Cardio Flashcards
Streptocuccus Bovis endocarditis
Associated with colon cancer. Causes subacute bacterial endocarditis. Occurs in patient with NO preexisting valvular abnormality.
Holosystolic murmur at the apex that radiates to the axilla. What is the best indicator of severity of the problem?
Presence of S3: indicates high volume of regurgitant flow (mitral regurgitation)
pt dies in motor accident n biopsy shows heavy calcification of the ortic valve. What most likely preceded this?
Cell necrosis
Stages of Dystrophic calcificaiton
Initiation: within the mitochondria of dying cells and Propagation: can perforate the membrane.
Pt with tetralogy of Fallot squats to relieve cyanosis. The posture helps to?
Increase systemic vascular resistance
A drug dilates arterioles and veins and promotes diuresis. What is its endogenous analog?
Brain natriuretic peptide/atrial natriuretic peptide
A drug that dilates arterioles and veins and promotes diuresis
Nesiritide.
MOA of Atrial natriuretic peptide
activate guanylate cyclase which increases intracellular cyclic GMP causing vasodilation and diuresis.
In systolic heart failure which is increased blood volume within the heart causing stretch of atria and ventricles, which hormones are released?
Atrial natriuretic peptide and brain (ventricular) natriuretic peptide
Risk factor for infective endocarditis
Prosthetic heart valves, prior valvular inflammation and scarring
Pathogenesis of vegetations caused by S.Aureus
S.aureus can bind to normal valves due to expression of multiple surface adhesins. Then tissue factor expression results in platelet and fibrin deposition and formation of vegetation. It can then embolize and cause sepsis.
S.Aureus vegetations in endocarditis have?
Fibrin and platelets deposition.
Mitras stenosis Murmur
opening snap early in diastole due to tensing of the leaflets after they have already opened.
Stable angina
chest pain with exertion, relieved by rest or nitroglycerin
Stable angina pathophysiology
Fixed atheromatous obstruction of coronary occluding at least 75% of the luminal cross sectional area.
Unstable angina pathophysiology
Ulcerated atherosclerotic plaque with a partially obstructive thrombus.
Drug that can cause Prinzmetal’s angina
Ergonovine
MOA of ergonovine
ergot alkaloid that constricts vascular smooth muscle by stimulating both alpha-adrenergic and serotonergic receptors. Can induce coronary spams
Pathophys of Prinzmetal’s angina (variant)
Caused by coronary artery vasospam that may occur near sites of atherosclerosis and can result in transient transmural ischemia with ST-segment Elevation
Prinzmetal’s angina
episodic angina that occurs at REST due to coronary vasospasm.
Mitral regurgitation
Blowing, holosystolic murmur heard best over the apex with radiation to the axilla.
Valve most affected by rheumatic heart disease
MITRAL, acute: regurgitaiton and chronic:stenosis
Congenital malformation that is normal in some adults
Foramen ovale: abnormalities increasing the right atrial pressure can produce a right to left shunt across the patent foramen ovale.
Rheumatic fever criteria
JONES, Joint, O is heart, Nodules, Erythema marginatum, Sydenham chorea
Theumatic fever
autoimmune reaction that occur following untreated Streptococcus pyogenes pharyngitis due to molecular mimicry.
Organism that causes subacute bacterial endocarditis
Viridians streptococci: colonizes valves with preexisting defects after dental manipulation
Bacteria that causes dental caries
Viridians streptococci (mutans)
gram-positive cocci in blood of patient with bactermia able to synthezise dextrans from glucose
Viridians streptococci
Aortic stenosis murmur
systolic crescendo-decrescendo following an ejection click
Kaussmaul’s sign
paradoxical rise in the height of the jugular venous pressure during inspiration
dense, thick fibrous tissue in the pericardial space between the visceral and parietal pericardium.
Constrictive pericarditis
Findings on constrictive pericarditis
Restricted ventricular filling, low cardiac output and right-sided heart failure resistant to medications
bilateral basilar lung crackels, left ventricular hypertrophy. Pulmonary arterial hypertension. The most likely mechanism for this pt pulmonary HTN?
Reactive vasoconstriction due to venous congestion
Most common cause of Right sided heart failure
Left sided heart failure
most common cause of left sided heart failure
Chronic hypertension
What does left ventricular dysfunction lead to?
Increased pulmonary arterial pressure due to reactive vasoconstriction secondary to pulmonary venous congestion
Fibromuscular dysplasia
irregular thickenning of large and medium sized arteries especially the renal artery, disease affecting women 20-30 years old
Renal artery stenosis treatment
be careful with ACE inhibitors because Angiotensin II is necessary to keep a GFR.
Gross finding in Renal artery stenosis
one sided kidney atrophy
which population does renal artery stenosis affect
elderly individuals due to atherosclerothic changes in intima and women in chilbearing age (fibromuscular dysplasia)
cherry hemangioma
affects adults, do not regress spontaneously yet number increase.
histology of cherry hemangioma
sharply circumscribed areas of congested capillaries and post-capillary venules in the papillary dermis
small red cutaneous papules common n aging adults that do not regress spontaneously
cherry hemangiomas
abnormal prominent left atrial v wave present in which murmur?
mitral regurgitation
Adult onset asthma and eosinophilia. P-ACNA
Churg-Strauss syndrome
fixed wide splitting of the second heart sound
ASD
complication of ASD
chronic pulmonary hypertension as a result of the left-to-right shunt. Aka increased blood flow through the pulmonary artery
Eisenmenger syndrome
late-onset reversal of a left-to-right shunt due to pulmonary vascular sclerosis resulting from pulmonary hypertension.
extreme myofiber disarray with interstitial fibrosis on cardiac histology
hypertrophic cardiomyopathy
mutation in genes coding for sarcomere proteins, Beta-myosin heavy chain
Hypertrophic cardiomyopathy
pt with extended consumption of appetite supressant, progressive dyspnea and dizzines on exertion. What pathologic findings would you have?
Right ventricular hypertrophy
side effects of appetite supressants
secondary pulmonary hypertension, leading to right ventricular hypertrophy and cor pulmonale
appetite supressant
Fenfluramine, Dexfenfluramine and phentermine
familial hypercholesterolemia
autosomal dominant mutation of the LDL receptor gene in the liver. Causes fast progression of atherosclerosis and early coronary artery disease
Only Right heart fibrosis. Which substance will appear high in urine?
5 hydroxyindoleacetic acid (serotonin metabolite)
skin flushing, abdominal cramping, nausea, vomit, diarhea and endocardial fibrosis of right heart
Carcinoid syndrome
What is abnormaly produced by carcinoid tumors?
serotonin, kallikrein, bradykinin, histamine, prostaglandins and or tachikinins.
eicosanoid that inhibits platelet aggregation and adhesion to the vascular endothelium, vasodilates, increases vascular permeability and stimulates leukocyte chemotaxis
Prostacyclin
artery most likely to be affected by atherosclerosis
Abdominal aorta
arteries most likely to affected by atherosclerosis in order
abdominal aorta, coronary arteries, popliteal, internal carotid, circle of willis.
Down syndrome
endocardial cushion defects: ASD and regurgitant AV valves
DiGeorge syndrome
tetralogy of fallot and aortic arch abnormalities
turners syndrome
coarctation of the aorta
marfan’s syndrome
Cystic medial necrosis of aorta: aortic insufficiency and dissection
tuberous sclerosis
valvular obstruction due to cardiac rhabdomyomas
friedreich ataxia
hypertrophic cardiomyopathy
infant of diabetic mother
transposition of great vessels
pt in ER cuz of chest pain, diaphoresis and lightheadedness. Symptoms started 1 hour ago. ST segment elevations. Which type of cell injury will most likely present?
Coagulative necrosis
small bluish lesion under the nail. Lesion is tender to touch. Which cells does it originate from?
Glomus bodies which regulate thermoregulation
small numerous encapsulated neurovascular organs found in the dermis of the nail bed. Role is to shunt blood away from the skin surface in cold temperatures in order to prevent heat loss and to direct blood flow to the skin surface in hot environments to fascilitate dissipation of heat.
Glomus bodies
cause of death in acute rheumatic fever
Severe myocarditis
Causes of death in lightning injuries
fatal arrhytmias and respiratory failure
pt with long extremities, long tapering fingers, spinal scoliosis and kyphosis. Lens discoloration and aortic dissection and/ormitral valve prolapse
Marfan’s syndrome
Mutation in marfan’s syndrome
autosomal dominant defect in connective tissue glycoprotein fibrillin-1
most common cause of death in Marfan’s
aortic dissection
most common cause of aortic stenosis in a pt 70 years old
degenerative calcification of aortic valve
aortic stenosis murmur
systolic ejection murmur heard at the cardiac base that radiates to the carotids arteries
presenttion of aortic stenosis
SAD syncope, angina and dyspnea
pt with severe headache and oliguria. BP 240/150. There is papilledema. What is the most likely pathologic process in this condition?
Onion-like concentric thickening of arteriolar walls. Malignant hypertension.
murmur present in hypertrophic cardiomyopathy
ejection type systolic murmur. Augmented by decreasing the LV end diastolic volume with maneuvers such as sudden standing and valsalva
tetralogy of fallot findings
pulmonic stenosis, ventricular septal defect, right ventricular hypertrophy and overriding of the aorta
Findings in bacterial endocarditis
FROM JANE, Fever, Roth’s spots, Osler’s nodules, Murmur, Janeway lesions, Anemia, Nailbed hemorrhages, Emboli
skin biopsy of kid has vascular lesions with IgA and C3 deposition. What other presenttions will you find?
Sking rash and adbominal pain. (henoch-shonlein purpura)
Finding in Henoch-schonlein purpura
skin, Arthralgia and GI. Palpable purpura, abdminal pain. Hematuria.
how to keep a patent ductus arteriosus open
protaglandins
how to close a patent ductus arteriosus
Indomethacin and ibuprofen by inhibiting PGE1 synthesis
Patent ductus arteriosus associations
Prematurity, perinatal distress, congenital rubella and fetal alcohol syndrome.
SLE cardiac findings
pleuritis and pericarditis
pt with proteinuria, malar facial rash, photosensitivity, arthralgias, chest pain relieved by leaning forwards and worse on inspiration
Systemic Lupus erythematosus findings
sundromes associated with mitral valve prolapse
Marfans and Ehlers-Danlos syndromes
Mid systolic click which is followed by a short late systolic murmur. Murmur disappears on squatting
Mitral valve prolapse
Atrial Septal defect sounds
pulmonary flow murmur because of increased flow through pulmonary valve and a diastolic rumble because of increased flow across tricuspid
jervell and lange-nielsen syndrome
Congenital long QT due to defects in cariac sodium or potassium channels. Presents with severe congenital sensrineural deafness.
Disease that leads to a 3rd degree block
Lyme disease
Pulsus paradoxus
decrease in systolic blod pressure of greater than 10 mmHg with inspiration.
Diseases that present with pulsus paradoxus
cardiac tamponade, constrictive pericarditis, restrictive cardiomyopathy, sevre obstructive pulmonary disease
How is pulsus paradoxis detected?
inflating a blood pressure cuff aboce systolic pressure and then slowly releasing it. Korotkoff sounds become audible during expiration.
Pt is tachypneic, expiration is prolonged and prominent bilateral wheezes. Which agent would bring immediate relief?
Beta-adrenergic agonist: relaxes bronchial smooth muscle by stimulation of beta 2 adrenergic receptor.
MOA beta 2 adrenergic agonist
bind to Gs protein coupled receptor and activates adenylyl cyclase and ncreases intracellular cAMP cncentrations.
most important factors involved in coronary blod flow
Adenosine and nitric oxide
MOA nitric oxide
causes vascular smooth muscle relaxation by a guanylate cyclase-mediated cGMP second messenger system. Increases cyclic GMP
repetitive ischemia of cardiac myocytes can result in chronicle reversible loss of contractile function called?
Hibernation
Myocardial stunning
less sevre form of ischemia induced reversible loss of contractile function. Repetitive stunning leads to hibernation
major determinant of the ratio of forwards to regurgitant left ventricular output in mitral regurgitation
Left ventricular AFTERLOAD
Where is Antiotensin converting enzyme produced
Pulmonary endothelium
Whre is angiotensinogen produced
liver
diffuse atherosclerotic vascular disease charachterized by intimal thickenning and collagen deposition is mediated by?
Smooth muscle cells
most common cause of death in a young athlete?
hypertrophic cardiomyopathy
Triad of wolff parkinson white syndrome
short PR interval, delta wave at the start of the QRS complex, wide QRS interval
how does wolff parkinson white syndrome manifest
Accessory AV conduction pathway: recurrent paroxysmal supraventricular tachycardia
what is the intiating process of an aortic dissection
intimal tear
severe retrosternal pain that radiates to the back
aortic dissection
carotid sinus massage
increases baroreceptor firing, increasing parasympathetic influence on the heart and vessels and prolongs the AV node refreactory period
Re entrant impulse traveling through slowly and rapidly conducting segments of the AV node
paroxysmal supraventricular tachycardia
treatment for paroxysmal supraventricual tachycardia
cartoid sinus massage and valsalva maneuver, increase cardiac parasympathetic tone, slows AV node conduction and abolishes the re entrant circuit.
holosystolic murmur loudest over the left mid sternal border
Ventricular septal defect
valvular vegetation on both sides of the valve
Lupus
Lupus valvular involvement
limbman-sacks endocarditis
blood flow through the coronary arteries is highest during
Diastole when blood vessesl are not compressed
pt with vascular tumor that expresses positive CD31. associated with past arsenic or PVC exposure
Liver angiosarcoma
major limitant factor for coronary blood flow during exercise
duration of diastole
what is the most common cardiac abnormality predisposing for native valve bacterial endocarditis
Mitral valve prolapse
murmur that increases pulse pressure
aortic regurgitation
diastolic decrescendo murmur heard loudest in early diastole. It is heard best at the left sternal border.
aortic regurgitation
cardiac function curve: decreased cardiac output without a change on venos return
indicated decreased contractility: due to negative inotropic drug or myocardial infarction
low pitched holosystolic murmur heard best at the left sternal border with accentuation during handgrip exercise
Ventricular septal defect
major determinant of the deegre of right-to-left intracardiac shunting in Tetralogy of fallot
pulmonic stenosis
interstitial myocardial granulomas or Aschoff bodies with anitschkiw cells
Therumatic carditis
Cardiac myocyte action potential
phase 0: rapid depolarization, Phase 1: initial rapid repolarization, Phase 2: plateau, Phase 3:late rapid repolarization, Phase 4: resting potential
pt does 12 days after MI, what do you find on biopsy?
Fibrovascular granulation tissue with neovascularization
Chronic arteriovenous fistula
decreased in TPR and increase in venour return
jaw claudication, headache, facial pain, vision loss, granulomatous inflammation of the media. Pt older than 50
Giant cell arteritis (temporal arteritis)
female, less than 40, medial granulomas, affects the aortic arch, lower blood pressure and pulses in the upper extremities and compared with lower extremities, cold and numb finger.
Takayasu arteritis
widened, descending thoracic aorta with a double barrel
aortic dissection
single most important risk factor for development of intimal tears leading to aortic dissection
hypertension
67 year old male with persistent headache and difficulty chewing, arterial biopsy shows giant cells and internal elastic membrane fragmentation. Immediate prednisone therapy is initiatied to prevent
Blindness (ophthalmic artery occlusion)
Giant cell arteritis initial treatment to prevent blindness
steroid
triad of muffle heart sounds, elevated jugular venous pressure and profound hypotension
Pericardial tamponade
most serious complication of kawasaki disease
coronary involvement leading to the development of coronary artery aneurysms
persistent fever, bilateral conjuctivitis, lymphadenopathy and cutaneous involvement (strawberry tongue, desquamation of the fingertips, polymorphous erythematous rash)
Kawasaki disease
murmur with bounding femoral pulses and carotid pulsations that are accompanied by head-bobbing
aortic regurgitation
ANP effects
kidney: dilates afferent arterioles and inhibits renin secretion, Adrenal gland: restricts aldosterone secretion, blood vessels: relaxes vascular smooth muscleproducing vasodilation.
rapid decrease in cytoplasmic calcium level immediately preceding relaxation is mediated by?
Na/Ca exchange mechanism
teartment of hypovolemic shock
intravenous fluid infusion
what does intravenous venous infusion cause in pt with hypovolemic shock
increases intravascular volume and ventricular preload. The preload increases the end diastolic sarcomere length in the ventricular myocardium, increases stroke volume and cardiact output.
which anatominal site have a blood oxygen content that differs the most with the O2 content from the aorta?
Coronary sinus: drains coronary venous blood
Features that distinguish heart circulation from other circulations
Cardiac muscle is perfused during diastole and consumes 5 percent of caardiac output, myocardial O2 requirement is higher than othe rorgans and Coronary flow is regulated by local metabolic factors such as nitirc oxide and adenosine
holosystolic murmur that increases intensity on inspiration
tricuspid regurgitation
opening snap followed by a diastolic rumbling murmur that is heard best over the apex of the heart
mitral stenosis
coronary steal phenomenon
blood flow in ischemic areas is reduced due to arteriolar vasodilation in nonischemic areas. Worsens hypoperfusion of existing ischemia
continuous murmur heard best in the left infraclavicular region with maximal intensity at S2
Patent ductus arteriosus
congenital long QT interval, autosomal recessive and congenital neurosensory deafness
Jervell and Lange Nielsen syndrome
Jervel and lange Nielsen syndrome mutation
autosomal recessive mutation of genes coding for cardiac cell potassium or sodium channels.
Beck’s triad: hypotension, distended neck veins and distand muffled heart sounds on auscultation AND pulsus paradoxus
Cardiac tamponade
organ thaa is least vulnerable to infarction in case of arterial oclusion
Liver
increased CK level is synonym of
Cell membrane damage
fast and irregular pulse. Tachycardia and irregular rhythm. Irregular QRS complexes and absent p waves
Atrial fibrilation
Precipitating factors of isolated episodes of Atrial fibrilation
binge alcohol, increased cardiac sympathetic tone and pericarditis
harash, crescendo-decrescendo systolic ejection murmur heard best at the right sternal border with radiation to the carotids
Aortic stenosis
Causes of aortic stenosis
Bicuspid valve, calcified normal valve and rheumatic heart disease
how to determine the severity of mitral stenosis
S2 to opening snap time internal: length of the interval between A2 and opening snap. The shorter the interval, the more severe the stenosis. The more thickened and fibrotic the valve, the earlier the tensing occurs.
hypersensitivity to intradermal injections of tobacco extracts (vasvulitis)
Buerger’s diease
segmental vasculitis extending into contiguous veins and nerves
Buerger’s diease
72 year old male with headaches, recent vision deterioraiton treated with prednisone and improves significantly. What is the pathologic process
granulomatous inflammaiton of the media
pt with heavy smoking hx, moderate dilatation of the right ventricle and increased central venous pressure. No edema. Absence of edema is best explained by which compensatory mechanism
increased tissue lymphatic drainage
man loses conciousness when buttoning his shirt collar. Stimulation of which afferent is most liekly responsible?
Glossopharyngeal
course of IVC through abd and inferior thorax
located anterior and to the right of the vertebral bodies
inferior vena cava filter
designed to prevent travel of deep vein thrombosis form the legs to the lung vasculature.
artery that supplies the inferior wall of the left ventricle which forms the diaphragmatic surface of the heart and the SA and AV node
Posterior descending which arises form the right coronary artery
provides the major proliferative stimuli for the cellular components of atherosclerotic plaques
platelets
embryonic veins from systemic circulation (superior vena cava)
common cardinal veins
embryonic veins of portal system
vitelline veins
embryonic ascending aorta
truncus arteriosus
embryonic pulmonary trunk
truncus arteriosus
presystolic sound that immediately precedes S1
S4
rapid emptying of atrial blood into a ventricle with reduced compliance (stiff ventricle)
S4
Moa of nitrates
converted to nitric oxide which increased intracellular cGMP causing smooth mucle relaxation
prevention of reflex tachycardia after treatment with nitrates
Beta blocker: OLOL, nitrates vasodilate and cause decrease blood pressure which the body responds to by releasing catecholamines which cause reflex tachycardia.
drugs that relaxes smooth muscle of arterioles but does not affect veins. Name a side effect
Reflex tachycardia and sodium and fluid retention
Side effects of verapamil
constipation, gingival hyperplasia, second and third degree AV nodal block.
contraindication for the use of verapamil
CHF due to the potent negative inotropic effect
Selectivity of verapamil
non-dihydropyridine Ca channel block heart
selectivity of nifedipine
dihydropyridine: peripheral vasculature
pt with irregularly irregular rhythm. Treatment with IV digoxin drop his heart rate but the rhythm remains irregular, what is the cause of this effect?
Increased parasympathetic tone
first line treatment for Atrial fibrilation
calcium channel blocker such as diltiazema and cardioselective beta blocker
second line treatment for atrial fibrilation
Digoxin
MOA milrinone
phosphodiesterase isoenzyme 3 inhibitor: increases concentration of cAMP which increases conductance of Ca channel in sarcoplasmic reticulum and increases force of contraction. Also causes vascular smooth mucle vasodilation.
Metoprolo MOA
selective B1 adrenergic antagonist. B1 is found on cardiac and renal juxtaglomerular cells . So it inhibits the production and release of renin, leading to decreased vasoconstriction and decreased renal sodium and water retention.
Class III antiarrythmics
Amiodarone, Sotalol, Ibutilide, Dofetilide
MOA of class III antiarrhytmics
slow K efflux from the ventricular myocyte, prolong repolarization and prolong refractory period.
during inflammation, high levels of an enzyme are detected in inflammatory cells, including macrophages. This enzyme is undetectable in most normal tissues. Which of the following directly binds to this enzyme?
Aspirin: binds irreversibly and modifies COX1 and COX2. COX2 is undetectable In most tissues except in cases where inflammatory cells are activated.
embryologic structure that gives rise to the pulmonary arteries and the ductus arteriosus
Sixth aortic arch
important recommendation for prevention of central venous catheter infections
hand washing with antibacterial soap prior to catheter insertion, maximal barrier during insertion, chlorhexidine for skin disinfection, avoid femoral insertion site, remove catheter when no longer needed.
Mid-diastolic rumbling murmur heard best at the apex, positional dyspnea, large pedunculated mass in the left atrium
atrial myxoma
histo of atrial myxoma
scattered cells within a mucopolysaccharide stroma. Abnormal blood vessels and hemorrhaging.
homocystinuria
defect in cystathione beta symthase which converts homocystine to cystathione. Cysteine is essential in the diet for these pt.
homocystinuria presentation
pt with premature atherosclerotic disease, ectopia lentis, osteoporosis and mental retardation.
kid with acute MI and with increased serum methionine level, which amino acid is essential?
Cysteine
Relationship between flow, resistance and radius
Resistance is inverse proportional to radius to the fourth power and flow is inveser proportional to resistance
fron and back of transesophageal echocardiograph
front: left atrium and back:descending aorta
course of descending aorta
left anterior surface of vertebral column
causes of dilated cardiomyopathy
Acohol, Beriberi(thiamine deficiency), Coxsackie(viral myocarditis), Chagas, Cocaine, Doxorubicin, Peripartum
acute onset heart failure in the setting of a recent viral infection
Dilated cardiomyopathy: coxachie
diagnosis of Polyarteritis nodosa which artery is spared
Pulmonary
Pt with PSVT, rapid IV injection results in instant resolution accompanied by flushing, burning in the chest and shortness of breath. Name the drug
Adenosine
drug of choice of paroxysmal supraventricula tachycardia
adenosine
first step in pathogenesis of atherosclerosis
endothelial cell injury
cause of hyperthrophic cardiomyopathy
autosomal dominant mutation in cardiac sarcomere proteins, Beta myosin heavy chain
third pharyngeal arch
common carotid artery and proximal internal carotid. Glossopharyngeal n. CN IX
pt with chest pain, difficulty catching his breath. Ventilation perfusion V/Q reveals a large perfusion defect that does not match a ventilation defect in the lungs. What is the cause?
Deep Vein Thrombosis causing a pulmonary thromboembolism.
early systolic murmur best heard over the left sternal border that is accentuated by inspiration
tricuspid regurgitation
Right sided endocarditis involving the tricuspid valve
IV drug users due to staph
congenital association of a berry aneurysm of the circle of willis
coarctation of the aorta
Causes of Spontaneous Intracranial Hemorrhage
arterovenous malformations, ruptured cerebral anurysms and abuse of sympathomimetic drugs such as cocaine.
aortic regurgitation murmur
blowing diastolic decrescendo. Augmented with hand grip
drug for atrial fib that causes mild bradycardia and significatng QT interval prolongation.
Sotalol: beta blocker and class III antiarrhythmic properties (K channel block)
the pulmonary capillary wedge pressure measures
left atrial end diastolic pressure
mitral stenosis PCWP
elevated PCWP which represents elevated left atrial end diastolic pressure compared to the left ventricular end diastolic pressure
antiarrhythmics that cause torsades de pointes
quinidine, procainamide, disopyramide, ibutilide, dofetilide and sotalol because they cause QT prolongation.
torsades de pointes
polymorphic QRS complexes of varying amplitude and cycle length with underlying QT nterval prolongation.
deletions involving the long arm of choromosome 22 associated with
Digeorge syndrome
Digeorge syndrome
thymic aplasia and failure of parathyroid formation, defective embryonic development of the third and fourth pharyngea pouches. Hypocalcemic tetany and recurrent viral and fungal infections due to T-cell deficiency
strawberry hemangioma
present at birth, grow in proportion to the child and regress spontaneously at or before puberty. Unencapsulated aggregates of closely packed, thin walled capillaries.
low serum potessium, depressed plasma renin, right sided adrenal mass and hypertension. How do you treat it?
It is an aldosetrone secreting tumor: aldosterone antagonist, spironolactone or eplerenone; or surgical resection
Conn’s syndrome
aldosterone secreting tumor causing hypokalemia, low renin, hypertension and metabolic alkalosis.
eplerenone
aldosterone antagonist
transmural inflammaiton of the arteries with fibrinoid necrosis. Some arteries show fibrous wall thickening. Disease?
Polyarteritis nodosa
What is Polyarteritis nodosa associated with
Liver infection: hepatitis B
Jervell and Lange Nielsen and Romano ward syndrome
Mutations in the K channel causing QT elongation. First is autosomal recessive and the other is autosomal dominant.
intrinsic ability of a drug to elicit an effect, such as receptor activation. Maximum pharmacodynamic effect
Eficacy
the dose of drug that is required to produce a given effect. Affected by afinity of the drug for its receptor or how the drug is able to bind tissues
Potency
ED50
dose of drug that is required to produce one half of the max biological response. Lower ED50 more potent
causes of isolated systolic hypertension
age related decrease in compliance due to aortic stiffness.
statins side effects
heatotoxicity and rhabdomyolysis(muscle pain)
statin of choice with agents that inhibit cytp450
pravastatin
where r statins metabolized
liver cytp450
side effects of ACE inhibitors
Dry, nonproductive persistent cough
side effecst of niacin
warmth, flushing and itchy skin. Insulin resistance (hyperglycemia/acanthosis nigricans) and hyperuricemia. Can also potentiate anti-hypertensives because they vasodilate.
apical displacement of the tricuspic valve, decreased right ventricular volume and atrialization of the right ventricle
Abstein’s anomality caused by lithium
treatment of bipolar disorder
lithium in manic phase and concurrent antidepressant in depressive phase
side effects of fibrates
gallstones, myopathy
side effects of bile acid-binding resins
GI upset, hyperglycemia, malabsorption
Beta blocker overdose treatment
Glucagon
Moa of glucagon
acts on G protein coupled receptors causing activation of adenylate cyclase, increasing intracellular cAMP and increasing the release of Ca.
MOA of beta blockers
decrease cAMP and decrease Ca, so decrease slope of phase 4
monitoring of warfarin
Prothrombin time
monitoring of heparin
PTT
pt with persistent right arm swelling following radiation. Increased risk of
Lymphangiosarcoma: rare malignant neoplasm due to chronic dilatation of lymphatic channels
the most likely complication of varicose veins
skin ulcerations. They are too superficial to cause a pulmonary embolism
side effects of Hydralazine and Procainamide
Drug induced lupus erythematous
80 year old myocardial cells show prominent intracytoplasmic granules that are tinged yellowish-brown. what is it?
Lipofuscin: product of lipid peroxidation, accumulating in aging cells, especially in pt with malnutrition and cachexia
side effects of Hydralazine and Procainamide
Drug induced lupus erythematous
80 year old myocardial cells show prominent intracytoplasmic granules that are tinged yellowish-brown. what is it?
Lipofuscin: product of lipid peroxidation, accumulating in aging cells, especially in pt with malnutrition and cachexia
Anaphylactic shock
Vasodilation, increased vascular permeability and bronchoconstriction
Drug of choice for anaphylactic shock
Epinephrine, counteracts vasodilation by acting on alpha 1 and increasing BP, beta 1 action increases cardiac out and beta 2 action causes bronchodilation.
