Cardiovascular Flashcards
(284 cards)
1
Q
Describe Paradoxical Splitting
A
“PAradoxical Splitting”
[Pulmonic Valve closes BEFORE Aortic Valve] which is abnormal
“Taking AP Classes were normal for me”
2
Q
Which conditions causes a [FIXED Widened S2 Splitting]?
A
Atrial Septic Defect
3
Q
A: 1st Choice Replacement Vessel for [L Anterior Descending Coronary Artery] occlusion
B1: Which Vessel is used for MULTIPLE coronary arteries/vessels occlusions
B2: Where is the vessel in B1 located and what are 2 ways it’s accessed?
A
1st Choice: [Left ITM (Internal Thoracic Mammary) Artery]
B1: MULTIPLE OCCLUSIONS = [Great Saphenous Vein]
B2: Inferolateral to [pubic tubercle] and
accessed in the [medial leg] or [femoral triangle of upper thigh]
[Great Saphenous Vein] empties into the Femoral Vein
4
Q
What makes up the Femoral Triangle (3)
A
- [Inguinal Ligament Superiorly]
- Sartorius M. Laterally
- [ADDuctor Longus M. Medially]
5
Q
What happens to [Cardiac-Vascular Function Curve] Intersection when there’s a:
A: [Change in Cardiac Output]
B: Give 2 examples
A
A: If there’s a [Change in Cardiac Output] —> Intersection slides along [VVV Curve -**Venous/Volume/Vascular]
Ex: Catecholamines / (HF - MI)
6
Q
What do these Embryonic Structures form into:
[R Common Cardinal Vein] + [R Anterior Cardinal Vein]
A
SVC - Superior Vena Cava
“I need a SVC Card”
7
Q
What does this Embryonic Structure form into:
Truncus Arteriosus (2)
A
[Trunk of Pulm (Pulmonary Trunk)]
&
[Ascending Aorta]
8
Q
What does this Embryonic Structure form into:
Bulbus Cordis
A
[Smooth OUTFLOW TRACT] of BOTH Ventricles
“Bulbs are smooth”
9
Q
What does this Embryonic Structure form into:
Primitive Atrium
A
”Trabaca is Primitive in his chamber”
Trabeculated L and R Atria
10
Q
What does this Embryonic Structure form into:
Primitive Ventricle
A
”Trabeca is Primitive in his chamber”
Trabeculated L and R Ventricles
11
Q
What does this Embryonic Structure form into:
Primitive Pulmonary Vein
A
[Smooth L Atrium]
12
Q
What does this Embryonic Structure form into:
Sinus Venosus - Left Horn
A
Coronary Sinus
(found in the AV groove of the Posterior Heart)
13
Q
What does this Embryonic Structure form into:
Sinus Venosus - Right Horn (2)
A
[Smooth R Atrium]
AKA [Sinus Venarum]
14
Q
Pathophysiology for [Tetralogy of Fallot]
A
[Anterior and Cephalad Deviation] of (Infundibular septum) during embryo —-> VOIR
“VOIR is to have See + Sight + Cry”
15
Q
Define Permissiveness
A
[1 Drug with no direct capabilities] Permits and enables a [capable drug] to reach a greater potential :-)
16
Q
Describe [SHAC Syndrome - Supine hypOtensive Aortocaval Compression]
A
Pregnant Women > 20 weeks gestation can experience hypOtension when [gravid uterus] (while supine) compresses IVC –> [DEC Venous Return] –> DEC CO
17
Q
What are the outcomes of Blunt Aortic Injury (2)
A
Tethered by [Ligamentum Arteriosum] and is fixed and immobile compared to adjacent [Descending Aorta]
A:
- Death
- [Chest or Back Pain] w/SOB and [Widened Mediastinum]
18
Q
What embryonic Structure does the [Ductus Arteriosus] develop from?
A
6th Embryonic Aortic Arch
19
Q
There are 6 Structures that derive from the Aortic Arch.
Name them
A
20
Q
SacubiTrill MOA (2)
A
[Neprilysin Inhibitor] –> Prevents ANP degradation —>
*DEC TPR
*INC GFR –> INC Urinary Output
21
Q
Name 3 EKG Signs of [Atrial Fibrillation]
A
- [irregularly irregular R-R intervals] (the already irregular R-R interval will occur at an irregular pace since atrial electrictivity is chaotic)
- Absent or [low-amp fibrillatory] P-waves
- Narrow QRS Complexes
22
Q
[Atrial Fibrillation] is the most common tachyarrhythmia. It is often precipitated by what 4 things?
A
“Smh, SAME Afib as before!”
- Acute Systemic Illness (Hyperthyroid / HF / HTN)
- Sympathetic Tone INC
- EtOH - excess
- Mitral Stenosis
23
Q
Most common [Congenital Heart Defect]
Describe the Mumur.
A
A: VSD (Ventricular Septal Defect)
B: (when small) = [Holosystolic Harsh Blowing Murmur] auscultated @ [tricuspid area]
24
Q
Aortic Stenosis
Mumur
A
[Crescendo-Descrescendo Systolic Ejection Murmur] auscultated @ [Heart Base w/radiation to carotids]
25
What does [Hemosiderin-laden **alveolar** macrophages] likely indicate? Why is this?
**L Vt Dysfunction**
## Footnote
*L HF --\> Pulmonary Edema and RBC extravasation from INC permeability of [capillary wall]. Macrophages phagocytose RBC and the iron is converted ---\> Hemosiderin*
26
Describe **S3 gallop.** What is it associated with? (3)
A: [low-frequency sound JUST after S2]
B: Associated with:
1) [Pts \> 40]:
* -(*[L Vt Systolic **HF**---\> *[**Dilated Vt**]*]
vs.
- [mitral regurgitation---\>[*INC Vt filling Rate*] --\> [***Dilated Vt***]]):
2) *Athletes/ [Pts younger than 40] / Preggos =* Normal
27
A: What do you use to treat **Beta Blocker Overdose?**
B: Why?
A: Glucagon
B: Activates [Cardiac GPCR] --\> Activation of [Adenylate cyclase] ---\> INC [cAMP in cardiomyocytes]--\> INC contractility and HR from Ca+ INC
28
How long does it take for cardiomyocytes to **stop contracting** after onset of a [COMPLETE ISCHEMIC EPISODE]?
60 Seconds
(*After 30 min. the ischemic injury will become irreversible*)
29
Dysfunction of **Platelets** would manifest how? (2) How is Platelet Function measured?
Mucocuntaneous Bleeding (Epistaxis or Petechiae) ; Measured by Bleeding Time
30
Mitral / Tricuspid **Regurgitation**
Mumur
[Holosystolic **High-Pitched** Blowing Murmur]
31
Causes of *Mitral Regurgitation* (3)
1. [Ischemic Heart Dz (post MI)]
2. MVP
3. [LV Dilatation]
32
**Familial Chylomicronemia Syndrome**
Sx (5)
**H****HALX**
1. Acute Pancreatitis - *recurrent*
2. HyperTriGlyceridemia (especially Chylomicrons)--\>**creamy supernatant**
3. [Lipdemia Retinalis]= *milky retinal vasculature*
4. [**SKIN** Xanthomas- *eruptive= yellow erythematous papules on extensor surfaces*]
5. HepatoSplenomegaly
33
Cardiac Tamponade MOD
Compression of Heart by Fluid in pericardial Space --\> DEC CO and equilibration of diastolic pressures in all 4 chambers
34
Describe **Pulsus Paradoxus**
DEC [Systolic BP] more than 10 mmHg **during inspiration**
"Pulsus for **CAPOT**"
35
What is **Lipofuscin**, and what is it a sign of
A: [lipid PerOxidation PRODUCT] **commonly** found in [**AGING CELLS'** macrophages]
B: sign of "wear and tear" aging
36
**S4** Heart Sound is AKA an \_\_\_\_\_. What is the Etiology
**Atrial Kick**
A: [STIFF Hypertrophic Ventricle]
*L atrium has to "KICK" hard against a STIFF Vt*
37
A: **Myocardial Hibernation**
B: Describe the pathogenesis
A: Myocardium that Hibernates (DEC its activity) due to coronary ischemia but is **invigorated and improved** after [Coronary ReVascularization]
B: Coronary Ischemia --\> [Myocardial Ischemia] --\> [*Myocardial Hibernation*] ---\> [L Vt Systolic HF]
38
Mitral **Stenosis**
Mumur
[*Delayed _Rumbling_ Diastolic murmur* that follows an **Opening Snap**] - @ [Apex + **LLDP** (**L** **L**ateral **D**ecubitus **P**osition)]
## Footnote
(Opening Snap comes from abrupt halt of leaflet motion in diastole after its rapid opening from the leaflet tips being fused together)
39
MAIN etiology for **Claudication**? Name 2 other less common etiologies
Atherosclerosis of Larger Arteries ---\>[Fixed Stenotic Intimal Atheroma (*lipid filled*)] ---\> Blood Flow Obstruction (especially during exercise)
Less common:
- [Giant Cell Temporal Arteritis]
- [BUerger Thromboangiitis Obliterans]
40
**Hypertrophic Obstructive CardioMyopathy (HOCM)**
Mumur
[Holosystolic **Harsh** Murmur] auscultated @ [L Sternal 2nd/3rd ICS]
41
When does [**Prinzmetal Variant Angina]** typically present? (2)
A: At rest and [during midnight - early morning]
42
3 Common signs of **CONSTRICTIVE Pericarditis**
1. Pericardial Knock= **Sharp** sound heard in early diastole
2. Kussmaul Sign= Paradoxic **[INC JVP during inspiration]** since *constricted* R Vt can accomdate the INC blood
3. Pulsus Paradoxus
43
MOD for [Carcinoid Syndrome Heart Disease]
[R sided **endocardial** fibrosis] ---\> [Pulmonic and Tricuspid Valve Stenosis] or [Restrictive Cardiomyopathy]
## Footnote
***C**arcinoi**D** **S**yndrome: (**C**utaneous Flushing)/**D**iarrhea/(**S**OB wheezing)*
44
Pts with [**Coarctation of Aorta**] are INC risk of dying from what 3 things?
HTN associated dz such as:
## Footnote
1) [L Vt Failure]
2) [Ruptured Aortic Aneurysm]
3) [Intracranial Hemorrhage] 2º to [Berry Saccular Aneurysm rupture]
45
Describe the Jugular Venous Pressure Points:
a
c
x
v
y
B: When is [x] absent?
\*Jugular Venous Pressure:
**a**: **a**trial contraction
**c:** [**c**losure of tri**c**uspid valve] from [RV **c**ontraction]
**x:** atrial Rela**X**ation -- *absent during [tricuspid regurgitation*]
**v:** **v**illing of atrial w/**v**enous blood
**y:** empt**Y**ing of atria into Vt
46
A: Dystrophic calcifcation is the Hallmark of _____ (3)
B: What is Plasma Ca+ in this DO?
A: [**Dystrophic** calcification] is the HALLMARK OF
- CELL INJURY
- CELL DEATH and
- Necrosis
B: Plasma Ca+ will be _normal_
*This occurs naturally from aging*
47
A: Which cells in an **atherosclerotic plaque** produce *collagen* and *[ExtraCellular Matrix*]?
B: What happens when these cells become ischemic and necrosed?
A: [**Vascular Smooth Muscle Cells**] produce *collagen* and *[ExtraCell Matrix*] when stimulated by cytokines from infiltrated macrophages
B: When **VSMC** die, fibromuscular cap becomes weak --\> rupture --\> Thrombosis
48
Describe [Strawberry Hemangioma]
[**BENIGN** CCM-Capillary Congenital Malformation] made of [unencapsulated capillaries]
49
Which organs have [**single** end arterial] blood supply? (3) What does this make them susceptible to?
[Heart / Spleen / Kidneys]= makes them susceptible to _[White infarcts]_
50
[Jervell and Lange-Nielsen Syndrome]
[Jervell and **L**ange Nielsen]
**auto recessive**
[Sensorineural deafness]
+
**[L**ong QT Syndrome]
51
7 common causes of **Dilated Cardiomyopathy**
"the **PIG PAID** for Dilated Cardiomyopathy"
1. **P**ost Myocarditis from [Coxsackie B Enterovirus]
2. **A**lcoholic Cardiomyopathy from long term EtOH usage (direct toxicity vs. nutritional deficiency)
3. [**D**oxorubicin and Daunarubicin Chemotherapy]= dose-dependent
4. **P**eripartum - (late in pregnancy vs. 5 mo. post partum)
5. **G**enetic= affects cytoskeleton
6. **I**ron Overload: [Hereditary Hemochromatosis] or [Multiple Blood Transfusion Hemosiderosis] = Iron accumulates and interferes with metal-dependent enzyme system in myocytes
7. **I**diopathic
* MOST COMMON CARDIOMYOPATHY*
52
A: Trousseau's Syndrome
B: What other Dz is it similar to?
A: [Pancreatic or Lung ADC] --\> releases products--\> **Hyper**coagulability --\> [**N**onBacterial **T**hrombotic **E**ndocarditis] and [migratory thrombophlebitis]
B: Similar to **MNTe** (**M**arantics **N**onBacterial **T**hrombotic **E**ndocarditis]
53
**Post MI evolution**
**\< 4 hours**
A: Gross Changes
B: Microscopic Changes
C: Complications (3)
**\< 4 hours**
C: [Cardiogenic Shock] / [Acute CHF] / Arrhthymia
54
**Post MI evolution**
**4-12 hours**
A: Gross Changes
B: Microscopic Changes (2)
C: Complications
**4-12 hours**
B: [Beg. of CIN] / [Wavy Fibers]
C: Arrhythmia
55
**Post MI evolution**
**1-3 DAYS**
A: Gross Changes
B: Microscopic Changes (2)
C: Complications
**1-3 DAYS**
A: No Gross
B:
1. Neutrophil Infiltration
2. [Loss of myocyte Nuclei]
C: [Fibrinous Pericarditis--\> [sharp & pleuritic Chest Pain] + friction rub] (*only with transmural infarcts*)
56
**Post MI evolution**
**3-7 _DAYS_**
A: Gross Changes
B: Microscopic Changes
C: Complications (3)
D: Lab
**3-7 _DAYS_**
A: Yellow Pallor
B: _Macrophage phagocytosis_ of dead debris --\> weakens cardiac tissue
C: Cardiac Tissue Weakning (Vt Free Wall Rupture) / (papillary m. rupture) / (interventricular septal rupture)
D: [CkMB] returns to Baseline at Day 3
57
**Post MI evolution**
**7-10 Days**
A: Gross Changes
B: Microscopic Changes (2)
C: Complications
D: Lab
**7-10 Days**
## Footnote
A:No Gross
B:
- [**Early** Granulation tissue w/collagen / fibroblast /MyeloFibroblast]
- Well developed Phagocytosis
C: No Complications
D: [Trop I] returns to baseline
58
**Post MI evolution**
**2 - 8 WEEKS**
A: Gross Changes
B: Microscopic Changes
C: Complications (3)
**2 - 8 WEEKS**
A: White Scar w/[Type 1 Dense Collagen]
B: Fibrosis
C: Aneurysm / [Mural Thrombus] / Dressler's
59
**Valvular Vegetations** of the AV valves
60
**Aortic Regurgitation**
Mumur
[**Early Diastolic Descrescendo Murmur**-*High Pitched Blowing noise*] auscultated @ [L Sternal 2nd/3rd ICS]
61
Name the proteins most likely responsible for these **Localized Amyloidosis**
* Cardiac Atria
* Thyroid
* Pancreatic Islets
* [Cerebrum and blood vessels]
* Pituitary gland
If a protein is misfolding and forming [Beta-pleated sheets] in the ...
* Cardiac Atria= [ANP]
* Thyroid= Calcitonin
* Pancreatic Islets= [Amylin Islet protein]
* [Cerebrum and blood vessels]= [Beta-amyloid protein]
* Pituitary gland= Prolactin
62
Identify
**Non-Caseating Granulomas**
63
What cellular ultrastructural change indicates [**irreversible** *myocardial* cell injury]
**Mitochondrial Vacuolization**
*Vacuoles and [Amorphous densities containing phospholipids] within the Mitochondria*
64
A: Which compound is responsible for the **Green** color of sputum associated w/ [productive cough]?
B: Where is it found?
C: What is this compound use for?
A: Myeloperoxidase
B: Neutrophil Azurophilic Granules
C: Respiratory Burst for *Bacterial Infections*
65
Describe the process of how Endothelial Cell injury leads to Formation of an **Atheroma**
66
Name the 7 most common manifestations of **Marfan Syndrome**
"Marfan **BAATHES** a lot! "
1. **E**ctopia Lentis
2. **A**rm-to-Height Ratio that's INC
3. **H**eart issues (*MVP vs. [idiopathic _Aortic_ cystic medial degeneration]--\> _Aortic Dissection and Aneurysm_*)
4. **S**coliosis vs. Kyphosis
5. **B**reastbone w/structural abnormalities
6. **A**rachnodactyly (Steinberg thumb & wrist)
7. **T**all / slender / flat feet
67
*Describe the circled below*
\_\_\_\_\_\_ are _______ that contain ________ - which are \_\_\_\_\_\_\_\_
**Aschoff Bodies** are **[Interstitial Myocardial Granulomas]** tht contain [**ACM**-Anitschkow Caterpillar Macrophages] - which are full of cytoplasm and [ribbon-like chromatin]
68
What 3 maneuvers **INCREASE** intensity of **Aortic Regurgitation**
"*AR* your **Hands** & **Breath** [**Leaning Forward**] ?
* with **Hand** Grip
* when **B****reath** is held after exhalation
* with Patient **leaning forward**
69
List the common causes of **Restrictive Cardiomyopathy** (8)
**RAMILIES**
1. **R**adiation Fibrosis
2. **A**myloidosis (heterogenous misfolded proteins)
3. **S**arcoidosis= [Noncaseating granuloma formation] in multiple organs 2º to [CD4 Helper T] attack on unidentified antigen
4. **M**etastatic Tumor
5. **I**nborn metabolism errors
6. **E**ndomyocardial fibrosis= Common in [African/Tropic children]
7. [**L**oeffler Endomyocardial fibrosis] = (Has [Peripheral blood eosinophilia and infiltrate])
8. **I**diopathic
70
Describe [**Libman Sacks Endocarditis**]
[**Non-bacterial** wart-like vegations] accumulate on either side of a heart valve --\> Fibrotic Valve Thickening--\> MI
## Footnote
*Associated with SLE Lupus*
71
[BUerger Thromboangiitis Obliterans] Tx
Smoking Cessation
72
Lichtenberg Figure
Erythematous Cutaneous [fern-leaf pattern] from **Lightning Strike**
73
Identify the manifestation and name what dz it's associated with
[**N**ailbed Subungal _Splinter_ Hemorrhage] - **Bacterial Endocarditis**
"Bacteria **FROM JANE**"
74
3 Major signs of **Coarctation of Aorta**
1. Upper body HTN--\> *HA & Epistaxis*
2. Diminished LE pulses (*from inadequate LE perfusion*)
3. [Enlarged Intercostal Artery Collaterals]
75
Occlusion of the **[R Coronary Artery]** would cause:
Transmural ischemia in what part of the heart?
[R Vt **inferior wall**] ---\> [**R Vt MI** **and HF**]
76
Occlusion of the **[Proximal LAD Artery]** would cause:
Transmural ischemia in what part of the heart?
**Anteroseptal**
77
Occlusion of the **[L Circumflex Artery]** would cause:
Transmural ischemia in what part of the heart?
[**L Vt Lateral Wall**]
78
Chest CT Scan + IV contrast
79
A: 3 Heart Structural Effects of Aging
B: At what age do these changes onset?
* Sigmoid shaped septum
* Hypertrophied Myocyte
* DEC LV Chamber Size
B: **AFTER 65**
80
Which Murmur?
## Footnote
(*Auscultation Site is attached*)
B: Maneuvers that INC (2)
**Mitral Regurgitation**
*[Holosystolic High-Pitched Blowing Murmur]*
"*MR*. **Hand** me a **Squat**"
B: INC with...
1) Hand Grip
2) Squatting
81
Which Murmur? (*Is Not VSD*)
## Footnote
(*Auscultation Site is attached*)
B: Maneuvers that INC
**Tricuspid Regurgitation**
*[Holosystolic High-Pitched Blowing Murmur]*
B: INC with... Inspiration
82
Which Murmur?
(*Auscultation Site is attached*)
B: Maneuvers that INC (2)
C: Maneuvers that DEC
**Aortic Stenosis**
*[Crescendo-Descrescendo Systolic Ejection Murmur]*
"**Lean forward**...& then **Squat** with that *As*s, that'll turn it up!"
B: INC with...
1. Leaning Forward
2) Squatting
C: DEC with...handgrip (*INC afterload*)
83
**M**itral **V**alve **P**rolapse
Murmur
"He was _MVP_...OF COURSE he had a **Mid Clique** to hang with"
[Late Systolic Crescendo Murmur + **MidSystolic Click**] @ Apex
84
Which Murmur?
## Footnote
(*Auscultation Site is attached*)
**M**itral **V**alve **P**rolapse
## Footnote
*[Late Systolic Crescendo Murmur + **MidSystolic Click**]*
85
Which Murmur?
B: Name the Auscultation Site
C: Maneuvers that INC sound
**Mitral Stenosis**
*[Delayed Rumbling Diastolic murmur that follows an **Opening Snap**]*
B: [Apex + **LLDP** (L Lateral Decubitus Position)]
C: Maneuvers that [INC Afterload]
-handgrip
86
Which Murmur?
(*Auscultation Site is attached*)
**Hypertrophic Cardiomyopathy**
*[Holosystolic **Harsh** Murmur] auscultated @ [L Sternal 2nd/3rd ICS]*
87
Which Murmur?
## Footnote
(*Auscultation Site is attached*)
**V**entricular **S**eptal **D**efect
*[Holosystolic **Harsh** Blowing Murmur]*
88
Which Murmur?
## Footnote
*(Auscultation site is attached)*
**P**atent **D**uctus **A**rteriosus
*[Machinery Continuous Murmur] ausculated over [L infraclavicular region]*
89
Which murmurs are heard at the **Apex**? (3)
ALL THINGS **Mitral**!
1. **Mitral** Regurgitation
2. **Mitral** Stenosis (*Apex* *+ LLDP*)
3. **Mitral** Valve Prolapse
90
Which murmurs are heard at the **Tricuspid Area**? (4)
1. Tricuspid Regurgitation
2. Tricuspid Stenosis
3. VSD
4. ASD (*from flow across Tricuspid valve initially---\>progresses to Pulmonic regurgitation from pulmonic valve damage*)
91
Which murmurs are heard at the **Pulmonic Area**? (2)
1. Pulmonic **Stenosis**
2. [Physiologic Flow Murmur]
92
Which murmurs are heard at the [**L Sternal 2nd/3rd ICS**] ? (3)
1. Aortic **Regurgitation**
2. Pulmonic **Regurgitation**
3. (**HOCM**) Hypertrophic Cardiomyopathy
93
Which murmurs are heard at the **Aortic Area**? (2)
1. Aortic **Stenosis**
2. Aortic Valve Sclerosis
94
[**Aortic** **Cystic Medial Degeneration**] is often seen in ____ pts with ____ syndrome.
B: Describe [**Cystic Medial Degeneration**] (2)
[**Aortic** **Cystic Medial Degeneration**] is often seen in YOUNGER pts with _Marfan_ Syndrome
B: Myxomatous changes (*connective tissue weakening*) + [pooling of proteoglycans] in the [*Tunica Media* of Large Arteries]
95
When do Ventricles release BNP? (2)
(BNP) AND (ANP) are both released during [**Heart Failure** -Vt Hypertrophy and/or Vt Dilitation
96
What microscopic changes occur during [**REVERSIBLE (sublethal) Ischemic injury**] to cardiac myocytes (4)
"It's not *lethal yet (sublethal/Reversible*) **S**o **R**elax **A**nd **L**ayback"
* **S**welling of Mitochondria
* **R**elaxation of Myofibrils
* [**A**TP & Glycogen DEC]
* **L**actate Accumulation
97
Paradoxical Embolism occurs when \_\_\_\_\_
Occurs when thrombus **from** **venous system (DVT)** crosses **into** **arterial** system _via [ASD / VSD / PDA]_ in lieu of going to lungs.
[ASD] murmur = [Wide and FIXED S2 Spliting (*since pulmonic will always take longer to close if there's extra fluid in R vt*)
98
List the associated **cardiac pathology** which each *inherited disorder*
A: Down Syndrome
B: DiGeorge Syndrome (2)
C: Friedreich's Ataxia
D: Marfan Syndrome
E: Tuberous Sclerosis
F: Turner's Syndrome (2)
A: "Put the **cusions** *Down*" = [Endocardial **Cusion** Defects: (Ostium Primum ASD) **+** (Regurgitant AV valves)]
B: [Tetralogy of Fallot] + [Aortic Arch abnormalities]
C: Hypertrophic Cardiomyopathy ("*sweet, big heart*")
D: [Aortic Cystic Medial Dengeration]
E: [Cardiac Rhabdomyomas ---\> Valvular Obstruction]
F: [Aortic CoArctation] vs. [Biscuspid Aortic Valve]
99
Describe **Angiosarcoma**
[**Rare** Blood Vessel Malignancy] usually in [Head/Neck/Breast] but can originate from Liver as well
100
Clinical Presentation for *LARGE* **PDA** (2)
1. Large PDA Shunt will eventually --\> (**Eisenmenger R to L shunt**) --\> PDA delivers _DeOxygenated_ blood distal to [L subclavian a.]--\> LE cyanosis & clubbing with NO BP/pulse discrepancies
2. HF (SOB + Fatigue)
*Note: LARGE PDA can progress from small PDA if untreated*
101
Which Drugs cause [**Coronary Artery CORONARY STEAL**] (2). Why is this?
A: [Adenosine vs. Dipyridamole] = VasoDilators
B: These 2 drugs selectively vasodilate coronary arteries in non-ischemic myocardium --\> steals blood flow from [occluded coronary arteries] which perfuse ischemic areas --\> EXACERBATES ISCHEMIA
102
How does **Reperfusion Injury** cause its damage (5), and what is the ultimate result?
"**MICCO** injured himself from Reperfusing"
1. [**O**xygen Free Radical Generation] by endothelial cells
2. [**M**itochondrial damage(not vacuolization) - Severe & Irreversible]
3. [**I**nflammation - which attracts neutrophils--\>more injury]
4. [**C**omplement & **C**ell membrane damage]
Ultimate Result = Cell **Membrane** Damage ---\> Elevated [Creatine Kinase] *if brain/heart/muscle are affected*
103
What should you suspect if [**Right** Vt] is Hypertrophied ( *\>3-4 mm*) and Dilated?
[**Cor Pulmonale** 2° to Pulm HTN]
104
**Post MI evolution**
**12-24 hours**
A: Gross Changes
B: Microscopic Changes (3)
C: Complications
D: Lab
**12-24 hours**
**MCN CAT**: M/CNC/A/T
A: Myocardial **Mottling**
B:
1. [CIN Continues]
2. Nuclei **Pyknosis**
3. [Contraction Band Necrosis]
C: Arrhythmia
D: [Trop I] and [CkMB] peaks at 24 hours
105
**Post MI evolution**
**10 - 14 _Days_**
A: Gross Changes
B: Microscopic Changes (2)
C: Complications
**10 - 14 _Days_**
*{Use TriChrome Stain*}
A: No Gross
B:
1. [Granulation tissue with **neovascularization** and **Fibroblast**]
2. Red Border from Granulation tissue entering from edge of infarct
C: No Complications
106
In which Arteries do **Atherosclerotic Plaques** develop? (7)
[Large Elastic Arteries (-CIA: *Carotid, iLiac, Aorta*)]
&
[Medium Muscular Arteries (Coronary & Popliteal)]
&
[Circle of Willis]
*[**Abd** Aorta] \> Coronary \> Popliteal \> [Internal Carotid] \> [COW]*
107
What is the _single_ most important risk factor for developing **Aortic DISSECTION**
HTN
(*causes intimal tears*)
scan shows intimal flap torn away from Aortic wall
108
Pathogensis of **Aortic Aneurysm**
[Chronic **Transmural Inflammation**] of Aortic wall ---\> [Loss of Elastin and Smooth Muscle] --\> [Abnormal Collagen remodeling] --\> [progressive Weakening of Aorta] --\> Wall Expansion
*[Chronic Transmural Inflammation*] *can come from Atherosclerosis but ⬆︎ risk of rupture comes from smoking!*
109
What does a [**FIXED and Widened S2 Spliting**] likely indicate?
**[ASD] murmur**
= [FIXED and widened S2 Spliting (since pulmonic will always take longer to close if there's extra fluid in R vt)
110
A: Describe the Heart changes in *JONES syndrome* from **Rheumatic Fever** (2)
B: What are the 2 dangerous developments of this?
**Mitral Stenosis** from
1. Mitral Valve Leaflet Distortion 2° to fusion of leaflet edges
2. L Atria with [diffuse fibrous thickening]
B: Afib --\> [Embolic Stroke]
111
Describe the **[OWR - O**sler **W**eber **R**endu syndrome**]**
[Hereditary Hemorrhagic Telangiectasia] described as **pink** and **spider-like lesions**
112
A: Explain the physiology for [**Carotid Sinus**] massage
B: Where, *in the CNS*, does the nerve responsible for this physiology terminate?
A: [Hering nerve] of [Carotid Sinus] starts to fire when BP in [Carotid Sinus] INC --\> [**Glossopharyngeal CN9]** to [DEC BP / HR / [induce syncope] ]
B: [Solitary nucleus of medulla]
113
A: What is the **major limiting factor** to Coronary blood flow during Exercise?
B: How does the Body compensate for this during Exercise? (2)
A: [**Shorter Duration of Diastole** 2° to Tachycardia**]** -*Max blood flow to coronary arteries occurs during Diastole*
B:
1. Flow-mediated Dilation
2. VasoDilators (*Adenosine / NO*)
114
What is the **Coronary Sinus**, and what's unique about it's _O2 content_
A: **Vein** that collects [**De**Oxygenated Blood FROM HEART MUSCLE] --\> [Dumbs into IVC]--\> [R Atrium]
B: Has the [**_LOWEST_ O2 Content in Body**] since Myocardial O2 extraction is VERY high
*Remember: Heart muscle is perfused during Diastole*
115
How does [AV Shunts] affect *Preload* and *Afterload*
\* INC Preload--\> [High Output Cardiac Failure]
\*DEC afterload (*since they'll be less blood in Arterial system once it travels to the venous system*)
116
A: Which **Collagen** type do you find in *Mature Scars*?
B: Is this type of **Collagen** Abundant?
A: Type **1** Collagen
B: Most prevalent Collagen in Body
117
Describe **Collagen** Type 1
A: Location (3)
B: Associated DO
[**b**e **s**o **t**otally] **C**ool, **R**ead **B**ooks
## Footnote
Type 1 = MOST PREVALENT (especially in _mature scars_)
A: **b**one / **s**kin / **t**endon
B: [Osteogensis Imperfecta type 1]
118
*Blood is in incompressible fluid*
A: State the [Law of Conservation of Mass] formula
B: Which formula is used for **constant flow through a tube**
A: [Total Flow] = [Flow Velocity] x [Cross Sectional Area]
B: [(Area 1) x (Velocity 1)] = [(Area 2) x (Velocity 2)]
119
List the Pressures for the following Heart chambers:
A: **C**entral **V**enous **P**ressure
B: [R Atrium] (2)
C: [R Ventricle]
D: Pulmonary Artery (2)
E: [Pulm Wedge / L Atrium] (2)
F: [L Ventricle]
G: Aorta
H: Brachial Artery
A: CVP = **2**
B: [R Atrium] = **2** (*8 / 0 range*)
C: [R Ventricle] = **25 / 2**
D: Pulmonary Artery = **25 / 10** (*15 Mean*)
E: [Pulm Wedge / L Atrium] = **6** (*12 / 2 range*)
F: [L Ventricle] = **120 / 6**
G: Aorta = **120 / 70**
H: Brachial Artery = [**95 Mean**]
120
List the 2 Formulas for **Cardiac Output**
1. [CO = HR x SV]
2. [CO = (O2 consumption) ÷ (AV O2 Difference)] = **Fick Principle**
121
List, from FASTEST to slowest, [**_Conduction_ Speed**] between:
## Footnote
- Atria
- AV node
- Purkinje Fibers
- Ventricles
**P**ark **At** **Vent**ure **Av**enue
**P**URKINJE \> **At**rial \> **V****ent**ricle \> [**AV** node]
122
[**Aortic / pharyngeal Arch 1**]
A: Key *Derivative* from this Arch
B: Associated *Cranial Nerve* with this Arch
"**1st** arch is **Max**imal "
A: **Max**illary artery (*portion of it*)
B: [Trigeminal CN5]
123
[**Aortic / pharyngeal Arch 2**]
A: Key *Derivative* from this Arch
B: Associated *Cranial Nerve* with this Arch
"**S**econd = **S**tapedial"
A: **S**tapedial artery (*WHICH COMPLETELY REGRESSES EVENTUALLY*)
B: [Facial CN7] *"Don't be **2** faced"*
124
[**Aortic / pharyngeal Arch 3**]
A: Key *Derivatives* from this Arch (2)
B: Associated *Cranial Nerve* with this Arch
"**C** = **3rd** letter in Alphabet & 3x3 = **9**"
A: [**C**ommon **C**arotid] / [Internal **C**arotid - proximal part]
B: [Glossopharyngeal CN9]
125
[**Aortic / pharyngeal Arch 4**]
A: Key *Derivatives* from this Arch (2)
B: Associated *Cranial Nerve* with this Arch
A: [True Aortic Arch] / [R Subclavian Artery]
B: [Vagus CN10 - *Superior Laryngeal branch*]
126
[**Aortic / pharyngeal Arch 5**]
A: Key *Derivatives* from this Arch
B: Associated *Cranial Nerve* with this Arch
**EVERYTHING FROM THIS ARCH OBLITERATES!**
127
[**Aortic / pharyngeal Arch 6**]
Key *Derivatives* from this Arch (2)
[Ductus Arteriosus] & [Pulmonary Arteries]
" 666 is **Recurrent**"
128
What 2 Heart Defects are associated with **Cryptogenic Stroke**
A:
1. **ASD**
2. **Patent Foramen Ovale (*occurs in 25% of normal adults*)**
129
Clinical Presentation for [**TGA - *T****ransposition of **G**reat **A**rteries]* (3)
Neonate with...
1. [Aorta lies **ANTERIOR** and to the **RIGHT** of Pulm Artery]
2. Cyanosis
3. Tachypnea
130
Which *Artery* is injured from a fracture to the **Pterion**? Name the *_Parent_* Artery of this vessel
A: [**Middle meningeal a. - *frontal branch*]** (*courses thru Foramen Spinosum deep to the Pterion*)
B: MAXILLARY ARTERY (*Derivative of 1st Aortic/pharyngeal arch*)
131
*Identify*
132
*Identify*
A: Duodenum (*lies at level L2*)
B: IVC (*Remember that R renal vein drains into IVC*)
C: [Abd Aorta] (*Bifurcation of Abd Aorta occurs at level L4*)
D: iLeum (*LOOKS LIKE FIGURE 8 SOMETIMES*)
E: [L Renal Vein]
133
Where is the **SA node** located?
[Junction of (R Atrium) and (SVC)]
134
*Identify*
*Remember:*
* *[R middle Lung lobe] is adjacent to [R **Atrium**]*
* *R side of Heart of CXR is [R **Atrium**]*
135
A: Cannulation _above_ the **inguinal ligament** INC risk of developing what *condition*?
B: What is *this condition* the most common cause of?
**RETROPERITONEAL HEMORRHAGE---\>** Unexpected Mortality post cardiac-cathertization
136
Name the **Autoregulator Factors** for the Heart (4)
- **NO** (*MOST IMPORTANT AND AUTOREGULATES HEART'S LARGE/MEDIUM VESSELS)*
* -***Adenosine** (*small coronary arterioles*)
- **DEC O2**
- **CO2**
137
Which Heart Chamber does a [**TEE - *T****rans**E**sophageal **E**chocardiography*] face when placed?
**L Atrium!**
*Probe is placed in mid-esophagus facing _anteriorly_, which faces* ***L Atrium***
138
[**ST Elevations**] or [**Q waves**] in these leads indicate **INFARCT** in which areas?
A: [V1 - V2]
B: [V3 - V4]
C: [V5 - V6]
D: [Lead 1 / aVL]
E: [Lead 2 / 3 / avF]
A: [(V1 - V2) = Anteroseptal - LAD]
B: [(V3 - V4) = Anteroapical - *distal* LAD]
C: [(V5 - V6) = AnteroLateral - LAD vs. LCX]
D: [Lead 1 / aVL] = [Lateral - LCX]
E: [Lead 2 / 3 / av**F**] = [In**F**erior - RCA] - DONT GIVE BETA BLOCKERS
139
*Identify*
140
Where are the **3** leads of a **Biventricular PACEMAKER** placed?
1. **R Atrium** (*via L subclavian vein --\> SUP Vena Cava--\> R Atrium*)
2. **R Ventricle** (*via L subclavian vein--\> SUP Vena Cava--\> R Atrium --\> R Vt*)
3. **L Ventricle** (*via R atrium ---\> [_Coronary Sinus within the AV groove_] of Post Heart --\> L Vt*)
141
What part of the heart forms the [**diaphragmatic surface**]?
[**L Vt - INFERIOR WALL**]
142
What areas of the heart do these **Coronary Arteries** perfuse?
[**LCX - *L****eft **C**ircumfle**X***] (2)
[**LCX**] - *from [L Main Coronary Artery]*
1. [L Vt - *Lateral AND Posterior Surface*]
2. [Anterolateral Papillary muscle]
143
What areas of the heart does this **Coronary Artery** perfuse?
[R Coronary A.] (3)
[R Coronary A.]
1. SA Node
2. **PDA** -[***P**osterior **D**escending Interventricular **A**rtery*] (*70% population*) ---\> **PERFUSES AV NODE**
3. [R Marginal Acute A.]
144
What areas of the heart do these **Coronary Arteries** perfuse?
[**PDA - *P****osterior **D**escending **A**rtery*] (3)
[**PDA**]
1. [Post 1/3 of Interventricular septum]
2. [Post Vt Walls (*including Diaphragmatic surface of heart*)]
3. [Posteromedial Papillary muscle]
145
What areas of the heart do these **Coronary Arteries** perfuse?
[**LAD** - ***L****eft **A**nterior **D**escending]* (3)
[**LAD**] - *from [L Main Coronary Artery]*
1. [ANT 2/3 of Interventricular septum]
2. [Anterolateral Papillary muscle]
3. [L Vt - *Anterior Surface*]
146
What areas of the heart do these **Coronary Arteries** perfuse?
[R Marginal Acute A.]
Right Ventricle
147
A: What does the **Red** arrow indicate?
B: What does the **White** arrow indicate?
A: [**L Main Coronary Artery**] *originating from [L coronary cusp] from Aortic Root and continuous anteriorly as ...*
B: [**LAD**]
148
What 2 diseases is ***Streptococcus Gallolyticus Bovis*** associated with?
1. [**SBE-S**ubAcute **B**acterial **E**ndocarditis] (*Aortic Regurgitation*) (***SBE** also caused by Strep Viridans)*
2. [GI Lesions --\> Colon CA]
AKA S. Bovis
149
A: Clinical Manifestations of **DiGeorge Syndrome** (5)
B: Genetic Cause
C: Embryologic cause
"**CATCH 22** & **P**a**3**"
## Footnote
**C**ardiac (*Aortic Arch abnormalitites*)
**A**bnormal face (Bifid Uvula/low set ears)
**T**hymus Aplasia
**C**left Palate
[**H**ypOcalcemia from PTH deficiency] *may*--\> *Carpopedal Spasms*
**22**q.11.2 deletion
**P**haryngeal arch - **3**rd/4th both fail to develop
150
List the most important steps for preventing [**CVC**-*Central Venous Catheter*] Infections (5)
'CVC's need a good **BRACH** b4 being inserted!"
1. **H**and Washing prior to insertion
2. **B**arrier precautions during Central line insertion
3. **C**hlorhexidine for skin disinfection
4. **A**void [Femoral catheter insertions] (*instead use SubClavian or Internal Jugular Vein*)
5. **R**emove Catheter when *no longer* needed for good
151
In terms of *Accuracy* and *Precision*, what is another term for ***Precision***?
**RELIABILITY**
* R is just a P with a kickstand!*
* Precision = Reliability*
152
**Bicuspid Aortic Valve**
Mumur
[Early Systolic High-frequency click] @ [*R Border 2nd ICS*]
153
Monoamine Oxidase is a ___ enzyme that degrades excess ______ and detoxifies \_\_\_\_\_\_\_
Monoamine Oxidase is a **Mitochondrial** enzyme that degrades excess [**monoamine NTS** in presynpatic n. temrinals] and detoxifies [Dietary **Tyramine** in the GI tract]
154
Explain **Coronary Dominance**
The Dominating coronary a. tht perfuses the [**PD****A**-***P**osterior**D**escending interventricular**A**rtery]*
155
Describe the *path* a thrombus would take in order to cause [**RAO**-***R**etinal **A**rtery **O**cclusion] (3)*
[Internal Carotid Artery] --\> [Opthalmic Artery] --\> [**Retinal Artery**]
156
**Atrial Fibrillation** INC risk of ______ Thromboembolism
B: What location is the *source* of [Afib thrombus formation]?
**Atrial Fibrillation** INC risk of _Systemic_ Thromboemoblism
B: **L Atrial Appendage**
157
What is a good *parameter* for _certain_ BP medication **non-compliance**? Describe it.
A: **PRA** - **P**lasma **R**enin **A**ctivity
B: **PRA** measures the amount of [Angiotensin 1] made in a certain time = assess [Renin-Angiotensin-Aldosterone Axis].
158
A: Describe **Fetal Circulation** starting with *Placenta*
B: Which Structure has the **MOST OXYGENATED BLOOD**?
B: **Umbilical VEIN**
## Footnote
*Remember: Single Umbilical A. = Chromosomal & Congenital anomalies*
159
What happens to [Cardiac-Vascular Function Curve] **_Intersection_** when there's a:
A: [Change in **Venous Return**]
B: Give 2 examples of each
A: If there's [Change in **Venous Return** (*venous/volume/vascular*)] ---\> Intersection slides along [*Cardiac Output* *Curve*]
Ex: [Acute Hemorrhage] / Sympathetics / [Fluid Infusion]
160
What happens to [Cardiac-Vascular Function Curve] **_Intersection_** when there's a:
A: [Change in **T**otal **P**eripheral **R**esistance]
B: Give 2 examples of each
A: If there's a change in [**T**otal **P**eripheral **R**esistance] ---\> Intersection FLEXES Up or Down
Ex: Vasopressors / Exercise(*DEC TPR to get blood to musculature*) /
[_Exercise_ and _AV Shunt_ *DEC TPR ⬇︎--\> **Intersection FLEXES UP ⬆︎***]
161
3 classic **Clinical** Manifestations of [Tetralogy of Fallot]
A:
1. [**S**ystolic Ejection Murmur] from [**RVOT** -R Vt Outflow Obstruction]
2. **S**quatting relieves sx (INC afterload--\> [DEC amount of R to L shunt]
3. [**C**yanotic Tet Spells]
"**VOIR** is to have **S**ee + **S**ight & **C**ry"
162
Describe the 3 Clinical Manifestations of [**PDA**- Patent Ductus Arteriosus]
[R--\> Left Shunting] causes....
## Footnote
- [**Machinery** Continuous Murmur] over [L infraclavicular region]
- Palpable Thrill over [L infraclavicular region]
- HF sx (Failure To Thrive and Respiratory Distress)
163
What protein is Defective (2) in [**Familial Chylomicronemia Syndrome]** and why does Heparin exacerbate this?
A: [Lipoprotein Lipase (LPL) Deficiency] or [ApoC2]
B: exacerbated by [Exogenous Heparin] since LPL is naturally bound to Heparin
Sx = **H****HALX**
164
Which demographics are likely to develop Lipofuscin? (3)
Aging / Cachectic / Malnurished pts
165
[**HOCM** - **H**yper**O**bstructive **C**ardio**M**yopathy] MOD
[Beta myosin heavy-chain mutation] --\> Defective cardiosarcomeres--\> [*Hypertrophied* myocytes that are *haphazardly* arranged]
+
Abnormal [ANT motion of (ANT leaflet mitral valve) toward [Hypertrophied interventricular septum]
166
**Upregulators** of Cytochrome P450 Enzymes (8)
**Chronic alcohol**ics **St**eal **Phen-Phen** & **N**ever **R**efuse **Gr**easy **Carb**s
* **Chronic alcohol** use
* **St**.John's wort
* **Phen**ytoin
* **Phen**obarbital
* **N**evirapine
* **R**ifampin
* **Gr**iseofulvin
* **Carb**amazepine
167
**Inhibitors** of Cytochrome P450 Enzymes (11)
**A**AA **RACKS IN GQ M**agazine
INHIBIT me from doing my job!
**A**cute Alcohol Abuse
**R**itonavir (HIV Protease inhibitor)
**A**miodarone
[**C**imetidine & Ciprofloxacin]
**K**etoconazole
**S**ulfonamides
**IN**H (Isoniazid)
**G**rapefruit Juice
**Q**uinidine
**M**acrolides (except Azithro)
168
What **Substrates** does the Cytochrome P450 enzymes work on? (6)
**C**an **A**lways **T**hink **W**hen **O**utdoors, **S**on....i need it!
## Footnote
**C**yclosporine (Liver AND small intestine)
**A**ntiEpileptics
**T**heophylline
**W**arfarin
**O**CP
**S**tatins (*NOT PRAVASTATIN*)
169
What type of Cardiovascular predispositions do Down Syndrome pts have? (2)
1. Atrial Septal defect
2. Vt Septal Defect
170
2 Conditions that cause Paradoxical Splitting
"**PA**radoxical Splitting"
## Footnote
1. LBBB
2. Aortic Stenosis
"Taking **AP** Classes were *normal* for me"
171
4 anatomic abnormalities associated with [Tetralogy of Fallot]
**VOIR**
(**V**t Septal Defect / **O**verriding Aorta / [**I**nfundibular Pulmonary Stenosis] / [**R** Vt Hypertrophy with [**R** --\> L shunt] = Boot shaped on CXR ]
"**VOIR** is to have **S**ee + **S**ight & **C**ry"
172
How does _Cortisol_ utilize Permissiveness?
Cortisol upregulates [alpha-1 adrenergic receptors] on vascular and bronchial smooth m. --\> better response to Catecholamines(such as NorEpi)--\> MORE Vasoconstriction
173
What are the Sx of [**SHAC** Syndrome] (4)
## Footnote
Syncope / Nausea / Dizziness / Fetal Demise (when severe)
174
Blunt Aortic Injury
Rapid Deceleration while restrained/seatbelted (occurs in MVC) causes **Aortic Isthmus** to tear ---\> Aortic Rupture
175
Which pts benefit from SacubiTrill
Heart Failure Pts
176
A: What is the Typical Heart Rate for [aFib with RVR]
B: What does the Ventricular Rate depend on in [Atrial Fibrillation]
A: 90-170 bpm
B: AV Node Refractory Period
177
A: What is **Lymphangiosarcoma**
B: What predisposes a pt to **Lymphangiosarcoma**
A: MALIGNANT neoplasm of the [endothelial lining of lymphatic channels]
B: Persistent Lymphedema w/chronic Dilation of lymphatic channels
178
Heart Manifestations of VSD (2)
* [INC R Vt O2 Sat] with [NORMAL L Vt O2 Sat]
* LARGE VSD *--\>* Heart Failure
179
Aortic **Stenosis**
Manifestations (5)
\*) [Pulsus parvus et tardus]= weak pulses with delayed peak
\*) **SAD**: [**S**yncope / **A**ngina / (**D**yspnea on exertion)]
\*) [S4 Atrial Kick]
180
Causes of Aortic **Stenosis** (3)
[Age-Related calcification ( \>65 y/o)]
vs.
[Bicuspid Aortic Valve] calcification ( \>50 y/o)]
vs.
[Rheumatic Fever Endocarditis (**Fish Mouth**)]
181
Describe the histology for [Hemosiderin-laden **alveolar** macrophages]
Golden cytoplasmic granules **that turn blue with [Prussian blue stain]**
## Footnote
*L HF --\> Pulmonary Edema and RBC extravasation from INC permeability of [capillary wall]. Macrophages phagocytose RBC and the iron is converted ---\> Hemosiderin*
182
Auscultation Site for S3 gallop (3)
[Apex + (LLDP) + (End Exhalation)]
## Footnote
*End Exhalation brings heart closer to chest wall*
183
Best indicator for *_severity_* of valve Regurgitation?
Presence of an **additional S3** (*indicates Vt Dilitation in addition to regurgitaiton*)
184
Auscultation site for Mitral vs. Tricuspid Regurgitation each
* Mitral Regurgitation:* [Apex w/radiation to axilla]
* Tricuspid Regurgitation:* [Tricuspid Area w/radiation to R Sternal border]
185
Causes of *Tricuspid Regurgitation*
[RV Dilatation]
186
Which Dz's cause **EITHER OR** Mitral vs. Tricuspid Regurgitation (2)
Rheumatic Fever and [Infective Endocarditis]
187
*Clinical* Manifestation of Cardiac Tamponade (3)
"**H**eavy **B**leeding in **P**ericardialSpace
* [**B**eck Triad: hypOtension / JVD / Distant Heart Sounds]
* [**H**R INC but CO DEC]
* **P**ulsus Paradoxus (Pulsus for CAPOT)
188
*EKG* Manifestation of Cardiac Tamponade (2)
[low-voltage QRS] + [Electrical Alternans *from Heart swinging in fluid*]
189
Describe **Lipofuscin** (3)
Yellow-brown / fine granular / perinuclear pigment
190
What conditions cause Pulsus Paradoxus (5)
"Pulsus for **CAPOT**"
1. **C**roup
2. **A**sthma
3. **P**ericarditis
4. **O**bstructive sleep apnea
5. **T**amponade
191
What Conditions are associated with S4 Atrial Kick (2)
1. Aortic Stenosis
2. Restrictive Cardiomyopathy (*includes HOCM*)
192
A: Explain the opening snap for Mitral Stenosis
B: Best Tool for assessing *Degree* of Mitral **Stenosis**
A: Opening Snap comes from abrupt halt of leaflet motion in diastole after its rapid opening from the leaflet tips being fused together)
B: DEC interval between S2 and **Opening Snap** = INC severity of [Mitral Stenosis]
193
Mitral Stenosis is associated with which condtion
Rheumatic Fever
194
Which 2 bedside maneuvers **⬆︎** **Intensity** of the HOCM mumur?
"***Val*** [***Stood Up****]* to Hulk HOCM, the MVP, which _⬆︎_ his anxiety"
Valsalva
[Standing Up]
(both ⬇︎ Preload **AND** ⬇︎ Afterload)
195
**Hypertrophic Obstructive CardioMyopathy (HOCM)**
Mode of Inheritance
AUTO DOM
196
How does [Prinzmetal Variant Angina] manifest on EKG. Why is this?
[Temporary transmural myocardial ischemia (*typically near atherosclerosis)*] --\> manifest as transient ST-elevations
197
A: What drug provokes **[Prinzmetal Variant Angina]** episodes and possibly aids in diagnosis?
B: How do you treat **[Prinzmetal Variant Angina]**
A: **ErGonovine** ***(stimulates [alpha adrenergic] and serotonergic receptors--\>coronary spasm induction)***
B: Nitrates and CCB
198
Clinical Presentation of [Carcinoid Heart Disease] (3)
[Cutaneous Flushing] / Diarrhea / Bronchospasms
199
What 3 Congenital defects are also associated with [**Coarctation of Aorta**]?
[Turner Syndrome] (pre-PDA)
[Berry Saccular Aneurysm]
[Bicuspid Aortic Valve]
200
Histology for [Dystrophic Calcification]
Dark-purple aggregates that may develop outer layers known as **psammoma bodies**
201
A: [Strawberry Hemangioma] Demographic
B: Prognosis
A: Infants
B: Grows proportionally with child and regresses by age 5-8
202
Which 2 organs have **DUAL** blood supply?
Lungs and Liver = NOT SUSCEPTIBLE TO INFARCTS
203
[Jervell and Lange-Nielseon Syndrome]
Mode of inheritance
auto recessive
204
PGN of [Jervell and Lange-Nielseon Syndrome] (3)
[Prolonged QT] --\> Torsades De Pointes --\> [Syncope and Sudden Cardiac Death]
205
Dilated Cardiomyopathy Clinical Findings (3)
"the **PIG PAID** for Dilated Cardiomyopathy"
HF / S3 / [Systolic Regurgitant Murmur]
*MOST COMMON CARDIOMYOPATHY*
206
3 Main Causes of Aortic Regurgitation
- [Aortic Root Dilitation]
- [Bicuspid Aortic Valve]
- Endocarditis (i.e. Rheumatic Fever)
207
Aortic Regurgitation Clinical Presentation (2)
1. [**Widened Pulse Pressure** (*may manifest as head bobbing with each heart beat = [de Musset sign]*)]
+
2. [**Large Stroke Volumes** (*may manifest as head / heart pounding* )]
208
A: What dz are these formations associated with?
B: What is the Cardiac Dz Progression?
**Aschoff Bodies**
## Footnote
A: Acute Rheumatic Fever - 2º to Strep A
B: Mitral Regurgitation ---\> Mitral Stenosis
209
What Dz is associated with [Libman Sacks Endocarditis]
**S**ystemic **L**upus **E**rythematosus
210
A: 2 Demographics at risk for [**BUerger Thromboangiitis Obliterans**]
B: These pts show a *hypersensitivity* to what?
A: [Heavy Smokers] / [Males
B: [Intradermal injection of Tobacco Extract]
211
Describe [**BUerger Thromboangiitis Obliterans**] and what 3 things it leads to
[**STMV**- **S**egmental **T**hrombosing (**M**edium vessel) **V**asculitis] that leads to:
- Intermittent **claudication** --\> Extremity Gangrene
- Corkscrew Collaterals *on imaging*
* -*Raynaud Phenomenon
212
Name the manifestations of Bacterial Endocarditis (7)
"Bacteria **FROM JANE**"
## Footnote
**F**ever
[**R**etinal Roth Spots - *Immunologic phenomena*]
[**O**sler "Ouch" Nodes- *Immunologic phenomena*]
[**M**umur that's new]
[**J**aneway lesions on palms/sole]
**A**nemia
[**N**ailbed Subungal _Splinter_ Hemorrhages] - shown in image
[**E**mboli from valvular vegetations]
213
Occlusion of the **[R Coronary Artery]** would cause:
A: ST elevation in which leads? (3)
B: Any other associations?
A: Leads 2 / 3 / avF
B: Sinus Node Dysfunction (also supplied by RCA)
214
Occlusion of the **[Proximal LAD Artery]** would cause:
ST elevation in which leads? (4)
V1 - 4
215
Occlusion of the **[L Circumflex Artery]** would cause:
ST elevation in which leads? (4)
V5 / V6 / Lead 1 / aVL
216
Causes of MVP (3). MVP can predispose to what condition?
"He was _MVP_...OF COURSE he had a **Mid Clique** to hang with"
1. Myxomatous Degeneration (*Marfan vs. [Ehlers Danlos]*)
2. Rheumatic Fever
3. Chordae Rupture
Usually benign b*ut can predispose to infective endocarditis*
217
Which Maneuvers make MVP murmur **delayed**
Squatting
218
Which Maneuvers make MVP murmur occur **earlier** (2)
"*They were all _Standing_ and _Bearing Down_ before the MVP got there"*
Occurs **earlier** with...
1) Standing
2) Valsalva
219
Maneuvers that INC HOCM murmur (2)
**Hypertrophic Cardiomyopathy**
*[Harsh Holosystolic Murmur] auscultated @ [L Sternal 2nd/3rd ICS]*
INC with... [Manuevers that DEC **P****A**-***P**reload AND**A**fterload*]
- Valsalva
- Standing
220
Maneuvers that DEC HOCM murmur (2)
**Hypertrophic Cardiomyopathy**
*[Harsh Holosystolic Murmur] auscultated @ [L Sternal 2nd/3rd ICS]*
:DEC with..
- No Valsalva
- sitting
221
What 2 conditions does [Aortic Cystic Medial Degeneration] potentially lead to?
[Aortic Dissection] and [Aortic Aneurysm]
## Footnote
*[Basket Weave Pattern**] on Histo*
222
Describe the Histology for [**Aortic** **Cystic Medial Degeneration**]
[Elastic Tissue Fragmentation (*from Myxomatous changes*)]
--\> [**Basket Weave** Pattern]
223
Angiosarcoma Risk Factors (6)
"*Angie* was only attracted to **SLAVER**'s"
1. [**E**lderly on sun exposed areas]
2. **S**un Exposure
3. **R**adiation therapy
4. **L**ymphedema PostMastectomy (LymphAngiosarcoma)
5. **V**inyl Chloride (*HEPATIC Angiosarcoma*)
6. **A**rsenic (*HEPATIC Angiosarcoma*)
224
A: Prognosis for Angiosarcoma
B: Which markers do these tumors express (2)
"*Angie* was only attracted to **SLAVER**'s"
## Footnote
A: VERY AGRESSIVE TUMOR and difficult to resect due to delay in dx
B: [CD31 and endothelial cell markers]
225
Which demographic is _most_ at risk for developing Cor Pulmonale idiopathically?
[Females ages 20-40]
226
Which demographics develops Cor Pulmonale secondarily? (2)
COPD pts / smokers --\> [Obliteration of pulmonary vasculature] --\> **Cor Pulmonale**
227
List the **5** vessels from MOST to least susceptible to **Atherosclerotic Plaques**
[**Abd** Aorta] \> Coronary \> Popliteal \> [Internal Carotid] \> [Circle Of Willis]
228
Which _mucous membranes_ are affected by [**OWR** - Osler Weber Rendu syndrome](6).
What's the worst complication?
Telangiectasias on...
1. [Skin/Lips/Oronasopharygeal]
2. GI
3. Respiratory
4. Urinary
**May rupture --\> Bleeds**
229
[**OWR** - Osler Weber Rendu syndrome] Mode of Inheritance
AUTO DOM
230
Complications of [**OWR** - **O**sler **W**eber **R**endu syndrome] (3)
Rupturing of Telangiectasia --\>
Epistaxis
GI bleeding
Hematuria
*DO of blood vessels --\> AV malformations --\> Telangiectasia*
231
What therapeutic tool is associated with the **Coronary Sinus**
[L Vt **Pacemaker Lead]** traverses thru [**Coronary Sinus** *that lies* *within the AV Groove*] to reach L Vt
*Remember: Heart muscle is perfused during Diastole*
232
When can the **Coronary Sinus** become Dilated?
[**Pulmonary HTN**] --\> [R Vt AND R Atrial Pressure INC] ---\> [Coronary Sinus Dilatation]
*Remember: Heart muscle is perfused during Diastole*
233
Describe **AV Shunt**. Name 2 ways they're formed
A: Abnormal communication from [Artery --\> vein] that _bypasses arterioles_
B:
- Iatrogenic (*AV Fistula for Hemodialysis*)
- Penetrating injuries
234
Describe **Collagen** Type 2
A: Location
B: Associated DO
[**b**e **s**o **t**otally] **C**ool, **R**ead **B**ooks
## Footnote
Type 2 "**C**ar*_two_*lage"
A: **C**artilage (*including hyaline and vitreous body*)
B: none
235
Describe **Collagen** Type 3
A: Location (3)
B: Associated DO
[**b**e **s**o **t**otally] **C**ool, **R**ead **B**ooks
## Footnote
Type 3 "**R**ead **ThreE D**"
A: **R**eticulin (*blood vessels / granulation tissue / fetal tissue*)
B: [**E**hlers **D**anlos]
236
Describe **Collagen** Type 4
A: Location (2)
B: Associated DO (2)
[**b**e **s**o **t**otally] **C**ool, **R**ead **B**ooks
## Footnote
Type 4 "Type *4* is under the *floor*"
A: [**B**asement Membrane and lens]
B: [Alport Syndrome] & Goodpasture
237
[**Aortic / pharyngeal Arch 6**]
Associated *Cranial Nerve* with this Arch
[CN10 Vagus - *_Recurrent_ Laryngeal branch*]
" 666 is **Recurrent**"
238
How are Cryptogenic Stroke lesions typically closed?
1. **ASD**
2. **Patent Foramen Ovale (*occurs in 25% of normal adults*)**
[Umbilical cord clamping and DEC Pulm vascular resistance] --\> [DEC R Atrial pressure] and [INC L Atrial pressure] --\> closes [Septum **Primum**] flap against [Septum **Secundum**] --\> Closes [Formaen Ovale]
239
What causes [TGA - Transposition of Great Arteries] embryogenically?
Failure of [Fetal Aorticopulmonary septum] to sprial normally during [**Truncus Arteriosus Septation**]
240
What Mothers are at high risk of having Neonates with [**TGA - *T****ransposition of **G**reat **A**rteries]*?
Diabetic Mothers
241
What Bone segments make up the **Pterion**? (4)
Frontal, Sphenoid, Temporal, Parietal
242
What is the Ultimate _result_ of a [fractured Pterion]?
[**Epi**dural Hematoma]
243
Where is the [R Vt] located
[L sternal **4th** ICS - Anterior Heart]
244
Where is the [Pulmonary Trunk] located?
[L sternal **2nd/3rd** ICS]
245
What structure makes up most of the heart's **posterior** surface? How is this structure related to dysphagia?
[L Atrium] ([*[Mitral Stenosis vs. aFib] --\> [L atrial enlargement] --\>* *can compress esophagus --\> dysphagia*)
246
Name the **Autoregulator Factors** for the Brain
[CO2 (pH)]
247
Name the **Autoregulator Factors** for the Kidneys (2)
[Myogenic & Tubuloglomerular feedback]
248
Name the **Autoregulator Factors** for the Lungs
[DEC O2]
249
Name the **Autoregulator Factors** for the Skeletal Muscle (6)
Sk. Muscle = [Lactate / Adenosine / K+ / H+ / CO2 / (Sympathetic tone when at rest)]
250
What perfuses the [diaphragmatic heart surface]? What is its *PARENT* artery?
[**PD****A**-***P**osterior**D**escending interventricular**A**rtery]*
251
What was the former name of ***Streptococcus Gallolyticus***, and where does it "live"?
*S Bovis;* Lives in **Colon** Normal Flora
252
Pts with **Bicuspid Aortic Valve** are at INC risk of what 3 things?
[Stenosis vs. Insufficiency vs. Infection]
253
How is Monoamine Oxidase associated with **Tyramine HTN Crisis**
Pts who are taking *_MAOI_*-*MonoAmine Oxidase Inhibitors* for depression but eat:
1) Aged cheese
2) Cured meats (*Sausage*)
3) Draft Beer
will develop _Tyramine HTN Crisis_ (*Tyramine is an Indirect **Sympathomimetic***)
254
List the Population breakdown for **Coronary Dominance** (3)
- 70% population use [**R Coronary Artery**] to perfuse PDA = *RIGHT DOMINANT CIRCULATION*
- 20% population use BOTH [**R Coronary Artery**] AND [**L Circumflex Artery**] to perfuse PDA = *CoDominant Circulation*
- 10% population use [**L Circumflex Artery**] to perfuse PDA= *Left Dominant Circulation*
255
If a pt with *Left Dominant Circulation* has [AV node ischemia], which artery is responsible?
[AV node] is perfused by PDA and in *Left Dominant Ciruclation* populations (10%), PDA is perfused by [**L Circumflex Artery**]
256
Clinical Presentation of a [**RAO**-***R**etinal **A**rtery **O**cclusion]* (2)
[Acute, painless, (monocular vision loss)]
+
[Macula cherry red spot with a surrounding white retina]
257
What factors INC [**PRA** - **P**lasma **R**enin **A**ctivity] (2). How is it used to assess BP med non-compliance?
1) low Na+ intake
2) certain BP meds - HCTZ vs. Angiotensin blockers
***PRA** should INC when pt is started on BP medications (HCTZ vs. Angiotensin blockers) and if it doesn't = med non-compliance*
258
How does [\_\_\_\_Stenosis] determine the degree of severity in [Tetrology of Fallot]
_Degree of [**I**nfundibular Pulmonary Stenosis]_ determines degree of symptoms since [INC stenosis] --\> [INC R--\>L Vt Shunt] --\> INC [Cyanotic Tet Spells]
"**VOIR** is to have **S**ee + **S**ight + **C**ry"
259
PDA Tx (2)
Indomethacin (PGE2 inhibitor)
vs.
[Surgical Ligation in older pts]
260
2 Main Causes of [**PDA**]
Prematurity & [Congenital Rubella]
261
Which organs is Lipofuscin normally found (4)
Heart
Liver
Kidney
Colon
262
HOCM Sx (3)
- [Syncope during exercise]
- [**S**udden **C**ardiac **D**eath] 2º to Vt Arrhythmia
- [S4 Atrial Kick]
263
[Familial Chylomicronemia Syndrome] Mode of Inheritance
auto recessive
264
[Familial Hypercholesterolemia (2A)] Mode of Inheritance
AUTO DOM
265
Common Causes of [Constrictive Pericarditis] - 5
'**Ur** an **Idiot** to *constrict* my **Radio** & **T-V**"
**Ur**emia
**Idio**pathic
**Radi**ation
**T**B
**V**iruses
266
What's the most frequent [1° Cardiac Peds Tumor]?
[Tuberous Sclerosis: **Rhabdomyoma**] --\> Valvular Obstruction
267
ALPHA 1 RECEPTOR
Tissues - Actions (3)
"Gimme an *alpha 1* **VID**"
(1) Most **V**ascular smooth muscle- contracts (inc. vascular resistance)
(2) **Dilator** Pupillary muscle- contracts (myDriasis)
(3) **I**nternal Urethral Sphincter- contracts
268
ALPHA 2 RECEPTOR
Tissues- Actions (5)
"You'll find alpha 2 receptors on a **P****PEAA**"
(1) [**A**drenergic and cholinergic nerve terminals]- inhibits NTS release--\> [CNS-mediated BP DEC]
(2) **P**latelets- stimulates aggregation
(3) **P**ancreas- DECREASES Insulin Release
(3) **A**dipocytes - DEC Lipolysis
(4) **E**ye - DEC Intraocular pressure
269
BETA 1 RECEPTOR
Actions (2)
(1) Heart- INC rate and force by [INC [Na+ I(f) channels] in phase 0 of AV node] --\> **shortens PR interval**
(2) JGA cells- Stimulates renin release
270
BETA 2 RECEPTOR
Tissues-Actions (4)
"*B* Team Team *2* **R**arely **L**oves **P**lay **T**ime"
## Footnote
(1) Relaxes **RUV** - (**R**espiratory, **U**terine and **V**ascular) smooth muscle
(2) **L**iver- stimulates glycoGenolysis
(3) **P**ancreatic B cells- stimulates insulin release
(4) **T**remor activation by @ [voluntary m. somatic n. terminals]
271
BETA 3 RECEPTOR Tissues-Actions
Fat cells- stimulates Lipolysis
## Footnote
*(B1 and B2 may also contribute)*
272
DOPAMINE 1 RECEPTOR
Tissues-Actions
Renal and other splanchnic blood vessels- vaso**D**ilates (reduces resistance)
**D** for **D**opamine Receptor
273
DOPAMINE 2 RECEPTOR
Tissues-Actions
Nerve terminals- inhibits adenylyl cyclase
274
What target organ does the M1 Receptor work in
"[M1s need Brain], [M2s need Heart], [M3s BEGs for Private Lounges"
Brain
275
What target organ does the M2 Receptor work in
"[M1s need Brain], [M2s need Heart], [M3s BEGs for Private Lounges"
Heart
276
What target organ does the M3 Receptor work in (6)
"[M1s need Brain], [M2s need Heart], [M3s BEGs for Private Lounges"
"M3's **BEGS** for **P**rivate **L**ounges"
**B**ladder(contraction) / **E**yes / **G**I / **S**kin / [**P**eripheral Vasculature] / **L**ungs
277
Name the 4 Medications that **Prevent LV Remodeling** in HF pts
"**BANA** helps HF pts live Loonger"
## Footnote
**B**eta Blockers (Metoprolol / Carvedilol)
[**A**CEk2 inhibitors AND ARBs]
[**N**itrates + Hydralazine]
[**A**ldosterone Blockers (Spironolactone / Eplerenone)]
278
When does Lymphangiosarcoma present
~10 years after [radical mastectomy w/axillary lymph node dissection]
279
M INC Severity of [**Carcinoid** Heart Disease] correlates with what compound?
[INC Urinary/Plasma **5HiAA** (**5H**ydroxy**i**ndole**A**cetic **A**cid)] = INC Severity
***C**arcinoi**D** **S**yndrome: (**C**utaneous Flushing)/**D**iarrhea/(**S**OB wheezing)*
280
When do you hear a loud P2?
Pulmonary HTN
281
[T or F] ASA, alone, is sufficient to treat DVT/PE in high risk pts
**NO**
282
[Fetal Alcohol Syndrome] is asociated with which Congenital Heart Defect
VSD (the most common)
283
Where is the **AV node** located?
near Interatrial septum around the coronary sinus opening
284
**Acute Coronary Syndrome** consist of what 3 conditions
"We have *ACS* in the **USA**"
1. [**U**nstable vulnerable Angina]
2. **S**udden Cardiac Death
3. **A**cute MI
