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CARDIOVASCULAR Flashcards

0
Q

Where occurs fetal erythropoiesis (4)?

A

ƒ Yolk sac (3–8 weeks)
ƒ Liver (6 weeks–birth)
ƒ Spleen (10–28 weeks)
ƒ Bone marrow (18 weeks to adult)

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1
Q

CO and MAP ecuations

A

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.

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2
Q

Wall tension equation

A

Wall tension = (pressure × radius) / (2 × wall thickness)

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3
Q

Which drugs interfering whit preload an after load?

A

Venodilators (nitroglycerin) ⬇️ preload
Vasodilators (hydralazin) ⬇️ afterload
ACE inhibitors and ARBs️️⬇️ preload and afterload

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4
Q

How is best heard S4 sound?

A

Atrial kick is best heard in

Left lateral decubitus position

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5
Q

Explain Jugular Venus pulse

A

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.

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6
Q

When you heard wide splitting(2)?

A

Pulmonic stenosis

Right bundle branch block

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7
Q

When you heard fixed splitting (2)?

A

Atrial septal defect

L-R shunt

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8
Q

When you heard paradoxical splitting (2)?

A

Advance aortic stenosis

Left bundle branch block

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9
Q

What about the cardiac murmurs(5)?

A

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

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10
Q

How maximize some murmurs(3)?

A

Hand grip (⬆️afterload)
Murmur regurgitation
aortic regurgitation
Ventricular septum defect

Valsava(⬇️preload)p
Mitral valve prolapse earlier onset

Rapid squatting (⬆️ preload)
Aortic stenosis
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11
Q

What is the most frequent valvular lesion?

A

Mitral valve prolapse

Late systolic crescendo murmur

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12
Q

How you heard Persistent ductus arteriosos?PDA

A

Continue machine like murmur

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13
Q

What Drugs induce long QT (ABCDE)?⬇️K ⬇️Mg

A 
AntiArrhythmics (class IA, III) 
AntiBiotics (e.g., macrolides) 
Anti“C”ychotics (e.g., haloperidol) 
AntiDepressants (e.g., TCAs)
AntiEmetics (e.g., ondansetron)
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14
Q

What’s brugade syndrome?

A

Autosomal dominant Asian males
Pseudo right bundle branch block
ST elevations ,V1-V3

High risk ventricular tachyarrhythmias tto cardio defibrillator

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15
Q

Which nerves uses aortic arch and carotid sinus to carry out impulses from its chemo and Baroreceptors?

A

Aortic arch : vagus nerve to solitary nucleus in medulla

Carotid sinus: glossopharyngeal nerve to solitary nucleus in medulla

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16
Q

What’s eisenberger syndrome?

A

Left to right shunt lead to pulmonary hypertension leads to right ventricle hypertrophy leads to right to left shunt late cyanosis and polycythemia , clubbing

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17
Q

Types of arteriosclerosis

A

Hyaline

Hyperplasic

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18
Q

Types of aortic dissection

A

Stanford A—Qx

Stanford B—BBs

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19
Q

What’s dressler’s syndrome?

A

autoimmune phenomenon resulting in fibrinous pericarditis

(several weeks post-MI).

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20
Q

Causes of Dilated Cardiomyopathy(9)

A 
Alcohol abuse
wet Beriberi
Coxsackie B virus myocarditis
chronic Cocaine use
Chagas disease
Doxorubicin toxicity
hemochromatosis
sarcoidosis
peripartum cardiomyopathy.
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21
Q

Ethiology of hypertrophic cardiomyopathy

A

Eat -myosin heavy chain mutation

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22
Q

What’s loeffler syndrome?

A

Endomyocardial fibrosis whit prominent eosinophilic infiltrate

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23
Q

Presentation of bacterial endocarditis(8)

A

Bacteria FROM JANE ♥:
Fever
Roth spots
Osler nodes
Murmur
Janeway lesions Anemia
Nail-bed hemorrhage
Emboli

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24
Q

Clinical findings in rheumatic fever

A 
J♥NES (major criteria):

Joint (migratory polyarthritis)
♥ (carditis)
Nodules in skin (subcutaneous) 
Erythema marginatum 
Sydenham chorea
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25
Q

What’s Beck triad?

A

Hypotension
Distended neck veins
Distant heart sounds

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26
Q

What’s pulsus paradoux?

A

⬇️amplitude so systolic BP by >10 mmhg during inspiration

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27
Q

What’s kussmaul sign?

A

⬆️ jugular Venus pressure on inspiration

Sign of restrictive cardiomyopathy

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28
Q

Clinical features of Kawasaki disease

A 
Conjunctival injection
 Rash (polymorphous Ž desquamating)
 Adenopathy (cervical)
 Strawberry tongue (oral mucositis) D
 Hand- foot changes (edema, erythema)
 fever.
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29
Q

What’s Granulomatosis with polyangiitis (Wegener)

A

ƒ Focal necrotizing vasculitis
ƒ Necrotizing granulomas in the lung and
upper airway
ƒ Necrotizing glomerulonephritis

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30
Q

What’s the clinical findings of Eosinophilic granulomatosis with polyangiitis (Churg- Strauss)

A

Asthma
sinusitis
skin nodules or purpura
peripheral neuropathy (e.g., wrist/foot drop).
Can also involve heart, GI, kidneys (pauci- immune glomerulonephritis).

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31
Q

Labs in Churg-strauss

A

MPO-ANCA/p-ANCA,

⬆️  IgE level.

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32
Q

What’s Henoch-Schönlein purpura clinical findings?

A

Classic triad:

ƒ Skin: palpable purpura on buttocks/legs
Arthralgias
ƒ GI: abdominal pain

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33
Q

What’s cinchonism?

A

Headache
Tinnitus

Whit use of quinidene

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34
Q

Difference among class 1 antiasritmics

A

Class IA. ⬆️action potential ⬆️ effective refractory period

Class IB ⬇️action potential

Class IC ⬆️⬆️effective refractory period
AV node accessory bypass

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35
Q

What drugs can mask hypoglycemic symptoms?

A

BBs

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36
Q

What’s class III antiasritmics AIDS (4)?

A

Amiodarone
Ibutilide
Dofetilide
Sotalol.

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37
Q

What’s actions of class III antirrhythmics ?

A

. ⬆️action potential
⬆️ effective refractory period
⬆️QT interval

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38
Q

Which mechanisms are used to calcium eflux in order to initiate muscular relaxation?

A

NA/ca exchange

Ca-ATP ase pump

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39
Q

What is the calmodulin function in the muscle?

A

Calmodulin activates plasma membrane Ca-ATPase to get out calico calcium

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40
Q

What type of collagen is implicated in congenital diseases?

A

Collagen type I—-Osteogenesis imperfecta
Collagen type III—- Ehlers Danlos syndrome (types 3 and 4)
Collagen type IV—-Alport syndrome

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41
Q

What type of collagen is in nucleus purpose?

A

Collagen type II

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42
Q

Tissue changes after myocardial infarction (8)

A

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

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43
Q

What’s the use of class IV antiarrhythmic ?

A

Good for atrial tachyarrhythmias cause slows AV node conduction
Contraindicated in ventricular tachycardia

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44
Q

Indication of adenosine ?

A

Paroxysmal supra-ventricular tachycardia

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45
Q

Indication of digoxin ?

A

Atrial fibrillation
Because slow conduction through AV node
Contraindicated in WPW

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46
Q

Indication of amlodipine?

A

Hypertension and angina

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47
Q

How innominate vein forms?

A

(Right external Jugular vein + right subclavian vein) + right internal vein = innominate vein ( here drains right lymphatic duct)

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48
Q

How nitroprusside interferes whit cardiac work?

A

VENOUS AND ARTERIAL VASODILATOR
⬇️Preload ⬇️ left ventricular end diastolic pressure
⬇️Afterload ⬇️ mean systolic intraventricular pressure

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49
Q

How you consider hype pulmonary arterial hypertension?

A

Pulmonary artery pressure >25mmHg

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50
Q

What mutation is related whir PAH?

A

BMPR2 mutation autosomal dominant

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51
Q

Which drug improve survival in systolic heart failure (4)?

A

BBs
ACE inhibitors
ARBs
Aldosterone inhibitors

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52
Q

What organisms are implicated in culture-negative endocarditis(5+HACEK)?

A

Micoplasma
Histoplasma
Chlamydia

Haemophilus
Actinobacilus
Cardiobacteium
Eikenella
Kingella
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53
Q

What bacteria is linked with colon cancer?

A

S.bovis =S.gallolyticus

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54
Q

Bacteria linked whit subacute endocarditis

A

S. Viridansl

More common in patients whit valvular abnormality

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55
Q

What is the cardiac tissue conduction velocity?

Fastest to lowest

A

Purkinge 🐆
Atrial muscle🐎
Ventricular muscle🐊
AV node 🐢

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56
Q

When the use of thiazides and when ACE inhibitors is relevant?

A

thiazides ☑️hypertension whit-out CHF or Diabetes

ACE inhibitors☑️️hypertension PLUS CHF or Diabetes

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57
Q

How you can increase contractility?

A

⬆️heart rate

⬆systolic volume

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58
Q

Effects of heart function whit acetylcholine

A

M2 ⬇️heart rate

M3 relaxation of vascular smooth muscle

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59
Q

Adenosine mechanism

A

Increase potassium conductance

Delay atrioventricular node

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60
Q

What’s the most specific symptom of giant cell arteritis?

A

Jaw claudication

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61
Q

What’s the histologic presentation of polyarteritis nodosa?

A

Segmental transmural necrotizating inflammation
Inmunoclompex , complement, eosinophilic cells
FIBRINOID NECROSIS

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62
Q

What vases are affected in rheumatoid arteritis?

A

Visceral vases

Visceral Infractions

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63
Q

What type of Channels are in action potential of SA node?

A

Phase 4. T-type Ca pacemaker
Phase 0 L-type Ca
Phase 3. K channels

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64
Q

How adenosine and acetylcholine prolongs phase 4 action potential in SA node?

A

Increasing potassium conductance

Keeping hyper-polarized the SA node

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65
Q

What’s the best indicator of severity of mitral regurgitation?

A

Left ventricular S3 gallop

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66
Q

What are Kerley B lines?

A

Sisuritis

Edema of interlobular septa

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67
Q

How much time take de deletions of ATP resulting in loss contractility of myocardium?

A

60 SECONDS!!!!!!

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68
Q

When ischemia is irreversible?

A

30 MINUTS!!!!

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69
Q

Equation of Flow

A

Q= (P1-P2)/ R

R = (viscosity X length)/ r4 potency

If the radios goes to 50%
The flow ⬇️16 times

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70
Q

How patients appear whit double valve lesion in rheumatic fever?

A

Mitral stenosis
Aortic regurgitation

⬆️⬆️diastolic pressure in the left ventricle

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71
Q

The liberation of creatinine kinase is related whit…

A

Cell membrane damage

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72
Q

How is the early embryonic development veins?

A

SINUS VENUS
▪️ Viteline
▪️ Umbilical
▪️ Cardinal veins

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73
Q

What’s the mechanisms of cough produced by ACE inhibitor?

A

bradykinin
Substance P
Prostaglandins

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74
Q

How Cilostazol improve claudication symptoms?

A

⬆️cAMP by inhibiting phosphodiesterase ⬇️platelets aggregation

Arterial vasodilator

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75
Q

How is the drug dissociation speed of class I antiarrythmics ?

A

IB>IA>IC

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76
Q

What’s the mechanism of pulmonary hypertension in left heart failure?

A 
⬆️ left ventricular pressure
⬆️ pulmonary Venus congestion
⬆️ endothelial damage and protein leaking
⬆️endotheline ⬇️NO
⬆️smooth muscle cell proliferation
⬆️collagen and elastase deposition
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77
Q

Where beta 1 receptors are located?

A

Cardiac tissue

Renal juxtaglomerular cells

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78
Q

What’s the definition of cor pulmonalle?

A

Right ventricle hypertrophy caused by pulmonary hypertension

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79
Q

What’s the problem of long use of arteriolar vasodilators?

A

Acts reducing vascular resistance
Leading to stimulation of Baroreceptors and sympathetic activation
Activating renin-angiotensin-aldosterone axis
Sodium and water retention

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80
Q

What’s the mechanism of viagra?

A

Inhibits phosphodiesterase 5

⬆️cGMP leads to smooth muscle relaxation

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81
Q

Explain different organ rejection types (4)?

A

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

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82
Q

What chronic anemia does to cardiac output?

A

Cardiac output is increases in order to reach metabolic demands

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83
Q

What is the consequences of Anaphylaxis in CO /RAP VR/EDV graph?

A

Anaphylaxis cause ⬇️preload and afterload

Leads to shift left and down de X intersection

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84
Q

What’s monckenberg sclerosis?

A

Medial calcifications sclerosis

Isolated systolic hypertension

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85
Q

What cause S3

A

Reduce intrinsic ventricular wall compliances

Restrictive cardiomyopathy

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86
Q

How can maximize S3 sound in HCF patients

A

S3 is cause because sudden limitation of ventricular Movement during rapid passive ventricular filling (diastole)

Decubitus left
Expiration
Bell sf stethoscope in mitral focus

87
Q

What predispose to bacterial endocarditis?

A

Valvular abnormalities

Conditions that promote bacteremia and fungemia

88
Q

What’s the first anomaly in order to initiate endocarditis?

A

Fibrin deposit which formation of sterile fibrin-platelet nidus

89
Q

What is the pathognomonic histologic finding of Acute Rheumatic fever?

A

Aschoff body!!!!
Interstitial myocardial granuloma
Interstitial fibrosis - macrophages lymphocytes

90
Q

Principal structural change when S3 and S4 are heard?

A

S4 ⬇️ ventricular compliance ventricular hypertrophy

S3 dilated cardiomyopathy ⬆️ CO

91
Q

Ecocardiograhic mitral alterations in hypertrophic cardiomyopathy

A

Systolic anterior motion of the mitral valve

Mitral regurgitation

92
Q

Say the level of the renal arteries and where is IVC?????

A

L1!!!!!

IVC is anterior to the right renal artery

93
Q

What kind of cardiomyopathy has aortic stenosis ?

A

Early ventricular hypertrophy DIASTOLIC DISFUNCTION

Late dilated cardiomyopathy !!!! SYSTOLIC DISFUNCTION

94
Q

Deferents calcium interactions in cardiac, smooth and skeletal muscle to cause contraction

A

Cardiac Ca TROPONIN
Smooth Ca CALMODULIN
Skeletal Ca TROPONIN C

95
Q

What antihipertensive intravenous drug has arteriolar vasodilator and renal dilator effect ?

A

FENOLDOPAM !!

D1 agonist
⬆️cAMP

96
Q

Structural alteration in crescendo-decrescendo systolic murmur peaking in midsystole

A

AORTIC STENOSIS

PULMONIC STENOSIS

97
Q

Term to describe the fact of an hormon allow another to exert its maximal effect

A

PERMISSIVENESS !!!!

98
Q

What kind of pulse is characteristic in hypertrophic cardiomyopathy?

A

Bifid carotid pulse whit brisk upstroke

“Spike and dome”

99
Q

What are the most frequent causes of pulses paradoxus besides pericardial disease?

A

COPD

ASTHMA

100
Q

Histologic Changes at vascular structures in Marfan syndrome

A

Cystic medial degeneration whit myxomatous changes in the media layer of large vases

Defect of fibrillin-1

AORTIC ANEURISMS AND DISSECTIONS

101
Q

Which congenital disease predisposes to berry aneurisms?

A

Type IV Ehlers - Danlos syndrome

Abnormalities in type III collagen

102
Q

Toxicity symptoms of Digoxin

A 
Fatigue 
Blurred vision
Changes in color perception 
Confusion
Delirium
GI symptoms nausea vomit abdominal pain
103
Q

Cause of side effects of Niacin used to hyperlipidemia management ?

A

RELEASE OF PROSTAGLANDINS!!!

Flushing
Warmth
Itching

104
Q

What kind of cancer is associated whit long term of thiazolidinediones ?

A

URINARY BLADER CANCER !!!

105
Q

What cellular changes is associated whit irreversible And reversible injury?

A

IRREVERSIBLE : MITOCHONDRIAL VACUOLIZATION

REVERSIBLE : MITOCHONDRIAL SWELLING

106
Q

Different ions implied in the three phases of pacemaker action potential

A

4: Na out
0: Ca in
3: k out

107
Q

Different ions implied in the five phases of non pacemaker action potential

A 
0 Na in
1 K out
2 Ca in
3 K out !!!
4 K in Na out
108
Q

Effects of CLONIDINE alpha-2 agonist (5)

A 
CNS mediated ⬇️ BP
⬇️ intranucular pressure 
⬇️ Lipolysis
⬇️ presynaptic  NE release 
⬆️ platelet aggregation
109
Q

Action ps of atrial natriuretic peptide (3)

A

🔹Dilate afferents arterioles ⬇️Na absorption ❎renine secretion
🔹❎aldosterone secretion
🔹vasodilation and permeability

110
Q

Explain the 4 mechanical complications after MI and its timing presentation

A

Right ventricular failure ACUTE!!!
Papillary muscle rupture 3-5 days
Interventional radiology septum rupture 3-5 days
Free wall rupture 5-7 days!!!!!!

111
Q

What is the most common cause of dead after MI

A

VENTRICULAR ARRYTHMIAS 48-72 hrs

112
Q

Wha is the histologic hallmark of cell injury and dead? Cause is valve caclcificactions?

A

DYSTROPHIC CALCIFICATIONS !!!

113
Q

EKG characteristics in pre-excitation syndrome WPW(3)

A

Shortened of PR interval
Delta wave
QRS is wider (narrow during tachyarrhythmia)

114
Q

What happen in total anomalous pulmonary venous return?

A

Oxygenated blood goes to right atrium and the to left atrium via interatrium defect

Right atrial and ventricular dilation

115
Q

In poliarteritis nodosa (PAN) what organ is spared and what is the cutaneous finding in PAN ?

A

LUNGS!!!!

Livedo Reticularis

116
Q

What is the most common cause of infective endocarditis? In 🇺🇸 and 🇨🇴 ?

A

MITRAL VALVE PROLAPSE!!!!! In 🇺🇸

RHEUMATIC FEVER !!!!! In 🇨🇴

117
Q

What valve is the MOST affected in the rheumatic heart disease?

A

MITRAL!!!!!!!

If there is two will be MITRAL and AORTA!!!!

118
Q

Order from upper to lower in the sub costal grove of neurovascular structures.

A

🔹Vein
🔹Artery
🔹Nerve

119
Q

How aortic arch aneurism can cause horse speaking ?

A

Lesion to left recurrent laryngeal nerve

120
Q

What is the effect of Hyperkalemia in myocites action potential?

A

Depolarization

  1. Reduce the slope of action potential 🔹 p wave ⬇️ amplitude
  2. Delays conduction through atria and ventricles🔹⬆️PR interval, ⬆️QRS duration .
  3. Accelerated ventricular depolarization🔹spiked T wave
121
Q

What’s the cardiac response to hypertension?

A

BRADICARDIA!!!!!

122
Q

What isolated hypertension means?

A

DECREASE ARTERIAL COMPLIANCE!!!

123
Q

What is the consequence of HYPOKALEMIA in the cardiac muscle?

A

HYPER POLARIZATION!!!!!

124
Q

How increase the conductance of a ION?

A

Take the membrane potential the nearest to its equilibrium potential!!!!!bitchhhh!!!!

125
Q

What happen with a patient which use digital and has Hypokalemia?

A

Hypokalemia potentiates the effects of Digitals by increasing the availability of digital binding sites on its therapeutic target

126
Q

What are the. Glycoproteins IIb/IIIa inhibitors receptors?

A

Tirofiban
Abciximab
Eptifibatide

127
Q

Which vascular structures are connected by ductus arteriosus?

A

Pulmonary artery and descending aorta

128
Q

What happens whit total systemic vascular resistance in exercise?

A

DRECREASE!!!

Muscle arteriolar Dilatation!!!!

129
Q

What is the physiopatology cause of Abdominal Aortic Aneurism?

A

Chronic transmural inflammation

Loss of elastin
Deposition of abnormal collagen

130
Q

What Is the physiopatologic cause of ascending aortic aneurism in marfan syndrome ?

A

Cystic medial necrosis

Loss of muscle, elastin and collagen

131
Q

What is the use-dependence phenomenon of class 1C antiarrhythmic drugs?

A

Block the Na channels in exercise

Prolongation of QRS in exercise

FLECAINIDE

132
Q

What vascular beds are more susceptible to atherosclerosis ?(2)

A

Lower abdominal aorta

Coronary arteries

133
Q

What is the clinical useful sign of degree of mitral stenosis?

A

Length in time between S2 and the opening snap of the murmur
A2-OS interval
The lesser time the worst the mitral stenosis

134
Q

what s4 in erderly patient means?

A

left ventricular hypertrophy by prolonged hypertension

135
Q

What is the objective , about cardiac work , of calcioantagonists and alpha blockers?

A

After-load

Arteriolar Dilators

136
Q

Precapillary sphincters are suceptible to…(2)

A

Norepinephrine
Epinephrine

Dilate in 
⬆️ histamine
⬇️ O2
⬆️ CO2
⬇️ pH
137
Q

What infeciosus disease is associated whit Polyarteritis Nodosa?

A

HEPATITIS B

138
Q

What’s the most common. Vasculitis associated whit antibiotic use?

A

Microscopic Polyangiitis

Type III hypersensitivity

139
Q

Vasculitis linked whit asthma ?

A

Churg-Strauss syndrome

140
Q

Cardiovascular abnormality related whit DiGeorge syndrome?

A

Tetralogy of Fallot

Interrupted aortic arch

141
Q

What are the microscopic findings in the aorta in Marfan syndrome ?

A

Cystic medial necrosis

142
Q

What are the factors involved in coronary blood flow autoregulation?(2)

A

Nitric Oxide

Adenosine

143
Q

Principal action of nitrates..

A

VENODILATATION!!!!!!
⬇️preload
⬇️myocardal oxigen demand

144
Q

Why the use of dyhidropyridine calcium channels have to be used whit precaution in coronary disease ?

A

CORONARY STEAL PHENOMENON!!!

145
Q

What is delayed afterdepolarization in the use of digoxin?

A

State of hyperexcitability of myocites because high calcium concentrations

Leads to ventricular tachycardia and death

146
Q

Say the different situations in eccentric and concentric hypertrophy?

A

CONCENTRIC (pressure overload)
Chronic. Hypertension
Aortic stenosis

ECCENTRIC (volume overload)
Aortic or mitral regurgitations
Myocardial infarction
Dilated cardiomyopathy

147
Q

What wide fixed splitting means??

A

ATRIAL SEPTAL DEFECT!!!!!

148
Q

How mitral valve prolapse , very common in Marfan and ehlers-Danlos syndromes, is heard ?

A

Mid-systolic click accompanied by late systolic murmur

149
Q

Drug of choice for beta blocker overdose?

A

GLUCAGON!!!!

150
Q

Where the AV node is located?

A

Right atrium

Near to the orifice of the coronary sinus

151
Q

Which cell is responsible by fibrous cap formation atheroma?

A

SMOOTH MUSCLE CELLS

Collagen synthesis

152
Q

Mechanism of action of digoxin?

A

🚫Na/K ATPase= ⬇️ k intracellular ⬆️Na intracellular

⬆️Na Intracellular ➡️🚫Na/Ca antiporter➡️⬆️Ca Intracellular (⬇️Ca efflux)

153
Q

What is the equation for resistance in a parallel system?

A

1/Rt=1/R1+1/R2+1/R3….

154
Q

What S3 in an older patient means?

A

LEFT VENTRICULAR FAILURE!!!!

155
Q

What drugs are contraindicated in hypertrophic cardiomyopathy?

A

⬇️preload: diuretics Venodilators

⬇afterload: arteriodilators

156
Q

Mechanism of action of sindenafil and Milrinone

A

SINDENAFIL 🚫phosphodiesterase 5 –⬆️cGMP

MILRINONE 🚫phosphodiesterase 3 –⬆️cAMP

157
Q

Which substances activate guanylyl cyclase leading to ⬆️cGMP?(3)

A

Nitric Oxide
Atrial natriuretic peptide
Brain natriuretic peptide

158
Q

What is the most common congenital cardiac anomaly related with berry aneurism?

A

Coarctation of the aorta

159
Q

How long is the duration of action potential among class I antiarrhythmics?

A

Class IA PROLONGED. Quinidene, procainamide, disopyramide
Class IB SHORTENED. Lidocaine, mexilitine
Class IC NO CHANGED Flecainide, propafenone

160
Q

explain how is seen hyperplastic ateriosclerosis, monckenberg , hyaline atherosclerosis, temporal arteritis, polyarteristis nodosa?

A

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.

160
Q

Why patients whit tetralogy of fallot will squatting to relieves its dyspnea?

A

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.

161
Q

most important risk factor of aorta dissection?

A

HYPERTENSION!!!!!!

161
Q

What is functional mitral regurgitation?

A

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 .

162
Q

wha is an important risk factor of aortic aneurism?

A

atherosclerosis

162
Q

Which enzymes become strength and weak the fibrous cap of atheroma?

A

Strength: LYSIL OXIDASE (cross link between LYSIL and hydroxylysine residues [requieres cooper])

Weak: METALLOPROTEINASES!!!

166
Q

Function of C1 esterase inhibitor ?(Loss in hereditary angioedema)

A

Inactivate kallikrein ( protein which produce bradykinin from kininogen)

167
Q

Remember that in the FA patient that you prescribe warfarin you have to take off which antiarrythmic?

A

AMIODARONE!!!

This is a CYP450 inhibitor
⬆️ bleeding risk

168
Q

Preload become very important in hat tipe of cardiac structural changes?

A

Hypertrophic cardiomyopathy

Atrial kick become important (lose in AF)

169
Q

Which factor determine the ventricular contraction rate in atrial fibrillation?

A

AV NODE REFRACTORY!!!!!

170
Q

Which molecule is find in localized amyloidosis confined to the cardiac atria?

A

NATRIURETIC PEPTIDE

171
Q

Cause of coronary sinus dilation?

A

High right side pressure due to PULMONARY HYPERTENSION!!!!

172
Q

Half-life of albumin ?

A

20 days!!!!

173
Q

what is the major side effect of nondihydropyridines Diltiazem and verapamil

A

CONSTIPATION!!!!

AV Block

174
Q

what are the proteins which cross- react in acute rheumatic fever

A

BACTERIA M protein and N-acetyl-beta -D glucosamine

CARDIAC myosin
BRAIN Lysoganglioside

175
Q

ECG findings in Hypokalemia?

A

T wave flattening
ST-segment depression
U Waves
Premature atrial and ventricular contractions

176
Q

Which congenital cardiac alterations have toe cyanosis and clubbing BUT NO FINGER ABNORMALITIES?

A

COARTATION OF AORTA (mostly)

PATENT DUCTUS ARTERIOSUS

177
Q

Where the Nitric oxide comes from??

A

ARGININE+O2➡️eNOS➡️NO➕cirtruline

178
Q

Acción of PROOTEIN KINASE G to relax the muscle?

A

⬇️ Ca levels ➡️ muscle relaxation

179
Q

Explain the sequence of atherosclerosis. (5)

A
  1. Endothelial injury/dysfunction
  2. Accumulation of LDL
  3. Monocyte adhesion transformation of foam cells (macrophages)
  4. Grow factors by platelets:activation of foam cells and endothelial
  5. ⬆️T cells and smooth muscle cell proliferation
180
Q

What’s Ortner syndrome?

A

Impinge of left recurrent laryngeal nerve
Causing Hoarseness

By enlarge tan of left atrium or blunt injury

181
Q

What’s flegmasia Alba dolens?

A

Iliofemoral venous thrombosis

In PERIPARTUM WOMEN

182
Q

Risk in hypertensive patient who takes diuretics and will start ACE inhibitor?

A

FIRST-DOSE HYPOTENSION

By arterial pressure depends on renin because there is an hypovolemic state

183
Q

What are the second messengers in smooth muscle relaxation by B2 stimulation?

A

Protein Gs
⬆️cAMP
RELAXATION IN SMOOTH MUSCLE

184
Q

Effect and second messengers after norepinephrine stimulation in Alpha and Beta1 receptors?

A

Alpha 1
Protein Gq
⬆️ IP3 ⬆️DAG

Beta 1
Protein Gs
⬆️cAMP

185
Q

What’s Carvallo sign?

A

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

186
Q

How is the phonogram in pulmonary regurgitation?

A

DIASTOLIC MURMUR DECRESCENDO!!!!

187
Q

Origen of vertebral artery?

A

SUBCLAVIAN ARTERY!!!!

188
Q

What is the innominate artery?

A

RIGTH BRACHIOCEPHALIC ARTERY !!!!

189
Q

Effects of class I antiarrhythmics on QRS and QT ?

A

IA ⬆️QRS. ⬆️QT
IB↔️QRS. ↔️QT
IC⬆️QRS ↔️QT

190
Q

Percentage of arterial occlusion needed to show symptoms in coronary disease?

A

> 75% obstrucción

191
Q

Effect of Beta-adrenergic receptors in potassium?

A

Leads potassium into the cell

192
Q

What is the worst combination of hypolipemiants which cause myopathy and hepatopathy?

A

HMG-CoA reductase inhibitor + fibrates (⬇️ metabolism of 1st)
Atorvastatin + gemfebrozil

193
Q

Function of sodium thiosulfate in cyanide intoxication?

A

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)

194
Q

What arteries are implied in Hypertensive vasculopathy and what is Charcot-Bourchard aneurisms?

A

LENTICULOSTRIATE ARTERIES branches of MCA

Basal ganglia hemorrhage by rupture of Charcot-Bourchard aneurisms

195
Q

What is the mechanism by cGMP cause smooth muscle relaxation?

A

Activate myosin light chain phosphatase

Dephosphorilate myosin preventing interaction with actin

196
Q

Order of atherosclerotic risk in arteries (major to minor)

A
  1. Abdominal aorta
  2. Coronary arteries
  3. Popliteal arteries
  4. Internal carotids
  5. Circle of Willis
197
Q

which determines the coronary dominance?

A

artery taht supplies the posterior descending artery

70% right coronary

198
Q

mechanism of action of Ivabradine?

A

selective inhibition of funny sodium channels
chronotropic negative
whitout inotropy nor lusotropy action

199
Q

which hypoglicemiant drug leads to hypetriglyceridemia?

A

CHOLESTYRAMINE!!!!!!!

200
Q

what are the first line therapy of hypertruglyceridemia?

A

FIBRATES!!!!!

201
Q

How is the systolic ejection murmur in the standing maneuver in hypertrophic cardiomyopathy Vs aortic stenosis?

A

hypertrophic cardiomyopathy INCREASES!!!!!

aortic stenosis DECREASES!!!!!

202
Q

what is the localization an symptoms of cardiac mixoma?

A

LEFT ATRIUM!!!!!!

diastolic murmur
breath dificulty IMPROVES when lying down.
IL-6 constitutional symptoms
VEGF angiogenesis

203
Q

Position which worse chest pain in pericarditis?

A

Lying flat

Relieved by leading forward

204
Q

What is cavernous hemangioma?

A

Benign neoplasm of small blood vessel endothelial cells

205
Q

What’s pyogenic granuloma?

A

After local trauma

Capillary hemangioma bleeds easily

206
Q

What’s cystic hygroma?

A

Is a cavernous lymphangioma whit out luminal blood cells

207
Q

What’s port wine stain? Nevus flemus

A

Birthmark
Red- purple patches
Face or limbs

208
Q

What’s kaposi’s sarcoma?

A

Hyperplasia or neoplasia of spindle-shaped cells

Smooth muscle and endothelium

209
Q

What’s liver hemangiosarcoma?

A

Vascular endothelial neoplasm linked with

Arsenic
Thorotrast
Polyvinyl chloride

210
Q

characteristic finding in Buergers disease?

A

segmental vasculitis extending into contigous veins and nerves

211
Q

congenital syndrome lynked whit congenital QT prolongation

A

Langed-Nielsen syndrome

long-QT
Neurosensory deafness

212
Q

Causes of pericarditis?

A
  • MI
  • Rheumatic fever
  • Uremia
  • Viral infection
213
Q

Causes of Paradoux Pulse?

A
  • Cor-pulmonalle
  • Chronic constrictive pericarditis
  • Cardiac tamponade
214
Q

Risks of Bicuspid aortic valve?(3)

A

Aortic stenosis 50%
Bacterial endocarditis 3%
aortic dissection 1%

215
Q

most common site of aortic rupture after blunt toracic trauma by rapid deceleration?

A

Aortic itsmus at ligamentus arteriosum

216
Q

How colateral arterioles can reduce the blood flow to the ischemic microvessels?

A

CORONARY STEAL!!!!
vasodilation of colateral arterioles leads to increasethe ischemic phenomenom in partial obstructed microvessels (dypiridamol -adenosine)

Step 1 (1) (16 decks)

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