Cardio Flashcards
Atherosclerosis is mainly caused by
endothelial cell dysfunction
Treatment of Prinzmetal angina
Calcium channel Blocker and nitrates
In myocardial infarction what do you observe in the 0-24hrs
- Early coagulative necrosis
- Edema and wavy fibers
- NEUTROPHILS appear
What is the mechanism of the short acting nitroprusside
Balance venous and arterial vasodilators; decreases left ventricular preload and After load
Best heard at the left 3rd and 4th intercostal spaces. Murmur is usually loud and accompanied by thrill
Ventricular Septal Defect
Endocarditis in (IVDU) intravenous drug users is caused by
Staphylococcus Aureus
The x descent is reduced or absent on the JVP (jugular venous pulse) graph in what conditions?
- Tricuspid Regurgitation
- Right side HF
(d/t reduced pressure gradients)
Which cardiac medication for AFib can cause Torsades de Pointes
SOTALOL, amiodarone, dofetilide (Class III antiarrhythmics)
Loss of sensation over right suprapubic area. Which nerve is most likely injured
IIiohypogastric nerve
CYP450 inducers
Carbamazapine, Phenobarbital, Phenytoin, Rifampin, Griseofulvin, Chronic Alcoholic use, Grapefruit Juice
Which antibiotic is most appropriate for treating lung abscess in alcoholoics
Clindamycin
Concurrent use of which medication with STATINS is associated with increased risk of MYOPATHY and RHABDOMYOLYSIS (muscle pain, dark urine)
Erythromycin (CYP 450 inhibitor)
Prominent Y descent on JVP (jugular venous pulse) graph is indicative of what condition?
Constrictive Pericarditis
Acetylcholine dilates epicardial coronary vessels by acting on
Arginine
Which medication is used to to reduce heart rate, cardiac output and myocardial oxygen demand
Cardio-selective Beta Blockers
Metoprolol, atenolol, bisoprolol, nebivolol
Atherosclerosis mainly affect
Abdominal aorta > coronary artery > popliteal artery > carotid artery
What is dextrocardia?
Heart on right side
Medication for Focal seizures, Depressive episodes and adverse effect of Steven -Johnson syndrome
Lamotrigne
Endomyocardial fibrosis with prominent eosinophilic infiltrate
Loffler syndrome
Thrombosis with incomplete coronary artery occlusion with T-wave inversion on ECG but no cardiac biomarker elevation
Unstable Angina
In hypovolemic shock what parameters are observed
Decrease PCWP (preload), Decrease Cardiac Output (CO) and Increased Systemic Vascular Resistance (SVR)
The most common cardiac anomalies with down syndrome are
Atrial Septal Defect and Ventricular Septal Defect
Which medication is most useful in treating Acute seizure disorder and Bipolar disorder
Valproate Acid
A thrombus of a LEFT DOMINANT circulation obstructs
Left Circumflex Artery
Heavy smoker male of <40 years old. Intermittent claudication leading to gangrene. Autoamputation of digits, superficial nodular phlebitis
Buerger disease (Thromboangiitis obliterans)
Diastolic murmur heard at the apex of the heart (mitral area) is associated with what? (Diastolic crescendo murmur)
Mitral Stenosis
What are the 2 types of holosystolic murmurs heard at the tricuspid area?
- Tricuspid Regurge
2. VSD
Exertional chest pain with ST depression on ECG resolved with rest or nitroglycerin
Stable Angina
What dz is associated with Paradoxical Splitting?
Aortic Stenosis
Left Bundle Branch Block
Failure of the aorticopulmonary septum to spiral causes
D-transposition of great vessels
Increased sensitivity to loud noise (hyperacusis) is most likely associated to injury to which nerve
Facial Nerve (stapedius nerve)
Endocardial thickening with dense fibrous thickening around the tricuspid and pulmonary valve
Carcinoid Syndrome
Hemorrhage, dehydration, burns, cold and clammy skin
Hypovolemic shock
Systolic murmur heard at the apex of the heart (mitral area) is associated with what?
Mitral Valve Prolapse
Treatment for Dilated cardiomyopathy
Na restriction ACE inhibitors Beta Blockers Diuretics Digoxin
What causes Patent Foramen Ovale?
Failure of Septum Primum and Septum Secundum to fuse at birth
Where is an S4 heart sound best heard?
At apex w/ pt in left lateral decubitus position
considered abnormal regardless of age
What parameters is most likely to decrease during peak stress compared to resting state
Total systemic vascular resistance
Rheumatic heart disease can lead to development of
Mitral Stenosis/Mitral Regurgitation
Electrical conduction in the heart flow
AV node–ventricular muscle–atrial muscle–purkinje system
What are the lab findings in Takayasu arteritis
- Granulomatous thickening and narrowing of aortic
arch and proximal great vessels - Increased ESR
What is Wide S2 Splitting?
Splitting varies on inspiration and expiration
- Double sound on expiration
- Double sound is accentuated on inspiration
Heavy smoker male of <40 years old. Intermittent claudication. Autoamputation of digits, superficial nodular phlebitis
Buerger disease (Thromboangiitis obliterans)
What causes wide splitting?
Conditions that delay the RV emptying –> delayed pulmonic sound on inspiration
Mitral Valve Prolapse is a common CONNECTIVE TISSUE disorder in conditions such as
Marfan and Ehlers Danlos Syndrome
An exposure to asbestos increase risk of
Bronchogenic Carcinoma
Medication for Maniac episode, depression and maintenance associated with Ebstein anomaly
Lithium
What is fixed S2 splitting?
wide and fixed
Splitting does not vary on inspiration and expiration
The splitting sound is equidistant on both expiration and inspiration
(GREATLY Delayed pulmonic closure)
MPO-ANCA/p-ANCA, Increase IgE level
Eosinophilic granulomatosis with polyangiitis (Churg-Strauss)
Which valve is the most commonly involved valve in bacterial endocarditis
Mitral valve
Most common site for thromboembolism in AFib
Left Atrial Appendage
What mechanisms are associated with S4 heart sound?
- High atrial pressure —> ventricular noncompliance
Left atrium pushes against stiff LV wall
Carotid artery is derived from which arch
THIRD aortic arch
Interruption of which central nervous pathway leads to BILATERAL MILKY NIPPLE DISCHARGE (galactorrhea), AMENORRHEA (absences of menses)
Tuberoinfundibular pathway
Treatment for Unstable Angina/NSTEMI
- Anticoagulation (Heparin)
- Anti-platelet (Aspirin)
- Beta blockers
- ACE
- Statins
Scarlet Fever can predispose to
Rheumatic Fever and Glomerulonephritis
Stab wound directed laterally at the anterior chest wall in the fifth intercostal space along mid clavicular line will affect
Left Lung
What are the symptoms of pericarditis?
- Pleuritic pain
- Pain on inspiration
- Friction Rub
- Relieved when lean forward
What structure lies at the L1/L2 level to prevent propagation of DVT
Inferior Vena Cava
Mid-diastolic, low pitched, rumbling murmur that may begin with an opening snap
Mitral Stenosis
Necrotizing vasculitis involving LUNG, KIDNEYS and SKIN with pauci-immune glomerulonephritis and palpable purpura. No granuloma
Microscopic polyangiitis
What is Patent Ductus Ateriosus (PDA) derived from
SIXTH Aortic Arch
Which medication used to treat MAJOR DEPRESSIVE DISORDER has NO sexual side effects
Bupropion
Dilated cardiomyopathy is associated with which conditions
- Alcohol Abuse
- Wet Beriberi
- Coxsackie B viral myocarditis
- Chronic cocaine use
- Chagas disease
- Doxorubicin
Friedreich ataxia is associated with which cardiac condition
Hypertrophic cardiomyopathy
Turner syndrome is associated with congenital anomalies of the aorta and the most common is
Bicuspid Aortic Valve
followed by Coarctation of Aorta
Cardiac Tamponade can present with
Beck Triad. (Hypotension, distended neck veins, distant heart sound)
Lack of aorticopulmonary septum formation leads to
Persistent Truncus Arteriosus
HBsAg with elevated ALT and AST is indicative of
Complete Resolution
Tearing sudden onset of chest pain radiating to the back (+/- unequal BP in arms). CXR show mediastinal widening.
Aortic Dissection
What Rx causes ebstin anomally in utero?
Lithium
Holo-systolic murmur best heard at the left 2nd and 3rd intercostal space. Increase with inspiration
Tricuspid Regurgitation
Fixed Splitting of the second heart sound
Atrial Septal Defect
Oxygen consumption in various organ measured will show the most difference between
Aorta and Coronary Sinus
3-14 days of myocardial infarction what is seen
- Macrophages
2. Granulations
Examples of Non-cardio selective Beta blockers
Nadolol, propranolol
In chronic kidney disease the conversion of which apart of the vitamin D synthesis is impaired
25-hydroxyvitamin D—> 1, 25-dihydroxyvitamin D
Posteromedial papillary muscle is supplied by which artery
Posterior Descending Artery
Aortic stenosis can lead to…?
SAD
- Syncope
- Angina
- Dyspnea
- Decreased perfusion (systemic)
Migratory polyarthritis, carditis, Nodules in skin, Erythema marginatum and Sydenham chorea
Rheumatic Fever
What causes delay in RV emptying?
Pulmonic stenosis
Right Bundle Branch Block
Asthma, sinusitis, skin nodules or purpura, peripheral neuropathy (eg. wrist/foot drop). Increase IgE level and p-ANCA
Churg - Strauss ( Eosinophilic granulomatosis with polyangiitis
Flu-like symptoms and joint pain associated with Giant cell arteritis is
Polymyalgia rheumatica
A lesion of which anatomical structure will affect adduction of the eye and stimulation of left cornea to elicit corneal reflex
Superior Orbital fissure
Late lesion in rheumatic heart disease causes
Mitral Stenosis
What artery supplies the atrioventricular node in left Dominant circulation
Left Circumflex Artery
What are the abnormalities associated with S4 heart sound?
Hypertrophy
Cyanosis of the toes and clubbing but no finger abnormalities. Equal and full extremity pulses. Diagnosis
Patent Ductus Arteriosus
What is the result of an enlarged Left atrium
Compression of the Recurrent Laryngeal nerve and Esophagus
Infective endocarditis affects mostly
Mitral valve
Earliest site of electrical activation in the heart
Right atrium near opening of superior vena cava
Which cerebral artery is most likely compromised in a patient with contralateral HOMONYMOUS HEMIANOPIA with macular sparing
Posterior Cerebral Artery
In a LINEAR skull fracture a branch of which arteries is severed
Maxillary
Inhibitors of metalloprotease (neprilysin) prevent degradation of
Natriuretic Peptide
S4 heart sound, Syncope during exercise and may lead to death in an young athlete is
Hypertrophic cardiomyopathy
Between Systemic and pulmonary circulation during exercise what parameters is similar
Blood Flow per minute
Strong pulse along Inner side of STERNOCLADIOMASTOID MUSCLE originates from
Carotid artery
Presentation of Kawasaki disease
Conjunctival injection, Rash ( polymorphous —> desquamating), Adenopathy (cervical), Strawberry tongue (oral mucositis) and Fever (CRASH and Burn)
What is hibernating heart?
Myocytes of ischemic area de rease their contractile ability and O2 demand but once revascularized will function normally again
What does splitting refer to?
It referes to the S2 heart sound
Heart failure, S3 heart sound, systolic regurgitant murmur, dilated heart on echocardiogram and ballon appearance of heart on CRX
Dilated cardiomyopathy
Presentation in Granulomatosis with polyangiitis
- Upper Respiratory tract-: perforation of nasal septum,
chronic sinusitis, otitis media, mastoiditis - Lower Respiratory: hemoptysis, cough, dyspnea
- Renal : hematuria, red cell cast
What are some CYP450 inhibitors
Cimetidine, Ciprofloxacin, Erythromycin, Grapefruit juice, Isoniazid, Retonavir (protease inhibitor)
Occluding thrombus overlying a ruptured atherosclerotic plaque in a 30 year female. Butterfly erythema
Systemic Lupus Erythematous
Audible heart sound at left sternal boarder that accentuate with hand grip excercise
Ventricular Septal Defect (VSD)
What is the mechanism of defect in Kartagener syndrome?
Defect in microtubular protein (Rt –> Lft Dynein)
What are the findings in Chronic Granulomatous with polyangiitis
Triad: 1. Focal necrotizing vasculitis
2. Necrotizing granulomatous in the lung and
upper airway
3. Necrotizing glomerulonephritis
PR3-ANCA/c-ANCA
Parameters involved in Distributive shock
Decrease Preload (PCWP), Increase Cardiac Output and Decrease After-load (SVR)
In what dz is the organs in an adult seen in reverse position?
Kartagener Syndrome
Which organ lays POSTERIORLY to the esophagus and left atrium
Descending Aorta
on the JVP (jugular venous pulse) graph, an absent a wave is indicative of what condition?
A-fib
What is a pulmonary artery Catheter used to measure
Left Atrial Pressure
Etanercept is added to methotrexate to treat
Rheumatoid Arthritis
What complications is associated with the 3-14days of an MI
Free wall rupture—–> tamponade; papillary muscle rupture—-> mitral regurgitation
A patient with Marfan syndrome is at an increased risk of which cardiac condition
Aortic Dissection
What dz are associated Fixed Splitting?
ASD
Lft –> Rt shunt –> inc. RA and RV volumes
Giant cell arteritis most commonly affects
Carotid artery
Protein responsible for rapid decrease in cytoplasmic calcium immediately preceding relaxation
Na / Ca exchange
Which pathway regulates coordination of voluntary movements
Nigrostriatal pathway
Treatment for Kawasaki disease
Aspirin and IV immunoglobulin
What is the most anterior portion of the heart?
Right Ventricle
Decrease in amplitude of systolic BP by >10mm Hg during inspiration
Pulsus paradoxus
Increase in preload stretches the myocardium causing an
End Diastolic Sarcomere Length
Which organ is least vulnerable to infarction when blood flow is interrupted
Liver
Bacterial endocarditis with small vegetation on CONGENITALLY ABNORMAL or DISEASED VALVES. Has gradual onset
SUBACUTE— STAPH Viridans
Treatment for Hypertrophic cardiomyopathy
Beta Blockers
or Non dihydropyridine Ca2+ (verapamil and diltazim)
Which cardiac chamber is first encountered when a probe is placed in a mid-esophagus anteriorly
Left Atrium
Ischemia of the INFERIOR surface of the heart; which coronary artery is occluded
Posterior descending artery; a branch of the RIGHT coronary artery
What complications is associated with the 1st -24hrs of an MI
Ventricular arrhythmia, heart failure and cardiogenic shock
Fever, new murmur, Roth spot (white spots on retina surrounded by hemorrhage), Osler node (tender raised lesions on finger or toe pads due to immune complex deposition) and Janeway lesions (small, painless erythematous lesions on palm and or sole)
Bacterial endocarditis
Mid-systolic click often accompanied by late systolic murmur
Mitral Valve Prolapse
2 weeks after Myocardial infarction light microscopy will show
- Contracted scar complete
A stub wound to the chest in the 4th intercostal space near the left sternal boarder injures
Right ventricle
How many types of S2 splitting (heart sounds) exists?
There are four S2 heart sounds:
- Normal splitting
- Wide splitting
- Fixed Splitting
- Paradoxical Splitting
Bacterial endocarditis in IV drug users involves which valve
Tricuspid valve
What is fixed S2 splitting?
Splitting does not vary on inspiration and expiration
1.
What artery supplies the Lower anterior abdominal wall as it runs superiorly and medially
Inferior Epigastric Artery
Opening-snap of mitral valve heard throughout diastole
Mitral Stenosis
Pt presents with dyspnea on exertion and angina. Physical examination reveals heart sound that is loudest at the heart base and radiates to the carotids and pulses that are weak with delayed peak. What is the diagnosis?
Aortic Stenosis
Carotid sinus massage works by
Prolong atrioventricular node refractory Period
What is Paradoxical S2 Splitting?
Pulmonic valves close before the Aortic valves
Double wide splitting sound heard on expiration
Single sound heard on Inspiration
Displacement of tricuspid valve leaflets downward into Right ventricle. Associated with tricuspid regurgitation and right heart failure
Ebstein anomaly
What is the best protein marker for re-infarction following acute MI
CK-MB
Palpable purpura on buttocks/legs, arthragias and abdominal pain associated with IgA nephropathy
Henoch-Schonlein purpura
Blanching skin lesion (telangiectasis), recurrent epistaxis, skin discoloration, arteriovenous malformation,, GI bleeding, hematuria
Hereditary Hemorrhagic telengeictasia
Absence of Tricuspid valve requires both ASD and VSD for viability
Tricuspid Atresia
What are some complications of Giant cell arteritis
Irreversible blindness due to ophthalmic artery occlusion
PALPABLE PULSATILE abdominal mass. Calcified aortic wall with partial crescent-shaped non-opacification of aorta due flap/clot
Abdominal Aortic Aneurysm
An EARLY DIASTOLIC MURMUR that is best heard along the left sternal boarder or over the right second intercostal space
Aortic Regurgitation
A mid-systolic murmur that starts after S1 and ends before S2 and heard best at the 2nd interspace
Aortic Stenosis
What are the 2 types of diastolic murmurs heard at the tricuspid area?
- Tricuspid stenosis
2. ASD
Early lesion in Rheumatic heart disease causes
Mitral regurgitaion
Holo-systolic murmur at the Left Lower Sternal Border
Ventricular Septal Defect
An intimal tear in Stanford type A aortic dissection (involving the ascending aorta) usually originates in the
Sinotubular junction
A crescendo- decrescendo murmur
Aortic Stenosis
Holocystolic (high pitched, blowing) murmur heard at the apex of the heart (mitral area) is associated with what?
Mitral Regurge
Tricuspid Regurge
What is Normal S2 Splitting?
Single sound on expiration
Double sound on inspiration (Inspiratory split)
Intravenous fluid increase leads to
Increase in Preload
Where is the placement of a pacemaker (radio frequency)
Inter-atrial Septum near the Opening of the coronary sinus
What does splitting refer to?
It refers to the different types of S2 heart sounds
Kawasaki disease (mucocutaneous lymph node syndrome) is found i which group of people
Asian children < 4years
Agatroban is a direct thrombin inhibitor which is used to treat HEPARIN-INDUCED THROMBOCYTOPENIA
Binds to thrombin active site
Elderly female older than 50 years with Unilateral headache, jaw claudication. Labs show focal granulomatous inflammation with increased ESR
Giant Cell (temporal) arteritis
Lab/pathological findings
Segmental thrombosing vasculitis
What is a feature of tricuspid valve regurgitation?
Loudest at tricuspid area ( 4th and 5th intercostal space)
What is the path of an embolus to the retina
Internal Carotid—ophthalmic artery—Retinal artery
Which medication has the following action increasing peripheral resistance, increase systolic blood pressure, decrease pulse pressure and decrease heart rate
Phenylephrine (alpha-1 adrenergic receptor agonist)
Adverse effect of ACE inhibitor (eg. enalapril) in patients with renal artery stenosis, decompensated heart failure, chronics kidney disease and volume depletion
Increase serum creatinine—> Reduction in renal filtration fraction
Embryological Structure that gives rise to the Superior Vena Cava
Common Cardinal Vein
Two hormones released by atria and ventricle during myocardial wall stretch
Atrial natriuretic peptide (ANP) and Brain natriuretic peptide (BNP)
Holosystolic murmur best heard at Apex and radiates to Axilla
Mitral Regurgitation
Location of Great Saphenous Vein
Inferior-lateral to the Pubic Tubercle
What are the causes of MR?
- Ischemic Heart dz (post MI)
- MVP
- LV dilatation
What medication is contraindicated in HYPERTROPHIC CARDIOMYOPATHY
Iso-sorbide Dinitrate
Left atrial enlargement can cause
Dysphagia, compression of left recurrent laryngeal nerve—-hoarseness
A form of arteriosclerosis caused by build up of cholesterol plaques
Atherosclerosis
Primary cause of death in lightening (thunderstorm) related death
Cardiac Arrhythmias
What is the most posterior portion of the heart?
Left atrium
Acute thrombosis due to rupture of coronary artery atherosclerotic plaque
Myocardial Infarction
Sharp pain, aggravated by inspiration and relieved by sitting up and leaning forward. Present with friction rub. ECG changes include widespread ST-segment elevation and /or PR depression
Acute pericarditis
What is measured to make diagnosis of carcinoid syndrome
Urinary 5-Hydroxyindolectic Acid (5-HIAA)
An symmetric inter ventricular septal hypertrophy that presents with a harsh systolic murmur can best be explained by left ventricular outflow obstruction created by
Mitral Valve leaflet and inter-ventricular Septum
The junction of frontal, parietal, sphenoid and temporal bones
Pterion
In Prospective studies, disproportionate loss to follow-up between the exposed and unexposed creates
Attrition Bias ( a form of selection Bias)
What complications is associated with the 1-3day of an MI
Post-infarction fibrinous pericarditis
Where is the femoral vein in relation to the femoral artery
Medial to Femoral Artery
What is hibernating heart indicative of?
Chronic ischemia
What are the three important shunts in fetal circulation?
- Foramen Ovale
- Ductus Ateriosus
- Ductus Venosus
What is diagnostic for Myocardial Infarction
Increase CK-MB and Troponin
Holosystolic (high pitched, blowing) murmur heard at the apex of the heart (mitral area) is associated with what?
Mitral Regurge
Tricuspid Regurge
Fever, pharyngitis, sandpaper-like rash and strawberry tongue
Scarlet Fever
An intimal tear (FLAP) in Stanford type B (aortic dissection involving descending aorta) usually starts near the origin of the
Left subclavian artery
What are the two types of VSD and which is more common?
Membraneous»_space;> Muscular
Aortic stenosis can lead to…?
SAD
- Syncope
- Angina
- Dyspnea
The y descent is absent on the JVP (jugular venous pulse) graph in what condition?
Cardiac Tamponade
Infective endocarditis is mostly caused by
Staphylococcus Aureus
Etanercept is best characterized as
Soluble receptor decoy protein
Which pathway regulates cognition and behavior
Mesolimbic and mesocortical pathway
ANP and BNP release promote
Glomerular Filtration rate
Occurs at rest, Coronary artery spasm with transient ST elevation on ECG
(Variant) Prinzmetal Angina
Bounding peripheral pulses and palpable thrills over the left upper sternal border
Patent Ductus Ateriosus
Diaphoresis, nausea,, vomiting, severe retrosternal pain, pain in left arm and/or jaw, shortness of breath fatigue
Myocardial Infarction
What is a feature of mitral valve regurgitation?
Loudest at apex and radiates towards axilla
What are the laboratory finding in Rheumatic heart disease
- Aschoff bodies (granuloma with giant cells)
- Anitschkow cells (enlarged microphages with ovoid,
wavy rod-like nucleus) - Increase ANTI-STREPTOLYSIN O titers.
Lab findings id Microscopic polyangiitis
MPO-ANCA/p-ANCA (Anti-microperoxidase)
1-3 days during an episode of Myocardial infarction
- Extensive coagulative necrosis
2. Acute inflammation with neutrophils
What is the cause of valvular stenosis?
Calcification of the valves
Normal in the aged
Can have early onset calcification in younger pts.
Mid-systolic click followed by short late systolic murmur that radiates to apex and disappears with squatting is related to abnormality in
Connective tissue
Mitral prolapse