Cardiovascular Flashcards Preview

USMLE Step 1 > Cardiovascular > Flashcards

Flashcards in Cardiovascular Deck (111):
1

MV auscultation

apex

2

TV auscultation

left parasternal border

3

TV auscultation

Left parasternal border

4

AV auscultation

Right 2nd intercostal border

5

PV auscultation

left 2nd intercostal border

6

S1

closure of MV and TV valves

7

S2

closure of AV and PV

8

Inspiration

split in A2 and P2; due to increased blood in right side of heart

9

S3

abnormal
due to blood entering volume overloaded ventricle in early diastole

10

S4

abnormal
due to blood entering non-compliant ventricle with atrial contraction in late diastole

11

Causes S4

Volume overloaded ventricle, hypertrophy

12

Causes S3

Valve regurgitation; congestive heart failure

13

Murmurs

stretching valve ring or damage to valve

14

Inspiration

increases right-sided abnormal heart sounds and murmurs

15

Expiration

increases left sided abnormal heart sounds and murmurs

16

Stenosis murmurs

problem in opening valve

17

Regurgitation murmus

problems in CLOSING valve

18

Valves opening in systole

AV and PV

19

Valves opening in diastole

MV and TV

20

Valves closing in systole

MV and TV

21

Valves closing in diastole

AV and PV

22

LDL

primary vehicle for carrying cholesterol

23

VLDL

primary vehicle for carrying liver-synthesized triglyceride

24

Familial hypercholesterolemia (type II)

Autosomal dominant
deficiency of LDL receptors
- increased LDL

25

Type III hyperlipoproteinemia

defiency in apo E
increased remnants (chylomicrons, IDL)

26

Type IV hyperlipoproteinemia

increased VLDL
seen in alcoholics

27

Apo B deficiency

deficiency
- apo B48 (chylomicrons)
- apo B100 (VLDL)

- decrease in cholesterol and triglycerides

28

Clinical findings in apo B deficiency

fat malabsorption
hemolytic anemia

29

Atherosclerosis

reaction to injury of endothelial cells

30

Risk factors for atheroscleroris

-smoking
- increased LDL
- increased homocysteine
- Chlamydia pneumoniae infection

31

Cells involved in atherosclerosi

- Platelets
- Macrophages
- Smooth muscle cells
- T cells with cytokine release

32

Fibrous plaque

Pathgnomonic lesion of atherosclerosis

33

C-reactive protein

marker of inflammatory atheromatous plaque

34

Inflammatory atheromatous plaque

predisposes to platelet thrombosis

35

Increased plasma homocysteine

Increased vessel thrombosis
Folate (most common)
Vitamin B12 deficiency

36

Hyaline arteriosclerosis

small vessel disease of DM and hypertension
Excess protein in vessel wall

37

Mechanisms of Hyaline arteriosclerosis in DM

Non-enzymatic glycosylation

38

Non-enzymatic glycosylation

Glucose attaches to amino acids in basement membrane
- causes increased permability to protein --> diabetic nephropathy

39

Abdominal aortic aneurysm rupture

due to atherosclerosis
flank pain
hypotension
pulsatile mass

40

Syphillitc aneurysm

vasculitis of vasa vasorum of aortic arch
aortic regurgitation

41

Aortic dissection

due to hypertension and collagen tissue disorders (e.g. Marfan)

42

Cystic medial degeneration

elastic tissue degeneration creates spaces filled with mucopolysaccharides

43

Intimal tear in aorta

due to wall stress from hypertension and structural weaknesses

44

Types of dissection

Proximal (most common)
Distal or combination of both

45

Sx of proximal aortic dissection

Chest pain radiating to back
Lack of pulse
Cardiac tamponade (most common cause of death)

46

Marfan's Syndrome

Autosomal dominant
Fibrillin defect
- Associated with aortic regurgitation/ dissection
- Lens dislocation
- Mitral valve prolapse with sudden death

47

Most common cause of death: Ehlers Danlos and Marfan's

Aortic dissection

48

Phlebothrombosis

Stasis of blood flow
Deep veins below knee (most common site)

49

Pulmonary thromboembolism

Emboli originate from femoral veins

50

Superficial migratory thrombophlebitis

Sign of carcinoma of head of pancreas

51

Thoracic outlet syndrome

Lymphedema hands/feet in newborn
- Preductal coarctation
- Bicuspid aortic valve

52

Thoracic outlet syndrome

Absent radial pulse with positional change

53

Spider telangiectasia

Arteriovenous fistula
Due to hyperestrinism (cirrhosis, pregnancy)

54

Capillary hemangioma in newborn

Regress with age
Do not surgically remove

55

Kaposi's sarcoma

HHV - 8
Vascular malignancy
most common cancer in HIV

56

Bacillary angiomatosis

Bartonella henselae
vascular infection in AIDS

57

Small vessel vasculitis

Palpable purpura
(e.g. Henoch Schonlein purpura)

58

Muscular artery vaculitis

Vessel thrombosis with infarction (e.g. classical polyarteritis nodosa)

59

Elastic artery vasculitis

Absent pulse
- stroke

60

Takayasi's arteritis

Pulseless disease
- young Asian woman

61

Giant cell arteritis

temporal artery granulomatous arteritis
ipsilateral blindness (ophthalmic artery)

62

Classical polyarteritis nodosa

Muscular artery vasculitis with vessel thrombosis infarction

63

Path findings of classical polyarteritis nodosa

Vessel inflammation at different stages
Aneurysms from vessel weakness

64

Sx of polyarteritis nodosa

Infarctions in kisneys, skin, GI tract, heart
HBsAg in 30%

65

Kawasaki's disease

coronary artery vasculitis/thrombosis/ aneurysms in children

66

Sx: Kawasaki's disease

Typically seen in young children
Chest pain
Desquamating rash
Swelling/hands feet
Cervical lymphadenopathy

67

Rx for Kawasaki's disease

IV Gamma-globulin

68

Buerger's disease (thromboangittis oblierans)

Smoker's digital vasculitis
Digital infarction

69

Reynaud's syndrome

Digital vasculitis in systemic sclerosis and CREST syndrome

70

Sx of Reynaud's syndrome

Digital pain, white-blue-red color changes

71

Cryoglobulinemia

Protein gels in cold temperature;
- asociated with Reynaud's syndrome; HCV association

72

Sx of cryoglobulinemia

Acral cyanosis relieved by coming indoors

73

Wegener's granulomatosis

Associated with c-ANCA
Sinusitis (nose)
Lung infarction (lung)
Crescentic GN (kidney)

74

Microscopic polyangiitis

Palpable purpura
Crescentic GN
association with p-ANCA

75

Henoch-Schonlein purpura

IgA-anti-IgA immune complexes
palpable purpura on buttocks/legs
arthritis
IgA glomerulonephritis

76

Serum sickness vasculitis

Horse antivenin in treatment of rattlenake venom

77

Rocky Mountain Spotted Fever

- tick borne Rickettsia infection
- vasculitis causes petichiae on palms --> trunk

78

Meningiococcemia

sepsis causes petichia/ecchymoses; potential for Waterhouse Friderichesen syndrome

79

Essential hypertension

- associated w/ blacks
- defect in renal excretion of Na
- Increased plasma volume
- decreased plasma renin activity

80

Renovascular hypertension

atherosclerosis renal artery in men
- fibromuscular hyperplasia renal artery in women

81

Sx of renovascular hypertension

Epigastric bruit
- Increased plasma renin activity (in affected kidney)
- Decreased plasma renin activity (in unaffected kidney)

82

Hypertension

- Left Ventricle Hypertrophy (most common complication)
- acute myocardial infarction (most common cause of death) followed by stroke and renal failure

83

Endocrine hypertension

- primary hyperparathyroidism
- Graves/hypothyroidism
- Cyshings
- Primary hyperaldosteronism
- Pheochromocytoma

84

Afterload

- resistance ventricles contract against

85

Preload

volume ventricles must eject

86

Concentric LVH

increased afterload (e.g. essential hypertension, aortic stenosis)

87

LVH with dilation/ hypertrophy

increased preload (e.g. valve regurgitation; left to right shunts)

88

Left Heart Failure

Forward failure
Pulmonary edema
Pillow orthopnea
Paroxysmal nocturnal dyspnea

89

Systolic dysfunction

Left Heart Failure due to decreased ventricular contractility (ischemia)

90

Diastolic dysfunction

LHF due to decreased ventricular compliance (hypertrophy)

91

Right Heart Failure

Backward failure
Increased venous hydrostatic pressure
Neck vein distension
Hepatomegaly
Edema

92

ACE inhibitos

Decrease afterload and preload in heart failure

93

Diuretics in CHF

Reduce preload

94

Non-pharm Rx to CHF

Restrict salt and water

95

Acute Myocardial infarction

Most common cause of death in US
Left anterior descending coronary artery thrombosis (most common cause)
- rupture of inflammatory plaque produces platelet thrombus

96

Exertional angina

Coronary artery atherosclerosis
Subendocardial ischemia
ST elevation

97

Sudden cardiac death

Death within 1 hour of symptoms

98

Pathological findings of sudden cardiac death

Severe coronary atherosclerosis
Absence of occlusive thrombosis

99

LAD coronary artery

- supplies anterior 2/3 of interventricular septum
- supplies anterior portion of left ventricle

100

RCA

- supplies posterior portion of left ventricle and papullary muscle
- supplies inferor 1/3 of interventricular septum
- supplies right ventricle

101

Ventricular fibrillation

most common cause of death in AMI

102

Path findings 24 hours after acute MI

No gross changes

103

Sx of acute myocardial infarction

retrosternal pain radiating down arms
diaphoresis

104

Risk of acute myocardial infarction ruptures occur when?

On the 3rd to 7th day of AMI

105

Most common type of Acute MI rupture

Anterior wall rupture
- due to LAD thrombosis
- cardiac tamponade

106

Cause of posteromedial papillary rupture

RCA thrombosis
Mitral regurgitation with LHF

107

Interventricular rupture

- cause of LAD thrombosis
- left to right shunt
- RHF

108

Mural thrombus

- caused by anterior AMI
- Danger embolization

109

Pericarditis

- can occur within 1st week of transmural AMI
- 6 weeks later ( it has an autoimmune cause)

110

Speed of conduction

Pukinje > Atria > Ventricles > AV node

111

Pacemaker speed

SA > AV > bundle of His/Purkinjeventricles