Ischemic Heart Dz

Question 1

the 3 main determinents of MVO2 (myocardial oxygen consumption)

Answer 1

1. contractility
2. afterload
3. heart rate

*note: NOT preload!! it’s a very minor contributor

Question 2

MVO2 double product estimation equation:
.
when does this underestimate?

Answer 2

HR * sysBP
.
underestimates in any outflow obstruction e.g. aortic stenosis or HOCM

Question 3

what are the 2 major determinants (in order) of coronary perfusion pressure? explain.

Answer 3

1. Aortic Pressure - determines if coronary ostia are occluded or not for blood to flow through them to coronaries.
   .
2. early diastole is when coronary blood flow is highest so longer diastole -> more blood. which is why SNS overactivity/tachycardia reduces CBF

Question 4

Coronary Blood flow equation (Q=)

significance?

Answer 4

Q = (Aortic pressure - RAP)/ coronary resistance
.
Q = (P-RAP) / R
.
so if high rap, low Q. this happens in tricuspid stenosis or other causes of obstructed flow from RA to RV

Question 5

what drugs can you give to someone who has had myocardial stunning to help reverse and restore myocardial function?

Answer 5

beta agonists: milrinone, digoxin

Question 6

which cells mediate thinning of fibrous cap?

Answer 6

Th1 T cells -> attract macrophages -> macrophages decrease amt of collagen

Question 7

in MI complications, what 2 specific findings will you have in ventricular septal rupture?

Answer 7

1. step-up oxygenation between right atrium and right ventricle
2. new holosystolic murmur

Question 8

2 specific findings in papillary muscle rupture?

Answer 8

1. acute mitral regurg -> new systolic murmur

2. giant v waves

Question 9

does ventricular septal rupture more commonly in anterior STEMI or inferior STEMI?

Answer 9

ANTERIOR STEMI

Question 10

papillary muscle rupture occurs more often after inferior MI or superior MI?

Answer 10

INFERIOR MI. both get blood from RCA. also its usually the posteromedial papillary muscle that ruptures, not anterolateral. posterior makes sense.

Question 11

signs/symptoms of LV free wall rupture (complication of MI)?

Answer 11

vomiting, pleuritic chest pain, agitation, jugular venous distention, paradoxic pulse, supine hypotension, cardiac tamponade with equalization of heart chamber pressures

Question 12

lateral free wall rupture of LV is most commonly caused by which artery?

Answer 12

left circumflex coronary artery thrombosis

Question 13

findings in LV aneurysm:

Answer 13

dyskinetic apical impulse + S3 plus or minus systolic murmur

Question 14

findings in autoimmune pericarditis aka Dressler syndrome:

Answer 14

sharp precordial chest pain when lying down. relieved by sitting up and leaning forward. pain may radiate to left trapezius.
pericardial friction rub
ECG: ST elevated

Question 15

most common cause of variant angina?

Answer 15

epicardial coronary artery spasm superimposed on atherosclerosis of that artery

Question 16

unique symptom of variant angina?

Answer 16

chest pain at REST AND NIGHT (wakens patient)

Question 17

what does ECG of stable angina episode look like?

Answer 17

same as NSTEMI. ST depression + T wave inversion

Question 18

what does ECG of variant angina episode look like?

Answer 18

ST segment elevation. like STEMI b/c both transmural

Question 19

what ECG finding is DIAGNOSTIC of STEMI?

when does it appear?

Answer 19

Q waves, same day as MI

Question 20

what characteristic findings in VSR?

Answer 20

new holosystolic murmur, step up in oxygenation from RA to RV

Question 21

does pulmonary edema develop in ventricular septal rupture?

Answer 21

why yes it does

Question 22

what new findings do you get with mitral papillary muscle rupture?

Answer 22

new systolic murmur. can be early, holo, or late

giant v waves

Question 23

where does pain from autoimmune pericarditis/Dressler syndrome radiate to?

Answer 23

trapezius. if it does radiate. also the chest pain is worse laying down and better up and leaning forward

Question 24

pericardial friction rub and resting ECG shows ST elevation in multiple leads? diagnosis??

Answer 24

autoimmune pericarditis/Dressler syndrome

Question 25

hypo ______ and hypo______ prolong QT interval and predispose to Torsades de Pointes

Answer 25

hypokalemia, hypocalcemia

Question 26

4 medications that prolong QT interval

Answer 26

quinidine
amiodarone
erythromycin
levofloxacin

Question 27

ECG findings of wolff-parkinson-white syndrome?

Answer 27

delta wave
short PR
plus or minus wide QRS…or narrow?

Question 28

which 3 medications can cause AV block?

Answer 28

beta blockers, verapamil, digoxin

Question 29

6 things that downregulate JG cells:

Answer 29

1. increased NaCl
2. increased renal perfusion
3. increased Calcium
4. adenosine (increases calcium)
5. decreased cAMP
6. hyperkalemia (increases calcium)

Question 30

6 things that upregulate JG cells:

Answer 30

1. increased cAMP
2. prostaglandins PGE2 (increases cAMP)
3. decreased calcium
4. decreased renal perfusion
5. decreased NaCl
6. hypokalemia (decreases calcium)

Question 31

what is the triad in Conn syndrome and what is it a mainfestation of?

Answer 31

Primary hyperaldosteronism.
1. HTN
2. hypokalemia (may have periodic hypokalemic paralysis)
3. metabolic alkalosis
and obviously high aldosterone

Question 32

drugs of choice for treating AVNRT?

Answer 32

adenosine and calcium channel blockers

Question 33

3 mutations that cause long qt syndrome

Answer 33

gain in function of fast sodium current channels means higher depol so longer to repol
.
loss of function of K channels so longer to repol.
so basically TAKES LONGER TO REPOLARIZE