Cardiology Flashcards
Tetralogy of Fallot results from and what are the 4 signs
Anterior and cephalad deviation of infundibular septum
- right ventricular hypertrophy
- ventricular septal defect
- overriding aorta
- pulmonary stenosis
The _______ composes most of the hearts anterior surface
Right ventricle
The middle meningeal artery is a branch of the _______ artery where the ______, ________, ______, and _______ bones meet
Maxillary artery, frontal, parietal, temporal, sphenoid bones meet
Patients who overdose on beta blockers should be treated with ____
Glucagon that stimulates cAMP in myocytes
The ________ is derived from the common cardinal veins
Superior vena cava
Fibrates activate ________ which leads to decreased _________ production and increased _________ activity
PPAR Alpha, hepatic VLDL production, lipoprotein lipase
AV shunts _______ preload and _______ afterload
Increase, decrease
Pulsus pardoxus is commonly seen in
Pericarditis
- is a dec in systolic blood pressure more than 10mmHg with inspiration
________ and _________ are the most common causes of pulsus paradoxus in the absence of pericardial disease. And how are they treated
Asthma and COPD
-a beta agonist that INC cAMP
____________ is the most common cause of sudden cardiac death in the first 48 hours after acute MI
Ventricular fibrillation
_________ (what group of diuretics) improve survival in patients with congestive heart failure and reduced LVEF
Mineralocorticoids : spironolactone, eplerenone
With exercise you see a _________ in total systemic vascular resistance
Decrease
Coronary ______ dilation is affected in coronary steal syndrome
Arteriolar
Endocarditis leading to a intracardiac fistula between aortic root and right ventricle has a ____ shunt continuously
Left to right shunt because pressure in the aorta is always higher than the right ventricle
Kawasaki is a ______ size vasculitis that presents with bilateral ______, ________, _________. __________ are a serious complication
Medium, bilateral conjunctivitis, Cervical LAD, mucocutaneous (bright red tongue and cracked lips). At high right for coronary artery aneurysm
Hypertrophic cardiomyopathy is associated with a mutation in
Beta myosin heavy chain and myosin binding protein C
_________ leads to bounding femoral pulses and carotid pulsation that are accompanied by head bobbing
Aortic regurgitation
________ vacuolization is a sign of irreversible myocyte damage
Mitochondrial, signifies that mitochondria can’t generate ATP
What is a severe complication of giant cell arteritis and why must you start steroid IMMEDIATELY?
b/c can get ischemic optic neuropathy from ophthalmic artery occlusion
aortic dissections from the descending aorta typically originate in the ______
subclavian artery
aortic dissections from the ascending aorta typically originate in the
sinotubular junction
The most common cause of aortic stenosis is __________ of the aortic valve
degenerative calcification
-calcification is from cell necrosis
Dilated cardiomyopathy presents with an ____ sound and what is it a result of. When do you hear it?
S3, results from blood sloshing against dilated ventricular walls during early diastole, after early diastole S2
__________ is the cause of death in 2/3rds of pts. with an acute aortic dissection
pericardial tamponade (rupture of the dissection into pericardial space)
Marfan syndrome causes dilatation of aortic root–>____________ murmur. It is a defect in ______ on car ____
decrescendo diastolic, fibrillin, 15
Be careful with what patients when using nonselective beta blockers
asthmatics,
-NPZ: nadolol, pindolol, propanolol, timolol
Low QRS complexes and oscillating cardiac amplitudes leads to ___________
cardiac tamponade
ST elevations and PR depression leads to ___________
acute pericarditis
Valsalva maneuver _____ thoracic pressure so it ____ venous return to the heart leading to a ______ end diastolic volume and ____ preload
inc, dec, dec, dec
Hand grip maneuver ____ after load
increases
Squatting ____ venomous return/preload
increases
Which two murmurs inc with valsalva
HCM and MVP(mid systolic click)
What vasculitis presents as “pulseless disease”? What size arteries does it affect?
takayasu, medium/large
_______ is a major complication of MI after 24 hours and if epinephrine doesn’t help, give ________, which is associated with what side effect
Ventricular fibrillation, amiodarone, pulmonary fibrosis
-don’t forget VFib is an arrhythmia
Classic triad of tuberous sclerosis is
seizures, intellectual disability, facial angiofibromas(kinda like acne looking), rhabdomyoma(50% pts)
In exercise, there is a ______ in total peripheral resistance
dec
Compare speed of conduction: AV node, bundle of His, Purkinje system
Purkinje system>Bundle of His>AV node
fastest to slowest
baroreceptors: aortic arch transmits via ____ nerve to ___________ of the medulla
vagus, solitary nucleus
baroreceptors: carotid sinus transmits via ______ nerve to solitary nucleus of the ________.
glossopharyngeal, medulla
in response to hypotension, baroreceptors ______ afferent firing and this leads to ________ sympathetic efferent firing
dec, inc
peripheral chemoreceptors respond to __ PO2, ___PCO2, __ pH of blood
dec, inc, dec
central chemoreceptors respond to ____ and _____ but not directly to ___
PCO2 and pH of brain interstitial fluid, PO2
what is pulsus paradoxus? What is it associated with?
systolic blood pressure that drops >10 during inspiration
-cardiac tamponade (air, blood, other fluid entering pericardial sac)
A positive inotropic agent causes inc ________ of the heart–>___ stroke volume, ____ CO
contractility, inc, inc
__________ has Ashcoff bodies
rheumatic heart disease
Buerger disease is primarily from _________ and can present with gangrene and Raynaunds
SMOKING
_________ can lead to a paradoxical embolus that leads to a stroke
atrial septal defect
The lungs overly most of the anterior part of the _______. A lateral stab wound at 5th rib would injure the ______ and a stab more medial would injure the ______
heart, lungs, left ventricle
beta blockers decrease _____ nodal conduction. So they affect what part of EKG the most? This interval is a measure of the beginning of ________ to the beginning of _________. The longer this interval, the longer conduction takes throughout the heart
AV, PR interval, atrial depolarization, ventricular depolarization
A widened pulse pressure is associated with bounding pulses and head bobbing and is seen in what condition?
aortic regurgitation
The electrical impulses in the myocardium are normally generated by the ______ node. When dysfunction occurs the _____ can take over but has a _______ heart rate and dyscynchronicity
SA, AV, decreased
- SA node: typ 60-100 bpm
- AV node: 45-55bpm
__________ arteriosclerosis can be caused by __________ and shows onion like concentric thickening
hyperplastic, malignant HTN
_________ arteriosclerosis shows homogenous deposition of acellular(hyaline) in the ____ and ____ of small arteries
hyaline, intima, media
Carotid sinus massage leads to inc ______ tone and temporary inhibition of _____ node activity—> prolonging _____ node refractory period. It is useful in terminating ___________ tachycardia
parasympathetic, SA, AV, paroxysmal supra ventricular
In hypertrophic cardiomyopathy, dynamic left ventricular outflow obstruction is because of which two changes in the heart
abnormal systolic anterior movement of the anterior leaflet of the mitral valve toward a hypertrophied inter ventricular septum
For HCM, maneuvers that ____ preload result in inc murmur intensity
dec
maneuvers that dec preload
valsalva, nitroglycerin, sudden standing
maneuvers that inc preload
squatting, sustained hand grip, passive leg raise
Wolf parkinson white is from a
another AV conduction tract bypassing the AV node
_________ is triggered by rapid electrical impulses originating in the pulmonary veins
Atrial fibrillation
_________ is caused by reentrant current that rotates around tricuspid annulus
atrial flutter
In mitral regurgitation, _______ is the best indicator of severity, it is associated with?
S3, regurgitant blood flow from the left ventricle back to the left atrium during systole–> inc blood in LV during diastole
In acute mitral regurgitation from chordal rupture, how are preload, after load, LVEF
preload increases as LV has to deal with more regurgitant blood flow=inc end diastolic volume and after load dec as the incompetent mitral valve provides low resistance
Combined use of _____ and beta blockers can lead to additive negative _______ effects yielding severe ______ and _______
non-dihydropyridine (verapamil, diltiazem), chronotropic, bradycardia, hypotension
-also cholinergic agonists, digoxin, amiodarone, sotalol,
Patients with _________ are at increased risk of cerebral aneurysm, left ventricular failure, intracranial hemorrhage
adult type coarctation of the aorta
ionotropy
contractility
chronotrophy
heart rate
Atrial fibrillation is associated with inc risk of thrombotic events. What is the most common site of thrombus formation
left atrial appendage
Major side effects of Calcium channel blockers are?
peripheral edema, dizziness, lightheadedness
- amlodipine
- nifedipine
Milrinone is a _________ inhibitor that leads to inc ______ levels—>
phosphodiesterase (PDE3), cAMP, inc cardiac contractility, vasodilation in smooth muscle cells
Consolidation in the right middle lobe of lung can lead to bunting of _______ on imaging
right atrium
_______ hypertrophy is characterized by uniform thickening of the ventricular wall and narrowing of the ventricular cavity due to ______ afterload
concentric, increased
-chronic HTN, aortic stenosis
_________ hypertrophy is characterized by ______ ventricular wall thickness with and _____ in chamber size due to volume overload
eccentric, reduced, increased
In infective endocarditis, vegetations are caused by bacterial colonization and growth on a sterile _______ nidus that forms on ________ endothelial surface of the valvular apparatus
fibrin-platelet, damaged
In WPW explain the EKG findings
Have a widened QRS because normal sinus impulses reach the ventricles first through an accessory pathway. PR interval is prolonged because the AV node gets it after ventricles
congenital QT syndrome has defects in the ______ channel. What are major risks?
potassium(delayed rectifier current I_k), ventricular arrythmias=torsades de pointes
dilated cardiomyopathy is due to ______ dysfunction
systolic (impaired ventricular contractility)
restrictive cardiomyopathy is due to ________ dysfunction
diastolic (impaired filling)
How do strawberry hemangiomas present
typically increase in proportion to size of baby and THEN REGRESS
Pressure can be inc in the _______ vein leading to a varicocele
left gonadal
The _____ supplies the inferior heart so if got an MI, which 3 leads would be affected
right coronary artery
-2,3,avF
The _______ supplies the anterior heart so if got an MI, which leads would be affected?
V1-4, h/e distal LAD occlusion spares V1-V2
The ________ gives rise to the LAD and lateral circumflex artery so it typically results in _______ infarction. An MI here would mess up which leads
left main coronary artery, anterolateral
-V1-V4, V5-6, I, aVL
Heart failure results in stimulation of ______ to preserve effective ________ volume. Inactive angiotensin 1 is converted to angiotensin 2 by endothelial bound _______ in the __________
RAAS, intravascular, ACE, small vessels of the lungs
angiotensionogen is produced by what organ?
liver
Congestive heart failure leads to _____ cardiac output, _____ perfusion to tissues, ____ arteriolar resistance
dec, dec, inc
-Heart isn’t pumping effectively so dec perfusion–> inc RASS system =–> inc aldosterone–> inc after load so its a vicious cycle even though the system is trying to protect itself
In a ______ patients can experience sudden onset neurological deficits (right arm weakness, diff speaking) that fully resolves within 20 min. What treatment is indicated for this and what’s a known side effect?
transient ischemic attack, low dose baby aspirin (COX1 & 2 inhibitor), GI bleeding
Fibrinolytic therapy for acute ST elevation is reasonable reperfusion when no indications to thrombolysis. How do these agents work and what is side effect?
they activate plasminogen to plasmin–> thrombolysis
-can cause cerebral hemorrhage
Symptoms of cerebral hemorrhage
asymmetric pupils, irregular breathing patterns, dec consciousness
PDA murmur has greatest intensity at what heart sound and describe the murmur
continuous with INTENSE S2
What is intermittent claudication? What is it typically a result of?
muscle pain with exercise that remits with rest, atherosclerosis–> atheromas (lipid filled intimal plaques that bulge into the arterial lumen
Medial band like calcifications lead to ________ and are typically asymptomatic
Monkeberg’s medial calcific stenosis
hyaline arteriosclerosis is associated with what disease
diabetic microangiopathy
For class one anti-arrythmics, what is sodium channel binding strength
1C>1A>1B (strongest affinity to least)
- since 1B binds least: great for ischemic induced ventricular arrythmias
- 1C great for terminating tachyarryhmias b/c needs use dependence
symptoms of digoxin toxicity
life threatening arrthymias, hyperkalemia(b/c inhibiting Na/K puma leads to inc ECF K+), n/v, color vision alterations
Dihydroergotamine is a ________ agonist so it can lead to _________
partial alpha and serotonergic, vasospasm
variant(prizmijntal) angina is characterized by transient ST _______ and _______ chest pain
elevation, spontaneous episodes of rest and nighttime
__________ refers to the presence of left ventricular systolic dysfunction due to _______ coronary blood flow at rest that is partially or completely reversible by coronary ____________
hibernating myocardium, dec, revascularization
-chronically hibernating myocardium leads to decreased expression and disorganization of contractile and cytoskeleton proteins
First dose hypotension can be a problem when initiating therapy with what med
ACE inhibitor
-more likely to occur in people with volume depletion (Ex: on a diuretic, HF)
_______ is a beta 1 and 2 agonist that increases myocardial contractility and decreases vascular resistance
isoproterenol
Constrictive pericarditis has ______ sign, ___ JVP, ________ and _____ knock
Kussmaul, inc, pulsus paradoxus, pericardial (sharper sound heard earlier than S3 in diastole)
wide fixed-split S2 and systolic ejection murmur best heard at upper left sternal border
atrial septal defect
more flow through pulmonic valve
early diastolic murmur
aortic regurgitation
systolic crescendo-decrescendo murmur best heard at base of heart with radiation to the neck
aortic stenosis
continuous murmur best heard left subclavicular region
patent ductus arteriosus
low pitched holosystolic murmur at left sternal border
ventricular septal defect
myocardial infarction causes a sharp ___ in CO due to ________ with ___ venous return
dec, loss of function of a zone of myocardium, unchanged
chronic anemia causes an ____ in CO
inc, to meet metabolic demands of tissues
acute hemorrhage leads to ____ volume
dec
right coronary artery supplies which ventricles? Proximal occlusion can lead to _____ MI –> ___ CO, ___ venous pressure. The lungs will be _____
inferior wall of left ventricle and majority of right ventricle, right ventricular, dec, inc venous pressure (JVP), clear b/c isolated right heart dysfunction
LV anterior infarcts are more likely to cause ___ dysfunction, ___ CO, ____ PCWP, ____ central venous pressure
left ventricular systolic, dec, inc, elevated (with persistent high left sided pressures)
In hypertensive emergency ______ is given and this drug acts on what receptor. How does it affect BP and it leads to ____ arteriolar dilation, ____ renal perfusion, _____ diuresis/naturesis
fenoldopam, dopamine 1 agonist, inc, inc, inc
Right sided _______ obstruction leads to edema and engorgement of subcutaneous veins. How is it different from superior vena cava syndrome?
brachiocephalic
- can be from compression of a lung tumor
- diff from SVC syndrome because this would have bilateral swelling
Blockage of subclavian vein would lead to ____ swelling
arm
radio frequency ablation of the ___ node is sometimes performed in pts with arrythmias who don’t respond to meds. Where would this be located
AV, interatrial septum near the coronary sinus
Patients with a DVT and PE require a filter in the _____. These are used to prevent the propagation of DVT from the ____ to the ____ vasculature and for people with contraindications to __________
IVC, legs to lungs, anticoagulation
When looking at CT correct way (R is on left): how are the IV and aorta oriented
IVC is on patients right, and abdominal aorta is on pt.s’ left
Cannulation (cannula placed inside a vein for venous access) above the inguinal ligament can inc the risk for ________
peritoneal hemorrhage
What is orthopnea and what is it a sign that’s specific for _______. What is it caused by
supine dyspnea that relives on standing, left sided heart failure, acute exacerbation of pulmonary edema that occurs when central venous, pulmonary venous, and cardiac filling pressures are inc by blood that’d been pooled in the veins
-may also have dyspnea but not specific
bilateral lower extremity edema and congestive hepatomegaly are signs of ________
right sided heart failure
The circulatory system is a _______ circuit so the volume from the left ventricle must closely match the output form the left ventricle
continuous
conduction speed for heart
Purkinje fibers> atrial muscle> ventricular muscle> AV node
fastest–>slowest: Park At Ventrue Avenue
________ syndrome presents with flushing, wheezing, diarrhea, deposits of ______ tissue in the endocardium—> ________ regurgitation
carcinoid, fibrous, tricuspid
Libman Sacks endocarditis is seen in _____ and leads to thickened ______ leaflets with small vegetations that are composed of _______. In lupus can also see small vessel _________.
SLE, mitral valve, sterile platelet thrombi, necrotizing vasculitis,
Path renal finding of diffuse thickening of glomerular capillary walls with “wire loop on microscopy”
LUPUS
Most common cause of coronary sinus dilation is from _________ pressure secondary to
elevated right heart, pulmonary hypertension
What is cor pulmonale?
abnormal enlargement of the right side of the heart as a result of disease of lungs of pulmonary blood vessels
Right heart failure ___ CVP—> _____ in hydrostatic pressure, and ___ in interstitial fluid pressure. As interstitial fluid pressure ___ so does lymphatic ______ and this prevents clinical appearance of ______.______ is a common cause
inc, inc, inc, inc, drainage, edema
-COPD, but anything that causes pulmonary hypertension
Diastolic heart failure is characterized by a ____ left ventricular ejection fraction, _____ LC end diastolic volume, ____LV filling pressures
normal, normal, inc
Aortic regurgitation leads to an ____ in preload and wall stress–> ______ hypertrophy—-> _____ in SV to maintain CO
inc, eccentric, inc
early diastolic opening snap with low diastolic rumble
mitral stenosis
a bird carotid pulse with brisk upstroke “spike and dome”
hypertrophic cardiomyopathy
fibrates such as gemfizobril can _____ hepatic clearance of stains
impair—> inc risk for severe myopathy
Niacin’s main side effect is _______ and it is mediated by _________. What can you give to prevent this?
flushing, prostaglandins
-can give aspirin to prevent because it dec prostaglandins
cilostazol is a _______ inhibitor and it _____ platelet activation by ___ cAMP. It also leads to vaso_________. It treats _______
phosphodiesterase, dec, in, vasodilation, peripheral artery disease
_______ are shown to improve survival in patients with HF due to systolic dysfunction
beta blockers (carvediol, metoprolol)
What are the 3 Class 1 A antiarrthymics?
- qunidine, procainamide, disopyramide
- they inhibit phase 0 and PROLONG the action potential length
Class 1 C antiarryhtmics
flecainide, propafenone
Class 1B antiarrthymics
lidocaine, mexilitene
Class 1 C antiarrythmics have inc effect at _____ so will ______ in exercise
higher heart rates, widen QRS at higher heart rates
Class 3 antiarryhmics block the outward _____ current during repolarization so get an ____ in QT interval
K+, prolongation
Nitrates are primarily venous______ that ____ peripheral venous capacitance —-> ___ preload
dilators, inc, dec
Pericarditis can manifest 2-4 days post MI and is an inflammatory reaction to what?
cardiac muscle necrosis that occurs in adjacent visceral and parietal pericardium
Late onset post MI is also known as _______ and presents as fever, pericardial friction rub. It is thought to be an _________ provoked by antigens exposed or created by infarction of cardiac muscle
Dressler syndrome, autoimmune polyserositis
MVP is a murmur with __________ and is characterized by ____________ which is associated with deterioration of what?
mid systolic click, myxomatous degeneration= deterioration of connective tissue that affect the chordae tendiane and leaflets
__________ are the only cells within the atherosclerotic plaque capable of synthesizing structurally important collagen isoforms (fibrous cap)
vascular smooth muscle cells
________ lesions are contender, macular, erythematous lesions that are typically located on the palms/soles of feet and are the result of
Janeway, microemboli to skin vessels
Buerger’s disease is seen in _______, and can have calf/hand intermittent claudication. You get hypersensitivity to intradermal injections of _______. This is a ________ vasculitis that extends into contiguous veins and nerves
smokers, tobacco, segmental thrombosing
Autosomal dominant condition with skin and mucosal tealngiectasias and recurrent nose bleeds
Osler-Weber-Rendu syndrome
Von Recklinghausen’s disease is also known as ______ and it is an inherited ______ tumor syndrome
NF-1, peripheral nervous sytem (Lisch nodules, cafe au laits, nurofibromas, optic nerve gliomas)
cutaneous facial angiomas and leptomeningeal angiomas, mental retardation, “tram-track calcifications”
Sturge-Weber syndrome
Skeletal muscle is ____ dependent on extracellular calcium influx. This is why they are resistant to what class of drugs,
NOT,Ca channel blockers that work on the L type Ca channels
-in skele muscle, Ca release by the SR is triggered by a mechanical interaction btwn RyR and L-type channels
_____ muscle and _____ muscle depend on extracellular Ca influx through L type Ca channels
cardiac, smooth
On the jugular venous tracing, what does the first big hump signify?
right atrial contraction
calcification and thickening of the pericardium are suggestive of _________. what are sx?
constrictive pericarditis
-dyspnea, peripheral edema, asceites
Holosystolic murmurs are associated with which three conditions
tricuspid regurgitation, mitral regurgitation, VSDs,
Low serum levels of C1 esterase inhibitors are diagnostic for_______. What drug is contraindicated
hereditary angioedema, ACE inhibitors
-normally 1 esterase inhibitor dec kalikren (kalikren converts kininogen to bradykinin)
IV infusion of isotonic saline leads to intravascular volume _______ which leads to the release of what 2 peptides? Both of these inc what 2nd messenger. This then leads to an _____ in GFR–>
expansion, ANP (atria) and BNP (ventricles), cGMP, increase–>naturesis and diuresis
anaphylaxis causes widespread venous and arteriolar _______ that leads to a significant _____ in venous return
dec
Progressive heart failure of in the setting of after a viral infection should raises suspicion for _________
dilated cardiomyopathy
Digoxin is _____ cleared
renally
Patients taking daily nitrates need a ____ every day to avoid ______ tot he drug
free period, tolerance
What are the nondihydropyridine CCBs and what are their side effects?
diltiazem, verapamil,
-constipation, bradycardia, AV block (negative chronotropic effect) and worsening of heart failure with dec left ventricular function
The ______ is the primary determinant of symptoms in tetrolagy of fallot
right ventricular outflow tract obstruction, if this is more severe, than more blue blood will go to the left side
Nitroglycerin dilates
VEINS
Anesthetics with high tissue solubility are characterized by _______ atriovenous concentration gradients and _______ onsets of action
large, slower
Blanching into a vein in which norepinephrine is being infused can lead to severe ________. This is prevented by local injection of a _________
vasoconstriction, alpha1 blocking drug (phentolamine)
_______ toxicity can occur in nitroprusside infusion. What element would be helpful to tx?
cyanide, sulfur
alpha agonists _____ systolic and diastolic BP causing vaso______. This then leads to a reflexive inc in _____ tone —> ___ HR and ____ AV node conduction
inc, constriction, vagal, dec ,dec
Calcium efflux from cells during relaxation is mediated by what two channels
Na/Ca exchanger, Sarcoplasmic reticulum Ca2+ ATPase pump (SERCA)
Calmodulin activates what to lead to smooth muscle contraction
myosin light chain kinase
Most deoxygenated blood in the body is in the ______
coronary sinus
-cardiac venous blood mixes with systemic venous blood before entering the RA
The carotid sinus reflex has an afferent limb that arises from the baroreceptors in the carotid sinus and travels to the vagal nucleus via the _______ nerve. The efferent limb carries parasympathetic impulses via the _____ nerve
glossopharyngeal (afferent), vagus(efferent)
-think can activate this by carotid massage so tight shirt collar
_________ presents with a pulsatile abdominal mass and is associated with ________ inflammation and _________ degradation within the aorta. This leads to weakening and progressive ______ of the aortic wall
abdominal aortic aneurysm, transmural, progressive, expansion
Intimal tear is associated with __________ and presents with tearing chest pain that radiates to the back
aortic dissection
vasa vorum endartitis is associated with what infection
syphillis
Lipofuscin is the product of __________ accumulating in aging cells (esp in malnutrition and cachexia). How does it look
lipid peroxidation, intracytoplasmic granules that are tinged yellowish brown
Granulomatous inflammation of the media with headaches, osteoarthritis, tx with predisone
think giant cell arteritis
-osteoarthritis=polymyalgia rheuamtica
transmural inflammation of aterial wall with fibrinoid necrosis
polyarteritis nodosa
Diastolic heart failure moves the pressure volume curve _____ and to the _____. Common causes are:
up and to the left (dec LV compliance–> inc pressure)
-transthyretin, amyloidosis, sarcoidosis, HTN, obesity
Systolic heart failure moves the pressure curve to the _____. Common causes are:
right (b/c inc volume)
-alcoholic cardiomyopathy, doxorubicin therapy, viral myocarditis
Ion pump failure due to ATP deficiency during cardiac ischemia leads to intracellular accumulation of what two molecules
Na and Ca, the inc intracellular solute concentration draws free water into the cell—>mitochondrial swelling
Loss of cardiomyocyte contractility occurs within ______ after the onset of total ischemia
60 seconds
________ is associated with exposure to arsenic and polyvinyl chloride
hepatic angiosarcoma
Myxomatous changes with pooling of proteoglycans in the media layer of large arteries are found in _______ degeneration which predisposes development of ______________ and _____________
cystic medial degeneration, aortic dissection and aortic aneurysms
Avoid the ______ site when placing a catheter
femoral vein
Vessel order for development of atherosclerotic plaques
abdominal aorta>coronary arteries>popliteal>internal carotids
You can access the saphenous vein
inferorlaeral to the pubic tubercule
rapid deceleration accidents can lead to aortic rupture, the most common site is?
aortic isthmus
varicose veins can lead to skin _______
ulcerations
intermittent claudication is caused by inadequate arterial blood flow and pain is ________ when standing
worse
eosinophilic granulomatosis=churg straus and is associated with?
asthma, eosinophilia, mononeuritis multiplex (wrist drop due to radial nerve involvement), antibodies against neutrophil myeloperoxidase
autoposy finding of platelet rich thrombi on sterile cardiac valves is? what is it associated with
nonbacterial thrombotic endocarditis, malignancy
In patients with AFib and concentric left ventricular hypertrophy, __________ contributes significantly to LV filling. Loss of this can lead to ________ LV preload —> _________
atrial contraction, dec, severe hypotension
-in hypotension (afterload dec)
If you have LV systolic dysfunction what would you see on ECG?
abnormal ST waves
What is an S4 sound
heard at the end of diastole, just before S1
- often heard in older adults from age related decrease in LV compliance and in these cases is benign
- is pathological in young adults
- is often associated with restrictive cardiomyopathy and left ventricular hypertrophy
In atherosclerotic plaques, platelets release _______ which is chemotactic for smooth muscle cells and induces interstitial collagen production
transforming growth factor beta
In a biventricular pacemaker, which 3 places are the leads placed?
right atrium, right ventricle, left ventricle (resides in the AV groove)
To treat resistant angina, ________ blocks late sodium channels in cardiac myocytes
ranolazine
viral pericarditis is treated with ________
NSAIDs
cardiac tamponade presents with what 3 things
hypotension, pulses paradoxus, elevated JVP, abnormal dec in systolic BP on inspiration
Plaque stability depends on the strength of the _______ and macrophages can destabalize this by secreting _________
fibrous cap, metalloproteinases
mid-diastolic rumbling mumur heard at apex with positional dyspnea and weight loss with a large pedunculated mass
think myxoma=most benign tumor and the cells are in a mucopolysaccharide stroma
a complete atrioventricular canal defect is composed of what 3 things and what is it associated with
ASD, VSD, common AV valve
What organ is typically spared in polyarteritis nodosa
the lungs
migratory thrombophlebitis puts you at risk for
visceral cancer
-hypercoagulibility from adenocarcinomas producing a thromboplastin like substance
Hydralazine can dec BP significantly and lead to reflex tachycardia which can lead to what in a patient with coronary artery disease?
Angina from demand ischemia secondary to inc CO or inc HR
_________ is the most important mediator of coronary vascular dilation in large and prearteriolar vessels in auto blood flow regulation. ________ is important in small coronary arterioles
nitric oxide, adenosine
In Atrial fibrillation, the __________ determines the ventricular contraction rate
AV node
The __________ can assume pacemaker activity in patients with severe bradycardia
purkinje system
What is the most important factor contributing to elevated arterial pressure in the thoracic aorta?
angiotensin 2, coarctation dec renal perfusion and activates RAAS
- sympathetic would be dec
- parasympathetic would be in
______magneisa and _____kalemia can predispose to torsades
hypo, hypo
AV shunts lead to _______ CO and _____ venous return
inc, inc
How are the coronary arteries in hypertrophic cardiomyopathy
normal
P2 closure is delayed by ______, causing physiological splitting of S2. Wide splitting can occur with anything that _______ right ventricular ejection time
inspiration, prolong (right bundle branch block, pulmonary stenosis)
________ causes widening of the mediastinum and abnormal contour on chest X-ray. Risk factors include __________
aortic dissection, chronic uncontrolled HTN, Marfan
Dihydropyridine CCBs are selective for the smooth muscle of the peripheral vasculature rather than the myocardium. Therefore, they work by dec _________
after load
nitrates dec cardiac _______
preload
Beta blockers and Non-hydropyridine blockers dec _______ and _______
cardiac contractility and heart rate
nitroprusside can lead to _______ toxicity and this inhibits what metabolic step
cyanide, mitochondrial cytochrome oxidase
right bundle branch block post MI is manifested by wide splitting sound and an RSR pattern and is located between _________
bundle of His and Purkinje fibers
AV nodal conduction is the slowest because of ___________ and is seen as the PR interval
time ventricles need to fill with blood before systole
Leg claudication is from peripheral vascular disease which involves what blood vessel
arteries
_____ interval on ECG represents ventricular diastole
TQ, T is when ventricular contraction stops and Q begins ventricular depolarization
_____ interval on ECG represents ventricular systole
QT
transposition of the great vessels is from failure of ___________
migration of neural crest and endocardial cells
