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Cardio Flashcards

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1
Q

Which two cardiac anomalies may occur in Turner Syndrome?

A

Bicuspid aorta

Coarctation of the aorta

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2
Q

Early diastolic murmur?

A

Aortic Regurgitation

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3
Q

Precursor amino acid for NO?

A

Arginine

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4
Q

Location of the AV node?

A

Interatrial septum near the opening of the coronary sinus

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5
Q

What must be present if an infant has transposition of great vessels and also is alive?

A

PDA- to allow for mixing of the blood

Patients may present as normal but deteriorate within the first 3 days as the ductus arteriosus closes

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6
Q

Which murmur is heard best in the left lateral decubitus position?

A

S3

Normal below 40, considered abnormal >40

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7
Q

Name the nerves that arise from pharyngeal arches 1-6

A

1- maxillary (5)
2- facial (7)
3- glossopharyngeal (9)
4- superior laryngeal branch of vagus (10)
5- nothing
6- recurrent laryngeal branch of vagus (10)

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8
Q

Name the arteries that arise from aortic arches 1-6

A 
1- maxillary
2- Stapedial (regresses)
3- Common carotid, proximal internal carotid
4- True aortic arch, subclavian
5- obliterated
6- Pulmonary arteries, ductus arteriosus
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9
Q

Where do aortic dissections occur?

A

Aortic isthmus (just beyond the 3 branches), by the ligamentum arteriosus

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10
Q

Common drainage for the entire right side of the body?

A

Brachiocephalic vein

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11
Q

4 abnormalities of tetrology of fallot?

A

VSD
Overriding aorta of the right and left ventricles
Right ventricular outflow tract obstruction
Right ventricular hypertrophy

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12
Q

Embryologic cause of tetrology of fallot?

A

Anterior and cephalad deviation of the infundibular septum

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13
Q

What causes a AAA?

A

Chronic transmural inflammation

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14
Q

What causes a thoracic aortic aneurysm?

A

Vaso vasorum enteritis from tertiary syphilis

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15
Q

Prominent findings in Osler-Weber-Rendu syndrome?

A

Congenital telangiectasias to the skin and mucus membranes

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16
Q

Other way to calculate cardiac output?

A

CO = Rate of O2 consumption/ arteriovenous O2 content difference

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17
Q

Peripheral neuropathy and cardiac findings?

A

Wet beriberi –> thiamine deficiency

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18
Q

Why does squatting help with tetrology of fallot?

A

INcreases peripheral vascular resistance and minimizes right to left shunt

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19
Q

Differentiate the role of Ca2+ in contractility in cardiac vs skeletal

A

Skeletal muscle: L-type calcium channels directly interact with Ryandine receptor

Cardica: Calcium-induced calcium- requires influx of calcium

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20
Q

What is the mutation involved in hereditary pulmonary hypertension?

A

Inactivating mutation of BMPR2. Patients with this mutation have a predisposition for dysfunctional endothelial and smooth muscle cell proliferation. A second insult is then thought to activate the disease process, resulting in vascular remodeling, elevated pulmonary vascular resistance and progressive pulmonary hypertension

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21
Q

Top for arteries involved in atherosclerosis?

A

Abdominal aorta > coronary arteries > popliteal > internal carotid

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22
Q

What is a non-cardiac consequence of an enlarged left atrium?

A

Mass effect on esophagus causing dysphagia

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23
Q

Name the two ways Ca2+ leaves the cardiac cell following contraction

A
  1. Na+/Ca2+ exchanger into the sarcolemma

2. SERCA (Ca2+ ATPase pump) into the sarcoplasmic reticulum

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24
Q

Wide, fixed splitting indicates which cardiac defect?

A

ASD

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25
Which antiarrhythmic drug prolongs QT without causing torsades de pointes?
Amiodarone
26
Strep Viridin only binds to previously damaged valves. To what does it adhere?
Fibrin-platelet aggregates
27
What statistical test is used to compare the means of two different groups?
Student T-test
28
What is the brownish pigment seen in normal aging of the heart?
Lipofuscin
29
What is the association between smoking and Buerger's disease?
Hypersensitivity to tobacco --> segmental thrombosing vasculitis that often extends into contiguous veins and nerves, encasing them in fibrous tissue
30
Describe the murmur detected in atrial stenosis?
systolic crescendo-decrescendo
31
Which two structures obstruct normal blood outflow in someone with HOCM?
Interventricular septum and the anterior mitral valve leaflet
32
What is the second messenger system when NE binds to alpha-1 receptors on smooth muscle endothelium?
IP3 and DAG
33
MOA of fibrates?
The lower triglyceride levels by activating PPRalpha which leads to decreased hepatic VLDL production
34
Best way to determine mitral stenosis severity?
A2 to opening snap time interval
35
Where does the saphenous vein drain?
Drains into the femoral vein, within the region of the femoral triangle, a few centimeters inferolateral to the pubic triangle.
36
What determines the ventricular rate in a fib?
AV node refractory period
37
What lipid lowering agent cannot be combined with a statin as it significantly increases the risk of rhabdomyolysis
Gemfibrozil
38
Where is the stenosis that leads retrograde flow of the vertebral artery?
Subclavian, just before the vertebral artery (creates low pressure)
39
Exposure to carcinogens such as arsenic, thorotrast and polyvinyl chloride leads to which carcinoma?
Liver angiocarcinoma
40
Angioedema with ACE inhibitors is caused by what?
Accumulation of bradykinin
41
Clinical signs of cardiac tamponade?
``` Becks triad: hypotension, JVD, diminished heart sounds Pulsus paradoxus (loss of pulse on inspiration) ```
42
Gram positive bacteria that synthesizes dextran from sucrose?
Strep viridans
43
How does lupus affect the cardiovascular system?
Accelerated atherosclerosis and increased risk of MI Pericarditis Leiman-Sacks endocarditis- on BOTH surfaces of the valve
44
How does lupus affect the kidneys?
Diffuse proliferative glomerulonephritis with "wire-loop" structures on exam
45
Effects of milrinone?
PDE-3 inhibitor inhibits the breakdown of cAMP --> Increased inotropy in cardiac muscle Increased vasodilation in smooth muscle
46
Main mediator for autoregulation of coronary blood flow?
NO
47
How might coarctation of the aorta be linked to intracerebral hemorrhage?
Coarctation of the aorta is associated with other cardiac anomalies or with berry aneurysms in the circle of willis
48
What cell type provides the major proliferative stimuli for the cellular components of an atherosclerotic plaque?
Platelets- they release PDGF promotes the migration of smooth muscle cells from the media to the intima and their subsequent proliferation
49
Dihydroergotamine is most similar to what drug that I know?
Triptans
50
Which anti-arrhythmic drugs block the potassium channels most substantially?
Class III- they prolong repolarization and total action potential duration
51
LVED volume in diastolic heart failure: normal, increased or decreased?
Normal
52
How does carotid massage affect the afferent firing rate?
Increases firing rate to increase vagal parasympathetic tone
53
Loss of contractility in cardiac myocytes occurs within what time period of the onset of ischemia?
60 seconds
54
What is transthyretin in relation to the heart?
TTR is a protein tetramer produced in the liver and acts as a carrier for thyroxine and retinol. Mutations cause it to misfold and deposit as an amyloid protein in the myocardium
55
How is TPR affected by exercise?
Decreases- vasculature dilates to permit maximal blood flow to the muscles being used
56
What type of drug is enoxaparin?
LMWH- use for acute DVTs
57
What is plasma renin activity?
Amount of angiotensin I generated per unit time
58
How are plasma renin levels affected by ARBs and ACE inhibitors?
Renin is increased
59
How do beta blockers affected plasma renin levels?
They block sympathetic stimulation
60
Kussmaul sign is indicative of what cardiac pathology?
Constrictive pericarditis
61
Name the two prostaglandins that are in balance with one another to regulate platelet aggregation
Prostacyclin I2: inhibits platelet aggregation | Thromboxane A2: promotes platelet aggregation
62
Where is prostacyclin I2 produced?
Vascular endothelial cells Damage inhibits the ability to produce prostacyclin I2 and therefore leaves the area susceptible to platelet aggregation and thrombus formation
63
First branch off of the external iliac?
Inferior epigastric
64
Normal pressures in the right ventricle?
30/5
65
Normal pressures in the pulmonary artery?
30/10
66
Cardiac findings in cardiac carcinoid disease?
endocardial thickening and fibrosis of tricuspid and pulmonary valves
67
What causes carcinoid heart disease?
Excessive secretion of serotonin from carcinoid tumors (rare neuroendocrine tumors of distal small intestine and proximal colon) stimulates fibroblast growth and fibrogenesis Only the right side of the heart is usually involved as the MOAs in the lungs degrade excess serotonin
68
What is the end product of serotonin metabolism?
5-hydroxyindoleacetic acid (5 HIAA)
69
What is the main determinant of symptom severity of tetralogy of fallot?
Right ventricular outflow tract obstruction The worse it is, the most deoxygenated blood is delivered to the systemic circulation
70
Dystrophic calcification of aging aortic valves follow what prior damage?
Cell injury and death occurring in all types of necrosis at normal plasma calcium levels
71
Blocking what part of the action potential prolongs the QRS duration?
fast Sodium channels Class 1 anti-arrhythmic drugs do this
72
What's the connection between migratory thrombophlebitis and pancreatic cancer?
Hypercoagulability develops because adenocarcinomas produce a thromboplastin-like substance that causes chronic intravascular coagulations that tend to disseminate and migrate
73
Which drug is used for chemical stress tests
Adenosine
74
Most common adverse effect of fibrinolytic therapy?
Intracerebral hemorrhage
75
Other than ACE inhibitors, ARBs, and ABEAM beta blockers, which other drug improves survival in people with heart failure?
Spironolactone
76
What determines coronary dominance?
The coronary artery that supplies that posterior descending artery
77
The AV nodal artery is a branch of which artery?
In right-dominant people: the RCA | In left-dominant people: the left circumflex artery
78
List the order of receptors bound by dopamine as the dose increases
D1 --> B1 --> A1
79
What causes pulsus parvus et tardus and which cardiac condition is traditionally associated with it?
Slow rising, low amplitude pulse due to diminished stroke volume and prolonged LV ejection time
80
What is the protein mutated in congenital long QT syndrome?
Potassium channel proteins - leads to decreased outward rectifying K+ current
81
Why do you avoid nitrites in patients with hypertrophic cardiomyopathy?
left ventricular outflow tract obstruction is INCREASED as the preload decreases. It is therefore important to maintain a high preload in these patients.
82
What predisposes someone to the development of lymphangiosarcoma?
Persistent lymphedema (with chronic dilation of lymphatic vessels)
83
Which artery may crush the left renal vein?
The left renal vein can get crushed below the SMA and the abdominal aorta
84
List the CYP 450 3A4 inducers
Carbamepazine, PHenobarbitol, Phenytoin, Rifampin, Griseofulvan
85
Between phentolamine and phenoxybenzamine, which is reversible and which is irreversible?
Phentolamine is reversible | Phenoxybenzamine is irreversible
86
Why is glucagon the drug of choice for beta blocker overdose?
Glucagon acts on G protein-coupled receptors, increasing intracellular cAMP and thus increasing the intracellular Ca2+ concentration
87
Which two drugs act as selective vasodilators of coronary vessels that cause coronary steal.
Adenosine and dipyridamole
88
What causes intracellular swelling following ischemic episodes?
Loss of ATP --> loss of ion concentration gradients and increased intracellular Na+ and Ca2+ concentrations
89
The middle meningeal artery is a branch of which artery?
Maxillary- Skull fractures --> hematomas
90
Alternative medication to aspirin?
Clopidogrel

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