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Flashcards in Congenital heart defects Deck (216):
1

22q11

truncus, tetralogy

2

Down's

ASD/VSD/endocardial cushion defect

3

Turner

Coarctation of the aorta (infantile, pre-ductal)

4

Marfan's

Aortic insufficiency/dissection.
--Weak connective tissue (fibrillin)
--So aorta dilates and the media of the vessel splits because of weakness in the wall!
--WEAK VESSELS

5

Diabetic mom

Transposition of Great vessels

6

Bulbus cordis

Smooth L and R ventricles

7

Primitive atria

Trabeculated L and R atria

8

Left horn of sinus venosus

coronary sinus

9

Right horn of sinus venosus

Smooth part of right atrium

10

Right common cardinal vein and right anterior cardinal vein

SVC

11

Smooth L and R ventricles

Bulbus cordis

12

Trabeculated L and R atria

Primitive atria

13

Coronary sinus

L horn of sinus venosus

14

Smooth part of right atrium

R horn of sinus venosus

15

SVC

R common cardinal and R anterior cardinal veins

16

erythopoiesis occurs in yolk sac during which weeks?

3-10 weeks

17

Erythropoiesis of the liver?

6 weeks-birth

18

Eryropoiesis of the spleen?

15-30 weeks

19

Erythropoiesis of the bone marrow?

22 weeks to adult

20

Major source of RBC at 25 weeks

Liver

21

Major source of RBCs at birth

Bone marrow

22

Major source of RBC at 7 weeks

Yolk sac

23

Which organs make RBCs at 25 weeks?

Liver, spleen and bone

24

Which organs make RBCs at 32 weeks?

Liver and bone

25

Ductus venosum

ligamentum venosum

26

Umbilical vein

ligamentum teres

27

Umbilical arteries

medial umbilical ligaments

28

Allantois

MEDIAN umbilical ligament

29

what conditions have pulsus paradoxus as a finding?

cardiac tamponade
pericarditis
asthma
sleep apnes

30

What are the sx of a cardiac tamponade?

1. mechanism: blood accumulates in pericardial sac

signs/symptoms: pulsus paradoxus (systolic blood pressure decreases > 10 mmHg during inspiration)

signs/symptoms: triad of hypotension, increased JVP, muffled heart sounds

31

Causes of serous pericardidits

Autoimmune disorder
Viral pericarditis

32

What else can cause an aortic dissection aside from marfans?

bicuspid aortic valve and hypertension
--Presents as sudden chest pain radiating to the back

33

What are the class IA antiarrythmics?

Disopyramide
Quinidine
Procainamide

34

How do class IA antiarrythmics work?

INCREASE AP duration and increase QT interval

35

What do you use Class IA for?

re-entrant/ectopic supraventricular tachycardia
Ventricular tachycardia

36

What are the side effects in general of class IA?

thrombocytopenia, Torsades from long QT

37

What is the side effect of quinidine?

headache/tinnitus

38

What is the side effect of procainamide?

SLE syndrome

39

What is the side effect of disopyramide?

heart failure

40

What are the class IB antiarrhythmics?

Lidocaine
Mexiletine
Tocainamide

41

How do class IB work?

Decrease AP duration

42

When do you use class IB?

Post MI Ventricular Arrhythmias
Also in DIGOXIN toxicity

43

What is the side effect of class IB?

CNS stimulation/depression
CV depression

44

What are the class IC drugs?

Propafenone
Flecainide

45

How does class IC work?

No effect on AP duration

46

When do you use class IC?

As a last resort for ventricular tachycardias-->VF and SVT

47

When is class IC contraindicated?

post-MI or pts with structural heart disease

48

Toxicity of class IC?

Proarrhythmic

49

What are the class II antiarrhythmics?

Beta blockers

50

How do beta blockers work as an antiarrhytmic?

Decrease SA and AV nodal activity by decreasing cAMP and Ca currents

51

When would you use a beta blocker?

Vtach
SVT
ALSO Afib and Aflutter

52

What are the side effects of beta blockers?

1. Impotence
2. sedation/fatigue
3. Metoprolol causes dyslipidemia

53

Who is contraindicated for a beta blocker?

1.ASTHMATICS--do not use a nonselective beta blocker
2. Also, MASKS hypoglycemia signs! Be careful with DIABETICS
3. Propranolol worsens prinzmetal's angina

54

What are the class III antiarrhythmics?

K+ channel blockers

55

How do class III drugs work?

Increase AP duration and QT and ERP

56

When do you use Class III

As a last resort

57

What are the toxicities of class III?

Sotalol: torsades
Ibutilide: torsades
Amiodarone: pulmonary fibrosis, Thyroid issues, hepatotoxicity, photodermatitis

58

What do you need to get labs on before giving amiodarone?

LFTs and PFTs and TFTs!!

59

Name the class III antiarrhythmics

Amiodarone
Ibutilide
Dofetilide
Sotalol

AIDS MNEMONIC

60

What are the class IV drugs?

calcium channel blockers verapamil and diltiazem

61

When do you use class IV drug?

SVT (nodal arrhtymias)

62

What are the side effects of class IV drugs?

Constipation, flushing, edema, CV effects

63

What are other antiarrhythmics?

Adenosine
Mg2+

64

What is the drug of choice in SVT?

Adenosine

65

How does adenosine work?

Increase K efflux out of cell, hyperpolarizing it and decreasing calcium influx

66

What are adenosine side effects

flushing, hypotension, chest pain.

effects blocked by theophylline and caffeine

67

When do you use mg?

torsade de pointes and digoxin toxicity

68

How can you treat digoxin toxicity?

Magnesium or Class IB antiarrhythmics (Lidocaine, tocainamide, Mexiletine)

69

What do veno/vasodilators do to preload and afterload?

Venodilators decrease preload
Vasodilators decrease afterload

70

Does viscosity of blood increase or decrease in anemia?

Decreases
--Fewer RBCs, more water in the blood

71

JVP A wave

atrial contraction

72

JVP c wave

RV contraction

73

JVP x descent

atrial relaxation

74

JVP v wave

Increased right atrial pressure with filling

75

JVP y descent

Flow of blood from RA to RV

76

When do you see wide splitting?

Pulmonic stenosis
RBBB

77

When do you see paradoxical splitting?

Aortic stenosis
LBBB

78

Which sound comes first in physiologically split S2?

A2 then P2 (aortic then pulmonic)

79

Most murmurs increase with hand grip. What are the exceptions?

AS and HOCM

80

Most murmurs decrease with valsalva (decrease venous return). What are the exceptions?

MVP and HOCM murmurs increase

81

What will rapid squatting do? Which murmurs are affected?

Rapid squatting increases venous return. After some time, afterload increases too
--MVP and HOCM murmurs decrease

82

How do you increase MVP and HOCM murmurs?

Valsalva

83

How do you decrease MVP and HOCM murmurs?

Squatting

84

What do you hear at the aortic area?

Aortic stenosis

85

What do you hear at the left sternal border?

Aortic regurg
pulmonic regurg
HOCM

86

What do you hear at the pulmonic area?

Pulmonic stenosus, PDA

87

What do you hear at the tricuspid area?

VSD, ASD, Tricuspid regurg/stenosis

88

What do you hear at the mitral area?

Mitral regurg and stenosis

89

You hear a holosystolic high pitched murmur at the apex which radiates to the axilla

Mitral regurg

90

Holosystolic high pitched murmur at tricuspid area extending to right sternal border

tricuspid regurg

91

Symptoms of aortic stenosis

SAD: syncope, angina, dyspnea on exertion

92

Holosystolic harsh sounding murmur at tricuspid area

VSD

93

Midsystolic click folowed by crescendo murmur. Heard best over apex

MVP

94

Blowing diastolic decrescendo murmur

Aortic regurg

95

What are the other signs of aortic regurg?

bounding pulses and head bobbing

96

You hear an opening snap in diastole followed by a rumbling diastolic murmur

Mitral stenosis

97

What is a common cause of PDA?

congenital rubella

98

What are the causes of sensorineural deafness with congenital torsades?

Jervell and lange-nielsen syndrome

99

How does ANP work its magic?

Decreases Na resorption
Constricts efferent renal arterioles
Dilates afferent arterioles

100

What's the difference between peripheral and central chemoreceptors?

Peripheral receptors respond to O2 < 60, but central chemoreceptors do not

101

What factors are important for autoreguation of the heart?

Adenosine
NO
CO2 all dilate the heart's vessels.

102

You see a cyanotic baby with a boot shaped heart

tetralogy of fallot

103

How do pts with Tetralogy of fallot alleviate their symptoms?

By squatting to increase PVR and decrease Right to Left shunting (cyanosis)

104

What causes adult type coarcatation of aorta?

Bicuspid aortic valve. Will present with HTN in upper extremities, weak pulses, and notching of the ribs.

105

Pipestem arteries

Monckeberg arteriosclerosis

106

onion skinning arteriolosclerosis

Malignant hypertension

107

How does PDA present as?

Cyanosis in the lower extremities

108

EKG shows I and aVL Q waves

Lateral wall infarction

109

When are you at greatest risk for ventricular aneurysm formation?

1 week post MI

110

When ar eyou at greatest risk for ventricular free wall rupture?

3-14 days

111

What are the causes of dilated cardiomyopathy?

ABCCCD
Alcohol
Beriberi
Coxsackie B
Chronic cocaine
Chagas
Doxorubicin

112

How do you treat dilated vs hypertrophic cardiomyopathy?

Dilated: ACE, diuretics, transplant
Hypertrophic: Beta blocker, NON DIHYDROPYRIDINE calcium channel blocker

113

You see endomyocardial fibrosis with a prominent eosinophilic infiltrate

Loffler's syndrome, a type of restrictive cardiomyopathy

114

What are the main causes of restrictive (fibrotic) cardiomyopathy?

sarcoidosis, hemachromatosis, loffler's,

115

Which drugs reduce mortality in CHF?

Beta blocker, ACEI, and spironolactone. Sometimes hydralazine

everything else is symptomatic, including other diuretics.

116

Nutmeg liver:

Right heart failure resulting in hepatomegaly

117

What are the symptoms of rheumatic fever?

Fever
Erythema marginatum
Valvular damage
ESR
Red-hot joints
Subcutaneous nodules
Sydenham's chorea

118

Which valves are most often affected in rheumatic fever?

Mitral>aortic>>tricuspid (high pressure valves)

119

Histological findings of rheumatic fever

Schoff bodies and anitschkow's cells with ASO titer elevation.

120

What type of hypersensitivity is rheumatic fever?

Type II hypersensitivity with antibodies to M protein

121

Symptoms of pericarditis

Sharp pleuritic pain relieved by sitting up and leaning forward with a friction rub. Widespread ST elevation

122

What are the symptoms of cardiac tamponade

Hypotension, diminished heart sounds, friction rub
PULSUS PARADOXUS

123

treebark aorta and calcifications of the aortic root

syphilitic heart disease

124

Kussmaul's sign

Increase in JVP on inspiration instead of a decrease. Seen in constrictive pericarditis, cardiac tamponade

125

What is the most common heart tumor?

A metastasis
In children: rhabdomyoma
In adult: myxoma

126

Resistance equals to

Delta P/Q (flow)

=(8n x l)/(pi*r^4)

127

Strawberry hemangioma

benign capillary hemangioma of infancy that regresses at age 5-8

128

Cherry hemangioma

Benign capillary hemangioma of the elderly that does not regress

129

cystic hygroma

cavernous lymphangioma of neck

130

What is cystic hygroma associated with?

Turner syndrome

131

Pyogenic granuloma

Polypoid capillary hemangioma that ulcerates and bleeds. Associated with trauma/pregnancy

132

Glomus tumor

Benign painful red-blue tumor under finger nails. FROM SMOOTH MUSCLE CELLS!!

133

bacillary angiomatosis

Benign capillary skin papules caused by cartonella henselae

134

What pts often get bacillary angiomatosis?

AIDS pts

135

Angiosarcoma

Blood vessel malignancy

136

What is angiosarcoma associated w/

breast cancer and hodgkins pts getting chemo

137

Lymphangiosarcoma

Lymphatic malignancy associated with persistent lymphedema

138

Sturge weber

port wine stain
Intracerebral AVM (leptomeningeal angiomatosis)
Seizures
early glaucoma

139

Why don't we use dihydropyridines (end in -dine) to treat angina?

do not treat angina because their powerful systemic vasodilator and pressure lowering effects can lead to reflex cardiac stimulation= increase myocardial oxygen demand.

140

Which are the non dihydropyridine CCBs to treat angina? they have stronger selectivity for the heart muscle

verapamil>>diltiazem
(V for ventricle)

Less of a systemic vasodilatory effect. These work more strongly on the HEART

141

First line anti-HTN therapy for diabetics

ACEI or ARBS, then everything else.

142

Which CCBs work stronger on the vascular smooth muscle?

amlodipine=nifedipine > diltiazem>verapamil

143

How does hydralazine work?

Increase cGMP=smooth muscle relaxation. Vasodilation of arterioles more than veins

144

Uses of hydralazine?

severe HTN, CHF

145

In which population is hydralazine first line?

Pregnancy! with methyldopa

146

What is hydralazine frequently prescribed with?

Beta blocker to prevent reflex tachycardia

147

Nitroprusside

Direct release of CO causing increase in cGMP. Mostly a vasodilator

148

toxicity of nitroprusside?

cyanide toxicity

149

Fenoldopam

Dopamine D1 agonist used for vasodilation to treat malignant hypertension

150

How does nitroglycerin work?

Dilates veins >> arteries, decreasing preload

151

What are the problems with using nitrates?

Increase in contractility and heart rate from reflex response

152

How do you solve the problem with nitrates?

Co-prescribe with beta blockers

153

Side effects of HMG-CoA reductase

Hepatotoxicity and rhabdomyolysis

154

effect of niacin

LDL decrease
HDL increase
--minor effect on triglycerides

155

How does niacin work?

Inhibits lipolysis in adipose tissue
Reduces VLDL secretion

156

Side effects of niacin?

flushing
Hyperglycemia
hyperuricemia

157

How do you prevent flushing from niacin?

Give aspirin

158

What are the effects of bile acid resins?

Decrease LDL

159

How does ezetimibe work?

Decreases cholesterol reabsorption at the small intestine brush border

160

What are the side effects of ezetimibe?

LFTs increase
diarrhea

161

What are the side effects of fibrates?

myositis, hepatotoxicity, gallstones

162

How do fibrates work?

upregulate LPL to increase triglyceride clearance

163

What are the side effects of cardiac glycosides?

cholinergic toxicity + blurry yellow vision
EKG changes, with arrhythmias
Hyperkalemia

164

Who is at risk for digoxin toxicity?

Renal failure
Hypokalemia
Quinidine

165

What is the antidote for digoxin tox?

Normalize K
Lidocaine
Cardiac pacer
Anti-dig Fab
Mg2+

166

Treatment for malignant hypertension

Nitroprusside or fenoldopam which are both VASOdilators

167

Does prinzmetal's angina cause ST elevation or depression?

elevation

168

You see wavy bands on biopsy of a pt's heart: How long has it been since infarct?

4-12 hours

169

You see a hyperemic border to a yellow section of heart. How long has it been since MI?

3-14 days

170

You see contraction bands on a heart. How long has it been?

12-24 hours

171

The infarcted heart tissue looks yellow

1-7 days (from WBC migration)

172

What are the four modifiable risk factors for atherosclerosis?

1. HTN
2. Hypercholesterolemia
3. Smoking
4. Diabetes

173

Who do you see kaposi's sarcoma in?

Elderly european males
transplant pts
Aids pts

174

Do kaposi's lesions blanch?

No, a tumor of endothelial cells, not vascular lesions

175

Angiosarcoma of the liver is associated with

PVC exposure

176

Major side effect of ACE inhibitors

angioedema, with swelling of face can cause difficulty breathing.
-->From increased bradykinin levels
-->ACE usually breaks down bradykinin

177

Which drugs reduce VLDL?

fibrates and nicotinic acid

178

Venous return fxn of

peripheral resistance
blood volume
-->starling curve stays the same if the above do

179

CO fxn of

SV x HR

180

Abrupt standing maneuver is similar to

valsalva-ing (decrease Venous Return)

181

passive leg raise maneuver is similar to

Squatting (increase preload)

182

Severity of mitral regurg determined by

S3

183

Most common cause of cor pulmonale

COPD
In 20-40 year old woman, can also be idiopathic pulmonary hypertension

184

Common cause of sudden cardiac death in a young healthy person

Wolff Parkinson White syndrome

185

Worrisome complication after coronary angioplasty

Embolization
-->Renalfailure
-->Livedo reticularis

186

Causes of restrictive cardiomyopathy

sarcoidosis
amyloidosis
hemochromatosis
radiation therapy

187

amylnitrite

vasodilation that decreases PVR--> should reduce most murmurs

188

Systolic ejection murmur accentuated by standing

Hypertrophic obstructive cardiomyopathy
(standing decreases VR, should decrease most murmurs EXCEPT MVP and HOCM)

189

Late diastolic decrescendo murmur decreased by amyl nitrite

aortic regurg

190

Late diastolic murmur eliminated by atrial fibrillation

mitral/tricuspid stenosis

191

Buerger's disease

Smokers < 35 presenting with claudication with cold sensitivity and ulcerations.

192

Granulomatous inflammation of the media

temporal arterities

193

The five cyanotic heart disease are caused by a problem with

neural crest cell migration

194

digoxin effect on Afib

increases parasympathetic tone, decreasing AV nodal conduction

195

Amaurosis fugax

transient monocular vision loss from an embolus to the ophthalmic artery lasting a few seconds

196

Which classes of antiarrhythmic class I have strong/weak sodium channel binding strength?

1C>1A>1B. Thus, 1C can promote arrhythmias. High use dependence, which means slow dissociation allows blocking effect to accumulate with time.

1B dissociates from sodium quickly, less likely for this effect to occur

197

Sx henoch-schonlein

henoch-schonlein

GI pain, bleeding
IgA nephropathy
palpable purpura
Joint pain

198

Coronary sinus lies within

atrioventricular groove

199

Myocardial hibernation

Persistent low flow causes chronic reversible loss of contractile functioning

200

Myocardial stunning

Brief ischemia causing a short trem reversible loss in contractility

201

Signs of digoxin toxicity

Arrhythmias!!
-color vision alterations, GI sx and Neuro Sx

202

Cause of varicose veins

impairment of venous valves and reflux of venous blood. Causes superficial venous thrombosis. Most commonly will cause ulcers over the medial malleolus

203

What does a HOCM murmur sound like

systolic ejection murmur

204

Most common site of injury of aorta in MVA

Aortic arch. heart and aorta decerate at different rates

205

DiGeorge heart abnormality

Tetralogy of fallot
Interrupted aortic arch (extreme coarctation dx at birth)

206

Friederich ataxia heart abnormality

HOCM

207

Marfan heart abnormality

mitral valve prolapse
cystic medial necrosis

208

Tuberous sclerosus heart abnormalities

rhabdomyomas causing valvular obstruction

209

Turner syndrome heart abnormalities

bicuspid aortic valve
coarctation

210

weight loss, fatigue
-mid diastolic rumble at apex
pedunculated mass

atrial myxoma, most common cardiac neoplasm

211

myxoma histology

scattered cells in a mucopolysaccharide stroma

212

QRS interval prelongation

bundle branch block

213

absent P waves

atrial fibrillation

214

Only P waves

Atrial flutter

215

Class 1C mechanism antiarrhyth

Inhibit sodium channels in phase 0
--prolong QRS
--Use dependence--effect stronger with increased heart rate

216

Class III antiarrhythmic mechanism

Blocks k repolarization, prolonging QT interval.
--Effect stronger at SLOWER heart rates