Cardio Flashcards
What is epinephrine reversal?
Epi + phentolamine (non-selective alpha antag) = epi acts as vasodilator and decreases HR
Which antiarrhythmics prolong QT interval?
Class IA: Quinidine, Procainamide, Disopyramide (Quid Pro Do)
Class III: Amiodarone, Ibutilide, Dofetilide, Sotalol (AIDS)
What characterizes mitral stenosis?
LA pressure > LV pressure towards the end of diastole
What characterizes mitral regurg?
LA pressure > LV pressure towards the end of systole
What is Hypertrophic cardiomyopathy (aka HOCM)?
Assymetric cardiac hypertrophy: characterized by increased ejection fraction and impaired diastolic function
Causes syncope during exercise and may lead to sudden death in young athletes
Whats the equation for net filtration pressure?
(Hc-Hi)-(Oc-Oi)
What is coartation of the aorta?
Constriction of the aorta that decreases perfusion of the kidneys –> activates RAAS system –> increased systolic pressure
What drug do you use to treat Tetralogy of Fallot until surgery can be done?
Alprostadil (prostaglandin E1)
What maintains a PDA? what closes it?
Maintains: Prostaglandin E (like Alprostadil)
Closes: NSAIDs (Indomethacin)
What are 4 effects of chronic HTN on vasculature?
- decreased # of arterioles
- thickened arteriole walls
- increased vascular resistance of end organs
- ischemic/hemorrhagic end organ damage
What are the early side effects of digoxin toxicity?
anorexia, nausea, ecg canges
What are the late side effects of digoxin toxicity?
disorientation, yellow-green halos, cardiac arrhythmias
What is the path of drainage for the ovaries?
Right ovarian –> IVC
Left ovarian –> left renal –> IVC
Same applies to testicles.
What are the hallmarks of coartation of the aorta?
Brachial-femoral delay (HTN in upper extremities, weak pulse in lower)
Collateral arteries erode inferior aspect of ribs
What are the effects of ACEI toxicity?
CATCHH: Cough (brady block) Angiodema Teratogen Creatinine increase HyperK HypoTN
Switch to AngioII block (Losartan)
Anterograde flow through which arteries is responsible for weak lower pulses in coartation of the aorta?
Internal thoracic (mammary) arteries
What is a common side effect of fibrates that activate PPAR-α?
LUQ pain (gallstones)
What is transposition of the great vessels?
Aorta and Pulm are switched = separates systemic and pulm circulations = death unless theres a shunt
Hallmarks of transposition of the great vessels?
Diabetic mother; early cyanosis
What is a concern for using beta-blockers in diabetics?
They block the symps of hypoglycemia with tachycardia
Cocaine-induced inhibition of which receptor causes cardiac arrest?
cocaine is a beta-blocker = unopposed alpha1-agonism
What is the clinical manifestation of VSD?
child* w holosystolic murmur that radiates over the precordium* and a palpable thrill at the left sternal border*
adult = tricuspid regurg
What transmitter/receptor comes into play in the anticipation of exercise (or anxiety)?
Norepinephrine, B1
What is the consequence for severing the glossophrangeal nerve?
Sends the medulla a false signal that theres a decrease in blood pressure –> HTN and tachy
What is a side effect of the repeated blood transfusion needed in Beta-thalasemia?
Fe overload –> hemosiderosis –> restrictive cardiomyopathy
Which beta-blocker is best used in asthmatics?
B1-(cardio)selective like atenolol
How to remember the beta-blockers?
A-M are B1-selective, N-Z are non-selective; C & L block all
(carvedilol & labetalol block a, b1, b2)
How does sepsis lead to pulm edema?
increase microvascular permeability
Which vein is the major accessory pathway for pts with portal HTN?
azygous vein (anterolateral aspect of spine)
What causes Thrombotic thrombocytopenic purpura?
deficiency of ADAMTS 13 (vWF metalloprotease) = platelet aggregates and thrombi
What cardiac structure can be found in the 3rd intercostal space of the left sternal border?
AV node
When does coronary blood flow occur?
diastole
How does nitroglycerin affect a normal person’s cardiac function?
decrease LV-EDV and decrease LV-ESV (bc BOTH arteries and veins are dilated)
What is amourosis fugax and what causes it?
painless transient vision loss from atherosclerotic disease of the carotid (microemboli to ipsi eye)
What is the pathogenesis of atherosclerotic plaques?
fatty streak –> fibrous plaque –> rupture of plaque –> rough surface induces clotting –> thrombotic occlusion of artery –> MI
What causes increased blood flow thru coronary arteries due to aortic stenosis?
Adenosine (vasodilator)
Enlargement of which chamber causes esophageal compression?
Left atrium
What is a paradoxical embolism?
Patent foramen ovale has clots bypass pulm and go into brain (stroke) and other organs
Which beta blocker is contraindicated in angina?
Pindolol bc its a partial agonist and thus does not lower HR enough
What causes varicose veins?
chronically high pressure in the leg veins
Which drugs cause gynecomastia?
Some Drugs Create Awesome Knockers Spironolactone, Digoxin, Cimetidine, Alcohol, Ketoconazole
What causes “double bubble” on xray in infants?
Duodenal atresia bc inadequate migration of neural crest cells
Whats the drug of choice for pts with HOCM?
beta blocker
How do loop diuretic contribute to digoxin toxicity?
They cause hypoK and hypoMg
What is niacin used to treat and what is its biggest side effect?
dyslipidemia; lowers levels of VLDL and raises levels of HDL.
-facial flushing (aspirin helps)
How does anemia affect arterial diameter?
Causes small arteries and arterioles to dilate to allow greater amounts of blood to return to the heart
1 cause of death in men and women?
cardiovascular disease
Where does the thoracic portion of the esophagus get blood supply?
branches of the aorta and the bronchial arteries.
What is the most common cause of renovascular HTN in middle-aged women?
Fibromuscular dysplasia (also has beads on string)
-atherosclerosis in men
What is the classic presentation of Dressler Syndrome (fibrinous pericarditis)?
fever, positional substernal chest pain (prefer upright or lean forward), and friction rub 4-6wks after MI
What are the classic findings of aortic dissection?
- sudden, severe chest pain radiating to the back
- aortic regurg w diastolic murmur
- wide mediastinum on x-ray
What is digoxin MOA?
decreases conduction thru AV node by inhibiting Na-K ATPase (for A-fib w rapid ventricular rate)
What additional finding often accompanies aortic regurg?
widened pulse pressure
What disease is dextrocardia (situs inversus) assoc with?
Kartagener disease (immotile cilia due to a dynein arm defect.)
Associate the change in pressure pulse with disease: increased pulse pressure
arteriosclerosis aortic regurg (dec diastolic)
Associate the change in pressure pulse with disease: decreased pulse pressure
aortic stenosis mitral stenosis (inc diastolic)
Associate the change in pressure pulse with disease: increased diastolic pressure
mitral stenosis
Associate the change in pressure pulse with disease: decreased diastolic pressure
aortic regurg
PDA
What is a cystic hygroma?
Cavernous lymphangioma of the neck; creates the webbed neck in Turner syndrome.
What causes unstable angina?
thrombosis (of coronary artery) with incomplete coronary artery occlusion
What causes angina?
atherosclerosis
The smooth part of the right atrium comes from which embryonic structure?
Sinus venosus
What causes muffled heart sounds?
cardiac Tamponade
What is Beck’s triad for cardiac tamponade?
- hypoTN
- JVD
- muffled heart sounds
What clinical signs strongly suggest pulm embolism?
- sudden hypoemia
- afebrile/bedridden
- but normal BP
What condition causes loss and vacuolization of myocytes with fibrosis in the heart?
chronic stable angina
You have an older pt with a history of MI, what would make you think of CHF?
(new) S3 heart sound
What causes a primum type ASD?
Failure of septum primum to fuse completely w endocardial cushions, leaves a persistent ostium primum
What drug is used to treat pregnant women w chronic HTN?
methyldopa (a2-agonist)
What drug is used to treat HTN and BPH?
Terazosin (a1-antagonist)
What are key side effects of Terazosin?
“first dose” syncope/hypoTN/dizziness
What pharmacotherapy is used to treat methemoglobinemia?
methylene blue
Where do the right and left umbilical arteries arise from?
internal iliac arteries
What happens to the umbilical arteries after birth?
They obliterate and become the medial umbilical ligaments
Which 2 enzyme elevations indicate atypical MI?
AST(w/o ALT increase) and lactate dehydrogenase
Which antihypertensive meds cause lipid abnormalities?
metoprolol and thiazides
Which drug class causes gout by decreasing elimination of uric acid?
Thiazide diuretics
