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Uworld > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Tetralogy of Fallot results from and what are the 4 signs

A

Anterior and cephalad deviation of infundibular septum

  • right ventricular hypertrophy
  • ventricular septal defect
  • overriding aorta
  • pulmonary stenosis
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2
Q

The _______ composes most of the hearts anterior surface

A

Right ventricle

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3
Q

The middle meningeal artery is a branch of the _______ artery where the ______, ________, ______, and _______ bones meet

A

Maxillary artery, frontal, parietal, temporal, sphenoid bones meet

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4
Q

Patients who overdose on beta blockers should be treated with ____

A

Glucagon that stimulates cAMP in myocytes

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5
Q

The ________ is derived from the common cardinal veins

A

Superior vena cava

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6
Q

Fibrates activate ________ which leads to decreased _________ production and increased _________ activity

A

PPAR Alpha, hepatic VLDL production, lipoprotein lipase

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7
Q

AV shunts _______ preload and _______ afterload

A

Increase, decrease

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8
Q

Pulsus pardoxus is commonly seen in

A

Pericarditis

  • is a dec in systolic blood pressure more than 10mmHg with inspiration
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9
Q

________ and _________ are the most common causes of pulsus paradoxus in the absence of pericardial disease. And how are they treated

A

Asthma and COPD

-a beta agonist that INC cAMP

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10
Q

____________ is the most common cause of sudden cardiac death in the first 48 hours after acute MI

A

Ventricular fibrillation

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11
Q

_________ (what group of diuretics) improve survival in patients with congestive heart failure and reduced LVEF

A

Mineralocorticoids : spironolactone, eplerenone

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12
Q

With exercise you see a _________ in total systemic vascular resistance

A

Decrease

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13
Q

Coronary ______ dilation is affected in coronary steal syndrome

A

Arteriolar

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14
Q

Endocarditis leading to a intracardiac fistula between aortic root and right ventricle has a ____ shunt continuously

A

Left to right shunt because pressure in the aorta is always higher than the right ventricle

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15
Q

Kawasaki is a ______ size vasculitis that presents with bilateral ______, ________, _________. __________ are a serious complication

A

Medium, bilateral conjunctivitis, Cervical LAD, mucocutaneous (bright red tongue and cracked lips). At high right for coronary artery aneurysm

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16
Q

Hypertrophic cardiomyopathy is associated with a mutation in

A

Beta myosin heavy chain and myosin binding protein C

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17
Q

_________ leads to bounding femoral pulses and carotid pulsation that are accompanied by head bobbing

A

Aortic regurgitation

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18
Q

________ vacuolization is a sign of irreversible myocyte damage

A

Mitochondrial, signifies that mitochondria can’t generate ATP

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19
Q

What is a severe complication of giant cell arteritis and why must you start steroid IMMEDIATELY?

A

b/c can get ischemic optic neuropathy from ophthalmic artery occlusion

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20
Q

aortic dissections from the descending aorta typically originate in the ______

A

subclavian artery

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21
Q

aortic dissections from the ascending aorta typically originate in the

A

sinotubular junction

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22
Q

The most common cause of aortic stenosis is __________ of the aortic valve

A

degenerative calcification

-calcification is from cell necrosis

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23
Q

Dilated cardiomyopathy presents with an ____ sound and what is it a result of. When do you hear it?

A

S3, results from blood sloshing against dilated ventricular walls during early diastole, after early diastole S2

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24
Q

__________ is the cause of death in 2/3rds of pts. with an acute aortic dissection

A

pericardial tamponade (rupture of the dissection into pericardial space)

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25
Q

Marfan syndrome causes dilatation of aortic root–>____________ murmur. It is a defect in ______ on car ____

A

decrescendo diastolic, fibrillin, 15

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26
Q

Be careful with what patients when using nonselective beta blockers

A

asthmatics,

-NPZ: nadolol, pindolol, propanolol, timolol

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27
Q

Low QRS complexes and oscillating cardiac amplitudes leads to ___________

A

cardiac tamponade

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28
Q

ST elevations and PR depression leads to ___________

A

acute pericarditis

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29
Q

Valsalva maneuver _____ thoracic pressure so it ____ venous return to the heart leading to a ______ end diastolic volume and ____ preload

A

inc, dec, dec, dec

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30
Q

Hand grip maneuver ____ after load

A

increases

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31
Q

Squatting ____ venomous return/preload

A

increases

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32
Q

Which two murmurs inc with valsalva

A

HCM and MVP(mid systolic click)

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33
Q

What vasculitis presents as “pulseless disease”? What size arteries does it affect?

A

takayasu, medium/large

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34
Q

_______ is a major complication of MI after 24 hours and if epinephrine doesn’t help, give ________, which is associated with what side effect

A

Ventricular fibrillation, amiodarone, pulmonary fibrosis

-don’t forget VFib is an arrhythmia

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35
Q

Classic triad of tuberous sclerosis is

A

seizures, intellectual disability, facial angiofibromas(kinda like acne looking), rhabdomyoma(50% pts)

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36
Q

In exercise, there is a ______ in total peripheral resistance

A

dec

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37
Q

Compare speed of conduction: AV node, bundle of His, Purkinje system

A

Purkinje system>Bundle of His>AV node

fastest to slowest

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38
Q

baroreceptors: aortic arch transmits via ____ nerve to ___________ of the medulla

A

vagus, solitary nucleus

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39
Q

baroreceptors: carotid sinus transmits via ______ nerve to solitary nucleus of the ________.

A

glossopharyngeal, medulla

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40
Q

in response to hypotension, baroreceptors ______ afferent firing and this leads to ________ sympathetic efferent firing

A

dec, inc

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41
Q

peripheral chemoreceptors respond to __ PO2, ___PCO2, __ pH of blood

A

dec, inc, dec

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42
Q

central chemoreceptors respond to ____ and _____ but not directly to ___

A

PCO2 and pH of brain interstitial fluid, PO2

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43
Q

what is pulsus paradoxus? What is it associated with?

A

systolic blood pressure that drops >10 during inspiration

-cardiac tamponade (air, blood, other fluid entering pericardial sac)

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44
Q

A positive inotropic agent causes inc ________ of the heart–>___ stroke volume, ____ CO

A

contractility, inc, inc

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45
Q

__________ has Ashcoff bodies

A

rheumatic heart disease

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46
Q

Buerger disease is primarily from _________ and can present with gangrene and Raynaunds

A

SMOKING

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47
Q

_________ can lead to a paradoxical embolus that leads to a stroke

A

atrial septal defect

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48
Q

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 ______

A

heart, lungs, left ventricle

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49
Q

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

A

AV, PR interval, atrial depolarization, ventricular depolarization

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50
Q

A widened pulse pressure is associated with bounding pulses and head bobbing and is seen in what condition?

A

aortic regurgitation

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51
Q

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

A

SA, AV, decreased

  • SA node: typ 60-100 bpm
  • AV node: 45-55bpm
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52
Q

__________ arteriosclerosis can be caused by __________ and shows onion like concentric thickening

A

hyperplastic, malignant HTN

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53
Q

_________ arteriosclerosis shows homogenous deposition of acellular(hyaline) in the ____ and ____ of small arteries

A

hyaline, intima, media

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54
Q

Carotid sinus massage leads to inc ______ tone and temporary inhibition of _____ node activity—> prolonging _____ node refractory period. It is useful in terminating ___________ tachycardia

A

parasympathetic, SA, AV, paroxysmal supra ventricular

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55
Q

In hypertrophic cardiomyopathy, dynamic left ventricular outflow obstruction is because of which two changes in the heart

A

abnormal systolic anterior movement of the anterior leaflet of the mitral valve toward a hypertrophied inter ventricular septum

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56
Q

For HCM, maneuvers that ____ preload result in inc murmur intensity

A

dec

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57
Q

maneuvers that dec preload

A

valsalva, nitroglycerin, sudden standing

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58
Q

maneuvers that inc preload

A

squatting, sustained hand grip, passive leg raise

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59
Q

Wolf parkinson white is from a

A

another AV conduction tract bypassing the AV node

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60
Q

_________ is triggered by rapid electrical impulses originating in the pulmonary veins

A

Atrial fibrillation

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61
Q

_________ is caused by reentrant current that rotates around tricuspid annulus

A

atrial flutter

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62
Q

In mitral regurgitation, _______ is the best indicator of severity, it is associated with?

A

S3, regurgitant blood flow from the left ventricle back to the left atrium during systole–> inc blood in LV during diastole

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63
Q

In acute mitral regurgitation from chordal rupture, how are preload, after load, LVEF

A

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

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64
Q

Combined use of _____ and beta blockers can lead to additive negative _______ effects yielding severe ______ and _______

A

non-dihydropyridine (verapamil, diltiazem), chronotropic, bradycardia, hypotension

-also cholinergic agonists, digoxin, amiodarone, sotalol,

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65
Q

Patients with _________ are at increased risk of cerebral aneurysm, left ventricular failure, intracranial hemorrhage

A

adult type coarctation of the aorta

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66
Q

ionotropy

A

contractility

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67
Q

chronotrophy

A

heart rate

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68
Q

Atrial fibrillation is associated with inc risk of thrombotic events. What is the most common site of thrombus formation

A

left atrial appendage

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69
Q

Major side effects of Calcium channel blockers are?

A

peripheral edema, dizziness, lightheadedness

  • amlodipine
  • nifedipine
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70
Q

Milrinone is a _________ inhibitor that leads to inc ______ levels—>

A

phosphodiesterase (PDE3), cAMP, inc cardiac contractility, vasodilation in smooth muscle cells

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71
Q

Consolidation in the right middle lobe of lung can lead to bunting of _______ on imaging

A

right atrium

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72
Q

_______ hypertrophy is characterized by uniform thickening of the ventricular wall and narrowing of the ventricular cavity due to ______ afterload

A

concentric, increased

-chronic HTN, aortic stenosis

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73
Q

_________ hypertrophy is characterized by ______ ventricular wall thickness with and _____ in chamber size due to volume overload

A

eccentric, reduced, increased

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74
Q

In infective endocarditis, vegetations are caused by bacterial colonization and growth on a sterile _______ nidus that forms on ________ endothelial surface of the valvular apparatus

A

fibrin-platelet, damaged

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75
Q

In WPW explain the EKG findings

A

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

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76
Q

congenital QT syndrome has defects in the ______ channel. What are major risks?

A

potassium(delayed rectifier current I_k), ventricular arrythmias=torsades de pointes

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77
Q

dilated cardiomyopathy is due to ______ dysfunction

A

systolic (impaired ventricular contractility)

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78
Q

restrictive cardiomyopathy is due to ________ dysfunction

A

diastolic (impaired filling)

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79
Q

How do strawberry hemangiomas present

A

typically increase in proportion to size of baby and THEN REGRESS

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80
Q

Pressure can be inc in the _______ vein leading to a varicocele

A

left gonadal

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81
Q

The _____ supplies the inferior heart so if got an MI, which 3 leads would be affected

A

right coronary artery

-2,3,avF

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82
Q

The _______ supplies the anterior heart so if got an MI, which leads would be affected?

A

V1-4, h/e distal LAD occlusion spares V1-V2

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83
Q

The ________ gives rise to the LAD and lateral circumflex artery so it typically results in _______ infarction. An MI here would mess up which leads

A

left main coronary artery, anterolateral

-V1-V4, V5-6, I, aVL

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84
Q

Heart failure results in stimulation of ______ to preserve effective ________ volume. Inactive angiotensin 1 is converted to angiotensin 2 by endothelial bound _______ in the __________

A

RAAS, intravascular, ACE, small vessels of the lungs

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85
Q

angiotensionogen is produced by what organ?

A

liver

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86
Q

Congestive heart failure leads to _____ cardiac output, _____ perfusion to tissues, ____ arteriolar resistance

A

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

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87
Q

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?

A

transient ischemic attack, low dose baby aspirin (COX1 & 2 inhibitor), GI bleeding

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88
Q

Fibrinolytic therapy for acute ST elevation is reasonable reperfusion when no indications to thrombolysis. How do these agents work and what is side effect?

A

they activate plasminogen to plasmin–> thrombolysis

-can cause cerebral hemorrhage

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89
Q

Symptoms of cerebral hemorrhage

A

asymmetric pupils, irregular breathing patterns, dec consciousness

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90
Q

PDA murmur has greatest intensity at what heart sound and describe the murmur

A

continuous with INTENSE S2

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91
Q

What is intermittent claudication? What is it typically a result of?

A

muscle pain with exercise that remits with rest, atherosclerosis–> atheromas (lipid filled intimal plaques that bulge into the arterial lumen

92
Q

Medial band like calcifications lead to ________ and are typically asymptomatic

A

Monkeberg’s medial calcific stenosis

93
Q

hyaline arteriosclerosis is associated with what disease

A

diabetic microangiopathy

94
Q

For class one anti-arrythmics, what is sodium channel binding strength

A

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
95
Q

symptoms of digoxin toxicity

A

life threatening arrthymias, hyperkalemia(b/c inhibiting Na/K puma leads to inc ECF K+), n/v, color vision alterations

96
Q

Dihydroergotamine is a ________ agonist so it can lead to _________

A

partial alpha and serotonergic, vasospasm

97
Q

variant(prizmijntal) angina is characterized by transient ST _______ and _______ chest pain

A

elevation, spontaneous episodes of rest and nighttime

98
Q

__________ refers to the presence of left ventricular systolic dysfunction due to _______ coronary blood flow at rest that is partially or completely reversible by coronary ____________

A

hibernating myocardium, dec, revascularization
-chronically hibernating myocardium leads to decreased expression and disorganization of contractile and cytoskeleton proteins

99
Q

First dose hypotension can be a problem when initiating therapy with what med

A

ACE inhibitor

-more likely to occur in people with volume depletion (Ex: on a diuretic, HF)

100
Q

_______ is a beta 1 and 2 agonist that increases myocardial contractility and decreases vascular resistance

A

isoproterenol

101
Q

Constrictive pericarditis has ______ sign, ___ JVP, ________ and _____ knock

A

Kussmaul, inc, pulsus paradoxus, pericardial (sharper sound heard earlier than S3 in diastole)

102
Q

wide fixed-split S2 and systolic ejection murmur best heard at upper left sternal border

A

atrial septal defect

more flow through pulmonic valve

103
Q

early diastolic murmur

A

aortic regurgitation

104
Q

systolic crescendo-decrescendo murmur best heard at base of heart with radiation to the neck

A

aortic stenosis

105
Q

continuous murmur best heard left subclavicular region

A

patent ductus arteriosus

106
Q

low pitched holosystolic murmur at left sternal border

A

ventricular septal defect

107
Q

myocardial infarction causes a sharp ___ in CO due to ________ with ___ venous return

A

dec, loss of function of a zone of myocardium, unchanged

108
Q

chronic anemia causes an ____ in CO

A

inc, to meet metabolic demands of tissues

109
Q

acute hemorrhage leads to ____ volume

A

dec

110
Q

right coronary artery supplies which ventricles? Proximal occlusion can lead to _____ MI –> ___ CO, ___ venous pressure. The lungs will be _____

A

inferior wall of left ventricle and majority of right ventricle, right ventricular, dec, inc venous pressure (JVP), clear b/c isolated right heart dysfunction

111
Q

LV anterior infarcts are more likely to cause ___ dysfunction, ___ CO, ____ PCWP, ____ central venous pressure

A

left ventricular systolic, dec, inc, elevated (with persistent high left sided pressures)

112
Q

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

A

fenoldopam, dopamine 1 agonist, inc, inc, inc

113
Q

Right sided _______ obstruction leads to edema and engorgement of subcutaneous veins. How is it different from superior vena cava syndrome?

A

brachiocephalic

  • can be from compression of a lung tumor
  • diff from SVC syndrome because this would have bilateral swelling
114
Q

Blockage of subclavian vein would lead to ____ swelling

A

arm

115
Q

radio frequency ablation of the ___ node is sometimes performed in pts with arrythmias who don’t respond to meds. Where would this be located

A

AV, interatrial septum near the coronary sinus

116
Q

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 __________

A

IVC, legs to lungs, anticoagulation

117
Q

When looking at CT correct way (R is on left): how are the IV and aorta oriented

A

IVC is on patients right, and abdominal aorta is on pt.s’ left

118
Q

Cannulation (cannula placed inside a vein for venous access) above the inguinal ligament can inc the risk for ________

A

peritoneal hemorrhage

119
Q

What is orthopnea and what is it a sign that’s specific for _______. What is it caused by

A

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

120
Q

bilateral lower extremity edema and congestive hepatomegaly are signs of ________

A

right sided heart failure

121
Q

The circulatory system is a _______ circuit so the volume from the left ventricle must closely match the output form the left ventricle

A

continuous

122
Q

conduction speed for heart

A

Purkinje fibers> atrial muscle> ventricular muscle> AV node

fastest–>slowest: Park At Ventrue Avenue

123
Q

________ syndrome presents with flushing, wheezing, diarrhea, deposits of ______ tissue in the endocardium—> ________ regurgitation

A

carcinoid, fibrous, tricuspid

124
Q

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 _________.

A

SLE, mitral valve, sterile platelet thrombi, necrotizing vasculitis,

125
Q

Path renal finding of diffuse thickening of glomerular capillary walls with “wire loop on microscopy”

A

LUPUS

126
Q

Most common cause of coronary sinus dilation is from _________ pressure secondary to

A

elevated right heart, pulmonary hypertension

127
Q

What is cor pulmonale?

A

abnormal enlargement of the right side of the heart as a result of disease of lungs of pulmonary blood vessels

128
Q

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

A

inc, inc, inc, inc, drainage, edema

-COPD, but anything that causes pulmonary hypertension

129
Q

Diastolic heart failure is characterized by a ____ left ventricular ejection fraction, _____ LC end diastolic volume, ____LV filling pressures

A

normal, normal, inc

130
Q

Aortic regurgitation leads to an ____ in preload and wall stress–> ______ hypertrophy—-> _____ in SV to maintain CO

A

inc, eccentric, inc

131
Q

early diastolic opening snap with low diastolic rumble

A

mitral stenosis

132
Q

a bird carotid pulse with brisk upstroke “spike and dome”

A

hypertrophic cardiomyopathy

133
Q

fibrates such as gemfizobril can _____ hepatic clearance of stains

A

impair—> inc risk for severe myopathy

134
Q

Niacin’s main side effect is _______ and it is mediated by _________. What can you give to prevent this?

A

flushing, prostaglandins

-can give aspirin to prevent because it dec prostaglandins

135
Q

cilostazol is a _______ inhibitor and it _____ platelet activation by ___ cAMP. It also leads to vaso_________. It treats _______

A

phosphodiesterase, dec, in, vasodilation, peripheral artery disease

136
Q

_______ are shown to improve survival in patients with HF due to systolic dysfunction

A

beta blockers (carvediol, metoprolol)

137
Q

What are the 3 Class 1 A antiarrthymics?

A
  • qunidine, procainamide, disopyramide

- they inhibit phase 0 and PROLONG the action potential length

138
Q

Class 1 C antiarryhtmics

A

flecainide, propafenone

139
Q

Class 1B antiarrthymics

A

lidocaine, mexilitene

140
Q

Class 1 C antiarrythmics have inc effect at _____ so will ______ in exercise

A

higher heart rates, widen QRS at higher heart rates

141
Q

Class 3 antiarryhmics block the outward _____ current during repolarization so get an ____ in QT interval

A

K+, prolongation

142
Q

Nitrates are primarily venous______ that ____ peripheral venous capacitance —-> ___ preload

A

dilators, inc, dec

143
Q

Pericarditis can manifest 2-4 days post MI and is an inflammatory reaction to what?

A

cardiac muscle necrosis that occurs in adjacent visceral and parietal pericardium

144
Q

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

A

Dressler syndrome, autoimmune polyserositis

145
Q

MVP is a murmur with __________ and is characterized by ____________ which is associated with deterioration of what?

A

mid systolic click, myxomatous degeneration= deterioration of connective tissue that affect the chordae tendiane and leaflets

146
Q

__________ are the only cells within the atherosclerotic plaque capable of synthesizing structurally important collagen isoforms (fibrous cap)

A

vascular smooth muscle cells

147
Q

________ lesions are contender, macular, erythematous lesions that are typically located on the palms/soles of feet and are the result of

A

Janeway, microemboli to skin vessels

148
Q

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

A

smokers, tobacco, segmental thrombosing

149
Q

Autosomal dominant condition with skin and mucosal tealngiectasias and recurrent nose bleeds

A

Osler-Weber-Rendu syndrome

150
Q

Von Recklinghausen’s disease is also known as ______ and it is an inherited ______ tumor syndrome

A

NF-1, peripheral nervous sytem (Lisch nodules, cafe au laits, nurofibromas, optic nerve gliomas)

151
Q

cutaneous facial angiomas and leptomeningeal angiomas, mental retardation, “tram-track calcifications”

A

Sturge-Weber syndrome

152
Q

Skeletal muscle is ____ dependent on extracellular calcium influx. This is why they are resistant to what class of drugs,

A

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

153
Q

_____ muscle and _____ muscle depend on extracellular Ca influx through L type Ca channels

A

cardiac, smooth

154
Q

On the jugular venous tracing, what does the first big hump signify?

A

right atrial contraction

155
Q

calcification and thickening of the pericardium are suggestive of _________. what are sx?

A

constrictive pericarditis

-dyspnea, peripheral edema, asceites

156
Q

Holosystolic murmurs are associated with which three conditions

A

tricuspid regurgitation, mitral regurgitation, VSDs,

157
Q

Low serum levels of C1 esterase inhibitors are diagnostic for_______. What drug is contraindicated

A

hereditary angioedema, ACE inhibitors

-normally 1 esterase inhibitor dec kalikren (kalikren converts kininogen to bradykinin)

158
Q

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–>

A

expansion, ANP (atria) and BNP (ventricles), cGMP, increase–>naturesis and diuresis

159
Q

anaphylaxis causes widespread venous and arteriolar _______ that leads to a significant _____ in venous return

A

dec

160
Q

Progressive heart failure of in the setting of after a viral infection should raises suspicion for _________

A

dilated cardiomyopathy

161
Q

Digoxin is _____ cleared

A

renally

162
Q

Patients taking daily nitrates need a ____ every day to avoid ______ tot he drug

A

free period, tolerance

163
Q

What are the nondihydropyridine CCBs and what are their side effects?

A

diltiazem, verapamil,
-constipation, bradycardia, AV block (negative chronotropic effect) and worsening of heart failure with dec left ventricular function

164
Q

The ______ is the primary determinant of symptoms in tetrolagy of fallot

A

right ventricular outflow tract obstruction, if this is more severe, than more blue blood will go to the left side

165
Q

Nitroglycerin dilates

A

VEINS

166
Q

Anesthetics with high tissue solubility are characterized by _______ atriovenous concentration gradients and _______ onsets of action

A

large, slower

167
Q

Blanching into a vein in which norepinephrine is being infused can lead to severe ________. This is prevented by local injection of a _________

A

vasoconstriction, alpha1 blocking drug (phentolamine)

168
Q

_______ toxicity can occur in nitroprusside infusion. What element would be helpful to tx?

A

cyanide, sulfur

169
Q

alpha agonists _____ systolic and diastolic BP causing vaso______. This then leads to a reflexive inc in _____ tone —> ___ HR and ____ AV node conduction

A

inc, constriction, vagal, dec ,dec

170
Q

Calcium efflux from cells during relaxation is mediated by what two channels

A

Na/Ca exchanger, Sarcoplasmic reticulum Ca2+ ATPase pump (SERCA)

171
Q

Calmodulin activates what to lead to smooth muscle contraction

A

myosin light chain kinase

172
Q

Most deoxygenated blood in the body is in the ______

A

coronary sinus

-cardiac venous blood mixes with systemic venous blood before entering the RA

173
Q

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

A

glossopharyngeal (afferent), vagus(efferent)

-think can activate this by carotid massage so tight shirt collar

174
Q

_________ 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

A

abdominal aortic aneurysm, transmural, progressive, expansion

175
Q

Intimal tear is associated with __________ and presents with tearing chest pain that radiates to the back

A

aortic dissection

176
Q

vasa vorum endartitis is associated with what infection

A

syphillis

177
Q

Lipofuscin is the product of __________ accumulating in aging cells (esp in malnutrition and cachexia). How does it look

A

lipid peroxidation, intracytoplasmic granules that are tinged yellowish brown

178
Q

Granulomatous inflammation of the media with headaches, osteoarthritis, tx with predisone

A

think giant cell arteritis

-osteoarthritis=polymyalgia rheuamtica

179
Q

transmural inflammation of aterial wall with fibrinoid necrosis

A

polyarteritis nodosa

180
Q

Diastolic heart failure moves the pressure volume curve _____ and to the _____. Common causes are:

A

up and to the left (dec LV compliance–> inc pressure)

-transthyretin, amyloidosis, sarcoidosis, HTN, obesity

181
Q

Systolic heart failure moves the pressure curve to the _____. Common causes are:

A

right (b/c inc volume)

-alcoholic cardiomyopathy, doxorubicin therapy, viral myocarditis

182
Q

Ion pump failure due to ATP deficiency during cardiac ischemia leads to intracellular accumulation of what two molecules

A

Na and Ca, the inc intracellular solute concentration draws free water into the cell—>mitochondrial swelling

183
Q

Loss of cardiomyocyte contractility occurs within ______ after the onset of total ischemia

A

60 seconds

184
Q

________ is associated with exposure to arsenic and polyvinyl chloride

A

hepatic angiosarcoma

185
Q

Myxomatous changes with pooling of proteoglycans in the media layer of large arteries are found in _______ degeneration which predisposes development of ______________ and _____________

A

cystic medial degeneration, aortic dissection and aortic aneurysms

186
Q

Avoid the ______ site when placing a catheter

A

femoral vein

187
Q

Vessel order for development of atherosclerotic plaques

A

abdominal aorta>coronary arteries>popliteal>internal carotids

188
Q

You can access the saphenous vein

A

inferorlaeral to the pubic tubercule

189
Q

rapid deceleration accidents can lead to aortic rupture, the most common site is?

A

aortic isthmus

190
Q

varicose veins can lead to skin _______

A

ulcerations

191
Q

intermittent claudication is caused by inadequate arterial blood flow and pain is ________ when standing

A

worse

192
Q

eosinophilic granulomatosis=churg straus and is associated with?

A

asthma, eosinophilia, mononeuritis multiplex (wrist drop due to radial nerve involvement), antibodies against neutrophil myeloperoxidase

193
Q

autoposy finding of platelet rich thrombi on sterile cardiac valves is? what is it associated with

A

nonbacterial thrombotic endocarditis, malignancy

194
Q

In patients with AFib and concentric left ventricular hypertrophy, __________ contributes significantly to LV filling. Loss of this can lead to ________ LV preload —> _________

A

atrial contraction, dec, severe hypotension

-in hypotension (afterload dec)

195
Q

If you have LV systolic dysfunction what would you see on ECG?

A

abnormal ST waves

196
Q

What is an S4 sound

A

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
197
Q

In atherosclerotic plaques, platelets release _______ which is chemotactic for smooth muscle cells and induces interstitial collagen production

A

transforming growth factor beta

198
Q

In a biventricular pacemaker, which 3 places are the leads placed?

A

right atrium, right ventricle, left ventricle (resides in the AV groove)

199
Q

To treat resistant angina, ________ blocks late sodium channels in cardiac myocytes

A

ranolazine

200
Q

viral pericarditis is treated with ________

A

NSAIDs

201
Q

cardiac tamponade presents with what 3 things

A

hypotension, pulses paradoxus, elevated JVP, abnormal dec in systolic BP on inspiration

202
Q

Plaque stability depends on the strength of the _______ and macrophages can destabalize this by secreting _________

A

fibrous cap, metalloproteinases

203
Q

mid-diastolic rumbling mumur heard at apex with positional dyspnea and weight loss with a large pedunculated mass

A

think myxoma=most benign tumor and the cells are in a mucopolysaccharide stroma

204
Q

a complete atrioventricular canal defect is composed of what 3 things and what is it associated with

A

ASD, VSD, common AV valve

205
Q

What organ is typically spared in polyarteritis nodosa

A

the lungs

206
Q

migratory thrombophlebitis puts you at risk for

A

visceral cancer

-hypercoagulibility from adenocarcinomas producing a thromboplastin like substance

207
Q

Hydralazine can dec BP significantly and lead to reflex tachycardia which can lead to what in a patient with coronary artery disease?

A

Angina from demand ischemia secondary to inc CO or inc HR

208
Q

_________ 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

A

nitric oxide, adenosine

209
Q

In Atrial fibrillation, the __________ determines the ventricular contraction rate

A

AV node

210
Q

The __________ can assume pacemaker activity in patients with severe bradycardia

A

purkinje system

211
Q

What is the most important factor contributing to elevated arterial pressure in the thoracic aorta?

A

angiotensin 2, coarctation dec renal perfusion and activates RAAS

  • sympathetic would be dec
  • parasympathetic would be in
212
Q

______magneisa and _____kalemia can predispose to torsades

A

hypo, hypo

213
Q

AV shunts lead to _______ CO and _____ venous return

A

inc, inc

214
Q

How are the coronary arteries in hypertrophic cardiomyopathy

A

normal

215
Q

P2 closure is delayed by ______, causing physiological splitting of S2. Wide splitting can occur with anything that _______ right ventricular ejection time

A

inspiration, prolong (right bundle branch block, pulmonary stenosis)

216
Q

________ causes widening of the mediastinum and abnormal contour on chest X-ray. Risk factors include __________

A

aortic dissection, chronic uncontrolled HTN, Marfan

217
Q

Dihydropyridine CCBs are selective for the smooth muscle of the peripheral vasculature rather than the myocardium. Therefore, they work by dec _________

A

after load

218
Q

nitrates dec cardiac _______

A

preload

219
Q

Beta blockers and Non-hydropyridine blockers dec _______ and _______

A

cardiac contractility and heart rate

220
Q

nitroprusside can lead to _______ toxicity and this inhibits what metabolic step

A

cyanide, mitochondrial cytochrome oxidase

221
Q

right bundle branch block post MI is manifested by wide splitting sound and an RSR pattern and is located between _________

A

bundle of His and Purkinje fibers

222
Q

AV nodal conduction is the slowest because of ___________ and is seen as the PR interval

A

time ventricles need to fill with blood before systole

223
Q

Leg claudication is from peripheral vascular disease which involves what blood vessel

A

arteries

224
Q

_____ interval on ECG represents ventricular diastole

A

TQ, T is when ventricular contraction stops and Q begins ventricular depolarization

225
Q

_____ interval on ECG represents ventricular systole

A

QT

226
Q

transposition of the great vessels is from failure of ___________

A

migration of neural crest and endocardial cells

Uworld (26 decks)

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