cardio Flashcards
subacute vs acute endocarditis
acute —s taph aureus and quick onset
subacute —- prosthetic vavles strept virdian
his patient presents with decreased distal pulses, dry gangrene, and ulceration over the digits. Together, these findings indicate a diagnosis of
buerger disease
history of sharp pain at rest but not while exercising
prinzmetal
pt has essential hyp and prizmetal angina plus wants to become pregnant
whats the best medicaiton
hydrochlorothiazide
amlodipine
bblocker overdose txt
and the cellualr signalling pathway
glucagon
activate Gs adenyl cyclase
which vasculitis has a . Granulomatous infiltrate
giant cell arteritis
cystic hygroma
cystic hygroma is a congenital malformation resulting in lymph accumulation in jugular lymphatic sacs; it is caused by congestion of the lymphatic system in the neck.
in turners or down
which pattern of inheritence is demonstrated by AD conditions likes BRCA 1
incomeplete penetrance
Loss of hetrozygosity
oss of heterozygosity is a phenomenon in which an individual who previously lost an allele (usually congenitally) loses the last and final allele due to an additional insult. This occurrence is well represented by the two-hit hypothesis in which loss of two alleles is required to activate a proto-oncogene. Retinoblastoma (Rb) gene is a well known example in which Rb mutations can either be sporadic or inherited.
pt works in a factory with high exposure to nitrates
what can this condition be
mondays disease
Monday disease, reflex tachycardia, dizziness, hypotension, flushing, and headache occur on Monday with re-exposure to nitrates
most severe consequence occurs when compensatory vasoconstriction is unopposed in critical areas such as the coronary vessels, leading to nonatherosclerotic-related cardiac ischemia.
digeorge pharyngeal arch or pouch
POUCH 3 4
treatment of septic shock and the receptors this drug works on
norepi
alpha1>2> beta1
short term SVT txt
diltiazem
negative dromotropic effect
which antiarrythmic drug can cause torsade pointes
sotalol
what drug is given to treat vent fibrillation
amiodarone
centrally acting hypertension medication
can cause
clonidine
presynaptic alpha 2 agonism …. decrease sympathetic outflow
virus causing pericarditis
small non enveloped single stranded RNA virus
the only two double stranded RNA virus
colti virus
rotavirus
what would increase prevalance but not incidence
better healthcare quality
sacubitril mechanims
inhibits neprilysin
which is responsible for deactivating ANP BNP … which help reduce BP
he compensatory neurohumoral mechanisms of CHF include
The activation of the RAASproduces an increase in the level of angiotensin II and aldosterone, which both function to increase sodium reabsorption in the kidneys.
Increased sympathetic output by the central nervous system
Increased activation of the RAAS
Increased secretion of ADH
acute SVT first second third line therapy
vagal manneuver
adenosine
BB
HCM treatment
BB or nondehydropyridine ca channel blocker
describe murmur in HCM
when heart it full murmur decreases (squatting)
atient presented with unexplained palpitations, tachycardia, and shortness of breath. These signs indicate that she should be evaluated for an
arrythmia
possibly SVT
treatment given to a patient iwth SVT
causes sudden drop in pressure and flushing
name of drug
adenosine
denosine is a very short-acting drug that is useful in terminating certain forms of supraventricular tachycardia by hyperpolarizing the cell and decreasing atrioventricular (AV) node conduction. Adverse effects include flushing, hypotension, chest pain, bronchospasm, and a sense of impending doom.
34-year-old man comes to the physician due to difficulties speaking and swallowing due to mitral stenosis
why is he having such symptoms
The left recurrent laryngeal nerve loops beneath the aortic arch leaving it vulnerable to compression from an enlarging left atrium in rare cases. Such an obstruction can also compress surrounding structures such as the esophagus, resulting in hoarseness and aphonia (loss of voice). In extremely severe cases, the enlargement of the left atrium may cause difficulty swallowing.
pt is on simvastatin
developds community acq pneumonia
txt is given and he expereiences muscle aches
WHY
Macrolides also inhibit the cytochrome P-450 enzyme, CYP3A4, which metabolizes simvastatin. Increased serum concentration of simvastatin results in simvastatin-associated muscle pain that may evolve to rhabdomyolysis.
Inherited defects of myocyte ion channels cause what condition
long QT syndrom
heart condition assoc to marfan
MVP
aortic regurg
mitral regurg
adenosine mechanism
Adenosine is an antidysrhythmic that hyperpolarizes the cell via potassium channels and inhibits L-type calcium channels. It will not significantly affect the calcium flow.
in order to reach the IVC … an umbilical vein catheter must pass thru which ductus
ductus venosus!!
nitroglycerin physiological impact
reduces PRELOAD
reduces oxygen demand by heart muscle
SLE endocarditis vegetations
SMALLLLLLLLL verrucous
fibrates mechanims
upregulate lipoprotein lipase
and activate PPR
umbilical vessels
one vein (oxygenated) two arteries
what is coronary dominance
which artery supplies the PDA
treatment of choice fortype IIa and IIb familial hyperlipidemia.
high dose statin
and ezetemib
statin with cholestyramine
NO
it will decrease absp of statin toooo
normal essential HTN drugs
thiazaide
CCB
ACEi
in blacks treatmnt for HTN
thiazide and long acting ACEi
necrotizing granulomas are seen in whcih type of vasculitis
polyangitis granulomatos
necrotizing vasculitis with eosinophilia
churg straus
igA complex deposition
henoch schonlen
segmental thrombosing vasculitis
beurger
drug x is given which causes increase in systolic diastolic and MAP
after the affect is worn off another drug Y is given before drugX is given again … now the BP DECREASES
drug x epinephrine (a b receptors)
drug y phenoxybenzamine
phenoxy blocks the a1 affects of epi ….. means only b1 and b2 rec are activated
patient presents with severe chest pain, a history of hypertension and type 2 diabetes mellitus, and asymmetric pulses in the upper extremities
aortic dissection
cardiac tamponade complication
define kawasaki disease
Kawasaki disease is an acute necrotizing vasculitis of medium to small muscular arteries. CRASH conjunctival injection Rash adenopathy strawberry tongue fever
digoxin effects on heart
increase EF
decrease HR
reperfusion injury histology
Contraction bands on histology following MI are caused by massive calcium influx, and result in hypercontraction of the sarcomeres
inhibition of hormone senstive lipase
niacin
increases HDL
also decreases triglyceride
what is a serious side effect of hydralazine
reflex tachy
use labetolol
when is flecainide used
it is also used for intractable supraventricular tachycardia.
lidocaine use
lass Ib antiarrhythmic, is used in the treatment of acute ventricular arrhythmias such as postmyocardial infarction arrhythmias.
PDA in a baby can be caused by which infection
rubella
fever lymphadenopathy arthralgia
rash from face down
many of the adverse effects are related to central nervous system (CNS) depression
fatigue drowsiness
clonidine
centrally acting
internal jugular vein anatomy
within the carotid sheath lateral to the common carotid artery and anterior to the vagus nerve.
stenosis/regurgitation vs endocarditis/RHF
stenosis in RHF
regurg in endocarditis
post MI fibrillation
1b lidocaine … decrease AP ARP
cardiac remodelling with sarcomeres added in parallel
concentric hyprtrphy
diastolic dysf
long qt syndrome with sensorineural deafness
which ion chanel involved
Jervell and Lange-Nielsen syndrome is an autosomal-= recessive condition caused by mutated voltage-gated potassium channels. Individuals commonly present with sensorineural deafness, a family history of sudden death, and a prolonged QT interval on ECG (>420 ms).
L-type Ca2+ channels mutation causes
malignant hyperthermia
ostium primum wall defect
. Ostium primum septal defect is seen in the lower portion of the septum at the level of the tricuspid and mitral valves. It is also known as endocardial cushion defect. It is associated with mitral and tricuspid valve defects as well as Downsyndrome.
2 days post MI
pt has pleuritic chest pain … widespread ST elevations … and friction rub
fibrinous pericarditis
ventricullar wall ruptture post MI occurs after
2-8 days
troponin levels
after 6 hours
can peak by 24
down in 2 weeks
CKMB
peak by 24 and down by 72
used to check for reinfarction
buproprion mechanism in smoking cessation
blocks reuptake of norepi and dopamine
what factors predispose digoxin toxicity
amiodarone
verapamil
quinidine
hypokalemia
brugada
Brugada syndrome is an inherited sodium channel abnormality that leads to arrhythmias in young men.
The Gαq subunit
The Gαq subunit is part of a G-protein pathway that activates phospholipase C (PLC) after exchanging guanosine diphosphate (GDP) for guanosine triphosphate (GTP). As a result, PLC splits phosphatidylinositol bisphosphate (PIP2) into diacylglycerol (DAG) and inositol trisphosphate (IP3). As a result, protein kinase C is activated and calcium levels increase intracellularly resulting in muscle contraction.
amiodarone mechanism
prolonging the repolarization phase via potassium channel blockade.
how to improve HDL
aerobic exercise and weigh tloss
how can an epidural hematoma present (what type of herniation)
causes increased ICP
transtentorial herniation
CN III palsy
acute kidney injury can lead to what electrolyte imbalance
hyperkalemia
which BB acts by decreasign phase 4 of pacemaker cells
The β-blocker metoprolol is the only cardioselective β-blocker among the options listed. It acts by decreasing the slope of phase 4 in cardiac pacemaker cells.
old pt has P.HTN i chose BMP2 is the cause
Patients with hereditary pulmonary arterial hypertension typically present at a younger age and do not have pulmonary crackles.
reinke crystals
Reinke crystals are found in Leydig cell tumors of the testis. They are plump, rod-like cytoplasmic inclusions.
Cytoplasmic inclusionLeydig cell tumor
Bottom Line:
mechanism of fibrates
Fibrates activate peroxisome proliferator-activated receptor α to decrease expression of 7-α-hydroxylase, which catalyzes the rate-limiting step of bile acid synthesis.
risk factor for AAA
smoking
atherosclerosis
HTN is more for thoracic AA
pressures of heart
The right atrium has a normal mean pressure range of 1-8 mm Hg.
The right ventricle has a normal pressure range of 1-30 mm Hg.
The mean pulmonary artery wedge pressure is normally 4-12 mm Hg and identical to that of the pulmonary artery diastolic pressure.
The left ventricle would normally have a dramatically higher peak systolic pressure (>90 mm Hg).
causes of dialated cardiomyopathy
Dilated cardiomyopathy has several causes, including chronic alcohol abuse, beriberi, coxsackie B myocarditis, chronic cocaine use, Chagas disease, and doxorubicin toxicity.
causes of dialated cardiomyopathy
Dilated cardiomyopathy has several causes, including chronic alcohol abuse, beriberi, coxsackie B myocarditis, chronic cocaine use, Chagas disease, and doxorubicin toxicity.
granulomatous inflammation with mononuclear and giant cells
giant cell arteritis
mitarzapine
Mirtazapine is a selective α2-receptor antagonist used in the management of depression.
granulomatous inflamamtion of cardiac myocytes is a sign of
Granulomatous inflammation of cardiac myocytes is characteristic of infiltrative diseases such as sarcoidosis.
dialated CM after viral infectino
autoimmune attack on cardiomyocytes
incidence formula
new cases / population at RISK
so subtract ppl that already have diseas
amiodarone works on which phases of action potential
phase 2 3
how does norepi effect heart rate
it decreases heart rate
a1 causes vasoconstricton which increases blod flow bak to heart… this increases SV … and lowers hr
which heart tumor is assoc with Tuberous sclerosis
rhabdomyoma
seizures, intellectual disability, and facial angiofibromas
TS
turner has a specific typoe of coarctation of aorta
The most common is coarctation of the aorta, a congenital narrowing of the descending aorta, usually just distal to the origin of the left subclavian artery and opposite the ductus arteriosus (and so termed “juxtaductal”). If the left subclavian artery is involved, juxtaductal coarctation of the aorta can result in a small left arm because of compromised blood flow.
central line technique
lateral to commmon carotid artery
MVP murmur increased by
valsalva
low flow brings the mid systolic click closer to S1
s1q3t3 found in
P embolism
which antiarrythmic can cause tosade pointes
class I a and III ibutilide
tyoes of amyloidosis
AL amyloidosis, also known as primary amyloidosis, which is due to immunoglobulin light chain deposition arising from bone marrow antibody production (most common type)
AA amyloidosis, also known as secondary amyloidosis, which occurs as a consequence of chronic inflammation
β2-microglobulin amyloidosis, which is related to long-term dialysis in patients with renal failure
Familal/senile ATTR amyloidosis, which is either inherited or acquired in old age
wpw treatment
procainamide 1A
hydralazine most imp side effect
sudden vasodialataion … activate baroreflex
can cause angina
increase her cardiac contractility and decrease her peripheral vascular resistance.
milrinone
pde5 inhibitors
