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Flashcards in Cardiology Deck (167):
1

Beta Blockers

slow AV conduction, increase PR interval
decrease cAMP, Ca currents

2

Esmolol

very short acting

3

Metoprolol side effect

dyslipidemia

4

Nitroglycerin - molecular mechanism

NO --> increase cGMP --> decrease Ca/MLCK --> dephosphorylation --> SM relaxation (vasodilate!)

5

Nitrates - sympomatic relief by

decrease cardiac preload/LV volume

6

NO/Nitrates primarily work on

VEINS

7

Nitrate with highest bioavailability

isosorbide mononitrate

8

Beta Blockers affect preload/afterload

afterload

9

Ca Channel blocker mechanisms

block L type channels
reduce muscle contractility
(slow diastolic depolarization)

10

Digoxin side effects

N/V, blurry vision
ECG changes
hyperkalemia

11

autoregulation of coronary blood flow

NO

12

Causes of Pulsus Paradoxus

acute cardiac tamponade
constrictive pericarditis
restrictive cardiomyopathy
severe obstructive lung dz

13

milrinone

vasodilation

14

maintenace dose

Cpss x CL / bioavailability fraction

15

cause of tetralogy of fallot

abnormal neural crest cell migration

16

trauma affects

aortic arch rupture

17

CO =

SV x HR

18

MAP

CO x TPR

19

preload

ventricular EDV

20

Preload increases with

exercise
increased BV
sympathetics

21

Afterload

mean arterial pressure

22

venodilators

nitroglycerin
decrease preload

23

vasodilators

hydralazine
decrease afterload

24

EF =

SV / EDV

25

increase handgrip, murmur at LSB

VSD

26

Bicuspid Aortic Valve

aortic stenosis

27

Severe Aortic Stenosis

LV hypertrophy, reduced LV compliance
decrease in LV preload

28

Mitral Stenosis Severity

S2 to opening snap interval

29

Ventricular Action Potential

Phase O - Na
1 - K influx
2 - Ca
3 - K efflux (close Ca channels)
4 - K permeability

30

Pacemaker Action Potential

0 - VG Ca channels open
3 - inactivate Ca channels, increase K efflux
4 - slow diastolic depolarization, inward Ca

31

heart rate determined by

slope of phase 4 in SA node

32

U wave

hypokalemia, bradycardia

33

Jervell and Lange-Nielsen syndrome

congenital long QT syndrome
defects in cardiac sodium or potassium channels
congenital sensorineural deafness

34

ANP

released in response to increase BV and atrial pressure
causes relaxation, decreased Na reabsorption
constricts efferent renal arterioles
dilates afferent renal arterioles
"escape from aldosterone"

35

PCWP

apprxoimation of LAP

36

LAD

anterior wall
V1-4

37

LCX

lateral wall
I, avL

38

RCA

inferior wall
II, III, aVF

39

Causes of Dialted Cardiomyopathy

Alcohol, wet Beriberi, Coxsackie B, Cocaine, Chagas, Doxorubicin
hemochromatosis, peripartum

40

Causes of Hypertrophic Cardiomyopathy

AD/B myosin heavy chain mutation
Friedreich's ataxia

41

Restricture Cardiomyopathy causes

sarcoidosis, amyloidosis, radiation, hemochromatosis,
endocardial fibroelastosis
Loffler's syndrome

42

Loffler's syndrome

eosinophilic infiltrate

43

Hypertrophic Cardiomyopathy treatment

B blocker
Non -DHP Ca Channel Blocker

44

CHF - systolic

decrease in contractility

45

CHF - diastolic

inability of heart to relax to accomodate incoming blood during diastole

46

CHF ultimately causes

decrease CO
inadequate O2 tissue delivery

47

Cellular Responses to CHF

increase RAS
increase Sympathetic output

48

increase RAS

Na retention
Aldosterone
Vasoconstriction (increase afterload)

49

cardiac cath

advance right to left

50

A fib ventricular rate determined by

AV node refractory period

51

Chronic AV fistula

increase CO
decrease TPR

52

V Wave

Mitral regurg

53

Biventricular pacemaker

RA, RV, LV
LV -- soronary sinus/AV groove

54

fibrinous pericarditis

dressler's syndrome
uremia
radiation

55

serous pericarditis

viral
non infections -- RA, SLE

56

purlent/suppurative pericarditis

bactieral infections (Pneumococcus, Streptocccus)

57

Cardiac Tamponade

increased JVD
distant heart sounds
pulsus paradoxus

58

scattered cells within a mucopolysacchride strome

myxoma

59

polyarteritis nodosa association

Hep B

60

Kawaski dz treatment

IV immunoglobulin and aspirin

61

Time after MI: 0-4 hrs

no change

62

Time after MI: 4-12 hrs

early coag necrosis
edema/hemorrhage
wavy fibers

63

Time after MI: 12-24 hrs

coag nec
marginal contraction band necrosis

64

Time after MI: 1-5 d

coag nec
neutrophilic infiltrate

65

Time after MI: 5-10d

macrophage phagocytosis of dead cells

66

Time after MI: 10-14 days

granulation tissue
neovascularization

67

Time after MI: 2 wks - 2 months

collagen deposition
scar formation

68

a

right atrial contraction

69

c

tricuspid valve during RV contraction

70

x

right atrial relaxation

71

v

inflow of venous blood

72

y

emptying of RA after TC valve opening

73

purpose of manuvers for PSVT

increase cardiac parasympathetic tone

74

cartoid sinus massage

prolong AV node refractory period

75

thiazide diuretics - side effects

hyper: uric, calcium, glycemia, lipidemia
hypokalemia, hypotension

76

diet drugs

secondary pulmonary hypertension

77

supine hypotension

compressing IVC
decrease venous return
decrease preload
decrease CO

78

Ca and muscle types

skeletal is intracellular only

79

AcH, adenosine

during phase 4, decrease hr

80

golden yellow/brown cytoplasmic granules

think lipofuscin or hemosiderin
hemosidern will stain blue/black

81

alveolar macrophages containing hemosidering

LSHF (heart failure cells)

82

Sotalol mofa

also has K channel blocking effects (increase QT interval)

83

Dobutamine

B adrenergic agonist (B1>B2)
increases mycoardial oxygen consuption

84

increased myocardial oxygen consumption

+ chronotropic effect

85

electrical speed of heart

purkinje > atria > ventricle > AV node

86

coagulative necrosis

ischemic injury

87

liquefactive necrosis

bacterial infection
cns infarcts

88

fat necrosis

acute pancreatitis

89

caseous necrosis

tb infection

90

Ebstein's anomaly

atrial displacement of tricuspid valve leaflets
lithium in utero

91

Verpamil side effects

2nd and 3rd degree heart block
contraindicated in pts with CHF

92

BAV associated with

Turners

93

Daptomycin

treatment for MRSA
depolarization of cellular membrane
myopathy/CPK elevation
inactivated by pulmonary surfactant

94

localized amyloidosis

due to natriuretic peptides

95

prostacyclin

inhibits platelet aggregation

96

Hibernating myocardium

decreasing energy metabolism but enough ATP to prevent contracture
also expression of TNF alpha, NOS
reverse with CABG or balloon angioplasty

97

plaque

lipid core
fibromuscular cap

98

foam cells

oxidized lipids consumed by macrophages

99

prinzmetal angina

coronary artery vasospasm

100

primzmetal angina treatment

ng or CCB

101

aspirin/heparin after MI

limit thrombosis

102

supllemental O2 after MI

minimize ischemia

103

nitrates after MI

vasodilate veins and coronary arteries

104

B blocker after MI

slows HR
decrease O2 demand
decrease risk for arrythmia

105

ACEI after MI

decrease LV dilation

106

fibrinolysis/angioplasty after MI

opens blocked vessel

107

risk 4-24 hrs after MI

arrythmia

108

risk 1-3 days after MI

fibrinous pericarditis

109

risk months after MI

aneurysm
mural thrombosis
dresslers

110

Anitschkow cells

reactive histiocytes with slender, wavy nuclei

111

microangiopathic hemolytic anemia

aortic stenosis

112

s. viridans

previously damaged valves

113

s. aureus

iv drug use

114

s. epidermis

prostheitc valves

115

s. bovis

coldon cancer

116

negative blood cultures

haemophilius, actinobacillus, cardiobacterium, eikenella, kingella

117

metastasis to heart

breast and lung carcinoma
melanoma
lymphoma

118

TEE (anatomy)

anterior - LA
posterior - descending aorta

119

Class IA

Disopyramide, Quinidine, Procainamide
Na
increase AP duration, Qt interval

120

Class IA Side Effects

thrombocytopenia, torsades

121

quinidine toxicity

tinnuitis

122

Class IB

Lidocaine, Tocainide, Mexiletine
decrese AP duration
best post MI

123

Class IC

flecainide, propafenone
contraindicated post MI and structural heart disease
signifcantly prolong refractory period in AV node

124

Class III

amodiarone, ibutilide, dofetilide, sotalol
increase AP duration, increase QT interval

125

Amodiarone

has Class I, II, III, IV effects
least chance of torsades

126

Class IV

verpamil, diltiazem
increase PR interval

127

adenosine

increases K out of cells

128

adenosine can be blocked by

theophylline, caffine

129

Mg2+

effective in torsades
digoxin toxicityc

130

carvedilol and HF

decreases mortality

131

patent foramen ovale

normal
RAP >> LAP, paradoxical emboli

132

carcinoid heart disease

endocardial fibrosis, usually right sided
5HIAA in urine

133

Neseritide

form of BNP

134

paradoxical emboli

venous system --> arterial
(DVT --> stroke)
example: ASD

135

Coronary Steal Syndrome

coronary arteriolar vasodilation exacerbates ischemia by decreasing collateral blood flow
examples: adenosine, dipyramide

136

midsystolic click

MVP

137

indicator of severity of MR

S3 gallop

138

to maintain CO in AR...

increase LV preload

139

Beta blockers work on what type sof tissue

cardiac
renal juxtaglomerular cells

140

atenolol

selective B1 antagonist

141

A fib treatment

1 - CCB, BB
2 - digoxin

142

Dopaminergic Receptor types

D1 - S
D2 - i

143

saline for hypovolemic shock

increase intravascular volume and preload

144

Ergonovine test

prinzmetal angina/provokes chest pain

145

causes of acute LV failure

MI, severe htn, arrythmia, drug use

146

nitroprusside

balanced venous and arterial vasodilator
decrease preload and afterload

147

beta blocker overdose

glucagona (increases cAMP)

148

ANP produced by ventricles

due to hypertrophy

149

CO calculation with O2

O2 consumption/ AV O2 difference

150

dystrophic calcification

cell necrosis

151

ASD consequences

pulmonary htn

152

diastolic hf and ef

normal ef
decrease ventricular compliance
increased LV EDP

153

increase in O2 sat from R atrium to ventricle

VSD

154

Class I Sodium Binding Strength

IC > A > B

155

arterial vasodilation leads to activation of

SNS

156

HCM LV outflow obstruction due to

mitral valve cusps and IV septum

157

ACE comes from

lung endothelium

158

irreversible myocardial cell injury path

mitochondrial vaculozation

159

drugs that act on proximal tubule

acetazolamide

160

drugs that act on descending limb

mannitol

161

drugs that act on thick ascending limb

loop diuretics/furesomide

162

drugs that act on DCT

thiazide

163

drugs that act on CT

na channel blockers/amiloride
aldosterone receptor antagonists

164

Concentric LV hypertrophic

pressure
AS, chronic HTN

165

Eccentric LV hypertrophy

volume overload
AR, MR, MI, DCM

166

Kussmaul sign

paradoxical rise in JVP
due to constrictive pericarditis

167

cyanosis in LE only

PDA