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Step 1 Smart Book > Cardio > Flashcards

Cardio Flashcards

1
Q

What growth factor is elevated in the blood within an hour after exercise?

A

VEGF

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2
Q

What does a diastolic murmur on the lower left sternal border suggest?

A

Aortic regurgitation

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3
Q

Why is enlargement of the azygos vein particularly dangerous in patients with portal hypertension?

A

Excess flow through the vessel results in congestion of the esophageal venous plexus which increases the risk of variceal rupture

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4
Q

Describe what happens to blood flow above and below an aortic coarctation and why.

A

In compensated aortic coarctation, BP above and below will be equal even though the pressures are vastly different. This is because of increased resistance above the coarctation.

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5
Q

What does the mitral valve look like following damage from rheumatic fever?

A

Thickened, blunted cardiac valve leaflets, often with fibrous bridging between valve leaflets and calcification

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6
Q

What class of drugs activate PPAR-alpha (proliferator activator receptor)?

A

Fibrates (e.g. gemfibrozil, fenofibrate, clofibrate)

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7
Q

What are some adverse effects of fibrates?

A

Gallstones and muscle toxicity

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8
Q

Why is acebutolol contraindicated in angina patients?

A
  1. Has intrinsic sympathomimetic activity and thus acts as a partial beta-1 agonist
  2. More importantly: does not cause a significant decrease in heart rate and maintains a high myocardial oxygen consumption
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9
Q

-Young patient (

A

Prinzmetal angina - coronary artery spasm

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10
Q

What is epinephrine reversal?

A

Epinephrine increases BP (from action on alpha receptors)

Give phentolamine (alpha antagonist) leading to unopposed vasodilatory action of beta receptors - decrease in BP

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11
Q

What is the most common etiologic cause of acute infective endocarditis in IV drug users?

A

Staph aureus

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12
Q

What is suggested by a holosystolic apical murmur radiating to the axilla and followed by a thrill? (Can also often hear wide splitting of S2.)

A

Mitral regurgitation

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13
Q

What class of drugs are first line for treating hypertension in patients with diabetic nephropathy and hyperuricemia?

A

ACE inhibitors - shown to slow the progression of renal disease

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14
Q

What drug decreases the hepatic production of VLDL and lipolysis in adipose tissue?

A

Niacin - vitamin B3

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15
Q

What is the most common side effect associated with niacin?

A

Facial flushing

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16
Q

How does severe anemia affect arteriolar diameter?

A

Increases arteriolar diameter

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17
Q

How do amphetamines produce hypertension?

A

Cause release of the mobile pool of norepinephrine

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18
Q

What does a systolic apical murmur suggest?

A

Mitral regurgitation

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19
Q

What is a common mechanism by which rheumatic fever causes mitral regurgitation?

A

Damage to the chordae tendinae –> rupture of those muscles

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20
Q

What is the inheritance of familial hypercholesterolemia?

A

Autosomal dominant

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21
Q

How can you distinguish Goodpasture syndrome from Wegener’s granulomatosis in a patient with hematuria and hemoptysis?

A

Check for nasal symptoms (e.g. rhinitis) - Wegener’s patients will have nasopharyngeal involvement whereas Goodpasture patients will not

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22
Q

When the ventricular muscle contracts, what happens to the flow in the left coronary artery?

A

Abrupt decrease (isovolumetric contraction) followed by gradual recovery

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23
Q

How does coarctation of the aorta lead to increased blood pressure?

A

Activation of the renin-angiotensin system

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24
Q

What is the underlying cause in abdominal aortic aneurysm?

A

Atherosclerosis

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25
Q

What peripheral finding is associated with aortic stenosis?

A

Weak peripheral pulses

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26
Q

What is the first step in the proposed mechanism of atherosclerosis pathogenesis?

A

Endothelial cell dysfunction

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27
Q

What is alprostadil?

A

PGE1 analog

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28
Q

What should you be suspicious of in a patient with an isolated AST increase and epigastric pain?

A

Ischemic heart disease

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29
Q

Which valve is commonly affected in acute infective endocarditis?

A

Tricuspid

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30
Q

Why is rheumatoid arthritis associated with restrictive cardiomyopathy?

A

Long-standing inflammatory conditions lead to deposition of a form of amyloid called AA –> deposition in the myocardium –> stiffened walls

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31
Q

What cardiac side effect can beta blockers cause?

A

AV block

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32
Q

A fracture of the supracondylar surface of the femur will cause compression or injury of what vessel?

A

Popliteal artery

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33
Q

What does an S3 sound suggest?

A

Look for right (tricuspid regurgitation) or left (mitral regurgitation) ventricular overload

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34
Q

What antihypertensive medication can exacerbate CHF in patients?

A

Verapamil

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35
Q

What lab value do we want to look at in trauma situations to assess possible damage to cardiomyocytes?

A

Ratio of CK-MB to total creatinine kinase because there may be a large amount of skeletal muscle damage

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36
Q

What kind of murmur does aortic regurgitation produce?

A

Diastolic murmur that is most intense in the precordium

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37
Q

What does the body constrict to maintain mean systemic filling pressure after major hemorrhage?

A

Veins and venules

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38
Q

80% of cases of aortic dissection are caused by what?

A

Uncontrolled hypertension

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39
Q

Describe the pulse pressure in extremely anemic patients.

A

Wide pulse pressure

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40
Q

What is the smooth part of the right atrium derived from?

A

Sinus venosus

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41
Q

What might a chest x-ray show on an infant with a patent ductus arteriosus

A

Enlargement of the left atrium and ventricle, as well as dilatation of the aorta

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42
Q

What does biopsy of temporal arteritis show?

A

Focal granulomatous inflammation with giant cells

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43
Q

How does sepsis cause pulmonary edema?

A

Alveolar injury from the damaging effects of LPS endotoxin leads to an inflammatory response in the lungs leading to increased microvascular permeability leads to pulmonary edema

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44
Q

What is the diagnosis for linear calcifications along small to medium arteries found in the elderly often asymptomatically/incidentally?

A

Monckeberg arteriosclerosis

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45
Q

Describe what happens in long-standing stable angina.

A

Loss of myocytes with fibrosis and vascuolization of myocytes in the subendocardium because of sustained ischemia

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46
Q

What gene product is abnormal in Marfan’s?

A

Fibrillin

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47
Q

Baby girl with neck mass

  • Just below the skin
  • Transilluminates
  • Biopsy shows clear fluid and lack of abnormal cells

What is it and what disease is it associated with?

A

Cystic hygroma - associated with Turner syndrome (will become the webbed neck)

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48
Q

What cardiac defect is associated with Turner syndrome?

A

Coarctation of the aorta

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49
Q

Describe the murmur associated with aortic stenosis.

A

Harsh, crescendo-decrescendo midsystolic murmur that radiates to the neck

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50
Q

What second messengers are used to stabilize blood pressure changes in the baroreceptor reflex?

A

IP3 and DAG via norepinephrine - smooth muscle vascular constriction

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51
Q

What happens to blood flow during ventricular fibrillation?

A

Blood flows from arterial to venous system until pressure has equalized

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52
Q

What is the cardiac output during ventricular fibrillation?

A

0

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53
Q

What is dextrocardia a sign of?

A

Situs inversus

Dextrocardia = apex of the heart points to the right and auscultation of the heart is best over the right chest

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54
Q

What measure of cardiac performance reaches its maximum value during isovolumetric contraction?

A

Positive rate of change of pressure

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55
Q

What is suggested by a restrictive heart disease with endomyocardial fibrosis and associated eosinophilia?

A

Loeffler endocarditis

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56
Q

What is the primary/first consequence of sepsis?

A

Increase in vascular permeability

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57
Q

What rib abnormality can be observed in coarctation of the aorta?

A

In postductal coarctation of the aorta, you will see rib notching.

This is because the descending thoracic aorta is supplied by reverse flow by the intercostal arteries which run in the inferior aspect of the ribs. Increased flow to these arteries causes erosion of the inferior aspect of the ribs.

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58
Q

How does digoxin affect conduction in the heart?

A

Decreases conduction through the AV node

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59
Q

Which blood vessels have the highest ratio of wall cross-sectional area to lumen cross-sectional area?

A

Arterioles

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60
Q

What happens to stroke work and tissue oxygen concentration in aortic stenosis?

A

Stroke work increases

Tissue oxygen concentration decreases

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61
Q

What causes a widened pulse pressure?

A

A decrease in vessel compliance making them stiff (e.g. arteriosclerosis) will lead to increased systolic and decreased diastolic - widened pulse pressure

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62
Q

How does aortic stenosis affect coronary blood flow during diastole/systole?

A

Decreased coronary blood flow during systole (because of compression of the vessels due to increased systolic pressure) –> leads to increased coronary blood flow during diastole

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63
Q

How does atropine affect heart rate?

A

Atropine - muscarinic receptor blocker

Increases HR by blocking M2 receptors on the SA node

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64
Q

On EKG, what is a QRS not preceded by a P wave?

A

Premature ventricular contraction

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65
Q

Why does premature ventricular contraction result in decreased left ventricular end-diastolic volume?

A

Reduced filling time so preload (i.e. left ventricular EDV) is reduced

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66
Q

Compare and contrast what happens to blood flow in skeletal muscles in high intensity static exercise (e.g. weight lifting) vs. dynamic endurance exercise (e.g. long runs).

A

High intensity static exercise - blood vessels are compressed by skeletal muscle, thus increasing vascular resistance and decreasing blood flow

Dynamic endurance exercise - blood flow increases due to metabolic vasodilation of arterioles

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67
Q

Describe what happens in long-standing stable angina.

A

Loss of myocytes with fibrosis and vascuolization of myocytes in the subendocardium because of sustained ischemia

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68
Q

Presentation: Chronic chest pain which occurs with moderate exertion and is relieved by rest.

Diagnosis?

A

Stable angina

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69
Q

What is suggested by a holosystolic apical murmur radiating to the axilla and followed by a thrill? (Can also often hear wide splitting of S2.)

A

Mitral regurgitation

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70
Q

What drug is able to both vasodilate and to decrease the release of insulin in response to glucose?

A

Diazoxide - K+ channel opener

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71
Q

What drugs are preferred for rapid rate control in patients with atrial fibrillation?

Which one is preferred in patients with pulmonary disease?

A

Calcium channel blockers and beta blockers are superior to digoxin

Calcium channel blockers preferred in patients with pulmonary disease because beta blockers may cause bronchospasm

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72
Q

What type of collagen is present in mature scars?

A

Type I (it is the most prevalent collagen in the human body)

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73
Q

Echocardiogram of an infant shows aorta lying anterior and to the right of the pulmonary artery. Diagnosis?

A

Transposition of the great vessels

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74
Q

What fails to develop in DiGeorge syndrome?

A

3rd and 4th branchial pouches

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75
Q

What pulse finding suggests cardiac tamponade?

A

Pulsus paradoxus - decrease in the systolic pressure of 10 mm Hg or more during inspiration vs. expiration

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76
Q

What does autopsy of the heart after MI look like within the first 4 hours?

A

Normal myocardium (signs of coagulative necrosis start after 4 hours)

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77
Q

How do beta blockers affect the EKG?

A

Prolong the PR interval because they slow AV conduction (PR interval is the time between atrial and ventricular depolarization)

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78
Q

The severity of cyanosis in patients with Tetralogy of Fallot depends on what?

A

Pulmonic stenosis - this would promote the right to left shunt leading to deoxygenated blood reaching the systemic circulation (i.e. cyanosis)

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79
Q

Which gram positive cocci produces dextrans from glucose and why?

A

Strep viridans - the dextrans aid these organisms in colonizing host surfaces (e.g. dental enamel and heart valves)

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80
Q

What do you need to maximize if you want to find a true relationship between two groups?

A

Power (1 - beta)

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81
Q

Describe how pregnant women can become hypotensive when they are pregnant.

A

Baby compresses IVC leading to reduced venous return

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82
Q

A patient being treated for MRSA develops myopathy and CK level elevation - which antibiotic are they being treated with?

A

Daptomycin (not vanc based on this toxicity profile)

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83
Q

Describe what happens in a carotid sinus massage.

A

Increase in baroreceptor firing –> increases parasympathetic influence on heart and vessels –> prolongs AV node refractory period (helps to treat arrhythmias)

84
Q

What is the first peak in a jugular venous pressure tracing?

A

A wave - from atrial contraction

85
Q

What cardiac medication can lead to disturbed color perception, anorexia, nausea, vomiting, and diarrhea?

A

Digoxin

86
Q

What’s the major toxicity in digoxin?

A

Ventricular tachyarrhythmia

87
Q

Where are the leads placed in a biventricular pacemaker?

A
  1. Right atrium
  2. Right ventricle
  3. Atrioventricular groove (coronary sinus)
88
Q

Which nitrate drug has the highest oral bioavailability?

A

Isosorbide mononitrate - nitroglycerin and isosorbide dinitrate undergo considerable first pass metabolism

89
Q

Bounding femoral pulses and carotid pulsations with head bobbing suggest what underlying cardiac problem?

A

Aortic regurgitation

90
Q

Early diastolic murmur - diagnosis?

A

Aortic regurgitation

91
Q

What is the mutation in hypertrophic cardiomyopathy?

A

Autosomal dominant mutations in cardiac sarcomere proteins - most common protein involved is beta-myosin heavy chain

92
Q

What blood vessel primarily supplies the diaphragmatic surface of the heart?

A

Posterior descending artery (from the right coronary artery)

93
Q

How does an AV shunt affect preload and afterload?

A

AV shunt allows blood to go from arterial side to venous side and skip the capillaries - this leads to increased preload and decreased afterload

94
Q

How would an AV shunt appear on a pressure volume curve?

A

Increased preload and decreased afterload –> increased volume but lower pressure

95
Q

Acute onset, mid-chest pleuritic pain that decreases on sitting up and leaning forward. Diagnosis?

A

Pericarditis

96
Q

What congenital defect can present in a child as differential cyanosis restricted to the lower body (e.g. just the extremities)?

A

PDA

97
Q

What drug is the agent of choice for prevention and treatment of post-MI arrhythmias? Why?

A

Lidocaine - it specifically binds depolarizing and depolarized cells (i.e. ischemic tissue)

98
Q

What is the most common site of aortic rupture?

A

Aortic isthmus - the connection between the ascending and descending aorta distal to where the left subclavian artery branches off the aorta

99
Q

Gram positive cocci that are catalase negative and able to grow in 6.5% saline are?

A

Enterococci

100
Q

What usually causes enterococcal endocarditis?

A

Usually occurs in elderly who have recently undergone manipulation in areas colonized by this organism - e.g. GI and GU tracts

101
Q

What does nitroglycerin primarily dilate?

A

Large veins

102
Q

When do you hear the opening snap in mitral stenosis?

A

Right at the start of diastole

103
Q

How does MI affect a cardiac function curve?

A

Decreases both the slope and the maximal height of the line

104
Q

What paces the ventricles if conduction between the SA and AV nodes are impaired?

A

The AV node itself becomes a pacemaker

105
Q

What holosystolic murmur increases in intensity upon inspiration?

A

Tricuspid regurgitation

106
Q

How would you characterize diastolic heart failure in terms of LVEDP. LVEDV, and LVEF (ejection fraction)?

A

The end diastolic pressure will increase (due to loss of compliance of the left ventricle) to maintain normal EDV and stroke volume.

107
Q

What is the main effect of nitroglycerin?

A

Venodilator –> decrease in cardiac work by decreasing left ventricular filling volume or preload

108
Q

What side effects are seen with selective arteriolar vasodilators (e.g. hydralazine, minoxidil)?

A

They cause reflex sympathetic activation resulting in tachycardia and edema

109
Q

What is strong use vs. reverse use dependence?

A

Antiarrythmics can prolong the QRS duration either at higher rates (strong use) or at lower rates (reverse use)

110
Q

What are patients with QT prolongation at increased risk for?

A

Torsades de pointes

111
Q

What drugs can have additive chronotropic effects when added to a beta blocker?

A

Non-dihydropyridine calcium channel blockers (e.g. verapamil, diltiazem)

112
Q

Almost all cases of mitral stenosis are caused by?

A

Rheumatic fever

113
Q

Which antiarrhythmics exhibit strong use dependence vs. reverse use?

A

Class Ic - strong use

Class III - reverse use

114
Q

When is an aortic regurgitation murmur heard loudest?

A

Early diastole - when pressure gradient between aorta and left ventricle is maximal

115
Q

How do phosphodiesterase inhibitors work?

A

Lead to increased cardiac contractility by increasing intracellular cAMP concentration

116
Q

Why would you limit the use of phosphodiesterase inhibitors in hypotensive patients?

A

Leads to increased intracellular cAMP –> vasodilation –> exacerbates hypotension

117
Q

What can you expect to see on light microscopy 10-14 days post MI?

A

Granulation tissue and neovascularization

118
Q

What would you use as first line treatment for hospital acquired staph infection?

A

Vancomycin +/- rifampin or gentamycin

119
Q

Which anti-arrhythmics are associated with Torsades de Pointes?

A

Class IA (quinidine, procainamide, disopyramide) and Class III (ibutilide, dofetilide, sotalol)

120
Q

Presentation: constitutional symptoms, mid-diastolic rumbling murmur, positional dyspnea, large pedunculated mass in the left atrium

Diagnosis?

A

Atrial myxoma

121
Q

What does an atrial myxoma look like on histology?

A

Scattered cells within a mucopolysaccharide stroma

122
Q

In cardiac pacemaker cells, phase 0 depolarization is marked by an influx of what ion?

A

Calcium

123
Q

A mid systolic click followed by a systolic murmur is the classic auscultatory finding for?

A

Mitral valve prolapse

124
Q

What typically causes mitral valve prolapse?

A

Defects in mitral valve connective tissue proteins

125
Q

When do you see the opening snap in mitral stenosis?

A

Early diastolic sound - shortly after left ventricular pressure drops below left atrial pressure

126
Q

What can cause ventricular release of ANP and BNP?

A

Ventricular hypertrophy and volume overload

127
Q

When would you see increased compliance - acute or chronic mitral regurgitation?

A

Chronic - in the acute form, heart hasn’t had time to adjust/compensate

128
Q

What do you tend to see clinically in acute mitral regurgitation vs. chronic mitral regurgitation?

A

Pulmonary edema and pulmonary hypertension

129
Q

Unprovoked syncope in a previously asymptomatic young individual with QT prolongation on EKG

Diagnosis?

A

Congenital syndromes with QT prolongation:

  1. Romano-Ward Syndrome
  2. Jervell and Lange-Nielsen Syndrome

Thought to arise from mutations in a K+ channel protein

130
Q

Where are beta 1 receptors found - cardiomyocytes vs. JGA vs. vascular smooth muscle?

A

Cardiomyocytes and the JGA

NOT found on vascular smooth muscle

131
Q

What are the 4 “HYPER” problems of thiazide diuretics?

A
  1. Hyperuricemia
  2. Hypercalcemia
  3. Hyperglycemia
  4. Hyperlipidemia
132
Q

What are 2 drugs that have the highest risk of causing drug induced lupus?

A

Hydralazine and procainamide

133
Q

List the cardiac tissues in order of conduction velocity.

A

Mnemonic: Park at ventura avenue.

Fastest to slowest: Purkinje system, atrial muscle, ventricular muscle, AV node

134
Q

What is use dependence in anti-arrhythmics?

A

Higher rates of depolarization lead to increased sodium channel blockade due to channels spending less time in the resting state

135
Q

Contrast the class I anti-arrhythmics in terms of use dependence and sodium channel binding strength.

A

1C (most use dependence) > 1A > 1B (least use dependence)

136
Q

What anti-arrhythmic can cause both QT prolongation and bradycardia?

A

Sotalol - QT prolongation (from the effects of blocking K) and bradycardia (sotalol is the only class III anti-arrhythmic with beta-adrenergic blocking effects)

137
Q

What is the major determinant for whether or not a coronary artery plaque will cause ischemic myocardial injury?

A

Rate at which it occludes the involved artery - if it’s slow enough, there is time for formation of collaterals that can prevent myocyte necrosis

138
Q

What is dobutamine?

A

Selective beta 1 adrenergic agonist

139
Q

Dystrophic calcification is considered a hallmark of what preceding event?

A

Cell necrosis and death

140
Q

How would verapamil affect pacemaker cells?

A

Slow diastolic depolarization by blocking the calcium channel which is responsible for the phase 0 depolarization

141
Q

What is the most common cause of coronary sinus dilatation?

A

Elevated right-sided heart pressure secondary to pulmonary artery hypertension

142
Q

Why is the liver less susceptible to infarction than the CNS or the heart?

A

Presence of dual/collateral blood supply - better able to handle arterial infarction than CNS or heart which has end-arterial circulation

143
Q

What should you suspect if you see a significant increase in oxygen saturation between two right sided chambers?

A

VSD

144
Q

What kind of murmur does a VSD produce?

A

Holosystolic that is loudest over the left mid-sternal border

145
Q

What lies posterior to the esophagus and the left atrium?

A

Thoracic aorta

146
Q

Describe how strep viridans are able to colonize a heart valve.

A

They produce dextrans (extracellular polysaccharides) which facilitate their adherence to fibrin

147
Q

What statistical method is used to compare the means of 2 groups of subjects?

A

Two-sample t test

148
Q

In a patient with mitral regurgitation, what is the most reliable auscultatory finding indicating a high regurgitant volume?

A

S3 gallop

149
Q

What are the 3 effects of nitrate drugs?

A

Mimics NO:

  1. Increased cGMP
  2. Decreased intracellular calcium
  3. Myosin dephosphorylation
150
Q

For carotid sinus vs. aortic arch baroreceptors, which one is mediated by CN IX and which one is mediated by CN X?

A

Carotid sinus - CN IX

Aortic arch - CN X

151
Q

Presentation: Infant with apical displacement of the tricuspid leaflets, decreased right ventricular volume, atrialization of the right ventricle. Diagnosis?

A

Ebstein’s anomaly (often secondary to lithium use by mom)

152
Q

Using a standard 2x2, what is the odds ratio?

A

(a/c) / (b/d) = ad/bc

153
Q

What are two potential causes of a pathologic S4 sound?

A

Due to decreased left ventricle compliance possibly from:

  1. Restrictive cardiomyopathy
  2. Left ventricular hypertrophy
154
Q

What is the auscultatory finding in an ASD?

A

Splitting of S2 that does not change with respiration

155
Q

ST elevation in leads II, III, avF suggest damage to what part of the heart and infarct to what vessel?

A

Inferior part of the heart

Likely right coronary artery

156
Q

How can you test for coronary vasospasm?

A

Ergonovine - ergot alkaloid that constricts vascular smooth muscle by stimulating both alpha-adrenergic and serotonergic receptors

157
Q

What is isoproterenol?

A

Non-selective beta agonist with little effect on alpha receptors

158
Q

What determines the ventricular contraction rate in a patient with atrial fibrillation?

A

AV node refractory period

159
Q

How does digoxin decrease AV node conduction?

A

Increasing parasympathetic tone

160
Q

What is the mechanism of action of digitalis?

A

Blocks the Na-K ATPase

161
Q

Why do ischemic cardiomyocytes get larger?

A

Ischemia –> lack of ATP –> Na/K pump and Ca pump (on sarcoplasmic reticulum) fails –> Na and Ca build up –> attract water –> cells swell

162
Q

How can you combat the reflex tachycardia that you get with nitrates (hypotension leads to body secreting catecholamines)?

A

Give beta blockers

163
Q

Why would you use nifedipine to treat hypertension in a patient with bradycardia?

A

Causes peripheral vasodilation which may result in reflex tachycardia

164
Q

Autopsy of heart shows decrease in left ventricular chamber apex to base dimensions, development of a sigmoid-shaped ventricular septum, myocyte atrophy with interstitial fibrosis, accumulation of lipofuscin pigment

Diagnosis?

A

Normal aging

165
Q

High output congestive heart failure combined with neurological symptoms are suggestive of what?

A

Wet beriberi (thiamine or B1 deficiency)

166
Q

What predisposes to infective endocarditis?

A

Valvular inflammation, damage, and scarring

167
Q

What is the key predisposing insult in the development of infective endocarditis?

A

Endothelial damage –> fibrin deposition (bacteria can adhere to fibrin)

168
Q

Presentation: 6 year old male with QT prolongation and family history of sudden cardiac deaths.

Diagnosis?

A

Congenital long-QT syndromes (e.g. Jervell and Lange-Nielsen syndrome)

169
Q

What is Jervell and Lange-Nielsen syndrome typically associated with?

A

Neurosensory deafness

170
Q

What is head bobbing a sign of?

A

Widened pulse pressure (e.g. in the case of aortic regurgitation)

171
Q

Presentation: Child from abroad has throat pain and difficulty breathing, develops heart failure.

Diagnosis?

A

Diphtheria

172
Q

What antibody must be produced to guard against diphtheria?

A

The DPT vaccine induces formation of IgG antibodies against the exotoxin B. IgA does not work against diphtheria because it expresses K antigen (anti-phagocytic molecule) on its cell surface.

173
Q

In an old person, what is the prominent intracytoplasmic granules that are tinged yellowish-brown that you see in myocardial cells?

A

Lipofucsin - product of lipid peroxidation

174
Q

How do you calculate Number Needed to Treat?

A

1/Absolute Risk Reduction

ARR = event rate in placebo group - event rate in treatment group

175
Q

Interpret cardiac and venous return curves:

  1. Increase in the height of the cardiac function curve
  2. Increased slope of both curves
  3. Rightward shift of venous return curve
A
  1. Increase in height of cardiac function curve - increased cardiac output
  2. Increased slope of both curves - decreased TPR
  3. Rightward shift of venous return curve - increased mean systemic pressure
176
Q

Calcium efflux prior to myocyte relaxation is accomplished through the use of what?

A

Ca-ATPase and Na/Ca exchange mechanisms

177
Q

What does an EKG show for atrial fibrillation?

A

Absent p waves and irregularly spaced ventricular contractions (variable R-R interval)

178
Q

Presentation: New onset palpitations, tachycardia, irregular rhythm, binge alcohol consumption

Diagnosis?

A

Atrial fibrillation

179
Q

What auscultatory finding would you hear in CHF and how can you accentuate the finding?

A

S3 - Have patient lie in the left lateral decubitus position and fully exhale

180
Q

How soon after total ischemia does loss of cardiomyocyte contractility occur?

A

Within 60 seconds

181
Q

Autopsy of heart: fibrous intimal thickening with endocardial plaques limited to the right heart

Diagnosis?

A

Carcinoid heart disease (associated with carcinoid syndrome)

182
Q

What lab value correlates with the severity of carcinoid syndrome?

A

Plasma levels of serotonin and urinary levels of the serotonin metabolite - 5 hydroxyindoleacetic acid

183
Q

What can cause acute systemic hypotension in patients with severe aortic stenosis?

A

Atrial fibrillation - heart relies on atrial contraction to help fill left heart which has lost compliance due to LV hypertrophy

184
Q

How are Trousseau syndrome and non bacterial thombotic endocarditis similar?

A

Thought to arise from tumor associated release of procoagulants

185
Q

Repetitive ischemia or persistent hypoperfusion of cardiac myocytes can result in a chronic but reversible loss of contractile function called what?

A

Hibernation

186
Q

Extended consumption of appetite suppressants (fenfluramine, phentermine) is associated with an increased incidence of what side effect?

A

Pulmonary hypertension - can manifest with dyspnea on exertion and cor pulmonale with RVH

187
Q

What drug is associated with the side effects of flushing, chest burning, hypotension, high grade AV block?

A

Adenosine

188
Q

How do you calculate maintenance dose?

A

Maintenance dose = Cpss x CL x time
Cpss = plasma steady state concentration
CL = clearance

189
Q

What antiarrhythmic is likely to cause AV block in a cardiac patient with history of COPD?

A

Verapamil

Not beta-blocker because they are contraindicated in patients with mild to moderate asthma

190
Q

Alveolar cells with golden cytoplasmic granules that turn dark blue with Prussian blue staining?

A

Hemosiderin (iron) laden macrophages

191
Q

What heart problem is associated with the finding of hemosiderin laden macrophages in the lung?

A

Left sided heart failure - leads to increased pulmonary capillary hydrostatic pressures

192
Q

Amyloid in the cardiac atria is likely composed of?

A

ANP

193
Q

Amyloid in the thyroid is likely composed of?

A

Calcitonin

194
Q

Amyloid in the pancreatic islets is likely composed of?

A

Islet amyloid protein (amylin)

195
Q

Amyloid in the cerebrum/cerebral blood vessels is likely composed of?

A

Beta-amyloid protein

196
Q

Amyloid in the pituitary gland is likely composed of?

A

Prolactin

197
Q

Why do patients taking nitrates need to have a nitrate free period during the day?

A

Avoid tolerance

198
Q

Describe the pericarditis that can develop in a patient 2-4 days post MI.

A

Inflammation overlying the necrotic segment of myocardium (not as a result of infection)

199
Q

What accentuates the murmur in hypertrophic cardiomyopathy?

A

Standing from the supine position, Valsalva - decrease venous return and accentuate the murmur

200
Q

What causes Janeway lesions?

A

Septic microemboli to cutaneous blood vessels

201
Q

What are the side effects associated with nitrates?

A

Flushing and headaches (from vasodilation in the skin and meninges)

202
Q

IV drug users are most likely to get what kind of valvular infection?

A

Staph infection of the tricuspid valve –> tricuspid regurgitation

203
Q

What is the difference in pressure volume loops between an infusion vs. activating beta adrenergics?

A

Both will increase pressure and volume but an infusion will extend the loop to the right (greater volume than normal) vs. activating beta adrenergics will extend the loop to the left (same volume but greater stroke volume/ejection fraction)

204
Q

Describe mathematically how constant flow in a cylindrical system (e.g. blood flow in the heart) can be expressed.

A

Flow is constant and flow = velocity x surface area so V1 x A1 = V2 x A2

205
Q

Vascular endothelium secretes what to inhibit platelet aggregation?

A

Prostacyclin

206
Q

Describe the mechanism by which left sided heart failure leads to pulmonary hypertension.

A

Reactive vasoconstriction secondary to pulmonary venous congestion

207
Q

How can you tell systolic vs. diastolic dysfunction in CHF?

A

Diastolic - hypertrophied walls of left ventricle (decreased compliance)

Systolic - dilated left ventricle, walls should be normal (decreased ventricular contraction force)

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