Shit - Cardio UWorld Flashcards Preview

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Flashcards in Shit - Cardio UWorld Deck (118):
1

Epi vs. NE receptors

Epi b > a

 

NE a1 > a2 > b1

2

Beta blocker selectivity

A-M olol = b1

N-Z olol = b1 and b2

ilol/alol = a and b

 

*nebivolol = b1 block and b3 stimulate (activate NOS)

*sotalol = K+ and b blocker

3

Most common hear defect in turners

Bicuspid aortic valve (early systolic high-pitched click) 

4

Effects of dobutamine: 

Use:

1) Inotropic (increased contractility is most useful effect)

2) slight chronotropy (increases O2 consumption with inotropic, so bad, can cause ischemia)

3) increases conduction velocity (bad; arrythmyas)

 

Used for heart failure with decreased contractility i.e. MI cardiogenic shock

5

Front of heart = 

Back of heart (against esophagus) = 

front = right ventricle

back = left atrium 

6

diastolic rumble with an opening snap

Mitral stenosis

7

Which vessel in the body has the lowest O2?

Coronary sinus (heart extracts 80-90% of the O2)

8

Rheumatic heart disease timeline post-strep throat

1-8 months

9

bounding pulses = 

 

weak pulses = 

(valve defects)

bounding = AR = Corrigan's/water-hammer

 

Weak = AS = pulsus parvus et tardus

10

most important aspect of nitrates

decreased preload

11

MI collagen 1 w vs few months

1w = type III

months = type I

12

MCC NVBE and MV valve

MVP, mitral valve

13

Maintenance dose = 

Cp x CL x dosage interval

 

DI i.e. ever 6 hours = 60min/hr x 6hrs

14

pulsus paradoxus: sign and mechanism and causes

> 10mmHg fall in SBP upon inspiration.

 

Mechanism: increase in RVP during inspiration (VR and pulmonary retrigrade flow) causes RVP>LVP → IVS pushed into LV decreasing filling → decreased CO and thus SBP

 

Causes: cardiac tamponade, asthma, OSA, pericaditis, croup

15

Hepatic Angiosarcoma

Vinyl chloride, arsenic, thorotrast

16

Daptomycin AE

Rhabdo and myopathy

17

Fates of embryonic veins:

Cardinal

Vitelline

Umbilical

Cardinal = systemic venous system

Vitellin = portal venous system

Umbilical = degenerate

18

highest oral bioavailable nitrate

isosorbide mononitrate

19

Biventricular pacemakers: path of LV lead

SVC, RA, coronary sinus (in A-V groove in post heart), LV

20

Blood supply to diaphragmatic part of the heart

posterior interventricular branch (85% of people via RCA)

21

AA creating NO

Arginine

22

Aortic arch baro-receptors to NTS via what nerve?

X (vagus)

23

carotid sinus baro-receptors to NTS via what nerve?

IX (glossopharyngeal)

[actually branch called hering's nerve]

24

Sign of pulsus paradoxus

Lose pulse sounds with BP cuff during inspiration

25

Irreversible change associated with wide fixed splitting of S2

Pulmonary hypertension (via ASD)

26

Stable angina vessel profile

AS plaque obstructing >75% of lumen, no thombus

27

Decrease platelet aggregation AND vasodilate arteries: drug names and condition they treat

Cilostazole and dipyridamole. Intermittent claudication (PVD), angina, prevent stroke/TIA

28

CCB toxicity

flush, edema, AV block, constipation (verapamil)

29

Orthopnea specific for:

LHF (dyspnia while supine relieved by sitting up)

 

Could also be mitral stenosis

30

2 major regulators of coronary flow, and the vessel size they work best on

Adenosine = arterioles

 

NO = large arteries and pre-arteriolar

31

Dilated coronary sinus indicates:

Increased RAP i.e. RHF or pulmonary hypertension

32

Thiazide AE

Hyper GLUC (glycemia, lipidemia, uricemia, calcemia)

33

Cardiac structures anterior and posterior to esophagus

anterior = LA

posterior = descending aorta

34

phenoxybenzamine vs phentolamine

phenoxybenzamine = irreversible a-antag, for pheo

 

Phentolamine = reversible a-antag, for MAO pts with cheese reaction

35

effects of increased vs decreased baro-R firing:

Increased (i.e. HTN, valsalva, carotid massage) = slowed AV node by increasing refractory perior

 

Decreased (i.e. low BP or BV) = increase HR, BP, contractility, vasocontriction

36

Chronic pericarditis causes + key features

Causes: TB, radiation, cardiac surgery

 

Pericardial Knock: just after S2 (confused with MS opening snap), from chronic pericarditis

Sharp y-descent, depper/steeper with inspiration

37

What does b2 vs glucagon do to alter myocardial contractility

BOTH INCREASE cAMP!

(just have different receptors)

38

cause of janeway lesions

Septic emboli to cutaneous vessels

39

mutations in genetic DCM vs HCM

DCM = mitochondrial enzymes for ox phos and cardiac cytoskeletal element

 

HCM = beta myosin heavy chains

40

holosystolic murmur = 

MR

TR

VSD

41

anti-hyperlipidemia drug causing flushing, warmth, and itching. What is drug and what mediates this AE?

Niacin (B3)

 

Prostaglandins (reduce with asprin)

42

Fenoldopam MOA

selective D1-agonist, causes arteriolar dilation and naturesis 

43

Leads II, III and AvF

Specific s/s

RCA (inferior heart; inf wal of LV)

Bradycardia (RCA supplies SA and AV nodes)

44

Familial hyperchylomicronemia (type I hyperlipoproteinemia):

- Dx

- complications

LPLase deficiency, milky plasma on standing via chylomicrons

 

Hypertriglyceridemia, recurrent acute pancreatitis, lipidema retinalis, erruptive xanthomas

45

Nitroprusside action

VS BOTH arterioles and veins, so decreases preload AND afterload, maintaining SV

46

Diastolic HF: LVP, LVV, LVEF

LVP increased

LVV normal (increase pressure ot achieve normal volume)

LVEF normal

47

polymorphic QRS complexes (varying amplitude and cycle length) with prolonged QT = 

 

causes = 

torsades des pointes V tach

 

causes = class Ia + III (not amiodarone) antiarythmics + TCAs

48

substitute for asprin allergy in angina + MOA

Clopidogrel; irreversibly blocks platelet ADP-Rs

49

SCD: cause and predisposing factors

Cause = ventricular arrythmia

 

Predispose = CAD (70%), cardiomyopathies, channelopathies

50

Adenosine MOA

K+ efflux from nodal tissues (prolongs phase 4), as well as Ca++ influx (phase 0)

51

Small ventricular space, sigmoid shaped septum, brown pigments = 

normal aging

52

Distance from A2 to OS: disease and what it tells you

Mitral stenosis Severity: decreased time = worse. Tighter stenosis = higher LAP needed to overcome it = LAP > LVP sooner (during LV isovolumetric relaxation) = valve opens sooner thus closer to aortic valve shutting

53

Calcific aortic stenosis via:

dystrophic calcification: abnormal organ calcification via damage (i.e. longterm hemodynamic stress os AS), with NORMOcalcemia

54

Hibernating myocardium

Ischemia so that myocardium doesn't work, but they make enough ATP to survive. If oxygen is returned with CABG or angioplasty, the hibernating myocardium wakes up and s/s improve (overs hrs-months)

55

Myocardial stunning

Less severe version of hibernation. Ischemia

56

Anti-arythmic specific for rapidly depolarizing and repolarized myocytes (i.e. ischemic cells in v. tach)

Lidocaine

57

Best beta blocker for decreasing M/M in CHF; and its function

Carvedilol. B1, B2, A1 antagonist

58

Sotalol Special properties

Only class III (K+ blocker, prolong Q-T) with beta-antagonist effects (so will also cause bradycardia)

59

what part of the wave do beta blockers alter and how

Increased PR interval by slowing down AV node conduction

60

Drugs producing dilated cardiomyopathy

Anthracyclines = doxorubicin and daunorubucin. Prevent with dexrazoxane

61

Nesiritide

BNP analog

62

SVT DOC

Adenosine (especially paroxysmal SVT)

63

Adenosine AE

Flushing, burning chest pain, sense of impending doom, bronchospasm, hypotension

64

Drug for chemical stress test

Adenosine

65

HOCM heart changes (gross)

Asymmetrical septal hypertrophy, leading to systolic anterior motion (SAM) of anterior mitral valve leaflet

66

Class III antiarythmics

Amiodarone, Ibutilide, dofetilide, sotalol

67

how do vegetations form in bacterial endocarditis

Bug binds —> expresses tissue factor (thomboplastin/Factor III, extrinsic coagulation pathway)—> activates platelets and fibrin deposition —> vegetation

68

Osler-Weber-Rendu

Hereditary hemorrhagic telangectasias. AD. spider nevi with bleeds i.e. epistasis

69

Sturge-Weber

Facial, leptomeningeal, seizures, hemiplegia, skull tram track opacities

70

Conduction speed

Purkinje > atria > ventricles > AV

71

a fib ECG:

Lose P-waves, narrow QRS and irregularly spaced, variable RR

72

Hypercoaguable paraeoplastic: name, cause, s/s

Trousseau’s syndrome. Pancreatic, colon, lung adenocarcinomas. Make thromboplastin-like substance that causes migratory thrombophlebitis (and non-bacterial thrombotic endocarditis)

73

Aortic isthmus

tethered by ligamentum arteriosum, so injured during accel-deccel injuries

74

young woman with RVH

Cor pulmonale from primary pulmonary hypertension

75

What sets ventricle pace in 3rd degree block?

AV node = 45-55bpm

76

Coronary steal

giving adenosine or dipyridamole (coronary vasodilators) when there is a blocked vessel exacerbates it

77

Who has more compliant LA, chronic or acute MR?

Chronic; allows for room for blood to prevent acute pulmonary edema (seen in acute)

78

beck triad: what and when

What: severe hypotension, muffled heart sounds, distended neck veins. Via pericardial tamponade

79

Rx for AS with a fib

Cardioversion: they need the atrial kick to get blood into hypertrophied LV, and ot prevent acute pulmonary edema

80

Distance from A2 to OS: disease and what it tells you

Mitral stenosis

 

Severity: decreased time = worse. Tighter stenosis = higher LAP needed to overcome it = LAP > LVP sooner (during LV isovolumetric relaxation) = valve opens sooner thus closer to aortic valve shutting

81

Calcific aortic stenosis via:

dystrophic calcification: abnormal organ calcification via damage (i.e. longterm hemodynamic stress os AS), with NORMOcalcemia

82

Hibernating myocardium

Ischemia so that myocardium doesn't work, but they make enough ATP to survive. If oxygen is returned with CABG or angioplasty, the hibernating myocardium wakes up and s/s improve (overs hrs-months)

83

Myocardial stunning

Less severe version of hibernation. Ischemia

84

Anti-arythmic specific for rapidly depolarizing and repolarized myocytes (i.e. ischemic cells in v. tach)

Lidocaine

85

Best beta blocker for decreasing M/M in CHF; and its function

Carvedilol. B1, B2, A1 antagonist

86

Sotalol Special properties

Only class III (K+ blocker, prolong Q-T) with beta-antagonist effects (so will also cause bradycardia)

87

what part of the wave do beta blockers alter and how

Increased PR interval by slowing down AV node conduction

88

Drugs producing dilated cardiomyopathy

Anthracyclines = doxorubicin and daunorubucin. Prevent with dexrazoxane

89

Nesiritide

BNP analog

90

SVT DOC

Adenosine (especially paroxysmal SVT)

91

Adenosine AE

Flushing, burning chest pain, sense of impending doom, bronchospasm, hypotension

92

Drug for chemical stress test

Adenosine

93

HOCM heart changes (gross)

Asymmetrical septal hypertrophy, leading to systolic anterior motion (SAM) of anterior mitral valve leaflet

94

Class III antiarythmics

Amiodarone, Ibutilide, dofetilide, sotalol

95

how do vegetations form in bacterial endocarditis

Bug binds —> expresses tissue factor (thomboplastin/Factor III, extrinsic coagulation pathway)—> activates platelets and fibrin deposition —> vegetation

96

Osler-Weber-Rendu

Hereditary hemorrhagic telangectasias. AD. spider nevi with bleeds i.e. epistasis

97

Sturge-Weber

Facial, leptomeningeal, seizures, hemiplegia, skull tram track opacities

98

Conduction speed

Purkinje > atria > ventricles > AV

99

a fib ECG:

Lose P-waves, narrow QRS and irregularly spaced, variable RR

100

Hypercoaguable paraeoplastic: name, cause, s/s

Trousseau’s syndrome. Pancreatic, colon, lung adenocarcinomas. Make thromboplastin-like substance that causes migratory thrombophlebitis (and non-bacterial thrombotic endocarditis)

101

Aortic isthmus

tethered by ligamentum arteriosum, so injured during accel-deccel injuries

102

young woman with RVH

Cor pulmonale from primary pulmonary hypertension

103

What sets ventricle pace in 3rd degree block?

AV node = 45-55bpm

104

Coronary steal

giving adenosine or dipyridamole (coronary vasodilators) when there is a blocked vessel exacerbates it

105

Who has more compliant LA, chronic or acute MR?

Chronic; allows for room for blood to prevent acute pulmonary edema (seen in acute)

106

beck triad: what and when

What: severe hypotension, muffled heart sounds, distended neck veins. Via pericardial tamponade

107

Rx for AS with a fib

Cardioversion: they need the atrial kick to get blood into hypertrophied LV, and ot prevent acute pulmonary edema

108

Functions of ANP

Kidney: dilates afferent arteriole, prevents Na+ resorption, inhibits renin secretion

Adrenal: restricts aldosterone secretion

Blood vessels: vasodilation and increases capillary permeability to decrease circulating BV

109

Pressures in the heart

110

Maneuvers for murmurs

111

Best way to hear S3

Lateral decubitus and exhaled to decrease lung volume and bring heart closest to chest

112

Resistance = 

nL/r4

113

When is AS murmur the loudest?

When Aorta-LV pressure gradient is the largest, so mid-systole (hence the crescendo-decrescendo)

114

Response to arteriole vasodilators (minoxidil and hydralazine)

Decreased arterial BP causes baro-R firing causes increased SNS:

Reflex tachycardia/FOC

RAS causing fluid retention cuasing edema and Na+ retention

115

Congenital heart diseae causing toe cyanosis and clubbing

PDA

(deO2 blood from PA into descending aorta (past the 3 branches)

116

Signal for migration (and the proliferation) of smooth muscle cells into tunica intima

PDGF

From pletelets, endothelium, macrophages

117

Aortic aneurism vs aortic dissectoin major RF

aneurism = AS

dissection = HTN

118

effects of 5HT of the heart:

endocardial fibrosis