

Hydralazine
Procainamide
Isoniazid
Minocycline
Quinidine

431

In which percentage does procainamide cause drug induced lupus erythematosus?

20%

432

Which antibodies are present in drug induced lupus erythematosus?

ANA and antihistone antibodies in >95% of cases

433

Most notable side effects of amiodarone

Thyroid dysfunction, lung fibrosis, liver toxicity, as well as a blue or grey discoloration of the skin

434

Most frequently encountered adverse effects of nonselective beta blockers

Negative inotropy and bronchoconstriction in patients with asthma or COPD

435

Main side effects of lidocaine

Nonfocal neurologic signs such as tremor, drowsiness, and change in mental status, and can also lead to generalized seizures

436

Which drugs have the highest risk for drug induced lupus erythematosus?

Procainamide and hydralazine

437

Selective vasodilators of coronary vessels

Adenosine and dipyridamole

438

Drugs used in myocardial perfusion imaging studies to stimulate the generalized coronary vasodilation caused by exercise

Adenosine and dipiridamole

439

What is the effect adenosine and dipiridamole in myocardial ischemia due to an obstruction?

Cause coronary steal, may lead to hypoperfusion and potential worsening of existing ischemia

440

Calcific deposits in muscular arteries in people older than 50

Monckeberg's medial calcific sclerosis (medial slerosis)

441

What could be the result of malignant hypertension?

Hyperplastic arteriolosclerosis in renal arterioles

442

Onion like concentric thickening of arteriolar walls in the renal vasculature and elsewhere

Hyperplastic arteriolosclerosis

443

The left heart diastolic volume and stroke volume are reduced, resulting in decreased systemic blood pressure during inspiration, and hence pulsus paradoxus

Conditions that impair expansion into the pericardial space

444

Which pathologies impair expansion into the pericardial space?

Acute cardiac tamponade, constrictive pericarditis, severe obstructive lung disease, and restrictive cardiomyopathy

445

For acute asthma exacerbation treated with beta adrenergic agonist, which type of receptor do they have? What is the effect?

This receptor is a Gs protein coupled receptor that activates adenylyl cyclase and increases intracellular cAMP concentrations

446

This drug mechanism of action is to stabilize mast cells

Cromolyn

447

Which hormones increase the production of cGMP?

Nitric oxide and atrial natriuretic peptide

448

Drug that increases levels of cGMP by inhibiting its degradation

Sildenafil

449

Half life of adenosine

10 seconds

450

Which Is the drug used for chemical stress test?

Adenosine

451

Fever for 5 days, cervical lymph node>1.5 c,, rash, bilateral nonexudative conjunctivitis, mucositis, coronary artery aneurysms,swelling &/or erythema of palms/soles

Kawasaki disease

452

Clinical findings of Kawasaki disease

Fever for 5 days, cervical lymph node>1.5 c,, rash, bilateral nonexudative conjunctivitis, mucositis, coronary artery aneurysms,swelling &/or erythema of palms/soles

453

What is Kawasaki disease?

Vasculitis of Medium sized arteries that affects young children(usually age

454

How is Kawasaki disease diagnosis done?

Fever for more than 5 days plus 4:
1. Bilateral non exudative conjuntivitis
2. Cervical lymphadenopathy
3. Mucositis
4. Extremity changes
5. Rash

455

How is mucositis seen in patients with Kawasaki disease?

Erythema of palatine mucosa, fissured erythematous lips, "strawberry" tongue

456

Characteristics of the rash in Kawasaki disease

Polymorphous (usually urticarial) erythematous rash on the extremities that spreads centripetally to the trunk

457

A serious complication of Kawasaki disease

Coronary artery inflammation leading to development of coronary artery aneurysm

458

What does exertional syncope, harsh systolic murmur and asymmetric septal hypertrophy in a young man suggest?

Hypertrophic cardiomyopathy

459

Most common cause if ventricular fibrillation in individuals below age 30

Hypertrophic cardiomyopathy

460

Episodic and transient angina, chest pain, occurring during the nighttime hours and accompanied by temporal ST segment elevations

Prinzmetal's variant angina

461

When does Prinzmetal angina occur?

Generally occurs at rest

462

Which is the most sensitive provocative diagnostic test for coronary. Vasospasm?

Ergonovine

463

Ergot alkaloid that constricts vascular smooth muscle by stimulating both alpha adrenergic and serotoninergic receptors

Ergotamina

464

Which drug is used to treat Prinzmetal's angina?

Nitroglycerin

465

Used to treat and prevent Prinzmetal's angina

Calcium channel blockers

466

Which is the common evolution of capillary hemangiomas?

First increase in size then regresses

467

When do capillary hemangiomas normally completely regress?

By 7 years old

468

Situations that can lead to concentric left ventricular hypertrophy

Pressure overload: chronic hypertension or aortic stenosis

469

Situations that lead to eccentric ventricular hypertrophy

Volume overload: aortic or mitral regurgitation, myocardial infarction or dilated cardiomyopathy

470

What is deposited in localized amyloidosis confined to the cardiac atria?

Abnormally folded atrial natriuretic peptide derived proteins

471

In which patients is Amylin usually found?

In patients with localized pancreatic amyloidosis

472

Percentage of patients with type 2 diabetes that have Amylin deposits

90%

473

Who is responsible for primary systemic (not localized) amyloidosis?

Deposition of immune globulin light chains, especially delta light chains and fragments

474

When does primary systemic amyloidosis arise?

In association with monoclonal B cell proliferation (eg. Multiple myeloma)

475

Which deposit may be seen in Patients with medullary thyroid cancer?

Calcitonin

476

Which deposit may be seen in Patients with amyloidosis of pituitary gland?

Prolactin

477

Which is the most common cause of intermittent claudication?

Almost always the result of atherosclerosis larger named arteries

478

What does thigh claudication is suggestive for?

Occlusive disease of the ipsilateral external iliac or common femoral arteries and/or both superficial femoral and profunda femoris arteries

479

Seen in about 25% of patients with hypertrophic cardiomyopathy

Left ventricular outflow tract obstruction

480

In patients with hypertrophic cardiomyopathy how is Left ventricular outflow tract obstruction heard?

Harsh crescendo decrescendo systolic ejection type murmur that is best heard along the lower left sternal border and apex

481

On what varies the degree of Left ventricular outflow tract obstruction?

On Left Ventricular end diastolic volume

482

Maneuvers that decrease the preload

Sudden standing, Valsalva or Nitroglycerin administration

483

Maneuvers that increase preload and/or afterload

Squatting, sustained hand grip or passive leg rising

484

Which maneuvers will increase murmur intensity of Left ventricular outflow tract obstruction?

Maneuvers that decrease preload
Sudden standing, Valsalva or Nitroglycerin administration

485

Which maneuvers will decrease murmur intensity of Left ventricular outflow tract obstruction?

Maneuvers that increase preload and/or afterload
Squatting, sustained hand grip or passive leg rising

486

Hemodynamic signs for constrictive pericarditis

increased jugular venous pressure
Kussmaul sign
Pulsus paradoxus
Pericardial knock

487

When is a loud P2 heard?

In pulmonary hypertension