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Cardio Flashcards

1
Q 
IA class antiarrhytmics?
What channels block? 
3 drugs
A

Na channel blockers

Quinidine, Procainamide, Disopyramide

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2
Q

Adverse effects of IA antiarrhemics

A

Cinchonism (tinnitus) quanidine
SLE-like syndrome (procainamide)
HF (disopyramide)

Thrombocytopenia
Forsakes de pointes (⬆️QT)

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3
Q

Phase O in fast response fibers ?

A

Na channels open

Na enters cell - depolarization

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4
Q

Phase O in slow response fibers

A

No appreciable Na current

Depolarization depends on Ca channels

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5
Q

What do Ia antiarrhytmic drugs do to K?

A

Block - prolong repolarization

As well as Na block

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6
Q

Quinidine block what receptors? Channels?

A

Na
K a bit
M (muscarinic): ⬆️HR ⬆️AV conduction
May cause vasodilation alpha-block - reflex tachycardia

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7
Q

Drug interactions of quinidine?

A

⬆️toxicity of digoxin

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8
Q

Lupus causing drugs?

A

Hydralazine
Isoniazid
Procainamide

HIP

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9
Q

Ib antiarrhythmia drugs?
What channels block?
Ap duration?

A

Weak Na block
Lidocaine
Mexiletine

⬇️Ap duration

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10
Q

Ib antiarrhetmyc drugs use when ?
Ap duration?
Diastolic duration?
HR?

A

Use only in hospital
Post-MI (best!), open heart surgery

Only for VA
Lidocaine - IV
Mexiletine - oral
Non-prophylactic

⬇️Ap
⬆️Diastole
⬇️HR

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11
Q

Side effects of Ib antiarrhetmics?

A 
CNS toxicity (seizures, depression or stimulation)
Carfiovascular depression
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12
Q 
Ic antiarrhetmics?
Mechanism? 
Ap?
ERP?
Contraindications?
A

Flecainide
Propafenone
(Fries, please)

STRONG Na channels block (especially His-Purkinje)
No or little effect on Ap duration

Flecainide - bad reputation!
⬆️mortality in post-MI and in VT use
Good for atrial arrithmias

Proarrhytmic (promotes arrhythmia) in post MI, VA
Contraindicated in ischemic, structural ❤️ diseases

Good for SVT (including AF)

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13
Q

How Procainamide metabolized?

A

Metabolized via N-acetyltransferase to N-acetyl Procainamide (NAPA) -prolongs AP duration

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14
Q 
II class of antiarrhetmyc? 
6 drugs 
Mechanism?
A

B-blockers

Metoprolol
Propranolol 
Esmolol
Atenolol.                       -lol 😂
Timolol
Carvedilol

B-receptors activation - ⬆️ cAMP
B-blockers prevent activation - ⬇️cAMP, ⬇️Ca current
⬇️abnormal pacemakers by ⬇️slope of 4 phase

⬆️PR

⬇️AV (!) SV activity

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15
Q

Use of b-blockers?

A

SVT
Prophylaxis post MI

V and control of A fibrillation, A flutter
Because b receptors are all over the ❤️

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16
Q

Adverse effects of B-bl?
Metoprolol?
Propranolol?

A 
Impotence 
⬆️COPD, Astma
HF
Bradycardia 
AV block
Sedation
Metoprolol - dyslipidemia 
Propranolol - exacerbate vasospasm in vasospastic angina
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17
Q

B-by overdose? WhT to do?

A

Saline ( NaCl with water - изотонических раствор)
Atropine
Glucagon

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18
Q 
III class of antiarrhetmyc?
Mechanism?
4 drugs?
A

K channel blockers

⬆️Ap duration
⬆️ERP
⬆️QT
Slowing 3 phase - repolarization

AIDS:

Amiodarone
Ibutilide
Dofetilide
Sotalol

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19
Q

Clinical use of III class antiarrhetmyc

A

AF, AFlutter, VT (amiodarone, sotalol)
Life threatening ventricular arrhythmias

Amiodarone the smartest - mimic I, II, III, IV classes - blocks Ma, K, Ca, B- adrenoreceptors

⬆️APD ⬆️ERP in all cardiac tissues

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20
Q

Side effects of III antiarrhetmyc?

A 
Pulmonary fibrosis (amyodarone)
Smurf skin (iodine contain) - blue skin
Photo toxicity
Hepatic necrosis
Thyroid disfunction
Torsada (sotalole) - excessive b-blockade
(Sotalol - nonselectove b-bl)
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21
Q

What check while using amiodarone?

A

PFT, LFT, TFT

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22
Q

Which classes of antiarrhetmyc don’t use in long QT syndrome?

A

1A
III

POTASSIUM CHANNEL BLOCKERS

Tricyclic antidepressants
Antipsychotic (thioridazine)

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23
Q

How to treat Torsades?

A

Discontinue drug that prolong QT
Correct hypokalemia
Correct hypomagnesemia

Give magnesium or defibrillate

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24
Q

Treatment of A Fibrilation

A

Ventricular rate control: b-bl, CCB, digoxin

Anticoagulants

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25
Q

Pulmonary fibrosis what 3 drugs can cause ?

A

Amiodarone
Bleomycin
Busolfen

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26
Q

Which drug instead of amiodarone use to avoid blue skin?

A

Dronedarone

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27
Q

Thioridazine?
Group?
When avoid?

A

Antipsychotic

Long QT

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28
Q 
IV class antiarrhetmyc?
Mechanism?
2 drugs?
A

Ca-Chanel blockers

Verapamil
Diltiazem

Block slow cardiac Ca Channels

⬇️conduction velocity
⬆️ERP
⬆️PR interval
Prolonged repolarization

⬇️ 4, 0
Inhibit Ca influx in AV nose

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29
Q

Use of IV antiarrhetmyc?

A

SVT
Rate control in AF
PREVENT nodal arrhythmias

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30
Q

Side effects of IV antiarrhetmyc?

A 
Constipation (verapamil)
AV block
Dizziness
Flushing 
Hypotension 
HF
Edema
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31
Q

Drug interaction IV antiarrhetmyc

A

Verapamil displace digoxin

AV block with b-blockers, digoxin

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32
Q

Other antiarrhetmycs?

4

A

Adenosine
Magnesium
Ivabradine
Digoxin

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33
Q

Adenosine mechanism of action?
Duration of action?
When to use?

A

⬆️K out of cell
Hyperpolarizing the cell
Decrease AV node conduction

Duration - short, 15sec

Use in SVT

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34
Q

What’s activated of adenosine receptors cause? Where are they?

A

Cause Gi-coupled ⬇️ in cAMP

⬇️ SA AV activity

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35
Q

Side effects of adenosine?

A

Flushing, sedation, dyspnea

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36
Q

Drugs interaction?

Antagonized by…?

A 
By methylxanthines ( theophylline, caffeine)
Effects of adenosine blunted ⬇️
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37
Q

Adenosine is drug of choose …?

A

PSVT

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38
Q

Magnesium use?

A

Torsades

Digoxin toxicity

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39
Q

Ivabradine mechanism?

A

IVabradine prolongs slow depolarization (IV)

By selective inhibitions of funny sodium channels

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40
Q

Use of Ivabradine?

A

Chronic stable angina in those who can’t take b-bl

HF with reduced EF (HFrEF)

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41
Q

Adverse effects of ivabradine

A

Visual brightness (luminous phenomena)
Hypertension
Bradycardia

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42
Q

What drugs control HR?

A

B-bl, Ca cb

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43
Q

What to use in SVT?

How describe SVT?

A

II, IV, adenosine, digoxin

> 150
GRS narrows
P deformation

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44
Q

Drugs for VT?

Describe VT?

A

I, III

VT >120
Wide QRS >140ms
patients feel skipping beats
Ventricles contracts more often than Atrias

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45
Q

Saved By Pharm Class

A

I - Sodium
II - b-bl
III - potassium
IV - Calcium

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46
Q

If patient had ⬆️ ventricular response to stress, activity what to use?

A

Need for long usage
⬇️sympathetic
B-bl - propranolol

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47
Q

Drugs for essential HT

A

Thiazides diuretics
ACEI
ARB (angiotensin II receptors blockers)

Dihydropiridine
Ca cb

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48
Q

HT with HF treatment?

A 
Diuretics
ACEI
ARB
B-bl
Aldosterone antagonists (spironolactone, epelerenone, canrenone)
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49
Q

HT with DM

A 
ACEI
ARB
Ca cb
Thiazides 
B-bl
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50
Q

HT with Asthma

A

ARB
Ca cb
Thiazides
Cardioselective b-bl

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51
Q

HT with CKD

A

ACEI

ARB

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52
Q

HT with dyslipidemia

A

A-blockers
Ca cb
ACEI
ARB

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53
Q

HT in post MI

A

B-bl

Useful in preventing second MI

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54
Q

What anti HT ⬆️ lipids?

A

Thiazides

B-bl

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55
Q

HT in pregnancy

A

Hydralazine - preeclampsia (new HT)
Labetalole also good for both
Methyldopa - drug of choice
Nifedipine

He Likes My Neonate

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56
Q

B blockers contraindications

A 
Asthma
AV block
Bronchitis
Emphysema
Diabetic
CARDIOGENIC SHOCK
57
Q

Amiodarone?

Amlodipon?

A

Amlodipin - -dipines; CCBs

Amiodarone - K cb

58
Q

CCBs mechanism of ⬇️BP

A

Block voltage-dependent L-type of Ca channels of ❤️ and smooth muscles = ⬇️ intracellular Ca => ⬇️CO(verapamil, diltiaz), ⬇️TPR (all) = ⬇️ muscle contractility

59
Q

Use of CCBs?

A

Dihydropyridines (no nimodipine): HT, angina, Raynaud Phenomenon

Nimidopine: subarachnoid hemorrhage
Nicardipin, clividipine: HT urgency or emergency

Verapamil/ diltiazem: HT, angina AF, AFlutter

Arrhythmias: verapamil, diltiazem

60
Q

Adverse effects of CCBs

A

Reflex tachycardia
Gingival hyperplasia
Constipation (ver)
Hyperprolactinemia (verapamil )

61
Q

Pulmonary HT treatment

3 drugs

A

Bosentan - endoteline receptor blockers- vasodilation
Prostacyclin (PG2): Epoprostenol
Sildenafil: inhibit V PDE, ⬆️cGMP, pulmonary artery relaxation

62
Q

Pregnancy HT drugs?

HLMN

A

Hydralazine
Labetalol
Methyldopa
Nifedipine

63
Q

Slidenafil?

A

V type PDE inhibition
⬆️cGMP
Pulmonary artery HT

64
Q

Tamsulosin

A

Only in BPH , not useful in HTN

65
Q

Drug for:
HT + BPH
BPH

A

Prazozin

Tamsulozine

66
Q

Arteriolar specific anti hypertensive drugs?

A

Hydralazine
K blockers
Ca blockers

67
Q

Ventilations dilators anti hypertension drugs?

68
Q

Orthostatic hypotension

A

From ventilations dilation - mainly from a1 blockage or ⬇️sympathetic tone

A1 - nonselective, but very powerful vein effect

69
Q

Cyanide poisoning: 2 drugs

A

Hydroxocobalamin + sodium thiosulfate

70
Q

Hypertensive emergency 5

A 
Labetalol
Clevidipine
Fenoldopam
Nicardipine
Nitroprusside
71
Q

cGMP
cAMP

What drugs to use?

A

⬆️cGMP - smooth muscle relaxation by nitrates, nitroprusside, hydralazine

⬇️cAMP - heart ❤️ ⬇️activity of AV SA nodes

72
Q

Hypertensive emergency Ca drugs

A

Nicardipine, clevidipine

73
Q

Hypertensive emergency drugs

A

Nicardipine
Clevidipine

Labetalol

Fenoldopam

Nitroprusside

74
Q

Cyanid toxicity can be caused by what drug?

A

Nitroprusside

75
Q

RanolaIazine
Mechanism
Use. Adverse

A

Inhibit late onward of Na => ⬇️diastolic was tension and O2 consumption
Does not change HR, BP
Angina refractory to other drugs
Conztipation, dizziness, nausea

76
Q

Sacubitril

A

Neprilysin inhibitor
Prevents degranulation of natriuretic peptide, angiotensin II, substance P => ⬆️vasodilation, ⬇️ exstracellular fluid volume

Use with Valsartan (ARB) for HFrEF

Cough dizziness hypertension and Hyperkalemia

Contraindicated with ACEI inhibitors do you do angioedema

77
Q

Blurry yellow vision

78
Q

Digoxin tissue binding sites and ⬇️its clearance

A

Verapamil
Amiodarone
Quinidine

79
Q

Antidote for digoxin toxicity

A

Slowly normalize K
Cardiac pacer
Anti-digoxin Fab fragments
Mg

80
Q

Decstrocardia in what pathology

A

Kartagener syndrome - culinary dyskinesia

Defect in Left-right dynein - dextrocardia

81
Q

Drug induced long QT

A 
AntiArrhytmic (Ia, III)
AntiBiotic (macrolids)
AntiCychotic (haloperidol)
AntiDepressant (TCA)
AntiEmetics (ondansetron)
82
Q

Congenital long QT interval pathologies (2)

A

Romano-Ward syndrome - AD, no deafness

Jervell and Lange- Nielsen syndrome - AR, sensorineural deafness

83
Q

Brugada syndrome

A 
AD
Asian male
Pseudo R bundle branch block, ⬆️ST in V1-V3
Risk of VT VA and SCD
Prevent SCD with ICD
84
Q

Wolff-Parkinson White s

A 
Ventricular preexcitation syndrome 
Fast accessory conduction pathway from A to V , bypass the rate-slowing AV node
V begin to depolarize early 
Widened QRS
⬇️PR
Delta wave

May cause SVT

85
Q

AF

A

No discrete P between irregular QRS
Irregular H beat
Risk: HTN, CAD, holiday ❤️ syndrome
Can cause thromboembolism, stroke

Anticoagulants, rhythm and Hr control, or cardioversion

86
Q

A flutter

A

Saw tooth
R1=R2=R3…
Treat like AF
Catheter ablation

87
Q

VF

A

Erratic rhythm with no identifying waves.
Can be fatal
Need IMMEDIATE CPR and defibrillate

88
Q

I degree AV block

A

PR > 200 msec

No treatment

89
Q

Second degree AV block

90
Q

Third degree AV block

A

A and V beat independently

P=P
GRS=GRS

PG=/ PG
A rate > V rate
Pacemaker

Lyme disease

91
Q

Lime disease

What’s with ❤️

A

Can cause third degree AV block

92
Q

B type natriuretic peptide

Atrial natriuretic

A

From Ventricular myocytes in response to ⬆️tension

ANP - from atrial myocytes in response to ⬆️BV and Atrial P

Act via cGMP
vasodilation, ⬇️Na reabsorbtion
B type - linger half life

BNP - bliss test for HF

Nesiritid - recombinant form to treat HF

93
Q

Cushing reflex

A

In ⬆️ intracranial P: triad: bradycardia
⬆️BP
respiratory depression

These all are physiological nerves system response to ⬆️intracranial pressure

94
Q

Tetralogy of Fallot mnemonic

A 
Pulmonary stenosis 
R ventricular hypertrophy
Overriding aorda
VSD
e
95
Q

Lithium explosire of pregnant - ❤️?

A

Ebstein anomaly
Tricuspid valve down in RV
“Atrializing” ventricle

96
Q

Eisenmenger syndrome

Ebstein anomaly

A

Uncorrected L toR becomes R to L

Displacement of TV

97
Q

Turner syndrome what with ❤️

A

Coarctation of aorta

Bicuspid aortic valve

98
Q

Brachial femoral delay

A

Different pulse on upper and lower extremities

In coarctation

99
Q

Marfan syndrome ❤️?

A

MVP
Thor’s is aortic aneurysms
Dissection
Aortic regurgitation

100
Q

Infant of diabetic mother ❤️?

A

Transposition of great vessels

VSD

101
Q

Williams syndrome ❤️

A

Supravalvular aortic stenosis

102
Q

22q11 syndrome ❤️

A

DiGeorge

Truncus arteriosus
Fallot

103
Q

2 hypertension what diseases

A 
Fibromuscular dysplasia (string of beads renal artery)
1 hyper aldosteronism
Atherosclerotic renal artery stenosis
104
Q

Xanthelasmas composed of what ?

A

Lipid-laden histiocytes

105
Q

Mönckeberg sclerosis

A 
Medial calcific sclerosis 
Affect medial size arteries 
Vascular stiffening without obstruction 
Pipestime appearance on Xray 
Intima not involved 
Does not effect Q
106
Q

Dilated cardiomyopathy inheriting

WhT Gene?

A

TTN Gene, encoding the Sarcomeric protein titin

107
Q

Doxorubicin what with ❤️

A

Dilated cardiomyopathy

108
Q

What infections cause dilated cardiomyopathy

A

Coxsackie B virus

Chagas’ disease

109
Q

What systemic conditions cause dilated cardiomyopathy

A

Hemochromatosis
Sarcoidosis
Thyrotoxicosis
Wet beriberi

110
Q

Takotsubo cardiomyopathy

A

Broken ❤️syndrome

Stress cardiomyopathy

111
Q

Friedreich ataxia?

❤️?

A 
Difficulty walking.
Loss of sensation in arms, legs
Impaired speech 
Starts 5-15 years 
❤️ - hypertrophic cardiomyopathy
112
Q

Löffler endocarditis

A

Associate with hyper eosinophilic syndrome

Hydrology- eosinophilic infiltrates in myocardium

113
Q

Restrictive / infiltrative cardiomyopathy what cause?

A

Puppy LEASH

Postradiation fibrosis 
Loffler endocarditis 
Endocardial fibroelastosis 
Amyloidosis
Sarcoidosis 
Hemochromatosis
114
Q

Back triad

A

Cardiac tamponade
Hypertension
distended neck veins
distant heart sound

115
Q

Pulsus paradoxus

A

⬇️ in amplitude of systolic blood pressure by > 10 During inspiration

Pea COAT
Constrictive pericarditis
Obstructive pulmonary disease (Croup, Asthma, COPD, OSA, cardiac Tamponade)

116
Q

Symptoms of bacterial endocarditis

A

FROM JANE with ❤️

Fever
Roth spots (eye - white on retina surrounded by hemorrhage)
Osler nodes (ouchy raised lesions on the fingers or toe pads)
Janeway lesions (small painless Erythematos lesions on palm or sole)
Anemia
Nail-bed hemorrhage
Emboli

117
Q

Is culture is negative while bacterial endocarditis what culture is most likely to be

A

Coxiella burnetii

Bartonella

118
Q

S bovis

A

Colon cancer

119
Q

On prosthetic walls bacterial endocarditis what culture is most likely to be

A

S epidermidis

120
Q

Native valves bacterial endocarditis maybe do you to which organisms

A 
HÁČEK
HAEMOPHILUS
Aggregatibacter (actinobaccilus)
Cardiobacterium
Eikenella
Kingella
121
Q

Major criteria of rheumatic fever

A 
J❤️NES 
Joint - migratory polyarthritis
❤️carditis
Nodules  in skin subcutaneous
Erythema marginatum (evanescent rash with ring margin)
Sydenham chorea
122
Q

Aschoff bodies

A

Granuloma with giant cells in romantic fever

123
Q

Anitschow cells

A

Enlarged macrophages with ovoid wavy road like nucleus

124
Q

Blood test in rheumatic fever

A

⬆️ASO antistreptol

⬆️anti-DNase B titers

125
Q

Appearance of aorta in 3 syphilis

A

Tree bark - calcification and vasa vasorum disrupt

Can result in aneurysm of ascending A, aortic arch, A insufficiency

126
Q

Treatment for acute pericarditis

A

NSAIDs
Colchicine
Glucocorticoid
Dialysis - uremia

127
Q

Tuberous sclerosis

A

May cause no cancerous tumors in brain kidneys heart liver eyes lung skin

128
Q

Rhabdomyomas

A

In children
Benign
Hamartomatous growths

129
Q

Myxomas

A

Adults
IL-6 production symptoms (⬆️t, weight loss)
Tumor plop early diastole sound

Gelatinous material, myxoma cells immersed in glycosaminoglycans

130
Q

Kussmaul sign

A

⬆️ in JVP in inspiration instead of ⬇️

May be seen with constrictive pericarditis, restrictive cardiomyopathy, right heart failure, massive pulmonary embolism, right atrium or ventricular tumors

131
Q

Osler Weber Rendu syndrome

A

Hereditary hemorrhagic telangiectasia
AD
Twlangiectasias on skin, mucus M, recurrent epistaxis, skin discoloration, arteriovebous malformations, GI bleeding, hematuria

132
Q

Large vessel vasculitis

A

Giant (temporal) arteritis

Takayasu arteritis

133
Q

Medium vessel vasculitis

A 
Buerger d (thromboangiitis obliterans)
Kawasaki (mucocutaneus lymph nodes syndrome)
Polyarteritis nodosa
134
Q

Kawasaki

A 
Conjunctivitis
Rash
Erythema
Adenopathy
Mucous membranes - strawberry tongue, dry lips
135
Q

Kawasaki treatment

A

IV immunoglobulin

Aspirin

136
Q

What can cause polyarteritis nodosa

A

Hepatitis type B

137
Q

Polyarthritis nodosa treatment

A

Corticosteroids

Cyclophosphamide

138
Q

For the arthritis nodosum what’s wrong with Renal

A

Renal micro aneurysm - string of pearls

139
Q

Small vessels vasculitis

A

Becker syndrome
Cutaneous small vessels vasculitis
Eosinophilic geanulomatosis with polyangiitis (churg-strauss)
Granulomatosis with Polyangiitis (Wegenera)
Immunoglobulin a vasculitis
Microscopic polyangiitis
Mixed cryoglobulinemia

Pharma (3 decks)

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