CARDIO Flashcards
Which vessel type accounts for the majority of total peripheral resistance?
arteriole
Anterosuperior displacement of the infundibular septum results in __________
Tetralogy of Fallot
What are the 3 histologic layers of the valves?
Ventricular layer and Spongiosa (spongiosa is where myxomatous change may occur), as well as fibrous
Tx of Microscopic polyangiitis
corticosteroids and cyclophosphamide
Why are there muscle pains in Giant Cell arteritis?
It is associated with polymyalgia rhuematica
What murmur is heard in acute rheumatic fever? Chronic?
Carey-Coombs (if valvulitis is present); Mitral stenosis
Which vasculitis is associated with a strawberry tongue?
Kawasaki disease
What antibodies are present in Scleroderma with CREST and diffuse scleroderma?
Anti-centromere in CREST scleroderma; diffuse scleroderma = Scl-70
What are you approximating with the pulmonary capillary wedge pressure (PCWP)?
Left Atrial Pressure
What is Felty Syndrome?
Splenomegaly, neutropenia, and repeated infections (you “felty” the spleen)
What is a pyogenic granuloma?
A capillary hemangioma that ulcerates and bleeds
What protein do fibrates upregulate?
lipoprotein lipase
What kind of conditions would cause wide splitting of S2?
Anything that delays RV emptying, such as pulmonic stenosis and RBBB? This causes splitting REGARDLESS of breath
How do you treat HOCM?
BB and CCB
Which CV disease is associated with Friedrichs ataxia?
HOCM
What is the function of chylomicrons?
Deliver dietary lipids (main component is triglycerides)
2 infectious causes of dilated cardiomyopathy
Coxsackie B and Chagas disease
Endocarditis with spaghetti and meatballs appearance is most likely obtained via what route?
IVDA i.e. a Candida infection
Which murmur is loud at the apex and radiates to the axilla? What murmur radiates to the carotids?
Mitral regurgitation; Aortic stenosis
What dermatologic finding may be associated with early onset glaucoma?
Nevus flammeus in sturge weber
What is the main AIDS related pathology of the stomach?
Kaposi Sarcoma
What are the two most common causes of hyaline arteriolosclerosis?
Diabetes and essential hypertension
Why is stroke volume increased in pregnancy?
There is more blood
Compare and contrast the carotid sinus and aortic arch baroreceptors
Carotid sinus responds to increase and decrease in BP and sends info via CN IX to the nucleus solitarius? Aortic arch responds ONLY to increase BP and sends info via CN X to nucleus solitarius
What is Carney Syndrome?
Atrial myxoma with blue nevi and lentigines
Where to the SMOOTH parts of the left and right ventricles come from?
Bulbus cordis (trabeculated parts come from primitive ventricles)
Why are veins more susceptible to being a route for metastasis than arteries?
Veins have thinner walls
What lipid-lowering agent can cause acanthosis nigricans?
Niacin
Contrast Mobitz I and Mobitz II
These are both second degree AV blocks? The difference is that Mobitz I (Wenckebach) has longer and longer PR intervals until a beat is dropped. Mobitz II involves dropped beats as well usually with a 2:1 P to QRS ratio? Type I is usually asymptomatic and Type II is usually symptomatic…. The Tx of symptomatic bradycardia can involve atropine, DA, epi and transvenous pacing
Explain the transcriptional regulation of cholesterol synthesis by SREBP and SCAP
SREBP is Sterol Regulating ER binding protein and binds DNA to activate HMG-CoA reductase synthesis? When high cholesterol is present, it binds SCAP which then binds SREBP, changing its conformation and preventing cholesterol synthesis
What do the right and left horns of the sinus venosus give rise to?
right = smooth part of right atrium, left = coronary sinus)
What forms the medial umbilical ligaments? Median umbilical ligaments?
medial = umbilical arteries, median = urachus
What 3 uncorrected lesions may lead to Eisenmenger’s syndrome?
PDA (don?t forget this one!!), ASD, and VSD
What are 3 causes of mediastinal widening?
Aortic dissection, Thoracic aortic aneurysm, and Pulmonary anthrax
What cancer is associated with spindle cells in the dermis?
Kaposi Sarcoma
How do HDL and Nascent chylomicrons interact? (What does HDL do for them?)
HDL (in the bloodstream) gives chylomicrons apoCII (to deliver to skm and adipose via LPL) and it also gives them ApoE in order to be accepted by hepatocytes
Explain Jervell and Lange-Nielsen Syndrome
This is a congenital long QT interval syndrome that affects the same K channel as the one in the ear, hence the deafness. This predisposes to Torsade de Pointes which is treated with magnesium sulfate
Why do heart transplant patients have atypical S/S of MI?
Because their nerves have been severed. They will not experience angina and will have silent MI’s
Explain the wavy fiber formation after an MI on histology?
Edema from acute inflammation leads to fluid between the fibers, giving them a wavy appearance
Define Sudden Cardiac Death
Death from cardiac causes WITHIN 1 HOUR OF SX
Coal worker pneumoconiosis with rheumatoid arthritis is called what?
Caplan syndrome
A kid with a foot and hand rash with conjunctival injection and angina likely has what?
Kawasaki disease
What is a good way to differentiate Kawasaki from Hand Foot and Mouth?
Kawasaki will also have CONJUNCTIVAL INJECTION
What should you think with a large serous pericardial effusion?
Likely malignant
When do S3 and S4 occur?
S3 is early diastole, S4 is late diastole
Explain how coarctation of the aorta could lead to aortic regurgitation
The proximal high pressure prior to the coarctation can lead to dilatation of the aortic root = aortic regurgitation
Tx of polyarteritis nodosa
corticosteroids and cyclophosphamide
in whom is an S3 normal?
Kids and Pregnant women
Which part of the heart conducting system has the fastest conduction?
Purkinje fibers (purkinje > atria > ventricles > AV node)
What drug might cause the right ventricle to become atrialized?
Lithium is a common cause of the Ebstein anomaly
Which vasculitis is associated with pauci-immune glomerulonephritis and palpable purpura?
Microscopic polyangiitis and Churg Strauss
What is a mycotic aneursym?
Septic embolus from bacterial endocarditis went to vasa vasorum of aorta and caused aneurysm
What effect does atrial natriuretic peptide have on sodium reabsorption?
Decreases its absorption at the medullary collecting tubule
What dysrhythmia can have P on T and P on ST phenomena?
3rd degree (p and qrs don?t agree!) AV block
What artery supplies the SA and AV nodes?
RCA
What is the function of ApoA-1 and ApoE on HDL?
ApoA-1 activates LCAT which esterifies cholesterol so that it stays in the core; ApoE is recognized by hepatocytes, it also gives ApoE to chylomicrons and VLDL
What is it called when sarcomeres are added in series? In parallel?
Sarcomeres in series = eccentric hypertrophy; sarcomeres added in parallel = concentric hypertrophy
What drug decreases hepatic secretion of VLDL?
Niacin–watch that cutaneous flush!
Explain the outflow tract obstruction in hypertrophic cardiomyopathy
The banana shaped ventricle places the septum too close to the mitral valve leaflet which has a Venturi effect and creates lift on the mitral valve pulling it in close and obstructing the tract
The ligamentum teres hepatis is contained in what larger CT structure?
falciform ligament
Name 2 large vessel vasculitides
Takayasu (pulsless dz) and Temporal arteritis
Which cardiac tissue has permanently inactivated sodium channels due to the less negative resting voltage?
Nodal tissue–AV and SA nodes. The If channel allows a less negative resting membrane potential so their spike is due to Ca not Na because there is no activation of voltage gated Na channels
What classes of antiarrhythmics may be used to Tx atrial flutter?
Anti-arrhythmics = Class IA, IC and III (you should also rate control with a BB or CCB); note that the goal of anti-arrhythmic therapy is to CONVERT to sinus rhythm
Myofiber disarray on histology
HOCM
What artery supplies the IV septum?
Anterior 2/3 is by LAD (septal branch), Posterior 1/3 is by the PDA which may arise from either the RCA or LCX
What is an anitschkow cell?
A histiocyte with a caterpillar nucleus inside an Aschoff body, typical of rheumatic endocarditis
What disease involves nevus flammeus, ipsilateral leptomeningial angiomatosis, AVM, siezures, and early onset glaucoma?
Sturge Weber
Which ASD type is associated with total or partial anomalous pulmonary venous return?
Sinus venosus ASD
What is type I AV block?
This is simply a prolonged PR interval (> 200 msec)
Which cardiac disease results from a B-myosin mutation?
Hypertrophic Cardiomyopathy
What kind of inflitrate willl you find in Bacillary angiomatosis and in Kaposi?
Bacillary angiomatosis = neutrophilic; Kaposi = monocytic (bc viral)
What is the most important factor in maintaining cardiac output late in exercise?
HEART RATE? Stroke volume plateaus but HR can maintain it to a point (CO = SV x HR)
Where do you see Erythema marginatum?
in rheumatic fever
Tx of Buerger’s Dz
Quit fucking smoking
What is a cavernous lymphangioma in the neck?
Cystic hygroma (assoc with Turner’s)
What is affected in X-linked Dilated cardiomyopathy?
Dystrophin gene? it is bascially Duchenne muscular dystrophy of the heart? Dilated cardiomyopathies are problems with cytoskelton, HOCM is a problem with B-myosin chains
Explain why cardiac tamponade can lead to pulseless electrical activity
Eventually all of the pressures in all 4 chambers equalize due to the high external pressure and this leads to right ventricular collapse and no cardiac output = PEA
White spots on retina surrounded by hemorrhage
Roth spots of bacterial endocarditis
What phase of nodal tissue potential is most important for determining heart rate?
Nodal phase 4 depolarization SLOPE? The slope of this phase will set the HR. Ach/Adenosine decrease rate and Sympathetic increases chances that funny channels are open so increase rate
What is Naxos syndrome?
Arrhythmogenic Right Ventricular cardiomyopthy associated with hyperkeratosis of palms and feet?. Mutations in plakoglobin
What heart defects are associated with Down’s syndrome?
Endocardial Cushion defects (ASD, VSD, and AV septal defect)
What is the main complication of MI after several weeks?
Aside from ventricular aneurysm there can be Dressler’s syndrome which is an autoimmune pericarditis
What is the Trosseau sign of malignancy?
A paraneoplastic syndrome of some adenocarcinomas in which there is elaboration of pro-coagulant factors
What enzyme transforms cholesterol into bile acids/salts?
7-alpha-hydroxylase
Where can you see an exaggerated pulsus paradoxus?
mostly in cardiac tamponade but also, CROUP, asthma, sleep apnea, pericarditis
When can you first see coagulative necrosis (no nuclei) after an MI?
4-12 hours)
Explain the syncopal episodes of HOCM
The hypertrophied IV septum becomes close to the mitral valve leaflet and generates lift which pulls the leaflet in close and obstructs flow = syncope
In age-related calcific stenosis of a valve where do the deposits lay?
In the sinus of Valsalva
Which childhood vasculitis is associated with IgA nephropathy?
Henoch Schonlien purpura
Tx of Torsades de Pointes
Magnesium sulfate
What is required for an infant with total anomalous pulmonary venous return to survive?
An ASD, i.e. you need a way for the oxygenated blood that is “anomalously” returning to the right heart to get to the left heart
If there is a rhabdomyoma in the heart what tumor is expected in the brain? The kidney?
Hamartoma; Angiomyolipoma (tuberous sclerosis)
From where is the aorticopulmonary septum derived?
neural crest (therefore, any lesions in which the aorticopulmonary septum is defective are neural crest issues just like Hirschsprung’s!)
Myocardial ring abscesses are a complication of what?
Bacterial endocarditis
What are the 3 major shunts in the fetal circulation?
Foramen ovale, Ductus venosus, and Ductus arteriosus
What causes acute and subacue endocarditis?
S. aureus; Viridans strep
Cardiac cirrhosis would occur in a person with what kind of liver?
A “nutmeg liver” from congestion of the right heart
What is the function of VLDL?
Deliver endogenous lipids to the body (secreted from hepatocytes, blocked by niacin). Like Chylomicrons they are mostly triglycerides
What effect does too much LDL have on peripheral cells and hepatocytes?
These cells will downregulate their LDL receptors
What effect does hyponatremia have on cardiac contractility?
increases because there is decreased activity of the Na/Ca exchanger, therefore more Ca pools? This is similar to the MOA of digoxin
How do the lungs autoregulate flow?
via hypoxic pulmonary vasoconstriction
Explain how fatty acids taken into intestinal epithelial cells are transformed into chylomicrons
FA’s are taken in and re-esterified to glycerol in a CoA dependent manner in the smooth ER. Meanwhile, ApoB48 is translated in the rER. These two vesicles fuse in the Golgi in order to form the chylomicron
What do peripheral and central chemoreceptors sense?
Peripheral = O2 when below 60 mmhg, Central = PCO2
Where is the first place you’ll find a metastatic cancer in a lymph node?
Subcapsular; as the tumor tries to make whatever it is trying to make it will cause lymphatic obstruction and lymphedema
Which vasculitis is notable for sparing the lungs?
Polyarteritis nodosa (seropositive for Hep B)
Compare the atrial and ventricular rates in 3rd degree AV block. What infection may cause? What is the usual Tx?
Atrial rate is usually faster (i.e. more P waves than QRS complexes), no relationship between the 2? Lyme disease late in the course? Treatment is pacemaker. If you are treating Lyme disease it is doxycylcine and ceftriaxone
Tree bark aorta
Tertiary syphilis leading to calcification and fibrosis of ascending aorta (damages vasa vasorum)
Endocarditis with S. epidermidis
Prosthtetic valves
Explain how a vasodilator could aggravate angina
Coronary Steal syndrome occurs when a vasodilator is given and shunts blood away from an area of critical stenosis to one of higher perfusion
What should you think if there are thromobotic heart valve issues and recurrent pregnancies? What would you test for?
APA syndrome, test for anti-phospholipid antibody and lupus anticoagulant
Diff. Osler nodes from Janeway lesions
Osler nodes are painful, Janeway lesions are painless
What is the histopathologic sign of malignant hyptertension?
Onion skinning from smooth muscle hyperplasia
What is the relationship between the trosseau sign and marantic endocarditis?
Both are related to hypercoagulability associated with some adenocarcinomas
Explain why CK-MB is better for testing reinfarction than troponin
Troponin is elevated for 7-10 d but CK-MB is elevated for 48 hours
What is required for a viable infant with tricuspid atresia (2)?
ASD to allow the blood to get to the left heart, VSD to allow the blood to get back to the right side to get to lungs
Where on the EKG does MECHANICAL contraction of the ventricles occur?
in the QT interval
Tx of Wegener’s
corticosteroids and cyclophosphamide
Where are most metastatic diseases to the heart located?
in pericardium
Tx of dilated cardiomyopathy
Na restriction (decrease volume), ACE I, diuretic, digoxin, and heart transplant is only DEFINITIVE cure
What effect does a drop in blood pressure have on carotid sinus baroreceptors?
decreases afferent firing which allows for the CNS to increase sympathetic outflow
What causes hemosiderin laden MO in the lungs?
Left heart failure (pneumonia could as well)
What receptor does lipoprotein lipase bind to in order to breakdown chylomicron and VLDL triglycerides?
ApoCII
What is the function of IDL?
IDL is a breakdown product of VLDL? It can be either turned into LDL or it can return endogenous lipids to the liver
With what trinucleotide repeat is hypertrophic cardiomyopathy associated?
GAA, associated with Friedrich’s ataxia (the HOCM is from B-myosin mutation)
What does VLDL get from HDL?
ApoCII to deliver to lipoprotein lipase; ApoE to deliver to hepatocytes
What is the most common congenital cardiac anomaly?
VSD
Tx of Kawasaki Dz
IVIG and Aspirin
Tx of giant cell arteritis?
corticosteroids
T/F: cholesterol can be broken down into squalene and mevalonate
False. Although these are precursor molecules for cholesterol, that is irreversible. The only way to get rid of cholesterol is excretion i.e. bile salts
What gross and microscopic changes are observable within 1 hour of an MI?
none!
What is the triad of the Cushing Reaction?
Hypertension, Bradycardia, Respiratory depression
Why isn’t it possible for an acute pericardial effusion to show up as a “waterbottle heart” on X-ray?
Because a water bottle heart occurs as the pericardium expands CHRONICALLY to accommodate the fluid
What kind of metaplasia can you observe in calcific aortic stensois?
Osseus metaplasia
Tx of Takayasu arteritis
corticosteroids
Which valvular problem is notable for causing pulsus parvus et tardus?
Aortic stenosis (pulses are weak with a delayed peak)
What genotype is a congenital coarctation of the aorta associated with?
45 XO (Turner’s syndrome)
Explain why the subendocardial tissue is most susceptible to ischemia
It is the most distal from the area of stenosis in the coronary artery; the small vessels are compressed during systole by the contracting myocardium
What is Beck’s triad?
Distant muffled heart sounds, JVD, and Hypotension
What will you see on EKG of someone with unstable angina vs. Prinzmetal variant?
ST depression; ST elevation
What is the Carvallo sign?
Inspiration increases the intensity of right sided murmurs
What causes strong UE pulses? Weak UE pulses?
Strong = post ductal coarctation of aorta; weak = Takayasu pulseless disease
Where do all of the carbons on cholesterol come from?
Acetyl-CoA (The Acetyl-CoA to Mevalonate step is the rate limiting step, carried out by HMG-CoA reductase)
What do the right common and right anterior cardinal veins give rise to?
SVC
Why does the EKG of cardiac tamponade have electrical alternans?
The axis is shifting as the heart swings inside the blood filled pericardium
How is autoregulation of flow different for the kidneys than it is for heart, brain, and SKM?
The kidneys rely on the myogenic mechanism and tubuloglomerular feedback vs. local metabolites
What does restrictive pericarditis sound like on auscultation?
You’ll hear a pericardial knock as the heart knocks against the thick fibrous shell
Explain the significance of hypoxia in normal organs vs. the lungs in terms of flow autoregulation
In most organs hypoxia causes vessels to vasodilate so that more flow can go through? In the lungs, hypoxia causes vasoconstriction so that blood is diverted to areas that have oxygen
What is a corneal arcus?
lipid deposit in the cornea (sign of hyperlipidemia)
How is the pain of pericarditis relieved positionally?
Sitting up and leaning forward
Antibodies to what 2 strep enzymes can be used to Dx rhuematic fever?
ASO and DNaseB
What are the signs of malignant hypertension?
end organ damage (i.e. headaches and acute renal failure, flea-bitten kidney)
What are the 5 T’s i.e. the 5 cyanotic congenital heart lesions?
Truncus arteriosus, Tetralogy of Fallot, Transpostion of GA, Total anomalous pulmonary venous return, and Tricuspid atresia
What causes the midsystolic click of mitral valve prolapse?
A sudden tensing of the chordae tendinae
Which p-ANCA positive vasculitis contains granulomatous inflammation?
Churg-Strauss; micro polyangiitis does NOT
What is a swiss cheese septum?
Multiple VSD’s
What causes the Boot Shaped heart on CXR in Tet of Fallot?
RVH
What is the gold standard of MI IN THE FIRST 6 HOURS?
EKG; Troponin is not elevated until 4-6 hours after!
Endocarditis with S. bovis
Colon cancer
What is the most common cause of dilated cardiomyopathy?
Idiopathic? Other causes = Alcohol, Wet Beri Beri, Coxsackie B, Cocaine, Chagas, Doxorubicin, Hemochromatosis, and pregnancy
What are “soldier’s plaques” from healed pericarditis?
Fibrous (not fibrinous) strands that attach the parietal pericardium to the visceral pericardium and can lead to restriction
What is the most important prognostic indicator for tetralogy of Fallot?
The degree of pulmonary infundibular stenosis
What 4 drugs reduce mortality in CHF?
ACEI, ARB, BB (except in acute decompensated), and spironolactone
How is fixed splitting of S2 different from wide splitting of S2?
For all intents and purposes, it is not any different. However, FIXED splitting tends to refer to an ASD nearly pathognomically as the L->R shunt increases pulmonic ejection time. However, WIDE splitting is the same deal but more commonly occurs with RBBB and pulmonic stenosis. So it is mainly a semantic difference
What is another name for hereditary hemorrhagic telangiectasia?
Osler Weber Rendu
What is the most common cause of right heart failure? What is the most common cause of isolated right heart failure?
Left heart failure; Cor pulmonale (pulmonary HTN)
What ist he most common primary cardiac tumor in children?
Rhabdomyoma–assoc with tuberous sclerosis
Explain melena in polyarteritis nodosa
arteritis of the mesenteric arteries leads to mesenteric ischemia and villous shedding (necrosis) i.e. melena
What is paradoxical splitting of S2? What would cause it?
This is where S2 is split because the AORTIC valve is closing later than pulmonic (opposite of normal splitting)? Caused by LBBB and aortic stenosis? On inspiration P2 moves closer to A2 therefore “paradoxically” eliminating the split
What is Loffler’s syndrome?
Endomyocardial fibrosis with predominant eosinophilic infiltrate
What is a glomus tumor?
Painful tumor under fingernail (from modified smooth muscle cells of glomus body)
What is the most common cause of hemorrhagic pericarditis?
Cancer
Explain how Chylomicrons and VLDL are related by their apolipoprotein
Chylomicrons contain B-48 and VLDL contains B-100, these are from the same gene but it undergoes alternate splicing; Chylomicrons deliver dietary lipids, VLDL delivers endogenous lipids
Where on a lipoprotein will you find cholesterol? Cholesterol esters?
Cholesterol = Free surface; Cholesterol Esters = in lipid core
What is the cause of early death in Rheumatic fever?
Myocarditis (recall it causes a pancarditis)
What does it mean to say that the heart has codominant circulation?
The PDA arises from BOTH the RCA and LCX
What disease has diffuse (i.e. non-contiguous) ST elevation and PR depression?
acute pericarditis
Thick fibbroelastic tissue in the endocardium of young children leading to restrictive cardiomyopathy is called
Endocardial fibroelastosis
The mother of a child with transposition of the great vessels probably had what underlying condition?
Diabetes
Which cardiomyopathy has an S3? S4?
S3 = dilated; S4 = HOCM and restrictive
Why does MI predispose to ventricular fibrillation?
Ventricular automaticity foci are susceptible to hypoxia
Explain the red white and blue of Raynauds
White is from vasospasm, Blue is from cyanosis, and Red is from eventual hyperemia
What hereditary disease leads to recurrent epistaxis?
Hereditary Hemorrhagic Telangiectasia (Osler Weber Rendu)? GI bleeds are the most important concern here
What is the most common primary cardiac tumor in adults?
left atrial myxoma (myxomatous degeneration just like MVP)
What is the major limitation to long term success in heart transplant?
Graft Arteriopathy (intimal hyperplasia)
What is the main complication within 1 day of an MI? Within 1-3 days?
Lethal arrhythmia; Fibrinous pericarditis
What is it called when jugular venous pressure paradoxically increases in inspiration rather than drops?
Kussmaul’s sign (Note: Kussmaul respirations are seen in metabolic acidosis, most commonlly DKA)
