Cardio Reminders! Flashcards
1
Q
von hippel Lindau disorder is a rare, autosomal ___ condition, characterized by capillary ____ in the ____ and/or ____, and well as congenital cysts and/or neoplasms in the kidney, liver and pancreas. Patients are also at increased risk for what?
A
VHL - rare, AD condition, characterized by capillary hemangioblastomas, in the retina or cerebellum as well as congenital cysts and/or neoplasms in the kidney, liver and pancreas. Patients are at increased risk for RCC
2
Q
Tuberous Sclerosis
Cysts in ___, ___ and ___. CNS involvement involvement manifests not as angiomatous lesions but as cortical and ____ hamartomas. TSC1 mutation is on Cr. _. TSC2 hematin is on Cr. _.
What are the features?
A
TS:
Cysts in pancreas, kidney and liver. Involvement manifests not as angiomatous lesions but as cortical and subependymal hamartomas.
TSC1 mutation on Cr. 9
TSC2 mutation on Cr. 16
HAMARTOMASSS
Hamatoma in CNS Angiofibromas Mitral Regurg Ash leaf spots Rhabdomyomas Tuberous Sclerosis autosomal dOminant Mental retardation renal Angiomyolipomas Shagreen patches Seizures Subependymal giant cell astrocytomas
3
Q
Heparin MOA?
A
Activatins antithrombin III, which inhibits thrombin formation
4
Q
Strep viridian’s synthesize dextran which bind to host endothelium when damaged. Dextran binds to ___
A
fibrin-platelet deposition
5
Q
Endothelial surface___ mediate binding of immune cells to endothelium, facilitated by expression of cell adhesion molecules on the surface of inflamed endothelium. Neutrophils are then able to bind and migrate between the endothelial cells, followed by monocytes and lymphocytes
A
glycoproteins (like P-selectin and E selection, CD34 and glycam1
6
Q
late systolic crescendo murmur with mid systolic click ?
A
MVP
7
Q
Holosystolic, high pitched blowing murmur?
A
MR/TR
8
Q
Cresc-Decresc systolic ejection murmur and soft S2
A
AS
9
Q
High iptched blowing, early diastolic murmur
A
AR
10
Q
Opening snap
A
MS
11
Q
In patients with MR, the most reliable auscultatory finding indicating a high ___ ___ (severe MR) and left ventricular overload is left sided__ gallop.
A
In patients with MR, the most reliable auscultatory finding indication a high volume overload and left ventricular overload is a left sided S3 gallop.
12
Q
__ __ composes the majority of the anterior surface o he heart and is at risk in penetrating trauma at the left sternal border.
A
right ventricle
13
Q
IVC - penetrating wound to the ___ to the immediate __ of the vertebral bodies could strike the IVC
A
A penetrating wound to the back of the immediate right of the VB would strike IVC
14
Q
A stab wound in the __th intercostal space at the ___ line could strike the left ventricle, but only after passing through the bulk of the __ __
A
A stab wound in the 4th intercostal space at the midclaviclar line could strike the left ventricle but only after passing through the bulk of the leftt lung
15
Q
B6 deficiency symptoms?
A
Cheilosis, stomatitis, glossitis, convulsions,, hyper irritability, peripheral neuropathy (deficiency induced by INH or OCP), sideroblastic anemias (due to impaired heme synthesis and iron excess).
16
Q
B2 deficiency?
A
angular cheilitis, stomatitis, glossitis, normocytic anemia, corneal vascularization.
17
Q
Down syndrome
A
endocardial cushion defect (osmium primum ASD, regurgitant atrioventricular valves)
18
Q
DiGeorge
A
TOF, interrupted aortic arch, no thymus
19
Q
Frederichs Ataxi
A
hypertrophic cardiomayopathy
20
Q
Kartageners
A
situs inversus
cilia are immotile due to a micro tubular dyne arm defect. Infertility occurs as a result.
21
Q
Marfan
A
Cystic medial necrosis (aortic dissection and aneurysm), MVP
22
Q
Tuberous Sclerosis
A
valvular obstruction due to cardiac rhabodymyoms
23
Q
Turners
A
Aortic coarctation, biscupspid aortic valve
24
Q
Friederich’s Ataxia - Fridrich is Frataxic, he’s your favorite frat brother, always staggering and falling, but has a sweet big heart.
A
Normally, frataxin encodes for frataxin iron binding protein. Staggering gait, frequent falls, nystagmus, dysarthria, DM, hypertrophic cardiomyopathy (cause of death) and kyphoscholiosis.
25
Frataxin encodes for which gene?
iron binding protein, important for mitochondrial function
26
What is the equation for CO?
CO = SV x HR
27
CO = rate of O2 consumption/ what?
CO = rat of O2 consumption / AV o2 content difference
28
Blood O2 content = (O2 binding capacity x % saturation) + ____
Blood O2 content = O2 binding capacity x %sat + idissolved O2
29
Respiratory quotient is the ratio fo CO2 to O2 across the alveolar membrane, and is used to estimate the metabolic ___. What is the normal value?
RQ is the ratio of CO2 to O2 across the alveolar membrane, and it used to estimate e the metabolic rate. What is the normal value? 0.8
30
wHAT IS THE FICK EQUATION
CO = Rate of O2 consumption/ Arterial blood O2 content = venous blood O2 content
31
Liver angiosarcoma cell marker?
Angiosarcoma - malignant tumor of endothelial origin.
CD31, which is PECAM - platelet endothelial cell adhesion molecule, which helps with transmigration in the inflammatory response. Associated with past arsenic exposure of PVC pipes. Presents with abdominal pain
32
DiGeorge Sydnrome is characterized by thymus aplasia and hypoPTism...and is associated with which three cardiac anomalies?
TOGV, TOF, and Truncus arterioss
33
What type of cardiac abnormalities are seen in patients with tuberous sclerosis?
Cardiac rhabdomyomas in ventricular walls and AV valves. Thy also get cutaneosus angiofibromas (adenoma sebaceous), CNS hamartomas and renal cysts.
34
A complete AV canal defect is comprised o what?
ASD, VSD, and common AV valve. It is associated with DS.
35
Anaphylaxis causes widespread venous and arteriolar ____ along with ___ capillary permeability and ___-spacing of fluids. This results in a serious drop in ____. Cardiac contractilityy also ___ as the body attempts to maintain blood pressure
Anaphylaxis causes widespread venous and arteriolar dilation along with increased capillary permeability and third spacing of fluids. This results in a serious drop in BP. Cardiac contractility also increases as the body attempts ot maintain bP.
36
MI causes a sharp __ in cardiac output due to loss of function of a zone of myocardium.
decrease
37
Tetrology of Fallot - PROVe
Pulmonary infundibular stenosis, RV hypertrophy, Overriding aorta, VSD
Systolic murmur harsh mid left upper sternal border
38
TAPVR
blood from both pulmonary and systemic venous systems flow into the right atrium, leading to right atrial and ventricular dilation.
39
Eisenmenger Syndrome - explain in three steps
1. ASD, VSD PDA causes left to right shunt.
2. Overtime, pulmonary vascular resistance increases leading to bidirectional flow.
3. Pulmonary vascular resistance continues to increase with eventual right to left shunt - EISEMENGER
40
__ __ __ is a small saclike structure in the left atrium that is particularly susceptible to thrombus formation. Approximatel 90% of left atrial thrombi are found within the LAA in patients with nonvalvula afibb. These lots can then systemically embolism and lead to stroke as in this patient.
LAA
41
__ __ __ thrombus can develop in patients with severe generalized LV systolic dysfunction or impaired regional apical wall motion in patients with prior myocardial infarction.
left ventricular apical
42
Primar pulmonar HTN CXR?
enlargement of pulmonary arteries and right ventricle
43
ARDS is always preceded by events such as sepsis, aspiration, pneumonia, or trauma and it results in endothelial injury and fluid leakage from capillaries. CXR shows what?
bilateral airspace opacification
44
ADHF CXR?
Perihilar alveolar edema, dyspnea, orthopnea, cephalization of pulmonary vasculature, cardiomegaly, loss of costophrenic angle, cariogenic pulmonary edema
45
Turners SYndrome
short statue, short thick neck, broad chest, shortened 4th metacarpals.
46
Complete AV canal, ASD and VSD are most common cardiac abnormalities in what?
DS
47
What type of splitting would you hear in ASD?
Fixed splitting of second heart sound
48
MS heart sound?
Mid diastolic, low pitched rumbling murmur that nay begin with an opening snap
49
How does ivabradine work?
It slows the rate of SAnode firing by selective inhibitor of funny sodium channels, thereby prolonging the slow depolarization has (phase 4). It is the only drug that slows HR (negative chronotyope) with no effect on cardiac contractility (inotrophy) or/and relaxation (lusitropy). It is used in certain patients with Chronic HF with reduced EF and persistent symptoms despite appropriate medial therpy/
50
late systolic murmur with mid systolic click.
MVP
51
SE of ivabradine?
luminous phenomenon/visual brightness, HTN and bradycardia
52
Chronic stable angina, in patients who cannot take BB. Chronic HF with reduced EF..give which drug?
ivabradine
53
Senile Amyloidosis - causes what typeof HF?
diastolic heart failure due to restrictive cardiomyopathy. Restrictive cardiomoyathy can be idiopathic or caused by infiltrative diseases (E.g. amyloidosis, sarcoidosis, hemochromatosis), radiation fibrosis, or endomyocardial fibrosis.
54
__ __ results from abnormal extracellular deposition of insoluble proteins such as monoclonal light chains (AL amyloidosis), mutation transthyretin (familial ATTR amyloisis), or wild type transthyretin (senile systemic amyloidosis) in myocardial tissue.
cardiac amyloidosis
55
Endomyocardial biopsy in cardiac amyloidosis reveals what?
cross sections of normal myocardial cells with other areas od myocardium infiltrated by an amorphous, and acellular pink material. Colored stain shows apple green birefringence under polarized light.
56
Cardiac myxomas - 80% originate where?
LA. LA myxoma can obstruct blood flow cross MV, resulting in syncope, and symptoms of HF. Endomyocardial biopsy reveals numerous bald stellate cells in a background of myxoid ground substance
57
Cardiac Sacroidsis can cause what types of myopathies?
restricted or dilated
| with conduction defects and atrial or ventricular arrhythmias. PRescenf o noncaseating granulomas containing giant cells
58
Chagas disease occurs secondary to __ ___ and is a common cause of myopericarditis and dilated cardiomyopathy. What does the microscopy biopsy show?
T. CRuzi
| multiple parasitic protozoa with myocardial fibers with a dense cellular infiltrate and myofiber destuction
59
Hemochromatosis leads to excess ion deposits in myocardium, and can lead to restrictive or dilated cardiomyopathy. How can u confirm the diagnosis?
Prussian blue stain
60
What are the normal cardiac pressures?
```
RA <5
RV = 25/5
PA = 25/10
LA <10
LV = 120/10
Aorta = 120/80
```
61
During normal cardiac cycle, central aortic pressure is ___ than right ventricular pressure during systole and diastole. Consequently, an intra-cardiac fistula between the aortic root and right ventricle will most likely demonstrate a __ to ___ cardiac shunt as blood continuously flows from the aortic root (high pressure of 120/80) to the right ventricle (low pressure 25/5)
During normal cardiac cycle, central aortic pressure is higher than right ventricular pressure during systole ad diastole. Consequently, an intra-cardiac fistula between the aortic root and right ventricle will most likely demonstrates a left to right shunt as blood continuously flows from the aoritc root (high pressure) to right ventricle (low pressure)
62
What type of studies can be done to see if a person has any cardiac shunt?
a bubble study!
63
Cryptogenic strokes are strokes with unknown etiology....usually they are due to which type of cardiac abnormalities?
ASD and PFO
64
Truncus arteriosis defct in what?
aorticopulmonary septum (neural crest cells)
65
PFO - defective what?
sputum primum is not pushed against septum secundum, causing INCOMPLETE FUSION
66
ASD - defective what?
aplasia of septum premium or septum second.
67
Name the familial hypercholesterolemia:
I - hyperchylomicronemia
II - familial hypercholesterolemia
III - dysbetalipoproteinemia
IV - hypertriglyceralemia
68
Type I familial cholesterolemia?
AR
Problem with:
Apoe-C (ApoC is on VLDL and activates LPL). Decreased LPL activity either way.
High TAG, chylomicrons and cholesterol.
Pancreaitiis, hepatosplengomegaly, xanthomas, NO INCRTEASED RISK FOR ATHEROSCLEROSIS. Creamy layer in supernatant
69
Type II hyper cholesterolemia?
AD
Problem with LDL receptors, or defective APoB100.
IIa: lots of LDL, and cholesterol
IIb: LDL, cholesterol and VLDL increased
Heterozygotes (1:500)
Cholesterol ~300
Homozygous (rare)
Cholesterol ~700
Accelerated atherosclerosis, may have MI before 20. corneal Marcus and tendon xanthoma (achilles)
70
Type III cholesteorlemia?
Problem with ApoE.
High chylomicrons and VLDL. Need APoE to clear chylomicrons and VLDL. Premature atherosclerosis, tuber eruptive xanthomas and palmar xanthomas
71
Type IV cholesterolemia?
Problems with overproduction of hepatic VLDL, High VLDL and TAG. Hypertrglycerolemia >1000. Can cause acute pancreatitis, related to insulin resistance.
72
SNoW DRoP?
Southern blot - DNA
Northern - RNA
Western - Protein
SW - DNA binding proteins
73
How can coronary arteries become more perfused during diastole?
Ventricular relaxation during diastole is accompanied by a decrease in intraventricular pressure that is larger than the decrease in aortic pressure, which allows for coronary perfusion. However, during systole, the intraventricular pressure that opposes coronary blood Flow is slightly higher than the aortic perfusion pressure. This limits myocardial perfusion during systole.
74
Down syndrome features? Cardiac murmur?
Protruding tongue, small ears, epicentral eye fold, palmar crease, harsh holosystolic murmur (ASD or VSD)
75
Gene deletion for: prader willi, criduchat, and digeroge>
PW: 15q
CDC: 5p
DIGeroge : 22p11q
76
Where are biventricular pacemakers placed
In atrioventricular groove
LV leads in biventricular pacemakers course through the coronary sinus wjhich resides in the AV groove on the posterior aspect of the heart.
77
Right and left main coronary arteries rise directly from where?
root of aortia
78
Left main coronary arteries divers into what?
LCX and LAD
79
In 85-95% of people, the RCA gives rise to which artery?
PDA.
80
PDA runs down the where and supplies what?
Runs down the posterior interventricular groove and supplies the posterior 1/3 of the interventricular septum and most of the inferior wall of the LV.
81
LAD supplies what?
anterior 2/3 of tehe IVS.
82
LCX supplies what?
lateral and posterior walls of the LV via obtuse marginal branches
83
MVP murmur? Why? What can help?
late systolic crescendo murmur with with mid-systolic click
Midsystolic click are the mitral leaflets closing together (it is delayed cuz they are loose and floppy). Late systolic crescendo murmur is because MR accompanies MVP. Squatting helps because it increases the LV return, and pulls the leaflets apart more so it helps to close the leaflets.
84
Holosystolic murmur heard at apex - what valvular defect?
MR
85
What is S3 gallop?
It is when there is too much fluid in the LA and subsequent increased left ventricular filling rate during mid diastole. . Can be due to MR.
86
MVP is caused by what?
Myxomatous degeneration.
87
THICKENED AND DEFORMED MITRAL VALVE CUSPS ARE FIXED ANATOMICAL LESIONS THAT TYPICALLY RESULT FROM WHAT?
CHRONIC RHEUMATIC HEART DISEASE
88
Mitral annuclae calcifications are what?
degeneratie calcific deposits in the fibrous ring of the MV, generally does not impair function. MAC is common in women older than 60, people with history of myxomatous degeneration, and people with chronically elevated LV pressure.
89
Chordae tendinae rupture can cuz what type of valvular lesions? how can it happen>
Mitral regurgitation. and ca be caused by bacterial endocarditis,
90
Atherosclerosis - most common to least common areas?
Abdominal (this is NOT MESENTERIC!) --> CORONARY --> POPLITEAL --> CAROTID
91
CONTINOUS MURMUR along with inspiration splitting of S2 is what?
PDA
92
do ASD's give continuous murmurs?
very very rarely! PDA and VSD do
93
Chronic AV shunt would increase CO because why?
increased sympathetic stimulation ot the heart , decreased TPR, and increased VR. It would also cause the VR curve to shift to the right because circulating blood volume is increased through renal retention of fluids and because venous pooling is reduced by increased sympathetic tone.
94
Which pericarditis causes slowly progressive dyspnea, ascites and peripheral edema?
constrictive pericardiits
95
Ligamentum arteriosis is what?
remnant of ductus arteriosisu
96
AS murmur?
systolic cresc-decresc. murmur best heard at the base of the hear with radiation to neck
97
What murmur can give a wide fixed split?
ASD
98
PDA - gives what type of murmur?
continuous flow murmur best heard at the left subclavian region.
99
VSD murmur?
low pitched holosytolic murmur at left sternal border. Accentuated by maneuvers that increased after load like handgrip maneuver.
100
Microemboli from valvular vegetations of bacterial endocarditis are most common non-cardiac cause of what?
subungal plinter hemorrhages.
101
FROM JANE mnemonic? Bacterial endocarditis
Fever, Roth spots ((round white spots around retina), Osler nodes (tender raised lesions of dfinger or toe pad). Murmur, Janeway lesions (painless erythematous lesions on palm or sole), Anemia, Nail bed hemorrhage, Emboli
102
leads II, III, avf?
inferior wall of left vnentricle infarction caused by RCA
103
Most important steps of prevention of central venous catheter infections?
1. Proper hand hygiene
FUll barrier precautions during insertion
Chlorhexidine skin disinfections
Avoidance of femoral insertion site
Removal of catheter when it is no longer needed
104
Which vein should u use for CVC? subclavian
subclavian or Internal jugular. NOT FEMORAL!
105
WHICH Drug should be used for acute MI?
beta blockers.
106
What are some contraindications of beta blockers?
people who have bradycardia, heart block, hypotension and overt heart failure (pulmonary edema). In addition. noncardioselevtive beta blockers (propranolol and nadolol) can trigger bronchospasm in patients with underlying obstructive lung disease (asthma, COPD), and should be avoided.
107
___ beta blockers (ABEAM) with predominant beta 1 receptor action (metoprolol, bisoprolo, nebivolol) are safe in patients with stable obstructive lung disease and are the drug of choice in these patients.
cardioselective
108
Combined beta and alpha receptors such as __ __ are also well tolerated and have been used in acute MI in patents with COPD
carvediolol and labetalol
109
Migratory thrombophlebitiss should raise suspicion for what?
CANCER
hypercoagulbilty is very common paraneoplastic syndrome seen more frequently in visceral adenocarcinomas of the pancreas, colon, and lung. Hyperocoaguliaity develops because adenocarcino,as produce a thromboplastin-like substance capable of causing chronic intravascular coagulations that ca disseminate and tend to migrate.
110
Trousseau Syndrome?
Migratory superficial thrombophlebitis - seen in visceral cancer.
111
Beliac Sprue is associated with that?
hemorrhagic diathesis. Malabsorption restyling from celiac sprue can result in Vitamin K deficiency.
112
is polycystic kidney disease associated with prothrombotic states?
no
113
Hyperthyroidism is associated with hyper coagulable states. Is there associations with venous thrombotic events?
no. it is reported that they can get cerebral venous thrombosis though.
114
Paraneoplasrtic syndrome of hypercoagulabiltiy may be seen in some patients with cancer, especially what?
adenocarcinomas of the pancreas, colon or lung.
115
Calmodulin is a calcium binding messenger protein that is present on all cells and mediates many of the regulatory effects of Ca++. It is important fo excitations-contraction coupling is which cells?
smooth muscle cells, which lack troponin, unlike cardiac and skeletal muscles. In cardiac isle, calmodulin is not directly involved inexcitation-contraction coupling. Rather, it helps regulate intracellular calcium activity and transcription factor signaling.
116
What is calmodulin role in cardiac muscle?
It helps regulate intracellular calcium activity an transcription factor signaling
117
Calcium effaces from cardiac cells prior to relaxation is primarily. mediated via what?
Na/Ca exchange pump and sarcoplasmic reticulum Ca-ATPase pump (SERCA)
118
Base of the heart vs apex? which one is on top?
base is on top! apex on bottom. AS murmurs are heard at "base"
119
Myxomatous degeneration of MV leaflets cause what?
MVP - non ejection click and mid to late systolic murmur of mitral regurgitation.
120
Infective endocarditis can lead to what valvular defect?
usually mitrval
121
AR sound?
high pitched blowing early diastolic descrendo murmur
122
Platelet rich thrombi - attached to mitrala valve indicative of what?
nonbacterial thrombotic endocarditis - Libman Sacks.
NBTE is associated with ADVANCED MALIGNANCY as well as chronic inflammatory disorders such as anti phospholipid syndrome, SLE, and DIC. NBTE often found in mutinous adenocarcinomas
123
NBTE is associated with which three things>?
SLE, malignancy (adenocarcinoma), and hyper coagulable states
124
In the event of interruption of bod flow, secondary to arterial occlusion, which organ is least vulnerable to infarction and why>
liver
dual blood supply from portal vein and hepatic artery. If hepatic artery gets occluded, portal venous supply and retrograde arterial flow through accessory vessels (e.g. inferior phrenic, adrenal, and intercostal) is typically sufficiency to sustain liver parenchyma. -
125
Spleen is vulnurable to infarction why?
because splenic artery is end-arterial
126
Kidney is vulnerable to infarction why?
end arterial blood supply. can last up to 30 minutes without blood (a little longer than spleen)
127
Organ susceptivity to infarction after occlusion is ranked from greatest to least:
CNS, myocardium, kidney, spleen and liver.
