Cardio Flashcards
What gives rise to the ascending aorta and pulmonary trunk
Trucus arteriosus
What gives rise to the smooth parts (outflow tract) of left and right ventricles?
Bulbus cordis
What gives rise to the trabeculated part of the left and right atria?
primitive atria
What gives rise to the trabeculated part of left and right ventricles?
primitive ventricle
What gives rise to the smooth part of the left atrium?
primitive pulmonary vein
What gives rise to the coronary sinus?
Left horn of sinus venosus
What gives rise to the SVC?
right common cardinal vein and right anterior cardinal vein
When does the heart start to beat?
week 4
What causes a patent foramen ovale (PDA)?
septum primum and septum secundum failure to fuse after birth. Can lead to paradoxical emboli
What is the most common location of a VSD?
membranous septum
Where does coronary artery occlusion most likely occurs?
in the LAD (left anterior descending artery)
What drug treats subarachnoid hemorrhage by preventing cerebral vasospasm?
nimodipine-dihydropyridine CCB
What is fenoldopam?
D1 receptor agonist that vasodilates almost everything. Decreases BP and increases natriuresis.
What hypertensive emergency med can be used in patients with renal insufficiency?
fenoldopam, since it increases renal perfusion.
What antiarrhythmics control rate?
Class II (B-blockers) and Class IV (CCB)– pacemaker potential will be shown on a test question
What antiarrhythmics control rhythm?
Class I (Na channel blockers) and Class III (K+ channel blockers)–will show myocyte AP on test question
What is it called when there is narrowing of the small arterioles?
Arteriolosclerosis
What are the 2 type of arteriolosclerosis?
hyaline and hyperplastic
What are the main cuases of hyaline arteriolosclerosis?
benign HTN and diabetes
High BP pushes proteins into the vessel wall; non-enzymatic glycosylation of basement membrane makes the wall leaky so proteins can leak in
What is the pathogenesis of hyaline arteriolosclerosis?
proteins leak into the vessle wall producing vascular thickening. Porteins seen as pink hyaline on microscopy
What are the consequences of hyaline arteriolosclerosis?
Can causes glomerular scarring and lead to chronic renal failure
What is the pathogenesis of hyperplastic arteriolosclerosis?
thickening of the vessel wall via hyperplasia of smooth muscle leading to an onion skin appearance, not as pink as hyaline
What is the major causes of hyperplastic arteriolosclerosis?
malignant HTN
smooth muscle tries to multiply to try and contain the super high BP
When do you seen fibrinoid necrosis?
- Malignant HTN
- Vasculitis
What are the main consequences of hyperplastic arteriolosclerosis?
acute renal fialure with flea bitten appearance
What is thickening of the medium/large vessels in the intima called?
Atherosclerosis
What are the 2 requirements for formation of an aortic dissection?
needs to occur in a high stress region (first 10cm of the aorta) and with preexisting weakness of the media
What is the most common cause of aortic dissection?
HTN. Leads to arteriolosclerosis of vasa vasorum, which lessens the blood flow to the CT of the media causes atrophy of the media.
What is the most common causes of death associated with an aortic dissection?
pericardial tamponade
What is the classic cause of thoracic aneurysm?
ertiary syphilis due to endarteritis of vasa vasorum wwhich leads to atrophy of the vessel wall, tree bark appearance of vessel wall
What type of aneurysm are Marfan’s patients likely to experience?
thoracic aortic aneurysm
What is the pathogenesis of AAA?
AA doesn’t have a vaso vasorum, so if pt develops atherosclerosis in the AA, then the wall gets less O2 and leads to atrophy and predisposes to an aneurysm.
What triad is associated with AAA?
Hypotension, pulsatile abdominal mass, and flank pain
What percentage of an artery needs to be stenosed for there to be symptoms?
70%
With subendocardial ischemia, will you see ST depression or elevation?
ST depression
Which coronary artery supplies the papillary muscles?
RCA
What congenital heart disorder is associated with fetal alcohol syndrome?
Ventricular septal defect
What congenital heart disease is associated with Down’s Syndrome?
ASD of ostium primum
What congenital heart disease is associated with congenital rubella?
PDA
What congenital heart disease is associated with TUrner Syndrome?
Coarctation of the aorta, infantil type
What congenital heart disease is assocaited with maternal diabetes?
Transposition of the great vessels
How is digoxin cleared?
Renal clearance
How should treatment with digoxin be modified in elderly patients?
Need reduced levels of digoxin since their renal function decreases. (Even if normal creatinine levels, still give reduced levels of digoxin)
Statins combined with which drugs have increased risk of rhabdomyolysis?
fibrates and niacin (fenofibrate causes myopathy and gemfibrozil just increases the concentration of statins in the blood, increasing risk of myopathy)
Combination of which two lipid lowering agents increases the risk of cholesterol gallstones?
fibrinic acid derivatives and bile-acid binding resins
What is the best drug for lowering TG levels?
Fibrates
Which vasculitis have granulomatous inflammation?
Wegeners (granulomatosis with polyangiitis), Temporal Giant cell, Takayasu, Churg-Strauss
Which vasculitis are necrotizing?
polyarteritis nodosa, Buerger (thromboangiitis obliterans), Microscopic polyangiitis, Churg-Strauss, Kawasaki
What arteries are affected in Takayasu?
aortic arch at branching points
What is the classic Takayasu patient?
young asian woman with abset pulse in upper extremity, visual and neurologic sxs. Elevated ESR
High yield facts about Polyarteritis Nodosa?
Lungs spared, HBsAg association, fibrinoid necrosis, string of pearls appearance, tx corticosteroids.
High yield facts about Kawasaki?
asian children, nonspecific viral sxs, rash of palms and soles, coronary artery involvement (MI in child, think Kawasaki), Tx aspirin and IVIG
High yield association of Brueger’s?
necrotizing vasculitis due to heavy smoking, gangrene and autoamputation of fingers and toes
How do you treat wegeners?
cyclophosphamide
How is Microscopic Polyangiitis different from Wegeners?
Microscopic polyangiitis- no nasopharyngeal involvement and no granulomas. p-ANKA + (tx same as wegeners, cyclophosphamide)
High yield facts aout Churg-Strauss Syndrome?
necrotizing granulomatous inflammtion with eosinophils. Associated with asthma and peripheral eosinophilia. p-ANKA +
High yield facts about Henoch-Schonlein Purpura?
IgA immune complex deposition, most common vasculitis in children. Palpable purpura on butt and legs, GI pain and bleeding, and hematuria (IgA nephropathy). Follows URI.
Common cause of secondary HTN?
Renal artery stenosis
What causes renal artery stenosis? (2)
atherosclerosis in elderly males
fibromuscular dysplasia in young females
What are the most common locations for atheroscledrosis?
AA>coronary artery>popliteal>internal carotid artery
Modifiable risk factors for atherosclerosis?
HTN, hypercholesterolemia, smoking, diabetes
Nonmodifiable risk factors of atherosclerosis?
age, gender (male, postmenopausal female), genetics
What are the complications of atherosclerosis?
peripheral vascular disease, angina, and ischemic bowel disease
What is a major complication of thoracic aneurysm?
aortic valvue insufficiency
What cancer is caused by polyvinyl chloride?
liver angiosarcoma
How can you tell the difference between hemangioma and kaposi sarcoma?
hemangioma- press and it will blanch
kaposi- press and it will not blanch, blood not in vessels, simply interspersed between endothelial cells
Most common cause of death in sudden cardiac death?
fatal ventricular arrhythmia
What are aschoff bodies and anitschkow cells and what are they associated with?
Associated with myocarditis due to acute rheumatic fever. Aschoff bodies are granulomas with giant cells and contain anitschkow cells, enlarged macrophages with wavy nuclei
What do the jones criteria describe?
Sxs of acute rheumatic fever
