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Flashcards in CV 1 Deck (58):
1

Mitral valve regurgitation

Holosystolic murmur

2

Myocarditis due to acute rheumatic fever

- Develops after untreated strep
- Aschoff bodies on microscopy (interstitial myocardial granulomas)
- Aschoff bodies contain plump macros w/ abundant cytoplasm and central, slender ribbons of chromatin

3

Supine hypotension syndrom in preggers

=> Supine/right lateral decubitus position
=> Compression of IVC
=> reduced venous return
=> reduced preload
=> decreased CO
=> hypotension

Sx resolve when standing or sitting

4

Digoxin MOA

- Directly inhibits Na-K-ATPase in myocardial cells
- Causes v in Na efflux => ^ intracellular Na levels => reduces Na-Ca exchanger => ^ intracellular Ca => improved myocyte contractility and left ventricular systolic function

5

Go review blood vessel anatomy around the heart

NOW

6

V1-V2 ST elevation. Which coronary artery?

Left anterior descending

Anteroseptal infarct

7

V3-V4 ST elevation. Which coronary artery?

LAD distal

Anteroapical

8

V5-V6 ST elevation. Which coronary artery?

LAD or LCX

Anterolateral

9

I, aVL ST elevation. Which coronary artery?

LCX

Lateral

10

II, III, aVF

RCA

Inferior

11

Afib presentation

- Palpitations
- Tachycardia
- Irregularly irregular rhythm

Precipitated by acute systemic illness, increased sympathetic tone, excessive alcohol consumption (holiday heart syndrome)

12

ECG of Afib

- Absence of P waves
- Irregularly irregular rhythm with varying R-R intervals

13

Ergonovine

Ergot alkaloid
- Stimulates alpha-adrenergic and serotonergic recetpors
- In pts w/ pinzmetal's angina, low doses can induce coronary spasm, chest pain, and ST elevation

14

IV drug users and heart issues

- Tricuspid (right sided) endocarditis
- S. aureus (1) and P. aeruginosa (2)
- Can develop multiple septic emboli in lungs
- Pulm infarcts are almost always hemorrhagic

15

Turner syndrome cardiac anomalies

- Aortic coarctation
- Bicuspid aortic valve

16

Aortic coarctation presentation

Infancy:
- Cyanosis of LE
- Severe form

Adolescent/youth
- Decreased femoral pulses
- Pain/cramping in legs during exercise
- More common w/ Turner syndrome

17

Which part of the heart makes up the anterior surface?

Right Ventricle

18

Penetrating injury to RV occurs where?

Left sternal border

Fourth intercostal space

19

Which layers would a penetrating injury to RV go through?

1) Skin/subcutis 2) Pectoralis major m.
3) External intercostal membrane
4) Internal intercostal m
5) Internal thoracic a. & v.
6) Transversus thoracis m
7) Parietal pleura
8) Pericardium
9) R. ventricular myocardium

Pleura of lungs is injured but not the actual lungs (no middle lobe on left side)

20

Dry beriberi

- Peripheral neuropathy of distal L/UEs
- Sensory/motor impairments

21

Wet beriberi

- Dry beriberi plus cardiac involvement
- Cardiomyopathy, high-output CHF, peripheral edema, tachy

22

Femoral triangle

Subfascial space in upper thigh:
- Inguinal ligament (superior)
- Adductor longus (medial)
- Sartorius (lateral)

23

Path of LAD

- arises off l. main a.
- courses along anterior aspect in the anterior interventricular groove toward apex of the heart

24

Pathogenesis of atherosclerotic plaques

- Release of PDGF from locally adherent plts, endo cells, and macros
- Promotes migration of SMCs into intima

25

Which part of the body has the highest O2 extraction?

The heart!!!

Drains into coronary sinus

26

Nitroglycerin affects which vessels?

Venous anything

Decreases preload => decreases ventricular wall stress => decreasing CO demand

Large veins are most susceptible

27

What does the pulm cap wedge pressure measure?

L. atrial end diastolic pressure (LAEDP)

LAEDP = LVEDP in normal conditions

28

Go review the LV pressure-volume relationship

NOW

29

DiGeorge - lack of development of which embryologic structure

- Third & Fourth branchial/pharyngeal pouch

Deletion of chr 22

Absent thymic shadow, hypocalcemia, cleft palate, mandibular deformity, low-set ears, aortic arch abnormalities

30

VSD

presents in neonate period after pulm vascular resistance has declined (so not at birth)

HOLOsystolic murmur

31

Prussian blue stains what?

Intracellular IRON

32

Gold cytoplasmic granules in macros that turn blue with Prussian blue staining?

hemosiderin laden macrophases (siderophages)

33

What is the significance of hemosiderin laden macros?

- Indicates chronic elevation of pulm cap hydrostatic pressures
- Most commonly due to left-sided HF

34

Bicuspid aortic valve?

Common cause of aortic stenosis

Class auditory:
- harsh, cres-descres systolic ejection murmur
- heard best at R. 2nd intercostal space`

35

adenosine and dipyridamole

Selective vasodilators of coronary vessels

36

What is coronary steal?

- Blood flow to ischemic areas (after an MI) is reduced
- Because of arteriolar vasodilation in nonischemic areas
- Can lead to hypoperfusion and worsening existing ischemia

37

Right heart failure => ^ed CVP

What happens after that?

- Increased cap hydrostatic pressure
- Increased net plasma filtration
- Increased interstitial fluid pressure => increased lymphatic drainage (prevents peripheral edema development)

38

Cardiac AP (speed of conduction) slowest to fastest

AV node

39

Blood flow radius and resistance

BF:
- Directly proportional to vessel radius^4

Resistance:
- BF is innersely proportional to radius^4

40

Where do K sparing diuretics act on the kidney?

collecting duct

Blocks absorption of Na

Blocks excretion of K, H

41

Where do loop diuretics act?

Thick ascending limb of loop of Henle

Blocks absorption of Na, Cl, K

42

Where do thiazide diuretics act?

Distal convoluted tubule

Blocks absorption of Na, Cl

43

Beta blocker MOA

- Inhibits renin release from renal juxtaglomerular cells through antagonizing beta-1 receptors
- Prevents activation of RAAS pathway => decreased vasoconstriction & renal Na &H20 retention

44

Dobutamine

- Beta- adrenergic agonist
- Predominantly B1 receptors
- Increases HR, contractility => increase myocardial O2 consumption

45

Nitrates MOA

Vasodilation
- ^ NO in VSMCs => ^ in cGMP and SM relaxation
- Dilates veins >>> arteries
- Decrease preload

46

Nitrates SEs

- Reflex tachy
- Hypotension
- Flushing
- HA
- "Monday disease"

47

Where is the MI with a ST elevation of II, III, aVF?

Inferior

RCA occlusion

Think RVMI

Presentation: hypotension, distended jugular veins, clear lungs

48

Hemodynamic assessment of RVMI

- Elevated RA and CVP
- Reduced PCWP
- Reduced CO

49

Chlorthalidone MOA

Thiazide
- Inhibits NaCl resorption in early DCT
- Decreased Ca excretion

50

Chlorthalidone SEs

- Hypokalemic metabolic alkalosis
- HYPOnateremia
- HYPERglycemia/lipidemia/uricemia/calcemia

Sulfa allergy

51

Coadmin of ACEIs and diuretics

Significant first-dose hypertension

ACEIs must be initiated at low doses to decrease the reaction

52

Pros of using mineralcorticoid receptor antagonists (e.g. spironolactone, eplerenone) in pts with HF?

- Improve survival
- Regression of myocardial fibrosis & improvement of ventricular remodeling

Used in pts w/ decreased LVEF

53

In transient ischemia, why do myocytes increase in size?

No O2 = No ATP

- Can't stimulate Na(going out)/K (going in) pump
- Can't maintain Na (going in)/Ca (going out) exchange

54

MOA of statins

HMG-CoA reductase inhibitors

Lower total cholesterol and LDL

Most effective for prevention of CV events REGARDLESS of baseline lipid levels

55

Anatomical findings in tetralogy of Fallot

PROV

1) Pulm infundibular stenosis
2) R. ventricular hypertrophy
3) Overriding aorta
4) VSD

56

Cause of TOF

Anterosuperior displacement of infundibular septum

57

Clinical Presentation of TOF

Early childhood cyanosis

Squatting: ^ SVR, v R-to-L shunt, improves cyanosis

Harsh systolic murmur (pulm stenosis)

58

Hibernating myocardium

- Presence of LV systolic dysfunction
- Because of reduced coronary blood flow
- Completely reversible by coronary revascularization