Cardio Flashcards
Which two cardiac anomalies may occur in Turner Syndrome?
Bicuspid aorta
Coarctation of the aorta
Early diastolic murmur?
Aortic Regurgitation
Precursor amino acid for NO?
Arginine
Location of the AV node?
Interatrial septum near the opening of the coronary sinus
What must be present if an infant has transposition of great vessels and also is alive?
PDA- to allow for mixing of the blood
Patients may present as normal but deteriorate within the first 3 days as the ductus arteriosus closes
Which murmur is heard best in the left lateral decubitus position?
S3
Normal below 40, considered abnormal >40
Name the nerves that arise from pharyngeal arches 1-6
1- maxillary (5)
2- facial (7)
3- glossopharyngeal (9)
4- superior laryngeal branch of vagus (10)
5- nothing
6- recurrent laryngeal branch of vagus (10)
Name the arteries that arise from aortic arches 1-6
1- maxillary 2- Stapedial (regresses) 3- Common carotid, proximal internal carotid 4- True aortic arch, subclavian 5- obliterated 6- Pulmonary arteries, ductus arteriosus
Where do aortic dissections occur?
Aortic isthmus (just beyond the 3 branches), by the ligamentum arteriosus
Common drainage for the entire right side of the body?
Brachiocephalic vein
4 abnormalities of tetrology of fallot?
VSD
Overriding aorta of the right and left ventricles
Right ventricular outflow tract obstruction
Right ventricular hypertrophy
Embryologic cause of tetrology of fallot?
Anterior and cephalad deviation of the infundibular septum
What causes a AAA?
Chronic transmural inflammation
What causes a thoracic aortic aneurysm?
Vaso vasorum enteritis from tertiary syphilis
Prominent findings in Osler-Weber-Rendu syndrome?
Congenital telangiectasias to the skin and mucus membranes
Other way to calculate cardiac output?
CO = Rate of O2 consumption/ arteriovenous O2 content difference
Peripheral neuropathy and cardiac findings?
Wet beriberi –> thiamine deficiency
Why does squatting help with tetrology of fallot?
INcreases peripheral vascular resistance and minimizes right to left shunt
Differentiate the role of Ca2+ in contractility in cardiac vs skeletal
Skeletal muscle: L-type calcium channels directly interact with Ryandine receptor
Cardica: Calcium-induced calcium- requires influx of calcium
What is the mutation involved in hereditary pulmonary hypertension?
Inactivating mutation of BMPR2. Patients with this mutation have a predisposition for dysfunctional endothelial and smooth muscle cell proliferation. A second insult is then thought to activate the disease process, resulting in vascular remodeling, elevated pulmonary vascular resistance and progressive pulmonary hypertension
Top for arteries involved in atherosclerosis?
Abdominal aorta > coronary arteries > popliteal > internal carotid
What is a non-cardiac consequence of an enlarged left atrium?
Mass effect on esophagus causing dysphagia
Name the two ways Ca2+ leaves the cardiac cell following contraction
- Na+/Ca2+ exchanger into the sarcolemma
2. SERCA (Ca2+ ATPase pump) into the sarcoplasmic reticulum
Wide, fixed splitting indicates which cardiac defect?
ASD
Which antiarrhythmic drug prolongs QT without causing torsades de pointes?
Amiodarone
Strep Viridin only binds to previously damaged valves. To what does it adhere?
Fibrin-platelet aggregates
What statistical test is used to compare the means of two different groups?
Student T-test
What is the brownish pigment seen in normal aging of the heart?
Lipofuscin
What is the association between smoking and Buerger’s disease?
Hypersensitivity to tobacco –> segmental thrombosing vasculitis that often extends into contiguous veins and nerves, encasing them in fibrous tissue
Describe the murmur detected in atrial stenosis?
systolic crescendo-decrescendo
Which two structures obstruct normal blood outflow in someone with HOCM?
Interventricular septum and the anterior mitral valve leaflet
What is the second messenger system when NE binds to alpha-1 receptors on smooth muscle endothelium?
IP3 and DAG
MOA of fibrates?
The lower triglyceride levels by activating PPRalpha which leads to decreased hepatic VLDL production
Best way to determine mitral stenosis severity?
A2 to opening snap time interval
Where does the saphenous vein drain?
Drains into the femoral vein, within the region of the femoral triangle, a few centimeters inferolateral to the pubic triangle.
What determines the ventricular rate in a fib?
AV node refractory period
What lipid lowering agent cannot be combined with a statin as it significantly increases the risk of rhabdomyolysis
Gemfibrozil
Where is the stenosis that leads retrograde flow of the vertebral artery?
Subclavian, just before the vertebral artery (creates low pressure)
Exposure to carcinogens such as arsenic, thorotrast and polyvinyl chloride leads to which carcinoma?
Liver angiocarcinoma
Angioedema with ACE inhibitors is caused by what?
Accumulation of bradykinin
Clinical signs of cardiac tamponade?
Becks triad: hypotension, JVD, diminished heart sounds Pulsus paradoxus (loss of pulse on inspiration)
Gram positive bacteria that synthesizes dextran from sucrose?
Strep viridans
How does lupus affect the cardiovascular system?
Accelerated atherosclerosis and increased risk of MI
Pericarditis
Leiman-Sacks endocarditis- on BOTH surfaces of the valve
How does lupus affect the kidneys?
Diffuse proliferative glomerulonephritis with “wire-loop” structures on exam
Effects of milrinone?
PDE-3 inhibitor inhibits the breakdown of cAMP –>
Increased inotropy in cardiac muscle
Increased vasodilation in smooth muscle
Main mediator for autoregulation of coronary blood flow?
NO
How might coarctation of the aorta be linked to intracerebral hemorrhage?
Coarctation of the aorta is associated with other cardiac anomalies or with berry aneurysms in the circle of willis
What cell type provides the major proliferative stimuli for the cellular components of an atherosclerotic plaque?
Platelets- they release PDGF promotes the migration of smooth muscle cells from the media to the intima and their subsequent proliferation
Dihydroergotamine is most similar to what drug that I know?
Triptans
Which anti-arrhythmic drugs block the potassium channels most substantially?
Class III- they prolong repolarization and total action potential duration
LVED volume in diastolic heart failure: normal, increased or decreased?
Normal
How does carotid massage affect the afferent firing rate?
Increases firing rate to increase vagal parasympathetic tone
Loss of contractility in cardiac myocytes occurs within what time period of the onset of ischemia?
60 seconds
What is transthyretin in relation to the heart?
TTR is a protein tetramer produced in the liver and acts as a carrier for thyroxine and retinol. Mutations cause it to misfold and deposit as an amyloid protein in the myocardium
How is TPR affected by exercise?
Decreases- vasculature dilates to permit maximal blood flow to the muscles being used
What type of drug is enoxaparin?
LMWH- use for acute DVTs
What is plasma renin activity?
Amount of angiotensin I generated per unit time
How are plasma renin levels affected by ARBs and ACE inhibitors?
Renin is increased
How do beta blockers affected plasma renin levels?
They block sympathetic stimulation
Kussmaul sign is indicative of what cardiac pathology?
Constrictive pericarditis
Name the two prostaglandins that are in balance with one another to regulate platelet aggregation
Prostacyclin I2: inhibits platelet aggregation
Thromboxane A2: promotes platelet aggregation
Where is prostacyclin I2 produced?
Vascular endothelial cells
Damage inhibits the ability to produce prostacyclin I2 and therefore leaves the area susceptible to platelet aggregation and thrombus formation
First branch off of the external iliac?
Inferior epigastric
Normal pressures in the right ventricle?
30/5
Normal pressures in the pulmonary artery?
30/10
Cardiac findings in cardiac carcinoid disease?
endocardial thickening and fibrosis of tricuspid and pulmonary valves
What causes carcinoid heart disease?
Excessive secretion of serotonin from carcinoid tumors (rare neuroendocrine tumors of distal small intestine and proximal colon) stimulates fibroblast growth and fibrogenesis
Only the right side of the heart is usually involved as the MOAs in the lungs degrade excess serotonin
What is the end product of serotonin metabolism?
5-hydroxyindoleacetic acid (5 HIAA)
What is the main determinant of symptom severity of tetralogy of fallot?
Right ventricular outflow tract obstruction
The worse it is, the most deoxygenated blood is delivered to the systemic circulation
Dystrophic calcification of aging aortic valves follow what prior damage?
Cell injury and death occurring in all types of necrosis at normal plasma calcium levels
Blocking what part of the action potential prolongs the QRS duration?
fast Sodium channels
Class 1 anti-arrhythmic drugs do this
What’s the connection between migratory thrombophlebitis and pancreatic cancer?
Hypercoagulability develops because adenocarcinomas produce a thromboplastin-like substance that causes chronic intravascular coagulations that tend to disseminate and migrate
Which drug is used for chemical stress tests
Adenosine
Most common adverse effect of fibrinolytic therapy?
Intracerebral hemorrhage
Other than ACE inhibitors, ARBs, and ABEAM beta blockers, which other drug improves survival in people with heart failure?
Spironolactone
What determines coronary dominance?
The coronary artery that supplies that posterior descending artery
The AV nodal artery is a branch of which artery?
In right-dominant people: the RCA
In left-dominant people: the left circumflex artery
List the order of receptors bound by dopamine as the dose increases
D1 –> B1 –> A1
What causes pulsus parvus et tardus and which cardiac condition is traditionally associated with it?
Slow rising, low amplitude pulse due to diminished stroke volume and prolonged LV ejection time
What is the protein mutated in congenital long QT syndrome?
Potassium channel proteins - leads to decreased outward rectifying K+ current
Why do you avoid nitrites in patients with hypertrophic cardiomyopathy?
left ventricular outflow tract obstruction is INCREASED as the preload decreases. It is therefore important to maintain a high preload in these patients.
What predisposes someone to the development of lymphangiosarcoma?
Persistent lymphedema (with chronic dilation of lymphatic vessels)
Which artery may crush the left renal vein?
The left renal vein can get crushed below the SMA and the abdominal aorta
List the CYP 450 3A4 inducers
Carbamepazine, PHenobarbitol, Phenytoin, Rifampin, Griseofulvan
Between phentolamine and phenoxybenzamine, which is reversible and which is irreversible?
Phentolamine is reversible
Phenoxybenzamine is irreversible
Why is glucagon the drug of choice for beta blocker overdose?
Glucagon acts on G protein-coupled receptors, increasing intracellular cAMP and thus increasing the intracellular Ca2+ concentration
Which two drugs act as selective vasodilators of coronary vessels that cause coronary steal.
Adenosine and dipyridamole
What causes intracellular swelling following ischemic episodes?
Loss of ATP –> loss of ion concentration gradients and increased intracellular Na+ and Ca2+ concentrations
The middle meningeal artery is a branch of which artery?
Maxillary-
Skull fractures –> hematomas
Alternative medication to aspirin?
Clopidogrel
