CARDIOVASCULAR Flashcards
Where occurs fetal erythropoiesis (4)?
Yolk sac (3–8 weeks)
Liver (6 weeks–birth)
Spleen (10–28 weeks)
Bone marrow (18 weeks to adult)
CO and MAP ecuations
CO = stroke volume (SV) × heart rate (HR).
CO =rate of O2 consumption /(arterial O2 content − venous O2 content)
Mean arterial pressure (MAP) = CO × total peripheral resistance (TPR).
MAP = 2 ⁄3 diastolic pressure + 1⁄3 systolic pressure.
Wall tension equation
Wall tension = (pressure × radius) / (2 × wall thickness)
Which drugs interfering whit preload an after load?
Venodilators (nitroglycerin) ⬇️ preload
Vasodilators (hydralazin) ⬇️ afterload
ACE inhibitors and ARBs️️⬇️ preload and afterload
How is best heard S4 sound?
Atrial kick is best heard in
Left lateral decubitus position
Explain Jugular Venus pulse
a wave—atrial contraction.
c wave—RV contraction
x descent—atrial relaxation and downward displacement
v wave— right atrial pressure due to filling (“villing”)
y descent—RA emptying into RV.
When you heard wide splitting(2)?
Pulmonic stenosis
Right bundle branch block
When you heard fixed splitting (2)?
Atrial septal defect
L-R shunt
When you heard paradoxical splitting (2)?
Advance aortic stenosis
Left bundle branch block
What about the cardiac murmurs(5)?
Aortic stenosis : aortic focus
Pulmonary stenosis: pulmonary focus
Aortic and pulmonary insufficiency: Erbs focus
Tricuspid stenosis and insuffiency: tricuspid focus
Mitral stenosis and insufficiency: mitral focus
How maximize some murmurs(3)?
Hand grip (⬆️afterload)
Murmur regurgitation
aortic regurgitation
Ventricular septum defect
Valsava(⬇️preload)p
Mitral valve prolapse earlier onset
Rapid squatting (⬆️ preload) Aortic stenosis
What is the most frequent valvular lesion?
Mitral valve prolapse
Late systolic crescendo murmur
How you heard Persistent ductus arteriosos?PDA
Continue machine like murmur
What Drugs induce long QT (ABCDE)?⬇️K ⬇️Mg
AntiArrhythmics (class IA, III) AntiBiotics (e.g., macrolides) Anti“C”ychotics (e.g., haloperidol) AntiDepressants (e.g., TCAs) AntiEmetics (e.g., ondansetron)
What’s brugade syndrome?
Autosomal dominant Asian males
Pseudo right bundle branch block
ST elevations ,V1-V3
High risk ventricular tachyarrhythmias tto cardio defibrillator
Which nerves uses aortic arch and carotid sinus to carry out impulses from its chemo and Baroreceptors?
Aortic arch : vagus nerve to solitary nucleus in medulla
Carotid sinus: glossopharyngeal nerve to solitary nucleus in medulla
What’s eisenberger syndrome?
Left to right shunt lead to pulmonary hypertension leads to right ventricle hypertrophy leads to right to left shunt late cyanosis and polycythemia , clubbing
Types of arteriosclerosis
Hyaline
Hyperplasic
Types of aortic dissection
Stanford A—Qx
Stanford B—BBs
What’s dressler’s syndrome?
autoimmune phenomenon resulting in fibrinous pericarditis
(several weeks post-MI).
Causes of Dilated Cardiomyopathy(9)
Alcohol abuse wet Beriberi Coxsackie B virus myocarditis chronic Cocaine use Chagas disease Doxorubicin toxicity hemochromatosis sarcoidosis peripartum cardiomyopathy.
Ethiology of hypertrophic cardiomyopathy
Eat -myosin heavy chain mutation
What’s loeffler syndrome?
Endomyocardial fibrosis whit prominent eosinophilic infiltrate
Presentation of bacterial endocarditis(8)
Bacteria FROM JANE ♥:
Fever
Roth spots
Osler nodes
Murmur
Janeway lesions Anemia
Nail-bed hemorrhage
Emboli
Clinical findings in rheumatic fever
J♥NES (major criteria): Joint (migratory polyarthritis) ♥ (carditis) Nodules in skin (subcutaneous) Erythema marginatum Sydenham chorea
What’s Beck triad?
Hypotension
Distended neck veins
Distant heart sounds
What’s pulsus paradoux?
⬇️amplitude so systolic BP by >10 mmhg during inspiration
What’s kussmaul sign?
⬆️ jugular Venus pressure on inspiration
Sign of restrictive cardiomyopathy
Clinical features of Kawasaki disease
Conjunctival injection Rash (polymorphous desquamating) Adenopathy (cervical) Strawberry tongue (oral mucositis) D Hand- foot changes (edema, erythema) fever.
What’s Granulomatosis with polyangiitis (Wegener)
Focal necrotizing vasculitis
Necrotizing granulomas in the lung and
upper airway
Necrotizing glomerulonephritis
What’s the clinical findings of Eosinophilic granulomatosis with polyangiitis (Churg- Strauss)
Asthma
sinusitis
skin nodules or purpura
peripheral neuropathy (e.g., wrist/foot drop).
Can also involve heart, GI, kidneys (pauci- immune glomerulonephritis).
Labs in Churg-strauss
MPO-ANCA/p-ANCA,
⬆️ IgE level.
What’s Henoch-Schönlein purpura clinical findings?
Classic triad:
Skin: palpable purpura on buttocks/legs
Arthralgias
GI: abdominal pain
What’s cinchonism?
Headache
Tinnitus
Whit use of quinidene
Difference among class 1 antiasritmics
Class IA. ⬆️action potential ⬆️ effective refractory period
Class IB ⬇️action potential
Class IC ⬆️⬆️effective refractory period
AV node accessory bypass
What drugs can mask hypoglycemic symptoms?
BBs
What’s class III antiasritmics AIDS (4)?
Amiodarone
Ibutilide
Dofetilide
Sotalol.
What’s actions of class III antirrhythmics ?
. ⬆️action potential
⬆️ effective refractory period
⬆️QT interval
Which mechanisms are used to calcium eflux in order to initiate muscular relaxation?
NA/ca exchange
Ca-ATP ase pump
What is the calmodulin function in the muscle?
Calmodulin activates plasma membrane Ca-ATPase to get out calico calcium
What type of collagen is implicated in congenital diseases?
Collagen type I—-Osteogenesis imperfecta
Collagen type III—- Ehlers Danlos syndrome (types 3 and 4)
Collagen type IV—-Alport syndrome
What type of collagen is in nucleus purpose?
Collagen type II
Tissue changes after myocardial infarction (8)
1-4 hours. NOTHING!!!!
4-12 hours wavy fibers elongate myocites
12-24hours hypereosinophilia pyknotic nuclei
1-3days coagulation nutrophilia
3-7days desintegration myocites,macrophages in borders
7-10days phagocytosis of myofibres by macrophages
10-14 days granulation. Tissue
2wks-2months collagen and scar formation
What’s the use of class IV antiarrhythmic ?
Good for atrial tachyarrhythmias cause slows AV node conduction
Contraindicated in ventricular tachycardia
Indication of adenosine ?
Paroxysmal supra-ventricular tachycardia
Indication of digoxin ?
Atrial fibrillation
Because slow conduction through AV node
Contraindicated in WPW
Indication of amlodipine?
Hypertension and angina
How innominate vein forms?
(Right external Jugular vein + right subclavian vein) + right internal vein = innominate vein ( here drains right lymphatic duct)
How nitroprusside interferes whit cardiac work?
VENOUS AND ARTERIAL VASODILATOR
⬇️Preload ⬇️ left ventricular end diastolic pressure
⬇️Afterload ⬇️ mean systolic intraventricular pressure
How you consider hype pulmonary arterial hypertension?
Pulmonary artery pressure >25mmHg
What mutation is related whir PAH?
BMPR2 mutation autosomal dominant
Which drug improve survival in systolic heart failure (4)?
BBs
ACE inhibitors
ARBs
Aldosterone inhibitors
What organisms are implicated in culture-negative endocarditis(5+HACEK)?
Micoplasma
Histoplasma
Chlamydia
Haemophilus Actinobacilus Cardiobacteium Eikenella Kingella
What bacteria is linked with colon cancer?
S.bovis =S.gallolyticus
Bacteria linked whit subacute endocarditis
S. Viridansl
More common in patients whit valvular abnormality
What is the cardiac tissue conduction velocity?
Fastest to lowest
Purkinge 🐆
Atrial muscle🐎
Ventricular muscle🐊
AV node 🐢
When the use of thiazides and when ACE inhibitors is relevant?
thiazides ☑️hypertension whit-out CHF or Diabetes
ACE inhibitors☑️️hypertension PLUS CHF or Diabetes
How you can increase contractility?
⬆️heart rate
⬆systolic volume
Effects of heart function whit acetylcholine
M2 ⬇️heart rate
M3 relaxation of vascular smooth muscle
Adenosine mechanism
Increase potassium conductance
Delay atrioventricular node
What’s the most specific symptom of giant cell arteritis?
Jaw claudication
What’s the histologic presentation of polyarteritis nodosa?
Segmental transmural necrotizating inflammation
Inmunoclompex , complement, eosinophilic cells
FIBRINOID NECROSIS
What vases are affected in rheumatoid arteritis?
Visceral vases
Visceral Infractions
What type of Channels are in action potential of SA node?
Phase 4. T-type Ca pacemaker
Phase 0 L-type Ca
Phase 3. K channels
How adenosine and acetylcholine prolongs phase 4 action potential in SA node?
Increasing potassium conductance
Keeping hyper-polarized the SA node
What’s the best indicator of severity of mitral regurgitation?
Left ventricular S3 gallop
What are Kerley B lines?
Sisuritis
Edema of interlobular septa
How much time take de deletions of ATP resulting in loss contractility of myocardium?
60 SECONDS!!!!!!
When ischemia is irreversible?
30 MINUTS!!!!
Equation of Flow
Q= (P1-P2)/ R
R = (viscosity X length)/ r4 potency
If the radios goes to 50%
The flow ⬇️16 times
How patients appear whit double valve lesion in rheumatic fever?
Mitral stenosis
Aortic regurgitation
⬆️⬆️diastolic pressure in the left ventricle
The liberation of creatinine kinase is related whit…
Cell membrane damage
How is the early embryonic development veins?
SINUS VENUS
▪️ Viteline
▪️ Umbilical
▪️ Cardinal veins
What’s the mechanisms of cough produced by ACE inhibitor?
bradykinin
Substance P
Prostaglandins
How Cilostazol improve claudication symptoms?
⬆️cAMP by inhibiting phosphodiesterase ⬇️platelets aggregation
Arterial vasodilator
How is the drug dissociation speed of class I antiarrythmics ?
IB>IA>IC
What’s the mechanism of pulmonary hypertension in left heart failure?
⬆️ left ventricular pressure ⬆️ pulmonary Venus congestion ⬆️ endothelial damage and protein leaking ⬆️endotheline ⬇️NO ⬆️smooth muscle cell proliferation ⬆️collagen and elastase deposition
Where beta 1 receptors are located?
Cardiac tissue
Renal juxtaglomerular cells
What’s the definition of cor pulmonalle?
Right ventricle hypertrophy caused by pulmonary hypertension
What’s the problem of long use of arteriolar vasodilators?
Acts reducing vascular resistance
Leading to stimulation of Baroreceptors and sympathetic activation
Activating renin-angiotensin-aldosterone axis
Sodium and water retention
What’s the mechanism of viagra?
Inhibits phosphodiesterase 5
⬆️cGMP leads to smooth muscle relaxation
Explain different organ rejection types (4)?
Hyperacute minutes to hours preformed antibodies
Acute 1-4 wks T lymphocytes against graft MHC Ags
Chronic months to years scant inflammatory cells interstitial fibrosis
Graft Vs host immunocompetent tissue. Bone marrow
What chronic anemia does to cardiac output?
Cardiac output is increases in order to reach metabolic demands
What is the consequences of Anaphylaxis in CO /RAP VR/EDV graph?
Anaphylaxis cause ⬇️preload and afterload
Leads to shift left and down de X intersection
What’s monckenberg sclerosis?
Medial calcifications sclerosis
Isolated systolic hypertension
What cause S3
Reduce intrinsic ventricular wall compliances
Restrictive cardiomyopathy
How can maximize S3 sound in HCF patients
S3 is cause because sudden limitation of ventricular Movement during rapid passive ventricular filling (diastole)
Decubitus left
Expiration
Bell sf stethoscope in mitral focus
What predispose to bacterial endocarditis?
Valvular abnormalities
Conditions that promote bacteremia and fungemia
What’s the first anomaly in order to initiate endocarditis?
Fibrin deposit which formation of sterile fibrin-platelet nidus
What is the pathognomonic histologic finding of Acute Rheumatic fever?
Aschoff body!!!!
Interstitial myocardial granuloma
Interstitial fibrosis - macrophages lymphocytes
Principal structural change when S3 and S4 are heard?
S4 ⬇️ ventricular compliance ventricular hypertrophy
S3 dilated cardiomyopathy ⬆️ CO
Ecocardiograhic mitral alterations in hypertrophic cardiomyopathy
Systolic anterior motion of the mitral valve
Mitral regurgitation
Say the level of the renal arteries and where is IVC?????
L1!!!!!
IVC is anterior to the right renal artery
What kind of cardiomyopathy has aortic stenosis ?
Early ventricular hypertrophy DIASTOLIC DISFUNCTION
Late dilated cardiomyopathy !!!! SYSTOLIC DISFUNCTION
Deferents calcium interactions in cardiac, smooth and skeletal muscle to cause contraction
Cardiac Ca TROPONIN
Smooth Ca CALMODULIN
Skeletal Ca TROPONIN C
What antihipertensive intravenous drug has arteriolar vasodilator and renal dilator effect ?
FENOLDOPAM !!
D1 agonist
⬆️cAMP
Structural alteration in crescendo-decrescendo systolic murmur peaking in midsystole
AORTIC STENOSIS
PULMONIC STENOSIS
Term to describe the fact of an hormon allow another to exert its maximal effect
PERMISSIVENESS !!!!
What kind of pulse is characteristic in hypertrophic cardiomyopathy?
Bifid carotid pulse whit brisk upstroke
“Spike and dome”
What are the most frequent causes of pulses paradoxus besides pericardial disease?
COPD
ASTHMA
Histologic Changes at vascular structures in Marfan syndrome
Cystic medial degeneration whit myxomatous changes in the media layer of large vases
Defect of fibrillin-1
AORTIC ANEURISMS AND DISSECTIONS
Which congenital disease predisposes to berry aneurisms?
Type IV Ehlers - Danlos syndrome
Abnormalities in type III collagen
Toxicity symptoms of Digoxin
Fatigue Blurred vision Changes in color perception Confusion Delirium GI symptoms nausea vomit abdominal pain
Cause of side effects of Niacin used to hyperlipidemia management ?
RELEASE OF PROSTAGLANDINS!!!
Flushing
Warmth
Itching
What kind of cancer is associated whit long term of thiazolidinediones ?
URINARY BLADER CANCER !!!
What cellular changes is associated whit irreversible And reversible injury?
IRREVERSIBLE : MITOCHONDRIAL VACUOLIZATION
REVERSIBLE : MITOCHONDRIAL SWELLING
Different ions implied in the three phases of pacemaker action potential
4: Na out
0: Ca in
3: k out
Different ions implied in the five phases of non pacemaker action potential
0 Na in 1 K out 2 Ca in 3 K out !!! 4 K in Na out
Effects of CLONIDINE alpha-2 agonist (5)
CNS mediated ⬇️ BP ⬇️ intranucular pressure ⬇️ Lipolysis ⬇️ presynaptic NE release ⬆️ platelet aggregation
Action ps of atrial natriuretic peptide (3)
🔹Dilate afferents arterioles ⬇️Na absorption ❎renine secretion
🔹❎aldosterone secretion
🔹vasodilation and permeability
Explain the 4 mechanical complications after MI and its timing presentation
Right ventricular failure ACUTE!!!
Papillary muscle rupture 3-5 days
Interventional radiology septum rupture 3-5 days
Free wall rupture 5-7 days!!!!!!
What is the most common cause of dead after MI
VENTRICULAR ARRYTHMIAS 48-72 hrs
Wha is the histologic hallmark of cell injury and dead? Cause is valve caclcificactions?
DYSTROPHIC CALCIFICATIONS !!!
EKG characteristics in pre-excitation syndrome WPW(3)
Shortened of PR interval
Delta wave
QRS is wider (narrow during tachyarrhythmia)
What happen in total anomalous pulmonary venous return?
Oxygenated blood goes to right atrium and the to left atrium via interatrium defect
Right atrial and ventricular dilation
In poliarteritis nodosa (PAN) what organ is spared and what is the cutaneous finding in PAN ?
LUNGS!!!!
Livedo Reticularis
What is the most common cause of infective endocarditis? In 🇺🇸 and 🇨🇴 ?
MITRAL VALVE PROLAPSE!!!!! In 🇺🇸
RHEUMATIC FEVER !!!!! In 🇨🇴
What valve is the MOST affected in the rheumatic heart disease?
MITRAL!!!!!!!
If there is two will be MITRAL and AORTA!!!!
Order from upper to lower in the sub costal grove of neurovascular structures.
🔹Vein
🔹Artery
🔹Nerve
How aortic arch aneurism can cause horse speaking ?
Lesion to left recurrent laryngeal nerve
What is the effect of Hyperkalemia in myocites action potential?
Depolarization
- Reduce the slope of action potential 🔹 p wave ⬇️ amplitude
- Delays conduction through atria and ventricles🔹⬆️PR interval, ⬆️QRS duration .
- Accelerated ventricular depolarization🔹spiked T wave
What’s the cardiac response to hypertension?
BRADICARDIA!!!!!
What isolated hypertension means?
DECREASE ARTERIAL COMPLIANCE!!!
What is the consequence of HYPOKALEMIA in the cardiac muscle?
HYPER POLARIZATION!!!!!
How increase the conductance of a ION?
Take the membrane potential the nearest to its equilibrium potential!!!!!bitchhhh!!!!
What happen with a patient which use digital and has Hypokalemia?
Hypokalemia potentiates the effects of Digitals by increasing the availability of digital binding sites on its therapeutic target
What are the. Glycoproteins IIb/IIIa inhibitors receptors?
Tirofiban
Abciximab
Eptifibatide
Which vascular structures are connected by ductus arteriosus?
Pulmonary artery and descending aorta
What happens whit total systemic vascular resistance in exercise?
DRECREASE!!!
Muscle arteriolar Dilatation!!!!
What is the physiopatology cause of Abdominal Aortic Aneurism?
Chronic transmural inflammation
Loss of elastin
Deposition of abnormal collagen
What Is the physiopatologic cause of ascending aortic aneurism in marfan syndrome ?
Cystic medial necrosis
Loss of muscle, elastin and collagen
What is the use-dependence phenomenon of class 1C antiarrhythmic drugs?
Block the Na channels in exercise
Prolongation of QRS in exercise
FLECAINIDE
What vascular beds are more susceptible to atherosclerosis ?(2)
Lower abdominal aorta
Coronary arteries
What is the clinical useful sign of degree of mitral stenosis?
Length in time between S2 and the opening snap of the murmur
A2-OS interval
The lesser time the worst the mitral stenosis
what s4 in erderly patient means?
left ventricular hypertrophy by prolonged hypertension
What is the objective , about cardiac work , of calcioantagonists and alpha blockers?
After-load
Arteriolar Dilators
Precapillary sphincters are suceptible to…(2)
Norepinephrine
Epinephrine
Dilate in ⬆️ histamine ⬇️ O2 ⬆️ CO2 ⬇️ pH
What infeciosus disease is associated whit Polyarteritis Nodosa?
HEPATITIS B
What’s the most common. Vasculitis associated whit antibiotic use?
Microscopic Polyangiitis
Type III hypersensitivity
Vasculitis linked whit asthma ?
Churg-Strauss syndrome
Cardiovascular abnormality related whit DiGeorge syndrome?
Tetralogy of Fallot
Interrupted aortic arch
What are the microscopic findings in the aorta in Marfan syndrome ?
Cystic medial necrosis
What are the factors involved in coronary blood flow autoregulation?(2)
Nitric Oxide
Adenosine
Principal action of nitrates..
VENODILATATION!!!!!!
⬇️preload
⬇️myocardal oxigen demand
Why the use of dyhidropyridine calcium channels have to be used whit precaution in coronary disease ?
CORONARY STEAL PHENOMENON!!!
What is delayed afterdepolarization in the use of digoxin?
State of hyperexcitability of myocites because high calcium concentrations
Leads to ventricular tachycardia and death
Say the different situations in eccentric and concentric hypertrophy?
CONCENTRIC (pressure overload)
Chronic. Hypertension
Aortic stenosis
ECCENTRIC (volume overload)
Aortic or mitral regurgitations
Myocardial infarction
Dilated cardiomyopathy
What wide fixed splitting means??
ATRIAL SEPTAL DEFECT!!!!!
How mitral valve prolapse , very common in Marfan and ehlers-Danlos syndromes, is heard ?
Mid-systolic click accompanied by late systolic murmur
Drug of choice for beta blocker overdose?
GLUCAGON!!!!
Where the AV node is located?
Right atrium
Near to the orifice of the coronary sinus
Which cell is responsible by fibrous cap formation atheroma?
SMOOTH MUSCLE CELLS
Collagen synthesis
Mechanism of action of digoxin?
🚫Na/K ATPase= ⬇️ k intracellular ⬆️Na intracellular
⬆️Na Intracellular ➡️🚫Na/Ca antiporter➡️⬆️Ca Intracellular (⬇️Ca efflux)
What is the equation for resistance in a parallel system?
1/Rt=1/R1+1/R2+1/R3….
What S3 in an older patient means?
LEFT VENTRICULAR FAILURE!!!!
What drugs are contraindicated in hypertrophic cardiomyopathy?
⬇️preload: diuretics Venodilators
⬇afterload: arteriodilators
Mechanism of action of sindenafil and Milrinone
SINDENAFIL 🚫phosphodiesterase 5 –⬆️cGMP
MILRINONE 🚫phosphodiesterase 3 –⬆️cAMP
Which substances activate guanylyl cyclase leading to ⬆️cGMP?(3)
Nitric Oxide
Atrial natriuretic peptide
Brain natriuretic peptide
What is the most common congenital cardiac anomaly related with berry aneurism?
Coarctation of the aorta
How long is the duration of action potential among class I antiarrhythmics?
Class IA PROLONGED. Quinidene, procainamide, disopyramide
Class IB SHORTENED. Lidocaine, mexilitine
Class IC NO CHANGED Flecainide, propafenone
explain how is seen hyperplastic ateriosclerosis, monckenberg , hyaline atherosclerosis, temporal arteritis, polyarteristis nodosa?
hyperplastic ateriosclerosis onion-loke concentric thickening of arteriolar walls
monckenberg medail band- loke calcification
hyaline atherosclerosis homogeneus acelluar thickening
temporal arteritis granulomatous inflmation of the intima
polyarteristis nodosa transmural infamation fibrosis necrosis.
Why patients whit tetralogy of fallot will squatting to relieves its dyspnea?
Because ⬆️ systemic vascular resistance
Increasing the pressure at left ventricle
Forcing the deoxygenated blood to go to the pulmonary artery instead to the left ventricle through the ventricular septal defect.
most important risk factor of aorta dissection?
HYPERTENSION!!!!!!
What is functional mitral regurgitation?
Systolic Murmur heard in the mitral focus
In a congestive patient
Which disappears with diuretics and vasodilators
BECAUSE ACUTE LEF VENTRICULAR DILATATION GENERATES THE MITRAL REGURGITATION .
wha is an important risk factor of aortic aneurism?
atherosclerosis
Which enzymes become strength and weak the fibrous cap of atheroma?
Strength: LYSIL OXIDASE (cross link between LYSIL and hydroxylysine residues [requieres cooper])
Weak: METALLOPROTEINASES!!!
Function of C1 esterase inhibitor ?(Loss in hereditary angioedema)
Inactivate kallikrein ( protein which produce bradykinin from kininogen)
Remember that in the FA patient that you prescribe warfarin you have to take off which antiarrythmic?
AMIODARONE!!!
This is a CYP450 inhibitor
⬆️ bleeding risk
Preload become very important in hat tipe of cardiac structural changes?
Hypertrophic cardiomyopathy
Atrial kick become important (lose in AF)
Which factor determine the ventricular contraction rate in atrial fibrillation?
AV NODE REFRACTORY!!!!!
Which molecule is find in localized amyloidosis confined to the cardiac atria?
NATRIURETIC PEPTIDE
Cause of coronary sinus dilation?
High right side pressure due to PULMONARY HYPERTENSION!!!!
Half-life of albumin ?
20 days!!!!
what is the major side effect of nondihydropyridines Diltiazem and verapamil
CONSTIPATION!!!!
AV Block
what are the proteins which cross- react in acute rheumatic fever
BACTERIA M protein and N-acetyl-beta -D glucosamine
CARDIAC myosin
BRAIN Lysoganglioside
ECG findings in Hypokalemia?
T wave flattening
ST-segment depression
U Waves
Premature atrial and ventricular contractions
Which congenital cardiac alterations have toe cyanosis and clubbing BUT NO FINGER ABNORMALITIES?
COARTATION OF AORTA (mostly)
PATENT DUCTUS ARTERIOSUS
Where the Nitric oxide comes from??
ARGININE+O2➡️eNOS➡️NO➕cirtruline
Acción of PROOTEIN KINASE G to relax the muscle?
⬇️ Ca levels ➡️ muscle relaxation
Explain the sequence of atherosclerosis. (5)
- Endothelial injury/dysfunction
- Accumulation of LDL
- Monocyte adhesion transformation of foam cells (macrophages)
- Grow factors by platelets:activation of foam cells and endothelial
- ⬆️T cells and smooth muscle cell proliferation
What’s Ortner syndrome?
Impinge of left recurrent laryngeal nerve
Causing Hoarseness
By enlarge tan of left atrium or blunt injury
What’s flegmasia Alba dolens?
Iliofemoral venous thrombosis
In PERIPARTUM WOMEN
Risk in hypertensive patient who takes diuretics and will start ACE inhibitor?
FIRST-DOSE HYPOTENSION
By arterial pressure depends on renin because there is an hypovolemic state
What are the second messengers in smooth muscle relaxation by B2 stimulation?
Protein Gs
⬆️cAMP
RELAXATION IN SMOOTH MUSCLE
Effect and second messengers after norepinephrine stimulation in Alpha and Beta1 receptors?
Alpha 1
Protein Gq
⬆️ IP3 ⬆️DAG
Beta 1
Protein Gs
⬆️cAMP
What’s Carvallo sign?
Is a increase of murmur in TRICUSPID REGURGITATION during inspiration
Because ⬆️Venous return in the right ventricle
And. ⬇️venuous return in the left ventricle
For mitral regurgitation and ventricular septal defect
The murmur will decrease or stay the same
How is the phonogram in pulmonary regurgitation?
DIASTOLIC MURMUR DECRESCENDO!!!!
Origen of vertebral artery?
SUBCLAVIAN ARTERY!!!!
What is the innominate artery?
RIGTH BRACHIOCEPHALIC ARTERY !!!!
Effects of class I antiarrhythmics on QRS and QT ?
IA ⬆️QRS. ⬆️QT
IB↔️QRS. ↔️QT
IC⬆️QRS ↔️QT
Percentage of arterial occlusion needed to show symptoms in coronary disease?
> 75% obstrucción
Effect of Beta-adrenergic receptors in potassium?
Leads potassium into the cell
What is the worst combination of hypolipemiants which cause myopathy and hepatopathy?
HMG-CoA reductase inhibitor + fibrates (⬇️ metabolism of 1st)
Atorvastatin + gemfebrozil
Function of sodium thiosulfate in cyanide intoxication?
Sodium thiosulfate is a donor of sulfur groups
Which in turn are add to cyanide forming thiosulfate
thiosulfate is excreted in urine
TTO includes
cyanocobalamine (binding of cyanide ions)
sodium nitrite. ( induce methahemoglobinemia)
What arteries are implied in Hypertensive vasculopathy and what is Charcot-Bourchard aneurisms?
LENTICULOSTRIATE ARTERIES branches of MCA
Basal ganglia hemorrhage by rupture of Charcot-Bourchard aneurisms
What is the mechanism by cGMP cause smooth muscle relaxation?
Activate myosin light chain phosphatase
Dephosphorilate myosin preventing interaction with actin
Order of atherosclerotic risk in arteries (major to minor)
- Abdominal aorta
- Coronary arteries
- Popliteal arteries
- Internal carotids
- Circle of Willis
which determines the coronary dominance?
artery taht supplies the posterior descending artery
70% right coronary
mechanism of action of Ivabradine?
selective inhibition of funny sodium channels
chronotropic negative
whitout inotropy nor lusotropy action
which hypoglicemiant drug leads to hypetriglyceridemia?
CHOLESTYRAMINE!!!!!!!
what are the first line therapy of hypertruglyceridemia?
FIBRATES!!!!!
How is the systolic ejection murmur in the standing maneuver in hypertrophic cardiomyopathy Vs aortic stenosis?
hypertrophic cardiomyopathy INCREASES!!!!!
aortic stenosis DECREASES!!!!!
what is the localization an symptoms of cardiac mixoma?
LEFT ATRIUM!!!!!!
diastolic murmur
breath dificulty IMPROVES when lying down.
IL-6 constitutional symptoms
VEGF angiogenesis
Position which worse chest pain in pericarditis?
Lying flat
Relieved by leading forward
What is cavernous hemangioma?
Benign neoplasm of small blood vessel endothelial cells
What’s pyogenic granuloma?
After local trauma
Capillary hemangioma bleeds easily
What’s cystic hygroma?
Is a cavernous lymphangioma whit out luminal blood cells
What’s port wine stain? Nevus flemus
Birthmark
Red- purple patches
Face or limbs
What’s kaposi’s sarcoma?
Hyperplasia or neoplasia of spindle-shaped cells
Smooth muscle and endothelium
What’s liver hemangiosarcoma?
Vascular endothelial neoplasm linked with
Arsenic
Thorotrast
Polyvinyl chloride
characteristic finding in Buergers disease?
segmental vasculitis extending into contigous veins and nerves
congenital syndrome lynked whit congenital QT prolongation
Langed-Nielsen syndrome
long-QT
Neurosensory deafness
Causes of pericarditis?
- MI
- Rheumatic fever
- Uremia
- Viral infection
Causes of Paradoux Pulse?
- Cor-pulmonalle
- Chronic constrictive pericarditis
- Cardiac tamponade
Risks of Bicuspid aortic valve?(3)
Aortic stenosis 50%
Bacterial endocarditis 3%
aortic dissection 1%
most common site of aortic rupture after blunt toracic trauma by rapid deceleration?
Aortic itsmus at ligamentus arteriosum
How colateral arterioles can reduce the blood flow to the ischemic microvessels?
CORONARY STEAL!!!!
vasodilation of colateral arterioles leads to increasethe ischemic phenomenom in partial obstructed microvessels (dypiridamol -adenosine)