Cardiovascular Flashcards
(267 cards)
1
Q
what are the conduction velocities of cardiac tissues?
(relative to each other, not absolute)
A
FAST - purkinje fibres > atrial muscle > ventricular muscle > AV node - SLOW
2
Q
kawasaki disease Rx
A
aspirin and IVIG
3
Q
what is the mechanism and antedote of TCA toxicity?
A
binds to and blocks inward Na+ channels
also antimuscarinic, alpha-adrenoceptor and histamine receptors
Rx = sodium bicarb, more Na+ for competitive inhibition and alkalinisation of serum ionizes the TCA, stopping its binding to the target channel
4
Q
by 4 weeks gestation, what has been established in the primitive heart?
A
beating of the primative heart tube
L/R polarity
5
Q
2 causes of pulsus paradoxus
A
- pericardial disease (effusion or constrictive pericarditis) 2. COPD/asthma
6
Q
what is the distinguishing sign of digoxin toxicity?
A
yellow vision
7
Q
ST elevation in V5-6
A
anteriolateral, distal LAD or LCx
8
Q
kawasaki disease major complication
A
coronary artery aneurysm and rupture thrombosis and MI
9
Q
what branch of the coronary circulation supplies the inferior surface of the heart?
what part of the heart is the inferior surface?
A
posterior descending/interventricular artery
2/3 is post wall of left ventricle, 1/3 is post. wall of right ventricle
10
Q
how does flow mediated dilatation occur?
A
increased flow, increases shear stress on endothelium
opens shear-activated K+ channels, hyperpolarisation
K+-gates Ca++ channels open, Ca++ increases within the cell
Ca++-dependent activation of eNOS, NO generation
vasodilatation
11
Q
what are the class IB antiarrythmics?
A
Lidocaine and mexiletine
12
Q
function of ductus arteriosus
A
shunts blood from the pulmonary trunk to the descending aorta due to high pulmonary arterial resistance
mixing of very oxygenated with very deoxygenated blood gives PaO2 of 30 mmHg to foetus which is adequate
13
Q
harsh systolic crescendo-decrescendo murmur heard best at the lower left sternal border
A
HOCM
14
Q
WG blood finding
A
positive cANCA - levels correlate with disease activity
15
Q
what is the mechanism and adverse effect of nitroprusside?
A
short acting direct NO release causing increased cGMP
cyanide toxicity
16
Q
what channel does dihydropyridine calcium blockers target?
A
L-type voltage gated Ca++ channels
17
Q
apart from holosystolic MR murmur, which is the best aucultatory finding indicating severity of disease?
A
S3 gallop - reflects degree of left ventricular volume overload.
18
Q
How long can myocardial ischaemia continue before damage is irreversible?
A
30 mins
19
Q
following MI, what histological changes are apparent between 1 - 5 days? (2)
A
contraction band necrosis neutrophil infiltrate
20
Q
what percentage of medium size artery must be stenosed to yield end-organ complication?
A
70%
21
Q
tuncus arteriosus gives rise to
A
ascending aorta and pulmonary trunk
22
Q
2 most common causes of aortic dissection
A
- HTN (older)
- connective tissue disorder (Marfan & ED, younger)
23
Q
only organ spared by polyarteritis nodosa
A
lung
24
Q
which drugs help close and maintain ductus arteriosus?
A
close - indomethacin
maintian - PGE1 and PGE2
25
3 complicaton of thoracic aneurysm
1. aortic regurgitation 2. thrombosis/embolism 3. compression of mediastinal structures
26
define type B aortic dissection
aortic dissection exclusively involving the thoracic aorta
27
equation for EF
LVEF becomes symptomatic at?
(EDV-ESV)/EDV
'what has been ejected'/'what was in there to begin with'
around 40% LVEF begin to experience symptoms
28
what is the reaction catalysed by eNOS?
Arginine + O2 --\> NO + citrulline
increased cytosolic Ca++ activates eNOS; NO activates guanylyl cyclase to make cGMP
29
What process produces an S3 heart sound?
S3 occurs early in diastole as blood flows against a stiffened left ventricle
30
clinical features of HOCM (3)
1. decreased CO (LV cannot fill in diastole) 2. sudden death due to ventricular arrhythmia (young athlete, sudden death) 3. syncope with exercise
31
mutation in what protein gives rise to hypertrophic cardiomyopathy? mode of inheritance?
sarcomere autosomal dominant
32
TCA Rx
as soon as confirmed elevated ESR start IV corticosteroids to prevent blindness
33
what cell types provides the major proliferative stimulus for cellular component of atheroma?
what does this activate?
platelets - PDGF and TGF-beta
SMC migration from media to intima and proliferation, interstitial collagen production
34
blood in umbilical vein has PO2 of?
30 mmHg
35
what is the electrocardial adverse effect of type IA antiarrythmics?
prolonged QT, torsades de points
36
in traumatic deceleration injury, what part of the aorta is likely to dissect/rupture?
aortic isthimus, where the aorta is held stationary by the ligamentus arteriosus
just after the left sebclavian artery leaves at the top of the descending aorta
37
in which portion of the developing heart is a VSD most likely to occur?
membranous intraventricular septum
38
hyaline arterioloscelrosis - aetiology (2)
benign HTN diabetes (non-enzymatic glycosylation)
39
what are the class IA antiarrythmics?
quinidine, procainamide, disopyramide
40
following MI, what histological changes are apparent between 4 - 12 hours? (4)
early coagulation necrosis oedema haemorrhage wavy fibers
41
congenital RFs for cerebral aneurysm (4)
1. coarctation of aorta 2. PCKD 3. connective tissue disorder (Elhers-Danlos) 4. AV malformation
42
what is supplied by LCX?
lateral and posterior walls of left ventricle
papillary muscle
43
primitive ventricle gives rise to
trabeculated part of left and right ventricles
44
kawasaki disease main vessel involvement
coronary artery
45
what is a co-dominant circulation?
posterior descending/interventricular artery arrises from both the RCA and the LCX
7%
46
how does hydralazine work?
increase cGMP leading to smooth muscle relaxation
preferential vasodilatory action on arterioles \> veins, reduces afterload
47
Brugada syndrome
* inheritance
* EKG findings
* protein affected
* major complication
* Rx
* AD
* psuedo-RBBB & ST segment elevation in V1-3.
* myocardial sodium channelopathy
* sudden cardiac death from ventricular tachyarrhythmia
* implantable cardiac defib
48
Acute Rheumatic fever symptoms JONES
J - joint arthritis O - 'heart' = pancarditis N - nodules E - erythema marginatum S - Sydenham's chorea
49
most common causative organism for bacterial endocarditis
strep viridans
50
TCA epidemiology
old adults (\>50 y/o) females
51
complications of aortic stenosis (3)
1. concentric left ventricular hypertrophy 2. angina and syncope with exercise 3. haemolytic anaemia (schistocytes)
52
in lung histology, haemosiderin laden macrophages reflect what underlying process?
left heart failure increase pulmonary capillary pressure compromise of blood-gas barrier and extravasation of erythrocytes phagocytosis by resident alverolar macrophages and conversion to haemosiderin
53
is anteriolateral or posteriomedial papillary muscle rupture more likely? why?
posteriomedial - receives only blood from the posterior descending/interventricular artery
anteriolateral papillary muscles have dual blood supply from LAD and LCx
54
how can you best heard S3 and why?
at end expiration in the left lateral decubitus position
reduces lung volume and brings the left heart closest to the chest wall. Also increases pulmonary venous return to heart by closing small vessels in the lung
55
which ion channel is only responsible for the **rate of action potential firing** from pacemaker cells?
i.e. no inotropic or lusitropic effect
what drug can be used to target this?
funny sodium channels
more open - slower refractory period, more closed - longer refractory period
refractory period ==\> length of diastole
ivabradine
56
what are the steps in the pathogenesis of infective endocarditis? (4)
1. disruption of normal endocardial surface
2. fibrin deposition and nidus formation
3. microoganisms colonise the nidus, further coagulation
4. macroscopic vegiation formation from RBCs, neutrophils, platelets and microorganisms
57
ST elevation in V3-4
distal LAD
58
what are the side effects of amiodarone?
pulmonary fibrosis
blue/grey skin deposits
hepatotoxicity
hypo-/hyper-thyroidism (amIODarone)
59
in Tet of Falot, what is the factor determining symptom severity?
degree of pulmonary artery outflow obstruction
60
TCA is associated with another condition?
polymyalgia rheumatica - proximal myalgia and weakness
61
difference between acute and sub acute bacterial endocarditis?
acute - staph aureus, large vegitations that destroy the valve subacute - smaller vegitations that do not destroy the valve
62
Ortner syndrome
mitral stenosis causing dilation of the left atrium and subsequent impingement on the left recurrent laryngeal nerve, resulting in hoarsness
63
hyaline arterioloscelrosis - complication
glomerular scarring --\> CKD shrunken kidney
64
what structure of the primitive heart is defective in Tet of Fallot?
infundibular septum, part of conal septum
due to failure of migration of neural crest cells
65
4 complication of atherosclerosis
1. stenosis 2. thrombosis 3. embolism 4. aneurysm
66
layers of arterial wall inside to out - major component of each
intima - endothelium media - smooth muscle adventitia - connective tissue
67
CK-MB is useful in what setting? why?
reinfarction Troponin I remains elevated after first MI, whereas CK-MB is cleared within 72 hours (versus 7 - 10 days)
68
what is the coronary steal phenomenon? what drugs cause it?
paradoxically, in MI coronary vasodilators divert blood to the low resistance vessels, reducing collateral arteriolar flow to the myocardium distal to any blockage.
dipyridamole, adenosine
69
3 groups of patients that get Kaposi sarcoma
1. older, eastern European male - tumour localised to skin 2. transplant patient 3. AIDS
70
what is milrinione and when is it used?
PDE3 inhibitor allowing cAMP accumulation in tissues
vasculature = vasodilation
heart = positive inotropy and chronotropy
use in decompensated HF short-term
71
pathology - HTN causing aortic dissection
vasa vasorum deliver oxygen to media/adventitia of large veseel HTN induces hyaline arteriolosclerosis in VV VV become stenotic weakening of aorta SM wall
72
which organisms cause endocarditis with negative blood cultures? (5)
HACEK haemophilus actinobacillus cardiobacterium Eikenella Kingella
73
immediate management of TOGA in newborn?
identify the other malformation that allows mixing of blood and maintain it
TOGA is incompatible with life without PFO, PDA etc.
74
postnatal derivatives:
ductus arteriosus
ligamentum arteriosum
75
what are the pressures of the heart?
RA, RV, PA, LA, LV, root of aorta
**RA** \<5
**RV** 25/5
**PA** 25/10
**LA** \<10
**LV** 120/10
**aortic root** 120/80
76
when is Mg++ useful as an antiarrhythmic?
torsades de points and digoxin toxicity
77
Tet of Fallot typical ausculatation findings?
harsh, systolic ejection murmur over mid-to-left sternal border
RVOT obstruction
78
5 causes of restrictive cardiomyopathy
1. amyloidosis 2. sarcoidosis 3. haemochromatosis 4. endocardial fibroelastosis 5. Loeffler syndrome
79
inspiratory splitting of S2
patent ductus arteriosus
80
complication of MI in 1st day (3)
1. cardiogenic shock 2. congestive heart failure 3. arrhythmia (most common)
81
major mechanism of GTN
VENOUS dilatation, decrease preload to heart, decrease oxygen requirement
82
what vessels do the fourth aortic arch contribute to?
true aortic arch and subclavian arteries
83
complication of MI in 1st month (3)
aneurysm, mural thrombus, Dressler syndrome (AI pericarditis 6-8 week following infarction)
84
primitive atrium gives rise to
trabeculated part of left and right atria
85
what does phentolamine do?
non-specific alpha 1/2 blocker with no beta blocker effect
86
what Ca channel blocker do you use in hypertensive emergeny?
nicardipine, clevidipine
87
primitive pulmonary vein gives rise to
smooth part of left atrium
88
Churg-Strauss histopath
necrotizing granuloma (c/o microsocpic polyangiitis) eosinophils (assoc Asthma)
89
following MI, what histological changes are apparent between 12 - 24 hours? (2)
coagulation necrosis contraction band necrosis
90
describe the process of septation of the atria in 7 steps
1. septum primum, foramen primum
2. foramen secundum
3. septrum secundum
4. foramen ovale
5. septum primum expands
6. fusion of septa secundum (rostral) and primum (caudal)
7. closure of FO with increasing LA pressure at birth
91
what antiarrythmic drug gives luminous phenomena/visual brightness as adverse effect?
ivabridine
92
major risk factor for Buerger disease
smoking
93
in the setting of AF, where in the heart are clots likely to form?
left atrial appendage
94
what is Ebstein's anomaly?
downward displacement of the tricuspid valve allowing regurgitant flow from RV to RA and right heart failure
95
aetiology of S3 (3)
1. athletic left atrium pushing blood against healthy left ventricle 2. low ventricular compliance 3. high end-diastolic LV volume (overfilled)
96
what are the two vessels that can supply the SAN?
right coronary (60%)
left circumflex (40%)
97
ARF - histo features of myocarditis (4)
Ashoff bodies - foci of chronic inflammation - containing: Anitschkow cells - histiocytes with long, slender nuclei (caterpillar)
Giant cells
fibrinoid material
98
blowing, loud, holosystolic murmur at left mid sternal border
small VSD audible at days 4 - 10 of life
99
what is the effect of adenosine on the heart?
prolongs phase 4 of cardiac action potential by activating A1 receptor, reducing the rate of action potentials and lengthening diastole
A1 receptor activates outward K+ channels and blocks inward Ca++ channels
slows sinus rate and increases AV nodal conduction delay - used in pSVT to terminate tachyarrhythmia
100
borders of the femoral triangle
superior - inguinal ligament
lateral - sartorius
medial - adductor longus
101
where does the thoracic duct entre the thorax?
through diaphragm at T12 through aortic hiatus
102
what is the mechanism of ivabridine?
when do you use it?
slows funny Na+ current, negative chronotropy without inotropic effect
reduces cardiac O2 consumption
chronic stable angina in people who do not tolerate beta-blockers
103
ST **depression** in V1-3 with tall R waves
posterior, so opposite changes to electrical activity in anterior leads
posterior descending/interventrical artery
104
blood supply to the retina starting from the common carotid..
common carotid, internal carotid, opthalmic, retnal (within the optic nerve)
105
how do you treat hypertension in pregnancy? (not pre-eclampsia)
hydralazine, methyldopa, labetolol, nifedipine
106
micoscopis polyangiitis blood finding
pANCA
107
what is the main electolyte disturbance with digoxin toxicity?
hyperkalaemia
108
what is supplied by the posterior descending/interventricular artery? (4)
AV node
posterior 1/3rd interventricular septum
posterior walls of ventricles
posterior papillary muscles
109
postnatal derivatives:
ductus venosus
ligamentum venosum
110
constipation and heart block/AV node supression suggests what class of drug?
non-DHPR blockers - diltiazem and verapamil
111
what is the equation of Fick principle?
cardiac output = Rate of oxygen consumption/ateriovenous oxygen content difference
112
when used with a statin, which other lipid lowering agent increases the risk of rhabomyolysis/CK increase?
niacin or fibrates
esp gemfibrozil - which impairs the hepatic clearance of statins
113
how quickly following myocardial ischaemia does contraction stop?
60 seconds
114
what is monday disease?
industrial exposure to nitrates, tolerance during the week
loss of tolerance over the weekend, return on Monday
features: dizziness, tachycardia, headache
115
key lab finding in TCA
Elevated ESR (\>100)
116
What is lipofuscin? organs? what patients?
yellow-brown, granular perinuclear pigment lipid polymers and protein-phospholipid complex seen in heart and liver of aging/cachectic/malnourished patients
117
what is nimodipine used for?
cerebral vasospasm prophylaxis in SAH
118
what happens to the foetal circulation on first breath?
1. negative intrathoracic pressure, decrease pulmonary arterial resistance
2. increase in LA:RA pressure ratio, closure of FO
3. increase PaO2 and reduction in circulating maternal prostaglands (separation of placenta)
4. closure of ductus arteriosus
119
which are the partial beta-agonists?
pindolol and acebutolol
120
bulbus cordis gives rise to
outflow tracts of left and right ventricles
121
how does fendolopam work?
D1 agonist - coronary/peripheral/renal vasodialiton
drop in BP and increase natriuresis
122
what enzyme catalyses the primary breakdown pathway for natriuretic peptides?
what type of enyzme is this?
Neprilysin
Metalloprotease
.. inhibition of this would lead to increased BNP/ANP, which are opposers of RAAS and is beneficial in the setting of heart failure unresponsive to ACE inhibitors/ARB
123
postnatal derivatives:
notochord
nucleus pulposus
124
which type of Ca++ channel blockers result in constipation and hyperPRL?
NDHPR blockers - diltiazem/verapamil
125
ST elevation in V1/2
proximal LAD
126
which vessel does atherosclerosis most commonly affect?
abdominal aorta
127
mechanism of action of clopidogrel, pasugrel, ticlopidine
P2Y12 ADP-receptor inhibitor that stops the expression of GpIIb/IIIa
128
what is the clinical use of type 1B antiarrythmics?
preventing post MI tachyarrythmia or digitalis-induced arrythmia
129
what nerve innervates the pericardium?
phrenic nerve, pain referred to shoulder
130
what medication alters the effect of adenosine?
caffiene and theophylline
adenosine receptor antagonists
131
which vessels involved in large-vessel vasculitis?
aorta and major branches
132
which valvular disorder increases risk of infective endocarditis?
mitral valve prolapse
133
hyperplastic arteriolosclerosis - aetiology
malignant HTN
134
Takayasu vessels
aortic arch at the point of the branching vessels
135
Chrug-Strauss blood results
pANCA
136
a varicocele is a dilatation of what blood vessels?
**pampiniform plexus**
usually from compression/stasis of **left spermatic/gonadal** vein
137
middle meningeal artery is a branch of what atery?
maxillary, which is a terminal branch of external carotid
138
phosphorylation of myosin light chain give what response in vessels?
contraction
NO --\> cGMP --\> MLC phosphatase --\> dephosphorylation --\> relaxation
139
what are the side effects of quinidine?
chinchonism - headache/tinnitus
140
PDA best heard where?
left infraclavicular area
141
GDM assoication with which congential cardiac malformations?
1. VSD 2. truncus arteriosus
142
what are the contraindications of class IC antiarrythmics?
post MI or structural heart disease
only used for pSVTs (including AF)
143
what nerve is associated with 1st pharyngeal arch?
trigeminal (V)
144
Takayasu Rx
corticosteroids
145
Jervell and Lange-Nielsen syndrome 2 features protein affected? major complication
bilateral sensorineural hearing loss, congenital long QT voltage-gates K+ channel ventricular arrhythmia (TdP or VFib)
146
blood supply of SA and AVN
right coronary artery
147
which organism is associated with endocarditis in patients wtih underlying colorectal carcinoma?
strep bovis
148
what is the mechanism of adenosine as antiarrhythmic?
increases extracellular K+, hyperpolarising the cell
decreases intracelluar Ca++, decreases AV node conduction
short half life = 15 sec
149
TCA vessels and associated symptoms (2 arteries, 3 symptoms)
temporal (headache) opthalmic (visual disturbance/blindness) jaw claudication
150
split S2 that does not change with inhalation
atrial septal defect with left to right shunting
151
polyarteritis nodosa Rx
corticosteroids and cyclophosphamide fatal if not treated
152
Churg-Strauss site affected
lung and heart
153
3 abnormalitis of the heart associated with failure of the neural crest cell migration
1. TOGA
2. Tetralogy of Fallot
3. Truncus arteriosus
154
what is phenoxybenzamine and when it is used?
irreversible competitive inhibitor at alpha 1 and 2 receptors
used mainly for phaeochromocytoma
155
Raising the threshold potential of cardiac myocytes is the mechanism of action for what class of antiarrhythmic drugs?
type I (sodium channel blockers)
156
what structures does the thoracic duct drain?
lymph from whole left sie of body
all regions inferior to umbilicus
entire GI tract
157
what nerve is associated with the 2nd pharyngeal arch?
facial (VII)
158
what proportion of people have a right dominant circulation?
85%
159
treatment of MI
MONA BASH morphine oxygen nitrates aspirin beta-blocker, ACE inhibitor, statin, heparin
160
2 causes of RAS
1. atherosclerosis 2. fibromuscular dysplasia (young female)
161
3 conditions underlying nonbacterial thrombotic endocarditis
1. APL syndrome, SLE (Leibman-Sacks) 2. adenocarcinoma of viceral organs (mucin/cytokine production) 3. DIC in sepsis
162
RFs for spontaneous intracranial haemorrhage (3)
1. cerebral aneurysm 2. arteriovenous malformation 3. sympathomimetic drug abuse (cocaine)
163
what is the difference in vasodilation between hydralazine and nitrates?
hydralazine - arterioles \> veins (decrease afterload)
nitrates - veins \>\> arterioles (increase afterload)
164
polyarteritis nodosa histopath findings (3)
transmural inflammation resulting in aneurysm
whole vessel wall fibrinoid necrosis
'string of pearls' appearance of resulting fibrotic nodules
165
which type of calcium channel blocker affects the heart? which the vasculature?
dihydropiridine = vascular smooth muscle
non-dihydropyridine (diltiazem, verapamil) = heart
166
doxorubicin causes what cardiomyopathy?
dilated cardiomyopathy
167
Nonmodifiable RFs for atherosclerosis (3)
Age - older Sex - male Genetics - FHx
168
what nerve is associated with the 6th pharygeal arch?
recurrent laryngeal branch of vagus (X)
169
macroscopic changes to the aging heart 4
1. decreased LV cavity size
2. sigmoid septum
3. decreased base to apex length
4. increased intersitial connective tissue/myocardial atrophy
170
what is the order of sodium channel binding strength for class 1 antiarrhythmics?
1C \> 1A \> 1B
the stronger binding strength, slower the drug comes off the channel when bound.
so 1C shows greatest use-dependence, as they accumulate best over multiple cardiac cycles
171
following MI, what histological changes are apparent between 2 weeks and 2 months? (1)
scar formation/collagen deposit
172
1 major RF for TAA
tertiary syphilis - endarteritis of aortic vasa vasorum
173
what is the LVEDP, LVEDV and LVEF in isolated diastolic HF?
Examples of diastolic HF?
increased, normal, normal
HOCM, hypertrophy 2ary to hypertension, amyloidosis, stiff ventricular wall 2ary to MI scarring
174
what are the class III antiarrythmics?
| (4)
K+ channel blockers
amiodarone, ibutilide, dofetilide, sotalol (AIDS)
175
what vessels do the sixth aortic arch contribute to?
pulmonary arteries and ductus arteriosus
176
great saphenous vein runs on what aspect of the leg and where does it end?
medial aspect
acess: proximal anterior aspect of thigh, 3-4 cm inferolateral to pubic tubercle
joins the femoral vien at the femoral triangle
177
endocardial cushion gives rise to (3)
1. atrial septum
2. membranous intraventricular septum
3. AV and semilunar valves
178
Romano-Ward syndrome clinical features protein affected major complication
only long QT syndrome - no sensorineural hearing loss c/o Jervell and Lange-Nielsen syndrome voltage-dependent K+ channel in myocardium sudden cardiac death from ventricular arrhythmia
179
Buerger disease clinical features
ulceration/gangene autoamputation of fingers and toes
180
most common cardiac malformation with Down syndrome?
complete atrioventricular canal defect - ostium primum ASD - VSD - single atrioventricular valve
181
HSP histopath (1)
IgA immune complex deposition
182
HSP clinical findings (3 signs, 1 history)
* palpable purpura on buttocks and legs
* GI pain/bleeding
* IgA nephropathy (haematuria)
_history_ - URTI
183
mechanism of AT-II (2)
direct contraction of alveolar smooth muscle
promoting secretion of adrenal aldosterone -\> Na resorbtion in DCT
184
microscopic poylangiits sites affected
lung and kidney c/o WG - no nasopharynx
185
what does the third aortic arch give rise to?
common carotids
proximal internal carotids
186
what is the mechanism of niacin flushing side effects?
prostaglandin mediated
can administer aspirin 30-60 mins before to reduce s/e's
187
polyarteritis nodosa serology
Hep B surface antigen (HbSAg)
188
2 major RFs for aoritc regurgitation
1. aortic root dilitation (so murmur best heard on right sternal border instead) 2. bicuspid aortic valve
189
Takayasu arteritis epidemiolody
adult \<50 y/o - young asian female
190
what embryonic structures give rise to the superior vena cava?
right common cardinal vein and right anterior cardinal vein
191
when platelets bind vWF from the basement membrane (adhesion), what factors are release and what are their function? (3)
1. Ca2+ to promote **coagulation** cascade
2. ADP - activates P2Y12 receptor to stimulate externalisation of **GpIIb/IIIa**
3. TXA2 - platelet **aggregation**
192
Buerger disease Rx
smoking cessation
193
what is supplied by the right marginal artery
right ventricle
194
2 blood tests confirming group A beta-haemolytic Strep infection
positive ASO or anti-DNase B titre
195
function of ductus venosus?
shunts oxygenated blood from umbilical vein to IVC, bypassing the hepatic criculation
196
what do you usually give with hydralazine? why?
beta-blocker - prevent reflex tachycardia
197
following MI, what histological changes are apparent in the myocardium between 0 - 4 hours? (1)
minimal change
198
How do type IV antiarrhythmic drugs work?
examples? indication?
inhibition of slow T-type inward Ca++ channels at pacemaker cells
Verapamil, diltiazem
recurrent nodal tachyarrhythmias (pSVT etc..)
199
postnatal derivatives:
umbilical arteries
media**l** umbilical ligaments
200
function of the foramen ovale?
allows passage of blood from RA to LA, allowing most oxygenated blood in foetal circulation to bypass the lungs and be delivered to head and body
201
complication of MI 1st week (4)
fibrinous pericarditis (neutrophils) rupture of ventricular free wall, tamponade rupture of intraventricular septum, left to right shunt cordae tendinae rupture, mitral insufficiency
202
what nerve is associated with the 3rd pharyngeal arch?
glossopharyngeal (IX)
203
2 types of arteriolosclerosis
1. hyaline 2. hypertrophic
204
HSP Rx
usually self limited treat with steroids if very severe
205
location and supply of SA node
at the junction of the SVC and RA
supplied by right coronary artery
206
after 2 weeks of statin therapy what is a common complication?
myalgia, rhabdomyolysis and myoglobinuria
207
why is there right atrial collapse in cardiac tamponade?
rostral displacement of pericardial fluid as the right ventricle expands, putting inward pressure at the top of the heart that collapses the atrium
208
what smooth muscle relaxant causes compensatory tachycardia and fluid retention?
hydralazine
209
location and supply of the AV node?
right atrium near the septal cusp of the trisuspid valve/orifice of cornonary sinus
supplied by posterior descending/interventricular artery
210
right horn of the sinus venosus gives rise to
smooth part of right atrium (sinus venarum)
211
1 major RF for AAA
atherosclerosis - oxygen diffusion barrier
212
into what structure does the thoracic duct drain?
left subclavian vein, near its junction with internal jugular vein
213
histologic findings in HOCM
myofiber hypertrophy with disarray
214
modifiable RFs for atherosclerosis (4)
HTN, smoking, DM, hypercholesterolaemia
215
what are the four classes of antiarrythmics?
1 - sodium channel block
2 - beta-blocker
3 - potassium channel block
4 - calcium channel block
216
2 non-CVS syptoms of left atrial enlargement?
dysphagia (compression of distal oesophagus)
hoarsness (compression of left RLN)
217
postnatal derivatives:
umbilical vein
ligamentum teres hepaticus (round ligament)
## Footnote
*contained within the falciform ligament*
218
complications of fibrinolysis (2) at a tissue level (i.e. NOT haemorrhagic stroke etc)
1. contraction band necrosis (Ca return to tissue) 2. reperfusion injury (oxygen forming free radicals)
219
what is the ristocetin test? if +ve what is the differential diagnosis?
Ristocetin - promotes platelet adhesion by binding vWF to GpIb
if ristocetin does not promote platelet plug formation then either vWF or GpIb are missing
this is *von Willebrand disease* and *Bernard-Soulier syndrome*
220
RAS major distinct findings (2)
1. increased plasma Renin 2. unilateral renal atrophy
221
an uncorrected ASD leads to...
increased blood flow through the pulmonary artery tunica media hypertrophy increase RV afterload right heart hypertrophy Eisenmenger syndrome
222
intimal hyperplasia and fibrosis, medial hypertrophy and formation of capillary tufts refers to which pathology? epidemiology?
pulmonary arterial hypertension women, 20 - 40
223
Libman-Sacks define, association, complication
sterile endocarditis due to vegitations association with SLE
vegitations arise in mitral valve, leading to mitral regurg
224
temporal artery biopsy findings (4)
inflamed vessel wall giant cells present intimal fibrosis granulomatous vasculitis
225
postnatal derivatives:
allantois (urachus)
media**n** umbilical ligament
226
WG histology (vessel wall) (3)
large necrotizing granuloma adjacent necrotizing vasculitis giant cells & epithelioid histiocytes (hallmark of granuloma)
227
left horn of sinus venosus gives rise to
coronary sinus
228
what chemicals are released in the coronary vessels during exercise to promote adequate blood supply?
nitric oxide and adenosine
229
which are the cardioselective beta blockers?
selective for beta 1 - metoprolol, atenolol, bisoprolol, nebivolol
230
what are 3 effects of ANP/BNP physiologically?
1. stop Renin production
2. efferent arteriolar vasoconstriction, increasing GFR
3. natriuresis, decreasing circulating volume
231
what is a right-dominant circulation?
posterior descenting/interventricular artery arises from the right coronary artery
85%
232
what does vWF bind to?
subendothelial collagen and platelet GpIb (adhesion)
233
what are 4 determinants of myocardial oxygen consumption?
EDV, BP, HR, contractility
234
define type A aortic dissection
any aortic dissection involving the ascending aorta
235
ST elevation in II, III and aV**F**
in**f**erior, RCA
236
Prinzmetal pattern of angina
episodic chest pain unrelated to exercise
237
what is the antedote for digoxin?
slowly correcting K+, Mg++, anti-digoxin Fab fragments
238
what is a left-dominant circulation?
posterior descending/interventricular artery arises from left circumflex artery
8%
239
explain subclavian steal syndrome
significant stenosis of left subclavian artery proximal to bifurcation of left vertebral artery
poor LVA pressure
diversion of flow from contralateral vertebral artery at level of basilar artery, 'steal'
retrograde flow down LVA, vestibulobasilar insufficiency = dizziness, vertigo, drop attacks
240
what are the three main neurohormonal mechanisms activated during congestive heart failure?
1. sympathetic autonomic nervous system
2. RAAS
3. ADH
241
migratory throbophlebitis is associated with which condition?
visceral adenocarcinoma (pancreas, colon and lung) secretion of thromboplastin-like substance causing hypercoagulability
242
WG symptoms
nasopharynx = sinusitis and NP ulceration lung = haemoptysis kidney = RPGN - haematuria
243
which vessels are involved in medium-vessel vasculitis?
muscular arteries supplying organs (muscular defines medium sized vessels)
244
hyperplastic arteriolosclerosis - complications (3)
fibrinoid necrosis end-organ necrosis AKI - flea-bitten appearance of micro-haemorrhage
245
what is the action of dobutamine?
pure beta1-adrenoceptor agonist
1. positive inotropy
2. weaky positive chronotropy
3. vasodilation
246
what is the mechanism of TXA2 in promoting platelet aggregation?
two-fold
1. increases expression of GpIIb/IIIa
2. vasoconstriction, decrease blood flow
247
Takayasu clinical findings
visual and neurologic disturbance weak/absent pulses elevated ESR
248
major risk factor for lymphangiosarcoma? from which cells does this cancer develop? benign or malignant?
persistent lymphoedema, as after mastectomy w/ axillary clearance lymphatic endothelium malignant
249
Wegener granulomatosis - sites affected
nasopharynx, lung, kidneys
250
what are the antiarrhythmic drugs that prolong QT? which one has the least chance of causing TdP?
ones that prolong the overal duration of ventricular action potential
class Ia and III
**amiodarone**
251
following MI, what histological changes are apparent between 5 - 10 days? (1)
macrophage phagocytosis
252
internal iliac gives rise to 4 arteries...
1. inferior gluteal
2. superior gluteal
3. obturator
4. lateral sacral
253
what nerve is associated with the 4th pharyngeal arch?
superior laryngeal nerve of vagus (X)
254
hyaline arterioloscelrosis - histology findings
protein seen as pink hyaline in thick vessel wall
255
which organism colonises prothetic heart valves?
staph epidermis
256
hyaline arterioloscelrosis - caused by?
protein leaking into vascular wall --\> vessel thickening
257
hyperplastic arteriolosclerosis - pathoG histology
onion-skin appearance
258
what is the innominate vein?
what vessels join, in what order, to make up this structure?
right brachiocephalic vien
right subclavian vein joined first by external jugular, then by internal jugular
*right lymphatic duct* also drains into right brachiocephalic
259
following MI, what histological changes are apparent between 10 - 14 days? (2)
granulation tissue neovascularisation
260
postnatal derivatives:
foramen ovale
fossa ovalis
261
microscopic polyangiitis Rx
cyclophosphamide and corticosteroids
262
what are 3 contraindications for nitrates?
HOCM (worsens outflow tract obstruction)
right ventricular infarction (reduces preload, hence decreases CO)
PDE inhibitors (synergism increases hypotension risk)
263
which vessels are involved in small-vessel vasculitis?
arterioles, capillaries, venuoles
264
ST elevation in I and aV**L**
**L**ateral - LCx
265
what 2 types of medication can lead to erectile dysfunction?
SSRIs and sympathetic blockers
266
PathoG - myxomatous degeneration of valve leaflets
mitral valve prolapse
267
WG Rx
cyclophosphamide relapse are common
