Cardio 2.0 Flashcards
What can left atrial enlargement cause
Esophageal compression–> dysphagia
LA is anterior to esophagus
What is middle meningeal artery a branch of
Maxillary a.
artery is deep to the pterion (skull junction)
WHat is most common COD 2-3 days after MI
V fib
What is a common COD 5-14 days post MI
LV wall rupture
happens when immune system has substantially weakened the wall –> coag necrosis
What is the #1 risk factor for aortic dissection
HTN
What is nitric oxide synthesized from
Arginine
NO gets made when ↑ Ca–> eNOS–> Arg + O2 to NO + citrulline
What does NO act upon to cause vasodilation
NO acts on Guanylate Cyclase to:
GTP– (guanylate cyclase)–> cGMP –> vasodilation
What mediates vascular endothelial vasodilation
AcH Bradykinin 5HT Substance P shear forces
What are some non- infective causes of endocarditis
it is platelets stuck to the valve
asc. w/ advanced malignancy, chronic inflammation, and sepsis
How long does it take to lose contractility in heart after ishmeia
loss of cardiac contractility occurs after 60 seconds
How long for irreversible damage after cardiac ischemia
30 minutes
How do you calculate CO with the fick principle
CO= O2 consumed / AV O2 difference
cardiac output is equal to oxygen consumption of tissue / av oxygen difference
What can niacin treat
Hyperlipidemia
↑ HDL, ↓ LDL and ↓ TriGlyc
What are the s/e of niacin
flushing, warmth, itching
Mediated by PGs*
Aspirin 30 min before can minimize s/e
Wht is the most common congenital heart defect
VSD
causes holosystolic murmur over left sternal border
why might someone have right heart failure and no edema
↑ lymph drainage can compensate for moderate cvp elevations
when lymph capacity overwhelmed–> edema
If cardiac upstroke is slanty like, what antiarrhythmic drug drug are
Class 1
Blocks Na channel
What are the class 1a Cardiac Drugs
quinidine
disopyramide
procainamide
(prom queen disappears, to heartbreak hotel)
What two factor are the most important in determining coronary blood flow
NO- from arginine, for larger vessels
Adenosine- from atp, for small vessel
both vasodilate
What rxn type does warfarin block
carboxylation
What is the name of factor 2a
thrombin
What does thrombin do
fibrinogen –> fibrin
When would you/ when would you not use spironolactone/ eplerenone
Use in: decomp heart failure to improve survival
avoid in: hyperk or renal failure
Describe the use dependance of class 1a arrhythmia drugs
class 1a= Na blocker drugs w/ use dependance
use dependance= higher rates of depolarization lead to increased Na blocking
What mediates phase 0 non pacemeaker AP
phase 0= rapid depol
rapid Na entery in voltage gated na channel
what mediates phase 1 non pacemaker AP
transient outward K current - early repolarization
Rapid decline of inward Na
Describe phase 2 non pacemaker AP
Plataue phase
Late inward ca current
Outward k current
Describe phase 3 non pacemaker AP
late repolerization
Opening more k channel
Describe phase 4 non pacemaker AP
normal resting membrane -80 to - 95 mV
Na K ATPase pumps k in and na out
but k leaks out
Compare phase 0 of non pacemaker and pacemaker cell
non pacemaker= na influx
pacemaker= ca influx
How do statins work on cell surface
- statins cause LDL receptor density increase
- ↑ receptors–> ↑ LDL uptake –> ↓ serum LDL
What heart drug leads to hyperK
Digoxin- Na-K-ATPase inhibitor
What are s/s of digoxin toxicity
NV AMS Weakness color vision change hyperk
What are s/s of spironolactone toxicity
hyperk
gynecomastia
impotence
decreased libido
What is Milrinone
-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
What is myocardial hibernation
state seen in chronic myocardial ischemia
myocardial metabolism ↓ to match ↓ blood
What are the consequences of myocardial hibernation
LV systolic dysfunction from reduced blood flow
can be fixed or partially fixed by giving back better blood flow
What is the vasa vasorum
small blood vessels that supply large blood vessels
syphilis destroys these
What leads to varicose veins
incompetence of venous valves
What does persistent lymphedema predispose to
lymphangiosarcoma- malig neoplasm of endothelial lining of the lymph
often seen in arms after breast cancer removal
What are some of the less obvious reasons to avoid OCPs
Hx of estrogen tumor, ↑ triglycerides, or liver disease (steroid metabolism)
PLUS all the stuff I know you know
What is a good specific sign for left heart failure
Orthopnea (trouble breathing laying, good when standing)
What is the S3 heart sound
rapid passive ventricular filling sound
abnormality ONLY in people 40+
Heard best at the end of expiration
Risks for liver hemangiosarcoma
arsenic
thorotrast
polyvinyl chloride
