4. Cardio Flashcards
What substances act on smooth muscle myosin light-chain kinase? (3)
How does this affect blood pressure?
- Ca2+ channel blockers
- Epinephrine B2
- Prostaglandin E2
2 and 3 act to increase cAMP, inhibiting myosin light-chain kinase, which will decrease phosphorylation of myosin
- all the above lead to vasodilation, and decrease in BP
Describe the chain of events in which hypotension (vasodilators) causes reflex tachycardia
- baroreceptors in the carotid sinus sense low BP
- decrease stretch of carotid sinus
- decreased stimulation of CN9 (which transmits to solitary nucleus of medulla)
- decreased inhibition of sympathetic output => more sym
What would you most suspect the cause of HTN to be in a pt with paroxysms of increased sympathetic tone: anxiety, palpitations, diaphoresis
pheo
What would you most suspect the cause of HTN to be in a pt age of onset 20-50
essential HTN
What would you most suspect the cause of HTN to be in a pt with abdominal bruit
renal artery stenosis
What would you most suspect the cause of HTN to be in a pt with BP in arms > legs
coarct
What would you most suspect the cause of HTN to be in a pt with family hx of HTN
essential HTN
What would you most suspect the cause of HTN to be in a pt with tachycardia, heat intolerance, diarrhea
hyperthyroidism
What would you most suspect the cause of HTN to be in a pt with hyperkalemia
renal insufficiency
What would you most suspect the cause of HTN to be in a pt with hypokalemia
renal artery stenosis
- b/c body’s response to poor renal perfusion is to activate RAAS (=> aldo leads to potassium wasting)
What would you most suspect the cause of HTN to be in a pt with central obesity, moon-shaped face, hirsutism
Cushing
What would you most suspect the cause of HTN to be in a young pt with acute onset tachy
cocaine, amphetamine
What would you most suspect the cause of HTN to be in a pt with proteinuria?
renal disease
What category of BP medication is preferred in the treatment of aortic dissection?
b-blocker
Which antihypertensive class or drug fits each of the following S/Es? - hypertrichosis
Minoxidil
Which antihypertensive class or drug fits each of the following S/Es? - cyanide toxicity
sodium nitroprusside
Which antihypertensive class or drug fits each of the following S/Es? - reflex tachycardia
any vasodilators
Which antihypertensive class or drug fits each of the following S/Es? - cough
ACE-i
Which antihypertensive class or drug fits each of the following S/Es? - possible development of drug-induced lupus
hydralazine
- remember SHIPP
Which antihypertensive class or drug fits each of the following S/Es? - possible angioedema
ACE-i and ARBs
Which antiHTN are particularly beneficial to heart failure pts? (4)
- ACE-i or ARB
- aldosterone antagonist
- b-blockers (carvedilol, metoprolol, bisoprolol)
Which antiHTN are safe to use in pregnancy? (4)
- hydralazine
- methyldopa
- labetolol
- nifedipine
Hypertensive Moms Love Nifedipine
What is the most likely cause of chest pain in a pt who has ST segment elevation only during brief episodes of chest pain?
Prinzmetal angina
Which lipid-lowering agent matches
SE: facial flushing
niacin
Which lipid-lowering agent matches
SE: elevated LFTs, myositis
statins, fibrates
Which lipid-lowering agent matches
SE: GI discomfort, bad taste
bile acid resins
Which lipid-lowering agent matches
- best effect on HDL
niacin
Which lipid-lowering agent matches
- best effect on trig/VLDL
fibrates
Which lipid-lowering agent matches
- best effect on LDL/cholesterol
statin (HMG-CoA reductase inhibitors)
Which lipid-lowering agent matches
- binds C. diff toxin
Cholestyramine (bile acid resin)
- can use in C. diff pt
A 50 yo man is started on lipid-lowering medication. Upon his first dose, he develops a rash, pruritus, and diarrhea. What drug is he taking?
niacin
How can the flushing rxn of niacin be prevented?
- take aspirin or NSAID 30 min before niacin
What is the most common lethal complication after an MI?
arrhythmia
What would cause each of the following findings after an MI?
- cardiac tamponade
free wall rupture
What would cause each of the following findings after an MI?
- severe mitral regurg
papillary muscle rupture
What would cause each of the following findings after an MI?
- new VSD
rupture of intraventricular septum
What would cause each of the following findings after an MI?
- stroke
pseudoaneurysm –> mural thrombus –> embolus
Which ECG leads will show evidence of ischemia in an anterior wall MI?
V1-V4, maybe V5
this is LAD
What is the differences b/w acute and subacute infective endocarditis?
Acute: S. aureus
- rapid onset (days)
- normal valves
Subacute: Viridans
- insidious onset (wks to months)
- affects prev damaged/congenitally abnormal valves
An IVDU presents with chest pain, dyspnea, tachycardia, and tachypnea. What is the most likely cause?
Endocarditis –> bacterial embolism –> septic pulmonary emboli
A young girl with congenital valve disease is given penicillin ppx. In the ER, infective endocarditis is diagnosed. What is the next step in her management?
Empiric IV vanc pending culture results
Under what circumstances might you see pulsus paradoxus? (5)
- cardiac tamponade
- asthma
- croup
- obstructive sleep apnea
- COPD
What are the Jones criteria for the dx of acute rheumatic fever?
- Joints (migratory polyarthritis)
- carditis (pancarditis)
- Nodules (subQ)
- Erythema marginatum
- Sydenham chorea
What heart pathology cause focal myocardial inflammation with multinucleate giant cells?
Aschoff bodies
What heart pathology cause chest pain and course rubbing heart sounds in a pt with Cr of 5.0
Uremic pericarditis
What heart pathology cause tree-barking of the aorta?
Tertiary syphilis
What heart pathology cause child with fever, joint pain, cutaneous nodules 4 wks after a throat infection?
Acute rheumatic fever
What heart pathology cause ST elevation in all ECG leads
pericarditis
What heart pathology cause ECG showing electrical alternans
cardiac tamponade
Which type of vasculitis fits description
- weak pulses in upper extremities
Takayasu arteritis
Which type of vasculitis fits description
- granulomas of lung, glomerulonephritis, c-ANCA positive
GPA (granulomatosis with polyangiitis)
Which type of vasculitis fits description
- necrotizing immune complex inflammation of visceral/renal vessels
PAN (polyarteritis nodosa)
- spares the lungs, ANCA (-)
Which type of vasculitis fits description
- 2 yo East Asian female
Kawasaki
Which type of vasculitis fits description
- 20 yo East Asian female
Takayasu
Which type of vasculitis fits description
- young male smokers
Thromboangiitis obliterans (Buerger disease)
Which type of vasculitis fits description
- young asthmatics
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
Which type of vasculitis fits description
- infants and young children; involves the coronary arteries
Kawasaki
Which type of vasculitis fits description
- most common vasculitis
Giant cell (temporal) arteritis
Which type of vasculitis fits description
- associated with hep B infection
PAN
Which type of vasculitis fits description
- occlusion of ophthalmic artery can lead to blindness
Giant cell
Which type of vasculitis fits description
- perforation of nasal septum
GPA (Wegener’s)
Which type of vasculitis fits description
- unilateral headache, jaw claudication
Giant cell
Which disorders are commonly discovered in pts with Raynaud phenomenon? (4)
- lupus
- CREST scleroderma
- Buerger disease
- Mixed connective tissue disease
Which vascular tumor fits the following description?
- benign, raised, red lesion about the size of a mole in older pts
cherry hemangioma
Which vascular tumor fits the following description?
- raised, red area present at birth; increases in size initially then regresses over months to years
strawberry hemangioma
Which vascular tumor fits the following description?
- lesion caused by lymphoangiogenic growth factors in an HIV pt
Kaposi Sarcoma
Which vascular tumor fits the following description?
- polypoid red lesion found in pregnancy or after trauma
pyogenic granuloma
Which vascular tumor fits the following description?
- benign, painful, red-blue tumor under fingernails
glomus tumor
Which vascular tumor fits the following description?
- cavernous lymphangioma associated with Turner syndrome
cystic hygroma
Which vascular tumor fits the following description?
- skin papule in AIDS pt caused by Bartonella spp.
Bacillary angiomatosis
remember, it causes cat scratch disease
