Cardiology Combined Flashcards
(387 cards)
1
Q
Which artery supplies the SA and AV nodes?
A
RCA
1
Q
When do coronary arteries fill?
A
During diastole
2
Q
What inhibits the Na/K ATPase creating less extracellular Ca and more intracellular thus increasing contractility?
A
Digoxin/digitalis
3
Q
How to calculate EF?
A
What heart can pump out over what can hold. SV/EDV.
4
Q
2 Equations for CO
A
CO = SV X HR. CO= rate of O2 consumption / (arterial O2 - Venous O2)
5
Q
Equation for SV
A
EDV-ESV
6
Q
Do polycythemia, hyper proteinemic states, hereditary spherocytosis increase or decrease resistance in vessel?
A
Increase resistance because increase viscosity.
7
Q
S3 heart sound
A
rapid ventricular filling. Dilated cardiomyopathy(ventricles) CHF, Mitral regurg, Left to right shunt.
8
Q
S4 heart sound (right before S1)
A
High atrial pressure. LVH with atrial kick. Hypertrophic cardimyopathy, aortic stenosis, chronic HTN with LVH, after MI.
9
Q
At Carter’s Xing Vehicles Yield
A
JVP Pulse order.
10
Q
Normal S2 splitting happens with….
A
inspiration because it causes more venous return to right ventricle (negative pressure in chest due to diaphragm lowering) so pulmonic valve takes longer to close than aortic
11
Q
Phase zero of cardiac action potential
A
Upstroke, voltage gated Na+ channels open. Sodium channel blockers would affect this.
12
Q
Phase one of cardiac action potential
A
inactivation of sodium channels, K+ channels begin to open.
13
Q
Phase 2 of cardiac action potential
A
Calcium influx through voltage gated calcium channels. Plateau.
14
Q
Phase 3 of cardiac action potential
A
Rapid repolarization with massive efflux of K+ with opening of voltage gated slow K+ channels and closing of Ca2+ channels. Potassium channel blockers would affect this.
15
Q
Phase 4 of cardiac action potential
A
RMP with K+ permeability.
16
Q
Pacemaker action potential
A
Phase 4- RMP (K+ permeable). Na+ channels gradually open until threshold causes opening of voltage gated Ca2+ channels and phase 0 happens (upstroke). No plateua and now Potassium brings it back down in phase 3.
17
Q
What inhibits phase zero of pacemaker action potential?
A
Calcium channel blockers.
18
Q
What suppresses the slope of phase 4 in pacemaker action potential.
A
Beta blockers.
19
Q
4 classes of antiarrhythmics
A
No Bad Boy Keeps Clean. 1- Na+, 2- Beta Blockers. 3-K+. 4- Calcium channel blockers.
20
Q
Sodium channel blockers
A
Class 1 antiarrhythmics. Increase slope of phase 0 for cardiac action potential (sodium depolarization) so increase refractory period thus decreasing heart rate
21
Q
Sodium channel blocker used for Wolf Parkinson White
A
Procainamide. Can cause SLE (antihistone antibodies).
22
Q
Quinidine toxicity
A
Cinchonism (headache and tinnitus), thrombocytopenia, torsades (arrhythmia).
23
Q
Beta blockers
A
Class 2 antiarrhythics. Suppress abnormal pacemakers by decreasing slope of phase 4 (Calcium influx).
24
Sotalol and amiodarone
Class 3 antiarrhythmics. Potassium channel blockers. Used for atrial fib. Amiodarone for WPW.
25
Pulmonary fibrosis, hepatotoxicity, hypo/hyperthryoidism are side effects of......
Amiodarone. Check PFTs, LFTs, TFTs
26
Class 3 antiarrhythmics
K+ channel blockers. Class 3 phase 3.... (repolarization due to K+)
27
Verapamil and diltiazem
Class 4 antiarrhythmics, Calcium channel blockers. Non-Dihydropyridine CCB's. Prolong phase 0 of pacemaker cells (depolarization due to calcium).
28
Adenosine
Pushes K+ out of cells hyperpolarizing the cell and preventing depolarization causing flat line. Diagnose and abolish supraventricular tachycardia.
29
Conduction delay through AV node on ECG
PR Segment
30
Mechanical contraction of ventricles on ECG
QT interval
31
T wave inversion on ECG
Indicative of MI
32
QRS complex
Depolarization of ventricles. Less than 3 little boxes (120 msec).
33
Drugs which can prolong QT interval (possibly leading to torsades)
Macrolides (erithromycin), haloperidol and risperidone, methadone, protease inhibitors, chloroquine and primaquine, antiarrhythmics.
34
How to treat torsades
magnesium
35
Electrical signal not going through AV node
Wolf Parkinson White
36
Early ventricular depolarization with a delta wave on ECG
Wolf Parkinson White can lead to reentry current and supraventricular tachycardia.
37
How to treat WPW
Procainamide (NA channel blocker), Amiodarone (calcium channel blocker)
38
Irregularly irregular ECG with no discrete P waves how do you treat?
Atrial fibrillation and treat with Digoxin with beta blocker or CCB
39
Sawtooth appearance on ECG how do you treat?
Atrial flutter so use Na+ channel blocker or K+ channel blocker (Sotalol and amiodarone).
40
Completely erratic rhythm with no identifiable waves
Ventricular fibrillation. Leads to death.
41
Which baroreceptor (and which nerve is it on) responds to only increase in BP
Aortic arch (vagus nerve)
42
Which baroreceptor (and which nerve is it on) responds to both increase or decrease in BP
Carotid sinus (glossopharyngeal nerve)
43
HTN, bradycardia, respiratory depression. Also what kind of receptors are this sensed by.
Cushing triad due to Increased ICP sensed by CHEMORECEPTORS.
44
What releases NO which can lead to vasodilation?
Endothelial Cells.
45
What stimulates endothelial cells to release NO leading to vasodilation?
Bradykinin, Ach, alpha 2 agonist, histamine, serotonin, shear stress
46
Inhibits cGMP phosphodiesterase
Sildenafil. Leading to more cGMP and thus more vasodilation.
47
Which drug do you give for HTN but patient has renal stones?
Thiazide diuretics because thiazides retain Ca. Loops lose calcium so don't give with renal stones.
48
Which drug increases cGMP (decreasing afterload because it works on arterioles\>veins) for use for HTN in pregnancy
Hydralazine
49
What drug is a K+ channel opener relaxing hyperpolarizing and relaxing vascular smooth vessels for use in HTN?
minoxidil (hypertrichosis side effect)
50
Calcium channel blocker for use in HTN (reduces vascular smooth muscle contraction)
Nifedipine (verapamil and diltiazem are antiarrhythmics at the heart).
51
With smooth muscle spasm (prinzmetal's angina, raynaud's) what kinds of drug do you use?
Dihydropyridine Ca Channel Blocker (-dipines)
52
Releases NO in endothelial cells of smooth muscles (increasing cGMP) dilating veins more than arteries and decreasing preload.
Nitroglycerin
53
What drug can cause cyanide toxicity and vasodilates both arterioles and veins for use in malignant HTN?
Nitroprusside. (Labetolol also used in malignant HTN)
54
What antihypertensive drug has a first dose orthostatic hypotension?
Alpha Blockers (-zosins)
55
What anti-HTN drugs are ototoxic (especially with aminoglycosides)?
Loop Diuretics. And loops lose calcium.
56
What class of anti-HTN drugs can cause angioedema (swollen lips, eyes, face)?
ACE inhibitors
57
Anti HTN drugs that can result in hypercalcemia, hypokalemia?
Thiazide diuretics. Thiazides DON't lose CA2+.
58
First line treatment for aortic dissection?
Beta blockers.
59
Tearing chest pain radiating to the back (or scapula), CXR shows mediastinum widening?
Aortic Dissection
60
Main risk factor for AAA?
Atherosclerosis of descending aorta (most common site)
61
To have angina must have narrowing of at least.....
75% of Coronary Artery
62
What drugs lower LDL the most?
HMG-CoA Reductase inhibitors (statins)
63
Side effects of statins?
Rhabdomyolysis (muscle breakdown), hepatotoxicity (increased LFT's), myositis (muscle inflammation), myalgia (muscle pain)
64
What drug raises HDL the most?
Niacin
65
Red, flushed face, hyperglycemia, hyperuricemia side effects
Niacin
66
Drug that tastes really bad and lowers LDL
Bile acid resines(cholestyramine)
67
What drug causes liver to use more cholesterol?
Bile acid resins (block intestinal reabsorption of bile acids so liver must use cholesterol to make more)
68
What drug can cause cholesterol gallstones?
Bile acid resins
69
Which drug blocks cholesterol absorption? (Blocks at small intestine brush border.)
Ezetimibe.
70
Which drugs decrease triglycerides most?
Fibrates
71
Which drug upregulates LPL?
Fibrates
72
What can lead to pancreatitis?
Increased TG's.
73
Which lipid lowering drug binds to C. Dificile?
Cholestyramine (bile acid resin)
74
How can you prevent the flushing reaction of Niacin?
Aspirin
75
Which anti-HTN drug can cause hyperkalemia?
ACE inhibitors. Don't have us much aldosterone which helps excrete potassium.
76
Chest pain at rest (secondary to coronary artery spasm) with ST elevation on ECG?
Prinzmetal's angina
77
How to treat prinzmetal's angina?
Nifedipine (dihydropyridine ca channel blockers.
78
What most commonly leads to aortic dissection?
HTN
79
What can lead to sharp chest pain that is relieved by sitting forward?
Pericarditis which can be caused by Rheumatic fever among other conditions. Also fibrinous pericarditis from an MI (presents with friction rub).
80
Best treatment for angina?
Nitrates + Beta blockers
81
Contraction bands seen.......
at least 2 hours since MI.
82
What are the cells of acute inflammation in an MI (2-4 days)
Neutrophils
83
What kind of necrosis occurs in an MI?
Coagulative necrosis
84
Compression of heart by blood leaking into pericardium
Cardiac Tamponade.
85
Cells of inflammation in an MI 5-10 days after?
Macrophages come in and degrade things.
86
After 10 days from an MI at risk for........
Ventricular aneurysm at bulging scar.
87
When does toponin I rise after an MI?
After 4 hours and elevated 7-10 days.
88
ECG changes of ST elevation can indicate what type of MI?
Transmural infarct
89
ECG changes of ST depression can indicate what type of MI?
Subendocardial infarct/
90
ECG changes of t wave inversion can indicate what type of MI?
Transmural infarct
91
What persists on ECG weeks after MI?
Q wave
92
Most specific marker of an MI (gold standard).
Troponin I
93
Severe MI then five days later have mitral regurg what happened?
Macrophages came and degraded things and we had rupture of the papillary muscle.
94
What drugs directly aid conversion of plasminogen to plasmin (which degrades fibrin)?
Thrombolytics. Streptokinase, Urokinase, tPA.
95
When do you use thrombolytics?
STEMI MI.
96
What do you treat thrombolytic toxicity?
Aminocaproic acid
97
What does aspirin do?
Irreverisbly inhibits COX-1 and COX-2 to prevent conversion of arachidonic acid to thromboxane A2 (clotting).
98
How do you treat aspirin toxicity?
NaHCO3
99
What do Clopidogrel and Ticlopidine do?
ADP receptor blockers which inhibits platelet aggregation. Inhibits figrinogen binding by preventing glycoprotein IIb/IIIa expression
100
Which drugs inhibit platelet aggregation by preventing glycoprotein IIb/IIIa expression? (what other drug also does this)
Clopidogrel and Ticlopidine. Abciximab is the other drug (monoclonal ab binds glycoprotein Iib/IIIa receptor).
101
Which drug inhibits platelet aggregation by binding to the glycoprotein IIb/IIIa receptor on activated platelets?
Abciximab
102
Balloon appearance on x ray of heart (big and circular)?
Dilated Cardiomyopathy.
103
Most common cause of US of myocarditis?
Coxsackie Virus. (also eckovirus and influenza virus)
104
Lymphocytes with myocyte necrosis?
Myocarditis (viral infection).
105
Cause of sudden death in young athletes?
Hypertrophic cardiomyopathy
106
Disoriented, tangled, hypertrophied myocardial fibers?
Hypertrophic cardiomyopathy
107
What can you hear with hypertrophic cardiomyopathy?
S4 heart sound.
108
Endomyocardial fibrosis with eosinophilic infiltrate?
Loffler's Syndrome
109
How to increase contractility and cardiac output?
Digoxin/digitalis
110
Which artery supplies the SA and AV nodes?
RCA
111
Which artery supplies the inferior portion of the left ventricle and posterior septum?
Posterior descending (80% off the RCA, 20% off the circumflex)
112
Where does coronary artery occlusion occur most commonly?
LAD
113
What does the LAD supply?
apex and anterior interventricular septum
114
When do coronary arteries fill?
during diastole
115
Where is the most posterior portion of the heart and what can it cause?
The LA, can cause dysphagia because of compression of the esophageal nerve or hoarseness by compressing the the recurrent laryngeal nerve
116
What supplies the posterior left ventricle?
CFX (left circumflex coronary artery)
117
stroke volume x HR =?
CO
118
rate of 02 consumption/ arterial 02 - venous 02 ccontent=CO
fick principle
119
CO x Total peripheral resistance
mean arterial pressure
120
2/3 diastolic + 1/3 systolic
MAP
121
systolic - diastolic
pulse pressure
122
EDV - ESV
stroke volume
123
SV CAP means?
Stroke volume affected by contractility, afterload, and preload
124
How do catecholamines increase contractility?
Increasing activity of Ca pump in SR
125
What does increasing intracellular Ca do?
increase contractility
126
What happens with a decrease of extracellular Na
decrease in activity of Na/Ca exchanger and increase in contractility
127
How does digitatlis increase contractility?
Increase intracellular Na, resulting in increased Ca
128
How do beta blockers decrease contractility?
decrease in cAMP
129
Why is contractility decreased in heart failure?
systolic dysfunction
130
How does acidosis affect contractility?
decreased
131
Do dihydropyridine or non-dihyrdropyridine Ca channel blockers decrease contractility
Non
132
What cardiac change occurs in pregnancy?
increased SV
133
What 4 things drive myocardial 02 demand?
inc afterload, inc contractility, inc heart rate, inc heart size (inc wall tension)
134
If HR is too fast (V tach) what happens during diastole?
filling is incomplete and CO falls
135
EDV is also known as
Preload
136
MAP is also known as
Afterload (proportional to peripheral resistance)
137
Which class of drugs decrease preload
venodilators (nitrogylcerine)
138
Which class of drugs decreases afterload?
Vasodilators, (hydrAlAzine)
139
Exercise, overtransfusion and excitiment causes and increase in...?
Preload
140
What does the starling curve show?
changes in CO as a function of preload
141
When does EF decrease
in HF
142
What is the formula for EF?
SV/ EDV
143
What is a normal EF
at least 55%
144
Given P = QR, what factors influence resistance?
proportional to viscosity and inversely proportional to the radius to the 4th power
145
Which vessels account for the most total peripheral resistance
arteriorles
146
Which lab value indicates blood viscosity?
hematocrit
147
In what disease states is blood viscosity increased?
polycythemia, hyperproteinemic states (multiple myeloma), hereditary spherocytosis
148
In the cardiac and vascular function curves, in what instance is the vascular curve shifted to the left?
hemorrhage
149
In the cardiac and vascular function curves, in what instance is the vascular curve shifted to the right?
transfusion
150
What is indicated when CO and venous return are equal?
The operating point of the heart
151
What causes the CO curve to shift upwards?
pos inotropy, exercise
152
what causes the CO curve to shift downwards?
neg inotropy, HF, narcotic overdose
153
In the cardiac cycle, which period has the highest 02 consumption?
isovolumetric contraction
154
On the cardiac cycle graph, on which corners do the opening and closing of the aortic and mitral valves occur?
lower right, MC, upper right, AO, upper right AC, lower left MO
155
What is the S1 sound?
mitral and tricuspid closure
156
What is the S2 sound?
Aortic and pulmonary closing
157
When and why is the S3 sound heard?
normal in children and pregs, assoc with inc filling pressures, early in diastole during rapid ventricular filling
158
When and why do you hear the S4 sound
late in diastole, high atrial pressure, pushing against a stiff LV wall, associated with ventricular hypertrophy
159
in the JVP, what is the a wave?
atrial contraction
160
in the JVP, what is the c wave?
RV contraction (closed tricuspid valve bulging into atrium
161
in the JVP, what is the v wave?
inc RA pressure, due to filling against closed tricupsid valve
162
In normal S2 splitting, which valve closes first? What increases it?
the aortic before pulmonic, inspiration increases diff
163
What is the association with wide S2 splitting?
pulmonic stenosis and RBBB
164
What is association with fixed S2 splitting, does not increase with inspiration
ASD
165
What is associated with paradoxical spliting of S2
Aortic stenosis or LBBB
166
with what heart sounds do ASD usually present?
pulmonary flow murmur and diastolic rumble
167
Does blood flow across the actual ASD account for abnormal heart sounds? What is the reason?
No, no pressure gradient
168
Inspiration causes an increase in which sided heart sounds?
Right sided
169
Expiration causes an increase in which sided heart sounds
Left sided
170
What are the systolic heart sounds
aortic/pulmonic stenosis and mitral/tricuspid regurg
171
What are the diastolic heart sounds?
aortic/pulmonic regurg and mitral/tricuspid stenosis
172
Which murmur is characteristic of mitral/tricuspid regurg?
holosystolic
173
What are common causes of mitral regurg?
ischemic heart dz, mitral valve prolapse, LV dilation
174
What causes the murmur heard in MR to enhance?
inc TPR and LA return (expiration)
175
What causes the murmur heard in tricuspid regurg to enhance
in RA return (inspiration)
176
Which murmur is heard in aortic stenosis?
crescendo-decrescendo systolic ejection murmur following ejection click
177
What causes the ejection click in the Cres-decres murmur?
aburpt halting of valve leaflets
178
What is the characteristic pulse in aortic stenosis?
pulsus parvus and tardus, weak, can lead to syncope
179
What causes aortic stenosis
age related calcifications or bicuspid aortic valve
180
Which murmur is heard with VSD?
holosystolic, harsh sounding murmur, loudest over tricuspid area
181
Which murmur is heard with mitral prolapse?
late systolic crescendo murmur with a midsystolic click
182
what causes the midsystolic click
sudden tensing of chordae tendinae
183
What does mitral prolapse predeispose to?
infective endocarditis
184
What can cause mitral prolapse?
myxomatous degeneration, RF, chordae rupture
185
What murmur is heard with aortic regurg?
immediate high pitched blowing diasystolic murmur with a wide pulse pressure
186
What causes aortic regurg
aortic dilation, bicuspid aortic valve, RF,
187
Which class of drugs decrease the murmur heard in aortic regurg?
Vasodilators
188
Which murmur do you hear in mitral stenosis?
late diastolic murmur following an opening snap
189
Chronic mitral stenosis can lead to what changes in size of the LA
dilation
190
Mitral stenosis is most often secondary to which condition?
RF
191
What is the machine like murmur? What is the heart pathology and the predisposing causes
patent ductus arteriosus, congenital rubella or prematurity
192
When does extracellular calcium enter the cardiac muscle cells during contraction?
the plateau period
193
What stimulates release of calcium from the SR?
extracellular calcium, calcium induced calcium release
194
When during cardiac nodal cells depolarize?
during diastole
195
How are cardiac myocytes electrically coupled?
gap junctions
196
What happens in phase 0 of the cardiac ventricular action potential?
rapid upstroke, voltage gated Na channels open
197
What happends in phase 1 of the ventricular cardiac action potential?
initial repol, inactivation of of voltage gated Na channels, voltage gated K channels begin to open
198
What happens in phase 2 of the cardiac ventricular action potential?
plateau, influx of calcium through voltage gated ca channels, ca release from SR and contraction
199
What happens in phase 3 of the cardiac ventricular action potential?
rapid repol, massive K eflux, opening of voltage gated slow K channels and closure of Ca channels
200
What happens in phase 4 of the cardiac ventricular action potential?
resting potential high K perm
201
Where are pacemaker cells?
SA and AV nodes
202
What channels do the the pacemaker cells lack?
fast volatge gated Na channels
203
What constitutes the upstroke in pacemaker cells?
volatage gated Ca channels
204
What is the result of not having fast sodium channels in pacemaker cells?
Slow conduction velocity, used by AV node prolongs transmission from atria to ventrical
205
Which channel accounts for automaticity of the SA and AV nodes?
If sodium channel
206
What is the effect on the slope of phase 4 in pacemaker cells by Ach or adenosine?
decreases
207
What is the effect on the slope of phase 4 in pacemaker cells by catecholamines and
increase, increase the chance the If are open
208
In an EKG, what is the p wave?
atrial contraction
209
In an EKG, what is the PR segment?
conduction delay through AV node, nl \< 120 msec
210
In an EKG, what is the QRS complex?
ventricular depolarization, nl \< 120 msec
211
In an EKG, what is the QT interval?
mechanical contraction of the ventricles
212
In an EKG, what is the T wave?
Ventricular repolarization
213
What does T wave inversion indicated?
MI
214
What masks atrial repolarization?
QRS complex
215
What does an isoelectric ST segment indicate?
ventricles are depolarized
216
What does the U wave indicated?
hypoK and bradycardia
217
What does prolonged QT predispose to?
torsades de pointes
218
What is the danger of torsades to pointes?
can progress to V fib
219
What other sign is often present with congenital long QT syndrome, why?
sensironeural deafness, defects in sodium and potassium channels, jervell and lange-neilsen syndrome
220
Rank the following by speed of conduction, av node, atria, purkinjee, ventricles
purkingee\>atria\>ventricles\>AV node
221
Rank the pacemakers cells
SA\>AV\>bundle of His\>ventricles
222
delta wave on ECG, accesory conduction pathway from atria to ventricles, reentry leading to supraventricular tachycardia
Wolff-Parkinson white syndrome
223
Irregularly irregular ECG, no p waves: dx and treatment
A fib, beta block or ca channel block, warfarin, thromboembolism prophylaxis
224
sawtooth wave
Atrial flutter, identical back to back atrial depol's, convert to sinus, cal IA, IC or III antiarrhythmics
225
prolonged PR interval
1st degree AV block
226
progressive lengthening of PR until beat is dropped, a p wave not followed by QRS
2nd degree AV block, mobitz type 1
227
no change in PR interval followed by dropped beat
2nd degree AV block, mobitz type 2, may progess to 3rd degree block
228
no relation between p waves and QRS intervals, treatment and predisposing factor
3rd degree block, pacemaker, Lyme disease
229
Fatal arrhythmia
V fib
230
What does the atria release in response to inc blood volume and atrial pressure
ANP
231
Which two mechanisms sense decrease MAP?
medullary vasomotor center senses baroreceptors and JGA
232
Which sympathetic receptors raise MAP
beta 1 inc HR and cont, alpha 1 venocxn, alpha 1 arteriolar vascxn
233
How does angiotensin II raise MAP
vasocxn
234
How does aldosterone raise MAP
inc blood volume
235
The aortic arch receptors transmit along which nerve?
vagus to medulla
236
The carotid sinus transmits along which nerve?
glossopharyngeal to soliary nucleus of medulla
237
decrease stretch in baroreceptors leads to what response?
increased efferent SANS and decreased efferent PANS
238
What do the carotid and aortic bodies respond to?
dec P02, inc PC02 and dec pH
239
Central chemoreceptors do not respond directly to which parameter?
P02
240
What is the cushing triad?
HTN, bradycardia, and respiratory depression
241
What causes the cushing reflex and why
inc ICP, cerebral ischemia, inc SANS tone (HTN) and reflex bradycardia
242
Which organ gets the largest share of systemic cardiac output
Liver
243
Which organ has ht highest blood flow per gram of tissue
Kidney
244
Which organ has the largest arteriovenous difference
Heart, 02 extraction is always around 100%
245
PCWP(Pulmonary Capillary Wedge Pressure) \> LV Diastolic Pressure
Mitral Stenosis
246
PCWP is an estimate of
Left atrial pressure
247
What does hypoxia cause in the lung versus other tissues?
vasocxn, while other tissues it causes vasodilation
248
What does autoregulation do?
maintain blood flow to organ over wide range of perfussion pressures
249
What do the starling forces determine
fluid movement through capillaries
250
In terms of starling forces, why does heart failure cause edema?
increase in Pc
251
In terms of starling forces, why does nephrotic syndrome or liver failure cause edems
dec plasma proteins
252
Why is there edema after burns or during infection
inc Kf, capillary perm
253
what happens to capillaries in lymphatic blockage
inc interstitial osmotic pressure pulling fliud out of capillaries
254
What are the 5 T's of cyanoitc babies
tetralogy of fallot, transposition of great vessels, truncus arteriosus, tricuspid atresia, TAPVR
255
what does TAPVR stand for
total anomalous pulmonary trunk venous return
256
Right to left shunts are more common in babies or kids?
babies
257
Left to right shunts are more common in babies or kids?
kids
258
failure of truncus arteriosus to divide?
persistant truncus arteriosus
259
absecnce of tricuspid valve, hypoplastic RV
tricuspid atresia, requires ASD and VSD
260
pulmonary veins drain into right heart circulation (SVC, coronary sinus)
TAPVR
261
L to R shunt becomes R to L due to increase pulm pressures from original congenital heart defect
Eisenmenger's syndrome
262
PROVe
tetrology of fallot - pulmonary stenosis, RVH, overiding aorta, VSD
263
What causes the early cyanosis in Tet of Fallot?
R to L shunt caused by stenoic pulmonic valve
264
What is the classic X ray finding for tet of fallot?
boot shaped heart
265
What causes tet of fallot?
anterosuperior displacement of the infundibular septum
266
How does a patient with Tet of fallot learn to improve symptoms?
squat. Compression of femoral arteries, inc TPR, dec
267
What other congenital abnormality is necessary for life for a patient with transposition of the great vesses?
shunt, VSD, PDA or patent foramen ovale, due to failure of the aorticopulmonary septum to spiral
268
Weak pulses, notching of the ribs on xray, HTN in upper extremeties and weak peripheral pulses
adult type aortic coarctation
269
what is the difference between adult and infantile type aortic coarctation?
infantile is proximal to ductus arteriosus and adult is distal. Infantile IN and aDult is Distal to Ductus
270
What other syndrom is associated with infantile aortic coarctation
turners
271
machine murmer
PDA
272
What is the difference between the fetal and neonatal direction of blood flow in a patent ductus arteriosus
fetal right to left, neonate left to right leading to RVH and failure
273
which medications are used to maintain patency or close the ductus arteriosus?
indomethacin closes, and pge keeps it open
274
congenital heart defect with 22q11
truncus, tet of fallot
275
congenital heart defect withdown syndrome
ASD, VSD, AV septal defect (endocardial cushion defect)
276
congenital heart defect with congenital rubella
septal defects, PDA, pulm art stenosis
277
congenital heart defect with turner's
coarcation of aorta
278
congenital heart defect with marfan's
aortic insuffic, late
279
congenital heart defect in an infant with a diabetic mother?
transposition of great vessels
280
What is the definition of HTN?
140/90
281
which ethnic groups have higher association with HTN?
black \> white \> asian
282
what percentage of HTN is secondary to renal disease?
10%
283
What does HTN predispose to?
atherosclerosis, LVH, stroke, CHF, renal failure, retinopathy, aortic dissection
284
What are tendinous xanthoma, atheromas, and corneal arcus signs of?
hyperlipidemia
285
Hyperplastic onion skinning
arteriolosclerosis in malignant hypertension
286
fibrous plaques and atheromas in intima of arteries
atherosclerosis
287
moncekberg
calcification in media of arteries esp radial and ulnar, does not obstruct blood flow, intima not involved
288
disease of elastic arteries and large and medium sized muscular arteries
atherosclerosis
289
What is the progression of atherosclerosis?
endothelial cell dysfxn, mac and LDL accum, foam cell, fatty streaks, smooth muscle cell migration, fibrous plaque, comlex atheromas
290
what are the complications of atherosclerosis?
aneurysms, ischemia, infarcts, peripheral vasc dz, thromboemboli
291
what are the four most common locations for atherosclerosis?
abdominal aorta\>coronary artery\>popliteal artery\>carotid artery ACoPCa
292
tearing chest pain radiation to the back, associated with marfan
aortic disecction, intraluminal tear forming false lumen
293
retrosternal chest main with exertion, ST depression on ECG, likely due atherosclerosis
stable angina
294
coronary artery spasm, ST elevation
prinzmetal angina
295
thrombosis w/o necrosis, ST elevation, worsening chest pain at rest or with minimal exertion
unstable/crescendo angina
296
What is the most common cause of MI
acute thrombosis of coronary artery
297
What is sudden cardiac death most commonly due to
v fib arrhythima
298
list the coronary vessels most likely to be occluded
LAD \> RCA \> circumflex
299
diaphoresis, N/V, severe retrosternal pain, pain in left arm/jaw, SOB, fatigue, adrenergic symptoms
MI
300
What is the time frame for arrhythmia risk in the evolution of MI
the first 4 days
301
In an acute MI, are there any visible changes via LM in the first 2-4 hours
no
302
In the evolution of an MI, when the risk for free wall rupture, tamponade, papillary muscle rupture, or interventricular septal rupture the hightest? Why?
5-10 days, macs have degraded structural components
303
When do you see extensive coagulative necrosis in an MI
2-4 day, early coag necrosis on the first day
304
When is the scar completely formed in an MI?
7 weeks
305
Which enzyme rises after 4 hours and is elevated for 7 to 10 days after an MI?
troponin I
306
What is the gold standard for dx of MI in the first 6 hours
EKG
307
Which enzymes are useful for diagnosing reinfarction
CK-MB
308
Which kind of infarct show ST elevation, and/or pathologic Q waves
transmural
309
What kind of infarct show ST depression
subendocardial
310
Which area of the endocardium is especially vulnerable to infarction? Why?
subendocardial, fewer collaterals and higher pressure
311
In an anterior wall infarct, which artery is effected and which leads show Q waves
LAD, V1 -V4
312
In an anteroseptal infarct, which artery is effected, and which leads show Q waves?
LAD, V1-V2
313
In an anterolateral infarct, which artery is effected and which leads show Q waves
LCX, V4-V6
314
In a lateral wall infarct, which artery is effected, and which leads show Q waves?
LCX, I, aVL
315
In an inferior wall infarct, which artery is affected and which leads show Q waves,
RCA, II, III, aVF
316
The 7 complications of MI
arrhythmia, LV failure and pulm edema, cardiogenic shock, free wall rupture, aneurysm, postinfarcation fibrinous pericarditis, dressler's
317
friction rub, 3-5 days post MI
postinfarction fibrinous pericarditis
318
fibrinous pericarditis several weeks post MI
dressler's, autoimmune
319
S3, dilated heart on US, balloon appearance on CXR, eccentric hypertrophy
dilated cardiomyopathy
320
What are the different etiologies of dialted cardiomyopathy
EtOh, wet Beriberi, Coxsackie B, cocaine, chagas, doxorubicin, hemochromatosis, peripartum cardiomyopathy
321
How are the sarcomeres added in eccentric hypertrophy?
in series
322
sudden death in young atheletes, S4, apical impulses, outflow obstruction
hypertrophied cardiomyopathy
323
How are sarcomeres added in concentric hypertrophy?
in parallel
324
Does eccentric hypertrophy or concentric hypertrophy cause systolic disfunction
eccentric, concentric hypertrophy causes diastolic disfunction
325
Restrictive cardiomyopathy causes
sarcoid, amyloid, postradiation fibrosis, endocardial fibroelastosis, Loffler, hemochromatosis
326
What kind of dysfunction ensues in restrictive cardiomyopathy
diastolic
327
dyspnea, fatigue, edema and rales, multiple causes
CHF
328
The cause of dyspnea on exertion?
failure of LV to in CO during exercise
329
The cause of cardiac dilation?
greater ventricular EDV
330
The cause of pulmonary edema, paroxysmal nocturnal dyspnea?
LV failure, pulm venous distention transudation of fluid
331
When do you find hemosiderin laden macrophages in the lungs?
during HF from microhemorrhages from inc pulm cap pressure
332
what causes orthopnea?
inc venous return exaccerbates pulm vasc congestion
333
what causes hepatomegaly?
inc central venous pressure, inc resistance to portal flow
334
What causes ankle, sacral edema, jugular venous distention
RV failure, in venous pressure
335
What is the most common cause of right heart failure
left heart failure
336
What does FROM JANE stand for in bacterial endocarditis?
fever, roth's spots, osler's nodes, murmur, janeway lesions, anemia, nail-bed hemorrhages, emboli
337
Which valve is most commonly involved in bacterial endocarditis?
mitral valve
338
Which valve is commonly involved in bacterial endocarditis from IV drug use and which bacteria are most common?
tricuspid, don't tri drugs, S. aureus, pseudomonas, candida
339
bacterial endocarditis, previously normal valves, rapid onset, which bacteria?
s. aureus
340
smaller vegetations, congenitally abnormal or diseased valves, sequela of dental procedures. Insidious onset
viridans streptococci
341
Which bacteria causes endocarditis in the presence of colon cancer
s. bovis
342
which bacteria can cause endocarditis from prosthetic valves?
s. epidermidis
343
What are the complications from bacterial endocarditis?
chordae rupture, GN, suppurative pericarditis, emboli
344
Wartlike, sterile vegetations occur on both sides of the valve, commonly causes mitral regurg. SLE causes it
Libman-Sacks Endocarditis
345
Which bacteria causes rheumatic heart disease
group a beta hemolytic strep
346
what do patients die early from in rheumatic heart disease?
early deaths from myocarditis
347
Which heart valves are afected most in rheumatic heart disease
mitral\>aortic\>\>tricuspid, high pressure valves affected most
348
what is the early and late lesion in rheumatic heart disease
mitral valve prolapse
349
What are aschoff bodies
granuloma with giant cells
350
what are anitschkow's cells
activated histiocytes
351
Do you see elevated ASO titers in rheumatic heart disease
yes
352
What does FEVERSS stand for in rheumatic heart disease
fever, erythema marginatum, valvular damage, ESR, red hot joints, subQ nodules, St. vitus dance (chorea)
353
Equilibration of diastolic pressures in all 4 chambers, decreased CO from compression of heart by fluid in pericardium
cardiac tamponde
354
exaggerated decrease in pulse during inspiration.
kussmaul's sign, cardiac tamponade, pulsus paradoxus
355
clinical signs of cardiac tamponade
hypotension, inc venous pressure, distant heart sounds, inc HR, pulsus paradoxus
356
what conditions are associated with pulsus paradoxus
cardiac tamponade, asthma, obstructive sleep apnea, pericarditis and croup
357
disruption of the vasa vasorum of aorta, dilation of aorta and valve ring, tree bark appearance (calcifications on aortic root)
3rd degree syphillus, syphillit heart disease can lead to aortic valve incompetence
358
most common primary cardiac tumor in adults, ball-valve obstruction in left atrium
myxoma
359
most common primary cardiac tumor in children, associated with tuberous sclerosis
rhabdomyomas
360
most common heart tumor
metastasis from melanoma or lymphoma
361
dilated tortous veins due to chronically inc venous pressure, poor wound healing, varicose ulcers
varicose veins, thromboembolism rare
362
decrease blood flow to the skin due to arteriolar vasospasm in cold temp, emotional stress, also in SLE and CREST
raynaud's
363
necrotizing granulomas in lung and upper airways, nectrotizing GN, small vessel vasculitis
Wegener's
364
Wegener's presentation
hemoptysis, hematuria, perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis, cough dyspnea
365
serum marker for wegener's
c-ANCA
366
Wegener's tx
cyclophosphamide and corticosteroids
367
p-anca
microscopic polyangiitis, like wegener's without granulomas
368
Churg Strauss, presentation and test
granulomatous vasculitis with eosinophilia. Asthma, sinusitis, skin lesions and periphereal neuropathy (wrist/foot drop) heart, GI, kidneys
369
port wine stains on face, intracerebral AVM, siezures, early onset glaucoma, congenital
sturge weber, vasculitis of caps
370
skin rash on buttocks and legs, arthralgia, intestinal hemorrhage, abdominal pain, melena. Follows URI, IgA immune complex, most common childhood systemic vasculitis
Henoch-Schlonlein purpura
371
segmental thrombosing vasculitis of small and medium vessels in smokers with intermittent claudication, superficial nodular phlebitis, raynaud's, gangrene and severe pain, autoamputation of digits is possible
Buerger's disease
372
acute, self limiting necrotizing vasculitis in children associated with fever, conjunctivitis, strawberry tongue, desquamatous skin rash, lymphadenitis, coronary sinus aneurysms. Seen in asians
kawasaki
373
immune mediated transmural vasculitis with fibrinoid necrosis, small and medium vessels, renal and viscera, not pulm arteries, hep B seropos in 30% of pts,
polyarteritis nodosum
374
pulseless disease, granulomatous thickening of the aortic arch and/or proximal great vessels - elev ESR, asian females \> 40
takayasu's arteritis
375
what does FAN MY SKIN On Wednesday stand for?
Fever, Arthritis, Night sweats, Myalgia, SKIN nodules, Ocular disturbances, Weak pulses in upper extremities
376
Unilateral headache, jaw claudication, impaired vision,
tempral arteritis, may cause irreversible blindness
377
Most common vasculitis affecting medium and large arteries
Temporal arteritis
378
benign cap hemangioma of infancy, spont regresses
strawberry hemangioma
379
bening capillary hemangioma of elderly, does not regress
cherry hemangioma
380
polypoid capillary hemangioma that can ulcerate and bleed
pyogenic granuloma, associated with trauma and pregnancy
381
cavernous lymphangioma of the neck, associated with turner's
cystic hygroma
382
benign, painful, red-blue tumor under fingernails from smooth muscle cells
glomus tumor
383
benign capillary skin papules in AIDS patients mistaken for kaposi sarcoma, caused by bartonella henselae
...
384
highly lethal malignancy of the liver, associated with vinyl chloride, arsenic, and thorosrast exposure
angiosarcoma
385
lymphatic malignancy associated with persistant lymphadema, post radical mastectomy
lymphangiosarcoma
386
endothelial malignancy of the skin assocated with HHV-8 and HIV
kaposi's sarcoma
