Cardiology U WORLD Questions Flashcards
harsh crescendo-decrescendo systolic mumur, right sternal border, syncope, dizzy, angina, on exertion
Most common cause world wide?
Most common cause in US?
3rd cause
aortic stenosis
Rheumatic heart disease
calcific aortic valve disease
congenital bicuspid valve that calcifies
malaise, SOB, dec appetite, decrescendo diastolic murmur at 3rd intercostal space LSB, low hemoglobin, + Strep gallolyticus
symptoms similar to?
associated w/??
Subacute bacterial endocarditis
Strep viridans SBE
Colonic neoplasia (25%)
multiple epidoses of syncope, young male, sedentary, family history of sudden cardiac death
genetic mutation in
leads to
results in
congenital prolonged QT syndrome
K+ channel protein (dec. outward K flow)
prolonged QT interval and action potential
Ventricular arrhythmias (TSD, Vtach), sudden cardiac death
dyspnea, gen weakness, fatigue, palpitations, tingling and numbness in both lower limbs, bilateral edema, basal crackles, dec. touch and vibration, dec DTRs
Dry vs wet
Thiamine deficiency
Dry is peripheral neuropathy, wet include HF
non nodal conduction
rapid upstroke Na+, plateau w/ Ca++, hyperpolarize w/ K+
two categorical variables association test
Chi square test for independence
stroke symptoms + afib, normal valves =
most like formed in
treatment
thromboembolic event
left atrial appendage
long term anticoagulation
myocardial cells increase in size due to ischemia caused by?
Ca2++ accumulation and Na+ accumulation, draw water into cell
1st aortic arch
2nd aortic arch
3rd aortic arch
4th aortic arch
5th aortic arch
6th aortic arch
maxillary artery
stapedial artery
common and proximal internal carotid arteries
true aortic arch and subclavian (portion of)
obliterated
pulmonary arteries and ductus arteriosis
vasodilation of skeletal muscles blood vessels during active exercise results in ______ despite inc sympathetic tone
sympathetic tone inc
dec in Total systemic vascular resistence
inc Caridac output and splanchnic vasoconstriction
NAVEL femoral triangle
Nerve, artery, vein, empty space, lymphatics
lateral to medial
exertional dyspnea, orthopnea, bibasilar crackles, elevated JVP, LE edema =
diastolic HF due to and caused by
LV pressure/volume
decompensated congestive heart failure
dec. ventricular compliance
HTN, obesity, infiltrative disorders (TTR amyloidosis, sarcoidosis)
up and to the left
easy fatigue, exertional dyspnea, diminshed first heart sound, apical holosystolic murmur radiating to the axilla, diffuse pulmonary crackles, no elevated JVP, no peripheral edema =
major determinant of forward to regurgitant flow ratio
mitral regurgitation with left sided heart failure
left ventricular afterload
episodic substernal chest pain, inc w/ activity and dec w/ rest, HTN, hyperLipid, smoker, S4 heart sound, LVH on ECG, inducible ischemia on inferior surface of heart =
which coronary artery occluded
angina
posterior descending branch of RCA
exertional dizzyness then syncope, followed by LOC; ECG bradycardia, unsynched P and QRS =
paced by
3rd degree heart block
AV node
severe midback pain, nausea, diaphoresis, lightheadness, HTN, CKD, dissection flap of desc. aorta =
usually originates
Type A refers to?
usually originates
Standford Type B dissection
origin of L subclavian A
ascending aorta
sinotubular jxn
ANP secreted by
effects?
accentuated by
atrial cardiomyocytes
inc urinary exc. of Na+ and vasodilation
Neprilysin inhibitors (Sacubitril) prevents degradation
Sudden palpitations in young man, carotid sinus massage leads to
PNS tone inc via vagus nerve, dec AV node conduction and prolonged AV node refractory period
CO =
CO also =
SV x HR
rate of O2 consumption / AV O2 content difference
infant, continuous murmur along w/ inspiratory splitting of S2 machine like in left infraclavicular region
PDA
synthesis of fibrous cap on athersclerotic plaque caused by
Vascular smooth muscle cells
Lungs ant/post to heart?
midclavicular stab wound?
anterior
left lung, deep enough apex of LV
Wide fixed splitting S2 that does not vary w/ respiration =
can produce?
type of shunt
ASD
chronic pulmonary HTN, sclerosis, Eisenmenger syndrome (reversal of shunt)
L-to-R
dec in BP >10mmHg on inspiration, JV distention, tachycardia after blunt chest trauma, muffled heart sounds, hypotension
lung exam
cardiac tamponade
normal
most common cause of Mitral Stenosis
characteristics
can cause?
sounds like
Rheumatic fever
fibrous thickening and fusion of valve leaflets
atrial enlargement, a fib, mural thrombosis
loud S1, opening snap, mid diastolic murmur
Migratory superficial thrombophlebitis (Trousseau) due to
paraneoplastic syndrome of visceral cancer
short stature, short thick neck, broad chest, short metacarpals =
most common congenital cardiac malformation =
sound
at risk for
Turner Syndrome
Bicuspid aortic valve
early systolic high frequency click over right 2nd ICS
stenosis, insufficiency, infxn
afib w/ rapid ventricular response treated w/ ____ for rate control
works by
also used in
digoxin
dec. AV node conduction, inc PNS vagal tone, block Na+/K+ ATPase pump
heart failure
low grade fever, fatique, early distolic murmur at left sternal edge, subungal splinter hemorrhages, elevated ESR
gram stain
synthesize
associated w/
endocarditis: Strep viridans
G+ cocci
dextrans from sucrose
dental caries
young adult, progressive exertional dyspnea past 6mos, no chest pain, light headness or syncope, FH of mother dying of pulm HTN young adult, loud second heart sound at upper left sternal border, clear lung fields, RAD =
if inherited caused by
Gene
idiopathic pulmonary HTN
vascular sm muscle proliferation
BMPR2
10 yo, SOB, palpitations, fever, poor appetite, fatigue for few days, tachypnea, tachycardia, hypotension, new holosystolic murmur
pathology
acute rheumatic fever (untreated grp A Strep) - pancarditis, mitral regurg
interstitial myocardial granuloma (aschoff body)
Sudden death of young adult, usually athletic
biopsy shows
Genetics
HCM
myocyte hypertrophy and haphazard arrangemet
AD familial 50%
flushing, watery diarrhea, bronchospams, valvular fibrous plaque, abnormal growth in adult
diagnosis
carcinoid syndrome
elevated 24hr 5hydroxyindoeacetic acid (HIAA) (product of serotonin metabolism)
acute graft rejection in cardiac transplant
dense interstitial lymphocytic infiltrate weeks after transplant: cell mediated
STEMI, days later chest pain inc w/ coughing and swallowing, radiates to neck, low grade fever
pericarditis overlying necrotic segment
immigrant, fever, progressive weakness, dyspnea, vegetations on mitral valve =
most likely history of =
predisposing factor
initiating step (strep cultured)
infective endocarditis
Rheumatic heart disease
valvular abnormalities (valvular inflammation and scarring)
fibrin deposition
Dobutamine inc =
receptor?
increases?
used for?
heart rate and contractility
B1
myocardial oxygen consumption
acute MI w/ acute severe HF
young adult, progressive fatigue, dyspnea on exertion, LE edema over last 2 weeks w/ fever runny nose and myalgias resolved several days before, JVD, bibasilar crackles
Echo results
decompensated heart failure of DCM caused by viral myocarditis
Dilated ventricles w/ abnormal systolic ventricular fxn
decompensated systolic HF as a result of chemo for NHLymphoma: after initial stabilization use:
long term beta blockers: carvedilol, metoprolol
sudden death 1 week after after acute MI due to:
actual cause of death
free wall rupture of left ventricle (anterior wall MI)
profound hypotension and shock
pulsatile vessels w/in the intercostal spaces and diminished femoral pulses relative to brachial pulses in a 12 yo girl
syndrome
other problem w/ same syndrome
aortic coarctation
Turners
Bicuspid aortic valve
5yo, turning blue w/ exertion, relieved by squatting, prominent right ventricular impulse and a harsh systolic murmur
Embryological mechanism
Squatting does what
Tetralogy of Fallot: VSD, overriding aorta, Right ventricular outflow tract obstruction, RVH
deviation of infundibular septum (neural crest)
inc afterload and dec R-L shunt across VSD
chest pain, diaphoresis, dyspnea, thrombosis, elevated homocysteine in plasma, mutation in THF reductase =
inc risk of?
impaired conversion of homocysteine to methionine
Thromboembolic events
patient started on low dose aspirin but experiences SOB and wheezing, best alternative?
Mechanism?
Clopidogrel (blocks P2Y12 of ADP platelet receptors)
prevents aggregation
vascular endothelium secretes ____ to inhibit platelet aggregation?
what enhances platelet aggregation?
prostacyclin (PGI2)
TXA2
number need to treat =
ARR =
1/ARR
control rate - experimental rate
common cardinal veins give rise to
superior vena cava (know on CT)
AV node located at
RA near orifice of coronary sinus, radio ablated in afib
calcium efflux from cardiac cells prior to relaxation is mediated by ____
Na+/Ca++ exchange pump
progressively worsening dyspnea, orthopnea, HTN, bilateral basilar crackles, JVD, LE edema, hilar prominence and cardiomegaly, LVH on ECG, echo shows PHTN:
Mechanism
vasoconstriction due to pulmonary venous congestion
Pulmonary HTN due to hypertensive heart disease
nitric oxide endothelial vasodilation requires ____
arginine, eNOS, cGMP
Flow(Q) =
reduced by factor of __ means?
P1-P2/R or r^4 (radius of blood vessel to 4th power)
divided by
chronic AV shunt such as ____ would ____ CO because of SNS stim to heart and____ venous return
chronic arteriovenous fistula
increase
increase
chest wound directed posterior adjacent to LSB in 4th ICS would injure
would not injure?
RV last (anterior surface of the heart
left lung (no middle lobe)
4 year old, irritable, vomit, traveled to china, fever, bilateral conjunctivaal injection, brigh red tongue, cracked lips, nonpitting edema on hands and feet, Asian =
artery size?
greatest risk for?
Kawaski disease
medium
coronary artery aneurysms
CHF (dyspnea, orthopnea, JVD, edema) results in ____ CO, _____ renal perfusion, and _____ renin production by JGA cells
substance higher in pulmonary vein than pulmonary artery
decreased
decreased
increased
Angiotensin II
flank pain, hematuria, wedge shaped kidney infarct =
due to
thrombotic renal infarction
Afib
primary collagen in MI scars is
type I found in tendons
aorta and LV pressure dont match up =
peak of murmur intensity =
aortic stenosis
ventricle pressure
amiodarone, sotalol, dofetilide
work on downslope pahse ___
Class II antiarrhythmics: block K+ channels
3 of cardiac cycle
Free wall rupture occurs ____
5-14 days after acute MI
harsh ejection type systolic murmur at base of heart radiating to neck =
due to
aortic stenosis
calcific degen of trileaflet aortic valve (developed nations)
LV leads in biventricular pacemakers course thru _____ which resides in _____ on _______ aspect of heart
coronary sinus
AV groove
posterior
young boy, fatigue, clubbing, cyanosis w/o blood pressure-pulse discrepancy =
sounds like
PDA
continuous machine like murmur
ANP, BNP, and sildenafil (PDEI) all use
cGMP
depression, HTN, obtunded, hypotensive, bradycardic, IV glucagon admin and she improves =
treatment of choice
pathophys
beta blocker overdose
glucagon
glucagon increases cAMP, inc Ca++ release and inc SA node firing
lightning storm, dead, most likely cause of death
fatal arrhythmia
small heart, atherosclerosis, myocardial cells show intracytoplasmic granules tinged yellow brown due to ____
pigment name
lipid peroxidation
lipofuscin (wear and tear of aging)
flail posterior mitral valve leaflet
leads to ___left atrial pressure, ______ LV EDV (preload), and _____ afterload
acute mitral regurg due to chordae tendinae rupture
increased, increased, decreased
drug resistant hypertension, shrunken kidney due to?
oxygen and nutrient deprivation from unilateral renal artery stenosis
spironolactone, eplerenone =
spare?
improve?
should not be used with (2)
MC receptor antagonists: CHF
K+
ventricle remodeling and LV EF
hyperK or RF
absence of myocardial necrosis and scarring despite vessel occlusion explained by?
slow growth of occluding plaque
breast cancer survivor with radical mastectomy, radiation, presents with persistent right arm swelling: increased risk for
lymphangiosarcoma
chronic cough and angioedema due to
ACEI family (prils)
highest athersclerotic burden is on the ____ and ____ arteries
abdominal aorta
coronary
endocarditis, gram +, catalase -, grow in hypertonic saline and bile =
procedures in past month
enterococcus (normal UG flora)
cystoscopy
Statin MOA
Results in?
block HMG CoA
increase in hepatocyte LDLR density
post endocarditis, holosystoli murmur that increases during inspiration
Tricuspid regurg, 2nd and 3rd ICS Left
increased HR, CO, unchanged parital pressures of O2 and CO2 =
exercise
amlodipine, felodipine, nifedipine
location of action
effects
verapil effects?
Dilitazem effects?
Ca++ channel blockers
vascular smooth muscle only
vasodilate ( lower BP, no ECG change)
cardiac muscle (only ECG change)
Both, vascular and cardiac mscle, combined effects
Vancomycin binds to
resistance via
D alanyl D alanine
D Lactate substitute D alanine
neither pts nor physicians aware of who takes drug or placebo =
eliminates
double blind
observer bias
increase in blood O2 saturation from right atria to right ventricle indicates
Most commonly
sounds like
left to right shunt
VSD
holosystolic murmur over L Sternal border
most heavily involved vessel in athersclerosis
abdominal aorta
sudden onset vision loss, left sided neck bruit =
pathway
embolus
ICA, ophthalmic artery, retinal artery
Left dominance coronary circulation = ____ supplies posterior descending artery. Right dominance = _____ supplies PDA. AV nodal artery arises from dominant artery
left circumflex artery
right coronary artery
the most important mediator of coronary vascular dilation in larger arteries and pre arteriolar vessels is
NO
fastest to slowest cardiac tissue conduction velocity
PAVA
Purkinje, atrial, ventricular, AV
dec in LV size, sigmoid shaped ventricular septum, myocardial atrophy, inc collagen deposition, ipofuscin pigment =
normal aging heart
cyanotic newborn, elevated serum lactate, machine murmur between scapulae, aorta anterior, inferior, and right of pulmonary artery =
failure of
must have ____ to survive
Transposition of great vessels
spiraling
PDA, patent foramen ovale, or septal defect
rapid bacterial endocarditis, rigors, high fever, IV drug use =
can cause ____ sided endocarditis w/ ______ into the lungs
S aureus
right
septic embolization
combined use of __________ and ______ can lead to
verapamil, dilitiazem
atenolol
bradycardia and hypotension
abrupt onset severe chest pain radiates to back, high blood pressure =
aortic dissection: intimal tearing
chest pain reproduced w/ palpation and worsened w/ movement changes =
follows
costochondritis
repetitive activity
Rapid surge of serum CK due to
cell membrane damage from ischemia
nitroglycerin mainly affects
large veins
viridans infx, pre existing valvular lesion, adhere via
fibrin-platelet aggreagates
low frequency S3 over apex in older =
left ventricular failure and inc LV EDV
long history of HTN, S4 due to
inc stiffness of LV wall
measure for assessing the degree of mitral stenosis
A2 split to opening snap time interval, shorter is worse
Natriuretic peptides effects (3)
metabolized by??
drug??
inc GFR
dec Prox. Na+ resorb
dec renin secretion
neprilysin metalloprotease
neprilysin inhibitor
severe fatigue and dyspnea, HF, chest radiation or viral illness or TB in endemic areas =
path?
Signs
constrictive pericarditis
thick fibrous rigid pericardium
Inc JVP, on inspiration (usually drops), pulsus paradoxus, pericardial knock
Nitrates are _____dilators that _____ preload, _____ LV EDV, ______ peripheral venous capacitance, and ______ systemic vascular resistance
venous
dec
dec
incr
dec
the best indicator of severity of MR is ____ sound
Murmur associated w/ MR?
S3 gallop
holosystolic best heart at apex of heart, radiates to axilla
chronic cough, sometimes blood when coughing hard, right sided face and arm swelling and engorgement of subcutaneous veins on same side of neck =
due to
blockage of subclavian vein would cause
blockage of SVC would cause
blockage of JV would cause
right brachiocephalic vein obstruction
apical lung tumor or thrombotic occlusion (catheter placement)
unilateral arm swelling only
bilateral swelling
unilateral face swelling only
IVC formed by union of
R and L common iliac veins
recurrent episodes of paroxysmal afib, usually treated w/
sotalol, Beta adrenergic and K+ channel block, both rate and rhythm control
cardiac tamponade due to pericardial fluid accumulation can result in ______ in pulse amplitude during _______
called?
also seen in?
decrease
inspiration
pulsus paradoxus (>10mmHg)
constrictive pericarditis
midsystolic click followed by mid to late systolic murmur at cardiac apex that disappears w/ squatting is due to ___
Squatting ____ venous return and LV volume
MVP, connective tissue disorder
increases
common side effects of statins include _____ and _____ toxicity
Labs needed before initiation of therapy?
muscle and liver
hepatic transaminases
ate lots of fancy meats and cheeses w/ history of depression can lead to ______ because of ______ in the foods interaction w/ __________ used to treat depression
HTN emergency
tyramine
MOAI
started on low dose atenolol, stable angina w/ elevated BP
acts on ____ receptors at ____
results in____cAMP of cardiac myocytes and JGA cells, and has ______ in cAMP in vascular smooth muscle
B1 receptors on cardiac myocytes and JGA cells (renal)
decreased
no effect
recurrent paroxysmal SVT in healthy individual manifests as _______
ECG finding?
WPW syndrome
delta wave at start of QRS, short PR, widened QRS
0-4 hours after MI, biopsy would show ________ on cardiac myocytes
4-12 hours post MI
12-24hours post MI
1-5 days post MI
5-10 days post MI
10-14 days post MI
2wks - 2months post MI
minimal change
early coagulation, wavy fibers
coagulation necrosis
neutrophil infiltrate
macrophage infiltrate
granulation tissue and neovascularization
collagen deposition and scar
vague feeling of heaviness in legs, standing for long periods =
physical finding
complication
very rare complication
venous stasis
varicose veins
skin ulcerations
pulmonary embolism
Paroxysmal SVT (nodal arrhythmia) treated w/ ____
2 drugs in this class
block what type of channel
class IV antiarrhythmics
verapamil, diltiazem
L type Calcium channels
harsh holosystolic murmur, flat face, protruding tongue, small ears =
due to =
Down syndrome
meiotic nondysjxn
severe mitral regurg and pulmonary edema post MI due to rupture of posteromedial papillary muscle occurs because compromised blood flow through ______ artery
posterior descending
deep chest pain exacerbated on exertion or emotional stress relieved w/ nitroglycerin =
due to _____% blockage of lumen of a coronary artery
stable angina
> 75%
cryptogenic stroke in young adult, +bubble study =
ASD or Patent foramen ovale due to incomplee fusion of atrial septum primum and secundum
old, isolated systolic HTN and HA due
aortic stiffening
young healthy boy, audible LSB sound, accentuated w/ handgrip (______afterload) =
increase
VSD
immigrant, gray pharynx, cervical LAD, soft palate paralysis =
mechanism of exotoxin
risk of
Corynebacterium diphtheriae
diphtheria toxin, intracellular ribosylation EF2
myocarditis
cardiac cath through common femoral artery above inguinal ligament leads to risk of ________ hemorrhage
looks like
retroperitoneal
ecchymosis surrounding puncture site
antiarrhythmic agent bids to rapidly depolarizing ischemic ventricular myocardial fibers =
drug of choice?
effect on normal ventricular myocardium
lidocaine
no Amiodarone
minimal
QT prolongation syndrome also called
Romano-ward
Jervell and Lange Nielson
adenosine______ phase 4 in cardiac pacemaker cells by ______ K conductance
prolongs
increasing
posterior surface of the heart is the _____atrium
enlargement from _____ can lead to cardiovascular ________ from pressure on esophagus
left
mitral stenosis/regurg from RHD
dysphagia
bicuspid aortic valve predispose to early
aortic stenosis (50s rather than 70s-80s)
compare the means of 2 groups of subjects with
two sample T test
righward widening of the pressure volume loop due to an _____ in preload such as saline infusion
increase
best choice for long term HTN w/ congestive heart failure is not a diuretic but a ______
ACEI
coffee ground emesis, tachycardia, cool extremeties =
first intervention =
increases?
hypovolemic shock
saline infusion rapid
end diastolic sarcomere length due to increase preload
familial hypercholesteremia in heterozygotes
common segment on effected individuals in a southern blot would represent the ______ gene
AD, high LDL, premature athersclerosis
mutated
first peak on JVP tracing is
second, small peak is
steep decline is
3rd peak is
3rd decline is
RA contraction
tricuspid bulge on RV contraction
RA relax
inflow venous blood
passive RA emptying after Tricuspid open
thickened and calcified ring on CT around heart is =
slowly progressive dyspnea, peripheral edema, ascites
constrictive pericarditis
some clinical symptoms
early diastolic murmur at LSB
at RSB in developed countries
can be due to
Aortic regurg
aortic root dilation
aortic root dilation or bicuspid aortic valve
WPW due to
young, palpitations, light headed, rapid heart beats
accessory pathway bypasses AV node
infant, rapid breathing, tired, mid diastolic rumbe at LSB, holosystolic murmur at apex radiates to axilla, defect in lower interatrial septum and interventricular septum =
most common with?
complete AV canal defect
Down syndrome tri 21
HTN crisis and hyperplastic arteriosclerosis in renal arteries looks like
onion like concentric thickening of arteriolar walls
exertional calf pain, foot ulcers, hypersensitivity to tobacco extract =
path
thromboangiitis obliterans (Buergers)
segmental hypersensitivity vasculitis into veins and nerves
progressive fatigue, splinter hemorrhages on nails due to =
cause
sound associated
microemboli
infective endocarditis
regurgitant murmur
thigh and leg pain, hypercoagulable, weak dorsalis pedis pulse =
drug that acts as arterial vasodilator and inhibits platelet agg?
mechanism
should also recieve
peripheral artery disease
cilstazol
PDEI
aspirin or clopidogrel (antiplatelet)
muscle pain and cramps that remits w/ rest and decreased sexual performance, MI history, symptoms caused by
defined as
lipid filled intimal plaque
claudication
acute onset chest pain and dyspnea, HTN, large perfusion defect =
most likely from
pulmonary embolism
DVT
sudden cardiac death in young athlete most likely due to
HCM
lightheaded while buttoning tight shirt collar, pass out, low pulse, HTN, DM =
due to stimulation of _____ in carotid sinus
afferent limb?
efferent limb?
carotid sinus hypersensitivity
baroreceptors
CN9
CN10
dystrophic calcification of aortic valve preceded by
damaged or necrotic tissue
very high concentrations of NE, still no effect on BP
drug?
mechanism?
irreversible inhibitor
phenoxybenzamine
alpha 1 and 2 adrenergic antagonist
statins, muscle pain, fatigue, dark urine =
metabolized by?
precipitated by
stain induced myopathy
CYP450 3A4
macrolides (mycins)
family history of sudden death, young, systolic murmur that accentuates with standing from supine =
medications to avoid?
HCM
vasodilators, diuretics
sublingual nitroglycerin in stable angina = ______ in LV EDV
decrease
nontender lesions on foot or palms in infective endocarditis =
painful nodules on finger tips and toes in endcarditis =
vascular microemboli (Janeway lesions)
immune complex Osler nodes
ivabradine inhibits _______ channels, thus ______ SA node firing w/o affecting ______
funny sodium channels
slowing
contractility
side effects of ACEI =
use _____ instead
cough, angioedema
ARB, sartans
adverse effects of thiazide diuretics
hypoNa, K
HyperCa, glycemia, cholesterolemia, uricemia
esmolol is an IV _____ that decreases ______ node conduction, which correlates to PR interval _____ elongation
Beta blocker
AV
elongation
mitral valve replacement, fever, baceremia w/ catalase positive, coagulase neg g+ cocci in clusters
adhere w/ ?
assumed to be _____ resistant, so treat w/
nosocomial coagulase negative staph
polysaccharide slime
methacillin resistant
vancomycin
nonbacterial platelet rich thrombi characteristic of ______
due to______
nonbacterial thrombotic endocarditis
advanced malignancy
crescendo-decresendo systolic murmur peaking in midsystole, super old, due to _____ or ______ stenosis
due to _______
aortic, pulmonic
valvular calfication
medial branch off of external iliac artery is
lateral branch is
inferior epigastric
deep circumflex iliac artery
IV drug that causes increased contractility and deccresed systemic vascular resistance is
receptors
isoproterenol
B1 and 2
pregnant, hypotension while supine =
due to =
supine hypotension syndrome
compression of IVC and reduced venous return
phenylephrine, methoaxamine are _______ that vasoconstrict systemic blood pressure. This stimulates carotid baroreceptors to increase ____ tone and _____ conduction through ____ node
alpha 1 selective adrenergic agonists
vagal
decrease
AV
during ventricular systole (QRS), coronary arteries are _____ leading to a ________ in coronary blood flow
compressed
reduction
10 yr old, restlessness, involuntary jerking, sore throat 3 months ago_____ which is a neuro manifestation of _____ due to anti strep antibodies affecting the ______. Patient is at a high risk of _________
Sydenham chorea
acute rheumatic fever
basal ganglia
valvular heart disease
pulmonary edema, cephalization of pulmonary vessels, perihilar alveolar edema, plunting of costophrenic angles from pleural effusions =
acute decompensated HF
fatigue, progressive dyspnea, orthopnea, S3, recent MI =
third heart sound best heard when listening at
decompensated heart failure
end expiration in Lateral recumbent left side
LV EDV in MS is _____, and is _______ in combined aortic and mitral valve disease
decreased, increased
normal bleeding time indicates______
normal activated partial thromboplastin time indicates ______
prolonged Prothrombin time in setting of normal aPTT indicates _____ such as _____
adequate platelet hemostatic fxn
intact intrinsic coagulation system (Factor VIII)
defective extrinsic pathway in step not shared w/ intrinsic pathway such as deficient Factor VII
renin and BP stay the same after 3weeks of anti HTN therapy =
medication noncompliance
fatty streaks are the ______ lesions of atherosclerosis and are a collection of lipid laden ______ or foam cells in the intima
earliest
macrophages
acute asthma and COPD exacerbations controlled by _____ such as _______ by _______ via
Beta adrenergic agonists, clenbuterol
relaxing bronchial smooth muscle
inc cAMP in smooth muscle cells
patients with tetralogy of fallot, the major determing factor of resulting cyanosis is the
degree of right ventricular outflow tract obstruction
doxorubicin forAML can cause
presents w/
DCM
exertional dyspnea and orthopnea
varicose veins result from chronically elevated venous pressure and ____
incompetent venous valves
severe chest pain, thrombus, thickened mitral valve leaflets w/ vegetations, glomerular basement membrane thickening, young adult woman =
SLE
polyarteritis nodosa (PAN) affects ______ but spares _____
fever, weight loss, myalgias, abdominal pain, high blood pressure
kidneys, heart, liver, GI tract
pulmonary arteries
consolidation of _____ lung lobe can obscure x ray silhouette of ______ on X ray
right middle
right atrium
MAAM COCO
opening snap of mitral valve stenosis heard at bottom left corner of ventricular pressure looop (MO)
Mitral valve close
Aortic Valve open
Aortic Valve close
Mitral valve open
dobutamine is a ____ agonist, acting at a ______ and ______ cAMP, which _______ contractility
B1 and weak B2
Gs GPCR
increases
increases
HCM involves is an ____ inherited disorder invovling sacromere genes that encode for _______ and ________
autosomal dominant
beta myosin heavy chain
myosin binding protein C
cough, chronic HTN, hemosiderin laden macrophages =
left sided heart failure
higher dose of oral nitrate needed compared to sublingual due to _____
first pass metabolism
slightly elongated QRS at high heart rate (stress test) due to Class_____ antiarrhythmics such as ______
1C
flecainide (Na+)
pregnancy induced DVT, best anticogulant is
LMWH, such as enoxaparin
occasional dizzyness while moving UE, retrograde flow in left vertebral artery =
results from _________ of proximal subclavian artery
subclavian steal syndrome
severe stenosis
reliable
valid
how many times can you hit the bullseye
can you hit the bullseye
most coronary venous blood drains through
coronary sinus
abdominal pain, vascular tumor, arsenic or polyvinly chloride exposure, CD31+ cell
liver angiosarcoma: PECAM1
PDA remains open due to
sounds like
closes w/
PGE2
continous machine murmur
indomethacin or ibuprofen
aspirin is associated w/ _____ injury and bleeding
GI mucosal
newborn benign vascular lesion, cutaneous strawberry type =
most likely will
juvenile hemangioma
first inc in size then regress
spontaneous episodes of rest and nighttime angina w/ transient ST elevation =
due to
can be caused by____ which is used to treat____
can also be caused by____
treatment
Prinzmetal angia (variant)
coronary vasospams
dihydroergotamine, migraines
smoking, cocaine, meth, triptans
amlodipine, Ca++ channel blocker that vasodilates
descending thoracic aorta lies ____to the esophagus and the left atrium
posterior
sudden cardiac death post MI most commonly due to
Vfib
K+ sparing diuretics such as ______ act on the _____ and the ____ to antagonize the effects of
spironolactone and eplerenone
late distal tubule and CCD
aldosterone
young, constitutional symptoms, mid diastolic rumbling murmur heard best at apex, positional dyspnea, large pedunculated mass in LA =
Path?
atrial myxoma
scattered cells w/in a mucopolysaccharide stroma, abnormal blood vessels and hemorrhaging
aortic regurg murmur most loudly heard after _____
aortic valve closure
ACEIs can cause significant first dose hypotension in patients w/ ______ from ______ or ______
volume depletion
diuretic use
heart failure
around the clock nitrate administration rapidly results in the development of ______
tolerance
myxomatous changes w/ pooling of proteoglycans in the media layer of large arteries predisposes to ______
aortic aneurysms
an abnormally prominent left atrial “v” wave during cardiac cath is a finding of
presents w/
mitral regurg
exertional dyspnea and orthopnea
smokers over the age of 35 are contraindicated for
OCPs
an increase in stroke volume or EF is depicted on the LV pressure-volume relationship by widening of the loop to the _____
left
adenosine and dipyridamole are selective vaso______ that can cause coronary _____ _____ where blood flow to an ischemic area is reduced
dilators - arterial
steal syndrome
Subacute IE complicated by embolic stroke, most common predisposing factor in developed nations?
in developing nations?
regurgitant MVP
RHD
maintenance dose =
half life =
loading dose=
(desired steady state concentration x clearance) converted to hours
Volume distribution x 0.7/clearance
Volume distribution x Cpss/bioavailability fraction
ACEI induced angioedema is due to
bradykinin accumulation
Losartan (ARB) will cause an _____ in renin, AngI, AngII, and a ____ in aldosterone, with _____ in bradykinin
increase
decrease
no change
Milrinone is a selective ____ that ____ cAMP levels to causes systemic arterial and venous _____ and _____ contractility
PDE3 inhibitor
increases
dilation
increases
night palpitations, pounding heart and head bobbing w/ exertions =
due to
AR
widening of pulse pressure
warfarin monitored w/
unfractionated heparin monitored w/
PT or INR
aPTT
left ventricular systolic dysfunction due to reduced coronary blood flow at rest in angina
completely reversible by
Hibernating myocardium
coronary revascularization
nitrates are contraindicated for 24hrs w/
due to
PDEI
cGMP accumulation
HyperK+ secondary to ACEI therapy is most common in patients w/ _____ and in patients taking _______ such as _____
renal insufficiency
K+ sparing diuretics
amiloride, triamterene, spironolactone
statin induced myopathy risk increased w/ co administration of ____ such as ____ that impair hepatic clearance of statins
fibrates
gemfibrozil
most common adverse effect of alteplase post MI is
intracerebral hemorrhage
long standing HTN heart changes
LA
LV mass
LV wall thickness
enlarged
increased
increased
Class IA drugs (3) are _______ inhibitors of phase 0 depolarization and _____ action potential. CLass IB drugs (2) are _____ inhibitors of phase 0 and ____action potential. Class IC drugs (2) are ____ inhibtors of phase 0 depolarization and have ______ on action potental
IA: quinidine, procainamide, disopyramide
intermediate
prolong
IB: lidocaine, mexiletine
weak
shorten
IC: flecainide, propafenone
strong
no change
arteriovenous shunts ____ preload and ____ afterload, which decrease LV pressure and increase LV volume
increase
decrease
Leads I and aVL correspond to the lateral limb lead on ECG correspond to
supplied by
lateral aspect of left ventricle
Left circumflex artery
Fibrates (2) activate _______, which leads to _____ hepatic ________ production
gemfibrozil, fenofibrate
PPAR-alpha
VLDL production
Normal pressure in SVC and RA
RV
Pulmonary artery
1-6mmHg
15-30mmHg
6-12mmHg
great saphenous graft accessed just ____ to the _____
inferolateral
pubic tubercle
marfanoid habitus is associated w/
aortic disease and dissections
leads II, II, aVF correspond to
supplied by
hemodynamic findings
inferior wall infaraction
RCA
dec CO, pulmonary capillary wedge pressure, inc central venous pressure
ST elevation and subsequent Q wave formation
result of
transmural myocardial infarction
fully obstructive thrombus
at 20minutes post ischemia, myocardium will
at 30 minutes damage is
stop contracting
irreversible
_______ provide major proliferative stimuli for cellular components of atherosclerotic plaque
provide (mediator)
macrophages promote ______ migration
platelets
PDGF
smooth muscle
Digoxins initial cellular event is to _____ sodium ion efflux
decrease
cortisol exerts a ____ effect on many hormones to improve response to stressors. It increases bronchial smooth muscle reactivity to _______
permissive
catecholamines
DCM heart failure is due to
decreased ventricular contraction force
high interplaque activity of _____ results in MI
metalloproteinases
HCM murmur sounds like
decreased intesnity by
increased intensity by
harsh crescendo decrescendo at apex due to LVOT obstruction
passive leg raise, phenylephrine, squatting, sustained hand grip
sudden standing
selective arteriolar vasodilators (2) lower BP by reducing systemic vascular resistence. also results in reflex _____ activation, which inc HR, contractility and cardiac output. IT also stimulates ______ axis that results in ________ retention
hydralazine, minoxidil
sympathetic
RAA
sodium and fluid
cardiac arrhythmia, nausea, vomit, confusion, weakness, visual problems, ELEVATED K
digoxin toxicity
pulmonary artery catheters pressure reading most likley corresponds to pressure in
let atrium
CLass III antiarrhythmic drugs (3) block _____ channels, thus prolonging repolarization
amiodarone, sotalol, dofetilide
K+
old, progressive exertional dyspnea, edema, ascites, elevated JVP, prominent S4, left atrial enlargement, LVH, normal ejection fraction =
due to =
major causes
acellular pink material =
diastolic heart fialure
restrictive cardiomyopathy
amyloidosis, sarcoidosis, hemochormatosis
amyloid
straining during urination, HTN, which drug
mechanism
used for
Doxazosin
alpha 1 blocker
BPH
metnal status change, seizure, prolonged QRS, hallucinations, depression, arrhythmias, anticholinergic findings =
drug used to treat cardiac toxicity
TCA toxicity
sodium bicarbonate
metoprolol is a ____ blocker that ____ release of renin from renal JGA cells via B1 receptors
Beta
inhibits
adrenergic various effects (up then down) with different doses = drug used
receptor
dopamine
D1
young adult dies of HTN problems and intrracerebral hemorrhage with no history of head trauma associated w/
coarctation of the aorta
progressive exertional dyspnea, smoker, inc AP diameter of chest, scattered wheezes, dilated RV, absence of peripheral edema is explained by?
increased tissue lymphatic drainage
SA node located at the right atrium near the opening of the ____
SVC
nitroprusside dec both ____ and ____
preload
afterload
Congenital long QT syndrome mutations
KCNQ1, KCNE1
verapamil affects cardiac contractility but not skeletal muscle because skeletal muscle has little dependence on ______ influx
extracellular calcium
left atrial enlargement can impinge on _____
presents w/
also called
left recurrent laryngeal nerve
hoarseness
Ortner syndrome
supine dyspnea relieved by sitting up is indicative of
left sided heart failure
atherosclerosis is initiated by repetitive _______
endothelial cell injury
SLE cardiac manifestations
pericardial inflammation
statins inhibit
HMG CoA reductase
bounding femoral pulses, carotid pulsations, head bobbing =
aortic regurgitation
the ____ is an organ that is not vulnerable to arterial occulsion due to its dual blood supply, the ___ vein and_____ artery
liver
portal
hepatic
isolated diastolic heart failure shows ____ LVEDP, _____ LVEDV, _____LV EF
increased
normal
normal
IV agent that increased peripheral vascular resistance, increases systolic BP, decreases pulse pressure, decreases heart rate
phenylephrine: selective alpha 1 adrenergic receptor agonist
QT prolongation, lowest incidence of Torsades, what drug
amiodarone
MMA course deep to _____ and is a branch of the _____ artery. Laceration can lead to ______
pterion
maxillary
epidural hematoma
paradoxical embolism, atrial left to righ shunt: =
ASD wide a fixed splitting of S2
MI w/ COPD, use cardioselective beta blockers such as
meoprolol, atenolol, bisoprolol, nebivolol
compression in left renal vein can yield ____
can also form
hematuria and flank pain
varicocele
main adverse effects of nitrates are
HA and flushing
IV medication that causes arteriolar dilation, improves renal perfusion, and increases natriuresis =
fenoldopam - HTN crisisL D1 receptor agonist
ST elevation in leads II, III, and aVF =
RCA
thickened aortic on CT =
due to HTN
aortic dissection
severe aortic regurgitation is compensated by an ___ in total
increase
stroke volume
ventricular contraction rate in Afib is determined by
AV node refractory period
skin and mucosal telangiectasia with recurrent severe nosebleeds =
inheritence
Osler Weber Rendu syndrome (hereditary hemorrhagic telangiectasia)
AD
sharp mid chest pain that increases with deep inspiration and decreases when he sits up =
sounds?
acute pericarditis
friction rub
normal LV EDP, LV Peak systolic pressure, elevated pulmonary capillary wedge pressure
mitral stenosis
filter to preent further embolization is placed in the
IVC
central abdominal mass that pulsates =
characterized by
abdominal aortic aneurysm
chronic transmural inflammation
propranolol blocks ___ effects on HR and vasodilation
Epinephrine
Class IC>IA>IB ?
sodium channel binding strength
NE IV drip in vein, becomes white, cold, hard, pale =
treated with ____ injection of the affected tissue
NE extravasation
phentolamine
TdP polymorphic Vtach is precipitated by
sotalol, quinidine
haloperidol
macrolides
fluoroquinolones
S4 due to _____ or ____
restrictive cardiomyopathy and LVH
palpitations, tachycardia, irregularly irregular rhythm =
previous alcohol consumption night before
Afib, no P waves
orthostatic hypotension can be due to ____ blockade
alpha 1 adrenergic
hydralazine, procainamide, isoniazid can induce _____which shows with a rash and very high ____titers
lupus
ANA
HCM has a thickened ______ and abnormal systolic anterior motion of ____ leaflet
interventricular septum
anterior mitral valve
post op saddle embolism prevneted by
low dose heparin
constipation, AV block, worsening HF due CCB therapy such as (drugs)
diltiazem
verapamil
palpitations and PSVT relieved by IV injection of
adenosine
_NS activation of ____ and the _____ system result in an increased afterload and contribute to HF symptoms
SNS
JG cells
RAA
sterile draping + alcohol based hand scrub prior to beginning procedure would prevent intravascular _____ related infxns
catheter
systemic and pulmonary circulation maintain similar
blood flow per minute
severe aortic stenosis can result in a sudden decrease in _____ and syncope
left ventricular preload
undectable pulse during inspiration + JVP
cardiac tamponade
CHF reulsts in a decrease in ___ output
Cardiac
irreversible myocardial cell injury indicated by mitochondrial _____
vacuolization
blowing, holosystolic murmur heard best over the cardiac apex w/ radiation to the axilla
MR
S aureus in IV drug user + for infective endocarditis is most likely to infect which valve
tricuspid
proximal pulmonary arteries and the ductus arteriosus develop from the ____ aortic arch
6th
increased levels of cGMP (nitrates) lead to _____ dephosphorylation, resulting in vascular smooth muscle relaxation
myosin light chain
niacin causes cutaneous flushing, warmth, itching, due to release of ____
prostaglandins
no murmur at birth but murmur at sternal border present 1 week after is indicatie of a ____ due to a decrease in pulmonary vascular resistance
VSD
difficulty chewing, persistent HA, tenderness over temples
Takaysu or temporal or giant cell arteritis (granulomatous)
myocardial infarction causes a sharp decrease in ____ and no change in venous return acutely
Cardiac output
sensitivity =
a/a+c
Specificty =
d/b+d
true positive =
sensitivity x # of pts w/ disease
truee negative =
1- specificty x # of pts w/disease
most common site of injury to the aorta in a MVA is the ____ because it is immobile and tethered by the ______
aortic isthmus
ligamentum arteriosum
