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Cardiovascular Flashcards

1
Q

How is blood shunted from right atrium to left in the embryo?

A

through the foramen ovale (septum secundum) and ostium secundum (septum primum)

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2
Q

3 possible causes of atrial septal defect

A

1 ostium secundum overlaps foramen ovale
2 absence of septum secundum
3 neither septum secundum or septum primum develop

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3
Q

what structure grows to close the opening btw the atrial chamber and ventricular chamber into two small openings?

A

superior and inferior endocardial cushions

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4
Q 
embryoligic origins:
ascending aorta and pulmonary trunk
coronary sinus
SVC
smooth parts of ventricles
smooth right atrium
trabeculated atria
trabeculated ventricles
A 
truncus arteriosus
left horn of sinus venosus
right common cardinal vein and anterior vein
bulbis cordis
right horn of sinus venosus
primitive atria
primitive ventricle
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5
Q

Ebstein anomaly

A

tricuspid leaflets are displaced into ventricle: tricuspid regurg or stenosis
patent foramen ovale common
widely split S2, tricuspid regurgitation
associated with maternal lithium use for bipolar

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6
Q 
heart defects associated with:
22q11 deletion
trisomy 21
congenital rubella
turner syndrome
marfan syndrome
A 
truncus arteriosus, tetralogy
endocardial cushion defects (ASD, VSD)
septal defects, PDA, pulm stenosis, aortic insufficiency
coarctation
arotic insufficiency and dissection
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7
Q

boot-shaped heart

A

tetraolgy, RVH (adult)

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8
Q

rib notching

A

coarctation

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9
Q

most common congenital anomaly

A

VSD

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10
Q

most common congenital cause of early cyanosis

A

tetralogy

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11
Q

Cardiac equations

A

CO=HRSV
MAP=COTPR = 2/3 diastolic + 1/3 systolic
Fick’s CO= O2 consumption/(arterial O2-venous O2)
SV=EDV-ESV=CO/HR
EF=(EDV-ESV)/EDV

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12
Q

what congenital heart defects are helped by increasing afterload?

A

R -> L shunts

tetraolgy, transposition, truncus arteriosus, Eisenmenger syndrome

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13
Q

CHF drugs

A

improve survival: ACE, ARB, aldosterone antag (spironolactone), B-blockers (metoprolol, carvedilol, bisoprolol)
symptomatic relief: diuretics (loop and thiazide), digoxin, vasodilators (nitrates and hydralazine ( dec afterload))

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14
Q

drugs for acute heart failure

A 
Nitrates
Oxygen
Loop diuretics
Inotropic drugs
Position
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15
Q

what develops from 3, 4 and 6 aortic arches

A

3: common carotid, proximal internal carotid
4: left: arch of adult aorta
right: proximal right subclavian
6: proximal pulmonary and ductus arteriosus

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16
Q

Hypovolemic shock

A

low output HF
increased SVR decreased CO
Rx: IV fluids, blood

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17
Q

Cardiogenic shock

A

low output HF
increased SVR decreased CO
Rx: dobutamine

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18
Q

Sepsis/anaphylaxis shock

A

high output HF
decreased SVR increased CO
Rx: antibiotics, IV fluids, norepinephrine

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19
Q

Neurogenic shock

A

decreased SVR and CO

Rx: IV fluids, steroids

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20
Q

Central line placements

A

femoral
subclavian: risk of pneumothorax
internal jugular: risk of puncturing carotid
preferred sites for Swan-Glanz catheter: right IJ > left SC > right SC > left IJ

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21
Q

skin in cardiogenic vs septic shock

A

cardiogenic: cold, clammy, cyanotic, poorly infused
septic: hot, flushed

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22
Q

heart sounds

A

S1: closing AV valves
S2: closing aortic and pulmonary valves
S3: filling enlarged space (dilated cardiomyopathy, CHF)
S4: filling against stiffened ventricle (LV hypertrophy, post MI)

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23
Q

benign heart sounds when no evidence of disease

A

Split S1
Split S2 on inspiration
S3 in pt < 40
early, quiet systolic murmur

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24
Q

myocardial action potential phases

A 
Phase 0: Na open
Phase 1: Na closes, K slow open
Phase 2: K slow open, Ca open
Phase 3: Ca closes, K fast open
Phase 4: K closes
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25
Q

SV/AV node action potential

A

Phase 0: Ca open (influx)
Phase 3: K open, Ca close
Phase 4: K close, Na leak (If current)

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26
Q

QRS wide vs narrow

A

narrow: SA node is pacemaker with normal conduction
wide: abnormal conduction pathway, premature ventricular contraction (PVC), ventricular tachycardia, bundle branch block

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27
Q

Potassium effect on T wave

A

hyperkalemia: short peaked T waves
hypokalemia: wide flat T waves

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28
Q

vasopressor of choice for:
anaphylactic
cardiogenic
septic shock

A

epinephrine
dobutamine
norepi

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29
Q

drugs that prolong QT interval

A

macrolides, chloroquines (anti-infective)
haloperidol, risperidone (anti-psychotic)
methadone
anti-HIV protease inhibitors (-navir)
antiarrhythmias class IA (quinidine) and class III

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30
Q

drugs act on myosin light chain kinase to cause vasodilation

A

dihydroperidine Ca channel blockers: block calmodulin-Ca complex
epinephrin (B2) + PGE2: increase cAMP

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31
Q

which barorecptor senses both increases and decreases in BP

A

carotid baroreceptor

aortic only senses increase

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32
Q

paroxysms of increased sympathetic tone; anxiety, palpitations, diaphoresis

A

pheochromocytoma

episodic release of catecholamines

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33
Q

age of onset btw 20 and 50 for HTN

A

primary HTN

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34
Q

elevated serum creatinine and abnormal urinalysis with HTN

A

renal disease

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35
Q

HTN with abdominal bruit

A

renal artery stenosis

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36
Q

HTN with BP in arms>legs

A

coarctation of aorta

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37
Q

HTN with family history

A

primary HTN

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38
Q

HTN with tachycardia, heat intolerance, diarrhea

A

hyperthyroidism

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39
Q

HTN with hyperkalemia

A

renal failure

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40
Q

HTN with episodic sweating and tachycardia

A

pheochromocytoma

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41
Q

HTN with abrupt onset in pt younger than 20 or older than 50 and depressed serum K

A

hyperaldosteronemia

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42
Q

HTN with central obesity, moon-shaped face, hirsutism

A

Cushing syndrome

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43
Q

HTN with normal urinalysis and normal serum K levels

A

primary HTN

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44
Q

HTN in young pt with acute onset tachycardia

A

cocaine or amphetamines

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45
Q

HTN with hypokalemia

A

renal artery stenosis

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46
Q

HTN with proteinuria

A

renal disease

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47
Q

CXR finding in aortic dissection

A

widened mediastinum

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48
Q

treatment of aortic dissection

A

B-blocker

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49
Q

HTN with CHF

A

use: diuretics, ACEi/ARB, B-blocker, aldo antogonist
Avoid: B-blocker (acute decompnesated CHF or cardiogenic shock), CCB

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50
Q

HTN with DM

A

use: ACEi/ARB, thiazide (decrease strokes)
avoid: B-blocker (masks hypoglycemia)

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51
Q

HTN with posti-MI/CAD

A

use: thiazide, B-blocker, ACEi/ARB, CCB, nitrates (as needed)

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52
Q

HTN with atrial fibrillation

A

B-blocker, diltiazem/verapamil

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53
Q

HTN with bradycardia

A

avoid: B-blocker. diltiazem/verapamil

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54
Q

HTN with renal insufficiency

A

use: ACEi/ARB (for proteinuria)
avoid: ACEi/ARB (may increase creatinine), K sparing diuretics

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55
Q

HTN with renal artery stenosis

A

avoid ACEi/ARB

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56
Q

HTN with BPH

A

use a-blocker

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57
Q

HTN with hyperthyroidism

A

use propranolol

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58
Q

HTN with hyperparathyroidism

A

use: loop diuretic (loops lose Ca)
avoid: thiazide (retain Ca)

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59
Q

HTN with osteoporosis

A 
use thiazide
avoid loop (lose Ca)
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60
Q

HTN with Gout

A

avoid thiazides

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61
Q

HTN with pregnancy

A

Hot Moms Love Nifedipine
Hydralazine, methyldopa, labetalol, nifedipine
avoid: ACEi/ARB

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62
Q

HTN with migraines

A

use CCB, B-blocker

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63
Q

HTN with essential tremor

A

use propranolol

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64
Q

first dose orthostatic hypotension

A

a-blockers (zosin drugs)

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65
Q

ototoxic (especially with aminoglycosides)

A

loop diuretic

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66
Q

hypertrichosis

67
Q

cyanide toxicity

A

sodium nitroprusside

68
Q

dry mouth, sedation, severe rebound HTN

69
Q

bradycardia, asthma exacerbations

A

B-blockers

70
Q

reflex tachycardia

A

nitrates, hydralazine, dihydropyridine CCBs

71
Q

cough

72
Q

avoid in pts with sulfa allergy

A

loop and thiazide diuretics

73
Q

possible angioedema

74
Q

development of drug-induced lupus

A

SHIPP

hydralazine

75
Q

hypercalcemia, hypokalemia

A

loops and thiazides

76
Q

particularly beneficial to heart failure pts

A

ACEi/ARB, B-blockers (carvedilol, metoprolol, bisoprolol) and aldosterone antagonists

77
Q

ST segment elevation only during brief episodes of chest pain

A

Prinzmetal’s angina

78
Q

patient is able to point to localize the chest pain using one finger

A

musculoskeletal

79
Q

chest wall tenderness on palpation

A

musculoskeletal

80
Q

rapid onset sharp chest pain that radiates to the scapula

A

aortic dissection

81
Q

rapid onset sharp chest pain in a 20 year old and associated with dyspnea

A

spontaneous pneumothorax

82
Q

occurs after heavy meals and improved by antacids

83
Q

sharp pain lasting hours-days and is somewhat relieved by sitting forward

A

pericarditis

84
Q

pain made worse by deep breathing and/or motion

A

musculoskeletal

85
Q

chest pain in a dermatomal distribution

A

herpes zoster

86
Q

most common cause of non-cardiac chest pain

A

GERD or musculoskeletal

87
Q

acute onset dyspnea, tachycardia, and confusion in the hospitalized pt

A

Pulmonary embolism

88
Q

most common locations for atherosclerosis and disorders from plaques

A

abdominal aorta: AAA
coronary arteries: MI, angina
popliteal artery: claudicatio/peripheral vascular disease
carotid: TIA, strokes, multi-infarct dementia

89
Q

factors that increase myocardial O2 demand

A

preload, BP, contractility, ejection time, HR

90
Q

lipid drug causes facial flushing

91
Q

lipid drug causes elevated LFT and mysoitis

A

statins, fibrates

92
Q

lipid drug causes GI discomfort, bad taste

A

bile acid binding resins

93
Q

lipid drug causes best effect on HDL

94
Q

lipid drug causes best effect on triglycerides/VLDL

A

fibrates, omega-3-fatty acid

95
Q

lipid drug causes best effect on LDL/cholesterol

96
Q

lipid drug binds c. diff toxin

A

cholestyramine

97
Q

ekg changes in MI

A

ST elevation, R wave decreases, Q wave hours
T wave inverts and Q wave deepens
st normal, T wave inverted, Q wave persists
ST normal, T wave normal, Q wave persists

98
Q

most common lethal complication of MI

A

arrhythmias

99
Q

chest pain, pericardial friction rub, and persistent fever occuring several weeks after an MI

A

Dressler syndrome

100
Q

pathological characteristics of arteries in pulmonary HTN

A

medial hypertrophy
fibrosis of intima
arteriosclerosis

101
Q

anterior wall MI leads

A

V1-V3, maybe 4 and 5 also

102
Q

lateral wall MI

A

aVL, V5, V6

103
Q

inferior wall MI leads

A

II, III, aVF

104
Q

Posterior Wall MI

A

R precordial EKG; V4

105
Q

manage a pt presenting with acute MI

A 
ABCs
MONA (IV morphine, O2, NTG, aspirin)
B-bloker (metoprolol)
statin (atorvastatin)
antiplatelet
anticoag (heparin normally)
K>4, Mg>2
STEMI: cath/fibrinolysis
NSTEMI: cath
106
Q

long term management of MI

A 
aspirin or clopidogrel
B-blocker
ACE/ARB
K sparing diuretics
spironolactone
statins
decrease weight, exercise, diet
107
Q

diffuse interstitial infiltrate of lymphocytes with myocyte necrosis

A

myocarditis caused by coxsackie B virus

108
Q

causes of dilated cardiomyopathy

A 
ABCCCD
Alcohol
wet Beriberi
Coxsackie B
chronic Cocaine
Chagas' disease
Doxorubicin and daunorubicin
109
Q

why does valsalva make hypertrophic cardiomyopathy louder

A

valsalva reduces preload, so it worsens the LV outflow obstruction by getting less blood into the heart

110
Q

why does squating make a hypertrophic cardiomyopathy quieter

A

squatting lowers afterload, so it makes it easier to get blood past the obstruction

111
Q

bacteria most associated with endocardiits

A

S. aureus
viridans streptococci
enterococci
staph epidermidis (artificial valves)

112
Q

HACEK organisms

A 
Haemophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
113
Q

Symptoms of endocarditis

A 
FROM JANE
Fever
Roth's spots (on retina and rare)
Osler's nodes (painful on fingertips)
Murmur
Janeway lesions (painless)
Anemia
Nail bed hemorrhage
Emboli
114
Q

IV drug users and endocarditis

A

S. aureus, Pseudomonas, or Candida on tricuspid valves

115
Q

acute infective endocarditis

A

S. aureus
rapid onset (days)
affects normal valves

116
Q

subacute infective endocarditis

A

viridans strep
insidious onset (wks to months)
effects previously damaged or congenital valves

117
Q

IV drug user with chest pain, dyspnea, tachycardia, and tachypnea

A

Right sided endocarditis that sent embolism to pulmonary arteries
PE

118
Q

motor accident with chest pain, dyspnea, tachycardia, and tachypnea

A

tension pneuomothorax or

fat embolism from long bone fractures

119
Q

post-op pt with chest pain, dyspnea, tachycardia, and tachypnea

A

PE from DVT

120
Q

what drug is used with infective endocarditis in ER

A

IV vancomycin pending culture results

121
Q

splinter hemorrhages under fingernails

A

infective endocarditis

122
Q

retinal hemorrhages with pale centers

A

Roth’s spots (infective endocarditis)

123
Q

heart valve most commonly involved in infective endocarditis

A

mitral

tricuspid for IV drug users

124
Q

diagnostic criteria for rheumatic fever

A 
JONES
joints (polyarthritis)
Cardiac (pericarditis)
nodules (subcutaneous)
erythema marginatum
sydenham chorea
125
Q

pulsus paradoxus

A

decrease in systolic BP of >10mmHg with inspiration

126
Q

Kussmaul’s sign

A

JVD during inspiration due to constrictive pericarditis (increased blood from inspiration cannot fill RV, so it backs up into SVC)

127
Q

focal myocardial inflammation with multinucleate giant cells

A

Aschoff bodies

seen in rheumatic fever

128
Q

chest pain and course rubbing heart sounds in patient with Cr of 5.0

A

uremic pericarditis

129
Q

tree-barking of aorta

A

3 syphilis

130
Q

child with fever, joint pain, cutaneous nodules 4 weeks after a throat infection

A

acute rheumatic fever
acute causes mitral regurg
chronic causes mitral stenosis

131
Q

ST elevation in all EKG leads

A

pericarditis

132
Q

EKG shows electrical alternans

A

cardiac tamponade

133
Q

granulomatous nodules in the heart

A

Aschoff bodies

134
Q

most common primary cardiac tumor in adults

A

left atria myxoma

135
Q

most common primary cardiac tumor in children

A

rhabdomyoma

136
Q

most common cause of constrictive pericarditis

A

US: lupus
world: TB

137
Q

associated with asthma

A

Churg-strauss

138
Q

associated with polymalgia rheumatica

A

giant cell (temporal) arteritis

139
Q

associated with IgA nephropathy

A

Henoch-Schonlein purpura

140
Q

Hepatitis B infection with vasculitis that spares the lungs

A

polyarteritis nodosa

141
Q

elderly women with jaw claudication and vision loss

A

giant cell (temporal) arteritis

142
Q

desquamation of hands/feet

143
Q

palpable purpura on legs

A

Henoch-Schonlein purpura

144
Q

disorders common with Raynaud phenomenon

A

SLE
CREST scleroderma
Buerger disease
mixed connective tissue disease

145
Q

weak pulses in upper extremities

A

Takayasu arteritis

146
Q

necrotizing granulomas of the lung and necrotizing glomeulonephritis

A

granulomatosis with polyangitis (wegener’s)

147
Q

necrotizing immune complex inflammation of visceral/renal vessels

A

polyarteritis nodosa

148
Q

young asthmatics

A

Churg-Strauss

149
Q

infants and young children; involves the coronary arteries

150
Q

most common vasculitis

A

Temporal (Giant cell)

151
Q

perforation of nasal septum

A

Wegener’s

152
Q

benign, raised, red lesion about the size of a mole in older patients

A

cherry hemangioma

153
Q

raised, red area present at birth, increases in size initially then regresses over months to years

A

strawberry hemangioma

154
Q

lesion caused by lymphoangiogenic growth factors in an HIV patient

A

Kaposi sarcoma

155
Q

polypoid red lesions found in pregnancy or after trauma

A

pyogenic granuloma

156
Q

benign, painful, red-blue tumor under fingernails

A

glomus tumor

157
Q

cavernous lymphangioma associated with Turner syndrome

A

cystic hygroma

158
Q

skin papule in AIDS patient caused by Bartonella

A

bacillary angiomatosis

159
Q

cold, pale painful digits

A

Raynaud’s

160
Q

c-ANCA

A

granulomatosis with polyangitis (Wgener’s)

161
Q

p-ANCA

A

microscopic polyangitis and Churg-Strauss

162
Q

treatment for Buerger disease

A

smoking cessation

163
Q

treatment for temporal arteritis

A

high dose steroids

DIT (28 decks)

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