Cardiovascular Flashcards
1
Q
what forms foam cells?
A
mpg and LDLs
2
Q
monckeberg sclerosis
A
medial calcific sclerosis
medium sized arteries - elastic lamina and media
vascular stiffening, no obstruction
3
Q
what causes smooth muscle cell migration in atherosclerosis?
A
fatty streaks releasing PDGF and FGF
4
Q
coronary steal syndrome
A
ischaemia in poststenotic region after vasodilation
5
Q
primitive ventricle gives rise to
A
trabeculated part of left and right ventricles
6
Q
Right dominant circulation (% and what it means)
A
Posterior descending artery comes off the RCA
85%
7
Q
Primitive pulmonary vein gives rise to
A
smooth part of left atrium
8
Q
MAP =
A
CO x TPR
9
Q
Left horn of sinus venosus gives rise to
A
Coronary sinus
10
Q
V wave
A
increased R atrial pressure from filling against a closed tricuspid valve
11
Q
Fixed splitting seen in
A
ASD causing left to right shunt
12
Q
Y descent
absent in
prominent in
A
RA emptying into RV
tamponade
constrictive pericarditis
13
Q
C wave
A
RV contraction - closed tricuspid bulging into the atrium
14
Q
Normal ejection fraction
A
> 55%
15
Q
When do you get paradoxical splitting?
A
Delay in aortic valve colsure, aortic stenosis, LBBB
16
Q
Where to listen for septal defects
A
Tricuspid area
17
Q
What does the valsalva do?
A
Decreases preload
18
Q
Aortic stenosis
A
ejection systolic click, radiates to carotids, weak pulse, slow rising
19
Q
Aortic regurg
A
Blowing early diastolic, collapsing/ hyperdynamic pulse, head bobbing, wide pulse pressure
20
Q
What can long QT cause?
A
Torsades de pointes
21
Q
Long QT syndrome found in
A
Romano-Ward
Jervell and Lange-Nielson
22
Q
VSD murmur
A
pansystolic
23
Q
ECG U waves seen in
A
hypokalaemia, bradycardia
24
Q
QRS complex length
A
< 120s
25
2nd degree Wencheback type
type I
| progressive lengethening and drop
26
Cardiac defects seen in Down's syndrome
AV septal defect - endocardial cushion
VSD
ASD
27
Hypertensive urgency
> 180/120
| no end organ damage
28
22q11 syndromes
Truncus arteriosus
| Tetrology of Fallot
29
Late cyanosis in lower limbs
Patent ductus arteriosus
30
Marfan syndrome causes what cardiac issues?
MVP
Thoracic aortic aneurysm and dissection
aortic regurg
31
Pulmonary capillary wedge pressure value
4-12 mmHg
32
Carotid sinus baro-receptor transmits to
glossopharangeal --> solitary nucleus of medulla
33
Fetal alcohol syndrome causes what cardiac problems
VSD
PDA
ASD
Tetrology of Fallot
34
Tetrology of Fallot (4)
VSD
Pulmonary stenosis
RV hypertrophy
Overriding aorta
35
Afferent baroreceptor
Hypotension
36
wavy fibres, early coagulation necrosis
0-24 hrs after MI
37
Aortic dissection associated with
HTN
Bicuspid aortic valve
CTDs
38
> 2 weeks post MO
contracted scar
39
Rx prinzmetal angina
Ca channel blocker
Nitrates
Smoking cessation
40
Mpg with granulation tissue
3 - 14 days post MI
41
Prinzmetal angina
at rest, from artery spasm
42
Rx Stanford B
B blockers
| Vasodilators
43
Rx Stanford A
Surgery
44
When does troponin rise?
After 4 horus
45
Nutmeg liver
RSHF
46
Classification of aortic dissection
Stanford A - ascending
| B - descending
47
Sudden cardiac death linked with
CAD
Cardiomyopathy
hereditary ion channelopathies
48
1 - 3 days post MI
neutrophils, coagulative necrosis
49
Causes of dilated cardiomyopathy
Alcohol, beriberi, coxackie myocardidis, cocaine, chagas, doxorubicin toxicity, haemochromatosis, sarcoid, peripartum, idiopathic, familial
50
cause of interventricular septal rupture post MI
Mpg degredation
51
Rx hypertrophic cardiomyopathy
B blocker, Ca blockers (verapamil), ICD, no sports
52
Endomyocardial fibrosis with prominent eosinophilic infiltrate
Loffler syndrome
53
Rx HF
ACE inhibitrs/ AT II; B blocker, spironolactone, thiazide/ loop diuretic if needed (hydralazine + nitrate)
54
HF, S3, systolic regurg murmur
dilated cardiomyopathy
55
Thick fibroelastic tissue in endocardium of young children
endocardial fibroelastosis
56
mitral regurg post MI caused by
papillary muscle rupture
57
S4 systolic murmur (mitral regurg)
hypertrophic cardiomyopathy
58
Rx NSTEMI
```
AAABS
Anticoag
Antiplatelet (aspirin + clopidogrel)
ACE inhibitor
B blocker Statin
```
59
Rx dilated cardiomyopathy
```
Na restriction
ACE inhibitors
B blockes
diuretics
digoxin
ICD
```
60
Causes of restrictive cardiomyopathy
Sarcoid, Amyolid, postradition fibrosis, endocardial fibroelastosis, Loffler syndrome, haemochromatosis
61
Causes of hypertrophic cardiomyopathy
familial (60-70%)
| AD B myosin heavy chain
62
immediate MI complications
V arr., HF, shock
63
1-3 day post MI complications
postinfarction fibrous pericarditis
64
3 - 14 days post MI complication
tamponade, mitral regurg, LV pseudoaneurysm
65
> 2 weeks post MI complications
Dressler syndrome, HF, arrhythmia, ventricular aneurysm
66
how to prevent reflex tachy with B blocker
Give gtdralazine
67
How do Ca channel blockers work?
Block L-type voltage Ca channels
68
Where do non-dihydropyridines act?
Heart
69
Where do dihydropyridines act?
Vascular smooth muscle
70
Digoxin
Inhibits Na/K ATPase which inhibits Na/Ca increased Ca(i) stimulates vagus
71
HTN urgency
clevidipine
72
mechanism of hydralazine
increases cGMP --> smooth muscle relaxation
73
compensatory tachy, fluid retention, headache, angina, lupus like syndrome
hydralazine
74
S.E Ia
thrombocytopaenia, torsades de pointes
75
hyperkalaemia, nausea, vomiting, diarrhoea
digoxin
76
Ib clinical use
post MI, digitalis toxicity
77
S.E disopyramide
HF
78
Mechanism B blocker
decrease cAMP --> SAN, AVN
79
S.E Ib
CNS stimulation/depression, CVS depression
80
Ezetimibe
prevents cholesterol abosrption at the SI
81
Niacin (lipids) s.e
inhibits lipolysis in adipose, reduces hepatic VLDL synthesis
red flushed face, hyperglycaemia, hyperuricaemia, gout
82
C.I Ic
ischaemic heart disease, structural heart disease
83
S.E quinidine
headache, tinnitus
84
Ranolazine
inhibits late Na current deducing diastolic wall tesions
85
Fibrates
upregulate LPL increasing TG clearance, activates PPAR-a increaseing HDL synthesis
86
S.E Ic
proarrhythmic, don't give post MI
87
S.E reflex tachy, tOtn, lushing, heache
nitrates
88
quinidine other (2)
procainamide, disopyramide
89
S.E procainamide
SLE like syndrome
90
Fenoldopam mechanism, use
D1 antagnoist, HTN emergency
91
disrupts pyramidine synthesis
leflunemide, methotrexate, trimethoprim, 5-flurouracil
92
s.e. propranolol
exacerbates vasospasm
93
S.E amiodarone
pulmonary fibrosis, hepatotoxicity, hypothyroidism/ hyperthyroidism, photodermatitis, constibation, neuro effects, brady, heart block, HF
94
Rx htn in pregnancy
Hydralazine, labetalol, methyldopa, nifedipine
95
B blocker overdose
saline, atropine, glucagon
96
III use
AF/ flutter
| VT
97
B blocker arrhythmia use
SVT
| AF/ flutter
98
s.e. metoprolol
dyslipidaemia
99
B blocker adverse events
impotence, exacerbation of COPD/asthma, AV block, brady, HF, sedation, masks hypoglycaemia
100
S.E adenosine
flushing, hOtn, chest pain, impending doom, bronchospasm
101
Sotalol
III - K+ channel
102
S.E peripheral edema, flushing, dizziness, gingival hyperplasia
dihydropyridines
103
S.E cardiac depression, AV block, hyperprolactinemia, constipation
Non-dihydropyridines
104
hydroxyurea mechanism
inhibits ribonucleotide reductase
105
III mechanism
increases AP duration
106
disruption of purine synthesis
6-mercaptopurine
mycophenolate
ribavirin
107
adenosine use
SVT - short acting
108
Ib mechanism
decreases AP duration
109
HTN Rx
```
ACE AT CaT
Ace inhibitiors
AT receptor blockers
Ca channel blockers (dihydropyridines)
Thiazides
```
110
HTN + DM
add in B blockers
111
HTN + HF
Diuretics
| ACE inhibitor/ ATII blocker, B blockers, aldosterone antagonists
112
B blocker phaeochromocytoma
a1 agonism
113
Use of IV
SVT, AF rate control
114
Ia mechanism
increase AP duration and refractory period
| increase QT interval
115
5-fluouracil mechanism
forms 5-F-dUMP inhibiting thymidylate synthase
116
Ia use
SVT
| VT
117
Lidocaine (1 other)
Mexiletine
118
Blurry yellow vision
Digoxin toxicity
119
Fleccianide (1 other)
Propafenone
120
Mechanism Ic
increases ERP at AVN
121
Leflunemide mechanism
inhibits dihydro-orotate dehydrogenase
122
S.E IV
constipation, flushing, edema, SAN depression, AV block, HF
123
Arrhythmia use of Mg
Torsades des pointes, digoxin toxicity
124
Use of Ic
SVT, AF, (VT)
125
Mycophenolate, ribavirin mechanism
inhibits inosine monophosphate dehydrogenase
126
IV mechanism
decreases conduction velocity increasing PR interval
127
Adenosine mechanism
increases K efflux, causing hyperpolarisation
128
Nesiritide
Recombinant BNP for HF
129
Rx subarachnoid
Nimodipine
130
Rx digoxin overdose
Normalise K+, anti-digoxin Fab fragments, Mg
131
Disrupts base synthesis
hydroxyurea
132
Mechanism 6-mercaptopurine prodrug
azathioprine
| inhibits de novo purine synthesis
133
methotrexate, trimethoprim, pyrimethamine mechanism
inhibits dihydrofolate reductase decreasing deoxythymidine monophosphate
134
right horn of sinus venosus gives rise to
smooth part of RA (sinus venarum)
135
Pulse pressure is proportional to
Stroke volume
136
umbilical arteries form
medial umbilical ligaments
137
right common cardinal vein and right anterior cardinal vein
SVC
138
What is S3?
early diastole, increased filling pressure
139
A wave
Absent in AF
| atrial contraction
140
Where is S2 loudest?
Upper left sternal boarder
141
What helps close the ductus arteriosus?
Increased O2, decrease in prostaglandins
142
Acute IE
| Subacute IE
S aureas
| Viridians strep
143
Distributive shock caused by
sepsis
anaphylaxis
CNS injury
144
Criteria of rheumatic fever
```
joints (migratory polyarthritis)
carditis
nodules in skin
erythema marginatum
sydenham chorea
```
145
Prenatal lithium exposure
ebstein anomaly
146
Renovascular disease predisposing to htn
fibromuscular dysplasia
147
What causes wide splitting?
Delay in RV emptying, pulmoary stenosis, RBBB
148
Williams syndrome
Supravalvular aortic stenosis
149
What does hypotension cause?
increased HR, contractility, BP
150
Turner syndrome cardiac defects
Bicuspid aortic valve, coarctation of the aorta
151
3rd degree heart block
atria and ventricles independent
152
secondary endocarditis
malignancy, hypercoagulable, lupus
153
histiocytes
xanthomas
154
what does rapid squatting elicit in heart sounds
increased AS murmur
| decreased hypertrophic cardiomyopathy
155
What do you hear in paradoxical splitting?
Pulmoary heard first, most prominent on expiration
156
pulse pressure isinversley proportional to
arterial compliance
157
vasculidity following URI
| why?
Henoch-Schonlein purpura
| IgA immune complex deposition
158
Endocardial cushions give rise to
Atrial septum, membranous interventricular septum, AV and semilunar valves
159
Beck triad
Tamponade, hOtn, distended neck veins, distant heart sounds
160
Kawasaki disease
```
CRASH and burn
Conjunctival injection
Rash (polymorphus --> dequamating)
Adenopathy
Strawberry tongue
Hand-foot changes
Fever
```
161
Necrotizing vasculiis, granulomatous, eosinophilia
Churg-Strauss
162
raised JVP on inspiration
Kussmaul sign
163
PR3-ANCA/ c-ANCA
Granulomatosis with polyangitis
164
Primitive atrium gives rise to
Trabeculated part of left and right ventricles
165
Congenital rubella leads to
PDA, pulmoary artery stenosis, septal defects
166
Henoch-Schonlein purpura triad
Palpable purpura, arthralgia, abdo pain
167
Most common cardiac tumour in children
rhabdomyoma
168
When do you see Kausmaul sign?
constrictive pericarditis, restrictive cardiomyopathies, RA/V tumours
169
Decreased pulse pressure
```
HATS
HF
Aortic stenosis
tamponade
shock (cardiogenic)
```
170
Left dominant circulation (8%)
Posterior descending from LCX
171
Fetal O2blood transport
```
Umbilical vein
Ductus venosus
IVC
Foramen ovale
Aorta
```
172
Pulsus parodoxus seen in
```
Tamponade
Asthma
Sleep apnea
Percarditis
Croup
```
173
Urachus
part of the allantoic duct between the bladder and umbilicus
174
Fetal deO2blood transport
SVC, RA-->RV, pulmoary artery, patent ductus arteriosus, descending aorta
175
Codominant circulation
7%
176
Umbilical vein PO2 and sats
30mmHg
| 80%
177
Increased pulse pressure
hyperthyroidism, aortic regurg, aortuc stiffening, sleep apnea, exercise
178
Urachus forms
median umbilical ligament
179
Mitral stenosis
Opening snap, late diastolic murmur --> LA dilatation
180
What is the most posterior point of the heart?
LA
181
What does the notochord form?
Nucleus pulposus
182
Which prostaglandins keep the ductus arteriosus open?
E1 and E2
183
Bulbus cordis gives rise to
Smooth parts of Left and R entricles
184
Where is S1 loudest?
Mitral area
185
PR interval
< 200 ms
186
The effect of removing an organ in parallel arrangement
decreases TPR
| Increases CO
187
What does S4 suggest?
High atrial pressure, pushing against stiff ventricle
188
Drugs decreasing contractility
B1 blockers, systolic HF, acidosis, hypoxia/ hypercapnea, non-dihydropyridine Ca channel blockers
189
Turner heart
Coarctation of the aorta
190
when does the heart beat spontaneously?
week 4
191
Infant of diabetic mother
Transposition of great vessels
192
Coarctation of the aorta associated with
biscuspid aortic valve
other heart defects
Turner's syndrome
193
Which shunt presents earlier with cyanosis?
Right to left
194
Late cyanosis, clubbing, polycythaemia
Eisenmenger syndrome
195
Complications of coarctation
HF, berry aneurysm, aortic rupture, endocarditis
196
Aortic arch baroR transmits to
vagus nerve
197
BNP released from
ventricular myocytes
198
Prosthetic valve IE
S epidermis
199
Shock - warm and dry
Distributive
200
Bundle of Kent
WPW
201
PAN linked with
Hep B
202
Aorta looks like tree bark
Tertiary syphilis
203
Granulomatous thickening and narrowing of aortic arch. Called? Who is affected?
Takayasu arteritis
| < 40yr Asian women
204
Tricuspid IE
IVDU
S aureas
Pseudomonas
Candida
205
How does RF affect the valve?
Type II hypersensitivity reaction
| M protein antibodies cross react
206
Pulsus paradoxus is
systolic BP dropping on inspiration
207
Increased antistreptolysin O (ASO)
RF
208
Truncus arteriosus gives rise to
ascending aorta and pulmonary trunk
209
What would you hear in fixed heart splitting?
Inspiration and expiration the pulmonary sound is delayed
210
What does a hand grip do to heart sounds?
Increases MR, AR, VSD
| decreases hypertrophic cardiomyopathy
211
peripheral chemoRs respond to
O2, CO2, pH decrease
212
What accounts for most of the peripheral resistance?
Arterioles
213
Patent ductus arteriosus sound
continuois machine like murmur, loudest at S2, left infraclavicular area
214
What would you hear in wide splitting?
delayed pulmoary sound in inspiration
215
Asthma, sinusitis, peripheral neuropahty
Churg-Strauss
216
Granulomatosis with polyangiitis triad
Focal necrotizing vasculitis
Necrotizing granulomas in the lung and upper airway
Necrotizing glomerulonephritis
217
How does Lesch-Nyhan syndrome present?
```
HGPRT
Hyperuricemia
Gout
Pissed off (agression/ self mutilation)
Retardation
dysTonia
```
218
Cushing reaction
increased ICP constricts arterioles, increased CO2, acidosis, central reflex to increase perfusion O (htn), bradycardia
219
ANP action on kidneys
decreases Na reabsorption
220
What is microscopic polyangiitis associated with?
MPO-ANCA
| p-ANCA
221
What is absent in Lesch-Nyhan syndrome?
HGPRT
222
renal and visceral vessel arteritis
PAN
223
Brugada syndrome
Looks like anterior STEMI with RBBB, asian males, VTarr. and SCD
224
What does the valsalva do to heart sounds?
decreases most
| increases hypertrophic cardiomyopathies
225
What can cause long QT?
```
ABCDE
antiArrhythmics - Ia, III
antiBiotics - macrolides
antiCycotics - haloperidol
antiDepressants - TCA
antiEmetics - ondansetron
```
226
What is S4, where do you hear it?
late diastolic kick
| apex, left lateral position
227
Mitral valve prolapse
late systolic cresc, midsystolic click, apex
228
Mitral and tricuspid regurg
panssytolic blowing, mitral - radiates to axilla, tricuspid - radiates to R sternal border
229
Antischokow cells
RF, enlarged mpg with ovoid, wavy rod-like nucleus
230
When do you hear S3?
mitral regurg, HF, dilated ventricles
231
ductus arteriosus closed by
indomethacin
232
2 type II Block
dropped beat, no change in length
233
Umbilical vein forms
ligamentum teres hepatis (contained in the falciform ligament)
234
Most common congenital cardiac abnormality
| Usually occurs in
VSD
| Mebranous septum
235
Ejection fraction and HF
decreased in systolic, constant in diastolic
236
Drugs increasing contractility
catecholamines, increased Ca, decreased Na, digitalis
237
Drugs acting on phase 4 of pacemaker action potential
increasing HR - catecholamines, sympahtetic chain
| Decreasing HR - ACh, adenosine
238
Affects vasa vasorum of aorta
Syphilis
239
Aschoff bodies
RF
| granuloma with giant cells
240
central chemoRs respond to
| from
change in pH and CO2
| brain, interstitial fluid
241
Culture -ve IE
```
Coxiella burnetii
Bartonella
HACEK
haemphilus
aggregatibactin (actinobacillus)
cardiobacterium
eikenella
kingella
```
242
inferior MI bradycardia
atropine
