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1

decreased femoral to brachial blood pressure ratio

coarctation of the aorta

2

fixed wide splitting of S2

in patients with ASD
-

3

precordial continuous machine-like murmur that occurs both in systole and diastole

patent ductus arteriosus

4

bifid carotid pulse with brisk upstroke (sike and dome)

hypertrophic obstructive cardiomyopathy
-left entricular outflow tract obstruction during sytole

5

holosysolic murmur that is loudest over the left mid sternal border

VSD

6

which organ is least vulnerable to infgarction

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

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

kawasaki
-strawberry tongue seen in scarlet fever as well but persistent fever and bilateral conjunctivitis more suggestive of kawasaki

8

exertional dyspnea, lower extremity edema and hoarseness

ortner syndrome-mitral stenosis leading to rleft atrial enlargment that compresses the left recurrent laryngeal nerve

9

skin and mucosal telangiectasia with recurrent nosebleeds

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

segmental, transmural, necrotizing inflammation of medium to small sized arteries

polyarteritis nodosa
renal involement is oftenprominent
-lung rarely involved
1/3 have palpable purpura

11

best indicator of degree of mitral stenosis

A2-Os interval
-sshorter interval=more severe stenosis

12

truncus arteriosus gives rise to

ascending aorta and pulmonary trunk

13

bulbus cordis gives rise to

smooth parts (outflow tracts) of left and right ventricles

14

left horn of sinus venosus gives rise to

coronary sinus

15

right horn of sinus venosus

smooth part of right atrium

16

right common cardinal vein and right anterior cardinal vein

superior vena cava

17

failure of septum primum and septum secundum to fuse after birth

patent foramen ovale

18

defects resulting from abnormal neural crest cell migration to truncus/bulbus

transposition of the great vessles, tetralogoy of fallot, persistent truncus arteriosus

19

vitelline forms what vein

portal system veins

20

cardinal forms waht vein

systemic veins

21

what part of the aorta is most susceptible to injury in BAT

isthmus of the aorta (tethered to ligamentum arteriosum)
between l subclavian branch and where pul artery crosses over

22

fetal erythropoiesis occurs in

Young Liver Synthesizes Blood
Yolk sac (3-8weeks)
Liver (6 weeks-birth)
Spleen (10-28 weeks)
Bone Marrow (18weeks to adult)

23

3 fetal shunts

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

how does foramen ovale close

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