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Flashcards in Cardiology Deck (265)
1

Right dominant configuration of the heart

SA and AV nodes supplied by RCA. RCA supplies inferior portion of LV via PD artery (most common. In left dominant the PD arises from the CFX)

2

Fick equation

CO = (rate of O2 consumption) / (arterial O2 content - venous O2 content)

3

What is the pulse pressure proportional to?

Stroke Volume

4

Name a classic venodilator and a classic vasodilator

Veno - nitroglycerin, Vaso - hydralazine

5

How does nitroglycerin help in angina?

Venodilation, decreased preload, decreased cardiac work, decreased demand for O2

6

Normal ejection fraction

Greater than or equal to 55 percent

7

Causes of increased blood viscosity (3)

Polycythemia, hyperproteinemic states (eg multiple myeloma), hereditary spherocytosis

8

Cardiac function curves - give the curve affected (CO or venous return) and direction the intersection moves in each of the following: pos inotropy, neg inotropy, inc blood vol, dec blood vol

Positive inotropy - CO, intersection moves up and left. Neg inotropy - CO, intersection moves down and right. Inc BV - venous return, intersection moves up and right. Dec BV - venous return, int moves down and left

9

On a cardiac cycle graph, the slope of what curve gives contractility?

A line from the origin to the top left portion (where aortic valve closes) of the curve

10

What causes an S3

Increased filling pressure (e.g. MR, CHF) and dilated ventricles. Normal in children and preggers

11

What causes an S4?

High atrial pressure. Due to ventricular hypertrophy and stiffness

12

What is going on in the right heart during each of the following: a wave, c wave, x descent, v wave, y descent

A wave - atrial contraction, c wave - RV contraction, x descent - atrial relaxation, v wave - RA filling, y descent - blood flow from RA to RV

13

What disorders lead to wide splitting of A2 and P2?

Pulmonic stenosis, RBBB

14

What condition leads to fixed splitting

ASD

15

What conditions lead to paradoxical splitting?

Aortic stenosis, LBBB

16

What kind of murmurs can be heard in an ASD?

Pulmonary flow murmur (inc flow through pul valve), and diastolic rumble (inc flow across tricuspid)

17

Between inspiration and expiration, which increases right heart findings and which increases left?

Inspiration increases right heart sounds, expiration increases left

18

What murmurs are louder on hand grip?

MR and VSD

19

What murmurs are louder on valsalva (decreased venous return)

MVP, HOCM. (most murmurs are quieter on valsalva)

20

Pulse associated with AS

Parvus and tardus

21

Murmur associated with VSD

Holosystolic, harsh sounding. Loudest at tricuspid area

22

Two common causes of PDA

Congenital rubella and prematurity

23

Give the main ions flowing across the cardiac ventricular muscle membrane during each of the phases of the cycle

Phase 0 - Na, Phase 1 - K starts, Na stops, Phase 2 - Ca, K, Phase 3 - K, Phase 4 - K

24

Why do CCBs work on heart but not on skeletal muscle?

Skeletal muscle has no dependence on extracellular calcium during an action potential (due to sarcoplasmic stores) unlike cardiac muscle

25

What causes rapid calcium decrease immediately before relaxation in cardiac muscle cells?

Na/Ca exchanger

26

Give the ions traversing the cardiac pacemaker cell membrane during each phase of the cardiac cycle

Phase 4 - Na (funny current, If), Phase 0 - Ca, Phase 1 and 2 absent, Phase 3 - K

27

What property of heart cell action potentials determines heart rate in normal individuals?

The slope of Phase 4 in SA nodal cells

28

How does symphathetic stimulation affect the AP in heart cells?

Increases the chance that If channels are open in pacemaker cells

29

Normal length of PR interval, QRS complex, and AV node delay

PR - less than 200 ms, QRS - less than 120 ms, AV node delay - around 100 ms

30

Torsades de pointes is related to what EKG abnormality?

Long QT

31

Jervell and Lange-Nielsen syndrome

Severe congenital sensorineural deafness and long QT (predisposes to torsades)

32

Order the following from fastest to slowest conduction: Atrial muscle, AV node, Purkinje system, Vent muscle

(fastest) Purkinje, Atrial muscle, Vent muscle, AV node (slowest)

33

Common precipitants of a-fib

Alcohol binge, increased cardiac sympathetic tone, pericarditis

34

Treatments for a-fib

B-blocker, CCB, digoxin. Also give warfarin

35

Treatment for a-flutter

Class Ia, Ic, or III antiarrhythmics or B-blockers

36

Treatment for third degree heart block

Pacemaker

37

What infectious disease can result in heart block and which type?

Lyme, third degree

38

Release of what may cause normal sodium levels even in hyperaldosterone hypertension?

Atrial natriuretic peptide

39

What effect does ANP have on renal vasculature?

Constricts efferent arterioles and dilates afferent arterioles (via cGMP)

40

Does the aortic arch baroreceptor respond to high pressure, low pressure, or both?

High pressure only

41

Where does the parasympathetic system exert its influence to slow heart rate?

By slowing conduction through the AV node

42

Give the factors that determine autoregulation in the brain and heart respectively

Brain - CO2 (via pH), Heart - CO2, adenosine, NO

43

Congenital right to left shunts (early cyanosis) (5)

Tetralogy of Fallot (most common), Transposition of great vessels, Truncus arteriosus, Tricuspid atresia, Total anomalous pulmonary venous return (TAPVR)

44

What is required for viability in tricuspid atresia?

ASD and VSD

45

Congenital left to right shunts (late cyanosis) (3)

VSD (most common), ASD, PDA

46

What effect does indomethacin have on a PDA?

Closes it

47

Eisenmenger syndrome

Reversal of L to R shunt (making it R to L), causing late cynaosis (clubbing and polycthemia)

48

4 features of tetralogy of Fallot

Pulmonary stenosis, RVH, Overiding aorta, VSD

49

In what congenital condition do patients typically squat to improve symptoms?

Tetralogy of Fallot (increased TPR reduces R-to-L shunt)

50

Where are infantile and adult type coarcations located respectively?

Infantile - preductal, Adult - postductal

51

Describe the cyanosis in each of the following conditions: aortic coarctation, PDA, septal defects and tetralogy of fallot

Coarctation - no cyanosis, PDA - late lower extremity cyanosis, Septal Defect and ToF - whole body cyanosis

52

What should you check first if you suspect aortic coarctation?

Upper and lower extremity pulses (upper will be strong, lower will be weak)

53

Cardiac defects associated with 22q11 syndromes (DiGeorge, velocardiofacial)

Truncus arteriosus, tetralogy of fallot

54

Cardiac defects associated with Down syndrome

ASD, VSD, AV septal defect (endocardial cushion defect)

55

Cardiac defects associated with congenital rubella

Septal defects, PDA, pulmonary artery stenosis

56

Cardiac defects associated with maternal diabetes

Transposition of great vessels

57

List the four signs of hyperlipidemia

Atheromas, xanthomas, tendinous xanthomas, and corneal arcus

58

In patients with visible signs of hyperlipidemia, what should you check for?

Cholestasis (eg primary or secondary biliary cirrhosis)

59

Which form of arteriosclerosis is calcific, where is it most commonly seen, and what is the prognosis.

Monckeberg. Radial and ulnar arteries especially. Benign

60

What are the keywords for arteriolosclerosis in essential hypertension, diabetes, and malignant hypertension respectively

Essential HTN and DM - hyaline, Malignant HTN - hyperplastic, onion skinning

61

In what conditions are fatty streaks seen?

EVERYONE over 10 years old

62

List the steps of atherosclerosis (7) in order

Endothelial cell dysfunction, Macrophage and LDL accumulation, Foam cells, Fatty streaks, SM migrational (PDGF and TGF-b), fibrous plaque, complex atheroma

63

Most common locations of atherosclerosis (in order starting with most common)

Abdominal aorta, coronary artery, popliteal artery, carotid artery

64

What decreases atherosclerotic plaque stability and thus increases chance of rupture

Metalloproteinases from macrophages

65

What are abdominal and thoracic aortic aneurysms respectively associated with?

Abdominal - atherosclerosis (men, smokers, over 50), Thoracic - HTN, cystic medial necrosis (Marfan)

66

What are aortic dissections associated with?

HTN and cystic medial necrosis (Marfan). Same risk factors as THORACIC aortic aneurysms

67

What is the precursor lesion in aortic aneurysm and aortic dissection respectively?

Aneurysm - intimal streak (atherosclerosis), Dissection - intimal tear

68

Where do we typically harvest vessel from for CABG?

Great saphenous vein just below the pubic tubercle

69

Give the pathology associated with each of the following precursor lesions: intimal streak, intimal tear, medial degeneration, medial inflammation, vasa vasorum obliteration

Intimal streak - atherosclerosis, intimal tear - aortic dissection, medial degeneration - aortic dissection (eg Marfan), medial inflammation - takayasu, GCA, vasa vasorum obliteration - syphillis

70

How much narrowing has to occur in coronary arteries to get angina?

75 percent or greater

71

What is seen on EKG with prinzmetals angina?

ST elevation (note that ST DEPRESSION is seen in stable and unstable angina)

72

What kills you in sudden cardiac death?

Arrhythmia (usually V-fib)

73

What prevents or slows the development of pulmonary edema in pts with MR?

Increased left atrial compliance (holds more blood in the LA rather than refluxing it to the lungs)

74

Give the light microscopy findings at various points after an MI

0-4 hrs - normal, 4-12 hrs - edema, hemorrhage, wavy fibers, 12-24 hours - contraction bands, neutrophils arrive, 2-4 days - coag necr, neutrophils leave, 5-10 days - neovascularization, gran tissue, 7 weeks - scar

75

Give the main complications post MI and the time window for each

0-4 days - Arrhythmia. 3-5 days - pericarditis and friction rub. 5-10 days - Ruptures (free wall, papillary muscle, IV septum) and tamponade. After 10 days - ventricular aneurysm. Several weeks - Desslers

76

Which cardiac enzyme peaks first?

Troponin

77

CK-MB is not the first cardiac enzyme to peak (troponin is) and is less specific. What is the value of CK-MB in addition to troponin?

CK-MB goes away sooner, so you can use it diagnose reinfarction

78

What finding would you have in a patient with pulmonary edema post-MI

S3 (also crackles from the edema). Its due to LV failure

79

Which type of cardiomyopathy is most common?

Dilated

80

Which type of dysfunction (systolic or diastolic) is each type of cardiomypoathy associated with?

Dilated - systolic, Hypertrophic - diastolic, Restrictive/Obliterative - diastolic

81

Which cardiomyopathy is concentric hypertrophy and which is eccentric?

Dilated - eccentric, Hypertrophic - concentric

82

Causes of dilated cardiomyopathy (8)

ABCCD plus 2. Alcohol, wet Beriberi, Coxsackie B, Cocaine, Chagas, Doxorubicin, hemochromatosis, peripartum cardiomyopathy

83

What is the most common cause of hypertrophic cardiomyopathy?

Familial (AD)

84

What cardiac problem is associated with Friedreichs ataxia?

Hypertrophic cardiomyopathy

85

Treatment for hypertrophic cardiomyopathy

Beta blockers or non-dihydropyridine CCBs (eg verapamil)

86

Findings in hypertrophic cardiomyopathy

Systolic murmur and syncopal episodes

87

Causes of restrictive cardiomyopathy (6)

Sarcoidosis, amyloidosis, postradiation, endocardial fibroelastosis (kids), Lofflers (eosinophils), hemochromatosis (also dilated CM)

88

What drugs reduce mortality in CHF and what are just used for symptomatic relief?

Reduce mortality - ACEi, B-blocker, ARBs, Spironolactone. Symptomatic relief - Thiazides, Loop diuretics, Nitrates

89

Presentation of bacterial endocarditis

Fever, Roths spots (retinal white spots), Oslers nodes (fingers, toes), new Murmur, Janeway lesions (palm or sole), anemia, splinter hemorrhages

90

Most common causes of acute and subacute bacterial endocarditis respectively

Acute - s aureus. Subacute - viridans strep (dental procedures)

91

Most common causes of nonbacterial endocarditis

Malignancy, hypercoagulability, lupus, colon cancer (strep bovis), prosthetic valve (staph epidermis)

92

Most common agents in tricuspid endocarditis due to IV drug use

S aureus, pseudomonas, candida

93

What organisms cause rheumatic fever?

Group A beta hemolytic strep

94

Early death in rheumatic fever

Myocarditis

95

Early and late valvular lesions of rheumatic fever

Early - MVP, late - MS

96

Aschoff bodies and anitschkow cells

Aschoff - Granuloma with giant cells, associated with rheumatic fever, Anitschkow - activated histiocytes also associated with rheumatic fever

97

What type of hypersensitivity is rheumatic fever

Type 2 (antibodies are to M protein)

98

Presentation of rheumatic fever

FEVERSS. Fever, Erythema marginatum, Valvular damage, ESR inc, Red-hot joints (migratory polyarthritis), Subcutaneous nodules, St Vitus dance (chorea)

99

Pulses paradoxus

Associated with cardiac tamponade, asthma, OSAS, pericarditis, and croup. Decreased amplitude in sys BP by 10 or more during inspiration.

100

Most frequent cardiac tumor in children and what condition its associated with

Rhabdomyosarcoma, tuberous sclerosis

101

Complications of varicose veins

Poor wound healing and ulcers. Rarely throws emboli (as opposed to stasis in DEEP veins)

102

Causes of Raynauds phenomenon (3)

Mixed connective tissue disease, SLE, CREST

103

What vascular condition is associated with a hepatitis and which hepatitis?

Hep B with PAN

104

Fever, weight loss, malaise, headache, abdominal pain, melena, HTN, neurologic dysfunction, cutaneous eruptions

PAN

105

What vessels are typically involved in PAN?

Renal and visceral vessels. DOES NOT involve pulmonary arteries

106

Treatment for PAN

Corticosteroids, cyclophosphamide

107

Fever, lymphadenitis, conjunctivitis, oral mucosa changes, hand-foot erythema, desquamation

Kawasaki

108

Treatment for Kawaski

IVIG and aspirin

109

What finding is unique to Buergers disease?

Hypersensitivity to tobacco extract antigen

110

Give the ANCA associated with each of the following: microscopic polyangiitis, Wegners, Churg-Strauss

MP - p-ANCA, Wegener - c-ANCA, Churg-Strauss - p-ANCA

111

What is found in the kidney with Wegeners?

Necrotizing (crescentic) glomerulonephritis

112

Treatment for Wegeners

Cyclophosphamide, corticosteroids

113

Microscopy of Churg-Strauss

Granulomatous vasculitis with eosinophilia

114

Asthma, sinusitis, palpable purpura, peripheral neuropathy

Churg-Strauss (may also involve heart, GI, kidneys)

115

What does Henoch-Schonlein purpura typically follow?

Upper Respiratory Tract Infection

116

What type of immune complexes are seen in Henoch-Schonlein purpura?

IgA immune complexes

117

Palpable purpura of buttocks and legs, arthralgia, abdominal pain, melena

Henoch-Schonlein

118

What is an important difference between the lesions of PAN and Henoch-Schonlein

PAN the lesions are of different ages, Henoch-Schonlein they are all the same age

119

What size blood vessels are affected by Sturge-Weber

Capillary size

120

Findings with Sturge-Weber other than port-wine stain

Ipsilateral leptomeningeal angiomatosis (intracerebral AVM), seizures, early onset glaucoma

121

Best way to differentiate a strawberry from a cherry hemangioma

Strawberry in little kids (also they regress), Cherry in elderly (also they do not regress)

122

What are pyogenic granulomas associated with and what is the main complication?

Can ulcerate and bleed. Associated with trauma and preggers

123

What are cystic hygromas associated with, where are they found, and what do they look like on microscopy?

Associated with Turner. Found in neck. Appear as cystic spaces with connective tissue and lymph aggregates (they are cavernous lymphangiomas)

124

Where are glomus tumors found, what do they arise from, and what is the prognosis?

They are red-blue tumors under the fingernails, arising from smooth muscle cells of the glomus body. They are benign

125

What does a bacillary angiomatosis look like, what causes it, and what patients get them? What is the prognosis?

Look like Kaposi. Found in AIDS pts. Caused by bartonella henselae. Benign.

126

Where are angiosarcomas found, what causes them, what is their marker, and what is the prognosis?

Liver, vinyl chloride, arsenic, and thorotrast exposure, CD31 (endothelial marker), and they are highly lethal malignant

127

What are lymphangiosarcomas associated with?

Lymphedema (eg post-radical mastectomy)

128

Causal agent of Kaposi sarcoma

HHV-8

129

Hydralazine

Directly relaxes SM cells via increased cGMP. Vasodilates arterioles more than veins. Use in HTN, CHF (esp in pregnancy). AE - compensatory tachycardia, lupus like syndrome

130

What is the first line treatment for isolated systolic hypertension?

Thiazides and calcium channel blockers

131

Calcium channel blockers (4)

Nifedipine, verapamil, diltiazem, amlodipine

132

Which CCBs work mostly only vascular smooth muscle?

(most) Nifedipine, Diltiazem, Verapamil (least)

133

Which CCBs work most on heart muscle?

(most) Verapamil, Diltiazem, Nifedipine (least)

134

What agents are used to treat Prinzmetals angina and Raynauds disease?

CCBs

135

Nifedipine class

CCB (more SM than heart)

136

Verapamil class

CCB (more heart than SM)

137

Diltiazem class

CCB

138

Amlodipine class

CCB

139

Nitroprusside

Increases cGMP via NO release. Can cause cyanide toxicity. Decreases preload AND afterload

140

What do you give in a nitroprusside overdose?

Sulfur thiosulfate (prevents cyanide toxicity)

141

Fenoldopam

Dopamine D1 agonist. Relaxes renal vascular smooth muscle, use in malignant HTN

142

Diazoxide

K channel opener (hyperpolarizes vascular SM). Use in malignant HTN. AE - hyperglycemia (reduces insulin release)

143

Malignant HTN drugs (3)

Nitroprusside, fenoldopam, diazoxide

144

What drug works essentially the same as nitroglycerin?

Isosorbide dinitrate

145

Does nitroglycerine work more on arteries or veins

Much more on veins

146

Nitroglycerine is sublingual. If you wanted to give it PO, what would you give instead?

Isomononitrate

147

Symptoms of Monday morning disease (on monday morning) and what chemical it is due to.

Due to nitroglycerin. Will have tachycardia, hypotension, flushing, headache

148

What should you give when you want to lower BP and raise HR?

Nifedipine (causes vasodilation and reflex tachycardia)

149

What is it important for patients to do when taking nitrates

Have a nitrate free period every day to avoid developing tolerance

150

Nifedipine and verapamil are both CCBs but are somewhat different. For each, which other class of drugs is it most similar to?

Nifedipine is like nitrates, Verapamil is like B-blockers

151

Which beta blockers are contraindicated in angina and why?

Pindolol and Acebutolol because they are partial agonists

152

Effects of statins on lipids

LDL down, HDL up (a little), TGs down (a little)

153

Side effects of statins

Hepatotoxicity (inc LFTs), rhabdomylosis

154

Effects of niacin on blood lipids

LDL down, HDL up (quite a bit), TGs down (so all the good things)

155

What is the mechanism of niacin relative to lipids?

Inhibits lipolysis in adipose, reduces hepatic VLDL secretion

156

Side effects of niacin

Flushing (give aspirin), Hyperglycemia and acanthosis nigricans, Hyperuricemia (hope your patient doesnt have gout)

157

What mediates flushing when niacin is given?

Prostaglandins

158

What can you give when administering niacin to reduce pain associated with niacin?

Capsaicin (will decrease substance P levels)

159

List the bile acid resins (3)

Cholestyramine, Colestipol, Colesevelam

160

Effects of bile acid resins (cholestyramine, colestipol, colesevelam) on blood lipids

LDL down, HDL up (slightly), TGs up slightly

161

Mechanism and side effects of bile acid resins (cholestyramine, colestipol, colesevelam)

Prevent intestinal reabsorption of bile acids (liver must use cholesterol to make more). SEs - pts hate it, GI discomfort, GALLSTONES.

162

Ezetimibe

Cholesterol absorption blocker. Prevents cholesterol reabsorption at small intestine brush border

163

Effects of ezetimibe on blood lipids and side effects of ezetimibe

Decreases LDL, does not affect HDL or TGs. Rarely increases LFTs

164

List the fibrates (4)

Gemfibrozil, clofibrate, bezafibrate, fenofibrate

165

Effects of fibrates on blood lipids

LDL down, HDL up, TGs way down (all the good things)

166

Mechanism of fibrates and side effects

Upregulate LPL leading to increased TG clearance. AEs - myositis, hepatoxocity (inc LFTs), cholesterol GALLSTONES

167

Which lipid lowering agents lead to cholesterol gallstones?

Niacin and fibrates (also the two that do all the good things)

168

What combination of lipid lower agents gives a high risk of myopathy?

Statins and fibrates

169

What enzyme do fibrates inhibit

7a-hydroxylase (converts cholesterol to bile acid)

170

What effect does digoxin have on HR and how?

Slows it. Positive inotropy stimulates vagus nerve. This slows conduction at AV node and depresses SA node

171

Uses of digoxin

CHF and a-fib

172

What increases digoxin toxicity?

Renal failure, hypokalemia, quinidine

173

Digoxin non-EKG toxicity

Blurry yellow vision, cholinergic effects (n/v/d)

174

Digoxin EKG toxicity

Increased PR, short QT, scooping, T-wave inversion, arrhythmias, hyperkalemia

175

Antidote for digoxin

Lidocaine, anti-dig Fab, Mg, normal K, cardiac pacing

176

Nesiritide

Recombinant B-type natriuretic peptide (increases cGMP and vasodilates). Acute decompensated heart failure. AE - hypotension

177

Give the mechanism of each class of antiarrhytmic

1 - Na channel blockers, 2 - B blockers, 3 - K channel blockers, 4 - Ca channel blockers

178

List the class Ia antiarrhythmics

Quinidine, Procainamide, Disopyramide

179

Class Ic antiarrhythmics

Flecainide, propafenone, moricizine

180

What effect does each of the Class I subclasses have on AP duration?

Ia - longer, Ib - shorter, Ic - no effect

181

What is the mnemonic for class I antiarrhythmics?

Double Quarter Pounder. Lettuce Tomato Mayo. More Fries Please

182

Which antiarrythmics increase the risk of TdP?

Class Ia, and Sotalol (III)

183

Brief summary of the uses of class I antiarrhythmics

Ia - Reentrant and ectopic rhythms, Ib - Ventricular arrhytmias post-MI and digitalis toxicity arrhythmias, Ic - last resort in tachyarrhythmias

184

What increases the toxicity of all class I antiarrhythmic drugs?

Hyperkalemia

185

Class II antiarrhytmics

Beta blockers. Propanolol, esmolol, metoprolol, atenolol, timolol

186

What part of the EKG do beta blockers (class II antiarrhythmics) affect primarily?

P wave and PR interval

187

Uses of Class II antiarrhythmics

V-tach, SVT, slowing ventricular rate in a-fib and a-flutter

188

What do you treat overdose of Class II antiarrhythmics (b-blockers) with?

Glucagon

189

What class of antiarrhythmics may mask signs of hypoglycemia?

Class II (Beta blockers)

190

Class III antiarrhythmics

K blockers. Ibutilide, Sotalol, Bretylium, Amiodarone, Dofetilide

191

What drug increases the QT interval but does not increase risk of TdP?

Amiodarone

192

Effects of class III antiarrhytmics on EKG

Incrased AP duration, Increased ERP, increased QT interval

193

What do you need to check when using amiodarone?

PFTs, LFTs, and TFTs

194

Amiodarone toxicities

Pulmonary fibrosis, hepatotoxicity, hypo or hyper thyroidism, corneal deposits, skin deposits (blue or gray), photodermatitis, neurologic effects, constipation, CV effects

195

Amiodarone

A class III antiarrhythmic that has class 1, 2, 3 and 4 effects because it alters the lipid membrane

196

Class IV antiarrhythmics

Ca channel blockers. Verapamil and diltiazem

197

EKG effects of class IV antiarrhythmics

Increased ERP, Increased PR interval, decreased conduction velocity

198

What is the main use of Class IV antiarrhythmics?

Nodal arrhythmias (eg SVT)

199

What is the drug of choice in SVT?

Adenosine (for diagnosing or treating)

200

What blocks the effects of adenosine?

Theophylline

201

What arrhythmias is magnesium used to treat?

Torsades de pointes and digoxin toxicity

202

Why is the most common site of aortic aneurysm below the renal arteries?

Because in this section there is no vasa vasorum on the aorta

203

Signs and symptoms of abdominal aortic aneurysm

Severe left flank pain, hypotension, pulsatile mass

204

Most common cause of aneurysm in the arch of the aorta

Tertiary syphilis

205

Water hammer pulse

AR

206

Absent pulse on the left

Dissecting aneurysm of the aortic arch (has closed off the lumen of the subclavian)

207

Test of choice for a dissecting aortic aneurysm

Chest x-ray (look for widening of the proximal aortic knob)

208

Conditions predisposing to aortic dissection (3)

Marfan, Ehlers Danlos, Pregnancy

209

What are spider angiomas usually due to?

Hyperestrogenism

210

Typically what type of hypersensitivity is involved in all small vessel vasculitis?

Type 3

211

How can you tell polymyalgia rheumatic (eg with GCA) apart from polymyositis?

No elevation of serum CK in polymyalgia rheumatic (but will have aches and pains in muscles and joints)

212

A cause of saddle nose besides congenital syphillis

Wegners granulomatosis

213

What infection includes a rash that starts on the extremities and goes to the trunk?

Rocky Mountain Spotted Fever

214

CREST syndrome

Calcinosis (also Centromere Ab), Raynauds, Esophageal dysmotility, Sclerodactyly, Telangiectasia

215

What class of drugs can cause Raynauds?

Ergot derivatives

216

In the case of what heart murmur should you get an immediate surgical consult?

Austin flint murmur. The AR has gotten so bad that the valve needs to be replaced fairly soon

217

What is paroxysmal nocturnal dyspnea a sign of?

Left heart failure

218

Best nonpharmacologic treatment for heart failure

Restrict water and salt

219

Why are ACE inhibitors the treatment of choice in CHF

They decrease preload (decreased sodium reabsorption) and afterload (vasodilation)

220

How does thiamine deficiency lead to high output heart failure?

ATP depletion causes vascular smooth muscle to fail and dilate, causing your BP to tank

221

What impact does chronic hyperthyroidism have on the heart?

Increases synthesis of beta receptors, leading to increased force of contraction (high systolic pressure, high output heart failure eventually)

222

Brenhams sign

Heart rate slows when you press on the proximal part of an AV fistula

223

What vessels in the fetus have the highest and lowest O2 concentration respectively?

Highest - umbilical vein, Lowest - umbilical arteries (2)

224

Most common cause of a congenital ASD?

Fetal Alcohol Syndrome

225

Where is the murmur of a PDA heard best?

Between the shoulder blades

226

What is the most common cause of PDA?

Congenital rubella

227

Why are the junctions of the communicating arteries and main cerebral arteries common points for aneurysms (berry aneurysm)?

Because there is no internal elastic lamina or smooth muscle there

228

2 main ways to get around an aortic obstruction (such as a coarctation)

1) Superficial epigastric artery with internal mammary artery. 2) Intercostals (which is why you have notching of the ribs in coarctation)

229

CAD risk factors

Age (most important), Family History, Cigarette Smoking, HTN, Diabetes, LDL, HDL (negative risk factor)

230

Is tPA more effective on arterial or venous clots and why?

Arterial, they have less fibrin than venous clots

231

Thrombosis of what artery can cause MR?

RCA. It supplies the papillary muscles of the mitral valve

232

What type of an MI can present with epigastric pain?

An RCA MI

233

What type of MI is the most common antecedent to IV septum rupture?

LAD MI

234

If the patient had an LAD MI, what do you need to be sure to give to prevent a particular complication?

Warfarin or Heparin to prevent a mural thrombus from forming (most common after an LAD MI)

235

How would a post MI ventricular aneurysm present?

Massive pectoralis major which bulges with the pulse

236

What is the most common cause of death in ventricular aneurysm?

Heart failure (they generally do not rupture)

237

What is the best predictor of survival at time of discharge from an MI?

Ejection fraction

238

Reinfarction is defined by CK-MB that is still elevated after how long?

3 days

239

What is seen with LDH in MI?

LDH1 becomes higher than LDH2 (called the flip)

240

What is the pathology of MVP?

Myxomatous degeneration

241

What GAG makes up the mitral valve?

Dermatan sulfate. Too much of it becomes redundant and you get MVP

242

Which way do the murmur and click in MVP move when you increase and decrease preload respectively?

Increased preload - moves towards S2 (takes longer for all blood to get out), Decreased preload - moves towards S1

243

Does the murmur of MVP move closer to S1 or S2 when one is anxious?

Closer to S1 (ventricles have less time to fill due to higher HR)

244

In AS and HOCM respectively, does increased blood volume in the LV increase or decrease the intensity of the murmur?

AS - increases it, HOCM - decreases it

245

Most common symptom in rheumatic fever

Polyarthritis

246

Differential for polyarthritis

Juvenile rheumatic arthritis, Henoch Schonlein, rubella, rheumatic fever

247

2 genetic diseases associated with MVP

Marfans and Ehler Danlos

248

Most common cause of sudden death in the Marfan

MVP and conduction defect

249

Valvular lesions associated with carcinoid syndrome

Tricuspid insufficiency and pulmonic stenosis (TIPS)

250

Top two most common causes of infective endocarditis

1) Strep viridians, 2) Staph

251

What defect predisposes patients to getting infective endocarditis on the aortic valve?

VSD (because membranous portion of septum is right next to the valve)

252

What actually causes the visible findings in infective endocarditis (splinter hemorrhages, oslers nodes, janeway lesions, roth spots, and glomerulonephritis)?

Type 3 hypersensitivity (immune complex vasculitis)

253

Most common lesion of the heart in lupus

Pericarditis. Libman-Sacks endocarditis is associated with SLE but is less common

254

Most common cause of myocarditis and pericarditis

Coxsackie virus

255

Most common cause of viral menigitis

Coxsackie virus

256

Cause of hand, foot, and mouth disease

Coxsackie virus

257

Cause of herpangina (painful mouth blisters)

Coxsackie

258

What is contraindicated in HOCM?

Digitalis (as are all positive inotropic agents)

259

Treatment for HOCM

Beta blocker, Ca channel blocker

260

Most common cause of restrictive cardiomyopathy in children

Endocardial fibroelastosis

261

What heart defect does Pompes disease cause?

Restrictive cardiomyopathy (as does Fe overload, and amyloidosis)

262

First step in management of a suspected pericardial effusion

Echocardiogram (then call the surgeon to do a pericardiocentesis)

263

Most common cause of pericardial effusion

Pericarditis (the most common cause of which is Coxsackie)

264

Most common cause of constrictive pericarditis

Worldwide - TB, US - previous cardiac surgery

265

Auscultatory finding in constrictive pericarditis

Pericardial knock (important because no knock present in pericardial effusion)