cards Flashcards
(196 cards)
1
Q
decreased femoral to brachial blood pressure ratio
A
coarctation of the aorta
2
Q
fixed wide splitting of S2
A
in patients with ASD
-
3
Q
precordial continuous machine-like murmur that occurs both in systole and diastole
A
patent ductus arteriosus
4
Q
bifid carotid pulse with brisk upstroke (sike and dome)
A
hypertrophic obstructive cardiomyopathy
-left entricular outflow tract obstruction during sytole
5
Q
holosysolic murmur that is loudest over the left mid sternal border
A
VSD
6
Q
which organ is least vulnerable to infgarction
A
liver
- dual blood supply from portal vein and hepatic artery
- exception is during in transplanted liver-can develop biliary tree infarction and organ failure bc collateral blood supply is severed during transplantation
7
Q
persistenet fever, strawberry tongue, desquamation, bilateral conjunctivitis, erythema of mouth, edema of hands and feet ,generalized urticarial rash beginning on extremities and moving to trunk
A
kawasaki
-strawberry tongue seen in scarlet fever as well but persistent fever and bilateral conjunctivitis more suggestive of kawasaki
8
Q
exertional dyspnea, lower extremity edema and hoarseness
A
ortner syndrome-mitral stenosis leading to rleft atrial enlargment that compresses the left recurrent laryngeal nerve
9
Q
skin and mucosal telangiectasia with recurrent nosebleeds
A
osler weber rendu syndrome
hereditary hemorrhagic telangiectasia
lips, orpharynx, resp tract, GI tract, urinary tract
can affect brain, liver sleep and present with Gi bleed, epistaxis and hematuria
10
Q
segmental, transmural, necrotizing inflammation of medium to small sized arteries
A
polyarteritis nodosa
renal involement is oftenprominent
-lung rarely involved
1/3 have palpable purpura
11
Q
best indicator of degree of mitral stenosis
A
A2-Os interval
-sshorter interval=more severe stenosis
12
Q
truncus arteriosus gives rise to
A
ascending aorta and pulmonary trunk
13
Q
bulbus cordis gives rise to
A
smooth parts (outflow tracts) of left and right ventricles
14
Q
left horn of sinus venosus gives rise to
A
coronary sinus
15
Q
right horn of sinus venosus
A
smooth part of right atrium
16
Q
right common cardinal vein and right anterior cardinal vein
A
superior vena cava
17
Q
failure of septum primum and septum secundum to fuse after birth
A
patent foramen ovale
18
Q
defects resulting from abnormal neural crest cell migration to truncus/bulbus
A
transposition of the great vessles, tetralogoy of fallot, persistent truncus arteriosus
19
Q
vitelline forms what vein
A
portal system veins
20
Q
cardinal forms waht vein
A
systemic veins
21
Q
what part of the aorta is most susceptible to injury in BAT
A
isthmus of the aorta (tethered to ligamentum arteriosum)
between l subclavian branch and where pul artery crosses over
22
Q
fetal erythropoiesis occurs in
A
Young Liver Synthesizes Blood Yolk sac (3-8weeks) Liver (6 weeks-birth) Spleen (10-28 weeks) Bone Marrow (18weeks to adult)
23
Q
3 fetal shunts
A
ductus venosus: shunts blood from umbilical vein to IVC, bypassing hepatic circulation
foamen ovale: blood reaching the heart via IVC is directed through the foramen ovale to aorta bypass pulm circulation
ductus arteriosus: shunts blood coming from SVC to RA to RV to pulm artery straight to aorta
24
Q
how does foramen ovale close
A
breath–>decrease pulm resistance–>increase LA pressure vs RA–> closure of foramen ovale
25
how does ductus arteriosus close
increase O2 in baby and decrease prostaglandin from placental separation leads to closure of ductus arteriosus
26
fossa ovalis
remnant foramen ovale
27
nuclues pulpulsus comes from
notochord
28
medial umbilical ligament comes from
umbilical arteries
29
ligamented teres heaptis
is contained in falciform ligament and si derived from the umbilical vein
30
V1 V2 V3 V4
left anterior descending artery
| interventricualar septum of anterior wall
31
V5 V6 I aVL
left circumflex (lateral wall of lateral ventricle)
32
II III aVF
posterior descending artery
| -branch off right main in 80% of ppl
33
right marginal
supples right ventricle
34
pulse pressure is proportional to..... and inversely proportional to....
pulse pressure is proportional to SV and inversely proportional to arterial compliance
35
TPR highest in
arterioles
36
highest total cross sectional area with lowest flow velocity
capillaries
37
organ removal effect on hemodynamics
increases TP and decreases CO
38
how are cardiac myocytes electrically coupled to each other?
gap junctions
39
what are If channels
create automaticity in pacemaker cells, mixed Na/K current leading to slow depolarization
40
what determines HR in pacemaker cells?
slope of phase 4 (If current)
41
speed of conduction fastest to slowest
Purkinje (fastest)
atrial muscle
ventricular muscle
AV node (slowest)
42
AV node blood supply
RCA
43
long QT with sensorineural deafness
jervell and lange nielsen syndrome
autosomal recessive disorder of myocardial repolaization
-deacreased outward K-syncope, sudden cardiac death, torsades
44
brugada syndrome
psuedo RBBB with ST elevations in V1-3
increased risk for ventricular tachyarryhtmia and SCD
tx: implantable cardiac defribillator
45
abnromal fast accessory pathway bypassing the AV node leading to premature ventricular depolarization
wolf parkinson white syndrome
-characteristic delta wave with wide QRS and shortened PR interval
may result in reentrant circuit with supraventricular tachycardia
46
first degree heart block
prolonged PR interval
| benign and asymptomatic, no treatment necessary
47
progressive PR lengthening until a beat is dropped -p with no subsequent QRS
2nd degree Mobitz type I
| -regularly irregular
48
dropped beats that are not preceded by a change in length of the PR interval
Mobitz type II
-may progress to 3rd degree block
pacemaker may be indicated
49
atria and ventricles beat independently of one another, faster atrial rate than ventricualr rate
3rd degree complete heart block
| may be caused by Lyme disease
50
ANP/BNP
released from atrial mycotes due to increased blood volume and atrial pressure
-causes vasodilateion and decreased Na absorption, vasodilates afferent renal a and constricts efferent renal a
-blocks renin
bnp similar action but with longer half life
51
aortic arch baroreceptor
aortic arch-->vagus-->solitary nucleus of medulla
52
carotid sinus baroreceptor
carotid bifurcation-->glossopharyngeal nerve-->solitary nucleus of medulla
53
central chemoreceptors do not respond directly to
PO2
54
failure of aorticopulmonary septum to form
truncus arteriosus
| -most have VSD
55
failure of the aorticopulmonary septum to spiral
transposition of the great vessels
| -requires surgical intervention
56
anteriorsuperios displacemnt of the infundibular septum
tetralogy of fallot
1. pulm stenosis
2. RVH
3. overriding aorta
4. VSD
57
mst common congenital heart defect
VSD
58
ostium primum
rarer ASD; associated with Down's syndrome
usually involve other cardiac abnormalities
-celft in anterior leaf of MV or septal leaf of TV
59
ostium secdundum
are more common ASD defects and usually isolated
60
differential cyanosis
cyanosis in lower extremities, PDA
61
hypertension in upper extremities and weak delayed pulse in lower extremities
coarctation of the aorta
62
bicuspid aortic valve
accelerates normal aging-premature calcific aortic stenosis
63
cardiac anomaly in infant of diabetic mother
transposition of the great vessels
64
marfan syndorme associated with
MVP, thoracic aortic aneurysm and dissection, aortic regurgitation
65
prenatal lithium exposure
ebstein anomaly
66
turner sndrome
coarctation fo the aorta, bicuspid aorti c valve
67
williams syndrome
supravalvular aortic stenosis
68
22q11 syndromes
truncus arteriosus, tetralogy of fallot
69
fetal alcohol syndrome
VSD, PDA, ASD, tetralogy of fallot
70
corneal arcus
lipid deposit in cornea
71
xanthoma
plaque or nodule of lipid laden histiocytes in skin -xanthelasma -in eyelid
72
tendinous xanthoma
lipid deposit in tendon-especially achilles
73
hyaline arteriosclerosis
in essential hypertension or diabetes
74
concentric onion skinnning/hyperplastic arteriosclerosis
in malignant hypertension
75
decreased left chamber size, sigmoid shaped ventricular septum with accumulation of alpha lipfiscin in cytoplasm
normal aging
76
athersclerosis most commonly effects
abdominal aorta>coronary artery> popliteal artery>carotid artery >circle of willis
77
cystic medial degeneration aneurysm
thoracic aneurysm, fragmentation of the elastic tissues-sepration of the components of the tunica media
-rf: HTN, marfan, tertiary syphilis
78
atherosclerotic aneurysm most commonly found in the
abdominal aorta
79
consumption of beta aminoproprionile (found in sweet peas)
get blockade of lysyl oxidase and unefficient crosslinking of elastin fibers leading to marfan like myxomatous degeneration
80
most common cause of mitral stenosis
rheumatic fever
81
most common cause of MVP
myxomatous degeneration
82
most common cause of mitral regurg
post MI or complication of MVP
83
most common cause of aortic stenosis
age related calcificaiton or congenital bicuspid valve, can also be caused by rheumatic fever only if pt has has MS
84
ischemic precondition
increase resistance to ischmeia gained with prior repeated exposure to protect against future greater insults
85
myocyte hibernation
with chronic hypoperfucsion mycytes have reversible loss of contactile funciton, decrease their energy metabolism but can be reversed with CABG or angioplasty (within hours to months deopending on the degree)
86
myocyte stunning
less severe form of hibernation with brief ischemia repurfiusion episodes
87
longitundinal intima tear
aortic dissection
| -associated wtih hypertension, bicuspid valve, marfan
88
ST elevations at rest with angina
prinzmetal (variant) angina due to vasospasm-can be caused by tobacco, cocaine, triptans
89
ergononne test
alpha adrenergic given causes vasocontriction and induces cornoary vasospasm-a way to diagnose printzmetal vasospasm
90
+/- ST depression and or T wave inversio nbut no increase in cardiac biomarkers
unstbale angina
91
STEMI or NSTEMI with elevated cardiac biomarkers
MI
- STEMI transmural
- NSTEMI subendocardial
92
sudden cardiac death most commonly due to
arrythmia-ventricular fibrillation
93
commonly occluded cornoary artery
LAD>RCA>circumflex
94
edema, hemorrhage, wavy fibers, contraction bands
first 4-24 hrs post MI
95
formation of granulation tissue post MI
day 10 after macrophags have come (day 3) in and phagocytosed all of the necortic cells
96
pericarditis post MI
risk days 1-3 when macrophages and inflammatory response is phagocytosing all of necrotic tissue
presnets with pericardial friction rub, short lived adn willr esolve with asa
97
arrythmia, HF, cardiogeneic shock
biggest complication within first day post MI
98
ventricular free wall rupture post MI
occurs when macrophages destory heart structure-biggest risk 3-14 days post MI
- presents with cardiac tramponade, papillary muscle rupture, pulseless electrical activity
- also at risk for pseudoaneurysm at this time of interventricular septum rupture
99
true ventricular aneurysm post MI
2 weeks post MI, due to fibrosis , outward bulge during contraction associated with fibrosis
100
granulation tissue at margins post MI
beigns at day 10
101
colagen deposition/scar formation post Mi
begins 2 weeks to several months
| at risk for dressler syndrome and true aneurysm formation
102
autoimmune phenomenon resutling in fibrinous pericarditis
Dressler syndrome
| -fever, pleuritis, leukocytosis, pleural/pericardial effusions
103
pulseless electrical activity
free wall rupture
104
diagnosing MI
in first 6 hrs EKG is gold standard
-cardiac troponin rise after 4 hrous and is elevated for 7-10 days, most specific, but for reinfarct must use CK-MB (levels normalize after 48 hours)
105
CK-MB
used for diangosing reinfat
| troponin levels may remain elevated for 7-10 days and are not accurate for reinfarction
106
type of collagen in cardiac scar tissue
Type I collagen
107
causes of dilated cardiomyopathy
```
ABCDE
alcohol abuse
wet Beriberi
Chagas
Coxsackie B virus
Cocaine
Doxorubicin
also
-peripartum
-hemochromatosis
```
108
S3, balloon appearance on CXR
dilated cardiomyopathy, systolic dysfucntion
| -swelling of sarcoplasmic reticulum followed by loss of myocardiocytes=myofibrillar dropout
109
mitral regurgitation, S4, systolic murmur
hypertrophic cardiomyopathy
most commonly AD due to mutation in beta myposin heavy chain
associated with friedrish ataxia
diastolic dysfunction
-myofibrillary disarray and fibrosis
most common cause of death is ventriucular arrythmia
110
asymmetric septal hypertrophy and systolic anterior motion of mitral valve
obstructive hypertrophic cardiomyopathy
111
edomyocardia fibrosis with a prominent eosinophilic infiltrate
loeffler syndrome
| a type of restrictive/infiltrative cardiomyopathy
112
causes of restictive cardiomyopathy
sarcoid, amyloidosis, hemachromatossis (also dilated) loeffler, postradiation fibrosis
113
low voltage EKG with nm EF and decreased LVEDV
restrictive cardiomyopathy
114
increased JVP, kussmaul sign (increased JVP with inspr) pericardial knock, pulsus paradoxus
chronic constrictive pericarditis
115
hemosiderin laden macrophages
"heart fialure cells"
leaky capillary in pulm vasculature and subsequent macrophage phagocytosis leads to accumulation of macrophages with iron in cytoplasm
Prussian Blue +
116
coronary sinus dilation
sign of pulmonary HTN
| -cornoary veins through cornary sinus and rain into RA, if flow obstructed they dilate
117
fever, new murmur, Roth spots, janeway lesion, osler nodes, glomerulonephritis, splinter hemorrhae, septic arterial or pulmonary emboli
```
bacterial endocardidtis
-S. viridans-underlying valvular issue, dental procedures
-S. aureus most virulint, IVDU
-s bovis. colon cancer
-s epi biofilms on prosthetic valve
tricuspid valve most commonly involves
```
118
culture negative endocarditis
bartonella, coxiella (1), mycoplasma, histoplasma, chlamydia,
HACEK
Haemophilus Actinobacilliu Cardiobacterium Eikenela Kingella
119
aschoff bodies
granuloma with gian cells in rheumatic fever
120
anitschkow cells
enlarged macrophages with ovoid wavy rod like nucleus
121
what type of reaction is rheumatic fever
Type II hypersensitivty
-not direct effet of the bacteria
antibodies to M protein corss react with slef antigen-moleuclar mimicry
122
sharp pain aggravated by breathing in and relieved by sitting up and forward
acute pericarditis-pleuritic chest pain
may hear pericardial friction rub, widespread ST elevation and or PR depression
causes: viral, coxsackie, neoplasia, autoimmune, radiation therapy, UREMIA
123
fibrous intimale thickening with right endocardial plaques associated with nausea, vomiting, flushing, diarrhea, abd cramping
carcinoid syndrome
| -check urine 5 HIAA
124
hypotension, distended neck veins, distant heart sounds
beck triad for
cardiac tamponade
-incrased HR, pulsus paradoxus,
equilibriuation of diastolic pressures in all 4 chambers,
125
ECG: low voltage QRS and electircl alternans
cardiac tamponade
126
pulsus paradoxus seen in
cardiac tamponade, chronic pericarditis, asthma, obstructive sleep apnea, croup
127
pulus parvus et tardus
pulse of low magnitude with delayed pulse
| -seen in aortic stenosis
128
dicrotic pulse
pulse with 2 peaks in systole and one peak in diatole-seen with sever systolic dysfucntion
129
disruption of the vasa vasorum of the aorta with atrophy of the vessel wall and dilatation of aorta and valve ring
seen in syphilic heart disease
-can result in aortic aneurysm or aortic insufficiencey
tree bark appearance of aorta
130
pedunculated gelatinous mass in LA
myxoma
- leads to valve obstruction causing positional dyspnea, syncopal episodes
- mid diastolic rumble at apex
131
most frequent primary cardiac tumors in children
rhabdomyoma
| associated with tuberous sclerosis
132
vinyl chloride and arsenic exposure associated wtih
hepatic angiosarcoma
| -rare blood vessel malignancy
133
radiation therapy and chronic post mastectomy lymphedema assocaited wtih
lymphangiosarcoma
134
benign capillary skin papules commonly mistaken for Kaposi sarcome
bacillary angiomatosis caused by bartonella henselae in AIDS pts
has NEUTROPHIL infiltrate (kaposi has lymphatic)
135
endothelial malignany of the skin, less mouth, IG tract, respiratory tract, often mistaken for bacillary angiomatosis
kaposi sarcoma
asocaited with HHV 8 and HIV
-has LYMPHOCYTIC infiltrate (vs bacillary angiomatosis has neutophil)
136
benign capillary hemangioma of elderly that does not regress
cherry hemangioma
137
cavernous lymphangioma of the neck
cystic hygroma
| associated with Turners syndrome
138
benign, painful red blue tumors underneath fingernail
glomus tumor
| -arises from modified smooth muscle cells of the thermoregulatory glomus body
139
polypod capillary hemangioma that can ulcerate and bleed
pyogenic granuloma
| -associated with trauma and pregnancy
140
benign capillary hemangioma of infancy, how does it grow?
strawberry hemangioma
| -grows rapidly and progresses spontaneously by 5-8 years old
141
granulomatous infilammation of the media with fragmentation of the interanl elastic lamina in the carotid
indicative of large vessel vasculitis
| -temporal (giant cell) or Takayasu arteritis
142
pulseless disease
takayasu arteritis
-weak upper extremity pulses
fever night seat myalgia ocular disturbances
incrased ESR
granulomatous thickening and narrowing of AORTIC arch
143
granulomatous thickening nad narrowing of AORTIC ARCH
takayasu arteritis
| -treat with corticosteroids
144
temporal arteriitis
focal granulomatous infiltration of the media
elevated ESR
may lead to irreversible blindness due to opthalmic artery occlusion
associated with polymyalgia rheumatica
-most common branches off carotid
temporal artery biopsy
145
polyarteritis nodosa
kawasaki disease
buerger disease
medium vessel vasculitis
146
young adult with fever, weight loss, malaise, headache, abdominal pain, melena, HTN, neuro dysfunciton, cutaneous eruptions, renal damage, Hep B+
polyarteritis nodosa
- immune complex mediated transmural inflammationp of medium vessels of arterial wall with fibrinoid necrosis
- innumeroable renal microaneuryms and spasms
- treat with corticosteroid and cyclophosphamide
147
conjunctival injection, rash (polymorphous-->desquamating), adenopahty(cervical), strawberry tongue, hand and feet edema/erythema, fever
Kawasaki, asian kids under 4
medium vessel vasculitis
-may develop coronary artery aneuryssm
treat with IV ig and aspirin
148
intermittened caludication that may lead to gangrene, superficial phlebitis, raynaud phenomenon
buerger disease
thromboangiitis obliterans
-seen in heacy smokers, males <40
autoamputation of digits
149
granulomatosis with polyangiitis
microscopic polyangiitis
esosinophilic granulomatosis with polyangitis
henoch schonlein purpura
small vessel vasculitis
150
focal necrotizing vasculitis, necrotizing granulomas in the llung and upper airway, necrotizing glomerulonephritis,
```
granulomatosis with polyangitis
pr3ANCA, c ANCA
upper resp: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis
lower resp: hemptysis, cough, dyspnea
renal: hematuria, red cell casts
```
151
necrotizing vasculitis lung kidney skin with pauci immune glomerulonephritis and palpable purpura
NO nasopharyngeal involvement
microscopic polyangitis
-No granulomas (granulomatosis with polyangitis has granulomas in the lung)
MPO-ANCA/p ANCA (anti myeloperoxidase)
152
astham, sinusitis, skin nodules or purpura, peripheral neuropathy (ie wrist drop)
eosinophilic granulomatosis with polyangitis Churg Strauss
-migratory transient pulm infiltates and paranasal sinus
MPO ANCA/p ANCA increase IgE
153
palpapble purpura, athralgia, abd pain
henoch schonlein purpura
small vessel vasculitis
follows URI
-secondary to IgA immune ocmplex deposition
associated wtih IgA nephropathy (Berger disease)
154
small cardiac valvular vegetation on either side of valve
lipman sachs endocarditis
verrucous endocarditis associated wtih SLE
valvular insiff/embolism
155
mech of hydralizine
increases cGMP leading to smooth muscle relaxation
| vasodilates arterioles>veins leading to afterload reduction
156
hydralizine toxicity
```
compensatory tachycardia (contraindicated in angina/CAD), fluid retention, ehadache,
Lupus Like syndrome
```
157
dihydropyridine calcium channel blockers
```
amlodipine
clevidipine nicardipine
nifedipine
nimodipine
-act on vascular smooth muscle
```
158
CCB used in hypertensive urgency or emergency
clevidipine
159
toxicity of nondihyfropyridines
cardiac depression
AV block
hyperprolactinemia (verapimil)
160
toxicity of dihydropyridines
```
peripheral edema
flushing
dizziness
constipation
gingival hyperplasia
```
161
nitroprusside
used in hypertensive emergency
short acting, increases cGMP and causes relase of NO
tox: cyanide toxicity give sulfure
162
fenoldopam
Dopamine D1 agonist
-cornonary, splanchnic, renal, peripheral vasodilation used in hypertensive emergeny
increases natruresis ****
163
nitrates main effect
decrease cardiac preload by venous dilation
164
nitroglycerin, isosorbide nitrate, isosorbide mononitrate mech
incrase NO in vascular smooth muscle increasing cGMP and decreasing Ca and myosin light chain kinase leading to venous dialtion>>>arteriolar dilation
165
toxicity of nitreates
reflex tachycardia, hypotension, flushing, headache
"monday disease" due to increased tolerance over the week and loos of tolerance over the weekend
-nitrate free period ie at night prevents tolerance
DO NOT USE WITH eretcile dysfunction meds-PDE2 inhibitors leads to hypotension
166
statins
inhibit HMG CoA to mevalonate conversion
-increaase LDL receptors on liver membrane
decrease LDL
167
toxicity of statins
hepatotoxicity, myopathy (Esp when used with fibrates-gemfibrozil, clofibrate, bezafibrate, fenofibrate)
168
cholestyramine
colestipol
colesevelam
bile acid resins,
prevent intestinal absorption of bile acid-liver must use more cholesterol to make bile acid
decrease LDL, slightly increase triglycerides
169
toxicity of cheolestryamine, colestipol, solesevelam
GI upset, decrease absorption of other fat soluble drugs and vitamins, cholesterol component of bile is increases so gallstone formation
170
ezetimibe
prevent cholesterol absorption at small intestine brush border
-decreases LDL
171
toxiticty of ezetimibe
rare increase in LFTs, diarrhea
172
gemfibrozil
clofibrate
bezafibrate
fenofibrate
upregulate LPL and increase triglyceride clearance
activate PPAR alpha to induce HDL suynthesis
decrease triglycerides
173
side effects of gemfibrozil, clofibrate, beafibrate, fenofibrate
myopathy (increased risk with statins) and cholesterol gallstones fue to increased cholesterol content of bile salts
174
niacin
vit b 3
inhibits lipolysis in adipose tissue and reduces VLDL synthesis
-decreses LDL
175
seide effects of niacin
flushing, red, -diminished with pre NSAID treatment
hyperglycemia-increases incsulin resistance
hyperuricemia
176
digoxin
inhibits Na/K atpase (get increased Na in the cell and inhibits Na/Ca exchanger) increase Ca in cell--positive inotropy
also stimulates vagus nerve to deacrease HR
-increases contarctility and deacrases conduction at the AV node
177
digoxin toxicity
```
nausea
vomitting
diarrhea
color vision alterations/yello blurry vision
arrythmias
heart block
-can lead to hyperkalemia
```
178
factors predisposing to digoxing toxicity
renal faulire
hypokalemia-permissive for digoxin binding at K on NA/K atpase
verapimil
amiodarone
quinidine (decreases digoxin clearance, displaces digoxin from binding sites on tissue)
179
digoxin toxicity antidote
oral activated charcoal, treat hyperkalmeia -insulin, kayexalate, dialysis (not calclium gluconate) and dig antibodies
180
class IA antiarrythmics
```
Disopyramide
Quinidine
Procainamide
-increase AP duration
-increase effective refractory period
-increase QT interval
int phase O depol
used in both atrial and vent arrythmias, esp re entrant and ectopic SVT/VT
```
181
side effects of class IA antiarrythmics
-cinchonism-headache with tinnitus
-thrombocytopenia
torsades
-heart failure (DIsopyramide)
-reversible SLE syndrome (Procainamide)
quinidine
182
class IB antiarrythmics
lidocaine
tocainide
mexiletine
-preferentially affect ischemic or already depolarized purkinje
-decreases AP duration
-weak/no inhibition of phase 0 depol used in acute ventricular arrythmias post MI, digitalis induced arrythmias
183
side effects of class IB antiarrythmics
lidocain tocainide mexiletine
| -=CNS stimulation depression, cardiovascular depression
184
class IC antiarrythmics
flecainide
prpafenone
-shorten AP duration
-increase effective refractory period in AV node and accessory bypass tracts
-strong inhibiton of phase 0 depolarization
used for SVTs, (a fib) and only as a last resort in vts
185
side effects of Class IC antiarrhythmics
flecainide
propafenone
-proarrythmic and contraindicated in ischemic heart disease
186
class II anti arrhythmics
beta blockers
metropolol
propranolol
esmolol
atenolol
timolol
carvedilol
-decrease SA and AV nodal activity via decrease cAMP--> decrease in Ca-->decreased contractility
-increase PR interval
also decrease slow depol in pacemaker cells
used for : SVT, rate controll for a fib and a flutter
187
toxicity of class II anti arrhythmics
```
impotence
COPD exacerbatioun and asthma
bradycardia, HF, AV block
sedation
may mask signs of hypoglycemia
metoprolol-dyslipiemia
propranolol-can exacerbate vasospam in prinzmetal
-cannot be given first for pheo/cocaine tox-causes unoopsed alpha 1 stimuation and hypertensive crisis
```
188
treatment of beta blocker (class II antiarrhythmic) toxicity
glucagon (increase cAMP, increase Ca increase contractiility and HR)
atropine
saline
189
class III antiarryhtmics
```
K channel blockers
amiodarone
ibutilide
dofetilide
sotalol
AIDS
selective for vascualr smooth muscle
-increase AP duration
-Increase ERP
-increse QT interval
-no effect on QRS
used in a fib, a flutter, v tach (amiodarone/sotalol)
```
190
side effect of Class III anti arrhymthmics (K blockers)
Amiodarone
- PFTs
- LFTs
- TFTs
- acts as hapten-corneal deposits, blue/grey skin deposits (photodermatitis)
- neuro effects
- constipation
- bradycardia, heart block, HF
Ibutilide
-torsades
Stoalol
-torsades, excessive beta blockade
191
class Iv antiarrhythmic
ca channel blocker
-decrease conduction velocity
-increase PR interval
-increase ERP
negative inotrope
-used in prevention of nodal arrythmias (SVT), rate control in atrial fibrillation
192
side effects of class IV antiarryhtmics
```
constipation
flushing
edema
cardiovascualr effects (HF, AV block, sinus node depression)
contraindicated in CHF
```
193
adenosine
push K out of cell amking it hyperpolarized and decrease Ca current into cell
slows AV nodal conduction
-drug of coice for supraventricualr tachycardia
-very shrot acting
-blunted by theophylline and caffeine (adenosine receptor antagonists)
used in chemical stress test
194
adenosine averse effects
flushing
hypotension
chest pain
sense of impeding doom
195
Mg2+
effective in torsades and dig toxicity
196
milrinon
phosphodiesterase inhibitor
increase in cAMP
increase intracell Ca-->increase contractility
IV only
