Cardio 2.0

Question 1

What can left atrial enlargement cause

Answer 1

Esophageal compression–> dysphagia

LA is anterior to esophagus

Question 2

What is middle meningeal artery a branch of

Answer 2

Maxillary a.

artery is deep to the pterion (skull junction)

Question 3

WHat is most common COD 2-3 days after MI

Answer 3

V fib

Question 4

What is a common COD 5-14 days post MI

Answer 4

LV wall rupture

happens when immune system has substantially weakened the wall –> coag necrosis

Question 5

What is the #1 risk factor for aortic dissection

Answer 5

HTN

Question 6

What is nitric oxide synthesized from

Answer 6

Arginine

NO gets made when ↑ Ca–> eNOS–> Arg + O2 to NO + citrulline

Question 7

What does NO act upon to cause vasodilation

Answer 7

NO acts on Guanylate Cyclase to:

GTP– (guanylate cyclase)–> cGMP –> vasodilation

Question 8

What mediates vascular endothelial vasodilation

Answer 8

AcH
Bradykinin
5HT
Substance P
shear forces

Question 9

What are some non- infective causes of endocarditis

Answer 9

it is platelets stuck to the valve

asc. w/ advanced malignancy, chronic inflammation, and sepsis

Question 10

How long does it take to lose contractility in heart after ishmeia

Answer 10

loss of cardiac contractility occurs after 60 seconds

Question 11

How long for irreversible damage after cardiac ischemia

Answer 11

30 minutes

Question 12

How do you calculate CO with the fick principle

Answer 12

CO= O2 consumed / AV O2 difference

cardiac output is equal to oxygen consumption of tissue / av oxygen difference

Question 13

What can niacin treat

Answer 13

Hyperlipidemia

↑ HDL, ↓ LDL and ↓ TriGlyc

Question 14

What are the s/e of niacin

Answer 14

flushing, warmth, itching

Mediated by PGs*

Aspirin 30 min before can minimize s/e

Question 15

Wht is the most common congenital heart defect

Answer 15

VSD

causes holosystolic murmur over left sternal border

Question 16

why might someone have right heart failure and no edema

Answer 16

↑ lymph drainage can compensate for moderate cvp elevations

when lymph capacity overwhelmed–> edema

Question 17

If cardiac upstroke is slanty like, what antiarrhythmic drug drug are

Answer 17

Class 1

Blocks Na channel

Question 18

What are the class 1a Cardiac Drugs

Answer 18

quinidine
disopyramide
procainamide

(prom queen disappears, to heartbreak hotel)

Question 19

What two factor are the most important in determining coronary blood flow

Answer 19

NO- from arginine, for larger vessels
Adenosine- from atp, for small vessel

both vasodilate

Question 20

What rxn type does warfarin block

Answer 20

carboxylation

Question 21

What is the name of factor 2a

Answer 21

thrombin

Question 22

What does thrombin do

Answer 22

fibrinogen –> fibrin

Question 23

When would you/ when would you not use spironolactone/ eplerenone

Answer 23

Use in: decomp heart failure to improve survival

avoid in: hyperk or renal failure

Question 24

Describe the use dependance of class 1a arrhythmia drugs

Answer 24

class 1a= Na blocker drugs w/ use dependance

use dependance= higher rates of depolarization lead to increased Na blocking

Question 25

What mediates phase 0 non pacemeaker AP

Answer 25

phase 0= rapid depol rapid Na entery in voltage gated na channel

Question 26

what mediates phase 1 non pacemaker AP

Answer 26

transient outward K current - early repolarization Rapid decline of inward Na

Question 27

Describe phase 2 non pacemaker AP

Answer 27

Plataue phase Late inward ca current Outward k current

Question 28

Describe phase 3 non pacemaker AP

Answer 28

late repolerization Opening more k channel

Question 29

Describe phase 4 non pacemaker AP

Answer 29

normal resting membrane -80 to - 95 mV Na K ATPase pumps k in and na out but k leaks out

Question 30

Compare phase 0 of non pacemaker and pacemaker cell

Answer 30

non pacemaker= na influx pacemaker= ca influx

Question 31

How do statins work on cell surface

Answer 31

- statins cause LDL receptor density increase | - ↑ receptors--> ↑ LDL uptake --> ↓ serum LDL

Question 32

What heart drug leads to hyperK

Answer 32

Digoxin- Na-K-ATPase inhibitor

Question 33

What are s/s of digoxin toxicity

Answer 33

``` NV AMS Weakness color vision change hyperk ```

Question 34

What are s/s of spironolactone toxicity

Answer 34

hyperk gynecomastia impotence decreased libido

Question 35

What is Milrinone

Answer 35

-one in a million donkey campaign (digoxin dance) -works via PDE block (no cAMP-->AMP) poster reads: do not foster disinterest - ↑ cAMP--> ↑ Ca--> ↑ Contractility (strong donkey) - s/e: vasodilation, bad in hypotension

Question 36

What is myocardial hibernation

Answer 36

state seen in chronic myocardial ischemia myocardial metabolism ↓ to match ↓ blood

Question 37

What are the consequences of myocardial hibernation

Answer 37

LV systolic dysfunction from reduced blood flow can be fixed or partially fixed by giving back better blood flow

Question 38

What is the vasa vasorum

Answer 38

small blood vessels that supply large blood vessels syphilis destroys these

Question 39

What leads to varicose veins

Answer 39

incompetence of venous valves

Question 40

What does persistent lymphedema predispose to

Answer 40

lymphangiosarcoma- malig neoplasm of endothelial lining of the lymph often seen in arms after breast cancer removal

Question 41

What are some of the less obvious reasons to avoid OCPs

Answer 41

Hx of estrogen tumor, ↑ triglycerides, or liver disease (steroid metabolism) PLUS all the stuff I know you know

Question 42

What is a good specific sign for left heart failure

Answer 42

Orthopnea (trouble breathing laying, good when standing)

Question 43

What is the S3 heart sound

Answer 43

rapid passive ventricular filling sound abnormality ONLY in people 40+ Heard best at the end of expiration

Question 44

Risks for liver hemangiosarcoma

Answer 44

arsenic thorotrast polyvinyl chloride