Cardio Flashcards
1
Q
what does the truncus arteriosus give rise to
A
ascending aorta and pulmonary trunk
2
Q
what does the bulbus cordis give rise to
A
smooth parts (outflow tract) of LV and RV
3
Q
what does the primitive ventricle give rise to
A
trabeculated LV and RV
4
Q
what does the primitive atria give rise to
A
trabeculated LA and RA
5
Q
what does the left horn of sinus venosus (SV) give rise to
A
coronary sinus
6
Q
what does the right horn of SV give rise to
A
smooth part of right atrium
7
Q
what does the right common cardinal v.and right anterior cardinal v. give rise to
A
SVC
8
Q
fetal erythropoiesis in yolk sac
A
3-10 weeks
9
Q
fetal erythropoiesis in liver
A
6 weeks - birth
10
Q
fetal erythropoiesis in spleen
A
15-30 weeks
11
Q
fetal erythropoiesis in bone marrow
A
22 weeks - adult
12
Q
fetal hemoglobin
A
alpha 2 gamma 2
13
Q
adult hemoglobin
A
alpha 2 beta 2
14
Q
umbilical vein
A
ligamentum teres heptatitis - falciform ligament
15
Q
umbilical arteries
A
medial umbilical ligaments
16
Q
ductus arteriosus
A
ligamentum arteriosum
17
Q
ductus venosus
A
ligamentum venosum
18
Q
foramen ovale
A
fossa ovalis
19
Q
allantois
A
urachus - median umbilical ligament
urachus - allantoic duct (bladder-umbilicus)
20
Q
allantois remnant
A
urachal sinus/cyst
21
Q
notochord
A
nucleus pulposus of IV disc
22
Q
most common site of coronary a. occlusion
A
LAD
23
Q
what supplied SA and AV node
A
RCA
24
Q
what determines heart domination
A
posterior descending/interventricular a.
25
when do coronary a. fill
diastole
26
most posteiror part of heart?
LA
27
LA enlargements
compress esophagus --> dysphagia
| compress L. recurrent laryngeal n. (vagus) --> hoarseness
28
what to listen to at aortic area
systolic murmur - aortic stenosis, flow murmur, aortic valve stenosis
29
what to listen to at left sternal border
diastolic murmur - aortic and pulmonic regurg
| systolic murmur - hypertrophic cardiomyopathy
30
what to listen to at pulmonic area
systolic ejection murmur - pulmonic stenosis, flow murmur (ASD, PDA)
31
what to listen to at tricuspid area
pansystolic murmur - tricuspid regurgitation, VSD
| diastolic murmur - tricuspid stenosis, ASD
32
what to listen to at mitral area
systolic murmur - mitral regurg
| diastolic murmur - mitral stenosis
33
where to listen to a PDA and what it sounds like
left infraclavicular region - machine-like murmur
34
inspiration effect -->
RILE
| increase intensity right heard sounds
35
expiration effect -->
RILE
| increase intensity left heart sounds
36
what does handgrip cause
increase systemic vascular resistance
37
hand grip effect -->
increase intensity MR, AR< VSD murmurs
decrease intensity AS, hypertrophic cardiomyopathy mumurs
MVP - increase murmur intesnity - later onset of click/murmur
38
what does valsava cause
decrease venous return
39
valsava effect -->
decrease intensity of most murmurs
increase intensity of hypertrophic cardiomyopathy mumurs
MVP - decrease murmur intensity - earlier onset click/murmur
40
what does rapid squatting cause
increase venous return, increase preload, increase afterload with PROLONGED squatting
41
rapid squatting effect -->
decrease intensity of hypertrophic cardiomyopathy mumurs
| MVP - increase murmur intensity, later onset click/murmur
42
what are the systolic heart sounds
aortic/pulm stenosis, mitral/tricuspid regurg, VSD
43
what are the diastolic heart sounds
aortic/pulm regurg, mitral/tricuspid stenosis
44
holosystolic high pitched blowing murmur
MR/TR
45
crescendo-decrescendo systolic ejection murmur following ejection click
AS
46
holosystolic, harsh-sounding murmur
VSD
47
late systolic crescendo murmur with midsystolic click
MVP
48
immediate high-pitched blowing diastolic decrescendo murmur
AR
49
follows opening snap --> delayed rumbling late diastolic murmur
MS
50
continuous machine-like murmur
PDA
51
what enhances MR
increase TPR (squat/hand grip) or LA return (expiration)
52
what enhances TR
increase RA return (inspiration)
53
where is MR the loudest and where does it radiate
apex --> radiates to axilla
54
what causes MR
ischemic heart disease, MVP, or LV dilation
55
where is TR the loudest and where does it radiate
tricuspid area --> radiates to right sternal border
56
what causes TR
RV dilation
57
what can can either MR or TR
rheumatic fever and infective endocarditis
58
what causes ejection click in AS
abrupt halting of valve leaflets
59
AS
LV > aortic P in systole
60
where does AS radiate
carotids
61
pulsus parvus et tardus
AS - pulses are weak with a delayed peak
62
what can AS lead to
SAD - syncope, angina, and dyspnea on exertion
63
AS cause
age-related calcific aortic stenosis or bicuspid aortic valve - WEAR AND TEAR
64
where is VSD the loudest
tricuspid area
65
what accentuates VSD
hand grip manuever --> increased afterload
66
what causes midsystolic click in MVP
sudden tensing of chordae tendinae (parachute)
67
what is the most freq valvular lesion
MVP
68
where is MVP best heard
apex
| loudest just before S2
69
MVP
benign and can predispose to infective endocarditis
70
what can cause MVP
myxomatous degeneration, RF, or chordae rupture
71
what does MVP occur earlier with
manuevers that decrease venous return - standing or valsava
72
AR
chronic - wide pulse pressure (hyperdynamic circulation)
73
can present with bounding pulses and head bobbing
AR
74
what causes AR
aortic root dilation, bicuspid aortic valve, endocarditis, or RF
75
what increases AR murmur
hand grip
76
what decreases intensity of AR murmur
vasodilators
77
what causes opening snap in MS
abrupt halt in leaflet motion in diastole, after rapid opening due to fusion at leaflet tips
78
MS
LA > LV pressure during diastole
79
what does MS often occur secondary to
rheumatic fever
80
chronic MS presentation
LA dilation
81
what enhances MS
manuevers that increase LA return (expiration)
82
where is PDA the loudest
S2
83
what causes PDA
congenital rubella or prematurity
84
what is best heard at left infraclavicular area
PDA
85
continuous machine-like murmur
PDA
86
what causes R --> L shunts
**early cyanosis - blue babies
| Tetralogy of Fallot, Transposition, Truncus arteriosus, Tricuspid atresia, TAPVR (total anomalous pulm venous return)
87
what causes L --> R shunts
**late cyanosis - blue kids
| VSD > ASD > PDA
88
what is the most common cause of early cyanosis
tetralogy of fallot
89
what do most patients with persistent truncus arteriosus have
VSD
90
hypoplastic RV
tricuspid atresia
91
what is the most common congenital cardiac anomaly
VSD
92
flixed splitting S2
ASD
93
how do you close PDA
indomethacin - decrease prostaglandins (PGE - keeeeps PDA open)
94
fetal alcohol syndrome
VSD
95
what does eisenmergers syndrome cause
late cyanosis, clubbing + polycythemia
96
what does tetralogy of fallot consist of
PROVe - pulmonary infundibular stenosis, RVH, overriding aorta, VSD
97
what is the most important determinant for tetralogy of fallot prognosis
pulmonary infundibular stenosis
98
boot shaped heart on xray
tetralogy of fallot
99
maternal diabetes
D-transpition of great vessels
100
infantile coarctation of aorta
proximal to insertion of PDA
101
adult coarctation of aorta
distal to ligamentum arteriosum
102
turners syndrome
infantile coarctation of aorta
103
adult coarctation of aorta sx
collateral circulation --> notching of ribs
| UE - hypertension, LE - weak pulses
104
22q11 syndromes
truncus arteriosus, tetralogy of fallot
105
Down syndrome
ASD, VSD, AV septal defect (endocardial cushion defect)
106
congenital rubella
septal defects, PDA, pulmonary artery stenosis
107
turner syndrome
coarctation of aorta (preductal)
108
marfans syndrome
aortic insufficiency + dissection (late complication)
109
infant of diabetic mother
transposition of great-vessels
110
definition of HTN
> 140/90
111
definition of malignant HT
> 180/120
112
calcification in media of a.
monckeberg arteriosclerosis
113
fibrous plaques/atheromas in intima of a.
atherosclerosis
114
where do you see hyaline arteriolosclerosis
essential HTN and diabetes mellitus
| ***HYALINE = PINK
115
onion skinning in malignant HTN
hyperplastic arteriolosclerosis
116
incidental finding on mammogram
monckeberg arteriosclerosis
117
foam cells + fatty streaks
atherosclerosis
118
coronary a. occlusion order
LAD > RCA > circumflex
119
gold standard during first 6 hours of MI
ECG
120
MI dx
troponin I
121
MI reinfarction dx
CK-MB
122
transmural infarct
increase necrosis
| affects entire wall
123
subendocardial infarcts
ischemic necrosis < 50% of ventricle wall
| subendocardium espec. vulnerable to ischemia
124
transmural infarct ECG
ST elevation, Q waves
125
subendocardial infarct ECG
ST depression
126
LAD infarct - anterior wall
V1-V4
127
LAD infarct - anteroseptal
V1-V2
128
LCX infarct - anterolateral
V4-V6
129
LCX infarct - lateral wall
I, avL
130
RCA infarct - inferior wall
II, III, aVF
131
cardiomyopathy associated with systolic dysfunction
dilated
132
cardiomyopathy associated with diastolic dysfunction
hypertrophic and restrictive/obliterative
133
cause of sudden death in young athletes
hypertrophic cardiomyopathy
134
most common primary cardiac tumor in adults
myxoma
135
most common location of myxoma
left atrium - ball valve obstruction
136
most common primary cardiac tumor in kids
rhabdomyoma
137
what is rhabdomyoma associated with
tuberous sclerosis
138
asian children < 4 y/o
kawasaki disease
139
heavy male smokers < 40 y/o
buerfers disease
140
positive HBsAg
polyarteritis nodosa
141
wegeners granulomatosis triad
focal necrotizing vasculitis, necrotizing granulomas in lung + upper airway, necrotizing glomerulonephritis
142
positive p-ANCA
microscopic polyangiitis and churg strauss syndrome
143
positive c-ANCA
wegeners granulomatosis
144
henoch-schonlein purpura
URI --> IgA complex deposition --> childhood systemic vasculitis
145
henoch-schonlein purpura triad
skin - palpable purpura of butt/legs
arthralgia
GI - abdominal pain, melena, multiple lesions of same age
146
elevated IgE
churg-strauss syndrome
147
IgA nephropathy association
henoch-schonlein purpura
148
essential HTN tx
diuretics, ACE inhibitors, ARBs, CCB
149
CHF tx
diuretics, ACE inhibitors/ARBs, B-blockers (compensated CHF), K+ sparing diuretics
150
DM tx
ACE inhibitors/ARBs, CCB, diuretics, B-blockers, alpha-blockers
151
protective vs. diabetic nephropathy
ACE inhibitors
152
Ca+ channel blockers
nifedipine, verapamil, diltiazem, amlodipine
153
CCB MOA
block voltage gated L-type Ca channels of cardiac and smooth muscle --> reduce muscle contractility
154
CCB for vasc smooth muscle
amlopdipine = nifedipine > diltiazem > verapamil
155
CCB for heart
verapamil > diltiazem > amlodipine = nifedipine
| VERAPAMIL = VENTRICLE
156
CCB clinical use
htn, angina, arrhythmias (not nifedipine), prinzmetal's angina, raynaud's
157
CCB toxicity
cardiac depression, AV block, peripheral edema, flushing, dizziness, and constipation
158
hydralazine MOA
increase cGMP --> smooth muscle relaxation
vasodilate arterioles > veins
reduce afterload
159
hydralazine clinical use
severe htn, CHF
first line - htn in preggers with methyldopa
freq coadminister w/ beta-blocker to prevent reflex tachycardia
160
hydralazine toxicity
compensatory tachycardia, fluid retention, nauseua, headache, angina, lupus-like syndrome
CI - angina/CAD
161
malignant htn tx drugs
nitroprusside, nicardipine, clevidipine, labetalol and fenoldopam
162
nitroprusside
short acting
increase cGMP via direct release NO
releases cyanide --> can cause cyanide toxicity
163
fenoldopam
dopamine D1 receptor agonist - coronary, peripheral, renal and splanchnic vasodilationg
decrease BP and increase natriuresis
164
nitroglycerin and isosorbide dinitrate MOA
release NO into smooth muscle --> increase cGMP --> smooth muscle relaxation = vasodilation veins > arteries
decrease preload
165
nitroglycerin and isosorbide dinitrate clinical use
angina, pulmonary edema
166
nitroglycerin and isosorbide dinitrate toxicity
reflex tachycardia, hypotension, flushing, headache
167
monday disease
nitroglycerin and isosorbide dinitrate toxicity
in industrial exposure - develop tolerance for vasodilating action during work week + lose tolerance over weekend --> tachycardia, dizziness and headache upon reexposure
168
goal of antianginal tx
decrease EDV, BP, HR, contractility, or ejection time --> reduce myocardial O2 consumption
169
nitrates vs. angina
PRELOAD
decrease - EDV, BP, Ejection time, MVO2
increase HR and contractility via reflex response
170
b-blockers vs. angina
AFTERLOAD
decrease - BP, contractility, HR, MVO2
increase - EDV and ejection time
171
nitrates and beta-blockers vs. angina
really decrease MVO2
decrease HR and BP
little/no effect on ejection time/contractility
no effect or decrease EDV
172
pindolol and acebutolol
partial beta-agonists CI in angina
173
CCB similar to nitrates/Bblockers
nifedipine - similar to nitrates in effect
| verapamil - similar to b-blockers in effect
174
HMG-CoA reductase inhibitors
lovastatin, pravastatin, simvastatin, atorvastatin, rosuvastatin
175
HMG-CoA reductase inhibitors effect on LDL
DECREASE DECREASE DECREASE
176
HMG-CoA reductase inhibitors effect on HDL
increase
177
HMG-CoA reductase inhibitors effect on TG
decrease
178
HMG-CoA reductase inhibitors MOA
inhibit conversion of HMG-CoA --> mevalonate (cholesterol precursor)
179
HMG-CoA reductase inhibitors SE
hepatotoxicity - increase LFTs
| rhabdomyolysis
180
Niacin
Vitamin B3
181
Niacin effect on LDL
DECREASE DECREASE
182
Niacin effect on HDL
INCREASE INCREASE
183
Niacin effect on TG
decrease
184
Niacin MOA
inhibits lipolysisin adipose tissue
| reduce hepatic VLDL secretion into circulation
185
NIacin SE
red flushed fash - decrease by aspirin / long-term use
hyperglycemia - acanthosis nigricans
hyperuricemia - exacerbates gout
186
bile acid resins
cholestyramine, colestipol, colesevelam
187
bile acid resins effect on LDL
DECREASE DECREASE
188
bile acid resins effect on HDL
slightly increase
189
bile acid resins effect on TG
slightly increase
190
bile acid resins MOA
prevent intestinal reabsorption of bile acids
| liver must use cholesterol to make more
191
bile acid resins SE
patients HATE it - tastes bad and causes GI discomfort, decrease absorption of fat-soluble vitamins
cholesterol gallstones
192
cholesterol absorption blockers
ezetimibe
193
ezetimibe effect on LDL
DECREASE DECREASE
194
ezetimibe MOA
prevent cholesterol reabsorption at SI brush border
195
ezetimibe SE
rare - increase LFT's, diarrhea
196
fibrates
gemfibrozil, clofibrate, bezafibrate, fenofibrate
197
fibrates effect on LDL
decrease
198
fibrates effect on HDL
increase
199
fibrates effect on TG
DECREASE DECREASE DECREASE
200
fibrates MOA
upregulate LDL --> increase TG clearance
201
fibrates SE
myositis, hepatotoxicity (increase LFTs), cholesterol gallstones
202
cardiac glycoside
digoxin
203
digoxin MOA
direct inhibition of Na/K ATPase --> indirect inhibition of Na/Ca exchange --> increase intracellular calcium --> positive isotropy
stimualtes vagus nerve --> decrease HR
204
digoxin clinical use
CHF - increase contractility
| atrial fibrillation - decrease conduction at AV node and depress SA node
205
digoxin toxicity
cholinergic - N&V, diarrhea, blurry yellow vision (van goh)
ECG - increase PR, decrease QT, ST scooping, T-wave inversion, arrhythmia, AV block
poor prognostic indicator = hyperkalemia
206
factors predisposing to digoxin toxicity
renal failure - decrease excretion
hypokalemia -digoxin bdining K+ binding site on Na/K ATPASE
quinidine - decrease clearance - displace digoxin
207
digoxin antidote
slowly normalize K+, lidocaine, cardiac pacera, anti-digoxin Fab fragments, Mg2+
208
antiarrhythmics class I
Na+ channel blockers
local anesthetics
slow/block conduction in depolarized cells
decrease slow phase 0 depol
increase threshold for firing in abnormal pacemaker cells
state depemdent - selectively depress tissue that is freq depolarized (tachycardia)
209
what causes increase toxicity for all class I drugs
hyperkalemia
210
Class IA antiarrhythmics
quinidine, procainamide, disopyramide
211
Class IA MOA
increase AP duration, effective refractory period, and QT interval
atrial and ventricular arrhythmias - reentrant and ectopic supraventricular and ventricular tachycardia
212
quinidine toxicity
cinchonism - headache, tinnitus
213
class IB antiarrhythmics
lidocaine, mexiletine, tocainide
214
class IB MOA
decrease AP duration
pref affect ischemic or depolarized purkinje and ventricular tissue
used in acute ventricular arrhythmias (post-MI) and digitalis-induced arrhythmias
215
class IB toxicity
local anesthetic, CNS stimulation/depression, CV depression
216
class IC antiarrhythmics
flecainide, propafenone
217
class IC MOA
no effect on AP duration
useful in ventricular tachycardia that progress to VF and in intractable SVT
last resort in refractory tachyarrythmias - pts w/o structural abnormalities
218
class IC toxicity
proarrhythmic, especially post-MI (CI)
| significantly prolongs refractory period in AV node
219
procainamide toxicity
reversible SLE-like syndrome
220
disopyramide toxicity
heart failure
221
class IA toxicity
thrombocytopenia, torsades de pointes due to increase QT interval
222
IB is best...
post-MI
223
IC is contraindicated...
structural heart disease and post-MI
224
class II antiarrhythmics
beta-blockers --> metoprolol, propanolol, esmolol, atenolol, timolol
225
class II MOA
decrease cAMP and decrease CA current --> decrease SA and AV nodal activity
decrease slope of phase 4 - suppress abnormal pacemakers
AV node particularly sensitive - increase PR interval
226
very short acting class II
esmolol
227
class II toxicity
impotence, exacerabtion of asthma, CV effects (bradycardia, AV block, CHF), CNS effects (sedation, sleep alterations). may mask signs of hypoglycemia
228
metoprolol toxicity
dyslipidemia
229
metoprolol overdose tx
glucagon
230
propanolol toxicity
can exacerbate vasospasm in prinzmetal's angina
231
class III antiarrhythmics
K+ channel blockers - amiodarone, ibutilide, dofetilide, sotalol
232
class III MOA
increase AP duration, ERP
used when other antiarrhythmics fails
increase QT interval
233
sotalol toxicity
torsades de pointes, excessive beta block
234
ibutilide toxicity
torsades
235
amiodarone toxicity
pulmonary fibrosis, hepatotoxicity, hypothyroidism/hyperthyroidism (40% iodine by weight), corneal deposits, skin deposits (blue/gray) --> photodermatitis, neurologic effects, constipation, CV effects (bradycardia, heart block, CHF)
236
alters lipid membrane - has class I-IV effects
amiodarone
237
what do you check when using amiodarone
PFTs, LFTs, TFTs
238
class IV antiarrhythmics
Ca+ channel blockers - verapamil and diltiazem
239
class IV antiarrhythmics MOA
decrease conduction velocity, increase ERP and PR interval
| used in prevention of nodal arrhythmias (SVT)
240
class IV toxicity
constipation, flushing, edema, CV effects (CHF, AV block, sinus node depression)
241
adenosine MOA
increase K+ out of cells --> hyperpolarize the cell + decrease intracellular calclium
very short acting (15 seconds)
242
drug of choice in dx/abolishing supraventricular tachycardia
adenosine
243
adenosine toxicity
flushing, hypotension, chest pain
| effects blocked by theophylline and caffeine
244
effective in torsades de pointes and digoxin toxicity
Mg2+
