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Flashcards in Cardiology Deck (302):
1

Truncus Arteriosus becomes...
Pathology of TA

Ascending Aorta and Pulmonary Trunk
Transposition of the Great Vessels (failure to spiral), Tetralogy of Fallot (skewed AP septum), Persistent TA (partial AP septum development)

2

Bulbus Cordis becomes

Smooth part (outflow tract) of L and R Ventricles

3

Primitive Ventricle Becomes

Trabeculated Ventricles

4

Primitive Atria become

Trabeculated Atria

5

Left Horn of Sinus Venosus becomes

Coronary Sinus

6

Right Horn of Sinus Venosus becomes

Smooth part of RA

7

Right Common Cardinal Vein and Right Anterior Cardinal Vein become

SVC

8

What kind of cells forms the aorticopulmonary septum

Neural Crest Cells. Truncal and bulbar ridges spiral and fuse to form AP septum giving rise to the Ascending Aorta and the Pulmonary Trunk

9

Interventricular Septum Development

1. Muscular ventricular septum forms with interventricular foramen
2. AP septum rotates and fuses with muscular ventricular septum to form membranous interventricular septum, closing interventricular formane
3. Growth of endocardial cushions separate atria from ventricles and contributes to both atrial separation and membranous portion of interventricular septum

10

Membranous septal defect will lead to

L-R shunt which later reverses to R-L shunt due to onset of PHTN (Eisenmengers syndrome)

11

Interatrial septum development

1. Foramen primum narrows as septum primum grows towards endocardial cushions
2. Perforations in septum primum form foramen secundum and FP disappears
3. FS maintins R-L as suptum secundum begins to grow
4. Septum Secundum contains FO (permanent opening)
5. Foramen secundum enlarges and upper part of septum primum degenerates
6. Remaining portion of septum primum forms valve of FO
7. Septum secundum and septum primum fuse to form atrial septum
8. FO closes soon after birth because of increased LA pressure

12

PFO caused by

Failure of Septum Primum and Septum Secundum to fuse after birth

13

Fetal erythropoiesis occurs in?

"Young Livers Synthesize Blood"
Yolk Sac: weeks 3-10
Liver: week 6 - birth
Spleen: 15-30 weeks
Bone Marrow: 22 weeks to adulthood

14

Blood in umbilical vein
PO2
O2 Sat

PO2 = 30mmHg
O2 Sat = 80%

15

Umbilical arteries O2 Sat?

Low

16

Fetal Shunts

1. Umbilical vein --> ductus venosus --> IVC to bypass liver
2. RA --> FO --> LA
3. Pulmonary Artery --> Ductus Arteriosus --> Aorta

17

What happens to fetal circulation when the infant takes its first breath

Decreased resistance in pulmonary vasculature --> increased P in LA --> FO closes
Increased O2 --> decreased prostaglandins --> ductus arteriosus closes

18

Medication for PDA

Indomethacin closes the PDA
PGE keeps in open

19

Umbilical vein becomes

Ligamentum teres hepatis contained in the falciform ligament

20

Umbilical arteries become

Medial umbilical ligaments

21

Ductus arteriosus becomes

Ligamentum arteriosum

22

Ductus venosus becomes

Ligamentum venosum

23

Foramen Ovale becomes

Fossa Ovalis

24

Allantois becomes

Urachus - median umbilical ligament. The Urachus is part of the allantoic duct between bladder and the umbilicus
Urachal cyst or sinus is a remnant

25

Notochord becomes

Nucleus pulposus of IV disc

26

What vessels supplies the SA and AV nodes?

RCA

27

What percentage of individuals are Right Dominant? Left Dominant? Codominant?

PDA arises from RCA in 85% of individuals
From LCX in 8%
Both in 7%

28

Most commonly occluded coronary arteries?

LAD > RCA > CFX

29

Coronary arteries fill during

Diastole

30

Branches of RCA

Acute Marginal, PDA (80%)

31

Branches of LCA

CFX, LAD

32

If LA enlarged
How to diagnose?

Dysphagia (compression of esophagus) + Hoarseness (compression recurrent laryngeal nerve)
Transesophageal Echocardiography

33

What can transesophageal echocardiography be used to diagnose?

LA Enlargement, Aortic Dissection, Thoracic Aortic Aneurysm

34

What does LAD supply?

Ant 2/3 of IV septum, anterior papillary muscles, anterior surface of LV

35

What does LCX supply?

Lateral and Posterior walls of LV

36

What does PDA supply?

Posterior 1/3 of IV septum and posterior walls of ventricles

37

Cardiac Output Equation (2)?

CO = SV x HR
Fick Principle
CO = (Rate of O2 consumption)/(arterial O2 - venous O2)

38

Mean Arterial Pressure Equation? (2)

MAP = CO x TPR
MAP = 2/3 Diastole + 1/3 Systole

39

Pulse Pressure Equation?
What is PP proportional to?

PP = Systolic - Diastolic
PP α SV

40

Stroke Volume Equation?

EDV - ESV

41

During exercise, how is CO maintained?
Early?
Late

Early: Increases in HR and SV
Late: HR only, SV plateaus

42

What happens if HR is too high?

Diastolic filling is incomplete and CO decreases resulting in ventricular tachycardia

43

What variables affect SV?

SV CAP
Contractility, Afterload, Preload

44

What decreases Contractility?

BACH
β Blockers (decreased cAMP), Acidosis, Ca Channel Blockers (non-dihydropyridine), Hypoxia/Hypercapnea, Systolic Heart Failure

45

What Chemicals Increase Contractility?

Catecholamines (increase activity of Ca pump in SR). Digitalis (Increased intracellular Na --> increased intracellular Ca)

46

SV increases in what states?

Pregnancy, Exercise, Anxiety

47

Myocardial O2 demands increase with

CARS
Increased Contractility, Afterload, Rate, Size (wall tension)

48

Preload is equal to?

EDV

49

Afterload is equal to?

MAP
Proportional to peripheral resistance

50

What kind of drugs reduce preload?

Venodilators like Nitroglycerin

51

What kind of drug reduce afterload?

Vasodilators like Hydralazine

52

Preload increases with

Exercise, Volume, Excitement

53

Force of contraction proportional to?

Preload

54

Ejection Fraction
Formula
Index for?
Normal value
Decreases in?

EF = SV/EDV
Index for ventricular contractility
Normally ≥ 55%
Decreases in Systolic HF

55

Pressure formula

P = Q x R

56

Resistance formula (2)

R = P/Q = (8 x viscosity x length)/π(r^4)

57

Viscosity depends on...
Increases with...

Hct
Increases with Polycythemia, Hyperproteinemic state (multiple myeloma), Hereditary spherocytosis

58

Viscosity decreases with

Anemia

59

Most of the total peripheral resistance due to

Arterioles

60

S1
Loudest at

Mitral and Tricuspid valves close
Loudest in Mitral area

61

S2
Loudest at

Aortic and Pulmonary valves close
Loudest at L sternal border

62

S3
When
Associated with
Sign of
Normal in

In early diastole
Associated with increased filling pressures
MR, CHF
Sign of dilated ventricles
Normal in Pregnants and Children

63

S4
When
Caused by
Associated with

Atrial Kick in late diastole
Caused by high atrial pressure
Associated with ventricular hypertrophy

64

JVP wave

a: atrial contraction
c: RV contraction (tricuspid valve bulges into atrium)
x: atrial relaxation
v: RA filling
y: blood flow from RA to RV

65

Normal Splitting Physiology

S1 - A2-P2
Inspiration --> drop in intrathoracic pressure --> increased venous return to RV --> increased RV SV --> increased RV ejection time --> delayed closure of pulmonic valve
Inspiration also leads to increased capacity of pulmonary circulation which also delays P closing

66

Wide Splitting
Pathology
Seen in conditions with

Due to delayed RV emptying
Pulmonic stenosis, R bundle branch block

67

Fixed Splitting
Seen in
Pathophysiology

ASD. L-R shunt --> ⇑ RA and RV volumes --> ⇑ flow through pulmonic valves such that regardless of breath, valve closure greatly delayed

68

Paradoxical Splitting
PathoPhys
Seen in what conditions

Seen in conditions that delay LV emptying (Aortic Stenosis, Left Bundle Branch Block).
Reversal of A2 and P2

69

What can be heard in aortic area?

Systolic murmors: AS, Flow Murmur, Aortic Valve Sclerosis.

70

What can be heard over Left Sternal Border

Diastolic murmurs: AR, PR
Systolic murmurs: HOCM

71

What can be heard in Pulmonic Area?

Systolic ejection murmur: Pulmonic stenosis, Flow murmur from ASD or PDA.

72

What can be heard in the tricuspid area?

Pansystolic murmurs: Tricuspid Regurg, VSD
Diastolic murmurs: Tricuspid stenosis, ASD

73

What can be heard over Mitral area?

Systolic: MR
Diastolic: MS

74

ASD
Early presentation
PathoPhys
Later presentation

"Drs press forward"
Diastolic rumble and pulmonary flow murmur
Blood flow across ASD does not cause the murmur because there is no pressure gradient
The murmur later progresses to a louder diastolic murmur of pulmonic regurgitation from dilation of pulmonary artery

75

Where is the best place to hear a PDA?
What does it sound like?
Due to

Left infraclavicular region. Continuous machine like murmur. Loudest at S2
Often due to congenital rubella or prematurity

76

Bedside Maneuver: Inspiration

Increased intensity of R heart sounds

77

Bedside Maneuver: Expiration

Increased intensity of L heart sounds

78

Bedside Maneuver: Hand Grip
What does it do physiologically

⇑systemic vascualr resistance.
⇑ intensity of MR, AR, VSD, MVP
⇓ intensity of AS, HOCM

79

Bedside Maneuver: Valsala
What does it do physiologically

⇓ venous return
Bedside Maneuver: Valsala
⇑ MVP and HOCM

80

Bedside Maneuver: Rapid Squatting
What does it do physiologically?

⇑ venous return, ⇑ preload, ⇑ afterload (if prolonged)
⇓ MVP and HOCM

81

Sound of MR
Loudest at?
Radiates?
Enhanced by?
Often due to?

Holosystolic high pitched blowing murmur.
Loudest at apex and radiates towards axilla
Enhanced by maneuvers that ↑ TPR (squatting, hand grip) and ↑ LA return (expiration)
Most often due to Ischemic heart disease, MVP, LV dilation, RF, infective endocarditis

82

Sound of TR
Loudest at?
Radiates?
Enhanced by?
Often due to?

Holosystolic high pitched blowing murmur.
Loudest at tricuspid area and radiates to R sternal border
Enhanced by maneuvers ↑ RA return (inspiration)
Most often due to RV dilation, RF, infective endocarditis

83

Aortic Stenosis
Sound and Radiation
Pressures
Presentation
Caused by

Crescendo-decrescendo systolic ejection murmur following ejection click (due to abrupt halting of valve leaflets) that radiates towards carotids and loudest at heart base
P in LV > P in Aorta
"SAD" --> Syncope, Angina, Dyspnea
Pulsus Parvus et Tardus
Age related calcification or bicuspid valve

84

VSD
Sound
Location
Maneuvers

Holosystolic, harsh sounding murmur loudest at tricuspid area and ↑ by handgrip (increased afterload)

85

MVP
Sound
Location? When?
Predisposes pts to
Caused by
Enhanced by

Late systolic crescendo murmur with midsystolic click (from sudden tensing of chordae tendineae)
Best heard over apex during S2
Predisposes to infective endocarditis
Caused by myxomatous degeneration, RF, chordae rupture.
Enhanced by maneuvers that ↓ venous return (standing, valsala)

86

Most frequent valvular lesion

MVP

87

Aortic Regurgitation
Sound
Presentation
Due to
Affected by

Immediate high pitched blowing diastolic decrescendo murmur.
Wide pulse pressure, bounding pulse, head bobbing.
Due to aortic root dilation, bicuspid endocarditis, RF.
↓ by vasodilators
↑ by hand grip

88

Mitral Stenosis
Sound
Pressures
Due to
Can lead to
Enhanced by

Delayed rumble in late diastole with opening snap (abrupt halting of leaflets due to fusion)
P in LA (measured by PCWP) > P in LV
Due to RF and can lead to LA dilation
Enhanced by maneuvers that ↑ LA return (expiration)

89

Ventricular AP also occurs in

Bundles of His and Purkinje fibers

90

Phases of Ventricular AP

0: INa
1: Na channels inactivated, K channels open
2: Plateau. Ca channels open
3: Repolarization. K channels open. Ca channels close
4: Resting Potential. High K permeability

91

Ca enters cardiac myocytes by

Ca induced Ca release

92

Pacemaker AP Phases

0: Ca mediated upstroke
2: no plateau
3: Inactivation of Ca channels, Opening of K
4: Slow diastolic depolarization because of Na funny channels

93

What affects Slope of Phase 4 in pacemaker cells?

ACh and Adenosine --> ↓ Slope --> ↓ HR
Catecholamines --> ↑ Slope --> ↑ HR

94

P wave on EKG

Atrial depolarization

95

Speed of conduction of parts of heart

Purkinje > atra > ventricles > AV node

96

Speed of conduction of pacemaker cells

SA > AV > Bundle of His/Purkinje/Ventricles

97

PR interval represents
Normal value

Conduction delay through AV node
Normally < 200 msec

98

QRS Complex represents
Normally

Ventricular depolarization
Normally < 120 msec

99

QT interval represents

Mechanical contraction of the ventricles

100

T wave represents
Inversion may indicate

Ventricular repolarization
T wave inversion may indicate recent MI

101

ST segment

Isoelectric
Ventricles Depolarize

102

U Wave causes

HypoK, Bradycardia

103

Conduction pathway in heart

SA --> Atria --> AV --> Common Bundle --> Bundle Branches --> Purkinje Fibers --> Ventricles

104

Atrioventricular delay?
Allows for?

100 msec delay allows for ventricular filling

105

V Tach
Can progress to
What predisposes towards it
Treatment

Can progress to Vfib
Long QT interval predisposes towards it
Treatment is Magnesium Sulfate

106

Congenital Long QT syndrome
Defect in
Can present as

Defect in cardiac Na or K channels
Can present with congenitcal sensorineural deafness (Jervell and Lang Nielsen Syndrome)

107

Afib
ECG
Can lead to
Treatment

Irregularly irregular with no discrete P wave between irregularly spaced QRS
Can result in atrial stasis which leads to stroke
Treatment: anticoagulants, β Blockers, cardioversion, Ca Channel Blockers, Digoxin

108

Atrial Flutter
EKG
Treatment

Back to back P waves (sawtooth)
IA, IC, II, III, IV

109

V fib
EKG
Treatment

Erratic rhythm with no identifiable waves
Fatal without CPR and Defib

110

1st Degree AV Block

PR interval prolonged (>200 msec)
Asymptomatic

111

2nd Degree AV Block
Mobitz Type I

Wenckenbach
Progressive lengthening of PR interval until a beat is dropped
Usually asymptomatic

112

2nd Degree AV Block
Mobitz Type II
Treatment
Risk

Extra P waves
Treat with pacemaker
Can progress to 3rd degree black

113

3rd Degree AV Block
Treat with
Can be caused by

A and V beat independently
Treat with pacemaker
Can be caused by Lyme Disease

114

ANP
Released by
In response to
Leads to

Released by atrial myocytes in response to ↑ vol and atrial pressure.
Leads to vascular relaxation and ↓ Na reabsorption in medullary collecting tubule.
Constricts EA and dilates AA (via cGMP)

115

Aortic arch receptors
Transmit via ... to ... responds to ...

Transmit via Vagus nerve to NTS in medulla and respond to ↑ BP only

116

Carotid Sinus
Transmits via ... to ... and responds to ...

Transmits via glossopharyngeal nerve to NTS and responds to any change in BP

117

Baroreceptors
Course of signals

↓ BP --> ↓ stretch --> ↓ afferent baroreceptor firing --> ↑ efferent sympathetic firing and ↓ efferent parasympathetic firing --> vasoconstriction, ↑ HR, ↑ contractility, ↑ BP

118

Carotid Massage

↑ pressure on carotid artery --> increase stretch --> ↑ afferent firing --> ↓ HR

119

Cushings Rxn
Presentation
PathoPhys

HTN, Bradycardia, Respiratory Depression
↑ ICP constricts arterioles --> cerebral ischemia --> reflex HTN --> ↑ stretch --> Reflex baroreceptor induced bradycardia

120

Peripheral Chemoreceptors

Carotid and Aortic bodies stimulated by ↓ PO2 (< 60mmHg), ↑ PCO2, and ↓ pH

121

Central Chemoreceptors

Stimulated by change in pH and PCO2 of brain interstitial fluid
Do not directly respond to PO2

122

Organ with largest share of systemic CO

Liver

123

Organ with highest blood flow per gram of tissue

Kidney

124

Organ with largest O2 extraction

Heart
~80%. ↑ O2 demand must be met with ↑ blood flow

125

Pressures in the Heart

RA: less than 5
RV: 5-25
PA: 25-10
LA: less than 12
LV: 130-10
Aorta: 130-90

126

Approximation of P in LA
Measured with...

PCWP measured with Swan-Ganz catheter

127

Autoregulation of blood flow to heat mediated by

Local metabolites - CO2, Adenosine, NO

128

Autoregulation of blood flow to Brain mediated by

Local metabolites - CO2, pH

129

Autoregulation of blood flow to Kidneys mediated by

Myogenic and tubuloglomerular feedback

130

Autoregulation of blood flow to Lungs mediated by

Hypoxia vasoconstriction

131

Autoregulation of blood flow to Skeletal Muscle mediated by

Local metabolites - lactate, adenosine, K

132

Autoregulation of blood flow to Skin mediated by

Sympathetic stimulation for temperature control

133

Starling Equation

J = K[(Pc-Pi)-(πc-πi)]

134

Edema from Heart Failure in terms of Starling Equation

↑ Pc pushes fluid out of capillaries

135

Edema from ↓ plasma proteins in terms of Starling Equation

↓ πc

136

Edema from ↑ capillary permeability in terms of Starling Equation
What causes a change in capillary permeability?

↑ K
Toxins, Infections, Burns

137

Edema from ↑ interstitial fluid colloid osmotic pressure in terms of Starling Equation
Caused by

πi
Caused by lymphatic blockage

138

Blue Baby
PathoPhys
Causes

R-L shunt
Tetralogy of Fallot (most common)
Transposition of the great vessels
Persistent Truncus arteriosus (with PDA)
Tricuspid atresia
Total Anomalous Pulmonary Venous Return

139

What usually accompanies a persistent truncus arteriosus?

PDA

140

What accompanies TAPVR?

ASD and sometimes PDA to allow for R-L shunt to maintain CO

141

Blue Kids
PathoPhys
Causes
Frequency of causes

L-R shunt
VSD > ASD > PDA

142

Eisenmengers Syndrome
PathyPhys
Presents as

Uncorrected VSD, ASD, PDA causes compensatory pulmonary vascular hypertrophy --> PHTN
As pulmonary resistance ↑, the shunt reverses and becomes R-L
Presents as Cyanosis, Clubbing, Polycythemia

143

Tetralogy of Fallot
Caused by
Characteristics
Shunting?
XR
Treatment

Caused by anterosuperior displacement of infundibular septum
PROV
Pul stenosis, RVH, Overriding Aorta (overrides VSD), VSD
R-L shunting --> cyanosis
Boot-shaped heart on XR
Surgery

144

What do pts with ToF do to relieve symptoms

Squatting --> ↓ blood flow to legs --> ↑ Resistance --> ↓ R-L shunt across VSD

145

Transposition of the Great Vessels
Only compatible with life if there is a
Due to
Treatment

Only compatible with life if there is a VSD, PDA, or PFO
Due to failure of the aorticopulmonary septum to spiral
Surgery

146

Coarctation of the aorta
Results in

Aortic Regurgitation

147

Coarctation of the aorta: Infantile Type
Location of stenosis?
Associated with?
On physical exam remember to check...

Stenosis proximal to ductus arteriosus
Associated with Turners Syndrome
Check femoral pulses

148

Coarctation of the aorta: Adult Type
Location of stenosis?
Associated with?
On physical exam remember to check...

Stenosis distal to ligamentum arteriosum
Associated with bicuspid aortic valve
On Physical Exam: Notching of the ribs due to collateral circulation, HTN in upper extremities, Weak pulses in lower extremities

149

Presentation of uncorrected PDA

Cyanosis in the lower extremities (differential cyanosis)

150

Consequences of PDA on the heart?

L-R shunt --> RVH and/or LVH and failure

151

Cardiac defect associated with 22q11 syndrome (DiGeorge syndrome)

Truncus arteriosus and ToF

152

Cardiac defect associated with Down Syndrome

ASD, VSD, AVSD (endocardial cushion defect)

153

Cardiac defect associated with Congenital Rubella?

Septal defects, PDA, Pulmonary artery stenosis

154

Cardiac defect associated with Turners Syndrome

Preductal coarctation of the aorta

155

Cardiac defect associated with Marfan's Syndrome

Aortic insufficiency and dissection (late)

156

Cardiac defect associated with diabetic mother

Transposition of the great vessels

157

TAPVR pathophys?

Pulmonary veins drain into R heart

158

Definition of HTN?

> 140/90

159

Risk factors for HTN

Age, diabetes, obesity, smoking, genetics

160

Risk of HTN in different races?

Black > White > Asian

161

Primary vs Secondary HTN

90% primary. 10% Secondary

162

Primary HTN

Related to ↑ CO and TPR

163

Secondary HTN usually caused by

Renal disease

164

Malignant HTN definition and prognosis

> 180/120 and rapidly progressing

165

HTN predisposes pts to

Aterosclerosis, LVH, Stroke, CHF, Renal Failure, Retinopathy, Aortic Dissection

166

Atheroma definition

Lipid plaques in blood vessel walls

167

Xanthomas definition. Where are they found?

Plaques or nodules composed of lipid laden histiocytes in the skin. Found on eyelids (xanthelasma), tendons (Tendinous Xanthomas) (esp Achilles tendon)

168

Corneal arcus definition.
Sign of?

Lipid deposits in cornea.
Nonspecific (arcus senilis)

169

Monckeberg
PathoPhys
Usually affects
Problem?
Layers involved?

Calcification of media of arteries. Especially radial or ulnar. Usually benign and does not obstruct blood flow. Only involves media, not intima

170

Arteriolosclerosis
Types
Where is each type present?

Hyaline: Thickening of small arteries seen in essential HTN and DM
Hyperplastic: "onion skinning" seen in MHTN

171

Atherosclerosis
Definition
What kind of arteries
Where in the artery?

Fibrous plaques and atheromas for in the intima of elastic arteries and large/medium muscular arteries.

172

Modifiable risk factors of Atherosclerosis

Smoking, HTN, Hyperlipidemia, Diabetes

173

Non-modifiable risk factors for Atherosclerosis

Age, Male, Postmenopausal women, family history

174

Progression of Atherosclerosis

Endothelial cell dysfunction --> macs and LDL accumulation --> Foam cells --> Fatty streaks --> SM migration (PDGF and FGF), proliferation, and ECM deposition --> Fibrous plaque

175

Complications of Atherosclerosis

Aneurysm, ischemia, infarcts, peripheral vascular disease, thrombus, emboli

176

Common locations of Atherosclerosis

Abdominal Aorta > coronary arteries > Popliteal arteries > carotid arteries

177

Atherosclerosis presentation

angina, claudication, but may be asymptomatic

178

Abdominal Aortic Aneurysm
Classic pt?

Atherosclerosis in Male smoker >50 with HTN

179

Thoracic Aortic Aneurysm associations

HTN, Marfan's (Cystic Medial Necrosis), and Tertiary Syphilis

180

Aortic Dissection
Definition
Associations
Presentation
CXR
Can result in...

Longitudinal tear forms false lumen
Associated with HTN, Bicuspid Aortic Valve, Cystic Medial Necrosis, Connective Tissue Disorder (i.e. Marfan's)
Presents with tearing chest pain radiating to the back
CXR shows mediastinal widening with false lumen larger than true lumen
Can result in pericardial tamponade, aortic rupture

181

How narrow must the coronary artery be to produce angina?

> 75% but this does not produce myocyte necrosis

182

Stable Angina
Definition
Mostly due to
EKG

Retrosternal chest pain with exertion
Mostly secondary to atherosclerosis
ST depression on ECK

183

Prinzmetals Angina
Due to
EKG

Secondary to coronary artery vasospasms
ST elevation on EKG

184

Unstable Angina
Definition
Caused by
EKG

Worsening chest pain at rest or with minimal exertion. Caused by thrombosis with incomplete coronary artery occlusion. ST depression on ECK

185

Coronary Steal Syndrome

Vasodilators aggravate ischemia by shunting blood from affected area to region of higher perfusion

186

Myocardial infarction
Definition
Most often due to...
ECK

Complete occulsion of coronary artery producing myocyte necrosis.
Most often due to thrombosis
ST depression progressing to ST elevation

187

ST depression means

Subendocardial wall damage

188

ST elevation means

Transumarl wall damage

189

Sudden Cardiac Death
Definition
Most commonly due to
Associated with

Death from cardiac cause within 1 hour of symptom onset
Most commonly due to lethal arrhythmia (Vfib)
Associated with CAD

190

Chronic Ischemic Heart Disease
Definition
Progresses to

Chronic ischemic myocardial damage. Progresses to CHF

191

MI presentation

Diaphoresis, naseau, vomiting, retrosternal pain, pain in left arm and/or jaw, dyspnea, fatigue

192

0-4 hours after MI
Gross
LM
Risk

Gross: none
LM: none
Risk: Arrhythmias, CHF exacerbation, shock

193

4-12 hours after MI
Gross
LM
Risk

Gross: Dark mottling. Pale with tetrazolium stain
LM: Early coagulative necrosis, edema, hemorrhave, wavy fibers
Risk: Arrhythmias

194

12-24 hours after MI
Gross
LM
Risk

Gross: Dark mottling. Pale with tetrazolium stain
LM: Contraction bands from reperfusion injury, Release of necrotic cell contents into blood, Beginning of neutrophil migration
Risk: Arrhythmias

195

1-3 days after MI
Gross
LM
Risk

Gross: hyperemia
LM: Extensive coagulative necrosis. Tissue surrounding infarct shows acute inflammation. Neutrophil migration
Risk: Fibrinous pericarditis

196

2-14 days after MI
Gross
LM
Risk

Gross: Hyperemic border with centrally yellow-brown softening (maximally yellow at day 10)
LM: Macs. Granulation tissue at margins
Risk: Free wall rupture --> tamponade, Papillary muscle rupture, Aneurysm, IV septal rupture

197

2-Several weeks after MI
Gross
Risk

Gross: Gray-white tissue
Dresslers syndrome

198

Diagnosis of MI
EKG and blood tests

EKG is gold standard in the first 6 hours. Troponin I rises after 4 hours and is elevated for 7-10 days (specific). CKMB predominantly found in myocardium but also skeletal muscle. Useful in diagnosing reinfarction because returns to normal after 48 hours

199

Transmural infarct: EKG

ST elevation. Pathological Q wave

200

Subendocardial infarcts
EKG
Necrosis?

ST depression. Necrosis of <50% of ventricle wall

201

EKG diagnosis of Anterior wall infarct based on leads showing Q waves?

"SAL"
Anteroseptal: V1-V2 (LAD)
Anterior: V1-V4 (LAD
Anterolateral: V4-V6 (LCX)

202

EKG diagnosis of Lateral or Inferior wall infarct based on leads showing Q waves?

"Love Is Incredible. Nothing Like It"
Lateral: I, aVL (LCX)
Inferior: II, III, aVF

203

Dresslers Syndrome
PathoPhys

Autoimmune phenomenon resulting in fibrinous pericarditis several weeks post MI

204

Causes of Dilated Cardiomyopathies

Most common cause = idiopathic (>50%)
"A Bold, Devout Christian Crusader Charged Petrified Hindus"
Alcohol, wet Beriberi, Doxorubicin, Chagas, Coxackie B, Cocaine, Postpartum, Hemochromatosis

205

Dilated Cardiomyopathy
Common?
Sound, US, CXR
What kind of hypertrophy?
What kind of dysfunction?
Treatment

Most common cardiomyopathy (90%)
S3, US = dilated heart, CXR = balloon
Eccentric hypertrophy w/ sarcomeres added in series --> systolic dysfunction?
Treat w/ Na restriction, ACEI, diuretics, digoxin, transplant

206

HOCM: PathoPhys
Genetics
Association

Hypertrophied IV septum is too close to mitral valve and obstructs aortic outflow
60-70% are caused by autosomal dominant mutation in β myosin heavy chain --> disorganized, tangled myocardial fibers
Associated with Friedreich's Ataxia

207

HOCM
Classic Pt
Size, Sound, Murmur, Impulses
Treatment

Cause of death in young athletes
Normal sized heart, S4, Systolic murmur, apical impulses
Treat with II or nonDHP IV

208

HOCM
Hypertrophy
Kind of dysfunction?
May produce?

Concentric hypertrophy with sarcomeres added in parallel
Diastolic dysfunction ensues
May produce syncopal episodes.

209

Causes of Restrictive Cardiomyopathies

"A SHELF"
Amyloidosis, Sarcoidosis, Hemochromatosis, Endocardial fibroelastosis (thick fibroelastic tissue in endocardium of young children), Loffers Syndrome (endomyocardial fibrosis with eosinophils), Fibrosis (post radiation)

210

What kind of dysfunction ensues in restrictive cardiomyopathies?

diastolic

211

Treatment for CHF
Mortality reducers?
Symptom relief?
Both?

Mortality reducers: ACEI, II (except in acute decompensated HF), ATII antagonists, Spironolactone
Symptom relief: Thiazide and Loop Diuretics
Both: Hydralazine and Nitrates

212

CHF presentation

Dyspnea, fatigue, edema, rales

213

What produces Cardiac Dilation?

Greater EDV

214

Why do Pts experience dyspnea on exertion

Failure of CO to Increase

215

Results of LHF?

Pul Edema: transudation of fluid into alveoli. Hemosiderin laden Macs in lung
Paroxysmal Nocturnal Dyspnea and Orthopnea: Increased venous return --> pulmonary vascular congestion

216

Results of RHF?

Hepatomegaly (nutmeg liver), Peripheral edema, JVD

217

Bacterial Endocarditis Presentation

"FROM JANE"
Fever, Roth Spots, Osler's Nodes, Murmur, Janeway Lesions, Anemia, Nail-bed hemorrhages, Emboli

218

Roth Spots

Round, white spots on retina surrounded by hemorrhage

219

Osler's Nodes

Tender raised lesions on finger and toe pads caused by IC deposition

220

Janeway Lesions

Small, painless, erythematous lesions on palm or sole. Hemorrhagic

221

Complications of Bacterial Endocarditis

Chordae rupture, Glomerulonephritis, Suppurative pericarditis, emboli

222

Site of infection in Bacterial endocarditis?

Usually Mitral Valve
Tricuspid in IV drug users

223

Main Causes of Bacterial Endocarditis

Acute: S aureus (large vegetations on normal valve)
Subacute: S. viridans (small vegetations on abnormal or diseased valve)
Common after dental procedures

224

Organisms Causing Tricuspid Bacterial Endocarditis

S aureus, Pseudomonas, Candida

225

Causes of non bacterial endocarditis

Malignancy, Hypercoagulable state, SLE

226

Bacterial endocarditis in colon cancer caused by

S bovis

227

Bacterial endocarditis with a prosthetic valve caused by...

S epidermidis

228

Rheumatic Fever Presentation

"FEVERSS"
Fever, Erythema marginatum, Valve damage, ESR ↑, Red-Hot Joints (migratory polyarthritis), Subcutaneous nodules, St. Vitus dance (Sydenham's Chorea)

229

RF
Organisms causing it
Valves affected
Early vs Late
Type of Disease?

GAS (β hemolytic strep)
mitral > aortic >>> tricuspid
Early MR, late MS
Type II Hypersensitivity Rxn with Abs against bacterial M protein

230

RF
Histology
Blood titers

Aschoff Bodies (granuloma with giant cells), Antischkow cells (activated histiocytes), Elevated ASO

231

Acute Pericarditis
Presentation
PE findings
EKG

Sharp pleuritic pain relieved by sitting up and leaning forward.
Friction rub
Widespread ST elevation and/or PR depression

232

Fibrinous Pericarditis
Causes
Findings

Dressler's, Uremia, Radiation
Loud Friction Rub

233

Causes of Serous Pericarditis

Viral (often resolves spontaneously), noninfectious inflammatory disease (SLE, RA)

234

Causes of SuppurativePurulent Pericarditis

Bacterial infection (Pneumococcus Streptococcus)
Rare now with antibiotics

235

Cardiac Tamponade
What happens to diastolic pressures?
HR? Sounds? BP? PE findings?

Diastolic pressures equalize in all 4 chambers. HR↑, Distant heart sounds, hypotension and Pulsus Paradoxus, JVD

236

Pulsus Paradoxus
Definition
Seen in what diseases?

↓ in systolic P by >10mmHg during inspiration
Seen in pericarditis, tamponade, asthma, obstructive sleep apnea, croup

237

Syphilitic Hearth Disease
Causative agent
MoA
Risk for

Tertiary Syphilis disrupts vasa vasorum of the aorta and vessel wall atrophys and dilates.
Risk for aortic aneurysm (ascending and arch) and aortic insufficiency (dilation of aorta and valve ring)

238

In Syphilitic Hearth Disease, what happens to the aortic root and ascending aortic arch? How does the aorta appear?

Calcification
Tree bark appearance

239

Cardiac Myxoma
Common?
Usually described as
Location
Present with

Most common primary cardiac tumor in adults. "ball valve" obstruction of LA presents with multiple syncopal episodes

240

Rhabdomyomas
Common?
Associated with?

Most common primary cardiac tumor in children. Associated with Tuberous Sclerosis

241

Most common cardiac tumor?

Metastatic (melanoma, lymphoma)

242

Kussmaul's Sign
Definition
Seen in

↑ in JVP during inspiration because negative intrathoracic pressure not transmitted to the heart
Constrictive Pericarditis, Restrictive Cardiomyopathy, RA or RV tumors, Cardiac Tamponade

243

Raynaud's Phenomenon
PathoPhys
Location
Disease
Syndrome
Presentation

↓ blood flow to skin due to arteriolar constriction in response to cold or stress
Fingers and toes
Disease if primary (idiopathic)
Syndrome if secondary to connective tissue disease, SLE, CREST
Cyanosis of fingertips and toes

244

Temporal Giant Cell Arteritis
Kind of vasculitis?
Classic Pt Presentation
Risk of
Associated with
Affects which vessels?
Histo
Blood
Treatment

Large vessel
Old female with unilateral temporal headache and jaw claudication
Risk of blindness due to ophthalmic artery occlusion
Associated with Polymyalgia Rheumatica
Branches of Carotid artery.Focal Granulomatous inflammation, ↑ESR, Treat with corticosteroids

245

Takayasu's Arteritis
Kind of vasculitis?
Classic Pt Presentation
Affects which vessels?
Histo
Blood
Treatment

"FAN My Skin On Wed"
Large vessel
Asian female < 40 with weak upper extremity pulses, fever, night sweats, arthritis, myalgias, skin nodules, ocular disturbances
Granulomatous thickening of aortic arch and proximal great vessels, ↑ESR
Treat with corticosteroids

246

Polyarteritis Nodosa
Kind of vasculitis?
Classic Pt Presentation
Affects which vessels?
Histo
What mediates the disease?
Ages of lesions?
Arteriogram
Treatment

"Scalded My Right Hand on the PAN"
Medium vessels
Young Adult with HepB with fever, wt loss, malaise, headache, abdominal pain, melena, HTN, Neuro dysfunction (wrist drop), Cutaneous eruptions, renal damage
Renal and Visceral vessels
Transmural inflammation with fibrinoid necrosis
IC mediated
Typically of different ages
Arteriogram shows many aneurysms and constrictions
Corticosteroid and cyclophosphamide

247

Kawasaki Disease
Kind of vasculitis?
Classic Pt Presentation
Affects which vessels?
Risk of
Treatment

Medium vessels
"FEAR ME"
Asian child < 4 with Fever, conjunctival infection (Eye), cervical lymphAdenitis, desquamating Rash, Mouth and Extremity erythema
Coronary vessels
Risk of coronary aneurysm --> MI, Rupture
Treat with IV Igs and Aspirin

248

Buerger's Disease (Thromboangiitis Obliterans)
Kind of vasculitis?
Classic Pt Presentation
Treatment

Medium vessels
"SCRAPS"
Male < 40 with Segmenting Thrombosing vasculitis, Claudication (may lead to gangrene and auto-amputation), Raynaud's, Smoker, Painful, Superficial Nodular Phlebitis
Treat with smoking cessation

249

Microscopic Polyangiitis
Kind of vasculitis?
Histo
Organs involved w/ manifestation?
Blood
Treatment

Small vessels
Necrotizing vasculitis w/ No Granulomas
Lungs, Kidney (Pauci Immune Glomerulonephritis), and Skin (Palpable Purpura)
P-ANCA
Cyclophosphamide and Corticosteroids

250

Wegener's Granulomatosis (Granulomatosis with Polyangiitis)
Kind of vasculitis?
Presentation
Histo
Blood
CXR
Treatment

Small vessels
Upper Respiratory Tract: Perforated nasal septum, sinusitis, otitis media, mastoiditis
Lower RT: Hemoptysis, Cough, Dyspnea
Renal: Hematuria, RBC Casts
Focal Necrotizing vasculitis + Necrotizing granulomas in the lung and upper airway + Necrotizing glomerulonephritis
c-ANCA
Large Nodular Densities
Cyclophosphamide and corticosteroids

251

Churg Strauss Syndrome
Kind of vasculitis?
Classic Presentation
But can also affect
Histo
Blood

Small vessels
"BEAN SAP? No, Go to Hell"
Blood Eosinophils, Asthma, Neuropathy (food/wrist drop), Sinusitis, Allergies, Palpable Purpura, glomeruloNephritis (pauci immune), GI, Heart
Granulomatous, necrotizing vasculitis w/ eosinophilia
p-ANCA + ↑ IgE

252

Henoch-Schonlein Purpura
Kind of vasculitis?
Most common vasculitis in...
Classic Presentation
Disease Mediated by
Associated with
Age of lesions?

Small vessels
Most common vasculitis in children
"NAPA"
Child following URI with Nephropathy, Abdominal pain (melena), Purpura, Arthralgia
Mediated by IgA complex deposition
Associated with IgA nephropathy
Multiple lesions of same age

253

Essential HTN therapy

ACEI, ARB, Diuretics, IV

254

When are II contraindicated?

Cardiogenic shock and must be used with caution in decompensated CHF

255

Treatment for Diabetes Mellitus?

ACEI, ARB, Diuretics, II, α blockers, IV

256

Ca Channel Blockers
Names
MoA
Used to treat
Tox

Verapamil, Diltiazem, Nifedipine, Amlodipine
--/ Voltage gated L-type Ca channel in plasma membrane
Used to treat HTN, Angina, Arrhythmias (not N), Prinzmetals Angina, Raynaud's
Cardiac depression, AV block, Peripheral edema, Flushing, Dizziness, Constipation

257

Hydralazine
MoA
Used to treat
First line therapy for
Coadministration
Tox
Contraindicated in

↑cGMP --> Smooth Muscle relaxation. Vasodilates arterioles > veins --> ↓ afterload
Used to treat HTN, CHF
First line therapy for HTN in pregnancy with methyldopa
Coadministered with II to --/ reflex tachycardia
Compensatory tachycardia, fluid retention, nausea, headache, angina, Lupus.
Contraindicated in Angina/CAD

258

Treatment for MHTN

Nitroprusside (short acting) --> Release of NO --> ↑cGMP --> Smooth Muscle relaxation. Can cause cyanide poisoning

Fenoldopam = D1 agonist --> coronary, peripheral, renal, and splanchnic vasodilation. ↓ BP and ↑ Natriuresis

259

Nitric Oxide (NO) Releasing Drugs
Names
MoA
Use
Tox

Nitroglycerin, Isosorbide, Dinitrate
NO --> ↑cGMP --> Smooth Muscle relaxation. Dilates veins > arteries --> ↓ preload
Used to treat angina and Pul Edema
Reflex tachycardia, Hypotension, Flushing, Headache, Monday disease (industrial exposure)

260

Goal of Antianginal therapy

Reduce O2 demand of myocardium
Reduces Contractility, Afterload, Rate, Size (wall tension = Preload)

261

Nitrates as Antianginal
EDV
BP
Contractility
HR
Ejection time
MVO2

EDV ↓
BP ↓
Contractility ↑ (response)
HR ↑ (response)
Ejection time ↓ (response)
MVO2 ↓

262

II as Antianginal
EDV
BP
Contractility
HR
Ejection time
MVO2

EDV ↑
BP ↓
Contractility ↓
HR: ↓
Ejection time: ↑
MVO2: ↓

263

Nitrates + II as Antianginal
EDV
BP
Contractility
HR
Ejection time
MVO2

EDV: No change or ↓
BP: ↓
Contractility: NC
HR: ↓
Ejection time: NC
MVO2: ↓↓

264

Which IV are similar to Nitrates?
Which IV are similar to II?

Nitrates: Nifedipine
II: Verapamil

265

Partial β blockers contraindicated in angina

Pindolol, Acebutolol

266

Strawberry Hemangioma
Benign or malignant?
What kind of vessels?
Time and frequency
Course

Benign capillary hemangioma of infancy
Appears in first few weeks of life
1/200 births
Grows rapidly and regresses spontaneously at ages 5-8

267

Cherry Hemangioma
Benign or malignant?
What kind of vessels?
Time and frequency
Course

Benign capillary hemangioma of the elderly
Does not regress
Frequency increase with age

268

Cystic Hygroma
What kind of growth?
Where on body?
Associated with?

Cavernous lymphangioma of the neck. Associated with Turners Syndrome

269

Pyogenic Granuloma
What kind of tumor?
What can it do?
Associations?

Polyploid capillary hemangioma that can ulcerate and bleed. Associated with trauma and pregnancy

270

Glomus Tumor
Benign or malignant
Painful or not?
Color?
Location?
Arises from?

Benign, painful, red-blue, tumor of fingernails. Arises from modified smooth muscle cells of glomus body

271

Bacillary Angiomatosis
Benign or malignant
Which vessels?
Location?
What kind of Pts?
Cause?
Frequently confused with

Benign capillary skin papules found in AIDS pts. Caused by Bartonella henselae infection. Frequently mistaken for Kaposi Sarcoma

272

Angiosarcoma
Frequency?
Kind of malignancy?
Location on body?
Associated with what kind of pts?
Prognosis?

Rare blood vessel malignancy typically occuring in head, neck and breast areas. Associated with pts recieving radiation therapy (breast cancer, Hodgkin's lymphoma).
Very aggressive and difficult to resect due to delayed diagnosis

273

Lymphangiosarcoma
What kind of malignancy?
Associated with?

Lymphatic malignancy associated with persistent lymphedema (post-radical masectomy)

274

Kaposi Sarcoma
What kind of malignancy
Location on body
Associated with
Frequently mistaken for...

Endothelial malignancy found on skin, mouth, GI tract, respiratory tract. Associated with HHV8 and HIV. Frequently mistaken for bacillary angiomatosis

275

Sturge Weber Disease
What kind of disease?
Vessels affected?
Manifestation?

Congenital
Capillary sized blood vessels
Port-Wine stain (nevus flammeus) on face, Ipsilateral leptomeningeal angiomatosis (intracerebral arteriovenous malformation), Seizures, early onset Glaucoma

276

HMG CoA Reductase Inhibitors (Statins)
LDL
HDL
Tri
MoA
Tox

LDL ↓↓↓
HDL ↑
Tri ↓
MoA --/ conversion of HMG-CoA to mevalonate (a cholesterol precursor)
Hepatotoxic (↑LFTs), Rhabdomyolysis

277

Niacin (Vit B3)
LDL
HDL
Tri
MoA
Tox

LDL ↓↓
HDL ↑↑
Tri ↓
MoA Inhibits lipolysis in adipose tissue. Reduced hepatic VLDL secretion
Red, flushed face (↓ by aspirin). Hyperglycemia (acanthosis nigricans), Hyperuricemia (exacerbates gout)

278

Bile Acid Resins
Names
LDL
HDL
Tri
MoA
Tox

Cholestyramine, Colestipol, Colesevelam
LDL: ↓↓
HDL: Slightly ↑
Tri: Slightly ↑
Prevents intestinal reabsorption of bile acids forcing liver to use cholesterol to make Bile
Bad taste, GI discomfort, ↓ absorption of soluble vitamins, Cholesterol Gallstones

279

Cholesterol Absorption Blockers
Names
LDL
HDL
Tri
MoA
Tox

Ezetimibe
LDL: ↓↓
HDL: -
Tri: -
MoA: Prevents cholesterol reabsorption in small intestine brush border
Rare ↑ in LFTs, Diarrhea

280

Fibrates
Names
LDL
HDL
Tri
MoA
Tox

Gemfibrozil, Clofibrate, Bezafibrate, Fenofibrate
LDL ↓
HDL ↑
Tri ↓↓↓
Upregulate LPL --> ↑ TG clearance
Myositis, hepatotoxic (↑ LFTs), cholesterol gallstones

281

Cardiac Glycosides
Names
Bioavailability
Protein bound?
T1/2
Excretion

Digoxin
75% bioavailability
20-40% protein bound
T1/2 40h
Urinary excretion

282

Digoxin
MoA
Use

--/ Na/K ATPase. ↑ Na --/ Na/Ca exchanger --> ↑ Ca --> ↑ contractility
--> Vagus Nerve --> ↓ HR
Used to treat CHF (↑ contractility), Afib (↓ conduction at AV node, depression at SA node)

283

Digoxin
Tox
EKG
Factors predisposing to toxicity

Cholinergic --> nausea, vomiting, diarrhea, blurry yellow vision
AV block, Hyperkalemia,
↑ PR, ↓QT ST scooping, T wave inversion, arrhythmias
Predisposition: renal failure (↓ excretion), Hypokalemia (permissive binding of Na/K pump), Quinidine (↓ clearance. displaces digoxin from tissue binding sites)

284

Digoxin OD antidote

Slowly normalize K, Lidocaine, Cardiac Pacer, Anti Digoxin Fab Fragment, Mg

285

Class I antiarrhythmics
What kind of molecules
What do they do?
Dependence?
Toxicity is aggravated by...

Local anesthetics
↓ conduction in depolarized cells. ↓ slope of phase 0. ↑ threshold for firing in abnormal pacemaker cells
Are state dependent (selective depress frequently depolarized tissues)
Hyperkalemia ↑ toxicity

286

Class IA antiarrhythmics
Name
Action on AP?
Action on EKG?
Regions of heart?
Especially useful in treating

Procainamide, Disopyramide, Quinidine
↑ AP duration. ↑ effective refractory period
↑ QT
Affect both Atria and Ventricles
Reentrant and Ectopic SVT and Vtach

287

Class IA antiarrhythmics
Toxicity

Thrombocytopenia, torsades de pointes
Q --> cinchonism (headache + tinnitus)
P --> SLE
D--> heart failure

288

Class IB antiarrhythmics
Names
Affect on AP?
Preferentially affects
Useful in
Tox

Lidocaine, Mexiletine, Tocainide, (Phenytoin)
↓ AP duration
Preferentially affects ischemic or depolarize Purkinje and ventricular tissue
Useful in acute ventricular (Is Best Post MI) + digitalis induced arrhythmias.
Local anesthetic, CNS↑↓, CV depression

289

Class IC antiarrhythmics
Name
Affect on AP?
Useful in
Usually only used as
Affect on AV node
Toxicity
Contraindicated

Flecainide, Propafenone
No affect on AP duration
Useful in Vtach that progresses to Vfib + intractable SVT
Usually used only as a last resort for refractory tachyarrhythmias
Prolongs refractory period in AV node
Tox: Proarrhythmic
Contraindicated Post MI and structural heart disease

290

Class II antiarrhythmics
Names
MoA
Affect on AP
Area particularly sensitive?
Use

Metoprolol, propanolol, esmolol (very short acting), atenolol, timolol
Decrease SA and AV nodal activity by ↓ cAMP --> ↓ Ca currents
Decreases phase 4 slope in pacemaker cells
AV node particularly sensitive (↑ PR interval)
VTach, SVT, Slows ventricular rate during Afib + Aflutter

291

Class II antiarrhythmics
Tox

BBC Loses Viewers in Houston
Bradycardia (AV block, CHF), Bronchoconstriction (aggravates asthma), Claudication, CNS effects (sedation), Lipids (metoprolol), Vivid dreams, Hypoglycemia masked

292

Propanolol can exacerbate

Vasospasms in Prinzmetal's angina

293

Beta Blocker OD treatment

Glucagon

294

Class III antiarrhythmics
Names
MoA
Effect on AP
Used when
EKG effects

"AIDS"
Amiodarone, Ibutilide, Dofetilide, Sotalol
--/ K channels
↑AP duration, ↑ERP,
Used when other antiarrhythmics fail
↑QT interval

295

Class III
Toxicity

Sotolol: TdP, excessive β Block
Ibutilide: TdP,
Amiodarone: Pul Fibrosis, Hepatotoxic, Hypo/HyperThyroidism

296

Amiodarone Toxicity
Real Classification

Pul Fibrosis, Hepatotoxic, Hypo/HyperThyroidism (40% I by weight), Corneal deposits, Skin deposits (blue/gray) --> photodermatitis, neurological effects, constipation, AV affects (bradycardia, heart block, CHF)
Affects lipid membranes so has I, II, III, and IV activity

297

Class IV antiarrhythmics
Names
Affects on AP
Used to
Tox

Verapamil, Diltiazem
↓ conduction velocity, ↑ERP, ↑PR
Used to prevent nodal arrhythmias (SVT)
Constipation, Flushing, Edema, CV (CHF, AV block, Sinus node depression

298

Adenosine
MoA
Drug of choice for
Speed
Toxicity
Affects blocked by

↑K out of cells --> hyperpolarization and ↓ Ca current.
Drug of choice for SVT (diagnosis and treatment)
Very short acting (15 sec)
Flushing, hypotension, angina
Blocked by caffeine and theophylline

299

Mg used to treat

TdP and Digoxin toxicity

300

Names of β1 selective β Blockers

Start with A-N

301

Names of non-selective β Blockers (β1 and β2)

Start with O-Z

302

Breathing in a pt with CHF

Cheyne Stokes Breathing