Cardiology Flashcards
What is hemochromatosis?
Iron deposits in organs
Hyperpigmentation, Bronze DM, Arthritis
What murmur has water hammer pulse?
Aortic Regurgitation
What murmur has Pulsus Tardus?
Aortic Stenosis
What cardiomyopathy has Pulsus Alternans?
Dilated Cardiomyopathy
Regular-Irregular pulse
Premature Ventricular Contraction
What sound radiates to the axilla?
Mitral Regurgitation
What sound radiates to the back?
Pulmonic Stenosis
Boot shape on X-Ray
Right Ventricular Hypertrophy
Banana shape on X-Ray
Idiopathic Hypertrophic Sub-Aortic Stenosis (IHSS)
Egg shape on X-Ray
Transposition of the Great Vessels
Snowman shape on X-Ray
Total Anomalous Pulmonary Venous Return
“3” shape on X-Ray
Coarctation of the Aorta
Osler-Weber-Rendu
AV Malformation in Lung, GI, CNS
AVM sequestering platelets causes telangiectasias
Von Hippel-Lindau
AD Chr 3 Mut
Predisposition to RCC, AVM in head and retina
Holosystolic Murmurs
Tricuspid Regurgitation
Mitral Regurgitation
VSD
Diastolic Blowing Murmurs
Aortic Regurgitation
Pulmonic Regurgitation
Diastolic Rumbling Murmurs
Tricuspid Stenosis
Mitral Stenosis
Ejection Click
Aortic Stenosis
Pulmonic Stenosis
S2 Split Cause
Normal on inspiration
Pulmonic valve closing late
Wide Fixed S2 Split
ASD
Paradoxical S2 Split
Aortic Stenosis
LBBB
Cause of Transposition of Great Vessels
Aorticopulmonary Septum didn’t spiral
NCC migration problem
Drugs acting on RAAS
ACE Inhibitors
ARBs
ACE Inhibitor mechanism
Inhibits Ang I conversion to II
Indications for ACE inhibitors
HTN
CHF
Most-MI
Vasodilation
Adverse effects of ACE Inhibitors
Hyperkalemia
Cough
Angioedema
Fetal Renal Malformations (c/I Pregnancy)
Adverse effects of Losartan
Fetal Renal Toxicity
Hyperkalemia
Selective B1 blockers
Metoprolol
Atenolol
Acebutolol
Esmolol
B1 and B2 blockers
Propranolol
Timolol
A and B Blockers
Carvedilol
B-Blocker indications
HTN, Angina, MI, Anti-arrhythmic
Adverse effects of B blockers
Impotence, Asthma, Bradycardia, AV Block, HF, Sedation, Sleep Alterations
C/I w/ Non-DHP CCBs (Diltiazem, Verapamil)
Prazosin
A1 Blocker, Vasodilator, Decreases TPR
Used for Pheocromocytoma, HTN
Clonidine
A2 Agonist: Decreases TPR
HTN, Smoking / Cocaine / H withdrawl
AE: Dry Mouth, Rebound HTN w/ d/c
Methyldopa
A2 Agonist: Decreases TPR
Tx HTN
AE: Sedation, Hemolytic Anemia, +Coombs
Hexamethonium
Nicotinic Ganglion Blocker
Tx HTN Emergency
AE: HPTN, Blurred vision, Constipation, Sexual Dysfunction
Reserpine
Prevents monoamine storage into vesicle
Tx HTN
AE: Depression
Guanethidine
Interferes w/ NorEPI release
Tx Severe HTN
c/I w/ TCAs
Hydralazine
Increases cGMP: Vasodilators
Tx HTN (1st Line in Pregnancy)
AE: SLE, compensatory tach: c/I w/ angina/CAD
Minoxidil
K+ channel opener: SM relaxer
Tx Severe HTN
AE: Hyertrichosis, Pericardial Effusion
CCBs
Nifedipine and Verapamil
Tx HTN, Angina, Raynaud’s, Prinzmental
Verapamil for Arrhythmias
AE: Flushing, Dizziness, Edema, Cardiac Depression
Nitroprusside
NO blocker, Increasing cGMP: Vasodilatior
Tx HTN Emergency, CHF, Angina
AE: Cyanide Toxicity, HPTN, short acting
Diazoxide
K+ Channel Opener: SM relaxer
Tx HTN
AE: Hyperglycemia, HPTN
Niacin
Inhibits Lipolysis, reducing VLDL secretion
AE: flushing, aspirin, hyperglycemia, hyeruricemia
Bile Acid Resins
Cholestyramine, Colestipol, Colesevelam
Prevents intestinal reabsorption
Increases HDL, Decreases LDL
AE: Decreased ADEK, Cholesterol Stones
Ezetimibe
Cholesterol reabsorption at small Intestine: Decreases LDL
Fibrates
Upregulate LPL, TAG clearance
Strong decrease of TAGS
AE: Myositis, Hepatotoxicity, Cholesterol Gallstones
Digoxin MOA
Direct Na/K ATPASE inhibitor
Positive Inotrope
Stimulates Vagus N
AEs of Digoxin
Cholinergic
Increase PR, Decreased QT, Worsened RF
Digoxin toxicity treatment
Quinidine: displaces from tissue binding sites.
Nesiritide
Recombinant B-NP: Vasodilates b/c cGMP
Tx Acute Decompensated HF
AE: HPTN
IA Anti-Arrhythmics
Quinidine, Procainamide, Disopyramide
Na Channel Blockers
IA Anti-Arrhythmic indications
Increase AP, Increase effective refractory period, Increase QT, Affect reentrant and ectopic SVT and V Tach.
AE of IA Anti-Arrhythmics
Quinidine: Cinchonism
Procainamide: Torsades de Pointe
IB Anti-Arrhythmics
Lidocaine, Mexilitine, Phenytoin
Na Channel Blockers
Indications for IB’s
Decreased AP, Acute Ventricular Arrhythmias, Local Anesthesia
Ads of IB Anti-Arrhythmics
CNS Stimulation and Depression
CV Depression
Hyperkalemia Increases Toxicity
IC Anti-Arrhythmics
Flecainide, Encainide, Propafenone
Na Channel Blockers
IC Indications
V Tach progressing to V Fib
Last Resort
IC AEs
Prolonged refractory period in AV node
Hyperkalemia increases its toxicity
K+ Channel Blockers
Sotalol, Ibutilide, Bretylium, AMIODARONE
K+ Channel MOA
Increases AP duration, Effective refractory period, QT
Indications for K+ Channel Blocker
A Fib, A Flutter, V Tach
Ca Channel Blockers
Verapamil, Diltiazem
Decreases Conduction velocity of AV
Increases ERP an d PR interval
Tx SVT, prevent nodal arrhythmias
AE: CHF, AV Block, Flushing, Edema
Adenosine
Increases K Efflux: Hyperpolarizes cell
Dx and Tx AV Nodal Arrhythmias
Effects of K+ on the heart
Depresses ectopic pacemaker in Hypokalemia
Indications for Mg
Torsades and Digoxin toxicity
Ivabradine
Block Funny Na Channel
Negative Chronotrope
Tx chronic stable angina, HFREF
AE: Visual brightness
Treat A Fib w/ RVR
b-Blocker or CCB
Treat CHrEF
B-Blocker
Lab findings of Cardiogenic Shock
Increased SVR (trying to help the heart)
Decreased CO (Insult was to heart)
Increased RAP, PCWP (blood building up, can’t get out)
Lab findings of Distributive Shock
Decreased SVR (Whole system affected, vessels dilated)
Increased CO (trying to make up for dilation)
Decreased RAP, PCWP (heart pumping fast, not letting that much blood in at a time)
Lab findings of Hypovolemic Shock
Increased SVR (trying to make up for blood loss)
Decreased CO (not enough blood to pump)
Decreased RAP, PCWP (not enough blood to fill up heart)
Lab findings of Neurogenic Shock
Decreased SVR (nerves can’t pressurize system)
Decreased CO (nerves can’t activate heart)
Lab findings of Obstructive Shock
Increased SVR (Pressure building up from obstruction)
Decreased CO (can’t get anything out past the obstruction)
Where are CABG grafts taken from
Left internal thoracic
Second choice saphenous vein
Treat peripheral artery disease
Aspirin and a statin
Decrescendo Diastolic murmur at LSB
AR
Tx Bacterial meningitis
up to 50 yo: Coftriaxone and vanc
50 and older: Ceftriaxone, vanc, and ampicillin (for listeria)
B-blocker contraindications
Asthma
Cocaine (use Nitroprusside instead)
Diastolic blowing murmur
AV Regurg
Ejection Click
A/P stenosis
Aortic also has a paradoxical s2 split
Wide fixed split S2
ASD