Cardio Flashcards
Cushing’s Reflex
Respiratory depression, HTN, and bradycardia due to increased ICP Increased ICP = medullary compression = respiratory depression - cerebral arteriole constriction - increase sympathetic outflow to improve cerebral perfusion = HTN - increased baroreceptor outflow = bradycardia
Congenital heart defect associated with Fetal Alcohol Syndrome
VSD
Congenital heart defect associated with Down Syndrome
Endocardial cushion defects (ASD ostium primum type, VSD)
Congenital heart defect associated with Turner Syndrome
Coarctation of the aorta, bicuspid aortic valve
Congenital heart defect associated with maternal pre gestational DM
Transposition of the great vessels
Congenital heart defect associated with lower extremity cyanosis (differential cyanosis)
Coarctation of the aorta (infantile type - distal to PDA), PDA (late - following development of Eisenmenger Syndrome)
Evolution of MI (process, complication)
X 1 day X 1 wk X 1 mo X
Coagulative necrosis. Arrythmia, cardiogenic shock
-1 day-
Inflammation (PMN, M0). Papillary muscle rupture (esp RCA to posterior m), ventricular wall rupture
-1 wk-
Granulation tissue. Papillary muscle rupture (esp RCA to posterior m), ventricular wall rupture
-1 mo-
Fibsosis. Dressler syndrome, CHF.
Treatment for Acute MI
ABCs
MONA (morphine, O2, nitroglycerin, aspirin)
Anticoagulation (clopidogrel + heparin)
Beta blocker
Statin
Dilated Cardiomyopathy Causes
(ABCCCD)
Alcohol, wet beriberi (thiamine deficiency, vitB1), Coxsackie B, cocaine, Chagas disease, Daunorubicin/doxorubicin toxicity
Restrictive Cardiomyopathy Causes
(LEASH restricts your dog)
Loffler syndrome (eosinophilic myocardial fibrosis), Endocardial fibroelastosis (fibroelastic endocardium in African children), amyloidosis, sarcoidosis, hemachromatosis
What medications improve survival in chronic CHF?
ACEI/ARBs
Alsoderone antagonist (spironolactone, eplerenone)
B blockers (Metoprolol, carvediolo)
In AAs with moderate-severe symptoms - Nitrates + hydralazine
How do you treat acute CHF exacerbation?
(NO LIP)
Nitrates (nitroglycerin)
O2 - only if hypoxic
Loop diuretics
Inotropes (Dobutamine)
Positioning
Pathogens in bacterial endocarditis
Acute, subacute, culture negative, IV drugs
Acute - Staph aureus
Subacute - Viridans Strep
Culture negative - Coxiella burnetti (Q fever), Bartonella (Cat scratch fever)
IV drugs - Staph aureus, Pseudomonas, Candida
Causes of acute pericarditis:
Fibrinous, serous, hemorrhagic
Fibrinous - Dressler Syndrome, uremia, radiation
Serous - viral, inflammatory disease (SLE, RA)
Hemorrhagic - TB, melanoma
Kussmaul sign vs pulsus peridoxus
Kussmal sign - JVD with inspiration = RV insufficiency. Pericarditis
Pulsus peridoxus - BP drop > 10 mmHg with inspiration - LV insufficiency. Cardiac tamponade
HTN Treatment
Primary, + CHF, + BPH
Primary - HCTZ, ACEI/ARB
+ CHF - add BB, aldosterone antagonist
+ BPH - use a blocker instead of HCTZ
What CCB is used for subarachnoid hemorrhage?
Nimodipine (prevents ischemia-induced vasodilation of ruptured cerebral arteries)
What HTN drugs are safe in pregnancy?
(Hypertensive Moms Love Nifedipine)
Hydralazine
Methyldopa
Labetalol
Nifedipine
What medication class is used for aortic dissection?
B blockers (decreases slope of BP rise)
What is Fenoldopam and when is it used?
D1R agonist = vasodilation
Used in HTN emergency, maintains renal perfusion (renal a dilation) to promote natriuresis
How does Nitroglycerin improve symptoms of angina?
CANT directly vasodilate coronary arteries becuase theyre already maximally dilated.
Causes systemic venodilation - decreased preload - decreased myocardial O2 demand
What is a side effect specific to Nitroprusside? How would you treat it?
CN toxicity
Thiosulfate + vitamin B12 (sequesters CN)
Nitrate (causes metHb that CN cannot bind) + Methylene Blue (rescues the metHb)
What are the classes of antiarrhythmics?
(No BadBoy Keeps Clean)
What drugs are Class 1A, 1B, and 1C antiarrhytmics?
Class 1A (Double Quarter Pounder) - Disopyramide, Qunidine, Procainamide
Class 1B (Mayo, Lettuce, Tomato) - Mexiletine, Lidocaine, Tocainide
Class 1C (Fries, Please) - Flecanide, Propafenone
What is the clinical use for Procainamide? What side effect is specific to it?
What is Cinchonism? What drugs cause it?
Headache, dizziness, tinnitus
Quinidine (class 1A antiarrhythmic), Quinine (antimalarial)
What is the clinical use of Lidocaine? Why?
Tachyarrhytmias after an MI. It preferentially blocks Na channels in ischemic myocardial tissue.
How do you treat B blocker overdose?
Glucagon
What is the clinical use for Amiodarone? What are the side effects?
WPW
Check PFTs, LFTs, TFTs (pulmonary fibrosis, hepatotoxicity, dysthroid because high I content), photosensitivity
Less specific - neurological, constipation
How does Adenosine work?
When is it used clinically?
What drug can block it’s effect?
MOA: Increases K effluc, hyperpolarizing cardiomyocytes
Used to restart the heart in SVT at a slower rate
Blocked by Theophylline (COPD PDE inhibitor that causes bronchodilation)
What two ions can most strongly trigger dangerous arrhythmias if not optimized?
K and Mg
What drugs can be used to lower LDL?
Statins
Less effective - bile acid resins, ezetimibe (inhibits cholesterol uptake at the brush boarder)
What are the side effects of statins?
Hepatotoxicity, rhabdomyolysis (esecially + fibrates or niacin)
What lipid lowering agent can be given to bind C diff toxin?
What drug can be used to increase HDL? What are the side effects?
Niacin
Facial flushing, rhabdomyolysis if used with statins
What drug can be used to decrease TGs? What are the side effects?
Fibrates
Myositis (increased with concurrent statins), hepatotoxicity, cholesterol gallstones
Which lipid lowering drugs increase the risk of cholesterol gallstones?
Bile acid resins and fibrates
What are the side effects of Digoxin?
What puts you at higher risk for toxicity?
What is the antidote?
Bradycardia/AV block, blurry yellow vision, hyperkalemia
Higher risk of OD with renal failure, hypoK (increased Na/K ATPase binding)
Antidote = anti-digoxin Fab fragments
What is Sturge-Weber Syndrome?
Non-inherited mutation in GNAQ gene resulting in anomolies of neural crest derivatives (specifically, blood vessels)
Port-wine stain in CV V1 dermatome (non-neoplastic capillary overgrowth), leptomeningeal angioma (seizures, intellectual disability), and episcleral hemangioma (increases intra-ocular P = glaucoma)
What is Romano-Ward syndrome?
What is Jervell and Lange-Nielsen Syndrome?
Congenital long QT + sensorineural deafness
Pt with AF and CHF with bradycardia and hyperK - what is the cause?
Digoxin toxicity
What is the treatment for TdP?
IV Mg
