Cardiology Flashcards
1
Q
What anomaly has tricuspid leaflets that are displaced inferiorly in to the RV, a hypoplastic RV and tricuspid regurgitation or stenosis?
A
Ebstein Anomaly
2
Q
What embryological anomaly is associated with maternal lithium use?
A
Ebstein anomaly
3
Q
With what anomaly can you see a dilated RA leading to increased risk of Supraventricular tachycardia and WPW?
A
Ebstein anomaly
4
Q
what’s the mnemonic for fetal erythropoiesis and what are the locations and times?
A
Young Liver Synthesizes Blood Yolk sac - 3-10 wks Liver - 6 wk to birth Spleen - 15 to 30 weeks Bone marrow - 22 wks to adult
5
Q
What’s the importance of the fact that fetal hemoglobin is a2g2 and adult hemoglobin is a2b2?
A
Gamma hemoglobin has decreased affinity for 2,3 DPG so fetal Hb has higher affinity for O2
6
Q
Name places where bone marrow hematopoiesis occurs in infancy and childhood?
A
- flat bones
- sternum, pelvis, ribs, cranial bones, vertebrae, long bones of the legs (tibia and femur)
7
Q
Name places where bone marrow hematopoiesis occurs in adulthood?
A
Axial skeleton
- vertebrae, sternum, ribs and pelvis
8
Q
In fetal circulation, what’s the force that directs blood through the ductus arteriosus and into the descending aorta?
A
Increased resistance in the pulmonary circulation
9
Q
Name the 3 shunts used in fetal circulation
A
- Foramen Ovale (bypasses lungs)
- Ductus arteriosus (bypasses lungs)
- ductus venosus (bypasses hepatic circulation)
10
Q
When a baby is born and takes first breath what causes the closure of the ductus arteriosus?
A
With the first breath, you get decreased resistance in the pulmonary vasculature leading to increased left atrial pressure vs right atrium. The increase in oxygen leads to a decreased in prostaglandins causing closure of ductus arteriosus
11
Q
What will keep a PDA open?
A
PGE1 or PGE2
12
Q
What will close a PDA?
A
NSAIDS like indomethacin
13
Q
what vessel in a fetus has the highest O2 content?
A
Umbilical vein
14
Q
How many umbilical arteries and veins are there?
A
2 umbilical arteries and one umbilical vein
15
Q
What does the umbilical vein become and where is it contained?
A
Becomes the ligamentum teres hepatis - contained in falciform ligament
16
Q
What does the umbilical arteries become?
A
Medial umbilical ligaments
17
Q
What does the allantois become?
A
Urachus - median umbilical ligament
The urachus is the part of the allantoic duct between the bladder and the umbilicus
18
Q
What does the notochord become?
A
nucleus pulposus of the intervertebral disc
19
Q
What is the mnemonic for the 8 branches of the external carotid artery?
A
Some Attendings Like Freaking Out Potential Medical Students
Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superficial temporal
20
Q
What artery supplies the right ventricle?
A
Acute marginal artery
21
Q
What artery supplies the posterior 1/3 of the interventricular septum and posterior walls of the ventricles?
A
Posterior descending/interventricular artery
This can branch off the RCA or Left circumflex artery
22
Q
What artery supplies the anterior 2/3 of the interventricular septum, anterior papillary muscle and anterior surface of the LV?
A
LAD
23
Q
What artery supplies the lateral and posterior walls of the LV?
A
Left circumflex artery
24
Q
What artery usually supplies the SA and AV nodes?
A
RCA
25
What is the number 1 most likely area of coronary artery occlusion?
LAD
Widow maker
26
During what phase of the cardiac cycle do coronary arteries fill?
During diastole
27
What is the most posterior portion of the heart and what is a complication you can get from its enlargement?
Left atrium, enlargement can lead to dysphagia or hoarseness
28
What is the easy equation for cardiac output?
CO = SV x HR
29
What is the fick principle equation for cardiac output?
CO = (rate of O2 consumed)/ (arterial O2 content - venous O2 content)
30
What is the equation for mean arterial pressure?
```
MAP = CO x TPR = QxR
MAP = 2/3 diastolic pressure + 1/3 systolic pressure
```
31
What is the equation for stroke volume?
SV = CO/HR = end diastolic volume - end systolic volume
32
What is the equation for pulse pressure?
pulse pressure = systolic pressure - diastolic pressure
33
what is the problem that occurs if the HR is too high?
Diastolic filling will be incomplete so your cardiac output will decrease
Ex: ventricular tachycardia
34
what's the difference between how cardiac output is maintained early in exercise vs later in exercise?
Early in exercise: CO is maintained by increased HR and increased SV
Late in exercise: CO is maintained by increased HR only because the SV plateaus
35
What is the term used for the harder the heart pumps, the more that is pushed out?
Contractility
36
Name the 3 cardiac output variables?
SV CAP
Stroke Volume is affected by: Contractility, Afterload, Preload
37
Name 4 things that INCREASE contractility and therefore stroke volume
1. increased intracellular calcium
2. decreased extracellular sodium
3. catecholamines (increase the activity of the calcium pump in the sarcoplasmic reticulum)
4. Digitalis (leads to both 1. and 2.)
38
Name 5 things that DECREASE contractility and therefore stroke volume
1. beta-1 blockers - result in decreased cAMP
2. heart failure
3. acidosis
4. hypoxia or hypercapnea
5. non-dihydropyridine CCB like verapamil
39
What is seen with stroke volume in an anxious exercising pregnant patient?
you see INCREASED stroke volume in anxiety, exercise, and pregnancy
40
What is another name for ventricular end diastolic volume?
Preload
When the ventricles are their fullest right before they contract then the atrial P is = to the central venous pressure
41
What is another name for the mean arterial pressure/TPR?
Afterload
42
name a vasodilator?
Hydralazine - decreases afterload
43
Name 3 things that increase preload
1. exercise slightly due to muscles contracting and pushing more blood up to the heart
2. increased blood volume
3. excitement - increased Sympathetics
44
What is the percent of ejection fraction normally?
greater than or equal to 55%
45
What is the equation of Ejection fraction?
EF = SV/EDV = (EDV - ESV) / EDV
46
What is ejection fraction an index for?
ventricular contractility
47
what is the equation for a change in pressure?
Change in pressure = flow x resistance = QxR
48
What vessels account for most of TPR?
arterioles
This regulates capillary flow
49
What is resistance directly and indirectly proportionate to?
Directly proportionate to viscosity and vessel length and inversely proportional to the radius to the 4th power
50
Name 3 things that cause increased viscosity and therefore increased resistance?
1. Polycythemia
2. hyperproeinemic states (like multiple myeloma)
3. hereditary spherocytosis
note that viscosity is decreased in anemia
51
What is the S1 sound?
Mitral and tricuspid valve closing - this is loudest at the mitral area
52
What is the S2 sound?
Aortic and pulmonary valve closing. Loudest at the left sternal border
53
WHat is the S3 sound? What is it associated with?
Heard early in diastole during rapid ventricular filling phase.
Associated with increased filling pressure like in mitral regurg or CHF and it's more common in dilated ventricles - but more normal in children and pregnant women
54
What is the S4 heart sound? What is it associated with?
Atrial kick - occurs in late diastole. High atrial pressure
| Associated with ventricular hypertrophy - the LA must push against a stiff LV wall
55
What does the a wave in jugular venous pulse (right heart) stand for?
Atrial contraction
56
What does the c wave in jugular venous pulse (right heart) stand for?
RV contraction - the closed tricuspid valve bulging into the atrium
57
What does the x descent in jugular venous pulse (right heart) stand for?
atrial relaxation and downward displacement of the closed tricuspid valve during ventricular contraction
58
What does the v wave in jugular venous pulse (right heart) stand for?
Increased right atrial pressure due to filling against a closed tricuspid valve
59
What does the y descent in jugular venous pulse (right heart) stand for?
blood flow from the RA to RV
60
What does the brief increased in pressure or dichrotic notch mean?
it's a brief reversal of flow from the aorta back into the LV which actually helps the aortic valve to close - it's due tot he elastic revoic of the semilunar valve and aorta
61
What are some diseases that may give you a jacked up dichrotic notch on a diagram?
Diseases that effect the elasticity of the aorta - Marfan syndrome or syphilis
62
What is seen in normal splitting?
In normal splitting, you have delayed closure of the pulmonic valve during inspiration so inspiration has a wider split between A2 and P2
63
What type of splitting is seen in delayed RV emptying (pulmonic stenosis, RBBB)?
Wide splitting
64
What type of splitting is seen in an atrial septal defect?
Fixed splitting
This occurs because regardless of whether you're breathing in or out the pulmonic closure is delayed because of the left to right shunt causing an increase in RA and RV volumes
65
What type of splitting is seen in conditions that delay LV emptying like in aortic stenosis or LBBB?
Paradoxical splitting
This occurs because the normal order of valve closures is reverse so P2 is heard before a delayed A2 sound. So on inspiration, P2 closes later and moves closer to A2 thereby "paradoxically" eliminating the split
66
A patient presents with a NSTEMI splitting of S2 that narrows with inspiration and audibly eliminates the split - what does the patient most likely have?
Paradoxical splitting - most likely due to a LBBB
67
Why can S3 be a normal sound heart in children and pregnancy?
Due to increased preload and blood flow and filling pressure
68
What heart sound can be heart in dilated cardiomyopathy, CHF, mitral regurgitation, or L to R shunting?
S3
69
What heart sound can be heard in hypertrophic cardiomyopathy? aortic stenosis? chronic HTN with LVH? Post MI?
S4
70
when a patient breathes in, does that decrease or increase the filling of the heart?
When a patient inspires, that drops the intrathoracic pressure and increases the venous return to the right side of the heart
71
what is the result of hand gripping?
increased afterload
72
What is the result of valsalva? and what causes a similar result?
Valsalva decreases venous return - so does standing
73
What is the result of rapid squatting?
Increased venous return, increased preload and you can get increased afterload with prolonged squatting
74
What maneuver will increase the intensity of hypertrophic cardiomyopathy murmurs?
Valsalva (decreased venous return)
75
An 18 yo man presents with a systolic murmur heart best at the apex which increases with standing and decreases with squatting - what is the murmur due to?
Hypertrophic cardiomyopathy
76
A patient presents with a systolic murmur that is loudest at the apex and radiates toward the axilla. what is it?
Mitral regurgitation
77
A patient presents with a systolic murmur that radiates tot he right sternal border what is it?
Tricuspid regurgitation
78
An infant presents with a holosystolic harsh-sounding murmur that's loudest at the triscupid area and is accentuated with a hand grip maneuver due to increased afterload - what is it?
A VSD
79
A patient presents with a systolic murmur following an ejection click. It's heart loudest at the heart base and it radiates to the carotids - what is it?
Aortic stenosis
80
A patient presents with pulsus parveus et tardus what is the systolic murmur?
Aortic stenosis
81
What can be a result of aortic stenosis?
SAD - syncope, angina, and dyspnea on exertion
82
A patient presents with a late systolic murmur with a mid systolic click - what is the murmur?
Mitral valve prolapse
83
What can myxomatous degeneration, rheumatic fever or chordae rupture all lead to?
Mitral valve prolapse
84
a patient presents with a high pitched blowing diastolic decrescendo murmur - what is the murmur?
Aortic regurgitation
85
A patient presents with a chronic aortic regurgitation murmur - what are some things you will see on PE?
you can see bounding pulses and heat bobbing. The murmur will worsen with hand grip and the intensity will decreased with vasodilators
86
Name 4 possible causes of aortic regurgitation?
1. aortic root dilation
2. bicuspid aortic valve
3. endocarditix
4. rheumatic fever
87
A patient presents with a diastolic murmur with an opening snap and low pitched rumbling - what is it?
Mitral stenosis
88
what is the most common cause of mitral stenosis?
rheumatic fever
89
what is a common cause of a PDA?
Congenital rubella
90
What causes the plateau during a cardiac muscle action potential?
The balance between calcium influx and potassium efflux
Myocyte contraction occurs here because you have the calcium coming in leading to calcium induced calcium release from the sarcoplasmic reticulum
91
What type of channels allow for spontaneous depolarization of the cardiac nodal cells?
If channels (funny current channels responsible for a slow mixed Na/K inward current)
92
what determines the heart rate in the SA node?
The slope of phase 4
93
what effect do acetylcholine and adenosine have on heart rate and the rate of diastolic depolarization?
Decreases both
94
What two things can cause a U wave to appear of EEG?
Hypokalemia or bradycardia
95
Name the speed of conduction from fastest to slowest?
Purkinje > atria > ventricles > AV nodes
96
What is the length of delay at the AV node and why is this important?
100 msec delay occurs at the AV node to allow for time for ventricular filling
97
What is the conduction pathway through the heart?
SA node to the atria to the AV node to the common bundle to the bundle branches to the purkinje fibers to the ventricles
98
What is the treatment for torsades de pointes?
magnesium sulfate
99
Name drugs that prolong the QT interval?
```
Macrolides
chloroquine
haloperidol
risperidone
methadone
anti-HIV protease inhibitors
antiarrhythmics class IA and III
```
100
A patient presents with congenital long QT syndrome and sensorineural deafness - what is the syndrome?
Jervell and Lange-Nielsen syndrome
101
Name the EKG: No discrete P waves in between irregularly spaced QRS complexes. can result in atrial stasis and lead to a stroke
Atrial fibrillation
102
What are some precipitating factors that can lead to atrial fibrillation?
1. binge alcohol consumption ("holiday heart syndrome")
2. increased cardiac sympathetic tone
3. pericarditis
103
A patient presents with atrial fibrillation - what determines the ventricular contraction here?
AV node refractory period
104
Name the EKG: A patient presents with a HR of 280bpm, EKG shows rapid succession of identical back to back atrial depolarization waves.
Atrial flutter
105
Name the EKG: Sawtooth appearance
Atrial flutter
106
What can be used for pharmacologic conversion to sinus rhythm for a pt with atrial flutter? for Rate control?
Class IA, IC or III anti-arrhythmics for conversion to sinus rhythm
Beta blocker or CCB for rate control
107
Name the EKG: A patient presents with a completely erratic rhythm with no identifiable waves. what is this and what do you do?
Ventricular fibrillation - this is fatal so you TX with immediate CPR and fibrillation
108
Name the EKG: PR interval is greater than 200 msec but the patient is asymptomatic
1st degree AV block
109
Name the EKG: A patient presents with a progressive lengthening of their PR interval until a beat is dropped, they are asymptomatic but have been taking a CCB.
2nd degree AV block - Mobitz type I - Wenckebach
110
What drugs can cause 2nd degree AV block - Mobitz type I - Wenckebach?
Anything that slows the signal through the AV node - digoxin, CCBs (verapamil>diltiazem), beta blockers, amiodarone, adenosine
111
Name the EKG: A patient presents with dropped beats that are not preceded by a change in the length of the PR interval - they are abrupt nonconducted P waves and it is a 2:1 block with 2 or more P waves to 1 QRS
2nd degree AV block - Mobitz type II
112
What is the concern with 2nd degree AV block - Mobitz type II and how do you treat it?
The concern is that it will develop into a 3rd degree block. Treated with a pacemaker often
113
Name the EKG: Atria and ventricles beat independently of each other. Atrial rate is faster than the ventricular rate.
3rd degree AV block
114
What can cause a 3rd degree AV block?
Lyme disease
115
How do you treat a 3rd degree AV block?
Pacemaker
116
what can be released from atrial myoctes in response to increased blood volume and atrial pressure?
Atrial natriuretic peptide
117
What does ANP result in ?
ANP causes generalized vascular relaxation (vasodilation) and decreased Na reabsorption at te medullary collecting tubules
118
What effect does ANP have at the kidneys?
Constricts efferent renal arterioles and dilates afferent arterioles (via cGMP) promoting diuresis and an escape from the aldosterone mechanism
119
If a patient has a premature ventricular contraction, what allows for this type of occurrence?
Usually due to microre-entry at the level of the purkinje fibers
120
Name the EKG: Shows delta waves
WPW
- may lead to supraventricular tachycardia
121
What do you use to treat wolff-parkinson-white?
Amiodarone or procainamide
122
What nerve and nucleus is used for the aortic arch receptors?
vagus nerve tot he solitary nucleus - responds to increased BP only
123
What nerve and nucleus is used for the carotid sinus receptors?
Glossopharyngeal nerve to solitary nucleus - responds to increased and decreased BP
124
What is the triad seen in a cushing reaction?
1. hypertension
2. bradycardia
3. respiratory depression
this is increased intracranial pressure
125
What stimulates peripheral chemoreceptors?
decreased PO2 (<60), Increased PCO2, decreased pH of blood
126
What stimulates the central chemoreceptors?
Changes in pH and PCO2 of brain interstitial fluid which are influenced by arterial CO2
127
which organ receives the largest blood flow (100% of CO)?
Lung
128
What organ has the largest share of the systemic CO?
liver
129
Which organ has the highest blood flow per gram of tissue?
Kidney
130
What is normal pulmonary capillary wedge pressure?
<12 mmHg
131
What is PCWP a good approximation of?
Left atrial pressure
132
What is the relationship between PCWP and LV diastolic pressure in mitral stenosis?
PCWP > LV diastolic pressure
133
What is the equation for net filtration pressure?
Pnet = (Pc - Pi) - (πc - πi)
134
What is the equation for net fluid flow?
Net fluid flow = Kf [(Pc - Pi) - (πc - πi)]
135
Describe Eisenmenger's syndrome
Uncorrected VSD, ASD or PDA causes compensatory pulmonary vascular hypertrophy which results in progressive pulmonary hypertension. As pulmonary resistance increases the shunt reverses from L-to-R to R-to-L which causes late cyanosis, clubbing and polycythemia
136
What is the cause of Tetralogy of Fallot and what mnecmonic helps you remember the findings?
Tetrology of fallot is caused by anterosuperior displacement of the infundibular septum.
Findings: PROV
1. Pulmonary infundibular stenosis --- MOST important determinant for prognosis
2. RVH = boot
3. Overriding aorta
4. VSD
137
what is the most important determinant for the prognosis in tetralogy of fallot?
Pulmonary infundibular stenosis
The pulmonary stenosis is what causes the VSD to be R to L instead of L to R which is why these kids get cyanotic
138
An infant is born to a diabetic mom - what congenital heart disease are they most likely to have?
Transposition of the great vessels
139
What is the cause of transposition of the great vessels
Failure of the aorticopulmonary septum to spiral
140
what murmur can result from a coarctation of the aorta?
Aortic regurgitation
141
What is the position of the coarctation in a patient with the infantile type of coarctation of the aorta?
Aortic stenosis proximal to the insertion of the ductus arteriosus
142
What is associated with an infant born with coarctation of the aorta?
Turner syndrome
143
What is the position of the coarctation in a patient with the adult type of coarctation of the aorta?
Stenosis is distal to ligamentum arteriosum
144
What is associated with an adult with coarctation of the aorta?
bicuspid aortic valve
145
What BP is considered hypertension?
greater than or equal to 140/90
146
What is a xanthelasma?
Xanthoma of the eye
147
What is a corneal arcus?
lipid deposit in the cornea
148
Name the Arteriosclerosis: Medial calcific sclerosis
Monckeberg arteriosclerosis
149
Name the Arteriosclerosis: Calcification in the media of the arteries - especially radial or ulnar.
Monckeberg arteriosclerosis
150
Name the Arteriosclerosis: Usually benign, "pipestem" arteries, does not obstruct blood flow and the intima is NOT involved. Commonly seen in elderly in the extremities
Monckeberg arteriosclerosis
151
Name the Arteriosclerosis: Thickening of the small arteries in essential hypertension or diabetes mellitus
Hyaline Arteriolosclerosis
152
Name the Arteriosclerosis: "onion skinning" in malignant hypertension
Hyperplastic Arteriolosclerosis
153
Name the Arteriosclerosis: Fibrous plaques and atheromas form in the intima of the artiers
Atherosclerosis
154
Name 4 modifiable risk factors for atherosclerosis
1. smoking
2, hypertension
3. hyperlipidemia
4. diabetes
155
What are the locations for atherosclerosis?
Abdominal aorta > coronary artery > popliteal artery > carotid artery
156
What is an abdominal aortic aneurysm associated with?
atherosclerosis
157
What is the patient profile for abdominal aortic aneurysm?
hypertensive male smoker >50 yo
158
What are the 3 associations with thoracic aortic aneurysm?
1. hypertension
2. cystic medial necrosis (marfan's syndrome)
3. tertiary syphilis
159
what is commonly seen on CXR of a patient with an aortic dissenction?
Mediastinal widening
160
With an aortic dissection, where is the blood ripping through and collecting?
Tunica media
161
What is the classic presentation seen with an aortic dissection?
Tearing chest pain that radiates tot he back
162
Describe a Stanford Type A aortic dissection?
Dissection involving the ascending aorta or aortic arch, regardless of how far down it goes --- emergency surgery!
163
Describe a Stanford Type B aortic dissection?
Descending aorta DISTAL to the left subclavian Artery --- medical treatment for type B --- beta blocker
164
What will you see on EKG with a patient with stable angina?
ST depression
165
What will you see on EKG with a patient with Prinzmeta's angina?
ST elevation of EKG
166
What will you see on EKG with a patient with unstable angina?
ST depression
167
What stage of an MI: Dark mottling is present with coagulative necrosis, edema and wavy fibers
4- 12 hr
168
What stage of an MI: Nothing seen on gross or light microscope
0-4 hr
169
What stage of an MI: Dark mottling with contraction bands from reperfusion injury
4-12 hr
170
What stage of an MI: beginning of neutrophil migration
4-12 hr
171
What stage of an MI: Hyperemia - red at the infarct. extensive coagulative necrosis with neutrophil migration
1-3 D
172
What stage of an MI: Risk of fibrinous pericarditis
1-3 D
| note that fibrinous pericarditis only occurs with a transmural infarct
173
What stage of an MI: Risk of arrhythmia
0 - 24 hr
174
What stage of an MI: Risk of Arrhythmia, CHF exacerbation, cardiogenic shock
0-4 hr
175
What stage of an MI: Yellow-tan softening, macrophage infiltrate
3-14 d
176
What stage of an MI: Granulation tissue at margins, hyperemic border
3-14 d
177
What stage of an MI: Risk of free wall rupture leading to tampnade, papillary muscle rupture, ventricular aneurysm, or intervetnricular septa rupture
3 - 14 d
178
What stage of an MI: Gray white scar
2 weeks to several months
179
What stage of an MI: Risk of dressler's syndrome
2 weeks to several months
180
Name the type of infarct: Increased necrosis, causes ST elevation of EKG and Q waves
Transmural infarct - involves the entire wall
181
Name the type of infarct: subendocardial especially vulnerable to ischemia, causes ST depression on EKG
Subendocardial infarcts - due to ischemic necrosis of <50% of ventricle wall
182
Autoimmune phenomenon resulting in fibrinous pericarditis several weeks post-MI, patient may have a fever and elevated ESR
Dressler's syndrome
183
What type of hypertrophy is seen in dilated cardiomyopathy?
eccentric - sarcomeres added in series
184
What is the most common type of cardiomyopathy?
Dilated
185
What are the possible causes of dilated cardiomyopathy?
Idiopathic mostly or ABCCCD-HP
```
chronic Alcohol abuse
wet Beriberi
Coxsackie B virus myocarditis
chronic Cocaine use
Chaga's disease
Doxorubicin toxicity
Hemochromatosis
peripartum cardiomyopathy
```
186
A patient presents with an S3 heart sound, a balloon appearance on chest X ray and a dilated heart on US - whats the DX?
dilated cardiomyopathy
187
What are the treatments for dilated cardiomyopathy?
Sodium restriction, ACE inhibitors, diuretics, digoxin, heart transplant
188
Which cardiomyopathy (ies) have systolic dysfunction?
Dilated cardiomyopathy
189
Which cardiomyopathy (ies) have diastolic dysfunction?
Hypertrophic cardiomyopathy and restrictive cardiomyopathy
190
A patient presents with a systolic murmur and syncopal episodes, they have hypertrophic cardiomyopathy - what is causing the above mentioned symptoms?
The hypertrophied interventricular septum is "too close" to the mitral valve leaflet leading to outflow tract obstruction
191
What familial autosomal dominant mutation can cause hypertrophic cardiomyopathy?
A mutation in the Beta-myosin heavy chain
192
What is hypertrophic cardiomyopathy associated with?
Friedrich's ataxia
193
A patient presents with a normal sized heart, the presence of an S4 sound, apical impulse that is large and diffuse and a systolic murmur - what is the cause?
Hypertrophic cardiomyopathy
194
What type of hypertrophy is seen in hypertrophic cardiomyopathy?
Asymmetric concentric hypertrophy - sarcomeres are added in parallel
195
What are the possible treatments for a patient with hypertrophic cardiomyopathy?
Beta blockers, non-dihydropyridine CCBs like verapamil
196
What are the possible causes of Restrictive/obliterative cardiomyopathy?
LEASH
```
Loffler's syndrome
Endocardial fibroelastosis
Amyloidosis
Sarcoidosis
Hemochromatosis (though this is more commonly causing dilated cardiomyopathy)
```
197
A child presents with a thick fibroelastic tissue in their endocardium and they have restrictive cardiomyopathy - what is this?
Endocardial fibroelastosis
198
What would cause an ISOLATED right heart failure?
Cor pulmonale
199
What symptoms are seen in left heart failure?
Pulmonary edema, paroxysmal nocturnal dyspnea (hemosiderin laden macrophages in the lungs)
orthopnea (shortness of breath when supine)
200
What symptoms are seen in right heart failure?
Hepatomegaly (nutmeg liver)
Peripheral edema
Jugular venous distension
201
What is a difference between infective and non-infective endocarditis?
Infective endocarditis tends to have vegetations on only one side of the valve
non-infective endocarditis tends to have vegetations on BOTH sides of the valve
202
What are the findings in a patient with bacterial endocarditis?
```
"FROM JANE"
Fever
Roth spots
Osler's nodes
Murmur
Janeway lesions (on palms or soles)
Anemia
Nail bed hemorrhages
Emboli
```
203
What bug causes acute bacterial endocarditis and what do the vegetations look like?
Staph aureus, large vegetations on previously normal valves
| has a rapid onset
204
What bug causes subacute bacterial endocarditis and what do the vegetations look like?
Viridans strep, smaller vegetations on abnormal valves
| - this is why you do Ab prophylaxis before dental procedures
205
What valve is commonly involved in bacterial endocarditis caused by IVDA?
Tricuspid valve
206
What valve is most commonly involved in bacterial endocarditis?
mitral valve
207
What bug should you think of when a patient with colorectal cancer gets bacterial endocarditis?
Strep bovis
208
What bug should you think when a patient with prosthetic valves gets bacterial endocarditis?
Staph epidermidis
209
A biopsy is done of a heart and Aschoff bodies are seen in the myocardium with Anitschkow cells - what did they die from?
Rheumatic fever
210
What criteria do you use to diagnose rheumatic fever?
JONES criteria need 2 major + 1 minor
```
Joints - migratory polyarthritis
Heart - pancarditis
Nodules - subcutaneous nodules
Erythema marginatum
Sydenham chorea
```
211
What causes rheumatic fever?
Recent infection with group A Beta hemolytic strep - you get molecular mimicry because the bacterial M protein resembles human tissue
212
What valve lesions are seen in acute vs chronic rheumatic fever?
Acute rheumatic fever - mitral regurgitation
| Chronic rheumatic fever - mitral stenosis
213
What type of hypersensitivity is rheumatic fever?
Type II HS - making antibodies to the M protein
214
A patient presents with the signs and symptoms of acute pericarditis but they also have a positive kussmaul sign - what is a kussmaul sign and what is the DX?
Kussmaul sign is a JVD with inspiration. They have chronic pericarditis
215
A patient presents with sharp pain that is aggravated with inspiration and relieved by sitting up and leaning forward. They also have a friction rub. What is the DX?
Acute pericarditis
216
What EKG findings can be seen with acute pericarditis?
Widespread ST segment elevation and/or PR depression
217
Name the acute pericarditis: Caused by dressler's syndrome, uremia, radiation. Presents with a loud friction rub
Fibrinous acute pericarditis
218
Name the acute pericarditis: Viral pericarditis that often resolves spontaneously or noninfectious inflammatory diseases ( RA or SLE)
Serous acute pericarditis
219
Name the acute pericarditis: Usually caused by bacterial infections - rare now with antibiotics
Suppurative/purulent acute pericarditis
220
Name the acute pericarditis: due to TB or melanoma
Hemorrhagic acute pericarditis
221
What triad is seen with pericardial tamponade?
Muffled heart sounds
Increased jugular venous pressure
profound hypertension
222
What is pulsus paradoxus?
decrease in amplitude of systolic blood pressure by greater than or equal to 10 mm Hg during inspiration.
223
Where is pulsus paradoxus seen?
severe cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, and croup
- whenever there's an exaggerated inspiration
224
A patient presents with equilibration of diastolic pressures in all 4 chambers and electrical alterans on EKG - what's the diagnosis?
Cardiac tamponade
225
What is seen in syphilitic heart disease?
Tertiary syphilis disrupts the vasa vasorum of the aorta with consequent atrophy of the vessel wall and dilation of the aorta and valve ring.
226
In what disease may you see calcification of the aortic root and ascending arch leading to a tree bark appearance of the aorta?
Syphilitic heart disease
227
What's the most common primary cardiac tumor in adults?
Myxoma
228
Where does a myxoma most commonly occur?
LA
229
What is the most common heart tumor overall?
Metastasis from melanoma, lymphoma
230
What is commonly seen in a patient with a myxoma?
syncopal episodes due to blockage of the mitral valve
231
What is the most frequent primary cardiac tumor in children?
Rhabdomyoma
232
What are Rhabdomyomas associated with in children?
Tuberous sclerosis
233
When is a kussmaul sign most commonly seen?
with a constrictive pericarditis
234
what is the name of decreased blood flow to the skin due to arteriolar vasopasm in response to cold temperature or emotional stress?
Raynaud's phenomenon
235
How do you distinguish between Raynaud syndrome and Raynaud disease?
Raynaud Syndrome is Secondary to a disease
Raynaud Disease is iDiopathic
236
what condition is associated with temporal giant cell arteritis?
Polymyalgia rheumatica
237
A 35 year old Asian female presents with a lack of pulses in her upper body, fever, nigh sweats, arthritis, mylagias, skin nodules and ocular disturbances - what does she have?
Takayasu's arteritis
238
What is the pathology seen in Takayasu arteritis?
Granulomatous thickening of the aortic arch and proximal vessels
239
Is temporal giant cell arteritis associated with granulomatous inflammation?
Yes, it's focal granulomatous inflammation
240
which medium vessel vasculitis involves the renal and visceral vessels but NOT the lungs?
Polyarteritis nodosa
241
What is a possible association with polyarteritis nodosa?
Hepatitis B or C or Hairy cell leukemia
242
Name the vasculitis: Immune complex mediated transmural inflammation of the arterial wall with fibrinoid necrosis. Shows many aneurysms and constrictions on arteriogram
Polyarteritis nodosa
243
Name the vasculitis: Treated by smoking cessation
Buerger's disease (thromboangiitis obliterans)
244
Name the vasculitis: segmental thrombosing vasculitis with intermittent claudications that may lead to gangrene, autoamputation of the digits and superficial nodular phlebitis. They may also present with Raynaud's phenomenon
Buerger's disease (thromboangiitis obliterans)
245
Name the vasculitis: A 2 year old Asian child presents with fever cervical lymphadenitis, conjunctival injection, changes in the lips/oral mucosa ("strawberry tongue"), hand-foot erythema, and desquamating rash
Kawasaki disease
246
Name the vasculitis: Necrotizing vasculitis with a fever for at least 5 days and 4/5 of CRASH (Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hands and feet)
Kawasaki disease
247
Name the vasculitis: Necrotizing vasculitis commonly involving the lung, kidnes, and skin with pauci-immune glomerulonephritis and palpable purpura
Microscopic polyangiitis
248
Name the vasculitis: NO granulomas, p-ANCA positive
Microscopic polyangiitis
249
Name the vasculitis: A patient has focal necrotizing vasculitis, necrotizing noncaseating granulomas in the lung and upper airway and necrotizing glomerulonephritis
Wegener's granulomatosis
250
Name the vasculitis: c-ANCA positive with a saddle nose
Wegener's granulomatosis
251
Name the vasculitis: Patient with painful mucosal ulcers and hematuria, hemoptysis and rapidly progressive (crescentic) glomerulonephritis
Wegener's granulomatosis
252
Name the vasculitis: A patient has asthma, sinusitis, palpable purpura and peripheral neuropathy. They are also p-ANCA positive
Churg-Strauss syndrome
253
Name the vasculitis: Granulomatous, necrotizing vasculitis with eosinophilia
Churg-Strauss syndrome
254
Name the vasculitis: most common childhood systemic vasculitis - often follows and Upper respiratory infection
Henoch-Schonlein purpura
255
Name the vasculitis: a kid presents with palpable purpura on the butt and legs, arthralgia, and abdominal pain
Henoch shonlein purpura
256
Name the vasculitis: Vasculitis secondary to IgA complex deposition
Henoch Schonlein purpura
| - this is a type 3 HS
257
Name the tumor: Benign capillary hemangioma of infancy. Appears in first few weeks of life, it grows rapidly but regresses spontaneously as a kid
Strawberry hemagioma
258
Name the tumor: Benign capillary hemangioma of the elderly. does not regress and the frequency increases with age
Cherry hemangioma
259
Name the tumor: Polypoid capillary hemagioma that can ulcerate and bleed. Associated with trauma and pregnancy
Pyogenic granuloma
260
Name the tumor: cavernous lymphangioma of the neck. Associated with turner syndrome
Cystic hygroma
261
Name the tumor: Benign, painful, red-blue tumor under the fingernails. Arises from modified smooth muscle cells of the glomus body
Glomus tumor
262
Name the tumor: Benign capillary skin papules found in AIDS patients. Caused by Bartonella henselae infections. Frequently mistaken for Kaposi's sarcoma
Bacillary angiomatosis
263
Name the tumor: Rare blood vessel malignancy typically occurring in the head, neck and breast areas. Associated with patients receiving prior radiation therapy, aggressive and difficult to treat
Angiosarcoma
264
Name the tumor: Lymphatic malignancy associated with persistent lemphedema
Lymphangiosarcoma
265
Name the tumor: Endothelial malignancy most commonly of the skin, but also mouth, GI tract and respiratory tract. Associated with HHV-8 and HIV
Kaposi's sarcoma
- this is often mistaken for bacillary angiomatosis
266
A patient has a port wine stain in the ophthalmic division of CN V what is the disease and what else is seen?
Sturge-Weber disease - describing a nevus flammeus
This is a congenital vascular disorder that affects capillary sized blood vessels. they can also have ipsilateral leptomaningeal angiomatosis, seizures and early onset glaucoma
267
What drug is first line therapy for hypertension in pregnancy?
Hydralazine with methyldopa
268
what is the number 1 drug used to treat lamignant hypertension?
Nitroprusside
269
How does hydralazine work?
Increasing cGMP leading to smooth muscle relaxation , vasodilates arteries
270
What is a side effect of using nitroprusside?
Can cause cyanide toxicity
271
What is Fenoldopam?
A drug to treat malignant hypertension
272
How does Fenoldopam work?
Dopamine D1 receptor agonist - causes coronary, peripheral , renal and splanchnic vasodilation
leads to decreased BP and increased natriuresis
273
Which lipid lowering agent inhibits the conversion of HMG-CoA to mevalonate, a cholesterol precursor?
Statins
274
How do statins work?
They inhibit HMG-CoA reductase
275
Which lipid lowering agent is a competitive inhibitr of mevalonate production?
Statins
276
Which lipid lowering agent has hepatotoxicity and rhabdomyolysis as side effects and can lead to myoglobinemia?
Statins
277
Which lipid lowering agent work to mostly decreased LDL?
Statins
278
Which lipid lowering agent inhibits lipolysis in adipose tissue?
Niacin
279
Which lipid lowering agent is the DOC for increasing HDL levels?
Niacin
280
Which lipid lowering agent reduces hepatic VLDL secretion into the circulation?
Niacin
281
Which lipid lowering agent can cause a red, flushed face and how do you stop this?
Niacin
| You can administer aspirin 30 min before or it will go away on its own with prolonged use
282
Which lipid lowering agent can cause hyperglycemia, acanthosis nigricans and hyperuricemia which can exacerbate gout?
Niacin
283
Which lipid lowering agent binds to clostridium difficile toxin?
Cholestyramine
284
Which lipid lowering agent prevents intestinal reabsorption of bile acids and so the liver must use cholesterol in order to make more?
Bile acid resins
285
Which lipid lowering agent do patients hate because it tastes bad and causes GI discomfort?
Bile acid resins
286
Which lipid lowering agent can decrease absorption of fat soluble vitamins?
Bile acid resins
287
Which lipid lowering agent Can lead to cholesterol gallstones?
Bile acid resins
288
Name 3 types of bile acid resins
Cholestyramine, colestipol, colesevelam
289
Which lipid lowering agent prevents cholesterol absorption at the small intestine brush border?
ezetimibe
290
Which lipid lowering agent rarely causes increased LFTs but can cause diarrhea?
Ezetimibe
291
Which lipid lowering agent mostly lowers triglycerides?
Fibrates
292
Which lipid lowering agent upregulates lipoprotein lipase leading to increased triglyceride clearance?
Fibrates
293
Which lipid lowering agent can caused myositis, hepatotoxicity and cholesterol gallstones?
Fibrates
294
Which two drugs should you not use in combination because they both cause hepatotoxicity?
Statins and fibrates
295
Name 4 types of fibrates
Gemfibrozil, clofibrate, bezafibrate, fenofibrate
296
What drugs can be used for Chronic CHF and are shown to improve survival?
ACE inhibitors
ARBs
Aldosterone antagonists
certain beta blockers - metoprolol, cervedilol, bisoprolol
297
What drugs can be used for chronic CHF symptoms but are NOT shown to improve survival?
diuretics esp loops - furosemide
digoxin
vasodilators like hydralazine or nitrates
298
What drugs should you use for Acute decompensated CHF?
"NO LIP"
```
Nitrates
Oxygen
Loop diuretics
Inotropic drugs like dobutamine or phosphodiesterase inhibitors
Positioning
```
299
What are the classes for antiarrhythmics?
```
"No Bad Boy Keeps Clean"
Class I: Na channel blockers
Class II: Beta Blockers
Class III: K+ channel blockers
Class IV - Ca 2+ channel blockers
```
300
what drugs are included in Class IA antiarrhythmics?
"Double Quarter Pounder"
| Disopyramide, Quinidine, Procainamide (IV)
301
Which Class IA antiarrhythmics can cause lupus like syndrome?
Procainamide
302
what drugs are included in Class IB antiarrhythmics?
"Mayo Lettuce Tomato"
| Mexiletine, Lidocaine, Tocainide
303
What drug should be used in WPW syndrome?
Procainamide
304
Which class of drugs increase the QT interval, affect both atrial and ventricular arrhythmias, especially reentrant and ectopic supraventricular and ventricular tachycardia?
Class IA antiarrhythmics
305
what drugs are included in Class IC antiarrhythmics?
"Fries Please"
| Flecainde, Propafenone
306
What class of drugs are useful in acute ventricular arrhythmias (especially post MI) and in digitalis induced arrhythmias?
Class IB
307
what drugs are included in Class II antiarrhythmics?
Beta blockers like Metoprolol, propranolol, esmolol, atenolol or timolol
308
How do Class II antiarrhythmics work?
Decreases the SA and AV nodal activity by decreasing cAMP and decreasing calcium currents
309
Which slope do Class II antiarrhythmics decrease?
Slope of phase 4
310
When are class II antiarrhythmics useful?
ventricular tachycardia, SVT, slowing ventricular rate during atrial fibrillation and atrial flutter
311
Which beta blocker can cause dyslipidemia as a toxicity?
Metoprolol
312
Which beta blocker can exacerbate vasospasm in Prinzmeta's angina?
Propanolol
313
How should you treat beta blocker overdose?
With glucagon
314
what drugs are included in Class III antiarrhythmics?
K+ channel blockers - "AIDS"
Amiodarone
Ibutilide, Dofetilide, Sotalol
315
which antiarrhythmic has class I, II, III, and IV effects because it alters the lipid membrane?
Amiodarone
316
What should you check when using amiodarone?
PFTs, LFTs, TFTs
amiodarone can cause pulmonary fibrosis, hepatotoxicity, hypo/er thyroidism, corneal deposits, skin deposits resulting in photodermatitis, neurologic effects, constipation and cardiovascular effects
317
What phase do class III antiarrhythmics work at?
Phase 3
318
what drugs are included in Class IV antiarrhythmics?
Nondihydropyridine CCBs - verapamil, diltiazem
319
Where do Class IV antiarrhythmics work?
they decreased the slope of phase 0
320
what is the mechanism of Class IV antiarrhythmics?
Decrease conduction velocity, increase the effective refractory period, increase the PR interval
321
what is the use of Class IV antiarrhythmics?
used in prevention of nodal arrhythmias like SVT
322
what is the toxicity of Class IV antiarrhythmics?
Constipation, flushing, edema, CV effects
323
When can Mg2+ be an effective treatment?
in Torsades de pointes and digoxin toxicity
324
What is the MOA of adenosine?
increases K+ out of cells leading to hyperpolarizing the cell and decreased calcium influx
325
What is the drug of choice in diagnosing/abolishing supraventricular tachycardia?
Adenosine
very short acting (15s)
326
What are the SE of adenosine?
flushing, hypotension, chest pain
327
What can block the affects of adenosine?
Theophylline and caffeine
328
What is Atropine used to treat?
Sinus bradycardia
329
What are the findings in a patient with ASD?
Loud S1 and wide, fixed split S2
