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
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
3
Q
drugs to close or keep open the ductus arteriosus
A
close w/ indomethacin
keep open w/ PGE1&2
4
Q
median umbilical ligament is remnant of
A
allantois
5
Q
nucleus pulposus is remnant of
A
notochord
6
Q
what coronary artery normally supplies SA and AV nodes?
A
RCA
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
8
Q
Fick principle
A
CO = rate of O2 consumption / (Arterial O2 conc - venous O2 conc)
9
Q
3 things that affect stroke volume
A
contractility, afterload, preload
10
Q
4 things that inc myocardial O2 demand
A
inc afterload
inc contractility
inc HR
inc heart size (wall tension)
11
Q
eqn for vascular resistance
A
8 * viscosity * length / (pi r^4)
12
Q
5 phases of cardiac cycle
A
isovolumetric contraction systolic ejection isovolumetric relaxation rapid filling reduced filling
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
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
15
Q
holosystolic, high pitched “blowing murmur”
A
mitral/tricuspid regurg
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
17
Q
crescendo-decrescendo systolic ejection murmur
A
aortic stenosis
18
Q
“pulsus parvus et tardus”
A
aortic stenosis
19
Q
2 causes of aortic stenosis
A
age related calcific aortic stenosis
bicuspid aortic valve
20
Q
holosystolic harsh sounding murmur
A
VSD
21
Q
late systolic crescendo murmur w/ midsystolic click
A
mitral valve prolapse
22
Q
high pitched blowing diastolic decrescendo murmur
A
aortic regurg
23
Q
causes of aortic regurg
A
aortic root dilation
bicuspid aortic valve
endocarditis
rheumatic fever
24
Q
opening snap followed by delayed rumbling late diastolic murmur
A
mitral stenosis
25
cause of mitral stenosis
rheumatic fever
26
continuous machine like murmur
PDA
27
phases of cardiac action potential
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
28
U wave
hypokalemia, bradycardia
29
cause and tx of torsades de pointes
anything that prolongs QT interval
| MgSO4
30
"sawtooth" p waves
atrial flutter
31
threshold for 1st deg AV block
PR interval > 200 ms
32
infectious cause of complete heart block
Lyme dz
33
ANP - what stimulates secretion and what does it do
stim by inc blood volume or atrial pressure
| causes general vascular relaxation and natriuresis - "escape from aldosterone" mech
34
difference in what central vs peripheral chemoreceptors respond to
central - determined by arterial CO2, does not respond to PO2
peripheral - respond to dec PO2, inc PCO2, or dec pH
35
which organ gets largest share of systemic cardiac output?
liver
36
congenital heart dzs causing early cyanosis (blue babies)
```
R>L shunts
5 Ts:
Tetralogy of Fallot (MC)**
Transposition of great vessels
persistant Truncus arteriosus
Tricuspid atresia
Total anomalous pulm venous return
```
37
MC congenital cardiac anomaly
VSD
38
causes of late cyanosis (blue kids)
VSD, ASD, PDA
39
Eisenmenger's syndrome
uncorrected ASD, VSD, PDA lead to compensatory pulm vasc hypertrophy > progressive pulm HTN > cyanosis, clubbing, polycythemia
40
tetralogy of fallot
pulm infundibulum stenosis
RVH
overriding aorta
VSD
41
coarctation of aorta - main consequence and difference between infantile and adult type
can cause aortic regurg
infantile - preductal, assoc w/ Turner syndrome
adult - postductal
42
who is at greater risk for transposition of great vessels?
infant of diabetic mother
43
Monckeberg arteriosclerosis
calcification in media of arteries. usually benign - no obstruction b/c intima not involved
44
causes of thoracic aortic aneurysm
HTN, Marfan's, tertiary syphilis
45
path process in aortic aneurysms due to Marfan's
cystic medial necrosis
46
ECG finding in stable angina
ST depression
47
MCC sudden cardiac death
Vfib
48
At what time point do neutrophils infiltrate an MI?
1-3 d after
49
diagnosis of MI - 3 methods and which is best for what
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
Dressler's syndrome
autoimmune phenomenon resulting in fibrinous pericarditis several wks after an MI
51
MC cardiomyopathy
dilated (congestive)
52
causes of dilated cardiomyopathy
HPI:
hemochromatosis, peripartum, idiopathic
ABCCCD:
Alcohol, wet Beriberi, Coxsackie B, Cocaine, Chaga's, Doxorubicin
53
cardiomyopathies showing eccentric vs concentric hypertrophy
eccentric - dilated
| concentric - hypertrophic
54
MCC hypertrohpic cardiomyopathy
familial (AD)
55
Loffler's syndrome
endomyocardial fibrosis w/ prominent eosinophilic infiltrate
56
"heart failure" cells
hemosiderin laden macrophages found in lungs - due to pulm edema from CHF
57
Roth's spots, Osler's nodes, and Janeway lesions - what are they and what are all 3 assoc w/?
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
MC cause of acute and subacute endocarditis
acute - staph aureus
| subacute - viridans strep
59
tricuspid valve endocarditis assoc w/
IV drug use
60
order of valves affected by rheumatic heart dz
mitral > aortic >> tricuspid
61
sx of rheumatic fever
```
FEVERSS
fever
erythema marginatum
valvular dmg
ESR up
red hot joints
subq nodules
St. Vitus' dance / Sydenham's chorea
```
62
Aschoff bodies and Anitschkow's cells assoc w/
rheumatic fever / heart dz
63
3 types of acute pericarditis and general causes of each
fibrinous - Dressler's syndrome after MI, uremia, radiation
serous - viral or noninfectious inflammatory
suppurative/purulent - bacterial
64
pulsus paradoxus - def and assoc condition
dec in amplitude of SBP by >10 mmHg during inspiration (not paradoxical, just exaggerated)
assoc w/ cardiac tamponade
65
"tree bark" appearing aorta
syphilitic heart dz
66
MC primary heart tumor in adults vs kids
adults - myxoma
| kids - rhabdomyomas
67
Kussmaul's sign
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
dzs assoc w/ Raynaud's phenomenon
mixed CT dz, SLE, CREST (limited systemic sclerosis)
69
temporal arteritis - who, unique sx/complications, assoc conditions, type of inflammation, tx
```
who - elderly females
sx - unilateral HA, jaw claudication, blindness from ophthalmic artery occlusion
assoc - polymyalgia rheumatica
type - focal granulomatous
tx - corticosteroids
```
70
Takayasu's arteritis - who, unique sx/complications, type of inflammation, tx
who - Asian females weak UE pulses
type - granulomatous thickening of aortic arch / great vessels
tx - corticosteroids
71
polyarteritis nodosa - who, unique sx/complications, assoc conditions, type of inflammation, tx
who - young adults
sx - abd pain, HTN, neuro dysfn, cutaneous eruptions, renal dmg
assoc - Hep B
type - transmural inflam from immune complexes
72
kawasaki's dz - who, unique sx/complications, tx
who - asian toddlers
sx - cervical lymphadenitis, "strawberry tongue", desquamating rash, hand/foot erythema, can lead to coronary aneurysms
tx - IVIG and aspirin
73
Buerger's dz / thromboangiitis obliterans - who, unique sx/complications, type of inflammation, tx
who - young male smokers
sx - intermittend claudication, gangrene / amputation of digits, Raynaud's phenom
type - segmental thrombosing
tx - smoking cessation
74
microscopic polyangiitis - sx, type of inflammation, what vessels, tx
sx - glomerulonephritis w/ palpable purpura
type - necrotizing, no granulomas, P-ANCA
vessels - lung, kidney, skin
tx - cyclophosphamide, steroids
75
Wegener's granulomatosis - sx, type of inflammation, what vessels, tx
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
Churg strauss - sx, type of inflammation
sx - asthma, sinusitis, palpable purpura, peripheral neuropathy
type - granulomatous, necrotizing w/ eosinophilia, P-ANCA
77
Henoch-Schonlein purpura - who, sx, assoc w/
who - children after UTI
sx - palpable purpura on buttocks, arthralgia, abd pain / melena
assoc - IgA nephropathy
78
MC childhood systemic vasculitis
Henoch Schonlein purpura
79
ANCA vasculitis
P-ANCA: microscopic polyangiitis, Churg Strauss
| C-ANCA: Wegener's
80
cystic hygroma
cavernous lymphangioma of neck. assoc w/ Turner syndrome
81
glomus tumor
benign, painful red-blue tumor under fingernail
82
another lesion frequently confused for Kaposi Sarcoma
bacillary angiomatosis - caused by Bartonella henselae in AIDS pts
83
who tends to get angiosarcoma?
pts getting radiation therapy (esp in chest - breast CA, hodgkin's)
84
Sturge Weber dz
congenital vascular disorder affecting small vessels. port wine stain on face, intracerebral AVM, seizures, early onset glaucoma
85
when to not use beta blockers in heart dz
decompensated CHF (use w/ caution if at all), NEVER in cardiogenic shock
86
order of CCBs from most affecting vasculature to most affecting heart
vasc: amlodipine = nifedipine > diltiazem > verapamil : heart
87
cardiac tox of CCBs
cardiac depression and AV block
88
hydralazine - mech, special use, important tox
inc cGMP > smooth muscle relax > dec afterload
first line for HTN in pregnancy
compensatory tachy, lupus like syndrome
89
nitroprusside - mech, use, tox
short acting, inc cGMP via direct release of NO
malignant HTN
CN tox
90
fenoldopam - mech, use
D1 receptor agonist > vasodilation
| malignant HTN
91
nitroglycerin / isosorbide dinitrate - mech, use, tox
vasodilate by NO > inc cGMP. dilate veins >> arteries. dec preload
angina, pulm edema
reflex tachy, hypotn, flushing, HA
92
main goal of anti-anginal therapy
dec myocardial O2 demand
93
tox of statins
hepatotox, rhabdomyolysis
94
niacin - mech, tox
inhibit lipolysis in adipose > reduce hepatic VLDL sec > good dec in LDL, good inc in HDL, some dec of TG
hyperglycemia and hyperuricemia
95
cholestyramine, colestipol, colesevelam - mech, tox
(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
ezetimibe - mech, tox
cholesterol absorption blocker - good dec in LDL but no effect on HDL or TGs
rare inc LFTs, diarrhea
97
fibrates - mech, tox
upregulate lipoprotein lipase > inc TG clearance - little effect on LDL/HDL, very good dec in TGs
myositis, hepatotox, cholesterol gallstones
98
signs of digoxin tox
cholinergic - N/V/D, blurry yellow vision
ECG - inc PR, dec QT, ST scooping, T wave inversion, arrhythmia, AV block
hyperkalemia (bad sign)
99
antidote for digoxin tox
```
slowly normalize K
lidocaine
cardiac pacer
anti-digoxin Fab
Mg
```
100
class 1 antiarrhythmics - mech
Na channel blockers (local anesthetics)
101
ex of class 1a/b/c antiarrhythmics
1a - quinidine, procainamid, diopyramide
1b - lidocaine, mexiletine, tocainide
1c - flecainide, propafenone
102
best class of antiarrhythmic to use after MI
1b
103
which class of antiarrhythmic is c/i in structural heart dz and post-MI
1c
104
class 2 antiarrhythmic mech
beta blockers
105
use of class 2 antiarrhythmics
Vtac, SVT, slow ventricular rate during afib and atrial flutter
106
class 3 antiarrhythmic mech
K channel blockers
107
class 3 antiarrhythmic ex
AIDS -
| amiodarone (this one is actually 1,2,3,4), ibutilide, dofetilide, sotalol
108
what labs to monitor when using amiodarone?
PFTs, LFTs, TFTs (thyroid)
109
class 4 antiarrhythmic mech
CCBs
110
adenosine - mech, use
inc K out of cell > hyperpolarize cardiac cell
| drug of choice for dx/abolish SVT
111
use of Mg as antiarrhythmic
torsades de pointes and digoxin tox
