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Step 1 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

hallmark of reversible cellular injury

A

swelling
ex: angina causes swelling of myocytes with 70% stenosis
subendocardial ischemia will produce ST depression
Swelling is due to failure to maintain ATP generation in hypoxic tissues therefore impaired Na/K ATPase function

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2
Q

incomplete occlusion of coronary artery

chest pain at rest

A

unstable angina

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3
Q

vasospasm of the coronary artery causing chest pain

A

prinzmetal variant angina

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4
Q

when does necrosis of the myocardium occur

A

> 20 min of occlusion of blood flow

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5
Q

When does ST elevation occur?

A

when there is damage to the entire wall of the myocardium => transmural infarct
Will see ST depression when it is subendocardial

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6
Q

What marker is helpful in determining another infarction occurring a few days following initial infarction?

A

CK-MB

troponin-I stays elevated for 7 days but CK-MB elevates within 4-6 hours and returns to normal level within 72 hrs.

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7
Q

CO2 produced/O2 consumed

A

Respiratory quotient (RQ) = 0.8

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8
Q

Which gas has a higher diffusion gradient in the alveolus: O2 or CO2?

A

O2
mixed venous O2 = 40 mm Hg; Alveolar PO2 = 100 mmHg
mixed venous CO2 = 46 mmHg; alveolar CO2 = 40 mmHg
BUT both gases diffuse at the same rate, because CO2 is 20x soluble in water than O2

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9
Q

How can volume depletion being assessed on physical exam?

A

Assess blood pressure while lying and standing. Normally blood pressure is compensated upon standing, but in volume depletion the blood pressure will drop due to decreased preload.

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10
Q

important buffering systems in the blood

A

bicarbonate and proteins (hemoglobin)

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11
Q

Apoptosis vs necrosis

A

Apoptosis is programmed cell death that “fine-tunes” cell populations. Necrosis is pathological and often the result of massive tissue destruction. Necrosis ultimately results in the spilling of cellular contents which invokes INFLAMMATION

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12
Q

3 layers of blood vessels (except capillaries)

A

tunica intima, tunica media, tunica adventitia

Note: the small vessels (vasa vasorum) that supply the large blood vessels with nutrients run through the adventitia

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13
Q

How much of the total blood volume do arteries contain?

A

12%

The small and large veins contain ~60% total blood volume (small veins having 45%)

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14
Q

Why does pulse pressure increase with age?

A

the amount of collagen in large arteries increases with age, decreasing the elasticity

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15
Q

major site for regulation of distribution of blood flow and arterial pressure regulation

A

arterioles

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16
Q

Why are capillaries not prone to rupture, but vena cavae can?

A

Capillaries have a small radius, and the vena cavae have a larger radius. The radius is what determines the wall tension.
LaPlace:
Tension ~ change in P x radius

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17
Q

What varies the strength of cardiac muscle cell contraction?

A

intracellular calcium concentration during cell activation
Depends upon the number of crossbridges
Note: skeletal muscle strength of contraction is controlled by changing the frequency of action potentials

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18
Q

What defines the ends of the sarcomere?

A

Z line

the Z line is composed of alpha-actin

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19
Q

parallel bundles of sarcomeres

A

myofibril

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20
Q

contain gap junctions (connexons) for electrical continuity and desmosomes (cadherin) for physical strength

A

intercalcated discs

21
Q

thin filaments are composed of

A

F-actin

22
Q

When is the heart muscle perfused?

A

During relaxation (diastole); the force of contraction impedes blood flow

23
Q

How does calcium ion trigger differ between skeletal muscle and cardiac muscle?

A

Cardiac muscle intracellular calcium comes from the SR (75%) and ECF (25%). Skeletal muscle only uses SR stores of calcium.

24
Q

How does intracellular calcium get expelled from the cell?

A

3 Na+-Ca2+ exchanger

25
Q

Pain of angina caused by?

A

narrowed CAs delivering less oxygenated blood to myocardium, resulting in anaerobic metabolism & production of lactic acid; decreased pH stimulates the pain receptors

26
Q

Why is the great saphenous vein used for CABG?

A

diameter similar to CA
easily dissected from lower limb
minimal branching

27
Q

Damage to one of the bundle branches of the RCA results in what?

A

timed contraction of the unaffected branch

late asynchronous contraction of the other ventricle

28
Q

coronary artery that supplies the right ventricle

A

right marginal

branch of RCA

29
Q

coronary artery that supplies the right atrium

A

RCA

30
Q

coronary artery that supplies most of the LA & LV as well as the IVS & AV bundles

A

LCA

31
Q

supplies the LA & LV

A

circumflex

32
Q

supplies and R & L ventricles, as well as the anterior 2/3 of the IVS

A

LAD

33
Q

main energy source for the heart

A

fatty acid oxidation
when energy levels are low, malonyl-CoA decreases, triggering FA uptake
Heart can metab ketones, but not the preferred source

34
Q

2 main hormones that influence energy metabolism in the heart:

A

catecholamines
insulin
Note: phosphorylation of cardiac isozyme PFK-2 is initiated by insulin

35
Q

balance of FA oxidation and glucose oxidation is regulated by

A

citrate

36
Q

late marker of MI

A

troponin T
elevated at 3-5 hrs; remains elevated for 5-10 days
Myoglobin is elevated within 2 hours of symptoms onset but is nonspecific.

37
Q

causes cardiomyopathy in teen years

A

mutations of phospholamban
Phospholamban association with SERCA2a controls rate of contraction. Decreased SERCA2a activity (mediation of calcium sequestration in the SR) increases relaxation time -> poor pumping action -> left heart failure

38
Q

rate-limiting step of cholesterol synthesis

A

HMG-CoA to mevalonate**
Enzyme: HMG-CoA reductase (requires 2 NADPH)
mevalonate produces isoprene units which condense to form squalene which cyclizes to form the steroid ring system
Note: most of cholesterol synthesis occurs in the liver

39
Q

Source of all carbons of cholesterol

A

acetyl CoA

40
Q

major function of HDL

A

transport of cholesterol to the liver
It also:
transfers ApoE (lipoprotein) and Apo CII to chylomicrons and VLDL

41
Q

When is it acceptable to give a small child aspirin?

A

Kawasaki disease
symps: rash on palms & soles, enlarged cervical lymph nodes, strawberry tongue
Risk of MI!!! involves the coronary arteries
self-limited disease

42
Q

Modifiable risk factors for atherosclerosis

A
  1. smoking
  2. diabetes
  3. hypercholesterolemia
  4. HTN
    Non-modifiable risk factors include: age, male gender, genetics
43
Q

Causes of hyaline arteriolosclerosis (note: small vessel!)

A
  1. long-standing benign HTN
  2. diabetes
    These patients gets chronic renal failure from glomerular scarring
44
Q

Type of arteriolosclerosis that results from malignant HTN

A

hyperplastic arteriolosclerosis
fibrinoid necrosis
See onion-skin appearance
get flea-bitten kidney from microhemorrhages

45
Q

causes calcification of the media of the medium arteries
not obstructive and not clinically signficant
might see this on mammography as an incidental finding

A

Monckeberg Medial Calcification

46
Q

Most common cause or aortic dissection

A

HTN
Most common cause of death: pericardial tamponade
Inherited CT disorders that can result in weakening of the media:
1. Marfan
2. Ehlers-Danlos

47
Q

complication of thoracic aneurysm

A

aortic valve insufficiency from ballooning of the aortic root

48
Q

Where does abdominal aortic aneurysm occur?

A

below the renal arteries but above the bifurcation of the aorta

Step 1 (19 decks)

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