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OS3 > Boards and Beyond- Cardio > Flashcards

Boards and Beyond- Cardio Flashcards

1
Q

Which valve problem?

Turner syndrome or aortic coarctation

A

Bicupsid aortic valve

Early stenosis

Aortic regurg

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2
Q

which blood vessel has the highest velocity? Lowest?

A

Highest: Large arteries

Lowest: Capillaries

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3
Q

_______________ ischemia occurs with flow obstruction but some distal blood flow.

A

Subendocardial ischemia

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4
Q

Kussmaul’s sign

A

Inspiration causes rise in JVP

*Classic sign of restrictive heart disease

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5
Q

Complications of Ischemia weeks later

A

Dressler’s syndrome

Aneurysm

LV Thrombus/ stroke

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6
Q

Loud S3 heart sound. Disease?

A

Rapid ventricular filling (such as mitral incompetence or congestive heart failure)

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7
Q

3 main ways to decrease conduction in AV node

A

Carotid massage

Vagal maneuvers

Adenosine

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8
Q

What conditions decrease oncotic pressure?

A

Nephrotic syndrome

Liver failure

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9
Q

Rhythm signs of restrictive heart disease

A
  • Arrythmias (sudden death)
  • AV block
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10
Q

Symptoms of atrial fibrillation

A

Palpitations, fatigue, dyspnea

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11
Q

Which baroreceptor only senses elevated BP?

A

Aortic arch

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12
Q

which genetic disorders has conotruncal anomalies?

A

DiGeorge syndrome

  • Outflow tract anomalies
    • Truncus arteriosus
    • Conus arteriousus
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13
Q

CO calculation

A

SV X HR

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14
Q

Neprilysin inhibitors

A

Sacubitril

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15
Q

Side effects of neprilysin inhibitors

A

Hypotension

Hyperkalemia

Angioedema

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16
Q

Which heart problem?

Healthy, young athelete, syncope

A

HCM

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17
Q

Carvallo’s sign

A

Right -sided murmurs increase with inspiration

Left sided murmurs increase with exhalation

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18
Q

Which drugs are implicated in causing coronary steal?

A

Adenosine

Persantine

Regadenoson

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19
Q

Mg blocks influx of _____ into cells.

A

Ca

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20
Q

________ (acute/chronic) regurgitation may cause shock.

A

Acute

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21
Q

_____________ inhibits sarcoplasmic reticulum Ca2+ ATPase. What effect does this have?

A

Phospholamban; prevents Ca2+ uptake by SERCA and prevents relaxation

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22
Q

When is a S3 heard?

A
  • Acute heart failure
  • Young patients
  • Pregnant women
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23
Q

Alprostadil

A
  • Prostaglandin E1
  • Maintains patency of ductus arteriosus
  • Delivers blood to lungs
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24
Q

Therapies for systolic HF

A

Drugs: ACE-inhibitors, beta blockers, aldosterone antagonists

Defibrillators

Bi-ventricular pacemakers

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25
Q

Type of shock?

Low CO

High cardiac pressures

High SVR

A

Cardiogenic

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26
Q

How is prinzmetal angina treated?

A
  • Quit smoking
  • Calcium channel blockers, nitrates
  • Avoid propranolol
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27
Q

Key control variables for autoregulation in kidneys

A

BP

NaCl feedback

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28
Q

In systolic heart failure, ejection fraction is ___________. In diastolic heart failure, ejection fraction is _________.

A

Reduced; normal

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29
Q

In what condition can you see a prolonged PR interval?

A

Primary AV block

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30
Q

Infundibulum develps from ______.

A

Bulbus cordis

*infundibulum is a funnel leading to pulm valve

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31
Q

Dystrophic calcification of coronary arteries is the result of ____________.

A

Chronic inflammation

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32
Q

Truncus arteriosus gives rise to what structures

A

Aorta

Pulm artery

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33
Q

How is prinzmetal angina diagnosed?

A
  • Intracoronary ergonovine
    • Acts on smooth muscle serotonergic receptors
    • Vasospasm visualized on angiogram
  • Intracoronary acetylcholine
    • Acts on endothelial muscarinic receptors
    • Endothelial dysfunction leads to vasoconstriction
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34
Q

ACE inhibitors

A

Captopril

Enalapril

Lisinopril

Ramipril

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35
Q

Side effects of loop diuretics

A

Hypokalemia

Volume deplettion

  • Renal failure
  • hypotension
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36
Q

Venous return is blood returned to the _____________.

A

Left ventricle

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37
Q

In which conditions are u waves seen?

A

Hypokalemia

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38
Q

Systolic crescendo-decrescendo murmur

A

Aortic stenosis

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39
Q

Class _______ antiarrhythmic drugs block K channels.

A

III

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40
Q

Conditions with right axis deviation

A

Right bundle branch block

Right ventricular hypertrophy

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41
Q

Structures effected by central cyanosis

A

Lips

Nail beds

Conjunctivae

*Warm extremities

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42
Q

normal QRS axis

A

Between -30 and +90

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43
Q

which blood vessel has the highest area? Lowest?

A

Highest: Capillaries

Lowest: Large arteries

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44
Q

Why are headaches an adverse of nitrates?

A

Meningeal vasodilation

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45
Q

For left axis deviation, lead ____ is negative.

A

II

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46
Q

Three major classes of calcium antagonists

A
  • Dihydropyridines (nifedipine)
  • Phenylalkylamines (Verapamil)
  • Benzothiazepines (Diltiazem)
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47
Q

Causes of pulmonic regurg

A

Repaired tetralogy of fallot

Endocarditis

Rheumatic heart disease

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48
Q

If you notice a wide QRS and V1 is facing downward. What is the prognosis?

A

LBBB

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49
Q

Conginetal heart defects seen in fetal alcohol syndrome

A

ASD

VSD

Tetralogy of Fallot

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50
Q

Inotropes

A

Milrinone

Dobutamine

Dopamine

Epinephrine

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51
Q

What venous pressure tracing is seen in tricupsid stenosis?

A

Large a wave

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52
Q

All forms of HF have a low CO except________.

A

High output heart failure

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53
Q

When do systolic murmurs occur?

A

Between S1- S2

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54
Q

Decreased S2 heart sound. Disease?

A

Aortic stenosis

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55
Q

Key control variables for autoregulation in brain

A

CO2

pH

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56
Q

Class ____antiarrhytmic drugs block Na channels

A

I

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57
Q

Which valve problem?

Young female, otherwise healthy

A

MVP

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58
Q

Typical symptoms of cardiac ischemia

A

Chest pain

Dyspnea

Diaphoresis

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59
Q

Symptoms of coarctation of the aorta are caused by closure of the ___________.

A

Ductus arteriosus

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60
Q

In which cases is emergent cardioversion performed regardless of possible thrombus?

A

Hypotension and shock

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61
Q

White infarcts

A
  • Occlusion of arterial supply to a solid organ
  • Common in heart, kidneys, spleen
  • Limited blood seepage from healthy tissue
  • Tissue becomes pale
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62
Q

WHat drugs is used during cardioversion

A

Ibutilide

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63
Q

Lysosomal storage disease

Deficiency of a-galatosidase A

Accumulation of ceramide trihexoside

A

Fabry disease

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64
Q

ST elevation if lead avR. Which artery is occluded?

A

Left coronary

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65
Q

Class IB antiarrhythmics

A

Lidocaine

Mexiletine

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66
Q

What viruses are associated with nonischemic cardiomyopathy

A

Coxsackie

Influenza

Adenovirus

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67
Q

Chemical cardioversion

A
  • Administration of antiarrhythmic medication
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68
Q

How should a NSTEMI be treated?

A

Aspirin

B-blockers

Heparin

Angioplasty (non-emergent)

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69
Q

how are the murmurs heard in aortic stenosis and hypertrophic cardiomyopathy differentiated?

A

Valsalva

  • Decreases venous return/preload
  • Increase HCM murmur
  • Decrease Aortic stenosis murmur
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70
Q

Key control variables for autoregulation in skeletal muscle

A

Lactate

Adenosine

K+

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71
Q

Excess fluid movement out of capillaries results in ___________.

A

Edema

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72
Q

In which conditions do we see a cannon a wave?

A

Complete heart block

PAC/PVC

Ventricular tachycardia

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73
Q

Rank calcium channel blockers based on vascular smooth mucscle effects (greatest to least)

A

Nifedipine>Diltiazem> Verapamil

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74
Q

Maternal _________ can lead to Ebstein’s anomaly.

A

Lithium

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75
Q

General symptoms of endocarditits

A

Fever, chills, sweats, petechiae

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76
Q

AV block seen in Lyme disease improves with _________.

A

Antibiotics

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77
Q

Neprilysin inhibitors should not be administered with ______.

A

ACE inhibitors

*Same side effects

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78
Q

HF leas to the activation of what two physiological systems

A
  • Sympathetic nervous system
  • Renin-angiotensin-aldosterone system
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79
Q

What conditions increase capillary permeability (Kf)?

A

Toxins

Infections

Burns

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80
Q

Types of Shock

A

Cardiogenic

Hypovolemic

Distributive

Obstructive

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81
Q

Prolonged Qt conditions

A

Hypocalcemia

Drugs

LQTS (Long QT syndrome)

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82
Q

Culture negative endocarditis

A

Coxiella burnetii

Bartonella

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83
Q

Diastolic murmur. Disease?

A

Turbulence during ventricular filling (mitral stenosis or aortic regurgitation

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84
Q

Results of K Channel blockage on EKG

A

Prolong Qt

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85
Q

Key control variables for autoregulation in heart

A

CO2

Adenosine

NO

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86
Q

Most common manifestation of chronic Q fever

A

Endocarditis

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87
Q

How is acute heart failure treated?

A

Most: Daily diuretic

Some: Daily long acting nitrate (often oral isosorbide mononitrate)

Rare: Chronic IV infusion inotrope, heart transplant, left ventricular assist device (LVAD)

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88
Q

How does digoxin supress AV node conduction?

A

Increased vagal tone

  • can be used to decrease heart rate
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89
Q

Where are aortic regurgitations heard?

A

Left sternal border

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90
Q

familial cuases of nonischemic cardiomyopathy

A

Mutations

  • Sacromere proteins
  • Beta myosin heavy chain
  • Alpha myosin heavy chain
  • Troponin
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91
Q

Symptoms of acute heart failure

A

Congested/swollen

Pulm edema

Pitting edema

Increased JVP

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92
Q

Valvular atrial fibrillation is associated with ___________.

A

Rheumatic heart disease

*Usually mitral stenosis

NOTE: Non-valvular fibrillation is NOT associated with rheumatic disease

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93
Q

B blocker used to treat glaucoma

A

Timolol

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94
Q

Loop diurectics

A

Furosemide

Bumetanide

Torsemide

Ethacrynic Acid

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95
Q

Phase 0 of myocyte AP

A
  • Nearby myocytes raise membrane potential via gap junctions
  • Rising potential opens fast Na Channels
  • Threshold potential reached (about -70mV)
  • Large Na+ currents leads to rapid depolarization
  • Membrane potential overshoots (>0mV)
  • Fast Na+channels close
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96
Q

a2 agonist

A

Clonidine

Methyldopa

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97
Q

Side effects of RAAS drugs

A

Hyperkalemia (due to decreased aldosterone)

Renal failure (due to decreased GFR)

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98
Q

Mechanism by which viridians strep causes endocarditits

A
  • Bacteria synthesize dextran
  • Dextran adheres to fibrin
  • Fibrin found with endothelial damage
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99
Q

Which valve problem?

IV drug abuser

A

Tricupsid regurgitation

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100
Q

Results of Na Channel blockage on EKG

A

Prolonged QRS

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101
Q

Acute exacerbations of HF

A
  • Infection/trauma/ surgery
  • Ischemia
  • NSAIDS
  • Dietary indiscretion
  • Poor medication compliance
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102
Q

How is dressler’s syndrome treated?

A

NSAIDs or steroids

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103
Q

Class IV antiarrhythmics

A

Ca channel blockers

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104
Q

When afterload ____________ (falls/rises), stroke volume and CO increase.

A

Falls

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105
Q

How is stable angina usually treated?

A

Revascularization

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106
Q

Cuases of heart block

A

Drugs

  • Beta blockers, calcium channel blockers
  • Digoxin

High vagal tone

  • Athletes

Fibrosis and sclerosis of conduction system

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107
Q

Which layer of the heart is infiltrated by eosinophils?

A

Endomyocardium

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108
Q

Which antiarrythymics prolong Qt?

A

Class Ia, III drugs

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109
Q

_________ (fast/slow) HR shortens diastole.

A

Fast

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110
Q

Supravalvular aortic stenosi

A

Narrowing of ascending aorta above aortic valve

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111
Q

Severe disease findings in aortic stenosis

A
  • Late peaking murmur
  • Soft/ quiet S2
    • Stiff valve can’t slam shut
  • Pulsus parvus et tardus
    • Weak and small carotid pulses
    • Delayed carotid upstroke
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112
Q

Which organs are great autoregulators?

A

Heart

Brain

Kidneys

Lungs

Skeletal muscle

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113
Q

S3 and S4 are heard during ______.

A

Diastole

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114
Q

Forms of nitrates

A
  • Nitroglycerin Tablets/ Spray
    • Take during angina attack, before exercise
  • Isosorbide Dinitrate
  • Isosorbide Mononitrate
  • Topical nitroglycerin
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115
Q

Which volumes are effected by an increase in afterload?

A
  • Increased ESV
  • Decreased SV
  • Decreased EF
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116
Q

Side effects of ranolazine

A

Constipation

Dizziness

Headache

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117
Q

Secundum type of ASD

A
  • Defects at site of foramen ovale/ ostium secundum
  • Poor growth of secundum septum
  • Or excessive absorption of primum septum
  • Often isolated defect
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118
Q

What two classes of drugs affect pacemaker AP?

A
  • Calcium channel blockers
    • Slow rate sinus depolarization (slow HR)
    • Slow AV node conduction
  • Beta blockers
    • Slows phase 4
    • Makes it longer to reach threshold
    • Decreases HR
    • Prolong repolarization
    • Slow AV node conduction
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119
Q

Why does the LVEF increase during exercise?

A

More vigorous contraction causes the ESV to decrease. There is more preload but less filling time at fast heart rates.

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120
Q

Which valve problem?

Immigrant or pregnant

A

Mitral stenosis

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121
Q

In which cases can the recurrent laryngeal nerve be compressed?

A

Aortic dissection

Massive LA enlargement

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122
Q

What factors cause a decrease in preload?

A
  • Remove volume
  • Raise heart rate
  • Rool blood in veins
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123
Q

Phospholamban is phosphorylated by ____________. What effect does this have?

A

Beta adrenergic stimulation; this causes phospholamban to stop inhibiting SERCA. SERCA takes up calcium. Muscle relaxes.

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124
Q

Which factor drives smooth muscle proliferation in the intima of arteries?

A

PDGF (Platelet derived growth factor)

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125
Q

Cause of NSTEMI

A
  • Atherosclerotic plaque rupture
  • Thrombus formation
  • Subtotal vessel occlusion
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126
Q

What venous pressure tracing is seen in tricupsid regurgitation?

A

Giant v wave

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127
Q

Mechanism of action of digoxin

A

Inhibits the Na-K pump, increases calcium in myocytes

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128
Q

Side effects of class Ib drugs

A
  • CNS stimulation
    • Tremor, agitation
  • CVS side effects
    • Bradycardia, heart block, hypotension
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129
Q

What is the effect on the arterioles of stenotic vessels in angina?

A

Arterioles are maximally dilated to maintain flow

*Arterioles are not maximally dilated in normal vessels.

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130
Q
  • Sacromeres added in parallel
  • Left ventricular mass increased
  • Wall thickness increased
A

Concentric hypertrophy

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131
Q

Phase 1 of myocyte AP

A
  • Membrane potential is positive
  • K+ channels open
  • Outward flow of K+ returns membrane to approximately 0 mV
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132
Q

most common cause of paroxysmal supraventricular tachycardia

A

Atrioventricular nodal rentrant tachycardia

*More common in young women and requires dual AV nodal pathways

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133
Q

What does a LVEDP pressure considerably greater than PCWP indicate?

A

There is a pressure gradient across the mitral valve, indicating stenosis

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134
Q

Nitroprusside can cause _______ toxicity with prolonged use.

A

Cyanide

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135
Q

How is stable angina diagnosed?

A

Cardiac stress test, which increases demand for O2

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136
Q

How does cushing’s syndrome cuase HTN?

A

Cortisol increases vascular sensitivity to adrenergic agonists

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137
Q

How does the kidney regulate high BP?

A

Decreases salt/ water retention

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138
Q

Common sites of red infarcts

A

Lungs

Small intestines

*Places with dual blood supply

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139
Q

What leads to a patent foramen ovale?

A

Septum primum and secundum fail to fuse

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140
Q

Organ that receives 100% of CO

A

Lung

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141
Q

Short Qt conditions

A

Hypercalcemia

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142
Q

Types of systolic clicks. When are they heard?

A
  • Ejection click
    • Early in systole
    • Before carotid pulse
  • Non-ejection click
    • Late in systole
    • After carotid pulse
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143
Q

EKG changes in NSTEMI

A

St depressions

T-wave inversions

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144
Q

Tamponade EKG

A

Sinus tachycardia

Prominent x decent

Blunted y descent

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145
Q

Type of shock?

High CO

Low SVR

A

Distributive

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146
Q

Inotropes are only for ________ heart failure.

A

Systolic

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147
Q

Which drugs can cause long qt syndrome?

A

Antiarrhythmic drugs

Levofloxacin

Haldol

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148
Q

Severe hypertension whithout end organ damage?

A

Hypertensive Urgency

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149
Q

What conditions decrease viscocity?

A

Anemia

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150
Q

In which conditions do we see a giant v wave?

A

Tricupsid regurgitation

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151
Q

Complications of treating a STEMI with B-blockers

A

Bradycardia and AV block can develop

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152
Q

Results of rupture of posteromedial papillary muscles in mitral valve

A

Severe mitral regurgitation

Acute heart failure

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153
Q

Classic causes of cardiogenic shock

A

Large MI

Advanced heart failure

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154
Q

Angiotensin Receptor blockers

A

Candesartan

Irbesartan

Valsartan

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155
Q

Complications of Ischemia in first 4 days

A

Arrhythmia

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156
Q

On what phase of myocyte AP do verapamil/ diltiazem work?

A

Phase 2

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157
Q

Digoxin benefits in HF

A

Increased CO

Improved symptoms and quality of life

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158
Q

What EKG change is an early sign of ischemia?

A

Hyperacute T waves

*Seen before ST elevations

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159
Q

Class II antiarrhythmics

A

Beta blocks

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160
Q

Of the a1 blckers which is “uroselective”?

A

Tamsulosin (less hpotensive effect)

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161
Q

Automaticity

A

Pacemakers do not require stimulation to initiate action potential. Capable of sel-initiated depolarization

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162
Q

Main regulator of contractility

A

Sympathetic nervous system

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163
Q

Clinical feautures of pericarditis

A
  • Chest pain
  • Fever
  • Leukocytosis
  • Elevated ESR
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164
Q

Digoxin Toxicity

A

GI

neurologic

visual changes

cardiac arrhythmias

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165
Q

Normal PR interval

A

120-200ms

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166
Q

Atherosclerosis Complications

A
  • Ischemia
  • Plaque Rupture
    • Thombi
    • Emboli
  • Hemorrhage into plaque
  • Aneurysm
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167
Q

All forms of heart failure lead to decrease in _________

A

CO

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168
Q

Valsalva manuever

A
  • Patient bears down as if moving bowels
  • Increased thoracic pressure
  • Aortic pressure rises
  • Decreased heart rate and AV conduction
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169
Q

IVC comes from __________

A

Posterior veins

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170
Q

Main use for Class Ib drugs?

A

Ischemic ventricular tachycardia

  • Fast heart rates
  • Depolarized Na channels
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171
Q

What are two main steps of atheroma growth?

A
  1. Fatty streaks
  2. Atherosclerotic plaque
  • Intima thickens
  • Lipids accumulate
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172
Q

Symptoms of hypercalcemia

A

Confusion

Consitipation

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173
Q

Complications of Ischemia in first 5-10 days

A

Free wall rupture

Tamponade

Papillary muscle rupture

VSD

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174
Q

Possible triggers of atrial fibrillation

A
  • Binge drinking
  • Increased catecholamines
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175
Q

Lung findings of HF

A
  • Rales
    • Fluid filled alveoli “pop” open with inspiration
  • X-ray: Congestion
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176
Q

Fatty streaks

A
  • Macrophages filled with lipids
  • Form line along vessel lumen
  • Do not impair blood flow
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177
Q

Clinical features of tamponade

A

Distant heart sounds

Dyspnea

elevated JVP

Hypotension

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178
Q

Key side effect of nifedipine

A
  • Edema
    • Increases capillary hydrostatic pressure
    • Pre-capillary arteriolar vasodilation
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179
Q

Type of shock?

Low CO

Low cardiac pressures

High SVR

A

Hypovolemic

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180
Q

Common location of ventricular pseudoaneurysm

A

Inferior wall

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181
Q

LVEDP

A

Pressure in the left ventricle when filled

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182
Q

Causes of mitral regurg

A

Mitral valve prolapse

Ischemia

Left ventricular dilation

Hypertrophic cardiomyopathy

Endocarditis

Rheumatic heart disease

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183
Q

Causes of congenital long qt syndrome

A

Abnormal K/Na channels

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184
Q

Preload

A
  • Amount of blood loaded into left ventricle
  • How much stretch is on fibers prior to contraction
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185
Q

Bacterial endocarditis complications

A
  • May form abscess beneath valve annulus
  • Persistent fever, bacteremia often indicates abscess
  • Aortic valve abscess can lead to heart block
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186
Q

3 causes of holosystolic murmurs

A

Mitral regurgitation

Tricupsid regurgitation

VSD

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187
Q

Symptoms of hypocalcemia

A

Tetany

Numbness

Spasms

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188
Q

Murmur heard in VSD. Where is it heard?

A

Harsh, holsystolic mumur in tricupsid area

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189
Q

Atrial fibrillation treatment

A
  • Control Heart rate (slow AV node conduction)
    • Beta blockers
    • Calcium channel blockers
    • Digoxin
  • Control heart rhythm
    • Cardioversion
  • Anticoagulation
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190
Q

EKG findings of pericarditis

A

Diffuse ST elevation

PR depression

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191
Q

PV loop: Isovolumic contraction disrupted

A

Mitral regurgitation

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192
Q

Results in an irregularly, irregular pulse

A

Atrial fibrillation

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193
Q

prophylaxis for endocarditis

A

Amoxicillin

Clindamycin

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194
Q

WPW syndrome

A
  • Causes “pre-excitation”
    • Ventricular depolarization before AV nodal impulse
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195
Q

What do the different waves represent on venous pressure tracings?

A
  • a wave= Atrial contraction
  • v wave= Venous filling
  • c wave= tricupsid valve
  • x descent= atrial relaxation
  • y descent= emptying of the atrium
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196
Q

Treatment for ventricular tachycardia?

A

Emergent electrical cardioversion

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197
Q

Absent a wave

A

No organized atrial contraction

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198
Q

Organ that receives highest blood flow by weight

A

Kidneys

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199
Q

only available oral inotrope

A

Digoxin

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200
Q

Escape Rhythm

A
  • Heart block: Lower pacemaker depolarizes ventricles
  • Rate of lower pacemaker determines symptoms
    • Very slow: Dizziness, syncope, hypotension
    • Less slow: Fatigue, exercise intolerance
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201
Q

Clinical features of primary aldosteronism

A

Resistant HTN

Hypokalemia

Normal volume status on physical exam

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202
Q

paradoxical S2 splitting

A

Delayed closure of aortic valve

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203
Q

What conditions increase interstitial osmotic pressure?

A

Lymphatic blockage

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204
Q

What maneuvers cause a decrease in afterload?

A

Amyl Nitrate- vasodilator

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205
Q

What molecules are produced by skeletal muscles during exercise that cause vasodilation?

A

Adenosine

Lactate

Potassium

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206
Q

Class III drugs bind best in ______ state.

A

Resting

*More binding at slow rates

207
Q

Side effects of a1 blockers

A

Postural hypotension

208
Q

Atrioventricular nodal rentract tachycardia (AVNRT) treatment

A
  • many patients need no therapy
  • Beta blockers, verapamil/ diltiazem
  • Surgical ablation of slow pathway
209
Q

Enteroccoccus endocarditis is associated with….

A

Manipulation of the GI/GU tract

  • Abdominal surgery
  • Urinary catheter
  • TURP for treatment of BPH
210
Q

Afterload

A

Factors resisting flow out of left ventricle

211
Q

How do ACE inhibitors precipitate renal failure?

A
  • Normal GFR depends on angiotension II
    • ATII causes efferent arteriole vasoconstriciton, which maintains GFR
212
Q

Channels prominent in phase 3 of pacemaker action potential

A

Delayed rectifier K+ channels open, return cell to -60 mV

213
Q

In what cases, do you see eccentric hypertrophy?

A
  • Volume overload of LV
    • Aortic regurgitation
    • Mitral regurgitation
  • Cardiomyopathy
214
Q

How is mean arterial pressure calculated?

A

Diastolic BP + 1/3(Systolic-Diastolic)

215
Q

Eventual result of L-transposition of great arteries

A

Eventually right ventricle fails

216
Q

Side effects of methyldopa

A

Hemolytic anemia

217
Q

Normal QRS

218
Q

Two cardiac effects of digoxin

A
  • Increases contractility
    • Used in systolic heart failure with decreased LVEF
  • Slows AV node conduction
    • Used in atrial fibrillation to slow ventricular rate
219
Q

Early filling sound. S3 or S4?

220
Q

Calcium channel blockers

A

Verapamil

Diltiazem

221
Q

Side effects of clonidine

A

Rebound hypertension

Sedation

222
Q

Complications interventricular septal rupture

A

Loud, holosystolic murmur

Hypotension

RHF (increases JVP, edema)

223
Q

Side effects of potassium-sparing diuretics

A
  • Hyperkalemia
  • Gynecomastia in men (not eplerenone)
  • Amenorrhea in women
224
Q

What endocrine problem can lead to atrial fibrillation?

A

Hyperthyroidism

225
Q

How is Wall tension calculated?

A

Tension= (P x r)/(2h)

h= wall thickness

226
Q

When is a s4 heard?

A

Stiff left ventricle

  • Long-standing HTN
  • Hypertrophic cardiomyopathy
  • Diastolic heart failure
227
Q

Late filling sound. S3 or S4?

228
Q

Restrictive heart disease leads to severe ________ dysfunction.

229
Q

Heart failure

A

Impaired ability of the heart to pump blood. Hallmark: low CO

230
Q

Risk factors for coronary artery disease

A
  • prior coronary disease
  • Coronary risk equivalents
    • Diabetes
    • Peripheral artery disease
    • CKD
231
Q

Prolonged QRS interval

A

Right bundle branch block

Left bundle branch block

232
Q

Class I drugs bind best in the _________ state. These drugs are said to exhibit ________ dependence.

A

open/inactive; use

*Class1 drugs work best at a fast HR

233
Q

least effect on AP of class 1 drugs

234
Q

Causes of 1st degree AV block

A
  • Beta blockers
  • Calcium channel blockers
  • Well-trained athletes
235
Q

How is obstructive shock treated?

A

resolve obstruction

236
Q

Quinidine

A

Class Ia

Oral

Can decrease recurrence rate of atrial fibrillation

Associated with increased mortality

237
Q

Causes of obstructive shock

A

Tamponade

Tension pneumothorax

Massive PE

238
Q

Large a wave

A

Increased atrial contraction pressure

239
Q

Electrical cardioversion

A
  • Deliver “synchronized” shock at time of QRS
  • Adminster anesthesia
  • Deliever electrical shock to chest
  • All myocytes depolarize
  • Usually sinus node first to repolarize/depolarize
240
Q

How is distributive shock treated?

A

Vasopressors

  • Phenyephrine
  • Epinephrine
  • Norepinephrine
241
Q

____________ is caused by untreated, rapid atrial fibrillation.

A

Cardiomyopathy

242
Q

Cold skin indicates what type of shock

A

Cardiogenic and hypovolemic

243
Q

Phase 2 of myocyte AP

A
  • L- type Ca2+ channels open, leading to inward Ca2+ current
  • Contraction trigger: excitation-contraction coupling
  • K+ leaks out (down gradient)
  • Delayed rectifier K+ channels
  • Plateau of membrane charge
244
Q

Class Ia antiarrythmic

A

Quinidine

procainamide

245
Q

Determinants of CO

A
  • Preload
  • Afterload
  • Contractility
  • HR
246
Q

If leads ____ and _________ are both positive, axis is normal.

247
Q

Weak peripheral pulses. Disease?

A

Aortic stenosis

248
Q

Common sites of white infarct

A

Heart, kidneys, spleen

249
Q

Causes of distributive shock

A

Sepsis

Anaphylaxis

Neurogenic

250
Q

Ivabradine

A
  • Selective sinus node inhibitor
  • Inhibits funny current
  • Used in patients on max-dose beta blocker with increased HR
251
Q

Carotid massage

A
  • Examiner presses on neck near carotd sinus
  • Strech of baroreceptors
  • CNS response as if high BP
  • Increased vagal tone
  • Decrease in AV node conduction
252
Q

What conditions can cause high viscocity?

A

Polycythemia

Multiple myeloma

Spherocytosis

253
Q

What is the relationship between anticoagulant administration and cardioversion?

A

If symptoms have lasted more than 48 hrs, a possible thrombus could have formed. Before conducting cardioversion, antiagulatants should be given for 3 weeks. Anticoagulants should be given 4 wks after cardioversion as well

254
Q

Which maneuvers increase preload/venous return?

A

leg raise

Squatting

255
Q

Which class I antiarrhythmic?

Increase QRS and QT

Increase AP and ERP

256
Q

LVEDV

A

Volume of blood in the left ventricle when filled

257
Q

Heaves. Disease?

A

Left ventricular hypertrophy or right ventricular hypertrophy

258
Q

Continous, “machine-like” murmur

A

Patent ductus arteriosis

259
Q

Abnormal heart sounds associated with heart failure

A
  • S3 (associated with high left atrial pressure)
  • S4 (associated with stiff left ventricle)
  • Displaced apical impulse- enlarged heart
260
Q

What effect does exercise have on pulse pressure?

A

Increase in PP

  • SBP rises
  • DBP decreases slightly or stays normal
261
Q

Potential causes of high output heart failure

A

Severe anemia

Thyroid disease

Beriberi

AV fistulas (post- surgical)

262
Q

What venous pressure tracing is seen in atral fibrillation?

A

Absent a wave

263
Q

Low flow symptoms

A

Cool extremities

Cachexia

Confusion

264
Q

___________ is life-threatening in WPW.

A

Atrial fibrillation

265
Q

What maneuvers cause an increase in afterload?

A

Hand grip-clench fist

266
Q

What are the 3 main situations that lead to a red infarct?

A
  • Blockage of venous drainage
  • Tissues with dual circulation
  • Flow re-establoshed to necrotic area
267
Q

Causes of diastolic murmurs

A

Aortic regurgitation

Mitral stenosis

Pulmonic regurgitation

Tricupsid stenosis

268
Q

Liddle syndrome

A

Genetic disorder

Increased activity of epithelial sodium channels

Low aldosterone levels

269
Q

Types of Aortic dissection

A

Type A

  • Involves ascending aorta and/or arch
  • Surgically

Type B

  • Descending aorta
  • Can be treated medically
270
Q

When do diastolic murmur occur?

A

Between S2-S1

271
Q

For right axis deviation, lead _________ is negative.

272
Q

Venous return should be equal to the __________.

273
Q

Major effect of a vagotomy

A

Decreases acid production in stomach

274
Q

Organ that receives largest O2 content from blood

275
Q

medical therapy for ischemia

A
  • Increase O2 supply
    • Dilate coronary arteries
    • Increase diastole
  • Decrease O2 demand
    • Decrease HR
    • Decrease contractility
    • Decrease afterload
    • Decrease preload
276
Q

Role of vasa vasorum

A

Supplies blood to medial layer in thick vessels

277
Q

What are the two ways the an ASD can form?

A

Septum secundum too short

Septu primum excessively reabsorbed

278
Q
  • Filling completed
  • Contraction beginning
279
Q

What factors increase afterload?

A
  • Raise in mean blood pressure
  • Obstruct outflow of left ventricle
    • Aortic stenosis
    • Hypertrophic cardiomyopathy
280
Q

Why are weak lower extremity pulses associated with coarctation of the aorta?

A
  • Low BP in lower extremities
  • Increase renin release
  • Salt/water retention
  • Vasoconstriction
  • Weak pulse
281
Q

In what condition can you see a short PR interval?

A

Wolff-Parkinson White Syndrome

282
Q

Special complications of an inferior MI

A
  • Right ventricular infarction
    • Loss of RV contractility
    • Elevated JVP
    • Decreased preload to left ventricle
      • Hpotension
  • Sinus bradycardia and heart block
  • Vagal stimulation from inferior wall ischemia
283
Q

What is the primary determinant of systolic BP?

284
Q

Supravalvular aortic stenosis is seen in ___________ syndome.

285
Q

Phases of valsalva maneuver

A

Phase I

  • Increased thoracic pressure
  • Decreased venous return (compression of veins-> increased RA pressure)
  • Transient rise in aortic pressure
  • Decrease in heart rate and AV node conduction

Phase II

  • Decreased preload, leads to decreased CO
  • Increased HR and AV node conduction
286
Q

SVC comes from _______ and __________.

A

R common cardinal vein and R anterior cardinal vein

287
Q

How is hypovolemic shock treated?

A

Blood transfusions

IV fluids

288
Q

Neprilysin

A

Degrades ANP/BNP

*Also degrades bradykinin

289
Q

In which conditions, do we see a large a wave?

A

Tricupsid stenosis

Right heart failure/ Pulm HTN

290
Q

Bilbus cordis gives rise to what structures

A

Smooth LV/RV

291
Q

___________ in a patient on mexiletine indicates toxicity.

292
Q

Causes of bundle branch blocks

A
  • Slowly progressive fibrosis/sclerosis
  • LBBB: Prior MI, cardiomyopathy
  • RBBB: Right heart failure

*More common in older patients

293
Q

Stent complications

A
  • Restenosis
    • Slow, steady growth of scar tissue over stent
  • Thrombosis
294
Q

a1 blockers

A

Tamsulosin

Alfuzosin

Doxazosin

Terazosin

295
Q

What is the key regulatory protein of lusitropy?

A

Phospholamban

296
Q

Causes of T wave inversions

A
  • Raised intracranial pressure
  • Resolving pericarditis
  • Bundle branch blocks
  • Ventricular hypertrophy
297
Q

Phase 4 of myocyte AP

A
  • Resting potential: about -85 mV
  • Constant outward leak of K+
  • “Inward rectifier channels”
  • Na + and Ca2+ channels are closed
298
Q

There are no signs of volume overload with renal artery stenosis. Why?

A

Normal kidney compensates

299
Q

Hydralazine

A
  • Direct arteriolar vasodilator
  • Rarely used for hypertension
  • Combined with nitrates for HF
  • Safe in pregnancy
  • Causes drug induced lupus
300
Q

Viridans strep causes __________ endocarditis.

301
Q

Anterior ST elevation in V1-V4. Artery?

302
Q

Subtotal occlusion of the coronary artery can result in..

A

Unstable angina

Non ST elevation myocardial infarction

303
Q

Classic imaging findings in restrictive heart disease

A

Normal left ventricular function/size

Bi-atrial enlargement

304
Q

Which type of cardiomyopathy is often seen in systolic heart failure?

A

Dilated cardiomyopathy (eccentric hypertrophy)

305
Q

How can the risk of recurrent events be reduced after coronary artery disease?

A
  • Aspirin
  • Statins
  • B-blockers
    • Used in patients with prior infarction (STEMI/NSTEMI)
306
Q

Complications of papillary muscle rupture

A
  • Acute mitral regurgitation (holosystolic murmur)
  • HF
  • Respiratory distress
307
Q

Requirement for endocarditis diagnosis

A

2 major

1 major 3 minor

5 minor

308
Q

Older patients and hypertensive patients have a/an ___________ (decreased/increased) pulse pressure

309
Q

Pheochromocytoma diagnosis

A

Catecholamine breakdown products

  • Metanephrines
  • Vanillylmandelic acid (VMA)
310
Q

Lateral wall of the heart is supplied by __________.

A

Left cicumlflex artery

311
Q

Ejection fraction calculation

312
Q

Primitive ventricle gives rise to what structure

A

Trabeculated LV/RV

313
Q

Warm skin indicates what type of shock

A

Distributive

314
Q

a ___________ aortic valve in seen in 60% of coarctation cases.

315
Q

Cannon a wave

A

Atria against closed tricupsid valve

316
Q

________ sometimes used for diagnosis in dyspnea. High levels suggest HF.

A

BNP (brain natriurectic peptide), released by ventricles

317
Q

Which drugs are associated with Drug induced Lupus

A

Isonozaid

Hydralazine

Procainamide

*Anti-histone antibodies

318
Q

Primitive atrium gives rise to what structure

A

Trabeculated atria

319
Q

How does digoxin increase contractility?

A
  • Inhibits Na-K- ATPase
    • Na trapped inside of cell
    • Less Na exchange for Ca
    • More Ca inside of cell
320
Q

Adenosine effects are blocked by ______ and __________.

A

Theophylline; caffeine

321
Q

Index of contractility

A

Ejection fraction

322
Q

Organ that receives largest systemic blood flow

323
Q

Physiological S2 splitting

A

Increased venous return delauys P2 by 40-60 ms

*Single to split inspiration

324
Q

Treatment of STEMI

A
  • Emergency angioplasty
    • Should be done <90 mins
  • Thrombolysis
    • Should be done <30 mins
325
Q

procainamide

A

Class Ia

IV

Slows conduction in accessory pathways (WPW)

used in arrhythmias associated with bypass tracts

326
Q

Clinical features of constrictive pericarditis

A

Dyspnea

Prominent right heart failure

327
Q

What EKG effect can be seen with ranolazine use?

A

QT prolongation

328
Q

In which types of CAD do you see subendocardial ischemia?

A

Stable angina, undtable angina, NSTEMI

329
Q

Which parts of the heart receive blood supply from the LAD?

A

Anterior wall

Anterior septum

Apex

330
Q

Pheochromocytoma symptoms

A

Palpitations

Headache

Episodic sweating

331
Q

Which valve problem?

Marfan’s

332
Q

Side effects of adenosine

A
  • Skin flusing, hypotension
  • Dyspnea, chest pain
333
Q

how can fibrinous pericarditis be distinguished from Dressler’s syndrome?

A
  • Occurs days after MI
  • Not autoimmune
334
Q

What effect do beta blockers have on the graph for pacemaker cells?

A

Decrease the slope of phase 4

Prolong repolarization (phase 3)

335
Q

What factors increase contractility?Decrease?

A

Increase: Exercise, Inotropes

Decrease: MI, HF

336
Q

Complications of treating STEMI with nitrates

A

Hypotension

337
Q

Potassium sparing diuretics

A

Spironolactone

Eplerenone

338
Q

Sinus p waves are upright in which leads?

A

II, III, and F

339
Q

Clinical feautures of restrictive heart disease

A

Dyspnea

Prominent right heart failure

340
Q

Mechanism of action of loop diuretics

A

Inhibit Na-K-Cl pump in ascending loop of Henle, result in salt-water excretion, which relieves congestion

341
Q

Endocardial cusion defects are common in __________.

A

Down syndrome

342
Q

How is cardiogenic shock treated?

A

Inotropes

  • Milrinone
  • Dobutamine
343
Q

Causes of Torsade de Pointes

A

Antiarrhytmic drugs

Hypokalemia

Hypomagnesemia

Hypocalcemia (rare)

344
Q

Low flow symptoms are seen in ________ (systolic/ diastolic) heart failure only.

345
Q

Which maneuvers decrease preload/venous return?

A

Valsalva

Standing

346
Q

How do nitrates relieve angina?

A

Cause pool of blood in veins, which lowers preload and leads to less work for the heart

347
Q

Symptoms of left heart failure

A
  • Dyspnea especially on exertion
  • Paroxysmal nocturnal dyspnea
  • Orthopnea
348
Q

When is alprostadil a useful drug?

A

Useful when poor RV to pulm artery flow

  • Tetralogy of Fallot
  • Pulmonary atresia
349
Q

Which type of Step bovis has the strongest association with colon cancer?

A

S. gallolyticus

350
Q

Which volumes increase with an increase in preload?

A
  • EDV
  • SV
  • EF (slightly)
351
Q

Where is the murmur heard in mitral regurgitation?

A

Holosystolic murmur heard best at the apex (at the 5th intercostal space, mid-clavicular line)

352
Q

Major indications for revascularization

A

Angina

MI

Systolic dysfunction

353
Q

What venous pressure tracing is seen in AV dissociation?

A

Cannon a wave

354
Q

Cause of STEMI

A
  • Atherosclerotic plaque rupture
  • Thombus formation
  • Complete vessel occlusion
355
Q

which blood vessel has the highest change in pressure? Lowest?

A

Highest: Arterioles

Lowest: Veins

356
Q

Why does an ASD result in a wide, fixed splitting of S2?

A

Increased volume in RA/RV delays closure of the pulmonic valve

357
Q

Rank calcium channel blockers based on HR/contractility effects (greatest to least)

A

Verapamil> Diltiazem> Nifedipine

358
Q

What part of the brain senses signals from baroreceptors?

A

Nucleus Solitarius

359
Q

Why is S4 not heard in atrial fibrillation?

A

You need the atria to contract to hear this sound

360
Q

Classic causes of concentric hypertrophy

A

Hypertension

Aortic stenosis

361
Q

Drugs used to treat STEMI

A
  • Aspirin
  • Heparin
  • B-blockers
  • Nitrates
  • Clopidogrel
  • Eptifibatide
  • Bivalirudin
362
Q

Risk factors for atrial fibrillation

A
  • >80 yrs
  • More common in women
  • HTN, CAD
  • Heart failure, valvular disease
363
Q
  • Emptying completed
  • Relaxation beginning
364
Q

Verapamil/diltiazem actions

A
  • Negative inotropes
    • Reduced HR/ contractility
    • Can precipitae acute heart failure if LVEF is very low
365
Q

What factors decrease afterload?

A
  • Lower the mean blood pressure
  • Treat aortic valve disease, hypertrophic cardiomyopathy
366
Q

Key control variables for autoregulation in lungs

A

Hypoxia->Vasoconstriction

367
Q

Poor R wave progression seen in ___________ ischemia.

368
Q

Atrial fibrillation eliminates ventricular _________.

A

Prefilling, which leads to a decrease in preload.

*Can lead to low CO and hypotension, especially in preload dependent patients.

369
Q

Coronary arteries are perfused during ________ (diastole/systole).

370
Q

How digoxin toxicity treated?

371
Q

Nonselective b blockers

A

Propanolol

Timiolol

Nadolol

372
Q

In which conditions are peaked T waves seen?

A

Hyperkalemia

Early ischemia (hyperacute)

373
Q

Amiodarone aslso hase effects of which class of drugs?

A

I, II, and IV antiarrythmics

374
Q

Patent ductus arteriosus becomes the ___________.

A

Ligamentum arteriosum

375
Q

Class Ic antiarrhythmics

A

Flecainide

Propafenone

376
Q

Major determinant of systolic BP

377
Q

In the body, which compartments are used to calculate the change in pressure?

A

Arterial pressure-right atrial pressure

378
Q

Which three beta blockers are useful in chronic systolic HF?

A

Metoprolol

Carvediol

Bisoproplol

379
Q

What conditions increase capillary pressure?

A

Heart failure

380
Q

Clinical features of HCM

A

HF, angina, sudden cardiac death, syncope, mitral regurg

381
Q

EKG in WPW

A

Delta Wave

Short PR

382
Q

Which baroreceptor senses elevated and low BP?

A

Carotid sinus

383
Q

Result of severed CN X on heart?

A
  • Vagotomy
  • Unopposed sympathetic cardiac stimulation
  • Increase in heart
384
Q

Causes of tamponade

A

Cancer

Uremia

Pericarditis

Trauma

385
Q

Which Beta blockers should be used to treat angina? Which should not?

A

Use: B1 selective drugs (Metoprolol, atenolol)

Don’t use: partial agonist (Pindolol, acebutolol)

386
Q

Slowest conduction is through __________. Fastest conduction is through ______.

A

AV node; Purkinje fibers

Purkinje>Atria>Ventricles> AV node

387
Q

Minor criteria for endocarditits

A

Fever

Risk factors

Roth spots, Osler node, Janeway lesions, splinter

388
Q

Conditions with left axis deviation

A

Left bundle branch block

Ventricular rhythm

389
Q

Casues of Systolic murmurs

A
  • Aotic stenosis
  • Mitral regurgitation
  • Pulmonic stenosis
  • Tricuspid regurgitation
  • Hypertrophic cardiomyopathy
  • Ventricular septal defect
390
Q

How does a decrease O2 effect the work of the heart?

A

Heart starved for O2->Reduce O2 demand->Low output->Need to increase work

391
Q

magnesium is used in the acute management of _________. By what mechanism?

A

Torsade de pointes. Mg blocks influx of Ca into cells. Ca influx leads to early after depolarizations

392
Q

What factors provide evidence of a hypertensive emergency?

A
  • Neurologic impairment
    • Retinal hemorrhages, encephalopathy
  • Renal impairment
    • Acute renal failure
    • Hematuria, proteinuria
  • Cardiac ischemia
393
Q

Which class I antiarrhythmic?

Increased QRS

+/- QT

+/- AP

394
Q

explain how epinephrine acts at different doses

A

Low dose: beta 1 and beta 2 agonis

High dose: alpha agonist

395
Q

Baroreceptors sense ___________.

396
Q

Symptoms of Mobitz II

A

Dizziness, syncope

397
Q

PV loop: Isovolumic Relaxation disrupted

A

Aortic regurgitation

398
Q

_________ is the most commonly injured cardiac chamber in penetrating chest trauma.

399
Q

Diastolic rumbling murmur, preceded by opening snap

A

Mitral stenosis

*time to opening snap associated with severity. Higher left atrial pressure, leads to a decreased time to opening snap

400
Q

which blood vessel has the highest resistance? Lowest?

A

Highest: Arterioles

Lowest: Veins

401
Q

Complications of coarctation of the aorta

A

Heart failure

Aortic rupture/dissection

Endocarditis/endarteritis

402
Q

sinus venosus gives rise to what structure

A

Right horn: RA

Left horn: Coronary sinus

403
Q

Why is there a widened pulse pressure in patent ductus arteries

A
  • Loss of volume in arterial tree through PDA
  • Low diastolic pressure, leads to increased pulse pressure
404
Q

Which type of hypertrophy is often seen in systolic heart failure?

A

Concentric

405
Q

How can radiation cause restrive heart disease?

A

May cause inflammation

Fibroblast recruitment

Extracellular matrix deposition

Collagens and fibronectin

406
Q

Major causes of restrictive heart disease

A

Amyloidosis

Sarcoidosis

Fabry disease

Hemochromotosis

Post-radiation fibrosis

Pericarditis

Loeffler’s syndrome

Endocardial fibroelastosis

407
Q

Hepatojugular reflux

A
  • Pressure on abdomen raises JVP
  • With failing RV, increase is greater
408
Q

Endocardial cushions give rise to what structures

A

Atrial septum

Ventricular septum

AV valves

Semilunar valves

409
Q

Primum type of ASD

A
  • Defect at site of ostium primum
  • Failure of primum septum to fuse with endocardial cushions
  • Located near AV valves
  • Often occurs with other defects
410
Q

In which types of CAD do you see transmural ischemia?

411
Q

How do viruses cause cardiomyopathy?

A

Virus enters myocytes causes myocarditis which leads to cardiomyopathy

412
Q

Decresendo blowing diastolic murmur

A

Aortic regurgitation

413
Q

Aorticopulmonary septum formed from ___________ and fuses with _________.

A

Neural crest cells; Interventricular septum

414
Q

Risk factors for aortic dissection

A

Aortic damage

  • HTN
  • Atherosclerosis
  • Thoracic aneurysm

Abnormal collagen

  • Marfan syndrome
  • Ehler’s Danlos

Others

  • Bicupsid aortic valve
  • Turner Syndrome
  • Tertiary syphilis
415
Q

explain how dopamine acts at different doses

A

Low dose: dopamine agonist

Medium dose: beta 1 agonist

High dose: alpha agonist

416
Q

How do cyclosprine and tacrolimus cause hypertension?

A
  • Calcineurin inhibitors
  • Renal vasoconstriction
    • Salt/water retention
417
Q

Sings and symptoms of HF

A
  • Low flow signs
    • Loss of appetitie
    • Cachexia
    • Confusion
    • Cool extremities
    • “Narrow pulse pressure”
  • Seen only with low CO
418
Q

Which antihypertensive drugs cause orthostatic hypotension?

A

A-1 blokers

ACE inhibitors (especially in patients on diuretics)

419
Q

Pulse pressure is _________ (directly/indirectly) related compliance.

A

Indirectly

420
Q

Class Ib drugs, bind Na channels in the _______ state.

A

Depolarized

NOTE: These drugs alsor rapidly unbind, so are more effective in fast heart rates

421
Q

Abdominal pain with isolated increase in ________ could be MI.

422
Q

Main roles of calcium channel blockers

A

Vasodilators

Negative chronotropes/inotropes

423
Q

Nesiritide

A

Recombinant BNP, vasodilator, decreases afterload and increases CO

424
Q

Adverse effects of Nitrates

A

Heachache

Flushing

Hypotension

Angina

425
Q

Milrinone

A
  • PDE3 INHIBITOR
    • PD3 breaks down cAMP in myocytes
  • INhibition leads to an increase in cAMP, which increase contraction
  • Vascular smooth muscle increase in cAMP leads to dilation
426
Q

Which class I antiarrhythmic?

+/- QRS

Decreased QT

Decreased AP

Decreased ERP

427
Q

Nitrates can be used to treat ischemia in what two ways?

A
  • Venous dilation
    • Lowers preload
  • Arterial dilation
    • Increase coronary perfusion, hence O2 supply

NOTE: In patients with severe CAD, sympathetic activation can cause a reflex effect, which increases contractility. Administering beta blocker Ca channel blockers blunt this effect.

428
Q

Carcinoid heart disease

A
  • Caused by carcinoid tumors of intestines
  • Secrete serotonin
  • Fibrous deposits tricupsid/pulmonic valves
  • leads to stenosis and regurg
429
Q

What phase of myocyte AP do class III antiarrhythmic drugs work?

430
Q

What factors cause an increase in preload?

A
  • Add volume
  • Slow heart rate
  • Constrict veins
431
Q

Aliskiren

A

Renin inhibitor

Reduces ATI levels

432
Q

What volumes/ pressure are effected in systolic heart failure?

A
  • Decreased contractility
  • Decreased cardiac output
  • Decreased SV
    • Drastic increase in ESV
    • Increase in EDV
    • Increase in LVEDP
433
Q

What drugs are used to prevent stent thrombosis

A

Aspirin

Clopidogrel

Prasugrel

Ticagrelor

*After 1 year stent no longer exposed to blod and most patients take aspirin only

434
Q

Metolazone

A
  • Thiazide-like diuretic
  • Inhibits Na-Cl reabsorption distal tubule
    *
435
Q

What factors increase contractility?

A
  • Sympathetic nervous system activity
    • Increased calcium
    • Exercise, stress
  • Sympathomimetic drugs
  • Digoxin
    • Inhibits Na-K pump, increases calcium in myocytes
436
Q

EKG abnormalitiy with SVT

A

Retrograde P waves

437
Q

side effects of amiodarone

A

Hyper and hypothyroidism

Increased liver function tests

Photosensitivity

Blue-grey discoloration

Corneal deposits

Pulmonary fibrosis

438
Q

Atrial fibrillation ablation

A

Electrically isolation of pulm vein creates small scar in LA, preventing conduction in that area

439
Q

Constrictive pericarditis venous curve signs

A

Rapid y descent

440
Q

Result of carotid occlusion

A

Increase in HR and BP, due to an interpretation of a decrease in BP

441
Q

Beta blockers used to treat portal hypertension

A

Nadolol

Propranolol

442
Q

Side effects of metolazone

A

additional fluid

K+ loss

443
Q

Thiazide diuretics

A

Hydrochlorothiazide

Chlorthalidone

Metolazone

444
Q

If you notice a wide QRS and V1 is facing upward. What is the prognosis?

445
Q

Digoxin should not be used in people with…

A

CKD

Hypokalemia

446
Q

Electrical causes of paradoxical splitting

A

Delayed LV activation

  • LBBB
  • RV pacing
447
Q

Treatment for primary aldosteronism

A

Spironolactone

Epleronone

*Aldosterone antagonists

448
Q

3 types of AV blocks

A
  • Type 1
    • Prolongation of PR interval only
    • All p waves conducted
  • Type 2
    • Some p waves conducted, some not
    • Progressive PR prolongation (Mobitz Type 1)
    • Two sub types: Mobitz 1 and Mobitz 2
    • RR intervals NOT regular
  • Type III
    • No impulse conduction from atria to ventricles
    • Regular RR intervals
449
Q

Most common site of aortic rupture

450
Q

How is cardiomyopathy caused by tachycardia-mediated?

A
  • Constant, rapid heart rate for weeks/months
  • Leads to depression of LV systolic function

*Reversible with slower heart rate

451
Q

another name for a systolic crescendo-decrescendo murmur

A

Ejection murmur

452
Q

WPW treatment

A

Ablation of accessory pathyway

453
Q

Phase 3 of myocyte AP

A
  • Ca 2+ channels inactivated
  • Persistent outflow of K+
  • Resting potential back to -85 mV
454
Q

____________ aneurysms occur in about 10% of patients with coarctation.

A

Intracranial

455
Q

Ebstein’s anomaly

A
  • Apical displacement of TV leads to small RV
  • Severe tricupsid regurg
  • Can leads to right heart failure
456
Q

Causes of loud P2

A

Pulmonary HTN

457
Q

Which defects can cause central cyanosis early in life

A

Tetralogy of fallot

transposition of great vessels

Truncus arteriosus

Tricusid atresa

Total anomalous pulm venous return

458
Q

Major determinant of diastolic BP

A

total peripheral resistance

459
Q

Two main causes of AV blocks. compare the two

A
  • AV node disease
    • Less dangerous
    • Conduction imprives with exertion
  • HIS- purkinje disease
    • More dangerous
    • Usually does not improve with exertion
    • Often progresses to complete heart block
    • Often requires a pacemaker
460
Q

Major sites of atherosclerosis

A

Abdominal aorta

Coronary arteries

Popliteal arteries

Internal carotid

Circle of Willis

461
Q

Histology of HCM

A

Myocyte disarray

Hypertrophy

Interstitial fibrosis

462
Q

_____________ is the most common cause of sudden death in adults.

A

Coronary artery disease

*In younger patients , its hypertrophic cardiomyopathy

463
Q

Class III antiarrhythmics

A

Amiodarone

Sotalol

Dofetilide

Ibutilide

464
Q

Mobitz II

A
  • Block usually in the HIS-purkinje system
  • Often seen with bundle branch block
465
Q

Channels prominent in phase 4 of pacemaker action potential

A

Funny current

  • Spontaneous flow of Na+
466
Q

Major criteria for endocarditits

A

Positive blood cultures

Vegetation on echocardiogram

467
Q

EKG abnormality seen in atrial fibrillation

A

No p waves

468
Q

What factors are modified by baroreceptor response?

A
  • HR/ contractility
  • Arterial tone
  • Venous tone
  • Renal renin release
469
Q

Pericarditis treatment

A

NSAIDS

Steroids

Colchicine

470
Q

How should HTN as a rsult on cyclosporine and tacrolimus be treated?

A

Diltiazem (allows lower amount of cyclosporine to be used)

471
Q

_____________ refractory period determines HR.

472
Q

What murmurs can be heard at the left upper sternal border?

A

Pulmonic murmurs

patent ductus arteriosus

473
Q

Lateral ST elevation in -> I,L,V5,V6.Artery?

A

Left circumflex artery

474
Q

__________ ischemia occurs with complete % flow obstructions.

A

Transmural

475
Q

Where are baroreceptors located?

A
  • Aortic arch
  • Carotid sinus
  • Kidneys
476
Q

Causes of persistent S2 splitting

A

RBBB or Pulmonary Hypertension

477
Q

Nifedipine function

A
  • Vasodilator
    • Lower blood pressure
    • Reduce afterload
    • Dilate coronary arteries
    • May cause reflex tachycardia
478
Q

Vagal manuevers

A
  • Valsalva
  • Breath holding
  • Coughing
  • Deep respirations
  • Gagging
  • Swallowing
479
Q

Mechanical causes of paradoxical splitting

A

Delayed LV outflow

  • LV systolic failure
  • Aortic stenosis
  • Hypertrophic cardiomyopathy
480
Q

Result of severed CN IX

A

Increase in HR and BP, due to an interpretation of a decreased BP

481
Q

Most common cause of systolic heart failure

482
Q

B1 selective antagonist

A

Atenolol

Metoprolo

Esmolol

483
Q

Inferior ST elevation in II, III, F. Artery?

A

Posterior descending artery

484
Q

SA and AV nodes supplied by the __________.

485
Q

Lusitropy

A

Myocardial relaxation

486
Q

Valvular atrial fibrillation has a very high risk of _________.

487
Q

Symptoms of AV blocks

A
  • Bradycardia
  • Fatique, dizziness, syncope

*Symptomatic AV block often treated with a pacemaker

488
Q

Types of Cardioversion

A
  • Electrical
  • Chemical
  • Spontaneous
489
Q

Which drugs block L-type Ca channels?

A

Verapamil/ Diltiazem

490
Q

Arteriolar Rarefaction

A

Loss of arterioles

Arterioles close off and get resorbed

491
Q

Symptoms of chronic heart failure

A

Euvolemic

Clear lungs

no pitting edema

JVP flat

492
Q

In which conditions do we seen an absent a wave?

A

Atrial fibrillation

493
Q

Pompe disease

A

Glycogen storage disease

Acid alpha-glucosidase deficiency

Enlared muscles, hypotonia

Cardiac enlargement

494
Q

How does the cardiac tissue extract more O2 during exercise?

A

Coronary vasodilation, which leads to an increased blood flow.

NOTE: Cardiac tissues cannot extract more O2 from RBCs as they already extract the maximum amount

495
Q

Coronary steal is induced by _________.

496
Q

Symptoms of paroxysmal supraentricular tachycardia

A
  • Sudden onset palpitations
  • Chest discomfort
  • Rarely syncope
497
Q

bundle branch blocks interfere with detection of ________.

498
Q

Result of carotid massage

A
  • Decreased HR and BP due to interpretation of increased BP
499
Q

What factors decrease contractility?

A
  • Sympathetic system blocking drugs
    • Beta blockers
  • Calcium channel clockers
  • Heart failure
500
Q

Verapamil side effects

A

Constipation

Hyperprolactinemia

Gingival hyperplasia (seen in all types of calcium channel blockers)

501
Q

What volumes/ pressure are effected in diastolic heart failure?

A
  • Decrease in LV compliance
  • Decrease in lusitropy (rate of myocardial relaxation)
  • Decreased CO
  • Decreased SV
    • Decreased EDV
  • Increase in LVEDP
502
Q

Key control variables for autoregulation in skin

A

Sympathetic stimulation

503
Q

SV calculation

504
Q

Channels prominent in phase 0 of pacemaker action potential

A

L-type Ca2+ channels open, which depolarizes the cell

505
Q

General mechanism of action of class II and IV antiarrhythmic

A

Slow sinus and AV node conduction

506
Q

Pulse Pressure calculation

A

Systolic- Diastolic

507
Q

Most murmurs increase with more preload except ________ and ________.

A

Hypertrophic cardiomyopathy; mitral valve prolapse

508
Q

Key exam finding of renal artery stenosis

A

Renal bruit

509
Q

Murmurs Grading

A

I- barely audible on listening carefully

II- faint but easily audible

III- loud and easily audible, no thrill

IV- loud murmur with a thrill

V- heard with scope barely touching chest

VI- audible with scope not touching the chest

510
Q

STEMI “special” subtypes

A
  • Left main
    • ST-elevation aVR
    • Diffuse ST depressions
  • Posterior
    • Anterior ST depressions with standard leads
    • ST-elevation in posterior leads (V7-V9)
511
Q

Mechanism of action of Ranolazine

A
  • Inhibits late sodium current
  • Reduces calcium overload
  • Reduces wall tension and O2 demand
512
Q

True or False. Stable Angina is a thrombotic problem.

A

False

*Stable coronary atherosclerotic plaque with no plaque rupture/ thrombus

513
Q

Classic signs of restrictive heart disease caused by amyloidosis and Fabry’s disease

A

Low voltage on EKG

OS3 (10 decks)

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