Cardiology Flashcards
What does bulbus cordis ake?
Smooth part of left and right ventricles
What does primitive pulmonary vein make?
Smooth part of left atrium
What does left horn of sinus venosus make?
Coronary sinus
What does right horn of sinus venosus make?
Smooth part of right atrium
What does acidosis do to contractility?
Decreases it because you want circulation to go slower so you have more time for gas exchange
Why do you hear S4?
Because during the atrial kick, the atria must push blood into stiff left ventricle
What is the a wave of JVP?
Atrial contraction
What is the c wave of JVP?
RV contraction (closed tricuspid bulges into atrium)
What is the x descent of JVP?
Atrial relaxation and downward displacement of closed tricuspid valve during ventricular contraction
In what situation would you see absent x descent of JVP?
Tricuspid regurg
What is the v wave of JVP?
Increased right atrial pressure due to filling against closed valve
What is the y wave of JVP?
Passive blood flow from RA to RV
Which murmur do you see radiation to carotids?
Aortic stenosis
Which murmur do you see pulsus parvus et tardus (weak pulses and delayed)?
Aortic stenosis
Which murmur specifically increases on handgrip?
VSD (low-pitch holosystolic murmur)
Which murmur does MVP predispose?
Mitral regurgitation
What decreases the intensity of aortic regurgitation murmur?
Vasodilators
What is the diagnosis? Thickened leaflets, fibrous bridging and calcifications.
Rheumatic Heart Disease
What is the diagnosis? Large vegetations, leaflet perforation.
Infective Endocarditis
What is the speed of conduction slowest at AV node?
To allow for ventircular filling
Decrease in which ions predispose to torsades?
K, Mg (Treat with magnesium sulfate)
What is the inheritance pattern of Romano Ward Syndrome?
AD
What is the inheritance pattern of Jervell and Lange-Nielson Syndrome?
AR
What are the precipitating factors for atrial fibrillation?
Binge alcohol, cardiac sympathetic tone, pericardiits
Which of the AV blocks are symptomatic?
Mobitz Type II and 3rd Degree
Which AV block does Lyme Disease cause?
3rd Degree AV block
What is the recombinant form of BNP?
Nesiritide
What is the Cushing triad?
Hypertension, bardycardia, and respiratory depression
Which organ has largest arteriovenous O2 difference?
Heart
What is the major factor for determining autoregulation in skin?
Sympathetic stimulation - temperature control
Which way does the heart shunt blood normally in septal defects?
Left to right
What does adult type coarctation increase the risk for?
Ruptured intracranial aneurysms because of increased incidence of berry aneurysm
What are the risk factors for PDA?
Birth at high altitude (low O2 tension), mternal rubella infection, premature birth
Where is atherosclerosis most likely to develop?
Abdominal aorta then coronary artery
What is corneal steal syndrome?
Giving vasodilators (adenosine, dipyradimole) sends blood to normal vessels that have now dilated rather than the poststenotic region
What is Loefller Syndrome?
Endomyocardial fibrosis with a prominent eosinophilic infiltrate
What are painless, small erythematous lesions on palms and soles?
Janeway lesions
What are tender raised lesions on finger or toe pads?
Osler nodes
Who gets subacute infective endocardiis?
Previously diseased or congenitally abnormal valves
What causes nonbacterial endocarditis?
Malignancy, hypercoagulable, or lupus
What do people with rheumatic heart disease die from?
Myocarditis
What are granuloma with giant cells?
Aschoff bodies
What are enlarged macrophages with ovoid, wavy, rod-like nucleus?
Anitschkow cells
What is the triad for cardiac tamponade?
Hypotension, distended neck veins, and distant heart sounds
What do you see on EKG for cardiac tamponade?
Low voltage QRS and electrical alternans
What causes a “tree bark” appearance of the aorta?
Syphilitic heart disease?
What do you see pulsus paradoxus with?
Asthma, OSA, pericarditis, cardiac tamponade, croup
What looks like scattered cells within mucopolysaccharide stroma?
Myxoma
What is a glomus tumor?
Benign, painful, red-blue tumor under fingernails
What do glomus cells do?
Thermoregulate
Which tumor do women get post radical mastectomy?
Lymphangiosarcoma (lymphatic malignancy associated with persistent lymphedema)
What is a rare blood vessel malignancy see in head, neck, and breast areas usually in elderly on sun exposed areas?
Angiosarcoma
What cardiac drug causes hyperprolactinemia?
CCB
What is Fenoldopam?
D1 agonist that causes vaodilation –> decreases BP and increases natriuresis
What decreases cholesterol absorption at small intestine brush border?
Ezetimibe
How do fibrates work?
Upregulate LPL (Increased TG clearance); activate PPAR-alpha (increases HDL)
How does digoxin slow HR?
Activates vagus nerve
What drugs decreases digoxin clearance?
Verapamil, Amiodarone, and Quinidine
What does digoxin do to the QT segment?
Decreases it
What causes increased toxicity for all class I drugs?
Hyperkalemia
Which of the Class I drugs is for ischemic or depolarized purkinje/ventricular tissue?
Class IB; used especially most MI
Which Class I drug significantly increases refractory period?
Class IC
Which drug do you use for digitalis induced arrhythmias?
Class IB
What side effect does metoprolol cause?
Dyslipidemia
What side effects do you see with beta blockers?
Impotence, COPD/asthma exacerbation, CV effects (AV block, bradycardia, decompensated CHF), CNS (sedation, sleep alterations), masks hypoglycemia
What do you use for atrial fibrillation?
CCB or beta blockers
What are the side effects of CCBs?
Hypotension, constipation, flushing, edema, AV block, sinus node depression, CJF
What is 1st line for supraventricular tachycardia?
Adenosine
Which drugs prolong QRS to a greater extent at higher heart rates?
Class 1C
Why do you get janeway lesions in bacterial endocarditis?
Due to septic microemboli
What are the side effects of statins?
Hepatotoxicity and myositis
How would you improve forward flow: regurgitant flow ratio in mitral regurgitation?
Decrease afterload
What is ergonivine?
Vasoconstrictors that activates alpha and serotonin receptors; worsens spasms/chest pain/ST elevation in patients with existing spasms (such as prinzmetal)
What looks like a pedunculated mass with scattered cells with mucopolysaccharide stroma?
Myxoma
What determines the severity of mitral stenosis?
A2-OS time interval (decreased interval means greater stenosis since left atrial pressure rises closer to aortic)
What is the diagnosis? Renal fialure, toe gangrene, livedo reticularis after invasive vascular procedure.
Thromebolic disease (will see choelsterol crystals/emboli obstructing renal arteries)
What are the major side effects of Verapamil?
AV block, constipation, flushing, edema, CHF, SA depression
What is livedo reticularis?
Purple lace like discoloration due to obstruction
What are the side effects of digoxin?
Bradycardia, hyperkalemia, decreased QT, increased PR, blurry yellow vision
What do you use for isolated HTN?
Dihydropyridine CCB (amlodipine, nifedipine) and thiazides
When do you hear an ASD murmur?
Diastolic
When do you hear a VSD murmur?
Holosystolic
What does it mean when you see increased left ventricular and atrial diastolic pressures in rheumatic heart disease?
Both aortic and mitral valves are affected
What is posterior to the esophagus?
Descending aorta
What activates arginine to NO conversion?
Bradykinin, Ach, substance P, serotonin, shear forces
What is a normal right ventricular pressure?
25/5
What is a normal pulmonary artery pressure?
25/10
What is segmental thrombosing vasculitis associated with?
Buerger
What are the symptoms of Buerger?
Rayandus, claudication, gangrene, autoamputation, phlebitis, hypersensitivty to intradermal tobacco injection
What are the atrial pressures usually?
~10
What is the embryological problem with tetralogy of fallot, persistent truncus arteriosus, TGA?
Abnormal neural crest migration to truncus and bulbus cordis
What happens 10-14 days after MI
Granulation tissue made of type III collagen (eventually replaced by type 1)
Which of the Class I drugs are for ischemic myocardium?
Lidocaine, Mexiletene
What is hibernating myocardium?
It is when repetitive ischemia causes reversible but chronic loss of contraction (myocardial stunning is a less severe form)
What is ischemic preconditioning?
It is resistance to infarction because of repetitive non lethal ischemia
Why do you need nitrate free period?
To avoid tolerance developement
What causes hereditary HCM?
Mutation in beta myosin heavy chain
What lab value can you test for with large vessel vasculitises?
increased ESR
How does nitroglycerin affect preload?
Decreases it because they increase venous capacitance . This reduces myocardial work and oxygen demand which is benficial in agina
What are the complications of an MI for the lung?
Acute pulmonary edema, pulmonary venous HTN, transudate of plasma into lung interstitium and alveoli?
What plays the biggest role with Valsalva?
Rectus abdominus: its like going to the bathroom
What can varicose veins cause?
Skin ulcerations
What percentage of the lumen must be narrowed to see symptoms of angina? What about if at rest?
> 75%: symptoms of angina
>95%: symptoms at rest
What type of tissue do you se dystrophic calcification on?
Necrotic tissue
When do you see dystrophic calcification of aortic valve?
With age (due to damage from hemodyanamic stress over time)
How does age affect the aorta?
Causes it stiffen (increased isolated systolic BP)
What is the physiology of pulsus paradoxus?
Inspiration –> increased pulmonary vessel capacitance –> more blood storage –> less return to left heart –> dec systolic BP (>10)
Why do you see pulsus paradoxus in cardiac tamponade?
There is pressure around heart so septum bulges into left ventricle further decreasing systolic BP
What is syphilitic aneurysm?
Obliteration of vaso vasorum, intimal wrinkling and dilation
What is there a seropositivity for in polyarteritis nodosa?
HBV
What do you use for HTN in pregnancy?
Methyldopa + hydralazine; also labetolol, nifedipine
What is the MAP equation?
MAP = CO x TPR (if venous pressure severely increased then do MAP - RAP = CO x TPR)
What deposits with Henoch Scohnlein
IgA immune complexes
How do you tell lipofuscin from hemosiderin?
Prussian blue stain will show hemosiderin (iron deposits) –> hemochromatosis
How does NO cause smooth muscle cell relaxation?
Decreases MLCK so causes dephosphorylation or increases MLCP which also dephosphorylates
What is responsible for desynchronization of atria and ventricles?
AV node
What helps improve cyanosis in tetralogy?
Squatting (increases afterload so more blood shunted from left to right into pulmonary artery)
Where is the filter to prevent PE placed?
IVC
What causes thoracic aortic aneurysm?
Cystic medial degeneration from HTN or marfan’s or tertiary syphilis (obliterates vaso vasorum)
What causes abdominal aneurysm?
Atherosclerosis; seen MC in smoking males >50
Where is the least O2 content in the body?
Coronary sinus because it has pure venous blood; pulmonary has mixed
What is CAD related sudden cardiac death from?
Ventricular arrhythmias
What is the intimal injury response due to?
Smooth muscle cells that migrate to media and intima
What receptors does NE act on?
Alpha1, alpha2, beta1
What would you see with acute MR vs chronic MR?
Acute MR: acute pulmonary edema since no time for LA compliance to increase
Chronic MR: at risk for atrial fibrillation, thromboemboism
How does adenosine slow HR?
Affects phase 4 (it causes K+ efflux so hyperpolarizes which slows depolarization)
What TTX from puffer fish inhibit?
Vna
What does TEA inhibit?
Vk
Why do you see pulmonary HTN in CHF?
Impaired NO and increased endothelin production leading to vasoconstriction
What do you see deposition of in infective endocarditis?
Fibrin
What happens do cardiac cells during ischemia?
They swell because of increased calcium
What is myocyte efflux from cytoplasm caused by?
Na/Ca exchanger and Ca-ATPase (to get Ca into SR)
What does lipofuscin look liek?
Brown perinuclear cytoplasmic inclusions
What do you see with normal aging of the heart?
Sigmoid ventricular septum and decreased left ventricular chamber size, increased colalgen
What happens if you use CCB and beta blockers together?
Decrease HR and hypotension due to slow SA conduction
How do macrophages destabilize plaques?
Secreting metalloproteinases that break down collagen
What can kawasaki kids develop?
Coronary artery aneurysms, thrombosing
Which small vessel vasculitises have necrotizing granulomas?
Wegener’s, Churg-strauss
What causes mitral valve prolapse?
Myoxmatous degeneration or inherited CT disorders (marfan, ehler’s)
What is person with T2DM most likely to die from?
Coronary heart disease
Where do left ventricular leads in biventricular packemakers go through?
Coronary sinus (in atrioventricular groove on posterior aspect of heart)
How early can fatty streaks show up?
10 years old
What can you give in a hypovolemic state?
Saline (increases SV and CO)
What is a side effect of nitroprusside?
Cyanide toxicity
What do you see with pulmonary infarction?
Hemorrhaging due to dual blood supply
What can tricuspid endocarditis cause?
Septic emboli leading to pulmonary infarction
What do cardinal give rise to?
SVC
What does MVP predispose to?
Bacterial endocarditis
What is nonbacterial thrombotic endocardiits from?
Hypercoagulable state (marantic from circulating products of cancer)
Why do pregnant women get postural hypotension?
Baby compresses on IVC and decreases venous return
What could early onset MI due to atherosclerosis be from?
Familial hypercholesterolemai (defective LDL receptor expression) - Type II
How do valves look different between infective endocarditis and rheumatic heart disease?
Infective endocarditis: valves more friable and destructive
Rheumatic heart disease: fibrosed
How does hyaline arteriosclerosis stain?
Pink on H&E
What is hyaline arteriosclerosis seen with?
Essential HTN and DM; due to excessive ECM production by sMC and plasma stuff leakage across the endothelium
Where is there damage if trauma to aorta?
Aortic isthmus because it is tethered by ligamentum arteriosum and is therefore fixed and immovable
How to you treat beta blocker overdose?
Glucagon
How does carcinoid present?
Hypotension, diarrhea, flushing
Which of the nitrates has the greatest bioavailability?
Isosorbide dinitrate
What is the MC ASD?
Ostium secundum
What is the MC ASD in Down’s?
Ostium primum
What drug improves long term survival of CHF patients?
Aldosterone antagonists, ACE-Inhibitors because it prevents aldosterone mediated heart remodeling
Why are the side effects of hydralazine?
Tachycardia and fluid retention and sodium retention from reflexive B1 activation, lupus like syndrome
Which of the class I drugs has greatest Na channel binding strength?
1C > 1A > 1B
Which has greatest use dependence and what does that mean?
1C: it is slow to disassociate from Na channel so if heart starts beating faster than their effects intensify since there is less time in between AP to disassociate
Which has reverse use dependence?
Class III blockers (as HR slows, they show greater effect)
Which drugs cause increased risk for gallstones?
Bile acid resins and fibrates (increase cholesterol in bile)
How does nitroprusside work?
Arterial AND venodilator (reduces afterload and preload)
How does Digoxin slow HR?
Inhibits vagal tone (slows conduction through AV node and depression of SA node)
Which drug has a slow disassociation from the VNa channels and what does this mean?
Class IC and this means use dependence. They are slow to disassociate and so when the channel is activated again from resting they exert their effect.
Which drug quickly disassociates from Vna when it is in the resting state?
Class 1B
What do hepatocytes increase in response to statins?
LDL receptor density to increase uptake of circulating LDL to make more cholesterol
What is the problem that leads to development of Transposition of great vessels?
Failure to septate
What is constrictive pericarditis?
Chronic process that takes months-years to create tamponade.
How is digoxin cleared?
By the kidneys
What are the side effects of nitrates?
Hypotension, flushing, headache, reflex tachycardia
What are people with OSA at risk for?
Pulmonary HTN and resulting Right HF
To what do you want to prevent irreversible damage to when you fix an ASD?
Pulmonary vessels because they get damaged from HTN
What murmur is heard best in the lateral decubitus position?
Mitral stenosis
What causes syncope during coughing?
Syncope is due to transient decrease in BF to the brain. Coughing diminishes venous return which can reduce BF to the heart.
What antiarrhythmic/antihypertensive drug would cause bilateral interstitial infiltrate?
Amiodarone (remember it causes pulmonary fibrosis)
