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UWorld Facts > Cardiology Facts > Flashcards

Cardiology Facts Flashcards

1
Q

Most common cause of death after MI

A

Cardiogenic shock/LV failure

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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
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3
Q

Most common site of left atrial thrombi

A

Left arterial appendage

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4
Q

QRS complex corresponds to which phase of the ventricular myocyte action potential?

A

Phase 0 - ventricular depolarization (Na+ in)

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5
Q

Class 1A drug effects on QRS and QT

A

Prolongs QRS and QT

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6
Q

Class 1B drug effects on QRS and QT

A

no significant change in QRS or QT - fast dissociation with receptor

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7
Q

Class 1C drug effects on QRS and QT

A

Shortens QRS, does not affect QT

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8
Q

Atenolol - class

A

Selective Beta-1 antagonist

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9
Q

Metoprolol

A

Selective Beta-antagonist

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10
Q

Beta 1 receptors are found where?

A

cardiac tissue

renal juxtaglomerulus cells

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11
Q

Beta 1 is coupled to which G-protein receptor?

A

Gs

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12
Q

Beta 2 is coupled to which G-protein receptor?

A

Gs

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13
Q

Alpha 1 is coupled to which G-protein receptor?

A

Gq

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14
Q

Alpha 2 is coupled to which G-protein receptor?

A

Gi

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15
Q

M1 is coupled to which G-protein receptor?

A

Gq

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16
Q

M2 is coupled to which G-protein receptor?

A

Gi

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17
Q

M3 is coupled to which G-protein receptor?

A

Gq

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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

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19
Q

Cardiac abnormalities seen with Turner’s Syndrome

A

Bicuspid Aortic Valve - most common

can be isolated or seen with AORTIC COARCTATION

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20
Q

Risk of CV events due to oral contraceptive pills are increased in which populations?

A
  • SMOKERS

- patients over 35

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21
Q

Valsartan - class

A

ARB - angiotensin receptor blockers

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22
Q

Losartan - class

A

ARB

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23
Q

Isolated systolic hypertension (systolic BP > 160 but diastolic BP

A

Aortic stiffening (decreased compliance)

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24
Q

Where is the SA node located?

A

Junction of the right atrium and SVC

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25
Q

Where is the AV node located?

A

Right atrium near the septal cusp of the tricuspid valve

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26
Q

What determines if whether or not a coronary artery plaque will cause ischemic myocardial injury?

A

The rate the plaque grows - if slow, can form COLLATERALS that can provide blood to hypoprofused areas

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27
Q

Amlodipine, Nifedipine - class

A

Dihydropyridine Ca2+ channel blockers

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28
Q

Calcium channel blockers - side effects

A

PERIPHERAL EDEMA, dizziness, flushing, headaches

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29
Q

Enoxaparin - class

A

LMWH

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30
Q

Daltiparin - class

A

LMWH

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31
Q

Acute endocarditis

A

Staph aureus

  • affects normal valves
  • LARGE vegetations
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32
Q

Subacute endocarditis

A

Strep viridans

  • affects ABNORMAL VALVES - grows on sterile fibrin-platelet nidus that forms on disrupted/damaged endothelial cells
  • SMALL vegetations
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33
Q

dobutamine - effect

A

Increases CONTRACTILITY (more than increasing HR)

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34
Q

Palpable pulsating abdominal mass describes . . .

A

Aortic abdominal aneurysm

  • associated with atherosclerosis
  • transmural inflammation
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35
Q

What is the most common underlying valvular disease predisposing to IE in DEVELOPED NATIONS?

A

Mitral valve prolapse

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36
Q

What to use of HTN if patients with CHF or diabetes?

A

ACE inhibitors

  • prevents chronic renal failure by dilating efferent arteriole
  • prevents chronic angiotensin II mediated LV HYPERTROPHY and REMODELING following MI
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37
Q

Familial Chylomicronemia Syndrome

A
  • inheritance: AR
  • protein defect: Lipoprotein lipase, APOC-II
  • clinical presentation: ACUTE PANCREATITIS, LIPEMA RETINALIS (milky-appearing retinal vasculature), eruptive skin xanthomas and heptosplenomegaly
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38
Q

Anteroseptal (LAD) - ischemia of interventricular septum

A

V1-V2

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39
Q

Anterioapical (distal LAD) - ischemia to anterior left ventricular wall

A

V3-V4

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40
Q

Anterolateral (LAD or LCX)

A

V5-V6

41
Q

Lateral (LCX) - ischemia to lateral wall of left ventricle

A

I, aVL

42
Q

Inferior (RCA) - ischemia to inferior wall of L ventricle

A

II, III, aVF

43
Q

Order in femoral triangle (lateral to medial)

A

Nerve, artery, vein and deep inguinal nodes/lymphatic vessels

44
Q

Ivabradine - effects, uses

A
  • 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
Q

Tricuspid Regurgitation

A
  • holosytolic murmur
  • louder with INSPIRATION (increased venous return to R side of heart)
  • heard best at LEFT STERNAL BORDER
46
Q

Constrictive pericarditis - clinical presentation

A
  • progressive dyspnea
  • ascites
  • peripheral edema
47
Q

Carcinoid heart disease

A
  • 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
Q

ANP and BNP does what?

A

Vasodilation (relaxes smooth muscle): acts on ANP receptors to activate guanylyl cyclase to increase cGMP

49
Q

Amiloride - class

A

K-sparing diuretic

50
Q

Indapamide - class

A

thiazide diuretic

51
Q

Fenoldopam - class/use

A

DOPAMINE 1 RECEPTOR AGONIST
- arterial vasodilation - increases cAMP
- renal vasodilation - increases RENAL PROFUSION, diuresis and natiuresis
USE IN HYPERTENSIVE EMERGENCY

52
Q

Niacin - class/use

A

Treatment for hyperlipidemia

  • decreases triglycerides and LDL
  • increases HDL
53
Q

Niacin - side effects

A

FLUSHING, warmth and itching - mediated by release of prostaglandins
- pretreat with ASPIRIN - inhibits prostaglandin synthesis

54
Q

Trousseau syndrome

A

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
Q

Phenylephrine - class

A

Alpha 1 Agonist

- causes vasoconstriction of renal, splanchnic and mesenteric arteries

56
Q

Biventricular pacemaker - lead placement

A
  • R atrium
  • R ventricle
  • L ventricle - course through coronary sinus which lies in the atrioventricular groove
57
Q

Which anti-arrhythmetic drug prolongs QT interval but not as much as other ones?

A

Amiodarone

58
Q

What important mediator is responsible for auto regulation of LARGE CORONARY ARTERIES?

A

Nitric Oxide - vasodilation

59
Q

What important mediator is responsible for auto regulation of SMALL CORONARY ARTERIES?

A

Adenosine - vasodilation

60
Q

Most involved arteries in ATHEROSCLEROSIS

A

Abdominal aorta > coronary arteries > popliteal > internal carotid > circle of Willis

61
Q

Atrial regurgitation - physical findings

A
  • 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
Q

Aortic stenosis - physical findings

A

delayed, prolonged carotid pulses: PULSUS PARVUS et TARDUS

63
Q

Phenoxybenzamine

A

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
Q

Phentolamine

A

REVERSIBLE alpha-adrenergic antagonist

  • increases Km but does not affect Vmax
  • if have enough NE, then can displace drug and reach Vmax
65
Q

How to treat peripheral artery disease

A
  • graded exercise program
  • Cilostazol: phosphodiesterase inhibitor (prevents cAMP degradation, cAMP prevents platelet aggregation) —> prevents platelet aggregation and is a direct arterial vasodilator
66
Q
  • Cilostazol - class and use
A

phosphodiesterase inhibitor: prevents breakdown of cAMP
- inhibits platelet aggregation
- direct arterial vasodilator
use for: peripheral artery disease

67
Q

Cardiac finding in SLE

A

Libman Sacks Endocarditis - nonbacterial, wart-like vegetations on both sides of the valve
Antiphospholipid Antibody syndrome - hypercoagulable state (even though prolonged aPTT)

68
Q

eccentric hypertrophy

A

The ventricle space is larger, the wall is not thicker

  • aortic or mitral valve regurgitation
  • myocardial infarction
  • dilated cardiomyopathy
69
Q

concentric hypertrophy

A

The ventricle wall is thicker, the space is smaller

  • chronic hypertension
  • aortic stenosis
70
Q

What is the major determinant of symptom severity in Tetralogy of Fallot?

A

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
Q

Organ susceptibility to infarction of feeding artery (greatest to least)

A

CNS (brain) > heart > kidney > spleen > liver

72
Q

Carotid baroreceptors: afferent nerve carried by _______ and efferent nerve carried by _______

A

Afferent: glossopharyngeal (IX) to solitary nucleus of medulla
Efferent: vagus (X)

73
Q

Aortic baroreceptors: afferent nerve carried by _______ and efferent nerve carried by _______

A

Afferent: vagus (X) to solitary nucleus of medulla
Efferent: vagus (X)?

74
Q

derivatives of 6th aortic arch

A 
Pulmonary arteries
Ductus arteriosis (left side)
75
Q

Derivatives of 4th aortic arch

A

Right: aortic arch
Left: proximal subclavian artery

76
Q

Derivatives of 3rd aortic arch

A

Common carotid artery

Proximal internal carotid artery

77
Q

Derivatives of 2nd aortic arch

A

Hyoid artery

Stapedial artery

78
Q

Derivatives of 1st aortic arch

A

Maxillary artery

79
Q

Fibrates - MOA

A

Activate PEROXISOME PROLIFERATOR ACTIVATED-RECEPTOR ALPHA —> decreased hepatic VLDL and increased lipoprotein lipase activity

  • Decreases triglycerides
  • increases HDL
80
Q

Most common cause of AS in patients >70 is?

A

senile, degenerative CALCIFICATIONS of aortic valve

81
Q

Does a shorter A2-opening snap interval indicate more severe or mild Mitral Stenosis?

A

More SEVERE

OS = tensing of mitral valve leaflets after it reaches maximum diameter during forceful opening

82
Q

Thiamine deficiency causes what syndromes?

A

Wernicke-Korakoff syndrome: ataxia, confusion, memory loss, oculomotor abnormalities, nystagmus
Beriberi
- dry: symmetrical peripheral neuropathy
- wet: symmetrical peripheral neuropathy + high-output CHFq

83
Q

Mitochondrial vacuolization

A

Sign of IRREVERSIBLE CELL INJURY - mitochondria can no longer produce ATP

84
Q

Mitochondrial swelling

A

Sign of REVERSIBLE CELL INJURY

85
Q

Most common side effect of fibrinolytic therapy

A

HEMORRHAGE (GI, intracerebral)

86
Q

How to treat beta-blocker toxicity?

A

GLUCAGON - acts on Gs receptors —> increase cAMP —> increase intracellular Ca —> increases muscle contraction —> increases HR and contractility

87
Q

Digoxin Toxicity

A
  • ARRHYTHMIAS due to hyperkalemia
  • BLURRY YELLOW VISION
  • GI symptoms
  • bradycardia, AV block
88
Q

Nitroprusside - class, effects

A

SHORT ACTING venous and arterial vasodilator

  • decreases PRELOAD and AFTERLOAD
  • maintains SV
89
Q

Acute pericarditis

A
  • 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
Q

Ergonovine - class

A
  • alpha-adrenergic and serotonergic agonist

- causes vasoconstriction

91
Q

Ergonovine test

A

provocative test for CORONARY VASOSPASM

92
Q

Statins - toxicity

A
  • Muscle toxicity
  • Hepatotoxicity: measure liver enzymes BEFORE starting statins but do not need to monitor routinely unless symptoms of hepatic injury develop
93
Q

Wide, fixed splitting of S2 heart sound is characteristic of what congenital defect?

A

Atrial septal defect

94
Q

S3 is best heard in which position?

A

Left lateral decubitus position at the END of EXPIRATION (decrease lung sounds)

95
Q

Disopyramide - class

A

IA antiarrhythmetic drug

96
Q

Gemfibrozil - class

A

Fibrate

97
Q

Which diuretic improves MORTALITY in heart failure patients?

A

Spironolactone

98
Q

Hepatic angiosarcoma is associated with exposure to which carcinogens?

A
  • arsenic

- polyvinyl chloride

99
Q

Diastolic heart failure

A
  • caused by DECREASED VENTRICULAR COMPLIANCE

- characterized by normal EF, normal LVED volume and increased LVED pressure

UWorld Facts (12 decks)

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