Cardiology Facts Flashcards
1
Q
Most common cause of death after MI
A
Cardiogenic shock/LV failure
2
Q
Two congenital syndromes that cause QT prolongation
A
Jervell and Lange-Nielsen syndrome - less common - AR - neurosensory deafness Romano-Ward syndrome - more common - AD - no deafness
3
Q
Most common site of left atrial thrombi
A
Left arterial appendage
4
Q
QRS complex corresponds to which phase of the ventricular myocyte action potential?
A
Phase 0 - ventricular depolarization (Na+ in)
5
Q
Class 1A drug effects on QRS and QT
A
Prolongs QRS and QT
6
Q
Class 1B drug effects on QRS and QT
A
no significant change in QRS or QT - fast dissociation with receptor
7
Q
Class 1C drug effects on QRS and QT
A
Shortens QRS, does not affect QT
8
Q
Atenolol - class
A
Selective Beta-1 antagonist
9
Q
Metoprolol
A
Selective Beta-antagonist
10
Q
Beta 1 receptors are found where?
A
cardiac tissue
renal juxtaglomerulus cells
11
Q
Beta 1 is coupled to which G-protein receptor?
A
Gs
12
Q
Beta 2 is coupled to which G-protein receptor?
A
Gs
13
Q
Alpha 1 is coupled to which G-protein receptor?
A
Gq
14
Q
Alpha 2 is coupled to which G-protein receptor?
A
Gi
15
Q
M1 is coupled to which G-protein receptor?
A
Gq
16
Q
M2 is coupled to which G-protein receptor?
A
Gi
17
Q
M3 is coupled to which G-protein receptor?
A
Gq
18
Q
Diagnostic echocardiogram finding of transposition of great arteries
A
Aorta lying ANTERIOR and to the RIGHT of the pulmonary artery - due to failure of SEPTATION
19
Q
Cardiac abnormalities seen with Turner’s Syndrome
A
Bicuspid Aortic Valve - most common
can be isolated or seen with AORTIC COARCTATION
20
Q
Risk of CV events due to oral contraceptive pills are increased in which populations?
A
- SMOKERS
- patients over 35
21
Q
Valsartan - class
A
ARB - angiotensin receptor blockers
22
Q
Losartan - class
A
ARB
23
Q
Isolated systolic hypertension (systolic BP > 160 but diastolic BP
A
Aortic stiffening (decreased compliance)
24
Q
Where is the SA node located?
A
Junction of the right atrium and SVC
25
Where is the AV node located?
Right atrium near the septal cusp of the tricuspid valve
26
What determines if whether or not a coronary artery plaque will cause ischemic myocardial injury?
The rate the plaque grows - if slow, can form COLLATERALS that can provide blood to hypoprofused areas
27
Amlodipine, Nifedipine - class
Dihydropyridine Ca2+ channel blockers
28
Calcium channel blockers - side effects
PERIPHERAL EDEMA, dizziness, flushing, headaches
29
Enoxaparin - class
LMWH
30
Daltiparin - class
LMWH
31
Acute endocarditis
Staph aureus
- affects normal valves
- LARGE vegetations
32
Subacute endocarditis
Strep viridans
- affects ABNORMAL VALVES - grows on sterile fibrin-platelet nidus that forms on disrupted/damaged endothelial cells
- SMALL vegetations
33
dobutamine - effect
Increases CONTRACTILITY (more than increasing HR)
34
Palpable pulsating abdominal mass describes . . .
Aortic abdominal aneurysm
- associated with atherosclerosis
- transmural inflammation
35
What is the most common underlying valvular disease predisposing to IE in DEVELOPED NATIONS?
Mitral valve prolapse
36
What to use of HTN if patients with CHF or diabetes?
ACE inhibitors
- prevents chronic renal failure by dilating efferent arteriole
- prevents chronic angiotensin II mediated LV HYPERTROPHY and REMODELING following MI
37
Familial Chylomicronemia Syndrome
- inheritance: AR
- protein defect: Lipoprotein lipase, APOC-II
- clinical presentation: ACUTE PANCREATITIS, LIPEMA RETINALIS (milky-appearing retinal vasculature), eruptive skin xanthomas and heptosplenomegaly
38
Anteroseptal (LAD) - ischemia of interventricular septum
V1-V2
39
Anterioapical (distal LAD) - ischemia to anterior left ventricular wall
V3-V4
40
Anterolateral (LAD or LCX)
V5-V6
41
Lateral (LCX) - ischemia to lateral wall of left ventricle
I, aVL
42
Inferior (RCA) - ischemia to inferior wall of L ventricle
II, III, aVF
43
Order in femoral triangle (lateral to medial)
Nerve, artery, vein and deep inguinal nodes/lymphatic vessels
44
Ivabradine - effects, uses
- MOA: inhibits If, slows SA node firing
- Slows HR but does not affect contractility and/or relaxation (lusitropy)
- used in CHF with reduced ejection fraction and persistent symptoms despite medical therapy
45
Tricuspid Regurgitation
- holosytolic murmur
- louder with INSPIRATION (increased venous return to R side of heart)
- heard best at LEFT STERNAL BORDER
46
Constrictive pericarditis - clinical presentation
- progressive dyspnea
- ascites
- peripheral edema
47
Carcinoid heart disease
- due to carcinoid syndrome
- can cause RIGHT SIDED endocardial fibrosis which may progress to pulmonary stenosis and/or restrictive cardiomyopathy
- measure serum SEROTONIN or urinary 5-hydroxyindoleacetic acid
48
ANP and BNP does what?
Vasodilation (relaxes smooth muscle): acts on ANP receptors to activate guanylyl cyclase to increase cGMP
49
Amiloride - class
K-sparing diuretic
50
Indapamide - class
thiazide diuretic
51
Fenoldopam - class/use
DOPAMINE 1 RECEPTOR AGONIST
- arterial vasodilation - increases cAMP
- renal vasodilation - increases RENAL PROFUSION, diuresis and natiuresis
USE IN HYPERTENSIVE EMERGENCY
52
Niacin - class/use
Treatment for hyperlipidemia
- decreases triglycerides and LDL
- increases HDL
53
Niacin - side effects
FLUSHING, warmth and itching - mediated by release of prostaglandins
- pretreat with ASPIRIN - inhibits prostaglandin synthesis
54
Trousseau syndrome
Migratory superficial thrombophlebitis
- associated with CANCER: VISCERAL adenocarcinomas of pancreas, colon, and lung secrete thromboplastin like substance —> get HYPERCOAGULABLE STATE
- causes intravascular coagulations that can disseminate and migrate
55
Phenylephrine - class
Alpha 1 Agonist
| - causes vasoconstriction of renal, splanchnic and mesenteric arteries
56
Biventricular pacemaker - lead placement
- R atrium
- R ventricle
- L ventricle - course through coronary sinus which lies in the atrioventricular groove
57
Which anti-arrhythmetic drug prolongs QT interval but not as much as other ones?
Amiodarone
58
What important mediator is responsible for auto regulation of LARGE CORONARY ARTERIES?
Nitric Oxide - vasodilation
59
What important mediator is responsible for auto regulation of SMALL CORONARY ARTERIES?
Adenosine - vasodilation
60
Most involved arteries in ATHEROSCLEROSIS
Abdominal aorta > coronary arteries > popliteal > internal carotid > circle of Willis
61
Atrial regurgitation - physical findings
- bounding femoral and carotid arteries: "water-hammer pulses"
- Head bobbing with each heart beat: "de Musset sign"
due to increased LV stroke volume (blood goes back from atrial valve so end systolic volume is increased) —> increased PULSE PRESSURES
62
Aortic stenosis - physical findings
delayed, prolonged carotid pulses: PULSUS PARVUS et TARDUS
63
Phenoxybenzamine
IRREVERSIBLE alpha 1 and 2 antagonist
- causes vasodilation (alpha 1 causes vasoconstriction)
- decreases Vmax but does not affect Km (the substrate affinity to the receptor)
64
Phentolamine
REVERSIBLE alpha-adrenergic antagonist
- increases Km but does not affect Vmax
- if have enough NE, then can displace drug and reach Vmax
65
How to treat peripheral artery disease
- graded exercise program
- Cilostazol: phosphodiesterase inhibitor (prevents cAMP degradation, cAMP prevents platelet aggregation) —> prevents platelet aggregation and is a direct arterial vasodilator
66
- Cilostazol - class and use
phosphodiesterase inhibitor: prevents breakdown of cAMP
- inhibits platelet aggregation
- direct arterial vasodilator
use for: peripheral artery disease
67
Cardiac finding in SLE
Libman Sacks Endocarditis - nonbacterial, wart-like vegetations on both sides of the valve
Antiphospholipid Antibody syndrome - hypercoagulable state (even though prolonged aPTT)
68
eccentric hypertrophy
The ventricle space is larger, the wall is not thicker
- aortic or mitral valve regurgitation
- myocardial infarction
- dilated cardiomyopathy
69
concentric hypertrophy
The ventricle wall is thicker, the space is smaller
- chronic hypertension
- aortic stenosis
70
What is the major determinant of symptom severity in Tetralogy of Fallot?
Right Ventricular Tract Outflow Obstruction
- if more obstructed, then less deoxygenated blood is pumped to lungs and there is more pressure in the RV
- more blood then pumps from RV to LV and up through the overriding aorta —> more deoxygenated blood delivered to body
71
Organ susceptibility to infarction of feeding artery (greatest to least)
CNS (brain) > heart > kidney > spleen > liver
72
Carotid baroreceptors: afferent nerve carried by _______ and efferent nerve carried by _______
Afferent: glossopharyngeal (IX) to solitary nucleus of medulla
Efferent: vagus (X)
73
Aortic baroreceptors: afferent nerve carried by _______ and efferent nerve carried by _______
Afferent: vagus (X) to solitary nucleus of medulla
Efferent: vagus (X)?
74
derivatives of 6th aortic arch
```
Pulmonary arteries
Ductus arteriosis (left side)
```
75
Derivatives of 4th aortic arch
Right: aortic arch
Left: proximal subclavian artery
76
Derivatives of 3rd aortic arch
Common carotid artery
| Proximal internal carotid artery
77
Derivatives of 2nd aortic arch
Hyoid artery
| Stapedial artery
78
Derivatives of 1st aortic arch
Maxillary artery
79
Fibrates - MOA
Activate PEROXISOME PROLIFERATOR ACTIVATED-RECEPTOR ALPHA —> decreased hepatic VLDL and increased lipoprotein lipase activity
- Decreases triglycerides
- increases HDL
80
Most common cause of AS in patients >70 is?
senile, degenerative CALCIFICATIONS of aortic valve
81
Does a shorter A2-opening snap interval indicate more severe or mild Mitral Stenosis?
More SEVERE
| OS = tensing of mitral valve leaflets after it reaches maximum diameter during forceful opening
82
Thiamine deficiency causes what syndromes?
Wernicke-Korakoff syndrome: ataxia, confusion, memory loss, oculomotor abnormalities, nystagmus
Beriberi
- dry: symmetrical peripheral neuropathy
- wet: symmetrical peripheral neuropathy + high-output CHFq
83
Mitochondrial vacuolization
Sign of IRREVERSIBLE CELL INJURY - mitochondria can no longer produce ATP
84
Mitochondrial swelling
Sign of REVERSIBLE CELL INJURY
85
Most common side effect of fibrinolytic therapy
HEMORRHAGE (GI, intracerebral)
86
How to treat beta-blocker toxicity?
GLUCAGON - acts on Gs receptors —> increase cAMP —> increase intracellular Ca —> increases muscle contraction —> increases HR and contractility
87
Digoxin Toxicity
- ARRHYTHMIAS due to hyperkalemia
- BLURRY YELLOW VISION
- GI symptoms
- bradycardia, AV block
88
Nitroprusside - class, effects
SHORT ACTING venous and arterial vasodilator
- decreases PRELOAD and AFTERLOAD
- maintains SV
89
Acute pericarditis
- Sharp, pleuritic pain
- Decreases when SIT UP AND LEAN FORWARD, increases with INSPIRATION
- Fibrinous or serofibrinous pericarditis is the most common form
- PERICARDIAL FRICTION RUB on physical exam
90
Ergonovine - class
- alpha-adrenergic and serotonergic agonist
| - causes vasoconstriction
91
Ergonovine test
provocative test for CORONARY VASOSPASM
92
Statins - toxicity
- Muscle toxicity
- Hepatotoxicity: measure liver enzymes BEFORE starting statins but do not need to monitor routinely unless symptoms of hepatic injury develop
93
Wide, fixed splitting of S2 heart sound is characteristic of what congenital defect?
Atrial septal defect
94
S3 is best heard in which position?
Left lateral decubitus position at the END of EXPIRATION (decrease lung sounds)
95
Disopyramide - class
IA antiarrhythmetic drug
96
Gemfibrozil - class
Fibrate
97
Which diuretic improves MORTALITY in heart failure patients?
Spironolactone
98
Hepatic angiosarcoma is associated with exposure to which carcinogens?
- arsenic
| - polyvinyl chloride
99
Diastolic heart failure
- caused by DECREASED VENTRICULAR COMPLIANCE
| - characterized by normal EF, normal LVED volume and increased LVED pressure
