Cardiovascular Flashcards
1
Q
pulsus paradoxus
A
systolic BP decreases by 10 with inspiration
asthma
COPD
tamponade
2
Q
Loeffler’s
A
causes restrictive cardiomyopathy
3
Q
SVC from
A
right common cardinal v.
right anterior cardinal v.
4
Q
bulbus cordis becomes
A
smooth LV, RV
5
Q
coronary sinus from
A
left sinus venosus
6
Q
rubella heart defects
A
PDA, PAS “Ruby”
7
Q
wide split S2, TR
A
Ebstein anomaly, 80% have PFO
8
Q
DiGeorge syndrome heart
A
TOF, TA “T”
9
Q
Increased TPR
A
flatten venous return slide (DIT pg 145)
10
Q
ejection fraction
A
SV/EDV
> 55%
11
Q
pulmonary capillary wedge pressure
A
less than 12
12
Q
NO LIP
A
treat acute CHF: nitrates oxygen loop diuretics ionotropes - milranone, dobutamine position up
13
Q
only symptomatic relief from CHF
A
diuretics
digoxin
vasodilators
14
Q
3rd aortic arch
4th aortic arch
6th aortic arch
A
CCA, proximal ICA
aortic arch, proximal right subclavian
proximal pulmonary, ductus arteriosis
15
Q
treat cardiogenic shock
A
dobutamine
16
Q
Swan-Ganz cath
A
right IJ > left SC artery
17
Q
venous a wave
venous c wave
x descent
venous v wave
y descent
A
not in afib, at S4
Tricuspid close, ventricles contract against, after S1
not in TR, during systole
filling against closed tricuspid, at S3
RA into RV, diastole
18
Q
wide S2
fixed S2
paradoxical S2
A
PS, RBBB
ASD
AS, LBBB
19
Q
isovolumetric contraction
A
at QRS
20
Q
heard best in LLD
A
MS, MR, S3, S4
21
Q
Calcium electrophysiology
A
phase 2 in myocardium
phase 0 in pacemaker
+20
22
Q
Na electrophysiology
A
phase 0 in mycocardium
phase 4 in pacemaker (funny current w/K)
+50
23
Q
K electrophysiology
A
phase 3
-75 to -95
24
Q
aVL
A
-30 degrees
25
left axis deviation
-30 to -90
| inferior MI, LVH, LBBB, left anterior fasc. block
26
right axis deviation
+90 to +180
| RVH, massive PE, RBBB, LP fascicular block
27
first degree AV block
>200 from p
| Lyme disease
28
Mobitz 1 (second degree)
dropped
| =Wenckebach = "warning block"
29
Mobitz II (second degree)
no warning
30
jucntional escape
Q = R
31
cause torsades, prolong QT
```
IA, III
macrolides**
chloroquine**
haloperidol
risperidone
methadone**
--navir protease inhibitors
ondansetron**
TCA**
```
32
vasocontrict via constitutive NOS in endothelium
bradykinin, ACh, alpha-2, histamine
| serotonin, shear stress
33
vasocontrict via inducible NOS in smooth muscle
LPS
34
MLCK inhibition
DHP CCB block calmodulin-Ca
| B2 epinephrine and PGE2 increase cAMP, which inhibits MLCK
35
treat:
aortic dissection
severe hypertension
B blocker
IV nitroprusside, IV labetalol
36
Stanford A aortic dissection
Stanford B
ascending, needs surgery
B-blockers then vasodilators
37
aliskiren
renin blocker
for HTN only
no CHF, MI
38
Black patient with HTN
give thiazide and CCB
39
minoxidil
opens K channels, hyperpolarize
relaxes smooth muscle
for severe HT, for hair loss
40
HTN + migraines
CCB or B-blocker
41
RCA
SA nodal branch
AV nodal branch
Posterior interventricular a.
Right main branch
42
LCA
Anterior interventricular a.
Circumflex branch
- 20% PIVA
- 20% SA nodal
- 20% AV nodal
43
Prinzmetal angina
give nifedipine
44
AAA needing surgery
5. 5 cm
| 0. 5 cm/6 mo
45
fibrates
decrease TAG
| cause myalgias, cholesterol gallstones
46
resins
bind C dif toxin (cholestyramine)
| cause gallstones
47
ezetimibe SE
increases LFT
| diarrhea
48
MI ECG findings
ST elevated 1 mm in consec
T inversion
new LBBB
new Q waves (1 block wide or 1/3 QRS height)
49
3-14 days after MI
```
ventricular aneurysm?
wall rupture?
papillary rupture?
yellow-tan softening
macrophage infiltrate
```
50
neutrophils after MI
12-24 hrs
wavy fibers too
reperfusion injury causes contraction bands
51
Dressler syndrome
>2 wks after MI
pericarditis + fever
have a gray white collagen scar
52
days 1-2 after MI ECG
T wave inverts
| Q wave deepens
53
Q wave
hours to weeks after MI
54
MI K and Na goals
K >4
| Na >2
55
NSTEMI
```
avoid fibrinolysis
do PCI (UF heparin needed)
```
56
Fe, cocaine, alcohol, ischemia
dilated cardiomyopathy
| 90% have S3
57
Ashcoff bodies
| Antichow cells
rheumatic fever granuloma
| giant cells
58
Minor Jones criteria
arthralgia, fever, ESR/CRP, long PR
2 major, 1 minor
59
pericarditis
ST elevation
| PR decrease
60
Kussmauls sign
| pulsus paradoxus
constrictive pericarditis - lupus
| cardiac tamponade - asthma, croup, COPD
61
syphilis heart
AS
AR
aortic calcifications, treebark aorta**
blocked aortic vas vasorum - thoracic AA
62
not in lungs
yes in gut/renal
after Hep B or C
polyarteritis nodosa
| ANCA negative
63
foot drop
Churg Strauss
| pANCA
64
saddle nose, perforate septum
Wegeners
| cANCA
65
leptomeningeal angioma
| eye hemiplegia, seizure, glaucoma
Sturge-Weber
66
Causes of Raynaud
MCTD
Beurgers (thromboangitis obliterans)
lupus
CREST
67
treat Raynaud
warm
| DHP CCB
68
small red mole in older patient
cherry hemangioma
69
primitive pulmonary vein
smooth left atrium
70
dextrocardia from
left-right dynein defect
71
valves come from
endocardial cushions
72
Young Liver Synthesizes Blood
```
fetal erythropoiesis:
Yolk sac 3-8 wks
Liver 6 wks to birth
Spleen 10-28 wks
Bone marrow 18 wks to adult
```
73
ductus venosus
umbilical vein bypasses liver into IVC
74
allantois becomes
urachus, then median umbilical ligament
75
umbilical arteries become
medial umbilical ligaments
76
umbilical vein becomes
ligamentum tere hepatis in falciform ligament
77
posteriomedial papillary muscle blood
RCA PIVA
78
pulse pressure and arterial compliance
inversely proportional
79
pulse pressure factors
increased with hyperthyroid, AR, stiff aorta, sleep apnea, transiently with exercise
decrease with AS, cardiogenic shock, tamponade, HF
80
decreases contractility
increases contractility
acidosis, high CO2, low O2, low cAMP
less extracellular Na (less Na/Ca exchanger)
81
Law of LaPlace
Wall tension = P*R / 2*thickness
hypertrophy to decrease wall tension
82
decrease both preload and afterload
ACEI and ARB
83
Resistance
8*viscosity*length / pie*radius^4
84
vessels in parallel
1/TR = 1/R1 + 1/R2
85
organ removal fluid dynamics
increase TPR
| decrease CO
86
heart and narcotic overdose
decrease contractility
87
heart and spinal anesthesia
decrease venous return
88
heart and exercise
decrease TPR
89
heart and sympathetic activity
increase venous return
90
heart and AV shunt
decrease TPR
91
TPR and mean systemic pressure
mean systemic pressure unchanged
| CO changes at given preload
92
left sternal border
AR, PR
93
hand grip afterload
decreases hypertrophic cardiomyopathy murmur
later MVP
94
Valsalva decreased preload
increases hypertrophic cardiomyopathy
murmur
earlier MVP
95
rapid squat increase preload
increase AS murmur
decrease hypertrophic cardiomyopathy
later MVP
96
rheumatic fever heart
MR early
TR, MVP, AR, Afib
MS late
mitral >aortic>tricuspid
Aschoff and Anitschkow, ASO
type II HS reaction
97
S2 and OS
less time between is worse
98
QT interval
ventricles depolarized
99
U wave
hypokalemia, bradycardia
100
speed of heart conduction order
Purkinje > atria > ventricles > AV node
101
treat torsades
magnesium sulfate
102
Congenital long QT
Romano Ward syndrome - AD, cardiac only
| Jervell/Lange-Nielsen - AR, sensorineural
103
Brugada syndrome
AD pseudo-RBBB with ST elevation in V1-V3
in Asian males
risk of V tach and sudden cardiac death
give ICD to treat
104
IC antiarrhythmics to treat
Afib
105
definitive treatment for atrial flutter
catherter ablation
106
Vfib management
CPR and defibrillate!
107
ANP
BNP
atrial myocytes after increased volume/P
cGMP vasodilate, lose Na at CT
dilate afferent, contrict efferent
ventricular myocytes after increased tension
longer half life,
HF diagnosis, nesiritide recombinant is Tx
108
aortic arch chemo/baroreceptors
via vagus nerve to solitary nucleus of medulla for low and high BP
hypotension decreases afferent firing
aortic body chemoreceptor stimilated by O2
109
carotid sinus baroreceptor
carotid body chemoreceptor
via CN9 to solitary nucleus of medulla
increased pressure/massage increases afferent firing, increases AV node refractory period --> slower HR
O2
110
Cushing reaction
HT, bradycardia, respiratory depression
increased ICP increased CO2 and decreases pH --> symp --> HT
stretch --> peripheral baroreceptor --> slow HR
111
central chemoreceptor
respond to CO2 and pH of brain ICF
no direct O2 effect
112
skeletal muscle autoregulation
lactate, adenosine, K, H, CO2
113
tricuspid atresia
needs ASD and VSD to live
has hypoplastic RV too
114
tet spells
TOF cyanosis
squatting increases SVR, decreases R to L shunt
115
left to right shunts
present later in childhood
116
ASD
ostium secundum more common, isolated
ostium primum with other cardiac
not a patent foramen ovale
117
PDA leads to
RVH, LVH, HF
| late cyanosis on lower extremities
118
Eisenmenger syndrome
late cyanosis, clubbing, polycythemia from PA hypertension/RVH flipping shunt
119
location of coarctation of aorta
near ductus arteriosus = juxtaductal
120
diabetic mother's baby heart
transposition of great vessels
121
Williams syndrome heart
supravalcular AS
122
DiGeorge heart
truncus arteriosus
| TOF
123
Rubella heart
PDA, PAS, septal defect
124
FAS heart
VSD, PDA, ASD, TOF
125
fibromuscular dysplasia
10% of HT cause
RA has string of beads appearance
young women
126
Monkeberg medial calcific sclerosis
calcified elastic lamina of medium sized arteries
stiff without obstruction of blood flow
pipestem x-ray
no intima involvement
127
atherosclerosis locations
AA > CAD > popliteal > carotid
128
unequal BP in arms
aortic dissection
129
ST depression
stable angina
or unstable angina
or NSTEMI (subendocardial
130
transient ST elevation
Prinzmetal/variant angina
trigger by tobacco, cocaine, triptans
give CCB, nitrates
131
complication 1-3 days after MI
fibrinous pericarditis
| -friction rub
132
complication 3-14 days after MI
```
wall rupture, causes MR or VAD
LV pseudoaneurysm (low CO, thrombus, arrhythmia)
```
133
MI diagnosis
134
complication 2 wks to months after MI
true ventricular aneurysm
| -outward bulge when contract, fibrosis
135
dilated cardiomyopathy has
S3
systolic regurgitant murmur
90% of cardiomyopathies
136
hypertrophic cardiomyopathy occurrence
70% familial AD from B-myosin heavy chain
in Friedrich's ataxia
ventricular arrhythmia death in young athlete
S4
systolic murmur
MR
137
hypertrophic cardiomyopathy treatment
B-blocker or nonDHP CCB
ICD if needed
stop athletics
138
spironolactone and HF
decreases mortality
139
hemosiderin laden macrophages in lungs
left HF causing pulmonary edema via venous congestion
140
SIRS
```
>2 of:
fever/low T
HR - first sign!
RR
WBC up/down
```
141
nonbacterial endocarditis
culture negative endocarditis
cancer, hypercoagulable, lupus
Coxiella, Bartonella, HACEK
142
widespread ST elevation
| PR depression
acute pericarditis
143
cause acute pericarditis
```
uremia
coxsackie
cancer
STEMI/Dressler
SLE, RA
radiation
```
144
JVP increases with inspiration
constrictive pericarditis
restrictive cardiomyopathy
RA/RV tumor
"Kussmaul sign"
145
Bacillary angiomatosis
neutrophilic infiltrate
| in AIDS from Bartonella
146
Kaposi sarcoma
lymphocytic infiltrate
skin, mouth, GI, respiratory
HHV8 and HIV
147
chronic postmastectomy lymphedema causes
angiosarcoma
148
hepatic angiosarcoma
vinyl chloride
| arsenic
149
```
pulseless disease
night sweats
arthritis, myalgias
skin nodules
visual distubance
```
Takayasu arteritis -
| narrowed aortic arch and great vessels
150
vasculitis with Raynaud
thromboangitis obliterans
151
pANCA
microscopic polyangiitis
| Churg-Strauss
152
renal microaneursyms
melena
neurological damage
polyarteritis nodosa
153
AS leads to
microangiopathic hemolytic anemia
syncope with exercise
concentric LV hypertrophy
154
louder with squatting and expiration
MR
155
mets to heart
breast
lung
melanoma
lymphoma
get pericardium effusion
