Cardio Flashcards
(90 cards)
1
Q
alpha-granules
A
FVIII, vWF, FV, FI, PF4, fibronectin, mitogens
2
Q
Dense granules
A
ADP, Ca2+, Mg2+, histamine, epinephrine, 5-HT
3
Q
DVT
A
M > W Lower extremity (calf) PE risk proximal > distal Virchows triad predisposes Pain, swelling, erythema (distal) Palpabale cord Low grade fever Treat w anticoagulation
4
Q
Virchows Triad
A
Hypercoaguability
Stasis
Endothelial injury
5
Q
Homan’s sign
A
DVT
Calf pain w foot dorsiflexion
Low sensitivity/specificity
6
Q
D dimer
A
DVT test
Fibrin degradation
Non specific
High sensitivity
7
Q
DVT diagnosis
A
D dimer
Duplex US
Contrast Venography (gold standard)
8
Q
Thrombophlebitis
A
Superficial inflammation and pain involving a vein (DVT differential)
Virchows
Trousseau’s syndrome
Treat w anti-inflammatories and local heat
9
Q
Aspirin
A
Anti TXA2 => Antiplatelet aggregation Irreversible COX1 inhibitor Low dose prophylactic High dose after MI Anti PGE2, low mucus, GI irritation
10
Q
P2Y12 inhibitors
A
Clopidogrel, ticlopidine, prasugrel
Irreversible ADP inhibitor
CYP2C19 metabolism
11
Q
GpIIb/IIIa inhibitors
A
Target platelet integrin etc Rs IV + aspirin + anticoagulants Abciximab: anti IIb/IIIa Ab Eptifibatide/tripfiban: inhibits fibrin binding High risk ACS and PCI
12
Q
Heparin
A
Anticoagulant Binds ATIII & Factor X Toxicity: bleeding, HIT, long term osteoporosis IV/SC Test aPTT throughout Use: DVT, MI, preg
13
Q
LMW Heparin
A
Anticoagulant
Inhibits FXa
SC, less bleeding
Prevent DVT post surgery
14
Q
Warfarin/coumarin
A
Vit K analogs Prevent reduction (activation) of Vit K Prevents y-carboxylation of glut residues on FII, VII, IX, X 8-12hr onset, 1-3day peak Oral Measure PT Use: AF, prosthetic heart valve
15
Q
Factor X inhibitors
A
Fondaparinux: indirect, SC, DVT/PE
Apixaban: oral, VTE (knee/hip surgery), nonvalvular AF (pre stroke)
rivaroxiban: nonvalvular AF
16
Q
Thrombin inhibitors (direct)
A
Desirudin: SC, post-op VTE
Bivalirudin: IV, PCI
Argatroban: IV, HIT thrombosis/PCI
Dabigatran etexiliate: prodrug CYP450, like warfarin w/o monitoring, AF, Preg C
17
Q
Streptokinase and APSAC (anistreplase)
A
Converts plasminogen to plasmin
18
Q
tPA
A
Activated plasminogen bound to fibrin
IV bolus
PE, DVT, acute MI (golden hour)
Not for unstable angina/NSTEMI
19
Q
Acetylcholine/analog effects
A
D: diarrhoea, dec BP U: urination M: mitosis B: bronchoconstriction, bradychardia E: excitation of skeletal muscle (N) L: lacrimation S: salivation, sweating (SNS)
20
Q
Bethanechol
A
ACh Agonist at GI M-Rs
AChE resistant
Postop/partum for bladder, promote salivation (xerostemia)
21
Q
Methacholine
A
M ACh agonist
CH3 inc M specificity
Bronchial hyperreactivity/asthma test
22
Q
Carbachol
A
All AChRs
Amine group
Highly AChE resistant
Wide angle glaucoma - use only when other drugs ineffective
23
Q
Pilocarpine
A
Agonist (partial) at M AChRs Wide angle glaucoma (not preferred) Acute closed angle glaucoma (low P) Salivation 3 Tert amine (CNS effects)
24
Q
Physostigmine
A
Reversible AChE inhibitor
Wide angle glaucoma
Tert amine (CNS) - reverse atropine effects (antiM)
Cataracts
25
Edrophonium
Competitive/reversible AChE inhibitor
Quat amine
MG test
Attracted to an ionic site
26
Neostigmine
```
Reversible AChE inhibitor
Quat amine
Short action
Paralytic loss of tone (GI, bladder)
MG
```
27
Pyridostigmine
Like neostigmine
Quat amine
MG- longer acting
28
Echothiophate
Organophosphate
AChEI
Glaucoma (not preferred)
Only one clinically used
29
Malathion/Parathion
Pro-drug insecticide
Detoxed in mammals via plasma esterases or metabolised by oxygenases
Farm poisoning (most common)
30
Sarin/Soman
Nerve gas
| Volatile, toxic synthetic agent
31
Organophosphate poisoning
```
S: sweating, salivation
L: lacrimation
U: urination
D: defacation
G: GI upset
E: emesis
B: bradycardia/bonchoconstriction
A: abdominal cramps, anorexia
M: miosis
```
32
Organophosphate treatment
Atropine + pralidoxime (PAM)
Support resp distress
Diazepam (convulsions)
33
Atropine
Anti-M (all)
| Use: muscarine poison, AChE inhibitor poison, diarrhea, long-lasting pupil dilation
34
Scopolamine
Atropine-like
| Motion sickness
35
Tropicamide/Homatropine
M-R antagonist
Short acting
Pupil dilation
36
Ipratropium/Tiotropium
M-R antagonist
Quat amine
COPD
37
Tolterodine/Oxybutynin/Solifenacin
Bladder M-R antagonist
| Treat overactive bladder
38
Dicyclomine/Hyocyamine
GI M-R antagonist
| IBS
39
Glycopyrrolate
M-R antagonist
| Use for secretion, sweating, M overshoot after AChE inhibition
40
Benztropine
Lipid soluble M-R antagonist
| Treats Extrapyramidal effects
41
Mecamylamine
N-R ganglion antagonist
Improve GI absorption
Tourette’s
42
Hexamethonium
N-R ganglion antagonist
| Prevent barroreceptor reflex
43
P Falciparum life cycle
```
10-14d incubation
No exoerythrocytic
All RBC stages infected
48hr erythrocytic cycle
High RBC parasitemia (60%)
```
44
P vivax
```
12-15d incubation
Yes exoerythrocytic
Reticulocyte stage
48hr RBC cycle
Low parasitemia (2%)
```
45
P ovale
```
12-15d incubation
Yes exoerythrocytic
Reticulocyte stage
48hr cycle
Low parasitemia
```
46
P malariae
```
18-30d incubation
No exoerythrocytic
Senescent
72hr cycle
Low RBC parasitemia
```
47
Cardiac endocarditis complications
```
Valve destruction
CHF
Myocardial/valve ring abscess
Superlative pericarditis
Emboli
```
48
Embolic endocarditis complications
L side: brain, Roth spots, heart, spleen, kidney
| R side: lung, septic emboli, infarct, pneumonia
49
Janeway lesions
Septic emboli
Hemorrhagic non-painful macules
Palms/soles
50
Osler nodes
Painful nodules
SC
Distal pads of fingers/toes
51
Roth spot
Retinal hemorrhage
Small central clearing
L sided IE
52
IE lab findings
```
Anemia
High ESR, CRP
Leukocytosis
RF
Ag-Ab complexes
Histocytes
Hematuria
+ blood culture
```
53
IE diagnostic tests
```
Blood cultures (mult over time)
Echocardiogram (all)
```
54
IE prophylaxis
B-lactam agent
Amoxicillin, ampicillin, cefazolin
Single dose 30-60min before procedure
55
Bacterial resistance mechanisms
1. B-lactamase antibiotic inactivation (constitutive or induced): staph to penicillin G
2. Reduced PBP affinity for antibiotic: staph to methicillin
3. Dec drug entry via porins: Gram(-) to B-lactams
56
P wave
Atrial depolarisation
57
PR interval
AV delay
| .12-.20
58
QRS
Ventricular depolarisation
59
ST segment
Ventricular depolarisation ending to repolarization beginning
No length
60
T wave
Ventricular repolarization
| No length
61
QT interval
Vent depol/repol
62
U wave
Vent afterpotentials
Purkinje repol
No length
63
Low voltage EKG causes
QRS amp <10mm (precordial) and <5mm (limb)
1. COPD
2. Pericardial effusion
3. Restrictive/infiltrative cardiomyopathies (amyloidosis)
64
Atherosclerotic plaque distribution
```
Ostia and branch points :
Abdominal aorta
Coronary a
Popliteal a
Circle of Willis
Internal carotid a
```
65
LAD
```
Anterior ventricles
Ant 2/3 septum
Ant papillary
Diagonal branch: LV surface
MI in V1-V4 (anterior)
```
66
Circumflex
L atrium
Post/lateral L vent
MI in V5, V6, I, aVL (anterolateral)
67
RCA
```
R atrium
R vent
SA/AV (nodal arteries)
R marginal: RV
PDA: Post 1/3 septum
MI in II, III, aVF (inferior)
```
68
LDL eqn
LDL = total cholesterol - HDL - TG/5
69
Metabolic syndrome
```
Abdominal obesity
TG
BP
Fasting glucose high
Low HDL
```
70
Ischemia
Demand > supply of blood/O2 to myocardium
| Usually bc of atherosclerotic coronary
71
Angina
Pain due to myocardial ischemia
70% dec in lumen w inc O2 demand (exercise)
90% dec in lumen w/o inc O2 demand
72
Stable angina
Transient angina
Activity/emotional upset
Relieved by rest (mins)
No myocardial damage
73
Silent ischemia
Asymptomatic
ECG
Seen in DM, elderly
74
Variant angina
Coronary a spasm at rest
No plaques
Prinzmetals
75
Unstable angina
Inc angina freq w less exertion
| Progress to MI
76
MI
Myocardial necrosis from blood supply loss
| Thrombus
77
Dressier Syndrome
```
Uncommon pericarditis weeks post MI
Immune against heart tissue
Fever, sharp pain
Pericardial effusion
Aspirin/NSAIDs
```
78
Lambl excrescences
Filiform processes on aortic/mitral valve closure lines
| Small thrombi organization
79
Heart Disease Principal Mechanisms
1. Pump failure
2. Flow obstruction
3. Regurgitant flow
4. Shunted flow
5. Conduction abnormalities
6. Heart/major vessel Rupture
80
Trisomy 21 cardiac defects
VSD, ASD, PDA (AV septal)
81
Trisomy 18 cardiac defects
VSD, double outlet RV, PDA
82
Trisomy 13 cardiac defects
VSD, ASD, PDA
83
Turners XO cardiac defect
Aortic coarctation
84
Marfans (connective tissue) cardiac defects
Mitral valve prolapse
| Aortic root dilation
85
DiGeorge cardiac defects (cardiofacial)
Conotruncal (truncus arteriosus)
86
TAR (upper limb) cardiac defects
Tetralogy of Fallot
87
Williams syndrome cardiac defects
Supravalvular aprtic/pulmonary stenosis
88
Cyanotic CHD
Fixed R —> L shunt
| Tetralogy of Fallot
89
Acyanotic CHD
No shunt
| Aorta Coarctation
90
Cyanosis Tardive
Initial L —> R shunt and later R —> L shunt
VSD
Pulmonary hypertension reverses flow
Eisenmenger’s Complex
