Cardiology Flashcards
1
Q
Beta Blockers
A
slow AV conduction, increase PR interval
decrease cAMP, Ca currents
2
Q
Esmolol
A
very short acting
3
Q
Metoprolol side effect
A
dyslipidemia
4
Q
Nitroglycerin - molecular mechanism
A
NO –> increase cGMP –> decrease Ca/MLCK –> dephosphorylation –> SM relaxation (vasodilate!)
5
Q
Nitrates - sympomatic relief by
A
decrease cardiac preload/LV volume
6
Q
NO/Nitrates primarily work on
A
VEINS
7
Q
Nitrate with highest bioavailability
A
isosorbide mononitrate
8
Q
Beta Blockers affect preload/afterload
A
afterload
9
Q
Ca Channel blocker mechanisms
A
block L type channels
reduce muscle contractility
(slow diastolic depolarization)
10
Q
Digoxin side effects
A
N/V, blurry vision
ECG changes
hyperkalemia
11
Q
autoregulation of coronary blood flow
A
NO
12
Q
Causes of Pulsus Paradoxus
A
acute cardiac tamponade
constrictive pericarditis
restrictive cardiomyopathy
severe obstructive lung dz
13
Q
milrinone
A
vasodilation
14
Q
maintenace dose
A
Cpss x CL / bioavailability fraction
15
Q
cause of tetralogy of fallot
A
abnormal neural crest cell migration
16
Q
trauma affects
A
aortic arch rupture
17
Q
CO =
A
SV x HR
18
Q
MAP
A
CO x TPR
19
Q
preload
A
ventricular EDV
20
Q
Preload increases with
A
exercise
increased BV
sympathetics
21
Q
Afterload
A
mean arterial pressure
22
Q
venodilators
A
nitroglycerin
decrease preload
23
Q
vasodilators
A
hydralazine
decrease afterload
24
Q
EF =
A
SV / EDV
25
increase handgrip, murmur at LSB
VSD
26
Bicuspid Aortic Valve
aortic stenosis
27
Severe Aortic Stenosis
LV hypertrophy, reduced LV compliance
| decrease in LV preload
28
Mitral Stenosis Severity
S2 to opening snap interval
29
Ventricular Action Potential
```
Phase O - Na
1 - K influx
2 - Ca
3 - K efflux (close Ca channels)
4 - K permeability
```
30
Pacemaker Action Potential
0 - VG Ca channels open
3 - inactivate Ca channels, increase K efflux
4 - slow diastolic depolarization, inward Ca
31
heart rate determined by
slope of phase 4 in SA node
32
U wave
hypokalemia, bradycardia
33
Jervell and Lange-Nielsen syndrome
congenital long QT syndrome
defects in cardiac sodium or potassium channels
congenital sensorineural deafness
34
ANP
released in response to increase BV and atrial pressure
causes relaxation, decreased Na reabsorption
constricts efferent renal arterioles
dilates afferent renal arterioles
"escape from aldosterone"
35
PCWP
apprxoimation of LAP
36
LAD
anterior wall
| V1-4
37
LCX
lateral wall
| I, avL
38
RCA
inferior wall
| II, III, aVF
39
Causes of Dialted Cardiomyopathy
Alcohol, wet Beriberi, Coxsackie B, Cocaine, Chagas, Doxorubicin
hemochromatosis, peripartum
40
Causes of Hypertrophic Cardiomyopathy
AD/B myosin heavy chain mutation
| Friedreich's ataxia
41
Restricture Cardiomyopathy causes
sarcoidosis, amyloidosis, radiation, hemochromatosis,
endocardial fibroelastosis
Loffler's syndrome
42
Loffler's syndrome
eosinophilic infiltrate
43
Hypertrophic Cardiomyopathy treatment
B blocker
| Non -DHP Ca Channel Blocker
44
CHF - systolic
decrease in contractility
45
CHF - diastolic
inability of heart to relax to accomodate incoming blood during diastole
46
CHF ultimately causes
decrease CO
| inadequate O2 tissue delivery
47
Cellular Responses to CHF
increase RAS
| increase Sympathetic output
48
increase RAS
```
Na retention
Aldosterone
Vasoconstriction (increase afterload)
```
49
cardiac cath
advance right to left
50
A fib ventricular rate determined by
AV node refractory period
51
Chronic AV fistula
increase CO
| decrease TPR
52
V Wave
Mitral regurg
53
Biventricular pacemaker
RA, RV, LV
| LV -- soronary sinus/AV groove
54
fibrinous pericarditis
dressler's syndrome
uremia
radiation
55
serous pericarditis
viral
| non infections -- RA, SLE
56
purlent/suppurative pericarditis
bactieral infections (Pneumococcus, Streptocccus)
57
Cardiac Tamponade
increased JVD
distant heart sounds
pulsus paradoxus
58
scattered cells within a mucopolysacchride strome
myxoma
59
polyarteritis nodosa association
Hep B
60
Kawaski dz treatment
IV immunoglobulin and aspirin
61
Time after MI: 0-4 hrs
no change
62
Time after MI: 4-12 hrs
early coag necrosis
edema/hemorrhage
wavy fibers
63
Time after MI: 12-24 hrs
coag nec
| marginal contraction band necrosis
64
Time after MI: 1-5 d
coag nec
| neutrophilic infiltrate
65
Time after MI: 5-10d
macrophage phagocytosis of dead cells
66
Time after MI: 10-14 days
granulation tissue
| neovascularization
67
Time after MI: 2 wks - 2 months
collagen deposition
| scar formation
68
a
right atrial contraction
69
c
tricuspid valve during RV contraction
70
x
right atrial relaxation
71
v
inflow of venous blood
72
y
emptying of RA after TC valve opening
73
purpose of manuvers for PSVT
increase cardiac parasympathetic tone
74
cartoid sinus massage
prolong AV node refractory period
75
thiazide diuretics - side effects
hyper: uric, calcium, glycemia, lipidemia
| hypokalemia, hypotension
76
diet drugs
secondary pulmonary hypertension
77
supine hypotension
compressing IVC
decrease venous return
decrease preload
decrease CO
78
Ca and muscle types
skeletal is intracellular only
79
AcH, adenosine
during phase 4, decrease hr
80
golden yellow/brown cytoplasmic granules
think lipofuscin or hemosiderin
| hemosidern will stain blue/black
81
alveolar macrophages containing hemosidering
LSHF (heart failure cells)
82
Sotalol mofa
also has K channel blocking effects (increase QT interval)
83
Dobutamine
B adrenergic agonist (B1>B2)
| increases mycoardial oxygen consuption
84
increased myocardial oxygen consumption
+ chronotropic effect
85
electrical speed of heart
purkinje > atria > ventricle > AV node
86
coagulative necrosis
ischemic injury
87
liquefactive necrosis
bacterial infection
| cns infarcts
88
fat necrosis
acute pancreatitis
89
caseous necrosis
tb infection
90
Ebstein's anomaly
atrial displacement of tricuspid valve leaflets
| lithium in utero
91
Verpamil side effects
2nd and 3rd degree heart block
| contraindicated in pts with CHF
92
BAV associated with
Turners
93
Daptomycin
treatment for MRSA
depolarization of cellular membrane
myopathy/CPK elevation
inactivated by pulmonary surfactant
94
localized amyloidosis
due to natriuretic peptides
95
prostacyclin
inhibits platelet aggregation
96
Hibernating myocardium
decreasing energy metabolism but enough ATP to prevent contracture
also expression of TNF alpha, NOS
reverse with CABG or balloon angioplasty
97
plaque
lipid core
| fibromuscular cap
98
foam cells
oxidized lipids consumed by macrophages
99
prinzmetal angina
coronary artery vasospasm
100
primzmetal angina treatment
ng or CCB
101
aspirin/heparin after MI
limit thrombosis
102
supllemental O2 after MI
minimize ischemia
103
nitrates after MI
vasodilate veins and coronary arteries
104
B blocker after MI
slows HR
decrease O2 demand
decrease risk for arrythmia
105
ACEI after MI
decrease LV dilation
106
fibrinolysis/angioplasty after MI
opens blocked vessel
107
risk 4-24 hrs after MI
arrythmia
108
risk 1-3 days after MI
fibrinous pericarditis
109
risk months after MI
aneurysm
mural thrombosis
dresslers
110
Anitschkow cells
reactive histiocytes with slender, wavy nuclei
111
microangiopathic hemolytic anemia
aortic stenosis
112
s. viridans
previously damaged valves
113
s. aureus
iv drug use
114
s. epidermis
prostheitc valves
115
s. bovis
coldon cancer
116
negative blood cultures
haemophilius, actinobacillus, cardiobacterium, eikenella, kingella
117
metastasis to heart
breast and lung carcinoma
melanoma
lymphoma
118
TEE (anatomy)
anterior - LA
| posterior - descending aorta
119
Class IA
Disopyramide, Quinidine, Procainamide
Na
increase AP duration, Qt interval
120
Class IA Side Effects
thrombocytopenia, torsades
121
quinidine toxicity
tinnuitis
122
Class IB
Lidocaine, Tocainide, Mexiletine
decrese AP duration
best post MI
123
Class IC
flecainide, propafenone
contraindicated post MI and structural heart disease
signifcantly prolong refractory period in AV node
124
Class III
amodiarone, ibutilide, dofetilide, sotalol
| increase AP duration, increase QT interval
125
Amodiarone
has Class I, II, III, IV effects
| least chance of torsades
126
Class IV
verpamil, diltiazem
| increase PR interval
127
adenosine
increases K out of cells
128
adenosine can be blocked by
theophylline, caffine
129
Mg2+
effective in torsades
| digoxin toxicityc
130
carvedilol and HF
decreases mortality
131
patent foramen ovale
normal
| RAP >> LAP, paradoxical emboli
132
carcinoid heart disease
endocardial fibrosis, usually right sided
| 5HIAA in urine
133
Neseritide
form of BNP
134
paradoxical emboli
venous system --> arterial
(DVT --> stroke)
example: ASD
135
Coronary Steal Syndrome
coronary arteriolar vasodilation exacerbates ischemia by decreasing collateral blood flow
examples: adenosine, dipyramide
136
midsystolic click
MVP
137
indicator of severity of MR
S3 gallop
138
to maintain CO in AR...
increase LV preload
139
Beta blockers work on what type sof tissue
cardiac
| renal juxtaglomerular cells
140
atenolol
selective B1 antagonist
141
A fib treatment
1 - CCB, BB
| 2 - digoxin
142
Dopaminergic Receptor types
D1 - S
| D2 - i
143
saline for hypovolemic shock
increase intravascular volume and preload
144
Ergonovine test
prinzmetal angina/provokes chest pain
145
causes of acute LV failure
MI, severe htn, arrythmia, drug use
146
nitroprusside
balanced venous and arterial vasodilator
| decrease preload and afterload
147
beta blocker overdose
glucagona (increases cAMP)
148
ANP produced by ventricles
due to hypertrophy
149
CO calculation with O2
O2 consumption/ AV O2 difference
150
dystrophic calcification
cell necrosis
151
ASD consequences
pulmonary htn
152
diastolic hf and ef
normal ef
decrease ventricular compliance
increased LV EDP
153
increase in O2 sat from R atrium to ventricle
VSD
154
Class I Sodium Binding Strength
IC > A > B
155
arterial vasodilation leads to activation of
SNS
156
HCM LV outflow obstruction due to
mitral valve cusps and IV septum
157
ACE comes from
lung endothelium
158
irreversible myocardial cell injury path
mitochondrial vaculozation
159
drugs that act on proximal tubule
acetazolamide
160
drugs that act on descending limb
mannitol
161
drugs that act on thick ascending limb
loop diuretics/furesomide
162
drugs that act on DCT
thiazide
163
drugs that act on CT
na channel blockers/amiloride
| aldosterone receptor antagonists
164
Concentric LV hypertrophic
pressure
| AS, chronic HTN
165
Eccentric LV hypertrophy
volume overload
| AR, MR, MI, DCM
166
Kussmaul sign
paradoxical rise in JVP
| due to constrictive pericarditis
167
cyanosis in LE only
PDA
