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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
Clinical findings in rheumatic fever
``` J♥NES (major criteria): Joint (migratory polyarthritis) ♥ (carditis) Nodules in skin (subcutaneous) Erythema marginatum Sydenham chorea ```
25
What's Beck triad?
Hypotension Distended neck veins Distant heart sounds
26
What's pulsus paradoux?
⬇️amplitude so systolic BP by >10 mmhg during inspiration
27
What's kussmaul sign?
⬆️ jugular Venus pressure on inspiration | Sign of restrictive cardiomyopathy
28
Clinical features of Kawasaki disease
``` Conjunctival injection Rash (polymorphous Ž desquamating) Adenopathy (cervical) Strawberry tongue (oral mucositis) D Hand- foot changes (edema, erythema) fever. ```
29
What's Granulomatosis with polyangiitis (Wegener)
ƒ Focal necrotizing vasculitis ƒ Necrotizing granulomas in the lung and upper airway ƒ Necrotizing glomerulonephritis
30
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).
31
Labs in Churg-strauss
MPO-ANCA/p-ANCA, | ⬆️  IgE level.
32
What's Henoch-Schönlein purpura clinical findings?
Classic triad: ƒ Skin: palpable purpura on buttocks/legs Arthralgias ƒ GI: abdominal pain
33
What's cinchonism?
Headache Tinnitus Whit use of quinidene
34
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
35
What drugs can mask hypoglycemic symptoms?
BBs
36
What's class III antiasritmics AIDS (4)?
Amiodarone Ibutilide Dofetilide Sotalol.
37
What's actions of class III antirrhythmics ?
. ⬆️action potential ⬆️ effective refractory period ⬆️QT interval
38
Which mechanisms are used to calcium eflux in order to initiate muscular relaxation?
NA/ca exchange | Ca-ATP ase pump
39
What is the calmodulin function in the muscle?
Calmodulin activates plasma membrane Ca-ATPase to get out calico calcium
40
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
41
What type of collagen is in nucleus purpose?
Collagen type II
42
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
43
What's the use of class IV antiarrhythmic ?
Good for atrial tachyarrhythmias cause slows AV node conduction Contraindicated in ventricular tachycardia
44
Indication of adenosine ?
Paroxysmal supra-ventricular tachycardia
45
Indication of digoxin ?
Atrial fibrillation Because slow conduction through AV node Contraindicated in WPW
46
Indication of amlodipine?
Hypertension and angina
47
How innominate vein forms?
(Right external Jugular vein + right subclavian vein) + right internal vein = innominate vein ( here drains right lymphatic duct)
48
How nitroprusside interferes whit cardiac work?
VENOUS AND ARTERIAL VASODILATOR ⬇️Preload ⬇️ left ventricular end diastolic pressure ⬇️Afterload ⬇️ mean systolic intraventricular pressure
49
How you consider hype pulmonary arterial hypertension?
Pulmonary artery pressure >25mmHg
50
What mutation is related whir PAH?
BMPR2 mutation autosomal dominant
51
Which drug improve survival in systolic heart failure (4)?
BBs ACE inhibitors ARBs Aldosterone inhibitors
52
What organisms are implicated in culture-negative endocarditis(5+HACEK)?
Micoplasma Histoplasma Chlamydia ``` Haemophilus Actinobacilus Cardiobacteium Eikenella Kingella ```
53
What bacteria is linked with colon cancer?
S.bovis =S.gallolyticus
54
Bacteria linked whit subacute endocarditis
S. Viridansl | More common in patients whit valvular abnormality
55
What is the cardiac tissue conduction velocity? | Fastest to lowest
Purkinge 🐆 Atrial muscle🐎 Ventricular muscle🐊 AV node 🐢
56
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
57
How you can increase contractility?
⬆️heart rate | ⬆systolic volume
58
Effects of heart function whit acetylcholine
M2 ⬇️heart rate | M3 relaxation of vascular smooth muscle
59
Adenosine mechanism
Increase potassium conductance | Delay atrioventricular node
60
What's the most specific symptom of giant cell arteritis?
Jaw claudication
61
What's the histologic presentation of polyarteritis nodosa?
Segmental transmural necrotizating inflammation Inmunoclompex , complement, eosinophilic cells FIBRINOID NECROSIS
62
What vases are affected in rheumatoid arteritis?
Visceral vases | Visceral Infractions
63
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
64
How adenosine and acetylcholine prolongs phase 4 action potential in SA node?
Increasing potassium conductance | Keeping hyper-polarized the SA node
65
What's the best indicator of severity of mitral regurgitation?
Left ventricular S3 gallop
66
What are Kerley B lines?
Sisuritis | Edema of interlobular septa
67
How much time take de deletions of ATP resulting in loss contractility of myocardium?
60 SECONDS!!!!!!
68
When ischemia is irreversible?
30 MINUTS!!!!
69
Equation of Flow
Q= (P1-P2)/ R R = (viscosity X length)/ r4 potency If the radios goes to 50% The flow ⬇️16 times
70
How patients appear whit double valve lesion in rheumatic fever?
Mitral stenosis Aortic regurgitation ⬆️⬆️diastolic pressure in the left ventricle
71
The liberation of creatinine kinase is related whit...
Cell membrane damage
72
How is the early embryonic development veins?
SINUS VENUS ▪️ Viteline ▪️ Umbilical ▪️ Cardinal veins
73
What's the mechanisms of cough produced by ACE inhibitor?
bradykinin Substance P Prostaglandins
74
How Cilostazol improve claudication symptoms?
⬆️cAMP by inhibiting phosphodiesterase ⬇️platelets aggregation Arterial vasodilator
75
How is the drug dissociation speed of class I antiarrythmics ?
IB>IA>IC
76
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 ```
77
Where beta 1 receptors are located?
Cardiac tissue | Renal juxtaglomerular cells
78
What's the definition of cor pulmonalle?
Right ventricle hypertrophy caused by pulmonary hypertension
79
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
80
What's the mechanism of viagra?
Inhibits phosphodiesterase 5 | ⬆️cGMP leads to smooth muscle relaxation
81
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
82
What chronic anemia does to cardiac output?
Cardiac output is increases in order to reach metabolic demands
83
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
84
What's monckenberg sclerosis?
Medial calcifications sclerosis | Isolated systolic hypertension
85
What cause S3
Reduce intrinsic ventricular wall compliances | Restrictive cardiomyopathy
86
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
87
What predispose to bacterial endocarditis?
Valvular abnormalities | Conditions that promote bacteremia and fungemia
88
What's the first anomaly in order to initiate endocarditis?
Fibrin deposit which formation of sterile fibrin-platelet nidus
89
What is the pathognomonic histologic finding of Acute Rheumatic fever?
Aschoff body!!!! Interstitial myocardial granuloma Interstitial fibrosis - macrophages lymphocytes
90
Principal structural change when S3 and S4 are heard?
S4 ⬇️ ventricular compliance ventricular hypertrophy S3 dilated cardiomyopathy ⬆️ CO
91
Ecocardiograhic mitral alterations in hypertrophic cardiomyopathy
Systolic anterior motion of the mitral valve | Mitral regurgitation
92
Say the level of the renal arteries and where is IVC?????
L1!!!!! | IVC is anterior to the right renal artery
93
What kind of cardiomyopathy has aortic stenosis ?
Early ventricular hypertrophy DIASTOLIC DISFUNCTION | Late dilated cardiomyopathy !!!! SYSTOLIC DISFUNCTION
94
Deferents calcium interactions in cardiac, smooth and skeletal muscle to cause contraction
Cardiac Ca TROPONIN Smooth Ca CALMODULIN Skeletal Ca TROPONIN C
95
What antihipertensive intravenous drug has arteriolar vasodilator and renal dilator effect ?
FENOLDOPAM !! D1 agonist ⬆️cAMP
96
Structural alteration in crescendo-decrescendo systolic murmur peaking in midsystole
AORTIC STENOSIS | PULMONIC STENOSIS
97
Term to describe the fact of an hormon allow another to exert its maximal effect
PERMISSIVENESS !!!!
98
What kind of pulse is characteristic in hypertrophic cardiomyopathy?
Bifid carotid pulse whit brisk upstroke | "Spike and dome"
99
What are the most frequent causes of pulses paradoxus besides pericardial disease?
COPD | ASTHMA
100
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
101
Which congenital disease predisposes to berry aneurisms?
Type IV Ehlers - Danlos syndrome | Abnormalities in type III collagen
102
Toxicity symptoms of Digoxin
``` Fatigue Blurred vision Changes in color perception Confusion Delirium GI symptoms nausea vomit abdominal pain ```
103
Cause of side effects of Niacin used to hyperlipidemia management ?
RELEASE OF PROSTAGLANDINS!!! Flushing Warmth Itching
104
What kind of cancer is associated whit long term of thiazolidinediones ?
URINARY BLADER CANCER !!!
105
What cellular changes is associated whit irreversible And reversible injury?
IRREVERSIBLE : MITOCHONDRIAL VACUOLIZATION | REVERSIBLE : MITOCHONDRIAL SWELLING
106
Different ions implied in the three phases of pacemaker action potential
4: Na out 0: Ca in 3: k out
107
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 ```
108
Effects of CLONIDINE alpha-2 agonist (5)
``` CNS mediated ⬇️ BP ⬇️ intranucular pressure ⬇️ Lipolysis ⬇️ presynaptic NE release ⬆️ platelet aggregation ```
109
Action ps of atrial natriuretic peptide (3)
🔹Dilate afferents arterioles ⬇️Na absorption ❎renine secretion 🔹❎aldosterone secretion 🔹vasodilation and permeability
110
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!!!!!!
111
What is the most common cause of dead after MI
VENTRICULAR ARRYTHMIAS 48-72 hrs
112
Wha is the histologic hallmark of cell injury and dead? Cause is valve caclcificactions?
DYSTROPHIC CALCIFICATIONS !!!
113
EKG characteristics in pre-excitation syndrome WPW(3)
Shortened of PR interval Delta wave QRS is wider (narrow during tachyarrhythmia)
114
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
115
In poliarteritis nodosa (PAN) what organ is spared and what is the cutaneous finding in PAN ?
LUNGS!!!! Livedo Reticularis
116
What is the most common cause of infective endocarditis? In 🇺🇸 and 🇨🇴 ?
MITRAL VALVE PROLAPSE!!!!! In 🇺🇸 | RHEUMATIC FEVER !!!!! In 🇨🇴
117
What valve is the MOST affected in the rheumatic heart disease?
MITRAL!!!!!!! If there is two will be MITRAL and AORTA!!!!
118
Order from upper to lower in the sub costal grove of neurovascular structures.
🔹Vein 🔹Artery 🔹Nerve
119
How aortic arch aneurism can cause horse speaking ?
Lesion to left recurrent laryngeal nerve
120
What is the effect of Hyperkalemia in myocites action potential?
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
What's the cardiac response to hypertension?
BRADICARDIA!!!!!
122
What isolated hypertension means?
DECREASE ARTERIAL COMPLIANCE!!!
123
What is the consequence of HYPOKALEMIA in the cardiac muscle?
HYPER POLARIZATION!!!!!
124
How increase the conductance of a ION?
Take the membrane potential the nearest to its equilibrium potential!!!!!bitchhhh!!!!
125
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
126
What are the. Glycoproteins IIb/IIIa inhibitors receptors?
Tirofiban Abciximab Eptifibatide
127
Which vascular structures are connected by ductus arteriosus?
Pulmonary artery and descending aorta
128
What happens whit total systemic vascular resistance in exercise?
DRECREASE!!! Muscle arteriolar Dilatation!!!!
129
What is the physiopatology cause of Abdominal Aortic Aneurism?
Chronic transmural inflammation Loss of elastin Deposition of abnormal collagen
130
What Is the physiopatologic cause of ascending aortic aneurism in marfan syndrome ?
Cystic medial necrosis Loss of muscle, elastin and collagen
131
What is the use-dependence phenomenon of class 1C antiarrhythmic drugs?
Block the Na channels in exercise Prolongation of QRS in exercise FLECAINIDE
132
What vascular beds are more susceptible to atherosclerosis ?(2)
Lower abdominal aorta | Coronary arteries
133
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
134
what s4 in erderly patient means?
left ventricular hypertrophy by prolonged hypertension
135
What is the objective , about cardiac work , of calcioantagonists and alpha blockers?
After-load Arteriolar Dilators
136
Precapillary sphincters are suceptible to...(2)
Norepinephrine Epinephrine ``` Dilate in ⬆️ histamine ⬇️ O2 ⬆️ CO2 ⬇️ pH ```
137
What infeciosus disease is associated whit Polyarteritis Nodosa?
HEPATITIS B
138
What's the most common. Vasculitis associated whit antibiotic use?
Microscopic Polyangiitis | Type III hypersensitivity
139
Vasculitis linked whit asthma ?
Churg-Strauss syndrome
140
Cardiovascular abnormality related whit DiGeorge syndrome?
Tetralogy of Fallot | Interrupted aortic arch
141
What are the microscopic findings in the aorta in Marfan syndrome ?
Cystic medial necrosis
142
What are the factors involved in coronary blood flow autoregulation?(2)
Nitric Oxide | Adenosine
143
Principal action of nitrates..
VENODILATATION!!!!!! ⬇️preload ⬇️myocardal oxigen demand
144
Why the use of dyhidropyridine calcium channels have to be used whit precaution in coronary disease ?
CORONARY STEAL PHENOMENON!!!
145
What is delayed afterdepolarization in the use of digoxin?
State of hyperexcitability of myocites because high calcium concentrations Leads to ventricular tachycardia and death
146
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
147
What wide fixed splitting means??
ATRIAL SEPTAL DEFECT!!!!!
148
How mitral valve prolapse , very common in Marfan and ehlers-Danlos syndromes, is heard ?
Mid-systolic click accompanied by late systolic murmur
149
Drug of choice for beta blocker overdose?
GLUCAGON!!!!
150
Where the AV node is located?
Right atrium | Near to the orifice of the coronary sinus
151
Which cell is responsible by fibrous cap formation atheroma?
SMOOTH MUSCLE CELLS | Collagen synthesis
152
Mechanism of action of digoxin?
🚫Na/K ATPase= ⬇️ k intracellular ⬆️Na intracellular | ⬆️Na Intracellular ➡️🚫Na/Ca antiporter➡️⬆️Ca Intracellular (⬇️Ca efflux)
153
What is the equation for resistance in a parallel system?
1/Rt=1/R1+1/R2+1/R3....
154
What S3 in an older patient means?
LEFT VENTRICULAR FAILURE!!!!
155
What drugs are contraindicated in hypertrophic cardiomyopathy?
⬇️preload: diuretics Venodilators | ⬇afterload: arteriodilators
156
Mechanism of action of sindenafil and Milrinone
SINDENAFIL 🚫phosphodiesterase 5 --⬆️cGMP MILRINONE 🚫phosphodiesterase 3 --⬆️cAMP
157
Which substances activate guanylyl cyclase leading to ⬆️cGMP?(3)
Nitric Oxide Atrial natriuretic peptide Brain natriuretic peptide
158
What is the most common congenital cardiac anomaly related with berry aneurism?
Coarctation of the aorta
159
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
160
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.
160
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.
161
most important risk factor of aorta dissection?
HYPERTENSION!!!!!!
161
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 .
162
wha is an important risk factor of aortic aneurism?
atherosclerosis
162
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!!!
166
Function of C1 esterase inhibitor ?(Loss in hereditary angioedema)
Inactivate kallikrein ( protein which produce bradykinin from kininogen)
167
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
168
Preload become very important in hat tipe of cardiac structural changes?
Hypertrophic cardiomyopathy Atrial kick become important (lose in AF)
169
Which factor determine the ventricular contraction rate in atrial fibrillation?
AV NODE REFRACTORY!!!!!
170
Which molecule is find in localized amyloidosis confined to the cardiac atria?
NATRIURETIC PEPTIDE
171
Cause of coronary sinus dilation?
High right side pressure due to PULMONARY HYPERTENSION!!!!
172
Half-life of albumin ?
20 days!!!!
173
what is the major side effect of nondihydropyridines Diltiazem and verapamil
CONSTIPATION!!!! | AV Block
174
what are the proteins which cross- react in acute rheumatic fever
BACTERIA M protein and N-acetyl-beta -D glucosamine CARDIAC myosin BRAIN Lysoganglioside
175
ECG findings in Hypokalemia?
T wave flattening ST-segment depression U Waves Premature atrial and ventricular contractions
176
Which congenital cardiac alterations have toe cyanosis and clubbing BUT NO FINGER ABNORMALITIES?
COARTATION OF AORTA (mostly) PATENT DUCTUS ARTERIOSUS
177
Where the Nitric oxide comes from??
ARGININE+O2➡️eNOS➡️NO➕cirtruline
178
Acción of PROOTEIN KINASE G to relax the muscle?
⬇️ Ca levels ➡️ muscle relaxation
179
Explain the sequence of atherosclerosis. (5)
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
What's Ortner syndrome?
Impinge of left recurrent laryngeal nerve Causing Hoarseness By enlarge tan of left atrium or blunt injury
181
What's flegmasia Alba dolens?
Iliofemoral venous thrombosis In PERIPARTUM WOMEN
182
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
183
What are the second messengers in smooth muscle relaxation by B2 stimulation?
Protein Gs ⬆️cAMP RELAXATION IN SMOOTH MUSCLE
184
Effect and second messengers after norepinephrine stimulation in Alpha and Beta1 receptors?
Alpha 1 Protein Gq ⬆️ IP3 ⬆️DAG Beta 1 Protein Gs ⬆️cAMP
185
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
186
How is the phonogram in pulmonary regurgitation?
DIASTOLIC MURMUR DECRESCENDO!!!!
187
Origen of vertebral artery?
SUBCLAVIAN ARTERY!!!!
188
What is the innominate artery?
RIGTH BRACHIOCEPHALIC ARTERY !!!!
189
Effects of class I antiarrhythmics on QRS and QT ?
IA ⬆️QRS. ⬆️QT IB↔️QRS. ↔️QT IC⬆️QRS ↔️QT
190
Percentage of arterial occlusion needed to show symptoms in coronary disease?
>75% obstrucción
191
Effect of Beta-adrenergic receptors in potassium?
Leads potassium into the cell
192
What is the worst combination of hypolipemiants which cause myopathy and hepatopathy?
HMG-CoA reductase inhibitor + fibrates (⬇️ metabolism of 1st) Atorvastatin + gemfebrozil
193
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)
194
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
195
What is the mechanism by cGMP cause smooth muscle relaxation?
Activate myosin light chain phosphatase Dephosphorilate myosin preventing interaction with actin
196
Order of atherosclerotic risk in arteries (major to minor)
1. Abdominal aorta 2. Coronary arteries 3. Popliteal arteries 4. Internal carotids 5. Circle of Willis
197
which determines the coronary dominance?
artery taht supplies the posterior descending artery | 70% right coronary
198
mechanism of action of Ivabradine?
selective inhibition of funny sodium channels chronotropic negative whitout inotropy nor lusotropy action
199
which hypoglicemiant drug leads to hypetriglyceridemia?
CHOLESTYRAMINE!!!!!!!
200
what are the first line therapy of hypertruglyceridemia?
FIBRATES!!!!!
201
How is the systolic ejection murmur in the standing maneuver in hypertrophic cardiomyopathy Vs aortic stenosis?
hypertrophic cardiomyopathy INCREASES!!!!! aortic stenosis DECREASES!!!!!
202
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
203
Position which worse chest pain in pericarditis?
Lying flat Relieved by leading forward
204
What is cavernous hemangioma?
Benign neoplasm of small blood vessel endothelial cells
205
What's pyogenic granuloma?
After local trauma | Capillary hemangioma bleeds easily
206
What's cystic hygroma?
Is a cavernous lymphangioma whit out luminal blood cells
207
What's port wine stain? Nevus flemus
Birthmark Red- purple patches Face or limbs
208
What's kaposi's sarcoma?
Hyperplasia or neoplasia of spindle-shaped cells | Smooth muscle and endothelium
209
What's liver hemangiosarcoma?
Vascular endothelial neoplasm linked with Arsenic Thorotrast Polyvinyl chloride
210
characteristic finding in Buergers disease?
segmental vasculitis extending into contigous veins and nerves
211
congenital syndrome lynked whit congenital QT prolongation
Langed-Nielsen syndrome long-QT Neurosensory deafness
212
Causes of pericarditis?
- MI - Rheumatic fever - Uremia - Viral infection
213
Causes of Paradoux Pulse?
- Cor-pulmonalle - Chronic constrictive pericarditis - Cardiac tamponade
214
Risks of Bicuspid aortic valve?(3)
Aortic stenosis 50% Bacterial endocarditis 3% aortic dissection 1%
215
most common site of aortic rupture after blunt toracic trauma by rapid deceleration?
Aortic itsmus at ligamentus arteriosum
216
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)

Step 1 (1) (16 decks)

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