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CV Flashcards

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1
Q

symptoms w/ EXERTION tend to occur w/ > x% stenosis

symptoms w/ REST tend to occur w/ > x% stenosis

A

> 75% (exertion)

> 85% (rest)

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2
Q

what’s the cap thickness that identifies rupture-prone fibrous caps?

A
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3
Q

atheroma (atherosclerotic lesion) consists of (4)

A
  1. cells: smooth muscle cells, chronic inflam cells (mac, lymphocytes)
  2. EMC molecules: collagen, proteoglycans
  3. intra/extracellular lipid deposits
  4. calcific deposits

HETEROGENOUS

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4
Q

ischemia to which wall causes sinus BRADYcardia and AV block?

A

inferior wall MI

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5
Q

cardiogenic shock (

A

when >40% LV infarct

mortality rate: >80%

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6
Q

LV free wall rupture (aMI complication)

A

4-7 days after
macrophages damages the tissue, weakening the wall
at the junction of preserved / infarcted tissue
risk factors: age, female, HT, first MI, poor coronary collateral circulation

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7
Q

acute papillary muscle rupture (aMI complication)

A

inferior MI

posterio-medial papillary muscle (b/c single blood supply from posterior descending artery)

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8
Q

LV aneurysm (aMI complication)

A

wall moves outward during systole (dyskinesis)
very rarely rupture
-> HF, arrythmia

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9
Q

what % of chest pain actually have STEMI?

A

15%

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10
Q

reperfusion: thrombolytics and PCI (percutaneous coronary intervention) should be done within what time of walking into the ED?

A

thrombolytic: within 30 min
angioplasty: within 90 min

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11
Q

“atypical” chest pain: common in which pt pop?

A

elderly, women

weakness, fatigue, heartburn, epigastric distress
RUQ pain (vs left)
nausea

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12
Q

acutely occluded coronary a (acute MI) changes in order

A
  1. metabolic changes (lactic acid)
  2. LV wall motion abnormality
  3. EKG changes
  4. chest pain
  5. enzyme release
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13
Q

Troponin level timeline

A

rise after 2-4 hrs
peak: 24 hrs
normal 7-10 days

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14
Q

CK-MB (creatinine kinase)

A

rise 4-6 hrs

peak: 24 hrs
* normal 72 hrs (3d) after: used to diagnose REINFARCTION

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15
Q

congenital aneurysms (4)

A

Cerebral (berry): circle of willis, r/f: smoking, HT
Marfan syndrome: fibrillin 1
Ehlers Danlos
Fibromuscular dysplasia

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16
Q

order the conduction velocity (slope of phase 0 in pacemaker AP graph): atria, ventricles, purkinje, AV node

A

purkinje > atria > ventricles > AV

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17
Q

what % of myocyte Na+ channels have to be open to go from absolute to relative refractory period?

A

25% Na+ channels have to be open

how many open depends on membrane potential

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18
Q

what % of myocyte Na+ channels have to be open to go from absolute to relative refractory period?

A

25% Na+ channels have to be open

how many open depends on membrane potential

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19
Q

rank the length of refractory period (phase 3): atria, ventricles, skeletal muscle

A

v > a > skeletal muscle

v has the longest refractory period to allow time to squeeze as much blood as possible

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20
Q

3 states of Na+ channel

A

resting (relative refractory period)
activated (open channel)
inactivated (absolute refractory period)

M gate: activation
H gate: inactivation - closed only during absolute refractory period

NaCB only binds during activated and inactivated states (not during resting cause not depolarizing)

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21
Q

what kind of tissue is accessory pathway (bundle of Kent)?

A

muscle tissue. so conduction is faster than via AV node, creating DELTA wave

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22
Q

LVH on EKG

A

tall QRS, “strain” pattern (disconcordant T in lateral leads) QRS widening

  • avL: R > 11mm
  • V5/6: R > 30mm
  • V1 S + V5/6 R > 35mm
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23
Q

what’s the most common cause of palpitation in hts w/ no structural abnormality

A

AVNRTachycardia

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24
Q

1 predictor of SUDDN CARDIAC DEATH & mortality

25
mean interval btw MI and SCD in yrs
6.5 yrs
26
mild-moderate-severe classes of HF: which class has the greater risk of SCD??
MILD severe die from pump/heart failure, less often from SUDDEn death
27
defib recommended for who?
coronary artery disease + EF
28
amiodarone CANT substitute defib to save lives in reduced EF!
.
29
Afib
AF increaes the risk of stokre by x5 vs no-AF. give warfarin. these strokes are more deadly than non-AF strokes the risk of stroke is similar in all types of non-acute AF (paroxysmal = persistent = long standing persitent = permanent) #1 risk factor: prior CVA (stroke) most prevalent pathologic arrhytmia cause 15% of all strokes thrombosis control, rate control, rhythm control catheter ablation more effective than drug tx to restore sinus aflut: ablation is the first-line tx
30
catheter ablation can cure pathologic SVT (supraventricular tachycardia: AVNRT, AVRT, atrial tachy)
.
31
differentials for STe
LBBB in V1 w/ wide QRS hyperkalemia (missed dialysis) pericarditis: in all leads w/ PR depression aMI: "tombstone appearance"
32
LBBB sign of MI which part of heart
``` anterior/septal MI wide QRS bunny ears anywhere look at V1 - negative QRS: LBBB - positive QRS: RBBB ```
33
acute coronary syndrome (unstable angina, aMI, sudden death) due to rupture w/ x% stenosis?
34
arteries affected by atherosclerosis in order
coronary > abdominal aorta > coronary arteries > popliteal > carotid
35
bilateral shoulder pain is 2x more likely to be an MI than to 1 shoulder. heart problem until proven otherwise
.
36
what is the biggest contributor to pulmonary edema (dyspnea, congestion symptoms)?
LVEDP | left ventricular end-diastolic pressure (due to high volume of blood in LV at ED)
37
HF pts have pathologic range of what endogenous molecules (3)
NE (independent predictor of hospitalization & lifespan of HF pts) AT II Aldosterone
38
what hormone cause LVH?
ATII increases growth factor
39
cardiac amyloidosis
in restrictive cardiomyopathy infiltrative in the interstitium non-braching extracellular fibrils, homogenous waxy material in the insterstitium, congro red, apple green birefringence
40
3 most common causes of cardiomyopathy/HF
coronary artery disease (MI), HT, idiopathic
41
reversible cardiomyopathy (HF)
tachyarrhythmias toxins (alcohol, cocaine) thyroid problem
42
what is the single largest expense for MEDICARE
heart failure
43
s/s of HF
orthopnea (specific, less sensitive): can't breath laying flat pulsus alternans, rales, heart sound (s3)
44
Marfan syndrome
mutation in fibrillin 1 (elastic tissue of medial wall) autosomal dominant on chormosome 15 ascending aortic aneurysm -> aortic dissection, mitral regurgetation
45
risk factors for aortic dissection (3)
HT, bicuspid aortic valve, Marfan NOT inflammation (aortitis)
46
approaches to vasculitis
``` radiographic studies (angiogram) BIOPSY is definitive ```
47
fibromuscular dysplasia
congenital cause of aneurysm * “string of beads”: renal artery, young women * dev defect of bv wall → irregular thickening of large/medium arteries * causes HT
48
Fiedler's myocarditis
Giant cell myocarditis: giants cells w/ lots of necrosis -> rapidly fatal autoimmune (unknown cause) young adults 20-50yo
49
Toxic myocarditis
cause: catecholamines, chemo (Adriamycin: breast cancer chemo) neutrophils, contraction bands
50
Loeffler syndrome
endomyocardial fibrosis w/ eosionphilic infiltrate | -> restrictive cardiomyopathy
51
for pts w/ normal lipid levels, repeat screening how often
5 yrs
52
ATIII risk factors (3)
cigs HT (140/90 or on HT med) family history of premature CHD (M 45, F >55) low HDL
53
22q11.2 Deletion DiGeorge Syndrome (Velacardiofacial syndrome)
CHD in 75-80% TOP, interrupted aortic arch, truncus arteriosus, VSD, arch anomalies 50% chance of transmission to offspring - screen for deletions!
54
TIMI risk factors
age, DM, HT, angina SBP (hypotension?), HR, weight anterior STE, LBBB time to Rx vs HEART: history, EDG, age, risk factors, troponin
55
early management of acute STEMI
relief of ischemic pain: nitrates, morphine assessment/correction of hemodynamics (BP) initiation of reperfusion (give fluids) antithrombotic/fibrinolytic therapy Beta-blockers prevent recurrent ischemia/arrhythmia O2 if hypoxic anti-plts: aspirin, cloidogrel, abciximab/eptifibatide
56
PCI indication
acute STEMI (
57
indication for thrombolytics
only within 4 hrs of onset
58
contraindication of thrombolytics
``` dissection/tamponade ACTIVE GI/internal bleeding anything to do w/ head bleeding disorder (incl. thrombocytopenia) HT >180/100 metastatic cancer ``` torsade (Can't perfuse) after defibullator
59
if STe in V4
RV failure (due to MI)

Q2 (6 decks)

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