AAW - Cardio Flashcards
Patient presents with fever, loud 3 component heart sound,, diffuse ST segment elevations, and chest pain that worsens while lying down 5 weeks after an MI
What is the most likely diagnosis
dresslers syndrome, autoimmune post-myocardial infarction fibrinous pericarditis
the heart sound is a friction rub
Biopsy of the heart in a child with a murmur shows densely packed striated muscle
What is the most likely diagnosis
rhabdomyoma, most common primary cardiac tumor in kids, assc. with tuberous sclerosis
Histological examination of a myxoid tumor of the heart will show what
scattered mesenchymal cells in a prominent myxoid background
Turner syndrome
Cystic hygroma on the neck (obstruction of lymphatic drainage into the venous system)
Broad chest
high arched palate
short stature
gonadal dysgenesis
Coarctation of the aorta
(like putting a Turner kit on the aorta)
Methyldopa
First choice for treating hypertension in pregnant women
converted intraneuronally to alpha-methylnorepinephrine, and alpha-2 agonist
Tx for methemoglobinemia
Methylene blue
What does nitro do to your Left ventricular end systolic volume? Diastolic?
decreases both
Congenital defect assc with maternal rubella
PDA
cataracts
deafness
Congenital defect assc with maternal diabetes
transposition of the great vessels
fixed split s2
ASD
Sx can be absent or minimal until late in childhood
drug that causes nausia, vommiting, diarrhea, and blurry yellow vision
digoxin
what heart condition is assc with “ring-enhancing radiologic lesions” in the brain
infective endocarditis, usually s. aureus
what happens to your arterial diameter and PVR in anemia
arterial diameter increases to allow more blood to go to the heart
peripheral vascular resistance is decreased because the blood viscosity is lowered
pneumonic for cyanotic babies
the T defects (right to left shunts)
Tetralogy of fallot
Transposition
persistent Truncus ateriosus
Treatment for hypertension with BPH
alpha 1 blocker
-azosin
what causes AAA
atherosclerosis is by far most common
inflammatory condition that produces thoracic aortic aneurisms
takayasu arteritis
left horn of sinus venosus gives rise to
coronary sinus
right horn of sinus venosus gives rise to
smooth part of right atrium
right common cardinal vein and right anterior cardinal vein give rise to
superior vena cava
first functional organ in vertebrate embryos is the
heart.
beats by week 4
conditions that can cause paradoxical emboli (a venous thromboemboli that enters systemic arterial circulation)
ASD
patent foramen ovale
endocardial cushions of the AV canal form what
endocardial cushions of the outflow tract of the heart become what
mitral/tricuspid valves
aortic/pulmonary valves
ebstein anomaly
displaced valves due to lithium toxicity
why does fetal hemoglobin have a higher affinity for oxygen binding
it has alpha2gamma2 instead of alpha2beta2
alpha2gamma2 binds to 2,3 BPG less avidly.
what causes the foramen ovale to close when a baby is born
baby takes a breath, decreasing resistance in pulmonary arteries. This causes more blood to flow through them, resulting in more pressure in the left atrium than the right atrium, which pushes the valve shut
when shut, it is called the fossa ovalis
What causes the ductus arteriosus to close
increase in 02 from respiration and decrease in prostaglandins
umbilical vein becomes the
ligamentum teres hepatis (contained in falciform ligament)
umbilical arteries become the
medial umbilical ligaments
ductus arteriosus becomes the
ligamentum arteriosum
ductus venosus becomes the
ligamentum venosum
foramen ovale becomes the
fossa ovalis
allantois becomes the
urachus-median umbilical ligament
urachal cysts or sinuses can appear as remnants
notochord becomes the
nucleus pulposus of the intervertebral disc
SA and AV nodes are supplied by what artery
RCA
what most commonly gives rise to the posterior descending artery of the heart
right coronary in 85%
left coronary in 8%
mixture in 7%
enlargement of which area of the heart can cause dysphagia and/or hoarseness
left atrium (the most posterior part)
cardiac output in relation to O2 consumption
CO = O2 consumption / (arterial O2 content - venous O2 content)
two ways to calculate mean arterial pressure
MAP = CO x TPR
(think V=iR)
MAP = 2/3 diastolic + 1/3 systolic
what does hyperkalemia do to an EKG
tall, “tented” T waves that rise slowly is most characteristic
(the heart has to work harder to repolarize because it is not as easy to pump potassium outside the cell during repolarization)
can also cause abridged or absent ST segment
“hyper?, K pitch a tent”
what does hypercalcemia do to an EKG
shortened QT with abridged or absent ST segment
the T wave will not be as tall as the r wave, as seen in hyperkalemia
(also, BP will go up and the patient will likely vomit)
eosinophilic granulomatosis with polyangiitis is also known as
Churg-strauss
p-ANCA (directed at myeloperoxidase) with asthma, necrotising vasculitis, and eosinophilic granulomas
4 to 8 weeks after an MI, patient presents with dyspnea, bibasilar lung crackles, and arrhythmia
what are you thinking
ventricular aneurysm
2-7 days most MI patient presents with high pitched, holosystolic murmur and rapid onset of pulmonary edema
what are you thinking
papillary muscle rupture
what vasculitis causes coronary artery aneurysm
kawasaki disease
Loeffler endocarditis
restrictive heart disease that causes endomyocardial fibrosis with associated eosinophilia and myocyte necrosis
Someone not from the US has myocarditis and megacolon
what are you thinking
Chagas disease, caused by trypanasoma cruzi
usually they will be from central and south america
what type of cardiomyopathy does alcohol cause
dilated
what shows apple-green birefringence on a congo red stain and what can it do to the heart
amyloid deposit
cause restrictive cardiomyopathy
fibroelastosis
causes a think fibroelastic tissue buildup in the endocardium of young children
restrictive cardiomyopathy
hereditary hypertrophic cardiomyopathy
what type of patient is it usually seen in
what happens to the heart besides hypertrophy
what are the genetics
usually seen in young, athletic adults
hypertrophy of the interventricular septum and free wall of the left ventricle
subaortic stenosis
diastolic dysfunction
myocyte hypertrophy and disarray
autosomal dominant
decrescendo diastolic murmur is characteristic of
aortic regurgitation
diastolic rumble best heard at the left lateral decubitus position is characteristic of
mitral stenosis
holosystolic murmur radiating to the apex is characteristic of
chronic mitral regurgitation
dihydropyridine calcium channel blockers
names
uses
amlodipine, nimodipine, nifedipine, felodipine (the dipines)
hypertension, angina (including prinzmetal), Raynaud
nimodipine is used for subarachnoid hemorrhage to prevent cerebral vasospasm
non-dihydropyridine calcium channel blockers
names
uses
diltiazem, verapamil - slow SA and AV node conduction
hypertension, angina, atrial fib/flutter
heart: verapamil >diltiazem > the dihydropyridines
terazosin
alpha-1 antagonist used for hypertension and benign prostatic hypertrophy
pulsus paradoxus is characteristic of what heart condition(s)
cardiac tamponade
sometimes pericarditis
kussmaul sign
an increase in venous blood pressure upon inspiration, usually indicative of right sided HF and pericarditis
Class III antiarrhythmics
Mech
some SE
Block K channels, prolong repolarization
Used for afib, aflutter, Vtach (amiodarone and sotalol)
AIDS
Amiodarone - lots of SE including ARDS, hepatotox, hyper/hypothyroid, blue/grey skin deposits, cardiovascular effects, etc. has class I, II , III, and IV effects.
Ibutilide - torsades
Dofetilide
Sotalol - torsades, can cause Beta blockade
esmolol
beta-1 selective beta blocker
ultra short acting
lidocaine does what to the heart and what is it used for
class IB antiarrhythmic for Vtach
blocks sodium channels and shortens the action potential duration
procainamide
class IA antiarrhythmic
triad of cardiac tamponade sx
hypotension, JVD, muffled heart sounds
isoproterenol
nonselective beta agonist
can be used for bradycardia
overdosing on what common heart meds can cause a third degree heart block and bradycardia
betablockers
biopsy a dead guys heart and you see focal fibrosis and subendocardial myocardial vacuolization
what are you thinking
he just had recurrent stable angina
what normally predisposes people to aortic dissection
uncontrolled hypertension
mexiletine
class IB antiarrhythmic used for vtach, esp in people who are iodine sensitive and cannot use amiodarone
shorten action potentials by blocking sodium channels
what common heart meds may prevent some of the premonitory signs and symptoms of acute episodes of hypoglycemia
beta blockers
alprostadil
PGE1 analog
can be used to maintain PDA
libman-sacks endocarditis
wart-like vegetations on both sides of mitral and aortic valve, seen in SLE
(sometimes described as small, verrucous vegetations)
SLE commonly presents as rash, joint pain, and fever in females
what does the moderator band do in the heart
it is in the right ventricle
carries purkinje fibers from the right bundle branch to the papillary muscle and causes it to contract at the very beginning of systole
what happens to your end-diastolic volume if you have a PVC
it is lower than normal because the ventricle didn’t have time to fill completely
person who was in the woods with joint pain and first degree heart block
what is name of the vector that infected them
Ixodes scapularis
aka deer tick
transmits lymes disease (borrelia burgdorferi)
what common heart medication can cause dyslipidemia
metoprolol
heart drug that causes cough and hyperkalemia
the -prils
ace inhibitors
What heart drug can cause constipation, flushing, edema
diltiazem, the non-dihydropyridine calcium channel blocker
what heart drugs have a first dose effect of profound onset of orthostatic hypotension?
the alpha-1 blockers like terazosin and prazosin
mech of sildenafil
inhibits PDE5
PDE5 degrades cGMP
cGMP vasodilates and increases blood flow
the medial umbilical folds used to be the
the median umbilical fold used to be the
umbilical arteries, they come off of the internal iliac arteries and deliver deoxy blood to the placenta
mediaN contains the urachus, a remnant of the allaNtois, which connects the bladder to the umbilicus
L-myc genes assc with
small cell Lung cancer
Lung-mycancer
PPARalpha activators
what do they do
SE
peroxisome proliferator-activated receptor alpha
AKA fibrates - used to raise HDL and lower triglycerides
they increase the expression of lipoprotein lipases.
Nuclear receptor proteins that act as transcription factors
SE: gallstones (increase the about of cholesterol in bile)
histiology of a syphilitic aneurism
plasma cell lesion of the small blood vessels (the vasa vasorum) that supply the aorta and eventually obliterate the small vessel lumina
also you see wrinkling of the aorta and massive root dilatation
what are you thinking if you see fibrinoid necrosis with a neutrophilic infiltration transmurally in an arterial wall
patient has fever, weight loss, malaise, headache, abdominal pain
polyarteritis nodosa
cystic medial necrosis of the aorta is characteristic of what
marfans, a fibrillin-1 defect
phentol
can see focal fragmentation of elastic elements on histology
phentolamine
mech
use
alpha adrenergic antagonist - nonselective
give to someone on an MAOI who just ate a bunch of tyramine
what arrhythmics exhibit a negative inotropic effect and can exacerbate CHF
diltiazem and verapamil
they block Ca channels
the negative inotropic effect is generally compensated for by its afterload reduction or decreased systemic vascular resistance in patients who do not have heart failure or are not prone to developing this condition
also beta blockers
THIS IS IN CONTRAST WITH THE DIHYDROPYRIDINE CALCIUM CHANNEL BLOCKERS, WHICH CAN MILDLY INCREASE INOTROPY
hydralazine
arteriodilator
decreases afterload
increased cGMP which leads to smooth muscle relaxation
SE can be SLE-like syndrome, reflex tachycardia, nausea, headache
big artery that runs behind the knee cap
popliteal artery
it is the continuation of the femoral artery as the femoral artery exits the adductor hiatus
weak upper extremity pulses in asian female
name
what do you see histologically
Tx
takayasu arteritis
granulomatous thickening and narrowing of aortic arch and proximal great vessels
treat with corticosteroids
warfarin can cause what vitamin deficiency
b12
presents as neuropathy/anemia
ST elevation in leads 2,3,aVF
what type of stemi
what do you give
inferior
you DON’T give nitro in an inferior STEMI because it can drop the BP (right coronary is involved)
give TPA
most blood in the peritoneal sac drains where
RUQ, usually in the potential space between the liver and kidney (known as morison’s pouch)
meds that prolong QT interval
Some Risky Meds Can Prolong QT:
Sotalol Risperidone (antipsychotics) Macrolides Chloroquine Protease inhibitors (-navir) Quinidine (class Ia; also class III) Thiazides
disorders of myocardial repolarization due to ion channel defects (usually)
increased risk of sudden cardiac death due to torsades
which one is deafness assc with
Romano-ward syndrome - autosomal dominant, pure cardiac phenotype (no deafness)
jervell and lange-neilsen syndrome - autosomal recessive, sensorineural deafness
patient has supraventricular tachycardia and
delta wave with shortened PR interval on ECG
wolff-parkinson-white syndrome
most common type of ventricular pre-excitation syndrome
abnormally fast conduction pathway from atria to ventricle, bypasses the rate-slowing AV node
type II heartblock
type II mobitz heart block
type II heart block: PR intervals elongate until a PR interval occurs that is not succeeded by a QRS complex
type II mobitz: Dropped beats that are not preceded by a change in the length of the PR interval
nesiritide
recombinant form of B-natriuretic peptide
can be used to treat heart failure
causes vasodilation and decreased Na reabsorption at the renal collecting tubule. Constricts efferent renal arterioles and dilates afferent arterioles
hep b seropositivity in 30% of these vasculitis patients
polyarteritis nodosa
asian kid
fever, cervical lymphadenitis, conjuctival injection, red lips/oral mucosa, hand-foot erythema
what is it
complications?
drugs?
kawasaki disease
may develop coronary arter aneurisms, thrombosis –> MI, rupture
gamma-globulin and high-dose aspirin
c-ANCA vs p-ANCA
what enzymes do they target
c - anti-proteinase 3
p - antimyeloperoxidase (myeloperoxidase in NEUTROPHILS turns H2O2 into HClO (hypochlorous acid) which is what kills bacteria directly)
which one of the ANCA vasculitis presents with neuropathy
Chrug-Strauss (asthma, sinusitis, palpable purpura, peripheral neuropathy
A med is given that significantly lowers a persons LDL while significantly raising their HDL
what is the mechanism
niacin
reduces hepatic triglyceride and VLDL synthesis
mech of beta blockers
inhibit the g-protein/cyclic adenosine monophosphate mechanism –> decreasesthe amount of cAMP and protein kinase A produced, decreasing the Na+ and Ca+ currents
virus that cause cause CHF
coxsackie B
treatment for infantile coarctation until surgery is performed
PGE1 to keep the ductus open
a statin combined with what other type of medication can lead to rhabdomyolysis
a fibrate
most common cause of slow onset infectious endocarditis in a previously damaged valve, no Hx of IV drug use.
strep virdans (50-60%)
what mechanistically happens to the aorta in someone with marfans
cystic medial necrosis –> aortic incompetence and dissecting aortic aneurisms
what drug is used for abolishing AV node arrhythmias by hyperpolarizing the cell by increasing K current
Adenosine
used for Dx and abolishment of AV node arrhythmia
extremely short duration of action (15 sec)
what function tests should you check when a patient is on amiodarone?
pulmonary, liver, thyroid function tests
what do you do if Vfib does not convert to sinus rhythm after cardioverting
epinephrine followed by amiodarone
medication that is used to treat hypertension in a “patch”
mech?
SE?
clonidine, alpha 2 agonist
SE: dry mouth, sedation , sexual dysfunction. Sudden discontinuation can result in rebound hypertension
Mechanism of fibrates
activate peroxisome proliferator-activated receptors (PPARs)
PPAR activation also increases lipoprotein lipase-mediated lipolysis and promotes rapid VLDL cholesterol turnover
person eats a whole birthday cake and presents with elevated temp, BP, pulse, RR, disorientation, dilated pupils.
what depression med is she on
one of the MAOIs
tranylcypromine, phenelzine, isocarboxazid, selegiline
alternations of the QRS height with each beat means what
cardiac tamponade
get pulsus paradoxus, hypotension, and elevated JVP that fails to decrease on inspiration (kussmaul’s sign)
Sx of digoxin toxicity
antiarrhythmic that can cause this toxicity
atrial tachycardia (supraventricular tachycardia) with AV block
quinidine, verapamil, and amiodarone, decreases digoxin clearance and displaces digoxin from tissue-binding sites.
what causes and increase in dromotropy, inotropy and chronotropy in the heart with regards to flow of ions
Dromo - increase of the conduction velocity, caused by increase influx of Ca into the AV node
ino - increased contractility caused be increased Ca influx into the myocytes
Chrono - increased heart rate, caused by increased Ca influx into the SA node
what causes most autosomal dominant forms of hypertrophic cardiomyopathy
beta-myosin heavy chain mutation
aka the sarcomere gene myosin-binding protein C
loop diuretic that is not sulfa-based
Ethacrynic acid
increased risk of ototox and is not usually a first line therapy for pulmonary edema
causes of subacute endocarditis with previously damaged heart valves
virdans group strep (mutans, sanguinis, mitis, oralis)
fever, weight loss, diffuse myalgias, abdominal pain
BP 168/92
areas of ulceration and mottled purple discoloration on lower extremities
hep b infections
what is it
what is the treatment
polyarteritis nodosa
fibrinoid necrosis of the medium sized muscular arteries
Tx: corticosteroids, cyclophosphamide for flares
factor V leiden
production of mutant factor V (g->a point mutation -> Arg506Gln mutation) that is resistant to degradation by activated protein C. most common cause of inherited HYPERcoagulability in caucasians
DVT, cerebral vein thromboses, recurrent pregnancy loss
phenoxybenzamine
irreversible alpha 1 and 2 blocker
used in pheochromocytoma to prevent catecholamine crisis
blocks alpha and can cause epi reversal
small brown heart in an old guy
its a buildup of what
lipofuscin
yellow brown wear and tear pigment associated with normal aging
formed by oxidation and polymerization of autophagocytosed organellar membranes
cholesterol of 700 in a teen
what disease
what inheritance pattern
what is the molecular defect
familial hypercholesterolemia
autosomal dominant
absent or defective LDL receptors
pancreatitis, hepatosplenomegaly, eruptive/pruritic xanthomas. creamy layer in supernatant
what disease
what inheritance
what is the molecular defect
hyper-chylomicronemia (type 1 familial dyslipidemia)
autosomal recessive
lipoprotein lipase or apolipoprotein C-II deficiency
hypertriglyceridemia and acute pancreatitis
what disease
what inheritance
what is the molecular defect
hyper-triglyceridemia (type IV familial dyslipidemia)
autosomal dominant
hepatic overproduction of VLDL
jones criteria - what is the name of the rash
erythema MARGINATUM
effects on lipid profile, mech, SE of:
Bile acid resins: cholestyramine, cholestipol, cholesevelam
LDL 2 arrows down
HDL slightly up
trig slightly up
prevent intestinal reabsorption of bile acids; liver must use cholesterol to make more
SE: decreased absorption of ADEK
effects on lipid profile, mech, SE of:
ezetimibe
LDL 2 arrows down
prevents cholesterol absorption at small intestine brush border
diarrhea
effects on lipid profile, mech, SE of:
fibrates: Gemfibrozil, bezafibrate, fenofibrate
LDL 1 arrow down
HDL 1 arrow up
trig three arrows down
activates PPAR-alpha to upregulate LPL –> increases TG clearance
causes myopathy (esp with statins) and cholesterol gall stones
