Cardio Flashcards
1
Q
How is dilated cardiomyopathy manifested?
A
Systolic disfunction
2
Q
How do ACE inhibitors produce angioedema?
A
Due to bradykinin accumulation
3
Q
Early findings of reumathic fever
A
Migratory arhthritis
Pancarditis
Syndenham chorea
4
Q
Late findings of rheumatic fever
A
Mitral regurgitation/ stenosis
Aortic valve less frequently involved
5
Q
Which is the most common cause of nephritic syndrome in children worldwide?
A
Post streptococcal glomeruloneohritis
6
Q
How is restrictive cardiomyopathy manifested?
A
With diastolic disfunction
7
Q
What leaks in case of cell wall damage caused by ischemia of heart, brain or skeletal muscle cells?
A
Creatinine kinase
8
Q
How is mitral stenosis heard?
A
Opening snap being heard after the S2 heart sound
9
Q
Most common cause of mitral stenosis
A
Prior rheumatic fever
10
Q
Low pitched murmur heard best at the sternal border with accentuation during handgrip exercise
A
Ventricular septal defect
11
Q
Mid systolic pulmonary ejection murmur which results from increased flow across the pulmonic valve
A
Atrial septal defect
12
Q
What does hand maneuver increase?
A
Afterload
13
Q
How does systolic ejection murmur of hypertrophic cardiomyopathy decrease?
A
With maneuvers that increase afterload
14
Q
Which maneuver decreases preload?
A
Valsalva maneuver
15
Q
Which maneuver accentuates the systolic ejection murmur of hypertrophic cardiomyopathy?
A
Valsalva maneuver
16
Q
Which maneuver accentuates aortic regurgitation murmur?
A
Maneuvers that accentuate afterload such as handgrip exercise
17
Q
What is paradoxical embolism?
A
They originate in the systemic venous circulation and enter the systemic arterial circulation via intracardiac or intrapulmonary shunt
18
Q
In whom can paradoxical embolism happen?
A
Patients with patent foramen ova,e , atrial septal defects, ventricular septal defects or Large AVMs
19
Q
Wide and fixed splitting (no change with respiration) of the second heart sound S2
A
Atrial septal defects with left to right shunting
20
Q
Early disstolic decrescendo murmur
A
Aortic regurgitation
21
Q
Systolic ejection murmur that increases in intensity with standing
A
Hypertrophic cardiomyopathy
22
Q
Diastolic murmur with presystolic accentuation
A
Mitral or tricuspid valve stenosis
23
Q
What causes the diastolic murmur with presystolic accentuation in mitral or tricuspid valve stenosis?
A
due to atrial contraction
24
Q
Which is a sign of delayed closure of the tricuspid valve?
A
Wide splitting of S1 that is accentuated by inspiration
25
What is associated to liver angiosarcoma?
With exposure to carcinogens such as arsenic, thorotrast and polyvinyl chloride
26
What does hepatic angiosarcoma express?
Tumor cell express CD 31 an endothelial cell marker
27
When does acute rheumatic fever occur after group A streptococcal pharyngitis?
10 day to 6 weeks after
28
Which group of age are most often affected by acute rheumatic fever?
Children between 5 and 15 years old
29
Which are the main clinical manifestations of Acute rheumatic arthritis fever?
Acute migratory poly arthritis and pancarditis
30
Signs of acute pancarditis
Weak heart sounds, tachycardia, pericardial friction rubs, and arrhythmia
31
What causes death in patients with acute reumathic fever?
Heart failure due to severe myocarditis
32
How long does mitral stenosis take to develop in case of Acute rheumatic fever?
Years or decades
33
On the ECG what correspond to phase 0 of ventricular myocyte action potential?
QRS complex corresponding to ventricular depolarization
34
Which drugs have shown slow progression of heart failure and reduce mortality in CHF?
Beta blockers and carvedilol i. Particular
35
How do beta blockers help in CHF?
Decrease cardiac work by slowing the ventricular rate and decreasing afterload
36
Refers to a conclusion that there is no difference between the groups studied when a difference truly exists
Beta error
37
Results from the inaccurate recall of past exposure by subjects
Recall bias
38
What is the main purpose to avoid observer bias?
The main purpose of blinding is to prevent patient or researcher expectancy from interfering with an outcome
39
How does digoxin primarily acts?
By inducing stimulation of the AV node of the vagus nerve causing slowing of conduction through the AV node
40
Possible findings of digitalis toxicity
Fatigue, blurry vision, changes in color perception, nausea and vomiting , diarrhea, abdominal pain, headache, dizziness, confusion and delirium
Bradycardia
Eventual ventricular tachycardia or ventricular fibrilation
41
Which electrolyte is mainly affected in digitalis intoxication? What could be seen?
K+
| Seen as high serum levels of potassium
42
What is needed to treat digitalis toxicity?
Oral activated charcoal as a GI decontaminant
Management Of serum potassium levels by the use of insulin, kayexalate or hemodialysis
Digoxin specific antibody fragments
43
What should be avoided in digitalis intoxication?
Calcium gluconate
44
Which cardiac manifestations does digoxin intoxication might show?
AV block and ventricular tachycardia
45
After MI when can we see ruptured of ventricular free wall?
Generally occurs 3-7 days after the onset of total ischemis
46
Clinical manifestations of ruptured of ventricular wall
Profound hypotension and shortness of breath
| On physical examination the heart sounds are muffled and the jugular venous pressure is elevated
47
Why can rupture of ventricular wall cause death?
Due to hemopericardium and cardiac tamponade
48
Most common cause of death in a patient hospitalized for a MI
Ventricular failure (cardiogenic shock) which is a 2/3 of death cause
49
In MI what causes weakening of ventricular walls?
After coagulative necrosis and neutrophil infiltration
| May cause ventricular ruptured
50
Most common cause of subungual splinter hemorrhages
Microemboli from valvular vegetations of bacterial endocarditis
51
What could be found in case of bacterial endocarditis?
Regurgitation murmur
52
What are the Janeway lesions?
Septic embolization from infected cardiac wall vegetations
| Localized in palms and soles
53
What compose Janeway lesions?
Bacteria, neutrophils, necrotic material ams subcutaneous hemorrhage
54
Which is the most common necrosis variant after MI?
Coagulative necrosis
55
When does coagulative necrosis develops?
After irreversible ischemic injury
56
Cellular changes in coagulative necrosis
Tissue architecture is preserved
Cells become anucleated with eosinophilic cytoplasm
Leukocytes eventually infiltrate necrotic tissue and digest cellular debris
57
When is liquefactive necrosis seen?
With focal bacterial infections that stimulate massive leukocyte recruitment
58
Where does liquefactive necrosis occur?
Central nervous infarcts
59
Where do we see fat necrosis?
Seen in acute pancreatitis
60
Morphology of fat necrosis
Saponification (chalky white deposits)
61
When is the saponification formed?
When fatty acids combine with calcium
62
When does caseous necrosis occur?
Most commonly with tuberculosis infection
63
What is the result of complete muscle ischemia for >30 minutes in MI?
Progressive cardiomyocyte death and coagulative necrosis
64
Yellow brown finely granular found in heart and liver cells
Lipid peroxidation
65
When are lipid peroxidation granules seen?
Seen in heart and liver aging or cachectic, malnourished patients
66
How are hemosiderin granules seen?
Brown pigments granules seen in iron overload
67
Dark brown to black pigmented granules
Melanin
68
Clear vacuoles within cytoplasm
Glycogen
69
Is a form of protein accumulation, typically appearing as glassy, homogenous pink deposit
Hyaline deposit
70
Which is the product of lipid peroxidation?
Lipofuscin, seen accumulated in aging cells (specially in patients with malnutrition and cachexia)
71
Percentage of total perfusion through the myocardium capillaries of the LV occurs during systole
10%, while the majority of left ventricular flow occurs during diastole
72
Which is the effect of nitric oxide within the vascular smooth muscle cell?
NO stimulates guanylate cyclase to convert GTP into cyclic guanosine monophosohate (cGMP)
73
What is the final effect of increased cGMP by Nitric oxide?
Decreased intracellular calcium concentration which leads to decreased activity of myosin light chain kinase and finally myosin light chain dephosphorylation and smooth muscle relaxation
74
In muscle what is the effect of muscle phosphorylation?
Contraction
75
What is the effect of chronic arteriovenous shunt?
Increase cardiac output because of increased sympathetic stimulation to the heart, decreased peripheral resistance and increase venous return
76
Drugs that inhibit cGMP degradation leading to its accumulation, which produce muscle relaxation
PDE Inhibitors (sildenafil, tadalafil, vardenafil)
77
How is atrial septal defect heard?
Fixed splitting of the second herat sound
78
When does S4 sound could be heard?
Occurs at the end of diastole just before S1
79
Associated with a mid systolic click and a mid to late systolic murmur
Mitral valve prolapse
80
What is associated to S4?
Due to decreased left ventricular compliance and is often associated with restrictive cardiomyopathy and left ventricular hypertrophy
81
When left anterior descending artery alone is occluded, which is the preferred vessel for bypass grafting?
Internal mammary (thoracic) artery
82
When multiple coronary arteries require vascularization, which is the preferred vessel to use?
Saphenous vein graft
83
Which is the longest vein in the body?
Great saphenous vein
84
Who forms the femoral triangle?
Inguinal ligament superiorly, sartorius muscle laterally, and adductor longus medially
85
Where are the majority of peripheral artery aneurysm formed?
In the popliteal artery
86
Adult derivative of first aortic arch
Part of maxillary artery
87
Adult derivative of second aortic arch
Hyoid artery
| Stapedial artery
88
Adult derivative of third aortic arch
Common carotid artery
| Proximal internal carotid artery
89
Adult derivative of fourt aortic arch
On left aortic arch
| On right proximal right subclavian
90
Adult derivative of sixth aortic arch
Proximal pulmonary arteries
| On left ductus arteriosus
91
From which structure does ductus arteriosus derivates?
From sixth aortic arch
92
What is the effect of carotid sinus massage?
Increases baroreceptor firing, and thus increases parasympathetic influence on the heart and vessels, and ultimately prolongs the AV node refractory period which stops AV re entrant tachycardias
93
Typically a re entrant circuit in the AV node
Paroxysmal supraventricular tachycardia seen in patients with no other disease
94
How is paroxysmal commonly manage?
With adenosine in the hospital setting, but vagal maneuvers such as carotid sinus massage and Valsalva can also be used
95
How is orthosthatic hypotension defined?
As a fall of >22 mm in systolic or > 10 mm in diastolic pressure when assuming upright posture
96
Who prevents cerebral hypoperfusion upon standing
a1 adrenergic receptors stimuli
97
Which is the most striking finding of pericarditis?
Pericardial friction rub
98
Chest pain sharp and pleuritic, and characteristically decreases when the patient sits up and leans forward
Acute pericarditis
99
Most common variant of pericarditis
Fibrinous or serofibrinous
100
Common causes of pericarditis
Myocardial infarction , rheumatic fever, uremia, viral infection
101
Paradoxical increase in the jugular venous pressure with inspiration
Kussmaul's sign
102
When is kussmaul's sign often found?
In chronic constrictive pericarditis
103
Differential diagnosis of kussmaul's sign
Restrictive cardiomyopathy, severe right sided heart failure, tricuspid stenosis and cardiac tamponade
104
Drop in systolic blood pressure of 10 mmHg or more during inspiration
Pulsus paradoxus
105
When is Pulsus paradoxus found?
Cor pulmonale, constrictive (chronic) pericardial disease, and cardiac tamponade
106
Brief, high frequency, precordial sound heard in early diastole (shortly after S2)
Pericardial knock in patients with constrictive (chronic) pericarditis
107
What are fenfluramine, dexfenfluramine and phentermine?
Appetite suppressants
108
What is a secondary effect of appetite suppressants used for more tha 3 months?
Pulmonary hypertension
109
Pathologies associated to cerebral aneurysm?
Autosomal dominant polycystic kidney disease
| Ehlers Danlos syndrome
110
What do pulmonary embolism patients develop?
Ventilation/perfusion (V/Q) mismatch
111
What is the result of pulmonary embolism?
Hypoxemia, causing subsequently hyperventilation and Respiratory ALKALOSIS
112
Increased pH and reduced PaCO2
Respiratory alkalosis
113
Increased pH and reduced PaCO2 + low PaO2
Acute Pulmonary embolism
114
pH of 7.30 and low HCO3-
Metabolic acidosis
115
pH of 7.32 and PaCO2 high, high HCO3-
Respiratory acidosis, with renal compensation
116
pH 7.47, low PaCO2 , low HCO3-
Respiratory alkalosis with partial renal compensation
117
PH 7.48 and high HCO3-
Metabolic alkalosis
118
Which is the first change in coronary artery atherosclerosis?
Endothelial cell injury
119
Inhibits platelet aggregation and also works as direct arterial vasodilator
Cilostazol
120
Clinical use for Cilostazol
In the treatment for intermittent claudication
121
Direct thrombin inhibitor
Argatroban
122
When is abciximab used?
Prior to percutaneous coronary intervention
123
Phosphodiesterase inhibitor used in patients with intermittent claudication
Cilostazol
124
Decreased femoral to brachial blood pressure ratio
Congenital coarctation of the aorta
125
Which enzyme is deficient in Ehlers Danlos syndrome?
Procollagen peptidase
126
Which is the effect of procollagen peptidase?
Transforms the procollagen into insoluble tropocollagen
127
How do macrophage reduce plaque stability of the intima?
By secreting metalloproteinases, which degrade collagen
128
Direct pathway of how HDL delivers cholesterol
Delivers cholesterol esters directly to the liver via a scavenger receptor (SCARB1)
129
Indirect pathway of how HDL delivers cholesterol
HDL transfer cholesterol to LDL and VLDL by cholesteryl ester transfer protein
130
Which are the most effective lipid lowering drugs for oreventing cardiovascular effects?
HMG CoA reductase inhibitors
131
When aren't thiazides recommended?
For diabetic, gout or hypercalcemia
| They can also cause hyponatremia
132
When are ACE inhibitors the drug of choice in hypertensive patients?
When diabetic and hypertension
133
In case of extravasation of NE what is recommended?
Infiltration of sodium chloride solution containing phentolamine mesylate
Must be given within 12 hours
134
What is phentolamine?
alpha receptor blocker
135
When is calcium gluconate used?
In severe hypocalcemia
136
What characterizes abdominal aortic aneurysm?
Transmural inflammation of the aortic wall
137
Cardiac action potential conduction where is the slowest
AV node
138
Cardiac action potential conduction where is the fastest
Purkinje system
139
Rate of each system id action potential
SA node 1.1m/sec
AV node .05 m/sec
His-Purkinje 2.2 m/sec
Purkinje- ventricles .3 m/sec
140
Adult onset asthma, eosinophilia, history of allergy, mono or poly neuropathy, migratory/ transient pulmonary infiltrates, and paranasal sinus abnormalities + pANCA
Churg Strauss syndrome
141
Which enzyme may be elevated in Sarcoidosis?
Angiotensin converting enzyme
142
Circulating autoantibodies against alpha 3 chain of collagen IV, which damage alveolar and glomerular basement membranes
Pulmonary goodpasture syndrome
143
Antibodies found in Scleroderma
Antibodies to Scl 70, a soluble nuclear antigen, and or anti centromere antibody
144
What is characteristic of Aspergillus fumigatus?
Eosinophilia and elevated IgE and IgG antibodies to Aspergillus fumigatus
145
What leaks in case of cell wall damage caused by ischemia of heart, brain or skeletal muscle cells?
Creatinine kinase
146
How is mitral stenosis heard?
Opening snap being heard after the S2 heart sound
147
Most common cause of mitral stenosis
Prior rheumatic fever
148
Low pitched murmur heard best at the sternal border with accentuation during handgrip exercise
Ventricular septal defect
149
Mid systolic pulmonary ejection murmur which results from increased flow across the pulmonic valve
Atrial septal defect
150
What does hand maneuver increase?
Afterload
151
How does systolic ejection murmur of hypertrophic cardiomyopathy decrease?
With maneuvers that increase afterload
152
Which maneuver decreases preload?
Valsalva maneuver
153
Which maneuver accentuates the systolic ejection murmur of hypertrophic cardiomyopathy?
Valsalva maneuver
154
Which maneuver accentuates aortic regurgitation murmur?
Maneuvers that accentuate afterload such as handgrip exercise
155
What is paradoxical embolism?
They originate in the systemic venous circulation and enter the systemic arterial circulation via intracardiac or intrapulmonary shunt
156
In whom can paradoxical embolism happen?
Patients with patent foramen ova,e , atrial septal defects, ventricular septal defects or Large AVMs
157
Wide and fixed splitting (no change with respiration) of the second heart sound S2
Atrial septal defects with left to right shunting
158
Early disstolic decrescendo murmur
Aortic regurgitation
159
Systolic ejection murmur that increases in intensity with standing
Hypertrophic cardiomyopathy
160
Diastolic murmur with presystolic accentuation
Mitral or tricuspid valve stenosis
161
What causes the diastolic murmur with presystolic accentuation in mitral or tricuspid valve stenosis?
due to atrial contraction
162
Which is a sign of delayed closure of the tricuspid valve?
Wide splitting of S1 that is accentuated by inspiration
163
What is associated to liver angiosarcoma?
With exposure to carcinogens such as arsenic, thorotrast and polyvinyl chloride
164
What does hepatic angiosarcoma express?
Tumor cell express CD 31 an endothelial cell marker
165
When does acute rheumatic fever occur after group A streptococcal pharyngitis?
10 day to 6 weeks after
166
Which group of age are most often affected by acute rheumatic fever?
Children between 5 and 15 years old
167
Which are the main clinical manifestations of Acute rheumatic arthritis fever?
Acute migratory poly arthritis and pancarditis
168
Signs of acute pancarditis
Weak heart sounds, tachycardia, pericardial friction rubs, and arrhythmia
169
What causes death in patients with acute reumathic fever?
Heart failure due to severe myocarditis
170
How long does mitral stenosis take to develop in case of Acute rheumatic fever?
Years or decades
171
On the ECG what correspond to phase 0 of ventricular myocyte action potential?
QRS complex corresponding to ventricular depolarization
172
Which drugs have shown slow progression of heart failure and reduce mortality in CHF?
Beta blockers and carvedilol i. Particular
173
How do beta blockers help in CHF?
Decrease cardiac work by slowing the ventricular rate and decreasing afterload
174
Refers to a conclusion that there is no difference between the groups studied when a difference truly exists
Beta error
175
Results from the inaccurate recall of past exposure by subjects
Recall bias
176
What is the main purpose to avoid observer bias?
The main purpose of blinding is to prevent patient or researcher expectancy from interfering with an outcome
177
How does digoxin primarily acts?
By inducing stimulation of the AV node of the vagus nerve causing slowing of conduction through the AV node
178
Possible findings of digitalis toxicity
Fatigue, blurry vision, changes in color perception, nausea and vomiting , diarrhea, abdominal pain, headache, dizziness, confusion and delirium
Bradycardia
Eventual ventricular tachycardia or ventricular fibrilation
179
Which electrolyte is mainly affected in digitalis intoxication? What could be seen?
K+
| Seen as high serum levels of potassium
180
What is needed to treat digitalis toxicity?
Oral activated charcoal as a GI decontaminant
Management Of serum potassium levels by the use of insulin, kayexalate or hemodialysis
Digoxin specific antibody fragments
181
What should be avoided in digitalis intoxication?
Calcium gluconate
182
Which cardiac manifestations does digoxin intoxication might show?
AV block and ventricular tachycardia
183
After MI when can we see ruptured of ventricular free wall?
Generally occurs 3-7 days after the onset of total ischemis
184
Clinical manifestations of ruptured of ventricular wall
Profound hypotension and shortness of breath
| On physical examination the heart sounds are muffled and the jugular venous pressure is elevated
185
Why can rupture of ventricular wall cause death?
Due to hemopericardium and cardiac tamponade
186
Most common cause of death in a patient hospitalized for a MI
Ventricular failure (cardiogenic shock) which is a 2/3 of death cause
187
In MI what causes weakening of ventricular walls?
After coagulative necrosis and neutrophil infiltration
| May cause ventricular ruptured
188
Most common cause of subungual splinter hemorrhages
Microemboli from valvular vegetations of bacterial endocarditis
189
What could be found in case of bacterial endocarditis?
Regurgitation murmur
190
What are the Janeway lesions?
Septic embolization from infected cardiac wall vegetations
| Localized in palms and soles
191
What compose Janeway lesions?
Bacteria, neutrophils, necrotic material ams subcutaneous hemorrhage
192
Which is the most common necrosis variant after MI?
Coagulative necrosis
193
When does coagulative necrosis develops?
After irreversible ischemic injury
194
Cellular changes in coagulative necrosis
Tissue architecture is preserved
Cells become anucleated with eosinophilic cytoplasm
Leukocytes eventually infiltrate necrotic tissue and digest cellular debris
195
When is liquefactive necrosis seen?
With focal bacterial infections that stimulate massive leukocyte recruitment
196
Where does liquefactive necrosis occur?
Central nervous infarcts
197
Where do we see fat necrosis?
Seen in acute pancreatitis
198
Morphology of fat necrosis
Saponification (chalky white deposits)
199
When is the saponification formed?
When fatty acids combine with calcium
200
When does caseous necrosis occur?
Most commonly with tuberculosis infection
201
What is the result of complete muscle ischemia for >30 minutes in MI?
Progressive cardiomyocyte death and coagulative necrosis
202
Who mediates vasodilation stimuli of vascular endothelium?
Acetylcholine, bradykinin, serotonin, substance P and shear forces
203
What is the effect of Acetylcholine, bradykinin, serotonin, substance P and shear forces in endothelium?
Increase in cytosolic calcium levels
204
Once calcium is elevated in endothelial cells what is activated?
Endothelial nitric oxide synthase
205
Which is the precursor of nitric oxide once stimulated by endothelial nitric oxide synthase?
Arginine
NADPH
O2
206
What is activated by nitric oxide?
Guanylyl cyclase and increases formation of cyclic G,P
207
What is the effect of high levels of cyclic GMP?
Activate protein kinase G, which causes a reduction in cytosolic calcium levels and relaxation of smooth muscle cells
208
Which is the most common cause of death in patients suffering from myocardial infarction?
Ventricular fibrilation
209
Which are the most lethal arrhythmias in patients with acute myocardial infarction?
Ventricular tachycardia and ventricular fibrillation
210
Clinical findings of ruptured of the intraventricular septum
Hypotension, bi ventricular failure and a new murmur
211
When does significant mural thrombosis occur after myocardial infarction?
Until three to seven days after the onset of infarction
212
What is used to treat hypertensive heart failure?
Nitroprusside
213
What is the effect of nitroprusside?
Decreases preload and afterload
| Doesn't affect contractility
214
Short acting balanced venous and arterial vasodilator that decreases both preload and afterload
Nitroprusside
215
Hereditary hemorrhagic telangiectasia
Osler Weber Rendu syndrome
216
Mode of inheritance of Osler Weber Rendu syndrome
Autosomal dominant
217
Better-known as encephalotrigrminal angiomatosis
Sturge Weber syndrome
218
Findings of Sturge Weber syndrome
Presence of continuous facial angiomas as well as leptomeningeal angiomas
Mental retardation, seizures, hemiplegia coma and skull radio opacity
219
When you see "tram track " image on skull radiography what should you suspect?
Sturge Weber syndrome
220
Capillary hemangioblastomas in retina and/or cerebellum as well as congenital cysts and/or neoplasm in the kidney liver and pancreas
Von Hippel Lindau
221
What should be suspected when seeing cortical and subependymal hamartomas?
Tuberous sclerosis
222
How is cardiac output affected when doing exercise?
Increase from a resting rate of 5 L per minute to approximately 20 L per minute during Maxima exertion
223
What is the effect of sympathetic stimulation to the venous system?
Causes contraction, increasing venous return to the heart
224
What is the effect of sympathetic in arterioles?
Contraction in arterioles in all tissues except that actively working muscles, effectively shunting blood toward exercising muscle
225
When doing exercise how much is the pressure increased by sympathetic nervous system?
Typically increases only 20-40 mmHg during full body exercise
226
When doing exercise which are local vasodilators?
Adenosine, potassium ions, ATP, CO2 and lactate
227
Percentage of total cardiac output for renal bloodflow?
25%
228
Elevation of the peak v wave pressure and an earlier upswing than would normally be seen
Mitral regurgitation
229
Most common cause of right heart failure
Secondary to left heart failure
230
Effects of increased Angiotensin II
```
Sodium retention (direct effect)
Aldosterone production
Vasoconstriction
```
231
In congestive heart failure how does it affects pressure?
Decreased renal flow causing increased renin which leads to increased arteriolar resistance
So... Increased pressure
232
In the kidney what is activated by decreased GFR?
Macula densa increasing renin
233
If heard in adults typically is a sign of left ventricular failure
S3
234
When is S3 heart sound heard?
Forceful, rapid filling of a ventricle that has normal or elevated compliance
Normal or even decreased filling rates when ventricular compliance is low
Blood flowing into Overfilled ventricle with high end systolic volume
235
When does bulging of intraventricular septum occurs?
In cardiac tamponade
236
Which finding is common in cardiac tamponade?
Pulsus paradoxus
237
Blowing, holsystolic murmur heard over the cardiac apex with radiation to the axilla
Mitral regurgitation
238
How is aortic regurgitation heard?
Early diastolic murmur
239
What may ascending aortic aneurysm develop?
Aortic regurgitation
240
Mid systolic ejection murmur best heard over the right second intercostal space with radiation to the neck
A bicuspid aortic valve
| Aortic stenosis
241
Opening snap at the beginning of diastole with a low pitched, mid diastolic rumbling murmur heard best at the cardiac apex
Mitral stenosis
242
In MI what is seen in 0-4 hours
No visible changes
243
In MI what is seen in 4-12 hours
Wavy fibers with narrow, elongated myocytes
244
In MI what is seen in 12- 24 hours
```
Coagulation necrosis (loss of nuclei & striations)
Prominent neutrophilic infiltration
```
245
In MI what is seen in 1-3 days
Disintegration of dead neutrophils and myofibers,
| Macrophages infiltration a border areas
246
In MI what is seen in 7-10 days
Robust phagocytosis of dead cells by macrophages,
| beginning formation of granulation tissue at margins
247
In MI what is seen in 10-14 days
Well-developed granulation tissue with neovascularization
248
In MI what is seen in 2 weeks to 2 months
Progressive collagen deposition and scar formation
249
Major changes in chronic ischemic heart disease
Subendocardial vacuolization
250
Normal morphological changes in the aging heart include
Decrease in left ventricular chamber apex to base dimension, development of a sigmoid shape ventricular septum, myocardium atrophy with increased collagen deposition, and accumulation of cytoplasmic lipofuscin pigment within cardiomyocytes
251
What is the problem of using around the clock nitrates?
Results in development of tolerance to nitrates
252
Mineralocorticoid receptor antagonist
Spironolactone
| Eplerenone
253
Potassium sparing diuretics
Spironolactone
| Eplerenone
254
Which drugs Block the deleterious effect of aldosterone on the heart, causing regression of myocardial fibrosis and improvement in ventricular remodeling
Mineralocorticoid receptor antagonists
Spironolactone
Eplerenone
255
Which drugs are recommended in heart failure therapy?
Mineralocorticoid receptor antagonist
ACE inhibitors
Beta blockers
256
When are mineralocorticoid receptor antagonist contraindicated?
In patients with hyperkalemia or renal failure
257
Most common side effects of mineralocorticoid receptor antagonists
Hyperkalemia and Gynecomastia
258
Which is the first line of treatment in atrial fibrillation?
Calcium channel blockers
Diltiazem
Verapamil
259
Which is the fsecond line of treatment in atrial fibrillation?
Digoxin
260
How does digoxin decreases rate of AV conduction?
Through increased parasympathetic tone throughout its action on the vagus nerve
261
How can Digoxin lead to ventricular tachycardia and dead?
By increasing intracellular calcium
262
When is clinically recommended the use of adenosin?
In paroxysmal supraventricular tachycardia
263
Between the arrhythmic drugs that cause torsades de points, with which one is less common to see this?
Amiodarone
264
Nonselective betta antagonist
Propanolol
265
Nonspecific alpha 1 and Alpha 2 Blocker with no beta effect
Phentolamine
266
Nonselective beta adrenergic agonist that stimulates both beta receptors on muscular smooth muscle and cardiac receptors
Isoprotenerol
267
Most common cause of atrial stenosis
Senile calcific aortic valve
268
At what age is common to see senile calcification of aortic valve
7th decade of life
269
Dominant Cardiac defect in DiGeorge syndrome
Tetralogy of Fallot and aortic arch anomalies
270
What is mutated in Friedreich ataxia?
Frataxin
271
What is frataxin?
A mitochondrial protein important in iron homeostasis and respiratory function
272
Spinocerebellar degeneration with predominantly spinal ataxia
Friedreich ataxia
273
Progression of Friedreich ataxia
Initial loss of sensory neurons in the dorsal root ganglia, with accompanying gait ataxia
274
How does Marfan syndrome causes dissecting aortic aneurysm?
With cystic medial necrosis of the aorta
275
Where is the mutation in Marfan syndrome?
In the gene that encodes fibrillin 1
276
Heart defects associated to Down syndrome
Ostium primum ASD, regurgitant AV valves
277
Which heart defect is seen in Friedreich ataxia
Hypertrophic cardiomyopathy
278
Heart defect in tuberous sclerosis
Valvular obstruction due to cardiac rhabdomyomas
279
Which syndrome is related to cause berry aneurysms?
Ehler Danlos syndrome
280
What its associated to hyperplastic arteriosclerosis of renal arterioles?
Malignant hypertension
281
It results from concentric lamellar reduplication of the intimal smooth muscle cells
Hyperplastic arterolosclerosis
282
Findings on hyperplastic arteriolosclerosis
Concentric lamellar reduplication of the intima smooth muscle cells "onion skinning"
283
Which structure composes most of the hearts anterior surface?
Right ventricle
284
It is defined as a drop in arterial blood pressure during inspiration of over 10 mmHg
Pulsus paradoxus
285
When does pulsus alternans occur?
Inpatients with left ventricular dysfunction
286
It is defined as a beat to beat variation in the magnitude of the lse upressure in the presence of a regular cardiac rythm
Pulsus alternans
287
Refers to a pulse with two distinct peaks, one during systole and the other during diastole
Dicrotic pulse
288
When does dicrotic pulse is found?
Severe systolic dysfunction
289
Refers to the pulse palpated in patients with aortic stenosis
Pulsus parvus et tardus
290
In patients with hypertensive heart disease what causes pulmonary hypertension?
Vasoconstriction due to pulmonary venous congestion
291
What should migratory thrombophlebitis make you think?
Cancer, leading to hypercoagulable state
292
How does adenocarcinoma produce hypercoagulability?
Because they produce thromboplastin like substance
293
What is Trousseau's syndrome?
Migratory superficial thromboplebitis
294
In the coronaries Vasculature who is responsible of dilation of large arteries and Pre arteriolar vessels?
Nitric oxide
295
From whom is adenosine product?
ATP metabolism
296
In the coronary system where does adenosine work?
In the small coronary arteries
297
Which diseases can cause myocardial fibrosis?
Dermatomyocitis, muscular dystrophy, sarcoidosis, and scleroderma
298
Most common causative organism of acute infective endocarditis
Staphylococcus aureus
299
How is the valvular vegetation caused by S. Aureus formed?
Following bacterial binding, tissue factor expression results in platelet and fibrin deposition and the formation of a valvular vegetation
300
Giant cell (temporal) arteritis
Takayasu arteritis
301
Which is the most specific symptom of Giant cell arteritis?
Jaw claudication
302
In Giant cell arteritis what does temporal artery biopsy demonstrates?
Granulomatous inflammation of the media
303
These bacterias are able to adhere to the surface of tooth enameland heat valves
Viridians streptococci: S. Mutans and S. Sanguis
304
What characteristic of streptococcus viridians let adhere to the surface of tooth enamel and heart valves and multiply in those locations?
Due to their ability to produce insoluble extra cellular polysaccharides (dextrans) using sucrose as a substrate
305
Immune response caused by post streptococcal glomeruloneohritis
Type III (immune complex mediated)
306
What is the result of post streptococcus glomerulonephritis?
Inflammation, renal dysfunction, hematuris and nephritic range protein
307
From which the disease is migratory polyarthritis characteristic?
Rheumatic fever
308
Agents that may cause anterior uveitis
Herpes viruses, syphillis, and Lyme disease
| Inflammatory conditions such as the HLA B27 related diseases and sarcoid
309
Most common cause of coronary sinus dilation
Elevated right sided heart pressure secondary to pulmonary artery hypertension
310
Most common cause of fatigue and new onset Cardiac murmur in a young adult
Bacterial endocarditis
311
Which Renal complication may be seen in patients with bacterial endocarditis?
Acute proliferative glomerulonephritis secondary to two collating immune complexes and there is Angelo and/or subepithelial deposition in the glomeruli
312
Tumor associated release of procoagulants responsible for Trombophlebitis
Trosseau syndrome
313
Humoral hypercalcemia of malignancy, The most common cause of hypercalcemia in hospitalized patients
Due to production of a parathyroid hormone like substance by tumors
314
Autoimmune paraneoplastic myasthenic syndrome that affects the presynaptic calcium channels
Lambert Eaton syndrome
315
What is the result of Lambert Eaton syndrome?
Decreased presynaptic acetylcholine release
316
With what is lambert eaton syndrome associated?
With oat cell carcinoma of the ling
317
Laboratory findings for systemic lupus erythematosus
Hemolytic anemia, thrombocytopenia and leukopenia
Hypocomplementemia (c3 & c4)
ANA and Anti dsDNA & anti SM
Proteinuria and elevated creatinine
318
Sensitive antibodies present in systemic lupus erythematosus
ANA
319
Sensitive antibodies present in systemic lupus erythematosus
Anti dsDNA & anti SM
320
Cardiovascular manifestations in SLE
Pericardial effusion, verrucous (Libman- Sacks) endocarditis and increased risk of coronary artery disease
321
In which patients does aortic dissection occurs?
With long-standing hypertension and those with Marfan and Ehlers Danlos syndrome
322
It presents would abrupt onset, Severe, tearing chest pain that radiates to the back
Aortic dissection
323
Distended neck veins, hypotension, Diminished heart sounds and pulsus paradoxus
Cardiac tamponade
324
It presents with dyspnea, Malaise, and findings associated with right ventricular failure
Pulmonary hypertension
325
Most common cardiovascular manifestation associated with SLE
Pericarditis
326
It presents with sharp pleuritic chest pain that is relieved by sitting up and leaning forward
Pericarditis
327
When do we consider that an ischemic injury becomes irreversible for contractility in myocardial infarction?
If it last more than 30 minutes
328
After MI, how long does the myocyte last in order to lose all ATP?
60 seconds
329
In MI, who Maintains vasodilation in coronaries the first 30 minutes?
Adenosine
330
Aschoff bodies
Interstitial myocardial granulomas typically found in acute rheumatic arthritis
331
Plump macrophages with abundant cytoplasm and central , round to ovoid nuclei with central , slender chromatin ribbons are called...
Anitschkow cells (caterpillar cells)
332
Characteristics of diastolic heart failure
Normal left ventricle her ejection fraction
| End diastolic volume with increase left ventricular filling pressure
333
How is left ventricular diastolic pressure determined?
By the blood volume in the left ventricle cavity and compliance of the left ventricle
334
Cause of Diastolic dysfunction
Decreased in ventricular compliance
335
Cause of systolic dysfunction
Decreased in myocardial contractility
336
Characteristics of systolic heart failure
Reduced left ventricular ejection fraction, along with progressive chamber dilation with increased left ventricular volume and elevated left ventricular end diastolic pressure
337
How is Atrial regurgitation best heard?
At the left sternal border, with the patient leaning forward and at end expiration
338
What does jugular venous distention mean?
Elevation or the central venous pressure in the superior vena cava
339
Acute onset central venous pressure elevation with hypotension and tachycardia
Cardiac tamponade
| Pneumothorax
340
Central venous pressure elevation
>15 cm H2O
341
Hypotension, distended neck veins, and distant or muffled hearts sounds on auscultation
Beck triad
342
Beck triad + tachycardia
Cardiac tamponade
343
In congestive heart failure, what does loss of a palpable pulse during inspiration means?
Is most likely due to an inspiratory fall in systolic blood pressure
344
Pulsus paradoxus + acute onset hypotension + tachycardia + JVD=
Cardiac tamponade
345
Characterized by pleuritic chest pain pain and a pericadial friction rub
Acute fibrinous pericarditis
346
The only class 3 antiarrhythmic with beta adrenergic blocking abilities
Sotalol
347
Class III antiarrhythmic
Amiodarone, ibutilide, dofelitide, sotalol
348
Possible side effect of class 3 antiarrhythmics
QT prolongation
349
How do beta blockers decrease heart rate and cardiac contractility?
By slowing AV nodal conduction and the phase 4 depolarization of cardiac pacemaker
350
Clinical use for beta blockers
As myocardium protective agents following myocardial infarction or in congestive heart failure resulting from systolic dysfunction, and as anti hypertensive
351
Slow the phase 0 depolarization of cardiac pacemaker cells and phase 2 of the myocyte action
Calcium channel blockers
352
Which Viral agent cause dilated myocardiopathy?
Coxsackie B
353
Dilation of all four chambers of the heart, systolic dysfunction, and myocardial failure
Dilated cardiomyopathy
354
Situations when thiazide diuretics are not recommended in patients with essential hypertension as a an initial treatment
In patients with CHF and diabetics
355
When are ACE inhibitors the recommended first line of treatment in patients with essential hypertension?
When the patients are diabetics or have CHF
356
Eiocosanoid, arachidonic acid derived substances with paracrine properties
Prostacyclin
357
What is the effect prostacyclin related to platelet aggregation?
Inhibits platelet aggregation and adhesion
| And also vasodilates, increases vascular permeability and stimulates leukocyte chemotaxis
358
Clinical use for prostacyclin
Pulmonary Hypertension, Peripheral vascular disease and Raynaud syndrome
359
It's action is to convert kininogen into bradykinin
Kallikrein
360
Which clothing factors are in inhibited by Protein C?
Va and VIIIa
361
Phosphodiesterase isoenzyme 3 inhibitor
Milrinone
362
Which is the effect of cyclic AMP in the heart?
Increases the conductance of the calcium channel in the sarcoplasmic reticulum, and as a result re calcium can enter the cell and strengthen the force of contraction
363
What is the effect of phosphodiesterase isoenzyme 3 in the heart?
Metabolizes cyclic AMP, so decreases calcium in the heart, with decreased contractility as a result
364
Which is the effect of cAMP in vascular smooth muscle?
Cause vasodilation
365
What is the effect of milrinone?
Increase contractility but induces vasodilation
366
When do we see tubular obstruction with urate Crystals?
During tumor lysis
367
Classic clinical presentation of tubular obstruction with urate Crystals
Acute renal failure during chemotherapy for a malignancy
368
What does cystic dilation of the collecting duct make you suspect of?
Autosomal dominant polycystic kidney disease (ADPKD)
369
Classic presentation of Autosomal dominant polycystic kidney disease (ADPKD)
A patient in his 40s or 50s with a family history of renal disease who presents with flank pain, hematuria and hypertension
370
What should you suspect when you see signs of renal failure and toe gangrene or livedo reticularis following an invasive vascular procedure?
Atheroembolic renal disease
371
Which vessels are affected in polyarteritis nodosa?
Medium to small sized arteries in any organ
372
Segmental, transmural, necrotizing inflammation of medium to small sized arteries in any organ
Polyarteritis nodosa
373
Which arteries are spare in polyarteritis nodosa?
Pulmonary arteries
374
What does persistent lymphedema predisposes to?
Lymphangiosarcoma
375
Typical scenario of lymphangiosarcoma
Approximately 10 years following radical Mastectomy for breast cancer
376
With which pathology are cystic hygromas associated?
Turner syndrome
377
In what do cystic hygromas differ to cavernous hemangiomas?
Only by the absence of luminal blood cells
378
What causes congenital QT prolongation?
Due to decreased outward K+ currents
379
When does dynamic left ventricular outflow obstruction happens?
Hypertrophic obstructive cardiomyopathy
380
Alternative name for Buerger disease
Thromboangitis obliterans
381
Which vessels are mainly affected in thrombangitis obliterans?
Vasculitis of medium and small sized arteries, principally tibial and radial arteries
382
What can thrombosed arteries of Buerger diaseas lead to?
Can often extend into contiguous veins and nerves
383
When is Buerger's disease commonly seen?
In heavy cigarette smokers, with onset before age 35
384
When can onion like concentric thickening of arteriolar walls be seen?
A condition that can result from malignant hypertension
385
How does malignant hypertension defined?
Diastolic pressure >120-130 mmHg
386
From which vasculitis is Granulomatous inflammation of the media characteristic?
Temporal (giant cell) arteritis
387
Most common form of systemic vasculitis in adults
Temporal (giant cell) arteritis
388
Which vessels are mainly affected by Temporal (giant cell) arteritis?
Medium to smaller branches of carotid artery, especially the temporal arteries
389
Transmural inflammation of the arterial wall with fibrinoid necrosis
Characteristic of polyarteritis nodosa
390
Heavy cigarette smoker with onset before age 35 and associated with hypersensitivity reaction to intradermal injection of tobacco extract
Thromboangitis obliterans (Buerger's disease)
391
When myocardial infarction occurs in the setting of normal coronary arteries, what should be suspected?
Hypercoagulability with acute thrombosis, or coronary vasospasm
392
Differential diagnosis for mitral valve thickening with vegetations
Infectious endocarditis, rheumatic valvulitis, Libman Sacks endocarditis
393
Pathologies associated to Libman Sacks endocarditis
SLE, and non bacterial thrombotic endocarditis
394
How does SLE affects coronary arteries?
Via arteritis and/or thrombosis
395
How does SLE produce thrombosis?
Due to hypercoagulable antiphospholipid antibody syndrome, present in 10-30%
396
What does bleeding time indicates?
Platelet function
397
What does aPTT indicate?
Intrinsic coagulation system
398
What does PT indicates?
Extrinsic coagulation pathway
399
What is the result of factor VIII deficiency?
Classic X linked hemophilia A
400
Which factor is deficient in hemophilia C?
Factor XI
401
Autosomal recessive disorder of factor XI deficiency
Hemophilia C
402
Which factor is Hageman factor?
Factor XII
403
Carrier molecule for factor VII and mediator of platelet adhesion to the endothelium
Von Willebrand factor
404
Niacin's main side effect
Cutaneous (flushing, warmth, itching)
405
Who mediates cutaneous effects of Niacin?
Prostaglandins
406
Which drug induces red man syndrome? And who mediates it?
Vancomycin by histamine release
407
Reduces pain by decreasing the level of substance P in the peripheral nervous system
Capsaicin
408
Which drug should be initiated promptly in patients with temporal arteritis?
Prednisone
409
Which lab is altered in patients with temporal arteritis?
Erythrocyte sedimentation rate (ESR)
410
How should patients with granulomatosis with polyangiitis be treated?
With cyclophosphamide and prednisone
411
How should patients with Goodpasture syndrome be treated?
Immediate plasmapheresis, along with immunosuppressive therapy
412
Granulomatosis with polyangiitis syndrome
Wegner's syndrome
413
Most common vasculitis associated with MI
Kawasaki's disease
414
Long extremities , scoliosis, pectus excavatum, ectopia lentis, and Aortic root disease
Marfan syndrome
415
Most common cardiac abnormalities
Mitral valve prolapse
| Cystic medial degeneration of the aorta
416
In Marfan syndrome patients what is the risk of cystic medial degeneration of the aorta?
Aneurysm dilation
417
Which is the most common cause of death in patients with Marfan syndrome?
Aortic dissection
418
Second most common cause of death in Marfan syndrome
Cardiac failure secondary to mitral valve prolapse and/aortic regurgitation
419
Where are beta 1 receptors found?
Cardiac tissue and on renal juxtaglomerular cells
420
Another effect of metoprolol
Blocks catecholamine induced renin release by the kidney
421
Which veins form brachiocephalic vein?
Right subclavian vein and right internal jugular vein
422
What is Ortner syndrome?
Mitral stenosis can cause left atrial dilation sufficient to impinge on the left recurrent laryngeal nerve
423
Which is the only structure of the intrinsic muscles of the larynx that isn't innervated by left recurrent?
Cricothyroid
424
What is the result of paresis of vocal cord muscles innervated by recurrent laryngeal?
Hoarness
425
Cause of left recurrent laryngeal nerve impingement
Left atrial enlargment
426
Most common cause of left ventricle diastolic dysfunction
Hypertensive heart disease due to chronic hypertension
427
From which situations is crescendo decrescendo systolic murmur characteristic of?
Aortic or pulmonic stenosis
428
Chronic inflammatory disease of the axial skeleton characterized by pain and stiffness of the spine, sacroiliitis and increased risk of aortic regurgitation
Ankylosing spondylitis
429
Characteristic sound of mitral regurgitation associated to chordal rupture
Holosystolic decrescendo murmur
430
Medications that cause Drug induced lupus erythematosus
```
Hydralazine
Procainamide
Isoniazid
Minocycline
Quinidine
```
431
In which percentage does procainamide cause drug induced lupus erythematosus?
20%
432
Which antibodies are present in drug induced lupus erythematosus?
ANA and antihistone antibodies in >95% of cases
433
Most notable side effects of amiodarone
Thyroid dysfunction, lung fibrosis, liver toxicity, as well as a blue or grey discoloration of the skin
434
Most frequently encountered adverse effects of nonselective beta blockers
Negative inotropy and bronchoconstriction in patients with asthma or COPD
435
Main side effects of lidocaine
Nonfocal neurologic signs such as tremor, drowsiness, and change in mental status, and can also lead to generalized seizures
436
Which drugs have the highest risk for drug induced lupus erythematosus?
Procainamide and hydralazine
437
Selective vasodilators of coronary vessels
Adenosine and dipyridamole
438
Drugs used in myocardial perfusion imaging studies to stimulate the generalized coronary vasodilation caused by exercise
Adenosine and dipiridamole
439
What is the effect adenosine and dipiridamole in myocardial ischemia due to an obstruction?
Cause coronary steal, may lead to hypoperfusion and potential worsening of existing ischemia
440
Calcific deposits in muscular arteries in people older than 50
Monckeberg's medial calcific sclerosis (medial slerosis)
441
What could be the result of malignant hypertension?
Hyperplastic arteriolosclerosis in renal arterioles
442
Onion like concentric thickening of arteriolar walls in the renal vasculature and elsewhere
Hyperplastic arteriolosclerosis
443
The left heart diastolic volume and stroke volume are reduced, resulting in decreased systemic blood pressure during inspiration, and hence pulsus paradoxus
Conditions that impair expansion into the pericardial space
444
Which pathologies impair expansion into the pericardial space?
Acute cardiac tamponade, constrictive pericarditis, severe obstructive lung disease, and restrictive cardiomyopathy
445
For acute asthma exacerbation treated with beta adrenergic agonist, which type of receptor do they have? What is the effect?
This receptor is a Gs protein coupled receptor that activates adenylyl cyclase and increases intracellular cAMP concentrations
446
This drug mechanism of action is to stabilize mast cells
Cromolyn
447
Which hormones increase the production of cGMP?
Nitric oxide and atrial natriuretic peptide
448
Drug that increases levels of cGMP by inhibiting its degradation
Sildenafil
449
Half life of adenosine
10 seconds
450
Which Is the drug used for chemical stress test?
Adenosine
451
Fever for 5 days, cervical lymph node>1.5 c,, rash, bilateral nonexudative conjunctivitis, mucositis, coronary artery aneurysms,swelling &/or erythema of palms/soles
Kawasaki disease
452
Clinical findings of Kawasaki disease
Fever for 5 days, cervical lymph node>1.5 c,, rash, bilateral nonexudative conjunctivitis, mucositis, coronary artery aneurysms,swelling &/or erythema of palms/soles
453
What is Kawasaki disease?
Vasculitis of Medium sized arteries that affects young children(usually age
454
How is Kawasaki disease diagnosis done?
Fever for more than 5 days plus 4:
1. Bilateral non exudative conjuntivitis
2. Cervical lymphadenopathy
3. Mucositis
4. Extremity changes
5. Rash
455
How is mucositis seen in patients with Kawasaki disease?
Erythema of palatine mucosa, fissured erythematous lips, "strawberry" tongue
456
Characteristics of the rash in Kawasaki disease
Polymorphous (usually urticarial) erythematous rash on the extremities that spreads centripetally to the trunk
457
A serious complication of Kawasaki disease
Coronary artery inflammation leading to development of coronary artery aneurysm
458
What does exertional syncope, harsh systolic murmur and asymmetric septal hypertrophy in a young man suggest?
Hypertrophic cardiomyopathy
459
Most common cause if ventricular fibrillation in individuals below age 30
Hypertrophic cardiomyopathy
460
Episodic and transient angina, chest pain, occurring during the nighttime hours and accompanied by temporal ST segment elevations
Prinzmetal's variant angina
461
When does Prinzmetal angina occur?
Generally occurs at rest
462
Which is the most sensitive provocative diagnostic test for coronary. Vasospasm?
Ergonovine
463
Ergot alkaloid that constricts vascular smooth muscle by stimulating both alpha adrenergic and serotoninergic receptors
Ergotamina
464
Which drug is used to treat Prinzmetal's angina?
Nitroglycerin
465
Used to treat and prevent Prinzmetal's angina
Calcium channel blockers
466
Which is the common evolution of capillary hemangiomas?
First increase in size then regresses
467
When do capillary hemangiomas normally completely regress?
By 7 years old
468
Situations that can lead to concentric left ventricular hypertrophy
Pressure overload: chronic hypertension or aortic stenosis
469
Situations that lead to eccentric ventricular hypertrophy
Volume overload: aortic or mitral regurgitation, myocardial infarction or dilated cardiomyopathy
470
What is deposited in localized amyloidosis confined to the cardiac atria?
Abnormally folded atrial natriuretic peptide derived proteins
471
In which patients is Amylin usually found?
In patients with localized pancreatic amyloidosis
472
Percentage of patients with type 2 diabetes that have Amylin deposits
90%
473
Who is responsible for primary systemic (not localized) amyloidosis?
Deposition of immune globulin light chains, especially delta light chains and fragments
474
When does primary systemic amyloidosis arise?
In association with monoclonal B cell proliferation (eg. Multiple myeloma)
475
Which deposit may be seen in Patients with medullary thyroid cancer?
Calcitonin
476
Which deposit may be seen in Patients with amyloidosis of pituitary gland?
Prolactin
477
Which is the most common cause of intermittent claudication?
Almost always the result of atherosclerosis larger named arteries
478
What does thigh claudication is suggestive for?
Occlusive disease of the ipsilateral external iliac or common femoral arteries and/or both superficial femoral and profunda femoris arteries
479
Seen in about 25% of patients with hypertrophic cardiomyopathy
Left ventricular outflow tract obstruction
480
In patients with hypertrophic cardiomyopathy how is Left ventricular outflow tract obstruction heard?
Harsh crescendo decrescendo systolic ejection type murmur that is best heard along the lower left sternal border and apex
481
On what varies the degree of Left ventricular outflow tract obstruction?
On Left Ventricular end diastolic volume
482
Maneuvers that decrease the preload
Sudden standing, Valsalva or Nitroglycerin administration
483
Maneuvers that increase preload and/or afterload
Squatting, sustained hand grip or passive leg rising
484
Which maneuvers will increase murmur intensity of Left ventricular outflow tract obstruction?
Maneuvers that decrease preload
| Sudden standing, Valsalva or Nitroglycerin administration
485
Which maneuvers will decrease murmur intensity of Left ventricular outflow tract obstruction?
Maneuvers that increase preload and/or afterload
| Squatting, sustained hand grip or passive leg rising
486
Hemodynamic signs for constrictive pericarditis
increased jugular venous pressure
Kussmaul sign
Pulsus paradoxus
Pericardial knock
487
When is a loud P2 heard?
In pulmonary hypertension
