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EBSE > Cardio > Flashcards

Cardio Flashcards

1
Q

what do bulbus cordis and the 2 horns of sinus venosus become?

A

bulbus cordis - smooth parts (outlfow tracts) of L and R ventricles
L horn of SV - coronary sinus
R horn of SV - smooth part of RA

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2
Q

sites of fetal erythropoiesis

A

yolk sac til 10 wks
liver 6 wks to birth
spleen 15-30 wks
bone marrow 22 wks onward

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3
Q

drugs to close or keep open the ductus arteriosus

A

close w/ indomethacin

keep open w/ PGE1&2

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4
Q

median umbilical ligament is remnant of

A

allantois

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5
Q

nucleus pulposus is remnant of

A

notochord

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6
Q

what coronary artery normally supplies SA and AV nodes?

A

RCA

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7
Q

left vs right dominant coronary circulation - which is more common and what does it mean

A

right more common

dominant is based on what side the posterior descending artery arises from

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8
Q

Fick principle

A

CO = rate of O2 consumption / (Arterial O2 conc - venous O2 conc)

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9
Q

3 things that affect stroke volume

A

contractility, afterload, preload

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10
Q

4 things that inc myocardial O2 demand

A

inc afterload
inc contractility
inc HR
inc heart size (wall tension)

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11
Q

eqn for vascular resistance

A

8 * viscosity * length / (pi r^4)

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12
Q

5 phases of cardiac cycle

A 
isovolumetric contraction
systolic ejection
isovolumetric relaxation
rapid filling
reduced filling
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13
Q

atrial waveform components

A 
a wave - atrial contraction
c wave - RV contraction
x descent - atrial relaxation
v wave - atrial filling
y descent - blood flow from RA to RV
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14
Q

what kind of conditions would cause wide, fixed, or paradoxical splitting of S2?

A

wide - delayed RV emptying
fixed - ASD / L>R shunts
paradoxical - delayed LV emptying

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15
Q

holosystolic, high pitched “blowing murmur”

A

mitral/tricuspid regurg

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16
Q

causes of mitral or tricuspid regurg

A

mitral - ischemic heart dz, mitral valve prolapse, LV dilation
tricupsid - RV dilation

either - rheumatic fever / infective endocarditis

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17
Q

crescendo-decrescendo systolic ejection murmur

A

aortic stenosis

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18
Q

“pulsus parvus et tardus”

A

aortic stenosis

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19
Q

2 causes of aortic stenosis

A

age related calcific aortic stenosis

bicuspid aortic valve

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20
Q

holosystolic harsh sounding murmur

A

VSD

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21
Q

late systolic crescendo murmur w/ midsystolic click

A

mitral valve prolapse

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22
Q

high pitched blowing diastolic decrescendo murmur

A

aortic regurg

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23
Q

causes of aortic regurg

A

aortic root dilation
bicuspid aortic valve
endocarditis
rheumatic fever

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24
Q

opening snap followed by delayed rumbling late diastolic murmur

A

mitral stenosis

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25
Q

cause of mitral stenosis

A

rheumatic fever

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26
Q

continuous machine like murmur

A

PDA

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27
Q

phases of cardiac action potential

A

0 - rapid upstroke, opening of Na channels
1 - initial repolarization - inactivation of Na, opening of voltage gated K
2 - plateau - Ca channels
3 - rapid repolarization - massive K efflux
4 - resting potential - high K permeability

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28
Q

U wave

A

hypokalemia, bradycardia

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29
Q

cause and tx of torsades de pointes

A

anything that prolongs QT interval

MgSO4

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30
Q

“sawtooth” p waves

A

atrial flutter

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31
Q

threshold for 1st deg AV block

A

PR interval > 200 ms

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32
Q

infectious cause of complete heart block

A

Lyme dz

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33
Q

ANP - what stimulates secretion and what does it do

A

stim by inc blood volume or atrial pressure

causes general vascular relaxation and natriuresis - “escape from aldosterone” mech

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34
Q

difference in what central vs peripheral chemoreceptors respond to

A

central - determined by arterial CO2, does not respond to PO2
peripheral - respond to dec PO2, inc PCO2, or dec pH

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35
Q

which organ gets largest share of systemic cardiac output?

A

liver

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36
Q

congenital heart dzs causing early cyanosis (blue babies)

A 
R>L shunts
5 Ts:
Tetralogy of Fallot (MC)**
Transposition of great vessels
persistant Truncus arteriosus
Tricuspid atresia
Total anomalous pulm venous return
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37
Q

MC congenital cardiac anomaly

A

VSD

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38
Q

causes of late cyanosis (blue kids)

A

VSD, ASD, PDA

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39
Q

Eisenmenger’s syndrome

A

uncorrected ASD, VSD, PDA lead to compensatory pulm vasc hypertrophy > progressive pulm HTN > cyanosis, clubbing, polycythemia

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40
Q

tetralogy of fallot

A

pulm infundibulum stenosis
RVH
overriding aorta
VSD

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41
Q

coarctation of aorta - main consequence and difference between infantile and adult type

A

can cause aortic regurg
infantile - preductal, assoc w/ Turner syndrome
adult - postductal

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42
Q

who is at greater risk for transposition of great vessels?

A

infant of diabetic mother

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43
Q

Monckeberg arteriosclerosis

A

calcification in media of arteries. usually benign - no obstruction b/c intima not involved

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44
Q

causes of thoracic aortic aneurysm

A

HTN, Marfan’s, tertiary syphilis

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45
Q

path process in aortic aneurysms due to Marfan’s

A

cystic medial necrosis

46
Q

ECG finding in stable angina

A

ST depression

47
Q

MCC sudden cardiac death

A

Vfib

48
Q

At what time point do neutrophils infiltrate an MI?

A

1-3 d after

49
Q

diagnosis of MI - 3 methods and which is best for what

A

ECG (ST elevation/depression, pathologic Q waves) - gold standard in 1st 6 hrs
Cardiac Troponin - rises after 4 hrs and stays for 7-10d. Most specific
CK-MB - not as specific, but good for dx reinfarction after acute MI b/c levels return to nl after 48 hrs

50
Q

Dressler’s syndrome

A

autoimmune phenomenon resulting in fibrinous pericarditis several wks after an MI

51
Q

MC cardiomyopathy

A

dilated (congestive)

52
Q

causes of dilated cardiomyopathy

A

HPI:
hemochromatosis, peripartum, idiopathic
ABCCCD:
Alcohol, wet Beriberi, Coxsackie B, Cocaine, Chaga’s, Doxorubicin

53
Q

cardiomyopathies showing eccentric vs concentric hypertrophy

A

eccentric - dilated

concentric - hypertrophic

54
Q

MCC hypertrohpic cardiomyopathy

A

familial (AD)

55
Q

Loffler’s syndrome

A

endomyocardial fibrosis w/ prominent eosinophilic infiltrate

56
Q

“heart failure” cells

A

hemosiderin laden macrophages found in lungs - due to pulm edema from CHF

57
Q

Roth’s spots, Osler’s nodes, and Janeway lesions - what are they and what are all 3 assoc w/?

A

Roth’s spots - round white spots on retina surrounded by hemorrhage
Osler’s nodes - tender raised lesions on finger/toe pads
Janeway lesions - small painless erythematous lesions on palm/sole

all assoc w/ bacterial endocarditis

58
Q

MC cause of acute and subacute endocarditis

A

acute - staph aureus

subacute - viridans strep

59
Q

tricuspid valve endocarditis assoc w/

A

IV drug use

60
Q

order of valves affected by rheumatic heart dz

A

mitral > aortic&raquo_space; tricuspid

61
Q

sx of rheumatic fever

A 
FEVERSS
fever
erythema marginatum
valvular dmg
ESR up
red hot joints
subq nodules
St. Vitus' dance / Sydenham's chorea
62
Q

Aschoff bodies and Anitschkow’s cells assoc w/

A

rheumatic fever / heart dz

63
Q

3 types of acute pericarditis and general causes of each

A

fibrinous - Dressler’s syndrome after MI, uremia, radiation
serous - viral or noninfectious inflammatory
suppurative/purulent - bacterial

64
Q

pulsus paradoxus - def and assoc condition

A

dec in amplitude of SBP by >10 mmHg during inspiration (not paradoxical, just exaggerated)
assoc w/ cardiac tamponade

65
Q

“tree bark” appearing aorta

A

syphilitic heart dz

66
Q

MC primary heart tumor in adults vs kids

A

adults - myxoma

kids - rhabdomyomas

67
Q

Kussmaul’s sign

A

inc in JVP on inspiration (nl would be dec)
due to impaired filling of RV, may be seen w/ constrictive pericarditis, restrictive cardiomyopathy, right heart tumors, cardiac tamponade

68
Q

dzs assoc w/ Raynaud’s phenomenon

A

mixed CT dz, SLE, CREST (limited systemic sclerosis)

69
Q

temporal arteritis - who, unique sx/complications, assoc conditions, type of inflammation, tx

A 
who - elderly females
sx - unilateral HA, jaw claudication, blindness from ophthalmic artery occlusion
assoc - polymyalgia rheumatica
type - focal granulomatous
tx - corticosteroids
70
Q

Takayasu’s arteritis - who, unique sx/complications, type of inflammation, tx

A

who - Asian females weak UE pulses
type - granulomatous thickening of aortic arch / great vessels
tx - corticosteroids

71
Q

polyarteritis nodosa - who, unique sx/complications, assoc conditions, type of inflammation, tx

A

who - young adults
sx - abd pain, HTN, neuro dysfn, cutaneous eruptions, renal dmg
assoc - Hep B
type - transmural inflam from immune complexes

72
Q

kawasaki’s dz - who, unique sx/complications, tx

A

who - asian toddlers
sx - cervical lymphadenitis, “strawberry tongue”, desquamating rash, hand/foot erythema, can lead to coronary aneurysms
tx - IVIG and aspirin

73
Q

Buerger’s dz / thromboangiitis obliterans - who, unique sx/complications, type of inflammation, tx

A

who - young male smokers
sx - intermittend claudication, gangrene / amputation of digits, Raynaud’s phenom
type - segmental thrombosing
tx - smoking cessation

74
Q

microscopic polyangiitis - sx, type of inflammation, what vessels, tx

A

sx - glomerulonephritis w/ palpable purpura
type - necrotizing, no granulomas, P-ANCA
vessels - lung, kidney, skin
tx - cyclophosphamide, steroids

75
Q

Wegener’s granulomatosis - sx, type of inflammation, what vessels, tx

A

sx - chronic sinusitis, perf of nasal septum, hemoptysis, hematuria
type - focal necrotizing vasculitis, necrotizing granulomas in lungs, necrotizing glomerulonephritis, C-ANCA
vessels - resp and renal
tx - cyclophosphamide, steroids

76
Q

Churg strauss - sx, type of inflammation

A

sx - asthma, sinusitis, palpable purpura, peripheral neuropathy
type - granulomatous, necrotizing w/ eosinophilia, P-ANCA

77
Q

Henoch-Schonlein purpura - who, sx, assoc w/

A

who - children after UTI
sx - palpable purpura on buttocks, arthralgia, abd pain / melena
assoc - IgA nephropathy

78
Q

MC childhood systemic vasculitis

A

Henoch Schonlein purpura

79
Q

ANCA vasculitis

A

P-ANCA: microscopic polyangiitis, Churg Strauss

C-ANCA: Wegener’s

80
Q

cystic hygroma

A

cavernous lymphangioma of neck. assoc w/ Turner syndrome

81
Q

glomus tumor

A

benign, painful red-blue tumor under fingernail

82
Q

another lesion frequently confused for Kaposi Sarcoma

A

bacillary angiomatosis - caused by Bartonella henselae in AIDS pts

83
Q

who tends to get angiosarcoma?

A

pts getting radiation therapy (esp in chest - breast CA, hodgkin’s)

84
Q

Sturge Weber dz

A

congenital vascular disorder affecting small vessels. port wine stain on face, intracerebral AVM, seizures, early onset glaucoma

85
Q

when to not use beta blockers in heart dz

A

decompensated CHF (use w/ caution if at all), NEVER in cardiogenic shock

86
Q

order of CCBs from most affecting vasculature to most affecting heart

A

vasc: amlodipine = nifedipine > diltiazem > verapamil : heart

87
Q

cardiac tox of CCBs

A

cardiac depression and AV block

88
Q

hydralazine - mech, special use, important tox

A

inc cGMP > smooth muscle relax > dec afterload
first line for HTN in pregnancy
compensatory tachy, lupus like syndrome

89
Q

nitroprusside - mech, use, tox

A

short acting, inc cGMP via direct release of NO
malignant HTN
CN tox

90
Q

fenoldopam - mech, use

A

D1 receptor agonist > vasodilation

malignant HTN

91
Q

nitroglycerin / isosorbide dinitrate - mech, use, tox

A

vasodilate by NO > inc cGMP. dilate veins&raquo_space; arteries. dec preload
angina, pulm edema
reflex tachy, hypotn, flushing, HA

92
Q

main goal of anti-anginal therapy

A

dec myocardial O2 demand

93
Q

tox of statins

A

hepatotox, rhabdomyolysis

94
Q

niacin - mech, tox

A

inhibit lipolysis in adipose > reduce hepatic VLDL sec > good dec in LDL, good inc in HDL, some dec of TG
hyperglycemia and hyperuricemia

95
Q

cholestyramine, colestipol, colesevelam - mech, tox

A

(bile acid resins) prevent intestinal reabs of bile acids > good dec in LDL but little effect on HDL and TGs
disliked - bad taste and GI discomfort, cholesterol gallstones

96
Q

ezetimibe - mech, tox

A

cholesterol absorption blocker - good dec in LDL but no effect on HDL or TGs
rare inc LFTs, diarrhea

97
Q

fibrates - mech, tox

A

upregulate lipoprotein lipase > inc TG clearance - little effect on LDL/HDL, very good dec in TGs
myositis, hepatotox, cholesterol gallstones

98
Q

signs of digoxin tox

A

cholinergic - N/V/D, blurry yellow vision
ECG - inc PR, dec QT, ST scooping, T wave inversion, arrhythmia, AV block
hyperkalemia (bad sign)

99
Q

antidote for digoxin tox

A 
slowly normalize K
lidocaine
cardiac pacer
anti-digoxin Fab
Mg
100
Q

class 1 antiarrhythmics - mech

A

Na channel blockers (local anesthetics)

101
Q

ex of class 1a/b/c antiarrhythmics

A

1a - quinidine, procainamid, diopyramide
1b - lidocaine, mexiletine, tocainide
1c - flecainide, propafenone

102
Q

best class of antiarrhythmic to use after MI

A

1b

103
Q

which class of antiarrhythmic is c/i in structural heart dz and post-MI

A

1c

104
Q

class 2 antiarrhythmic mech

A

beta blockers

105
Q

use of class 2 antiarrhythmics

A

Vtac, SVT, slow ventricular rate during afib and atrial flutter

106
Q

class 3 antiarrhythmic mech

A

K channel blockers

107
Q

class 3 antiarrhythmic ex

A

AIDS -

amiodarone (this one is actually 1,2,3,4), ibutilide, dofetilide, sotalol

108
Q

what labs to monitor when using amiodarone?

A

PFTs, LFTs, TFTs (thyroid)

109
Q

class 4 antiarrhythmic mech

A

CCBs

110
Q

adenosine - mech, use

A

inc K out of cell > hyperpolarize cardiac cell

drug of choice for dx/abolish SVT

111
Q

use of Mg as antiarrhythmic

A

torsades de pointes and digoxin tox

EBSE (18 decks)

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