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STEP 1 > Cardio > Flashcards

Cardio Flashcards

1
Q

rate of possible pacemakers in the heart

A 
SAN = 60-100
AVN = 40-60
His/BB/Purkinje = 25-40
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2
Q

what is Ortner syndrome

-sxs?

A

mitral stenosis causing so much LA dilation that it impinges on recurrent laryngeal nerve

-hoarseness, left vocal cord paresis

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3
Q

IVC is to the ___(side) of abdominal aorta

A

right

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4
Q

causes of nonbacterial thrombotic endocarditis

A

deposition of sterile platelet rich thrombi

valve damage from inflamm cytokines in setting of hypercoagulable state

  • advanced malignancy (esp mucinous adenocarcinoma)
  • SLE
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5
Q

what is most common murmur associated with rheumatic heart disease?
-describe

what other murmurs can be heard?

A

Mitral stenosis most common
OS and mid-diastolic rumbling

also:

  • mitral regurg (blowing holosystolic)
  • aortic valve
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6
Q

describe murmur of mitral stenosis

A

opening snap at beginning of diastole, mid-diastolic rumbling (best over cardiac apex)

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7
Q

describe murmur of mitral regurg

A

blowing holosystolic

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8
Q

HCM inheritance pattern

what are possible gene mutations

A

AD

beta-myosin heavy chain
myosin-binding protein C

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9
Q

mutation in long QT syndrome? what causes long QT?

A

K+ channel mutations

decr in repolarizing K+ current prolongs QT

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10
Q

what is most common cause of death 2-3 days after MI?

A

Ventricular arrythmia (eg vfib)

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11
Q

what is supine hypotension syndrome

A

usu pregnant women >20 weeks

bp drops when lying down b/c gravid uterus compresses the IVC

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12
Q

describe murmur of aortic regurg

A

diastolic decrescendo

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13
Q

describe concept of coronary steal

A

pharm vasodilators (eg adenosine, dupyridamole) that cause coronary arteriolar dilation can cause redistribution of blood flow from ischemic to nonischemic areas of myocardium

b/c arterioles that supply v ischemic myocardium are already max dilated at rest. with pharm vasodilators -> no change in blood flow to ischemic myocardium, but sig incr blood flow to nonischemic myocardium, amplifying the ischemia (makes it easy to detect on myocard perfusion imaging which uses these vasodilators

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14
Q

describe murmur of aortic stenosis

A

crescendo-decrescendo

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15
Q

what is best auscultatory indicator of mitral stenosis severity? why?

A

A2-OS interval

shorter interval = more severe stenosis
in worse MS, higher LA pressure causes the valve to open more forcefully/earlier

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16
Q

Hyperlipidemic agents MOA:

  • fibrates
  • omega 3
  • ezetimibe
  • statins
  • bile binding resins
A
  • fibrates: activate PPARa –> decr hepatic VLDL prod and increased LPL activity
  • omega3: decrease VLDL prod and inhib synthesis of apolipopro B
  • ezetimibe: blocks intestinal cholesterol absorption
  • statins: decrease hepatic cholesterol synthesis by inhibiting HMG CoA reductase
  • bile binding resins: incr fecal loss of cholesterol derivatives by binding bile acids in intestine and disrupting enterohepatic bile acid circulation

PCSK9 inhibitors: monoclonal Ab that reduce LDL receptor degradation in liver

17
Q

what is pulsus paradoxus and explain why it happens in cardiac tamponade

A

normally have <10 drop in SBP with inspiration (decr pressure in pleural space and lung interstitium, increasing pulm vasc capacitance = decr venous inflow to left heart = decr LV SV and drop in SBP)

> = 10mmHg drop in SBP with inspiration

cardiac tamponade -> external compression of ventricles which equalizes LV and RV diastolic pressures -> intraventricular septum bulges into LV as resylt if insp increase in RV filling.

this further reduces LV stroke vol, leading to a drop in systolic BP >100mHG

18
Q

what are two causes of holosystolic murmur

A

MR or VSD

19
Q

what medication should be started on pts w/ stable angina?

what is a good alternative if they’re allergic to it?

A

aspirin! inhibition of COX1 in platelets prevents synthesis of ThromboxaneA2, a potent stimulator of platelet aggreg and vasoconstriction.
-will reduce risk of occlusive thrombus formation and subsequent MI

clopidogrel if allergic to aspirin - irreversibly blocks P2Y12 part of ADP receptors on platelet surface -> prevents platelet aggregation

20
Q

Fenoldopam

  • what is it used for
  • MOA
  • effects
A

selective peripheral Dopamine-1 receptore agonist

given IV for hypertensive emergency (esp in pts with renal insuff ie high Cr)

effects

  • arteriolar dilation
  • incr renal perfusion
  • promotes diuresis and natriuresis
21
Q

phenylephrine

  • what is it used for
  • MOA
  • effects
A

alpha-adrenergic agonist

increases TPR due to arterial vasoconstriction

used in hypotension, shock

22
Q

Adenosine

  • what can it be used for and why
  • adverse effects
A

is a coronary arteriole vasodilator

also an anti-arrythmic.

  • hyperpolarizes the nodal pacemaker, briefly blocking conduction through the AV node.
  • short lived, but briefly blocking conduction from atria to ventricles often terminates reentrant circuit and leads to conversion of PSVT to NSR

adverse effects

  • flushing
  • chest burning (bc bronchospasm)
  • hypotension
  • high grade AV block
23
Q

what is Eisenmenger syndrome

  • cause
  • symptoms
A

initially congenital cardiac defect (eg ASD) causes left to right shunt

over time, pulmonary arteries get hypertrophy so severe that PVR > SVR and instead get right-to-left shunt

  • late onset cyanosis
  • clubbing
  • polycythemia
24
Q

what does Right Coronary Artery supply

A

RV and

inferior wall of LV

25
Q

wide fixed split S2 that does not vary with respiration indicates ?

what happens in this problem?

A

ASD

higher pressure in LA causes Left-to-right shunt of blood into RA. increased RA pressure causes pulmonary HTN

26
Q

In formation of an atherosclerotic plaque, what cells release growth factors that trigger smooth muscle cell recruitment?

A
  • platelets (platelet derived growth factor PDGF)
  • activated macrophages
  • endothelial cells

(T cells release inflamm cytokines, which activate macrophages, SMCs, endothelial cells)

27
Q

risk of severe myopathy highest when statins given concurrently with?

A

fibrates

-impair hepatic clearance of statins

28
Q

two major effects of digoxin

A
  • incr vagal tone (slows rate - slows conduction thru AV node)
  • inhibit Na-K-ATPase, increasing intracellular Na and Ca2+ (incr contractility), more extracellular K
29
Q

AV block can be a side effect of what 3 medications?

A

digoxin
beta blockers
CCBs

(they slow AVN conduction)

30
Q

infective endocarditis most commonly causes what valvular condition?

A

tricuspid regurgitation

31
Q

difference between dihydropyridines and nondihydropyridines?

A

dihydropyridines- affect arterial smooth muscle causing vasodilation (little/no effect on heart)

nondihydropyridines- slow HR and reduce contractility

32
Q

milrinone MOA

A

PDE3 inhibitor

can be used as inotropic agent in refractory HF due to LV systolic dysfunction

decreases rate of degradation of cAMP in cardiac tissues
increased cAMP = promotes Ca2+ influx into cardiac myocytes = incr myocardial contractility

also inhibits PDE3 in vascular smooth muscles, so can causes systemic arterial and venous dilation leading to decr BP. can’t use in pts with severe hpotension

33
Q

symptoms of digoxin toxicity

A

life-threatening arrythmias

GI

fatigue, confusion, weakness
*color vision alterations (esp yellow tinting)

34
Q

where is digoxin cleared

A

renally

35
Q

what is normal

  • PR interval
  • QRS duration?
A

PR <200 ms

QRS <120ms

36
Q

what is most common primary cardiac neoplasm

  • where do most originate
  • what does it look like on histo
A

myxoma

80% originate in LA
(sxs can mimic mitral valve stenosis)
can hear mid-diastolic murmr (tumor p;op) heard in early diastole from motion of tumor mass obstructing mitral valve orifice

amorphous extracellular matrix with scattered stellate or globular myxoma cells within abundant mucopolysaccharide ground substance

37
Q

side effects of CCBs

-why?

A

peripheral edema
dizziness

CCB preferentially dilate precapillary vessels (ie arteriolar dilation) -> incr capillary hydrostatic pressure and fluid extravasation into interstitium

38
Q

young patients who get HF after a viral prodrome -> suspect what?

A

viral myocarditis (is a common cause o f dilated cardiomyopathy)

STEP 1 (12 decks)

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