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UWORLD > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

With which disease are Aschoff bodies associated?

A

Rheumatic Fever

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2
Q

What valvular issues are seen with Rheumatic fever?

A

Early- mitral regurgitation

Late- mitral stenosis

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3
Q

What is the equation for flow?

A

Flow = (P1-P2)x(r)^4/(nl)

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4
Q

What are the most common causes of spontaneous intracranial hemorrhage in young adults?

A

AVM, ruptured cerebral aneurysm, or cocaine use

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5
Q

What congenital cardiac anomaly is associated with berry aneurysms of the circle of Willis?

A

Aortic Coarctation

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6
Q

How is cardiac output calculated using a Swan-Ganz catheter?

A

CO= rate of O2 consumption/ arteriovenous O2 content

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7
Q

Occlusion of which coronary artery is most likely to cause inferior MI?

A

RCA

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8
Q

What are the X-ray findings in transposition of the great vessels?

A

“egg on a string”- the mediastinum is narrowed and the heart is egg-shaped

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9
Q

What are the first signs seen on histology after an MI?

A

Contraction bands- hypercontraction due to increased intracellular calcium from sarcolemmal rupture

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10
Q

What causes HOCM?

A

Mutations in sarcomere genes such as Beta myosin heavy chain

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11
Q

What are the signs and symptoms of hypoglycemia and what drugs can mask them?

A

Diaphoresis and TachyC

Beta Blockers

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12
Q

What cardiac findings are associated with Marfan’s?

A

aortic root dilation (regurgitation), aortic dissection, mitral valve prolapse

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13
Q

What is seen on the EKG tracing in WPW?

A

Widened QRS (delta wave) with a shortened PR interval

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14
Q

What are the histological findings in PAN?

A

fibrinoid necrosis

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15
Q

Why can’t you mix MAOi with aged cheeses, smoked meats, and draft beer?

A

The tyramine (indirect sympathomimetic) degradation is blocked by MAOIs leading to sympathetic overstimulation and hypertensive emergency

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16
Q

What does Neprilysin (metalloprotease) cleave?

A

Natriuretic peptides, glucagon, oxytocin, and bradykinin

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17
Q

What forms the fibrous cap of an atherosclerotic plaque? What causes it to rupture?

A

Vascular smooth muscle cells (VSMC) create the extracellular matrix and fibrous cap. Progressive enlargement of the plaque causes ECM remodeling and VSMC death, making it less stable. Macrophages release matrix metalloproteinases that form a soft lipid core and thin the fibrous cap.

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18
Q

What causes aortic aneurysms?

A

myxomatous cystic change with pooling of proteoglycans in the media

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19
Q

What are the afferents and efferents for the carotid sinus reflex? What normal stimulants can trigger it

A

Buttoning a shirt to tight can trigger the baroreceptor in the carotid body
afferent: glossopharyngeal nerve
efferent: Vagus
Leads to hypotension, bradycardia, and syncope

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20
Q

Which vascular beds are most susceptible to atherosclerosis?

A

lower abdominal aorta and coronary arteries

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21
Q

What exposures are associated with liver angiosarcoma (CD31- PECAM1)?

A

arsenic, thorotrast, and polyvinyl chloride

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22
Q

How is strep viridans able to colonize teeth and heart valves?

A

It produces dextrans from sucrose to adhere to enamel or fibrin-platelet aggregates on damaged heart valves

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23
Q

What causes pulmonary HTN in a patient with LVH?

A

The venous congestion from diastolic dysfunction leads to endothelial damage. This causes the decreased production of NO and release of endothelin (vasoconstrictor). Remodeling leads to medial hypertrophy and intimal thickening and fibrosis (collagen and elastase)

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24
Q

What is the course of a strawberry hemangioma?

A

First it grows with the child then usually spontaneously regresses before puberty. Usually they begin to fade between the ages of 1-3

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25
Q

What is the effect of ivabridine on the heart?

A

It slows heart rate by blocking the funny sodium channel. It has no effect on contractility or relaxation

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26
Q

What are the changes to the aortic valve that come with normal aging?

A

chronic hemodynamic stress –> cell necrosis–> dystrophic calcification

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27
Q

What skin findings are associated with polyarteritis nodosa?

A

Livedo Reticularis, palpable purpura

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28
Q

What is the action of nitroglycerin?

A

Primarily a vasodilator at low doses

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29
Q

At what level do the common iliacs join to form the IVC? At what level does the IVC drain into the Right Atrium?

A

L4-5

T8

30
Q

Where is the clubbing and cyanosis seen in patients with PDAs?

A

In the feet. The hands are still well perfused.

Usually symptoms indicate eisenmenger syndrome (Right to Left shunt)

31
Q

What is lipofuscin and how does it look on histology?

A

lipid polymers and protein-complexed phospholipids. Product of free radical injury and lipid peroxidation, but considered normal wear and tear.
yellow-brown finely granular perinuclear pigment

32
Q

What commonly causes abdominal aortic aneurysm?

A

Chronic transmural inflammation of the aorta (age>60, HTN, Smoking, Male sex, family hx). Inflammatory cells release matrix metalloproteinases and elastases that degrade and progressively expand the aortic wall

33
Q

Which drug can increase the risk of myalgias from statins?

A

Macrolides inhibit CYP3A4 which metabolizes statins

34
Q

How much occlusion of a vessel is necessary for stable angina?

A

> 70%

35
Q

What causes ace inhibitor angioedema?

A

Bradykinin accumulation- potent vasodilator that increases vascular permeability

36
Q

How long after a cardiac ischemic event do myocytes lose contractility?

A

60s, but it is reversible up to 30 min

37
Q

What is the most common valvular disease that can lead to subacute endocarditis in the western world?

A

Mitral Valve Prolapse

38
Q

What are the histological findings in cardiac amyloidosis?

A

Some normal endocardium mixed with areas of acellular and amorphous pink material

39
Q

What are the most important factors influencing coronary blood flow autoregulation?

A

adenosine (from ATP metabolism)- vasodilates the small coronary arterioles
NO- Increases cGMP production and relaxes smooth muscle cells. Released by endothelial cells in response to histamine, bradykinin, neurotransmitters, platelet products, endothelin, and thrombin

40
Q

Why does verapamil affect myocardial and smooth muscle contractility, but not skeletal muscle contractility?

A

The smooth muscle and myocardial cells are dependent on extracellular Ca flow from the L type channels to open up the RYR on Sarcoplasmic reticulum and create huge calcium influx.
Skeletal muscle L type channels are mechanically connected to RYR channels and therefore do not require extracellular calcium influx

41
Q

What is the path of bloodflow from the common carotid that leads to painless monocular vision loss with occlusion

A

Common carotid–>internal carotid–>opthalmic artery–>retinal artery

42
Q

Name 3 potassium sparing diuretics

A

amiloride, triamterene, spironolactone

43
Q

What does prussian blue stain detect?

A

Intracellular iron.

44
Q

What are the main adverse effects of Nitrates?

A

headaches, cutaneous flushing, lightheadedness, hypotension, and reflex tachycardia

45
Q

What is the most common mutation in PAH?

A

Inactivating mutation of BMPR2

46
Q

What structure lies posterior to the esophagus?

A

The descending aorta

47
Q

What is the definition of permissiveness in the context of pharmacology?

A

One hormone allows another to exert its maximum effect.

48
Q

What is the best indicator of mitral stenosis severity?

A

The time between S2 and the opening snap (shorter= more severe)

49
Q

Which drug improves survival in patients with LV systolic dysfunction?

A

beta blockers- slow ventricular rate to reduce cardiac work.
Also- ACEi, ARBs, Aldosterone antagonists

50
Q

What changes in the heart are associated with normal aging?

A

Decreased LV chamber size (from apex to base) with septum that acquires a sigmoid shape. Atrophy of the myocardium–> increased interstitial connective tissue

51
Q

What causes reperfusion injury and what is used as a marker?

A

1) Oxygen free radicals
2) mitochondrial damage
3)inflammation
4) complement
Creatine Kinase

52
Q

What happens with rupture of the left ventricular free wall?

A

pericardial tamponade
JVD
Distant heart sounds
profound hypotension

53
Q

What is the presentation for cardiac tamponade?

A

Beck’s triad: JVD, hypotension, diminished heart sounds

Pulsus Paradoxus: Inspiratory decrease in BP >10

54
Q

Why does cardia tamponade lead to pulsus paradoxus?

A

With inspiration, there is increased return of blood to the heart and that causes the right ventricle to bow into the left ventricle, so that it cannot fill as much and there is less output

55
Q

What is associated with nonbacterial thrombotic endocarditis (sterile platelet-rich thrombi)?

A

advanced malignancy, SLE, Antiphospholipid syndrome, and DIC in patients with sepsis

56
Q

What causes LV outflow tract obstruction in HCM?

A

Abnormal systolic anterior motion of the anterior leaflet of the mitral valve toward a hypertrophied interventricular septum

57
Q

Why is pulse pressure decreased with the administration of phenylephrine?

A

Phenylephrine is an alpha 1 agonist. It causes vasoconstriction which is picked up by the baroreceptors, leading to an increase in vagal tone. This leads to decreased HR and Stroke volume. Decreased stroke volume leads to a smaller stroke volume

58
Q

What properties of an antiarrhythmic cause HR-dependent QRS widening?

A

A Sodium channel blocker that is very use dependent such as flecainide (class 1c)

59
Q

What is functional mitral valve regurgitation?

A

regurgitation caused by dilatation of the left ventricle in the absence of any fixed valve lesion

60
Q

What are the two congenital syndromes that are most likely to cause QT prolongation?

A

Jervell and Lange-Nielsen: AR, neurosensory deafness

Romano-Ward: AD, no deafness

61
Q

Which lessens the murmur of mitral valve prolapse- squatting or standing?

A

squatting- the increased venous return to the heart causes greater filling of the LV, which brings the leaflets to a more anatomically normal position

62
Q

What is Hibernating myocardium?

A

LV systolic dysfunction due to reduced coronary blood flow at rest that is reversible by coronary revascularization

63
Q

What increases the risk of first dose hypotension with ACEis?

A

Dehydration, especially from diuretices

64
Q

Which drugs are associated with drug-induced lupus?

A

Hydralazine, Procainamide, Isoniazid, minocycline, Quinidine

65
Q

What is the effect of nitroprusside?

A

Arterial and venous dilation–> decrease in preload and afterload without a change in stroke volume

66
Q

What is the action of dobutamine?

A

beta 1 selective agonist- increased inotropy, HR—> increased myocardial oxygen consumption

67
Q

What are the signs and symptoms of TCA overdose?

A

delirium, seizures, arrhythmias (blockage of sodium channels), anticholinergic toxicity

68
Q

What are indications for sodium bicarb?

A

Widened QRS interval or ventricular arrhythmias

Increased pH favors the neutral form of TCAs , so they are unable to block sodium channels

69
Q

What drugs are used to prevent the breakdown of ANP?

A

Neprilysin inhibitors

70
Q

Which drugs should be avoided in patients with HCM?

A

Vasodilators- decrease afterload and LV volumes

and diuretics:decrease LV filling

UWORLD (9 decks)

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