Cardio Flashcards
Cause of patent truncus arteriosus
failure of neural crest cells to form aorticopulmonary septum
Improper separation of aorticopulmonary septum
transposition of the great vessels
Drug for closure of PDA
indomethacin
Drug to maintain ductus arteriosus
PGE1 and PGE2
Cause of hoarseness/dysphagia with heart pathology
dilated L atrium
Drug class to decrease preload on heart
nitroglycerin (venodilators)
Drug class to decrease afterload on heart
hydralazine (vasodilators)
S3 heart sound
rapid filling (mitral regurg)/tensing of chorade tendiae
early diastole
“Kentucky”
S4 heart sound
L atrium pushing against stiff LV wall
late diastole
“Tennessee”
Wide S2 splitting
delay of RV emtpying
RBBB/pulmonic stenosis
Fixed S2 splitting
seen in ASD
increased RA and RV volumes
Paradoxical splitting of S2
delayed LV emtpying
seen in aortic stenosis/LBBB
during expiration
Sound for mitral/tricuspid regurg
holosystolic blowing murmur
assc with rheumatic fever/endocarditis
Sound for Aortic stenosis
crescendo-descrescendo systolic following ejection click
radiates to carotids
Sound for VSD
holosystolic machine like murmur
Sound for MVP
late systolic descrendo murmur
Sound for aoritc regurg
high pitched blowing diastolic decrescendo murmur
Sound for mitral stenosis
delayed rumbling in late diastole
secondary to rheumatic fever
Sound for PDA
continuous machine like murmur
Phases of ventricular AP
0-Na+ upstroke
1-K+ open,Na+ close
2-Ca2+ influx/K+ efflux balance (plateau)
3-K+ massive efflux repolarizes
4-high K+ permeability (flat hyperpolarized stage)
Phases of pacemaker AP
0-Ca2+ upstroke (Na+ closed, slow conductivity)
2-no plateau
3-Ca2+ inactivated/K+ efflux repolarizes
4-slow depolarization from spontaneous Na+ channels (I funny channels)
Normal PR interval
less than 200ms
Normal AV node delay
100ms
EKG with only irregular narrow QRS complexes
Atrial fibrillation
EKG with back to back atrial waves with QRS complexes at regular intervals
Atrial flutter
sawtooth pattern
Progressively lengthening PR interval with a dropped QRS complex at the end
2nd degree heart block type I
Wenckebach
PR interval over 200ms in length
1st degree heart block
Dropped QRS complexes with no PR interval change
2nd degree heart block type II
Independent atrial and ventricular depolarizations
3rd degree heart block
V1-wide rSR’ complex
I/V6-slurred S wave
R bundle branch block
V1-negative deflection with notching
I/V6-rSR’ complex
L bundle branch block
V1/V2 (-) deflection
V5/V6 (+) deflection
added together over 35mm
L ventricular hypertrophy
must be over 40
see T wave discordance/asymmetric T wave
R axis deviation (I deflected downward)
R/S > 1 on V1
Deep S wave on V6
R ventricular hypertrophy
Role of atrial natiuretic peptide
decrease blood volume
vascular relaxation and decreased Na+ resorption
constrict afferent, dilate efferent renal arterioles
QT prolongation resulting in polymorphic V tach
Torsades de pointes
Bypass of AV node and bundle of His
Wolff-Parkinson-White syndrome
no Q wave
delta wave with no PR segment
atria fire directly to ventricles
Brain center for BP maintenance
solitary nucleus
aortic arch/CN X
carotid sinus/CN IX
HTN
bradycardia
respiratory depression
Cushing rxn
increased ICP causes ischemia, increasing BP, which in turn results in bradycardia
Chemoreceptors for BP
Carotid/aortic bodies measure decreased oxygen/increased CO2/decreased pH
Central measures pH and CO2
Hypoxia in the lungs impact
Causes vasoconstriction
other tissues vasodilate in response to decreased O2
Pulmonary vascular hypertrophy/PAH
cyanosis/clubbing late in disease
L to R shunts
Eisenmenger’s syndrome
increased pulmonary resistance causes shunt to switch to R to L shunt
VSD
RVH
overriding aorta
pulmonic valve stenosis
Tetralogy of Fallot
PROVe
early cyanosis
squatting improves cyanosis
Early death
failure of aorticopulmonary septum to spiral
D transposition of the great vessels
need shunt to live allowing mix of blood
Rib notching
HTN in upper extremities
weak lower extremity pulses
Coarctation of the aorta
adult type
past ligamentum arteriosum
Cyanosis in lower extremities
goes away with indomethacin
patent ductus arteriosus
stays open with PGE1/2
machine like murmur
L to R shunt/LVH
22q11 syndrome assc with heart
Truncus arteriosus
Tetralogy of Fallot
Diabetic mother assc with heart
Transposition of the great vessels
Down syndrome assc with heart
ASD
VSD
AV septal defect
Xanthomas in Achilles
corneal deposits
ischemia of small vessels
Hyperlipidemia
Radial/ulnar artery calcification
pipstem arteries
Moenckeberg arteriosclerosis
calicification of media
no flow obstruction
Hyaline deposition in small arteries
Hyaline Arteriolosclerosis assc with essential HTN or diabetes mellitus
Onion skinning of small vessels
Hyperplastic Arteriolosclerosis assc with malignant HTN
Plaques on intima of arteries
atherosclerosis
Process of atherosclerosis
LDL accumulation foam cell formation fatty streaks/smooth m. cell migration extracellular matrix deposition plaques form
Male smoker age 55
HTN
pulsatile mass in abd
Abd aortic aneurysm
assc with atherosclerosis
Pt sexually active
hypotension in extremities
also has Marfan’s syndrome
Thoracic aortic aneurysm
assc with HTN/cystic medial necrosis (Marfan’s)/tertiary syphilis
Mediastinal widening
diminished heart sounds
tearing chest pain
Aortic dissection
assc with Marfan’s
4-12 hrs post MI
coagulative necrosis
wavy fibers
12-24 hrs post MI
contraction bands from reperfusion
neutrophil migration
24-72 hrs post MI
extensive coagulative necrosis
acute inflammation around infarct
risk of fibrinous pericarditis
3-14 days post MI
macrophage migration
granulationx tissue at infarct margins
risk of free wall rupture (due to macrophages)
2 weeks post MI
contracted scar
Dx for reinfarct of an MI
CK-MB
rises and falls within 48 hours
S3 heart sound
dilated heart on echo
alcoholic
Dilated cardiomyopathy
assc with EtOH/Beriberi/Coxsackie B/cocaine/Chaga’s disease/hemachromatosis
also can be X-linked (eccentric hypertrophy from sarcomeres added in series)
Normal heart size S4 heart sound systolic murmur syncope young athlete
Hypertrophic cardiomyopathy
outflow obstruction of mitral valve leaflet
Beta-myosin heavy chain mutation
sarcomeres added in parallel (haphazard myocytes)
assc with Friedriech’s ataxia
Causes of restrictive cardiomyopathy
amyloidosis (Congo red stain) sarcoidosis Loeffler's syndrome (eosinophilia/fibrosis) hemachromatosis results in loss of heart compliance
Pt has systemic lupus
eosinphilic/granular verucae on heart valves
Libman Sacks endocarditis
vegetations on both sides of valves
IV drug user
rapid onset
splinter hemorrhages
tricuspid valve stenosis
Acute Bacterial endocarditis (S. aureus)
lg vegetations on previously normal valves
assc with IV drug use
R sided heart valves
Vegetations on damaged heart valves Roth spots (on retina) Osler nodes (on fingers) Janeway lesions (on palms)
Subacute bacterial endocarditis (viridans strep)
assc with dental procedures
Assc of endocarditis with prosthetic valves
S. epidermidis
Endocarditis with colon cancer pts
Strep bovis
Baterial endocarditis sx (5)
Roth spots (retina hemorrhage) Olser's nodes (painful papules on fingers) Janeway lesions (emboli to palms/soles) Splinter hemorrhages of nails emboli
Mitral valve regurg
Granuloma with giant cells
activated histiocytes
increased ASO titer
Rheumatic fever beta-hemolytic strep post pharyngitis mitral/aortic valves most affected mitral regurg, then stenosis late Aschoff bodies (giant cells) Anitschkows cells (activated histiocytes) type II HS rxn, anti-M protein
Jones criteria
For rheumatic fever Joints-migratory arthralgia Heart-myocarditis Nodules sub q Erythema marginatum Sydenham's chorea
Pericarditis causes
Fibrinous-uremia/radiation/friction rubs seen
Serous-viral/RA/lupus
Suppurative/purulent-pneumococcus/strep
JVD
hypotension
systolic BP more than 10 mmHP greater on inspiration
Cardiac tamponade pulsus paradoxus (inspiration increased intrathoracic pressure, increasing BP)
Tree bark aorta
calcification at aortic root
aortic insufficiency
Tertiary syphilis
disruption of vasa vasorum in aorta
an cause aneurysm
L atrium obstruction
syncope
40 y/o male
Myxomas
ball valve obstruction in atria
Spider cells
pt also has Tuberous sclerosis
4 year old male
Rhabdomyoma
Increased JVD with inspiration
Kussmaul’s sign
from restrictive cardiac pathology
Unilateral headaches on L
73 y/o female
Lost sight out of L eye
Temporal (giant cell) arteritis
ophthalmic artery occlusion
granulomatous inflammation
assc with polymyalgia rheumatica
Asian 51 y/o female
weak upper extremity pulses
ocular problems
skin nodules
Takayasu’s arteritis
pulseless disease
granulomatous thickening of aortic arch/great vessels
23 y/o male Pt has Hep B cutaneous eruptions at different stages HTN renal damage
Polyarteritis nodosa
renal involvement, no pulmonary
immune complex mediated
Fibrinoid necrosis
2 y/o Asian male recovering from Chicken pox strawberry tongue erythema of hands/feet cervical lymphadenitis
Kawasaki disease
follows viral infection
can develop coronary aneurysms
MI/rupture
Male smoker 52 y/o
intermittent claudication
autoamputation of 2 fingers
Raynaud’s phenomenon seen
Buerger’s disease (thromboangiitis obliterans)
segmental thrombosing vasculitis
autoamputation of digits
tx with smoking cessation
Lung and kidney damage
palpable purpura
(+) for p-ANCA
Microscopic polyangiitis
necrotizing vasculitis
pauci-immune GN
no granulomas
Chronic sinusitis/otitis media
hemoptysis
hematuria
Wegener's granulomatosis lung and kidney involvement granulomas present (+) c-ANCA focal necrotizing vasculitis
Has allergies sinusitis palpable purpura wrist drop hematuria eosinophilia of vesels
Churg-Strauss syndrome highly allergic people (+) p-ANCA peripheral neuropathy pauci-immune GN granulomatous
6 y/o recovering from strep throat palpable purpura on buttocks arthralgia melena GI lesions of same stage
Henoch-Schoenlein purpura
childhood systemic vasculitis
IgA complex deposition
assc with IgA nephropathy
Female pt with 1 X chromosome
mass on the neck
3 y/o
Cystic hygroma
assc with Turner syndrome
cavernous lymphangiomas of neck
AIDS pt
skin papules
pt owns a cat
Bacillary angiomatosis
benign capillary skin papules
Bartonella henselae infections
mistaken for Kaposi’s
Pt has mastectomy for breast cancer 5 years ago
has chronic edema of R arm and R chest
Lymphangiosarcoma
assc with post radical mastectomy and persistent lymphedema
Mouth/skin/GI/respiratory tract purple lesions
pt has AIDS
Kaposi’s sarcoma
assc with HHV-8 and HIV
Nevus flammus on face
seizures at early age
glaucoma
6 y/o
Sturge-Weber disease
capillary sized blood vessels
ipsilateral leptomeningeal angiomatosis (AVM)
Lesion under the finger nail
extremely painful
red/blue color
Glomus tumor
benign
modified smooth m. cells of glomus body
HTN tx for diabetics
ACEI’s
nephroprotective
Essential HTN tx
thiazides
MOA of CCB’s
block L-type calcium channels
Cardiac and peripheral CCB’s
Cardiac-verapamil/diltiazem
Peripheral-amlodipine/nifedipine
Given with beta blockers to prevent reflex tachycardia
Hydralazine
peripheral (arterial) vasodilator
can cause lupus like syndrome
Can cause CN toxicity
decreased preload
nitroprusside
releases NO, vasodilates via cGMP increase
Drug for tx of HTN with renal insufficiency
Fenoldopam
D1 agonist that vasodilates renal and other arterioles
Contraindicated Beta blockers in angina tx
Pindolo/acebutolol
they are partial beta agonists
Impact of HMG-Coa reductase inhibitors
very lg decrease in LDL
decrease in TG
increase in HDL
Impact of Niacin on cholesterol
lg decrease in LDL
lg increase in HDL
decrease in TG
Impact of bile acid resins on cholesterol
lg decrease in LDL
slight increase in HDL and TG
Impact of ezetimibe on cholesterol
lg decrease in LDL
blocks cholesterol absorption
Impact of fibrates on cholesterol (gemifibrozil/fenofibrate)
very lg decrease in TG
decrease in LDL
increase in HDL
Risk with use of statins
rhabdomyolysis
hepatotoxicity
Risk with use of niacin
hyperuricemia
Risk of bile acid resins/fibrates
cholesterol gallstones
Role of ApoE
on IDL’s and chylomicrons
uptake of remnants by liver
Role of ApoA1
activates LCAT (free cholesterol to esterified) on HDL
Role of ApoCII
LPL cofactor (frees FA's) on chylomicron/VLDL/HDL
Role of ApoB48
chylomicron secretion by GI tract
on chylomicrons
Role of ApoB100
binds LDL receptor
on VLDL/IDL/LDL
MOA of digoxin
inhibit Na+/K+ ATPase, increasing Ca2+ conc (via decreased secondary Ca2+/Na+ transport)
Also stimulates vagus n.
Side effects of digoxin
blurry yellow vision
hyperkalemia
AV block
Phosphodiesterase inhibitors for antiplatelet effects
Cilostazol
dipyridamole
Thienopyridines and MOA
clopidogrel/prasugrel/ticlopidine
inhibit ADP platelet aggregation
Risk with thienopyridines
thombotic thrombocytopenic purpura
Tx of warfarin overdose
Vit K
fresh frozen plasma
Tx for heparin overdose
protamine sulfate
Side effects of class 1A antiarrhythmics
quinidine-cinchonism (tinnitus)
procainamide-lupus like syndrome
disopyramide- anticholinergic
all can cause Torsades de pointes
Use of Class 1A antiarrhythmics
reentry tachycardias
increase effective refractory period/QT interval
Use of Class 1B antiarrhythmics
acute ventricular arrhythmias and digitalis induced arrhythmias
decreased AP duration
Use of Class 1C antiarrhythmics
V tach going to V fib/intractable SVT
no effect on AP duration/prolongs refractory period
Class 1C antiarrhythmic drugs
flecainide/propafenone
propafenone does not cause Torsades
Class 1B antiarrhythmics
lidocaine/mexiletine/tocainide/phenytoin
side effect of CNS depression
Class II antiarrhythmics
beta blockers
decrease SA and AV nodal activity (via cAMP decrease)
increase PR interval
Class III antiarrhythmics
K+ channel blockers
amiodarone/ibutilide/dofetilide/sotalol
can cause Torsades
increase AP duration and QT interval
Side effects of amiodarone
pulmonary fibrosis
hepatotoxicity
hyper/hypothyroid (iodine structure)
corneal deposits
Class IV antiarrhythmics
CCB’s (verapamil/diltiazem)
decrease conduction velocity
increase PR interval
for SVT
MOA of adenosine
increased K+ out of cells
hyperpolarizes the cell
for SVT
does not work with caffeine/theophylline
Mg2+ tx for cardiac
Torsades de pointes
digoxin toxicity
Given with beta blockers to prevent reflex tachycardia
Hydralazine
peripheral (arterial) vasodilator
can cause lupus like syndrome
Cardiac and peripheral CCB’s
Cardiac-verapamil/diltiazem
Peripheral-amlodipine/nifedipine
MOA of CCB’s
block L-type calcium channels
Essential HTN tx
thiazides
HTN tx for diabetics
ACEI’s
nephroprotective
Lesion under the finger nail
extremely painful
red/blue color
Glomus tumor
benign
modified smooth m. cells of glomus body
Nevus flammus on face
seizures at early age
glaucoma
6 y/o
Sturge-Weber disease
capillary sized blood vessels
ipsilateral leptomeningeal angiomatosis (AVM)
Mouth/skin/GI/respiratory tract purple lesions
pt has AIDS
Kaposi’s sarcoma
assc with HHV-8 and HIV
Pt has mastectomy for breast cancer 5 years ago
has chronic edema of R arm and R chest
Lymphangiosarcoma
assc with post radical mastectomy and persistent lymphedema
AIDS pt
skin papules
pt owns a cat
Bacillary angiomatosis
benign capillary skin papules
Bartonella henselae infections
mistaken for Kaposi’s
Female pt with 1 X chromosome
mass on the neck
3 y/o
Cystic hygroma
assc with Turner syndrome
cavernous lymphangiomas of neck
6 y/o recovering from strep throat palpable purpura on buttocks arthralgia melena GI lesions of same stage
Henoch-Schoenlein purpura
childhood systemic vasculitis
IgA complex deposition
assc with IgA nephropathy
Has allergies sinusitis palpable purpura wrist drop hematuria eosinophilia of vesels
Churg-Strauss syndrome highly allergic people (+) p-ANCA peripheral neuropathy pauci-immune GN granulomatous
Chronic sinusitis/otitis media
hemoptysis
hematuria
Wegener's granulomatosis lung and kidney involvement granulomas present (+) c-ANCA focal necrotizing vasculitis
Lung and kidney damage
palpable purpura
(+) for p-ANCA
Microscopic polyangiitis
necrotizing vasculitis
pauci-immune GN
no granulomas
Male smoker 52 y/o
intermittent claudication
autoamputation of 2 fingers
Raynaud’s phenomenon seen
Buerger’s disease (thromboangiitis obliterans)
segmental thrombosing vasculitis
autoamputation of digits
tx with smoking cessation
2 y/o Asian male recovering from Chicken pox strawberry tongue erythema of hands/feet cervical lymphadenitis
Kawasaki disease
follows viral infection
can develop coronary aneurysms
MI/rupture
23 y/o male Pt has Hep B cutaneous eruptions at different stages HTN renal damage
Polyarteritis nodosa
renal involvement, no pulmonary
immune complex mediated
Fibrinoid necrosis
