last minute review

Question 1

1-4 hours after MI see on histology:

Answer 1

wavy fiber change (cells are not contracting, but are being pulled by other myocytes)

Question 2

4-24 hrs after MI see on histology:

Answer 2

pale, swelling, coag necrosis, contraction band necrosis, PMNs

See cellular outline, but no nuclei

Question 3

3-5 dys after MI see on histology

Answer 3

mottled, yellow, red; hemorrhage, many PMNs

Question 4

5-7 days after MI see on histology

Answer 4

mottled, many MØ + fibroblasts present

Question 5

2-4 weeks after MI see on histology

Answer 5

mottled granulation tissue

Question 6

5-8 weeks after MI see on histology

Answer 6

scarring

Question 7

Erzetimibe

Answer 7

blocks enterocyte NPC1L1 receptor, inh gut uptake of cholesterol
lowers LDL
good second line tx

Question 8

Familial hypercholesterolemia (Fredrickson Type II)

Answer 8

i. Mutation in LDLR (can’t clear LDL)
ii. Autosomal dominant, haploinsufficient - heterozygotes have LDL around 250 (normal 130)
iii. Homozygotes have LDLC 1000-1200 (BAD)
iv. Get xanthomas (accumulations of cholesterol) in tendons & eyelids, get premature atherosclerosis, can see a defect in the cornea

Question 9

Dysbetalipoproteinemia (Fredrickson type III)

Answer 9

i. Defect in ApoE2 synthesis (isoform of ApoE)
ii. Makes ApoE less able to bind lipoprotein receptors
iii. IDL accumulates, increases atherosclerotic risk
iv. Presents in adulthood as hyperlipidemia, xanthomas, premature CVD

Question 10

Familial hypertriglyceridemia

Answer 10

i. Autosomal dominant
ii. Elevated fasting TG without clear 2ary cause, due to overproduction of VLDL
iii. Can cause pancreatitis when combined with 2ary cause like diet (high fat or excess EtOH), drugs, disease, metabolic changes

Question 11

Familial chylomicronemia syndrome (Fredrickson Type I Hyperchylomicronemia)

Answer 11

High chylomicron levels –> high TG levels (>2000, normal is 150)
Creamy plasma
Deficiency of LPL or ApoC-II

Question 12

bivalrudin

Answer 12

direct thrombin inhibitor

Question 13

argatroban

Answer 13

direct thrombin inhibitor

Question 14

what gps bind vwf?

Answer 14

GPIIbIIIa, GPIb-IX-V

Question 15

what gps bind fibrinogen?

Answer 15

GPIIbIIIa

Question 16

what gps bind fibronectin?

Answer 16

a5b1

Question 17

what gps bind laminin

Answer 17

a6b1

Question 18

what gps bind collagen

Answer 18

GPIaIIa, GPVI

Question 19

what does norepi do?

Answer 19

bind a1, stimulate vasoconstr

Question 20

what does epi do

Answer 20

bind a1 –> vasoconstr

bind B2 –> vasodilation of skeletal muscle

Question 21

type I vs type II MI?

Answer 21

type I = ischemia due to 1ary coronary event (plaque erosion or rupture, fissuring or dissection). Type II = MI 2ary to ischemia due to imbalance of O2 supply and demand

Question 22

medical tx for all people leaving hospital after MI

Answer 22

aspirin, ADP receptor antagonist, B blocker, statin, ACEi/ARB

Question 23

anterior wall leads, what artery is occluded?

Answer 23

V1-V4 (think LAD)

Question 24

septal wall leads, what artery is occluded?

Answer 24

V1-V2 (think LAD)

Question 25

lateral wall leads, what artery is occluded?

Answer 25

I, aVL, V4-V6 (think LAD or LCX—high lateral wall = LCX)

Question 26

inferior wall leads, what artery is occluded?

Answer 26

II, III, aVF (think RCA if right-dominant or LCX if left-dominant)

Question 27

what is the PR interval? normal PR interval? where to look on ECG?

Answer 27

beginning of P wave --> beginning of QRS 0.12-0.2 ms (3-5 boxes) leads II and V1

Question 28

normal QRS duration | what does prolong QRS indicate?

Answer 28

<120 ms (3 boxes) | BBB, preexcitation (WPW)

Question 29

what is QT interval? | what's a normal one?

Answer 29

beginning of QRS to end of T wave | QTc >450 males >470 females is prolonged

Question 30

Left ventricular hypertrophy (the following criteria):

Answer 30

S in V1 + R in V5 or V6 >= 35 mm (Sokoloff-Lyon) OR R in aVL >= 12 mm (Modified Cornell) OR R in I + S in III >= 25 mm

Question 31

Right ventricular enlargement

Answer 31

R amplitude > S amplitude in V1 OR | S amplitude > R amplitude in V6

Question 32

RA enlargement

Answer 32

lead II or lead V1 amplitude > 2.5mm

Question 33

LA enlargement:

Answer 33

lead II width > 3mm or lead V1 area of negative component > 1mm

Question 34

Pathologic Q wave reflecting MI

Answer 34

>0.04 ms, often deep

Question 35

normal hemodynamic pressures (RA, RV, PA, wedge, LA, LV, aorta)

Answer 35

a. RA 6 mmHg b. RV 24/6 mmHg c. PA 24/12 mmHg d. Wedge 6-12 mmHg e. LA 6-12 mmHg f. LV 120/6-12 mmHg g. Aorta 120/60 mmHg

Question 36

calculate PVR and SVR

Answer 36

a. PVR = (MPAP – LAP)/CO x 80 | b. SVR = (MAP – RAP)/CO x 80