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Quick Notes for Step 1 > Cardio > Flashcards

Cardio Flashcards

1
Q

MC cause of cardiomyopathy

A

Cocksackie B Virus

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2
Q

Digoxin: Mechanism

A
  • Blocks Na/K ATPase which causes buildup of intracellular Ca → increased contractility
  • Increases parasympathetic tone by acting on Vagus nerve → decreased rate of AV conduction
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3
Q

Digoxin: Toxicity

A
  • Toxicity: yellow-green vision, arrhythmia (potentially fatal)
  • Hyperkalemia in acute digoxin toxicity, but hypokalemia makes patient more susceptible to effects of digoxin
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4
Q

Endocarditis in IV drug users

A

Staph Aureus

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5
Q

Endocarditis w/ S. Bovis

A

Colon Cancer

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6
Q

Endocarditis w/ Prothetic Valves

A

S. epidermis (if 60 days)

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7
Q

Endocarditis after Dental Procedure

A

Viridans/Mutans

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8
Q

Chemoreceptors: Central vs Peripheral

A
  • Central: (in medulla) senses high CO2

- Peripheral: (in carotid and aortic bodies) senses low O2, and also high O2

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9
Q

Chemoreceptors in COPD

A

Blunted response to pCO2 (hypercapnia)

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10
Q

Carotid Sinus

A
  • Most of BP regulation (responsible for 80% of the response to hypotension)
  • Fires more with HTN (increased stretch) and tachycardia
  • Cut nerve connections → less signals → body thinks it is hypotensive → HTN + tachycardia
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11
Q

Carotid Sinus Massage

A

Causes parasympathetics to decrease the AV node conduction (by prolonging the refractory period)

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12
Q

Baroreceptors: Carotid vs Aortic

A
  • Stretch increases signals
  • Carotid: afferent is glossopharyngeal (hering’s nerve); Both increases and decreases in BP sensed
  • Aortic: afferent is vagus; Only increases in BP sensed
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13
Q

VSD Murmur

A

Loud holosystolic murmur

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14
Q

ASD Murmur

A

Wide, fixed splitting of S2

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15
Q

Mitral Regurgitation Murmur

A

Holosystolic blowing murmur radiating to apex (aw/ Rheumatic fever)

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16
Q

Aortic Regurgitation Murmur and Signs

A
  • Blowing diastolic murmur (decrescendo)
  • Loudest in early diastole, end of expiration
  • Quinke pulse, and head bobbing
  • Wide/Increased pulse pressure
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17
Q

Delayed Closure of Pulmonic Valve Sound

A

Wide, fixed split S2

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18
Q

Mitral Valve Prolapse Murmur

A

Mid-systolic click with a regurgitation murmur following

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19
Q

Mitral Stenosis Murmur

A

Opening snap w/ diastolic rumble

aw/ Rheumatic Heart Disease

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20
Q

Aortic Stenosis Murmur

A

Crescendo-decrescendo (systolic)

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21
Q

Aortic Regurgitation Murmur

A

Decrescendo (diastolic)

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22
Q

Effect of Digoxin w/ Diuretic

A

Hypokalemia –> PVC (premature ventricular contractions)

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23
Q

Subendocardial infarction can be a result of _____

A

Prolonged hypotension

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24
Q

Dressler’s Syndrome

A

Autoimmune pericarditis 2-10 wks post-MI

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25
Q

Senile Cardiac Amyloidosis

A

Transthyretin

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26
Q

Amyloid Light Chain (AL) vs Amyloid Associated (AA)

A

AL: primary/systemic
AA: secondary or autoimmune

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27
Q

Wedge Pressure

A
  • Should equal left-ventricular end diastolic pressure

- If wedge is much higher, then indicates stenosis of mitral valve

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28
Q

Valve Affects w/ IV drug use

A

Tricuspid –> regurgitation

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29
Q

Mitral Stenosis

A

Right atrial pressure is much greater than left ventricular pressure near the end of diastole

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30
Q

Bicuspid Aortic Valve

A

Aortic stenosis w/ ejection click

  • aw/ Turner’s
  • Calcifies due to wear and tear after age 60
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31
Q

Pressure Volume Loop: Contractility

A

Increased Slope

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32
Q

Pressure Volume Loop: Stroke Volume vs Preload

A

SV: Increased Width
Preload: Increased Width to the Right

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33
Q

Pressure Volume Loop: Arterial Pressure/BP

A

Increase height

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34
Q

Churg-Strauss

A

Vasculitis w/ eosinophilia

  • aw/ atopic dermatitis and asthma
  • granulomatous
  • MPO and p-anca
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35
Q

Metoprolol + Thiazides cause ______

A

Dyslipidemia

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36
Q

Pathophysiology of Aortic Dissection

A 
Medial change (cystic medial degeneration w/ intimal tear) 
- smoking and high BP
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37
Q

Pathophysiology of Aneurysm

A

Intimal streak (atherosclerosis)

  • MC abdominal
  • Thoracic in Marfan’s
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38
Q

Infective Endocarditis

A

o Fever, new murmur, janeway lesions, osler nodes, roth spots, and splinter hemorrhages

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39
Q

Endocarditis w/ Negative blood cultures

A

HACEK (difficult to grow)

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40
Q

____ can Infect Normal/Undamaged Valves

A

Staph aureus

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41
Q

Non-infective Endocarditis: Causes

A
  • Hypercoagulable state associated vegetations
  • Underlying adenocarcinoma
  • Libman Sacks
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42
Q

Libman-Sacks:

A

Non-infective endocarditis (aw/ SLE): vegetations on surface and undersurface

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43
Q

Severity of a MR Holosystolic Murmur Indicated by ______

A

Presence of S3 gallop

- Accentuated on expiration

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44
Q

Dilated Cardiomyopathy: Sound and Causes

A

(S3 - Kan- kakee)
[turbulent blood flow into ventricles, heard during rapid filling]
- coxsackie B myocarditis, genetic mutation (in cytoskeletal proteins like dystrophin or mitochondrial enzymes of ox phos), alcohol, doxorubicin, pregnancy, hemochromatosis

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45
Q

Hemochromatosis: Defect

A

HFE defect (intestinal absorption)

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46
Q

Hypertrophic Cardiomyopathy: Sound and Cause

A

(S4)
[Heard immediately after atrial contraction as blood is forced into stiff ventricle]
- usually genetic cause (Genetic mutation in sarcomere proteins [disorganized])
- Syncope with exercise due to functional aortic stenosis due to hypertrophied ventricular septum
- LV obstruction due to anterior leaftlet of mitral valve and hypertrophied interventricular septum
- normal coronary arteries

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47
Q

Restrictive Cardiomyopathy: Effect and Causes

A
  • Low QRS amplitude
  • Decreased compliance
  • Loffler syndrome, amyloidosis, or sarcoidosis
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48
Q

Loffler Syndrome

A

Endomyocardial fibrosis and eosinophilia that causes Restrictive Cardiomyopathy

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49
Q

Rhabdomyoma

A

MC primary tumor of heart in children

- aw/ Tuberous Sclerosis

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50
Q

Hyaline Arteriolosclerosis

A

From benign hypertension or diabetes

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51
Q

Hyperplastic arteriolosclerosis

A

From malignant hypertension

- onion skinning of arterioles

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52
Q

Buerger’s Disease

A

Segmental vasculitis in Asian male smokers → claudication and gangrene/ulcers

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53
Q

Nitrates: Mechanism/Effects

A

Act primarily as venodilators to relieve stable angina by decreasing preload
- Can cause reflex tachycardia

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54
Q

Treat Nitrate-induced Reflex Tachycardia w/ _______

A

Beta blockers

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55
Q

Polyarteritis Nodosa

A

Transmural inflammation of arteries w/ fibrinoid necrosis

  • Fever, malaise, melena, weight loss
  • Hep B in 10-30%
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56
Q

Alpha-1 (3 effects)

A
  • Vasoconstriction
  • Dilates (mydriasis)
  • Contracts sphincters of bladder and intestine
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57
Q

Beta-2 (6 effects)

A
  • Relaxes uterus (inhibits contractions)
  • Bronchodilation
  • Ciliary muscle relaxation
  • Increase aqueous humor
  • Increase insulin release
  • Vasodilation
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58
Q

Treat Hypertensive Emergency w/ ______

A

Nitroprusside or Fenoldopam

  • Nitroprusside (equal effect on arteries and veins –> decreases preload and afterload)
  • Fenoldopam (arterial dilation and natriuresis)
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59
Q

Pulsus Paradoxus Definition

A

Decrease by greater than 10 in systolic BP on inspiration) (eg. w/ cardiac tamponade)

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60
Q

Assessing Pulsus Paradoxus

A
  • Inflate a cuff above systolic, slowly release and will only hear Korotkoff sounds on expiration, keep lowering and will hear it throughout
  • Inspiration causes increased venous return → increased right heart volume (normally this should have little effect on left side) but in conditions impairing expansion into pericardial spaces (tamponade, restrictive pericarditis etc ) → increased RV pressure pushes IV septum towards left and blocks outflow → decreased systemic BP on inspiration
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61
Q

Treat B-Blocker Overdose w/ _______

A

Glucagon

  • Raises HR and Contractility independent of adrenergic receptors
  • Increases cAMP in cardiac myocytes
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62
Q

Conduction Velocity: Fast to Slow

A

Purkinje > Atrial muscle > ventricular muscles > AV node

- (park at ventura avenue)

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63
Q

Myocardium Stops Contracting at ____ of ischemia

A

1 min

64
Q

Myocardial Damage Irreversible After _____

A

30 min (If ischemia resolves in less than 30, contractility will gradually return to normal (hrs-days))

65
Q

Cardiac Output Equation

A

CO = O2 consumption / arteriovenous difference in O2 content
or
CO = SV*HR

66
Q

Carcinoid Syndrome and Tumors

A
  • Fibrous endocardial thickening in right side of heart because MAO in lung breaks down the serotonin and bradykinin before reaching left side
    (Pulmonic stenosis and/or restrictive cardiomyopathy)
  • 5-HIAA in urine
  • Carcinoid Tumors: uniform nests or glands; minimal to no variation in cell size and shape
  • MC in the ileum; frequently in appendix and rectum; derived from enterochromaffin cells
  • No sx till it metastasizes
67
Q

Jugular Venous Pulse Curve: a,c,x,v,y

A

a: R atrial contraction
c: R ventricle contraction → bulging of tricuspid
x: R atrial relaxation
v: Inflow of venous blood
y: Tricuspid opens → passive emptying of R atrium

68
Q

Romano-Ward

A

QT prolongation (congenital): K+ channel mutation w/out deafness

69
Q

Jervell-Lange-Neilson

A

QT prolongation (congenital): K+ channel mutation + deafness

70
Q

Nitroprusside –> Cyanide Toxicity

A

Nitrites convert Fe2+ to Fe3+ Methemoglobin which binds cyanide tightly

71
Q

Treating Cyanide Toxicity

A
  • Amyl Nitrite followed by Thiosulfate to excrete it

- Can also use hydroxycobalamin

72
Q

Adenosine: Mechanism and Side effects

A
  • Very fast acting antiarrhythmic
  • Slows AV node conduction to treat paroxysmal SVT
  • Side effects: flushing, chest burning, hypotension
73
Q

_____ Increases VSD Holosystolic Murmur

A

Handgrip → increases afterload

74
Q

Systolic pressure gradient between the left ventricle and aorta is suggestive of _______

A

Left ventricular outflow (eg aortic stenosis)

- Would not be expected in dilated cardiomyopathy

75
Q

Transient Reperfusion Arrhythmias

A

Caused by fibrinolytics (tPA) but they are usually benign

76
Q

Paradoxical emboli

A

Can be facilitated by atrial left to right shunts (wide flixed split S2) during periods of transient shunt reversal (straining or coughing)

77
Q

Calcium Efflux Prior to Relaxation in Myocardium

A

Accomplished through Ca2+ ATPase & Na/Ca Exchange

78
Q

Saline Infusion in a Hypovolemic Patient will _______

A

Increase the intravascular volume → increased preload → increased SV and CO

79
Q

Transudate in CHF

A

Will have low LDH content (low in protein)

80
Q

In newborn, catheter through umbilical vein can reach right atrium via _______

A

Ductus venosus (which does not completely close for a week)

81
Q

Coronary Sinus Dilation

A

Coronary sinus may become dilated due to pulmonary hypertension (which increases right sided heart pressure)

82
Q

Common Cardinal Veins become:

A

SVC

83
Q

_______ Regulates Contraction of Ventricles During AFib

A

AV node

84
Q

Beta-1 (3 effects)

A
  • Renin release
  • Heart contractility
  • HR increase
85
Q

Muscarinic Receptor 1

A

CNS and enteric nervous system

86
Q

Muscarinic Receptor 2

A

Decrease HR/atria contractility

87
Q

Muscarinic Receptor 3

A

Increased gland secretions, bronchoconstriction, bladder contraction, gut peristalsis, accommodation

88
Q

Dopamine 1 Receptor

A

Relaxes renal vasculature

89
Q

Dopamine 2 Receptor

A

In brain

90
Q

H1 Receptor

A

Allergy

91
Q

H2 Receptor

A

Gastric Acid

92
Q

V1 Receptor

A

Vascular constriction

93
Q

V2 Receptor

A

ADH Effects

94
Q

Distributive Shock

A

warm and dry with decreased wedge pressure and vasodilation

95
Q

Cardiogenic Shock

A

cold and clammy, with high wedge pressure and vasoconstriction

96
Q

Hypovolemic Shock

A

cold and clammy, with low wedge pressure and vasoconstriction

97
Q

Ductus arteriosis derived from ____ Aortic Arch

A

6th

98
Q

Sinus Venosus (Rt and Lft Horn) → _______

A
  • Right horn: smooth R atrium

- Left horn: Coronary Sinus

99
Q

Primitive Pulmonary Vein → ________

A

Smooth L atrium

100
Q

Bulbus Cordis → _____

A

Smooth part/outflow tract of ventricles

101
Q

Umbilical Vein → ______

A

Round ligament (ligamentum teres)

102
Q

Umbilical Arteries → ______

A

Medial ligaments

103
Q

Allantois → ______

A

Median Ligament

104
Q

Preload Increases w/: ______, _______, & ________

A
  • Increasing venous tone
  • Increasing blood volume
  • Inspiration
105
Q

MSFP (Mean systemic pressure):

A

Fullness of vasculature with blood (changes with volume/venous tone); intercept with X axis

106
Q

Right Sided Murmurs Increase w/

A

Inspiration (due to increased venous return)

107
Q

S1

A

mitral and tricuspid close (just before contracting ventricles)

108
Q

S2

A

aortic and pulmonary close (just before relaxing ventricles)

109
Q

S3 Normal in:

A

pregnancy and children due to natural increased compliance

- (seen in dilated cardiomopathy but is pathologic)

110
Q

Non-Pacemaker Cardiac Cell Depolarization

A

Rapid depol by Na in → then start to inactivate → Ca influx and K efflux create plateau → Ca channels close and K continues to efflux out causing repolarization

111
Q

Pacemaker Cell Depolarization

A

4-0-3
Slow depolarization by funny channels (Na influx), spontaneous depol → Ca upstroke → Ca channel inactivated and K efflux to repolarize
- Sympathetic stimulation –> chance of funny channel being open so → increased HR

112
Q

Ach and Adenosine

A
  • Decrease rate of depolarization to lower HR (Act on Phase 4)
  • Slope of phase 4 determines HR
113
Q

Drugs to Avoid and Use in WPW

A

Avoid Digoxin, beta blockers, or CCBs

- Use IV amiodarone and procainamide

114
Q

AV Block: 1st degree

A

Prolonged PR

115
Q

AV Block: 2nd degree (Mobitz I)

A

Lengthening of PR till beat is dropped

116
Q

AV Block: 2nd degree (Mobitz II)

A

Randomly dropped beat

117
Q

AV Block: 3rd degree

A

Complete heart block, atria and ventricle beating independently

118
Q

Adult-Type Coarctation: Increased risk of _______

A

Berry aneurysms and rupture of those aneurysms

119
Q

Polymyalgia Rheumatica

A

aw/ Temporal Arteritis

120
Q

Coronary Steal Syndrome

A

Ischemia can be worsened in areas distal to an occlusion with addition of a coronary vasodilator (eg adenosine or dipyradamole)

121
Q

Endogenous substant that vasodilates and promotes diuresis

A

ANP/BNP

- mediates aldosterone escape

122
Q

Vascular reaction to endothelial injury

A

Endothelial dysfunction stimulates PDGF and smooth muscle cells to proliferate in the intima instead of the media

123
Q

Free wall ventricular rupture

A

Causes pericardial tamponade –> shortness of breath and profound hypotension

124
Q

S3 can be heard with:

A

Dilated Cardiomyopathy or Restrictive

125
Q

Expiring while in decubitus position, increases __________ heart sound

A

S3

- less air in lungs and heart closer to chest wall so it is easier to hear

126
Q

Venous Return Curve Affected by:

A 
hemorrhage (decreased)
fluid infusion (increased)
127
Q

Cardiac Output Curve Affected by:

A

MI, narcotics (decreased)

Inotropes, Chronic anemia, catecholamines (increased)

128
Q

Isolated Diastolic Heart Failure

A

Filling Problem, not systolic (eg. hypertrophic cardiomyopathy)
Ejection fraction will be preserved
End diastolic volume will be Normal, but decreased compliance will cause the End diastolic pressure to be increased

129
Q

In LV failure, accumulation of fluid in lung interstitium causes ________ compliance

A

decreased

130
Q

1st line for Atrial Fibrillation

A

Beta blockers and Ca Channel Blockers (Digoxin is 2nd line)

131
Q

Transesophageal Echo

A

Left Atrium will be anterior

Descending Aorta will be posterior

132
Q

Valsalva

A

Increases Vagal tone and can be used to abolish paroxysmal SVT tachycardia
- rectus abdominus is most important in increasing the intraabdominal and intrathoracic pressure

133
Q

Long-term compensatory response to Aortic Regurg

A

Increased LV preload and Eccentric LV hypertrophy

134
Q

Supine Hypotension Syndrome

A

Can be seen in pregnancy >20 weeks due to compression of the IVC by uterus reducing venous return and CO

135
Q

Tricuspid Regurgitation

A

Holosystolic Murmur

Increases with Inspiration (because it is right sided) due to increased venous return

136
Q

Normal Aging of Heart

A

Decreased LV chamber size, sigmoid-shaped ventricular septum, myocardial atrophy w/ increased collagen deposition, cytoplasmic lipofuscin accumulation in myocytes

137
Q

Salicylate Poisoning

A

Respiratory Alkalosis and Metabolic Acidosis

pH slightly low

138
Q

Aorta derived from _______ Aortic Arch

A

4th

139
Q

Right Subclavian Artery derived from ________ Aortic Arch

A

4th

140
Q

Third Aortic Arch Makes:

A

Common carotid and proximal internal carotid arteries

141
Q

Second Aortic Arch makes:

A

Stapedial and Hyoid arteries

142
Q

First Aortic Arch makes:

A

Maxillary Artery

143
Q

PDA: keep open w/

A

PGE

144
Q

PDA: close w/

A

PGE inhibitor (indomethacin) or NSAIDS (inhibits COX to prevent PG formation)

145
Q

A1V1 =

A

A2V2

146
Q

Chronic Aortic Stenosis w/ Afib

A

Can cause acute pulmonary edema/CHF because the hypertrophied LV depends greatly on atrial contraction to fill it. Loss of atrial contraction/kick due to afib can reduce preload and CO –> systemic hypotension and backup into LA and lungs

147
Q

Cough Syncope

A

Increased intrathoracic pressure during a coughing episode decreases venous return –> transient decrease in CO and cerebral perfusion

148
Q

IVC Obstruction

A

Symmetric bilateral lower extremity edema and often prominently visible abdominal wall collateral venous circulation

149
Q

Cardiac Tamponade

A
  • Electrical alternans means a big pericardial effusion (and usually cardiac tamponade)
  • heart cannot fill properly, preload decreases
  • hypotension and tachycardia
  • fluid backup leads to elevated JVP (pulsus paradoxus)
  • distant heart sounds
150
Q

Effect of Lyme Disease on Heart

A

Carditis causing 3rd degree heart block

151
Q

Isolated Systolic Hypertension

A

Commonly an age-related stiffening (decrease in compliance) of aorta

152
Q

Aschoff Bodies

A

Interstitial myocardial granulomas
Typically found in acute rheumatic carditis
(caterpillar cells)

153
Q

Abnormal migration of neural crest cells through primitive truncus arteriosus and bulbis cordis

A

Tetralogy of Fallot
Truncus Arteriosus
Transposition of Great Vessels

154
Q

Most useful measure for assessing degree of Mitral Stenosis

A

A2 to opening snap time interval

closure of aortic valve to opening of mitral

155
Q

Nitroglycerin vs Nitroprusside

A

Nitroglycerin: dilates veins –> decrease preload
Nitroprusside: dilates veins and arteries –> decrease both preload AND afterload

156
Q

MC Cardiac Abnormality predisposing to Native Valve Bacterial Endocarditis

A

Mitral Valve Prolapse

157
Q

Myxomatous changes in media of large arteries predisposes to development of: ________ and ________

A

aortic dissections and aortic aneurysms

cystic medial degeneration

Quick Notes for Step 1 (18 decks)

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