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UWorld > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Verapamil is a nondihydropyridine calcium channel bocker tht acts by blocking ____ calcium channels

A

L-type

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2
Q

Verapamil prevents the initial ____ influx into cariac myocytes and vascular smooth muscle

A

Calcium

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3
Q

Why are skeletal muscles no effected by calcium channel blockers

A

They do not rely on calcium influx to contract

Mechanical coupling betwwen receptors –> calcium release for SR

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4
Q

What changes on myocardial biopsy seen 0-4 hrs post MI

A

None

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5
Q

What changes on light microscopy are seen 4-12 hours following MI

A

Wavy fibers with narrow, elongated myocytes

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6
Q

What changes are seen 12-24 hours after MI on light microscopy

A

Myocyte hypereosinophilia with pyknotic (shrunken) nuclei

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7
Q

What changes on light microscopy are seen 1-3 days post MI

A 
Coagulation necrosis (loss of nuclei and striations)
Prominent neutrophilic infiltrate
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8
Q

What changes are seen on light microscopy 3-7 days post MI

A

Didintegration of dead neutrophils and myofibers

Macrophage infiltration at border area

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9
Q

What changes are seen on light microcscopy 7-10 days post MI

A

Robust phagocytosis of dead cells by macrophages

Beginning formation of granulation tissue at margins

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10
Q

What changes are seen on light microscopy 10-14 days post MI

A

Well-developed granulation tissue with neovascularization

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11
Q

What changes are seen on light microscopy 2-8 weeks following an MI

A

Progressive collagen deposition and scar formation

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12
Q

1-3 days after an MI, neutrophils infiltrate the border zone of the injured tissue in response to what proinflammatory cytokines

A

IL-6

IL-8

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13
Q

Where do potassium sparing diuretics act

A

Collecting duct

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14
Q

Increased sodium delivery to the late distal tbule and cortical collecting duct causes sodium reabsorption at the expense of potassium due to what molecules activity?

A

Aldosterone (increase ENaCs and Na/K pumps)

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15
Q

Stanford type A refers to aortic dissections that involve any part of the _____

A

Ascending aorta

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16
Q

Stanford type B refers to all aortic dissections involving the ______

A

Descending aorta

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17
Q

Type B dissections involving the descending aorta typically originate close to the origin of the ______ artery

A

Left subclavien

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18
Q

Type A aortic dissections usually originate in the ____ junction

A

Sinotubular

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19
Q

In treatment of hypovolemic shock, rapid infusion of blood or normal saline increases intravasucular volume and ventricular preload which has what effect on frank starling mechanism

A

Incrased preload –> stretch myocardium and increase end diastolic sarcomere length –> increase stroke volume and cardiac output

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20
Q

Classic clinical features of down syndrome inlude ___ facial profile, epicanthal folds, __-slanting palpebral fissures, protruding ____, and ___ ears

A

Flat
Up
Tongue
Small

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21
Q

Cranial nerve from pharyngeal arch 1

A

Trigeminal

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22
Q

Cranial nerve from pharyngeal arch 2

A

Facial

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23
Q

Cranial nerve from pharyngeal arch 3

A

Glossopharyngeal (IX)

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24
Q

Cranial nerve from pharyngeal arch 4

A

Superiorlaryngeal branch of vagus (X)

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25
Q

Cranial nerve from pharyngeal arch 5

A

None, it is obliterated

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26
Q

Cranial nerve from pharyngeal arch 6

A

Recurrent laryngeal branch of CN X

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27
Q

Aortic arch derivative from pharyngeal arch 1

A

Maxillary artery

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28
Q

Aortic arch derivative from pharyngeal arch 2

A

Stapedial artery (regresses)

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29
Q

Aortic arch derivative from pharyngeal arch 3

A

Common carotid artery

Proximal internal carotid artery

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30
Q

Aortic arch derivative from pharyngeal arch 4

A

True aortic arch

Subclavian arteries

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31
Q

Aortic arch derivatives from pharyngeal arch 5

A

None, it is obliterated

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32
Q

Aortic arch derivatives from pharyngeal arch 6

A

Pulmonary arteries

Ductus arteriosus

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33
Q

What are beta blockers used in acute MI patients

A

Reduce myocardial oxygen demand by lowering HR, contractility, and afteroad

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34
Q

Why is metoprolol a better option than some other beta blokers for a patient with COPD

A

It is beta 1 selective so will no produce bronchospasms

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35
Q

Once secreted, ANP and BNP bind to natriuretic peptide receptors to activate guanylate cyclase to form cGMP which stimulates ____ and ______ to alleviated volume overload

A

Diuresis

Peripheral vasodilation

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36
Q

Sacubitril MOA

A

Neprilysin inhibitor (decreased breakdown of ANPnad BNP)

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37
Q

Beriberi is due to what vitamin deficiency

A

Thiamine (B1)

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38
Q

B1 (thiamine) deficiency can cause Beriberi which has what clinical manifestation

A

Peripheral neuropathy

Heart failure

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39
Q

Dry Beriberi is charecterized by symmetrical peripheral neuropathy of the distal extremeties, with resulting sensory and motor impairments. Wet Beriberi includes the addition of _____

A

Cardiac involvemnt (cardiomyopathy, high-outpt congestive heart failure, peripheral edema, tachycardia)

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40
Q

Subclavian steal syndrome occurs due to hemodynamically significatn stenosis of the subclavian artery proximal to the origin of the ____ artery

A

Vertebral

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41
Q

Patients with subclavien artery stenosis are often asymptomatic but when symptoms occur they are typically related to ____ or ______

A 
Arm ischemia (fatigue, pain, paresthesia)
Vertebrobasilar insufficiency (dissiness, vertigo, drop attacks)
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42
Q

ACE inhibitors reduce ___ secretion –> ____ retention

A

Aldosterone

Potassium

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43
Q

The final stage of healing of a myocardial infarction begins approximately 2 weeks after infarction and involves increased deposition of type ___ collagen

A

One

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44
Q

Does systemic vascular resistance increase or decrease after birth (compared to fetal circulation)

A

Increase

Fetal systemic vascular resistance is low due to low resistance in the placenta

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45
Q

Does pulmonary vascular resistance increase or decrease when a baby is born (compared to fetal circulation)

A

Decrease

Hypoxic vasoconstriction in nonventilated lung during fetal life

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46
Q

Does left ventricular contribution to cardiac output increase or decrease when a baby is born (compared to fetal circulation)

A

Increase

Ductus arteriosus allows right heart output to be the majority in fetal life

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47
Q

Hemosiderin laden macrophages in the lungs are usualy a result of what

A

Chronic passive lung congestion in the setting of heart failure

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48
Q

Isolated systolic hypertension in an elderly patient is likely do to what

A

Increased arterial stiffness –> decreased aorta compliance–> high pressure during systole

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49
Q

MOA isoproterenol

A

Non selecive B agonist

Decrease vascular resistance via B2 and increase cardiac contractility B1

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50
Q

What is the most comon congenital cardiac malformation in patients with Turner syndrome

A

Bicuspid aortic valve

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51
Q

A nonstenotic bicuspid aortic valve can manifest as an early __, high frequency ____ over her right second interspace

A

Systolic

Click

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52
Q

Short stature, short and thick neck, broad chest, and shortened fourth metacarpals arecharacteristic of ______

A

Turner syndrome

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53
Q

Labetalol blocks what receptors

A

Beta 1, beta 2, alpha 1

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54
Q

how can aortic coarctation in a child or young adult present clinically

A

lower extremity claudication
blood pressure discrepancy between upper and lower extremities
delayed or diminished femoral pulses

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55
Q

an echocardiogram showing an aorta lying anterior to the pulmonary artery is diagnostic of _____

A

transposition of the great arteries

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56
Q

diltiazem MOA

A

nondihydropyridine calcium channel blocker

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57
Q

what causes a systolic murmur along the left sternal border that decreases in intensity with maneuvers that increase left ventricular blood volume such as leg elevation or handgrip

A

hypertrophic cardiomyopathy

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58
Q

why is Digoxin effective at controlling ventricular rate in atrial fibrillation at rest, but not during exercise

A

digoxin slows AV node conduction by increaseing parasympathetic tone (vagus nerve) which is relatively low during exercise compared to sympathetic tone

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59
Q

Retinal artery occlusion is caused by thromboembolic complications of atherosclerosis traveling from the ____ artery to the ____ artery to the retinal artery

A

internal carotid

ophthalmic

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60
Q

low dose dopamine infusion stimulates what receptors causing what effect?

A

D1 (in renal and mesenteric vasculature)

vasodilation and increased blood flow

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61
Q

high doses of dopamine stimulates what receptors causing what effect

A

beta 1 and alpha 1 –> increased cardiac output and elevated systemic vascular resistance
at the high end of the dose range, the increase in afterload can result in decreased cardiac output

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62
Q

what are the functions of atrial and brain natriuretic peptide?

A

vasodilation

salt and water excretion

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63
Q

list the following in order from slowest to fastest conduction speed:
atrial muscle
purkinje fibers
AV node ventricular muscle

A

AV node
ventricular muscle
atrial muscle
Purkinje system

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64
Q

describe the murmur heard in an neonate with a patent ductus arteriosis

A

continuous, machinelike murmur (from left to right shunting)

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65
Q

Production of ____ by the placenta maintains a patent ductus arteriosus and smooth muscle dilation

A

prostaglandin E2

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66
Q

A bubble study is performed by injecting agitated normal saline intravenously and observing for microbubbles in the left heart which would signify what?

A

right to left intracardiac shunts

ie patent foramen ovale and atrial septal defect

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67
Q

the pulmonary artery occlusion pressure/wedge pressure, is determined by entering and inflating a balloon catheter into a branch of the pulmonary artery. This is used to determine the pressure in what anatomic location?

A

left atria

and left ventricular end diastolic

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68
Q

Autosomal dominant mutations in the TTN gene, which encodes for the sarcomere protein titin, are the most common cause of familial ____ cardiomyopathy

A

dilated

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69
Q

what are the second messengers (ie. IP3, cAMP) for A1, A2, B1, B2, mus 2, and mus 3 receptors?

A 
A1 --> IP3
A2 --| cAMP
B1 --> cAMP
B2 --> cAMP
mus 2 --| cAMP
mus 3 --> IP3
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70
Q

aortic compliance progressively decreases with age which causes what changes in pulse pressure, diastolic pressure, and systolic pressure in elderly with cardiovascular disease

A

pulse pressure: increased
diastolic: slight decrease
systolic: increased
(“isolated systolic hypertension”)

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71
Q

diastolic blood pressure is directly related to _____

A

systemic vascular resistance

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72
Q

pulse pressure is the amount that arterial pressure increases above diastolic pressure during left ventricular contraction, it is directly related to ___ and inversely related to _____

A

stroke volume

aortic complaince

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73
Q

how does aortic stenosis cause angina in the absence of obstructive coronary artery disease

A

increased myocardial oxygen demand due to an increase in left ventricular mass and ventricular wall stress

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74
Q

A 5 year old patient that has cyanotic spells during mild exertion that are improved by squatting are consistent with what congenital malformation

A

tetralogy of fallot

squatting decreases right to left shunting causing less blood to bypass the stenotic pulmonary valve

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75
Q

tetralogy of fallot is characterized by what 4 distinct anatomic abnormalities

A

VSD
overriding aorta over right and left ventricles
right ventricular outflow tract stenosis
right ventricular hypertrophy

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76
Q

what are the 3 classic findings of cardiac tamponade that make up the Beck triad

A

hypotension
elevated jugular venous pressure
muffled heart sounds

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77
Q

what is pulses paradoxus?

A

exaggerated drop in systolic blood pressure (>10 mmHg) during inspiration (seen in cardiac tompanade)

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78
Q

triamterene MOA

A

directly inhibits ENAC channels (epithelial sodium channels preventing sodium from entering principal cells)

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79
Q

what is the cause of hypotension in septic shock

A

widespread vasodilation –> decreased systemic vascular resistance
(also increased vascular permeability)

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80
Q

how does septic shock effect cardiac index

A

increased (to compensate for hypotension)

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81
Q

why is there a high mixed venous oxygen saturation in septic shock

A

hypotension –> increased cardiac index –> high blood flow rate –> prevents tissues from extracting oxygen from blood completely

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82
Q

what is the characteristic pressure tracing finding in patients with mitral valve regurge

A

early and large V wave

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83
Q

when is an S3 heart sound heard in relation to normal heart sounds

A

after S2

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84
Q

when is a S4 heart sound heard in relation to normal heart sounds

A

before S1

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85
Q

what causes an S4 heart sound

A

blood being forced into a stiff ventricle (diastolic dysfunction)

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86
Q

oxygenated blood from the placenta is delivered into the fetus via the _____

A

umbilical vein

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87
Q

Blood from the umbilical vein is first delivered to the liver where it bypasses the hepatic circulation via the ______ and then enters the ____ before reaching the heart

A

ductus venosus

inferior vena cava

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88
Q

what congenital heart malformation will show a narrow-appearing mediastinum on chest xray

A

transposition of the great arteries

due to abnormal position of the aorta directly ontop of the pulmonary artery

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89
Q

Kawasaki disease can lead to what cardiovascular complication

A

coronary artery inflammation –> coronary artery aneurysm

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90
Q

____ disease is a vasculitis of medium sized arteries that presents with persistent fever for >5 days, bilateral conjunctivitis, cervical LAD, and mucocutaneous involvement

A

Kawasaki

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91
Q

A ____ hormone has no effect on a physiologic process by itself but allows another hormone to exert its maximal effects on that process

A

permissive

ex. cortisol exerts permissive effect on catecholamines to potentiate vasoconstriction and bcronchodilation

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92
Q

does the right ventricle or aortic root have higher pressure during systole? during diastole?

A

aorta has higher pressure than the right aortic root in both systole and diastole

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93
Q

______ presents as decompensated heart failure following a symptomatic viral predrome and should be suspected especially in young patients with this presentation

A

dilated cardiomyopathy due to viral myocarditis

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94
Q

chronic aortic regurge following infective endocarditis results in compensatory _____ which increases stroke volume in order to maintain cardiac output

A

eccentric hypertrophy

volume overload –> eccentric hypertrophy

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95
Q

what anatomical region controls the rhythm of ventricular contractions during A fib

A

AV node

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96
Q

The ______ artery supplies the AV node in 90% of patients and the SA node

A

right coronary

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97
Q

High degree AV blood is usually do an MI involving what vessel? while low degree AV block is usually due to an MI involving what vessel?

A 
high degree: left anterior descending
low degree (within the AV node): right coronary artery
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98
Q

_______ is characterized by an opening snap followed by a rumbling diastolic murmur that is best heard over the cardiac apex

A

mitral stenosis

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99
Q

Increased left ventricular diastolic pressure in a patient with mitral stenosis suggests concomitant ____ valve dysfunction

A

aortic

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100
Q

selective arteriolar vasodilators can lead to sodium and fluid retention with peripheral edema by what mechanism

A

arteriolar dilation –> decreased vascular resistance –> baroreceptor activation –> sympathetic activation –> renin-angiotensin-aldosterone axis stimulation

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101
Q

Pulsus paradoxus refers to an exaggerated drop (>____ mm Hg) in systolic blood pressure during inspiration

A

10

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102
Q

Pulsus paradoxus is defined by a decrease in systolic blood pressure of >10 mmHg with inspiration and is most commonly seen in patients with _____

A 
cardiac tamponade
(can also occur in severe asthma, chronic obstructive pulmonary disease, and constrictive pericarditis)
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103
Q

Acute obstructive pulmonary exacerbations are primarily treated with beta adrenergic agonists to product what response

A

relaxation of bronchial smooth muscle

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104
Q

Beta adrenergic agonists control acute asthma and COPD exacerbations by causing bronchial smooth muscle relaxation via increased intracellular ______

A

cAMP

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105
Q

What 2 structures cause left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

A

mitral valve leaflet

interventricular septum

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106
Q

A large, pedunculated mass in the left atrium is most likely what?

A

atrial myxoma

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107
Q

Cardiac myxomas often show _____ rich stroma with scattered myxoma cells and ________ as characteristic findings

A

mucopolysaccharide

hemosiderin laden macrophages

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108
Q

What are 2 side effects associated with statin therapy

A

hepatotoxicity (test liver enzymes)

muscle toxicity

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109
Q

statin MOA

A

inhibit HMG CoA reductase

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110
Q

ezetimibe MOA

A

decrease cholesterol absorption

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111
Q 
What are the major lipid effects of each of the following? 
statin
ezetimibe
bile acid sequestrants
niacin
fibrates
fish oil/omega 3 FA
A

statin: decrease LDL and triglycerides
ezetimibe, bile acid sequestrants: decrease LDL
niacin: decrease LDL, increase HDL
fibrates and omega 3: decrease triglycerides and increase HDL

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112
Q

Niacin MOA in treating hyperlipidemia

A

decreases: FA release, VLDL synthesis, and HDL clearance

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113
Q

The AV node is located on the endocardial surface of the right atrium, near the insertion of the septal leaflet of the ___ valve and the orifice of the _____

A

tricuspid

coronary sinus

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114
Q

A patent foramen ovale is a one way tissue valve in the atrial septum that opens only when ______

A

right atrial pressure exceeds left atrial pressure

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115
Q

During the release /relaxation phase of a valsalva maneuver, ____ increases and encourages the opening of a patent foramen ovale

A

right atrial pressure (preload/venous return)

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116
Q

Is systemic vascular resistance increased or decreased in patent ductus arteriosis

A

decreased

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117
Q

In the presence of a patent ductus arteriosus, venous return to the left atrium and ventricle are increased or decreased?

A

increased

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118
Q

What 2 mechanisms of Cilostazol helps treat claudication symptoms in peripheral arterial disease

A

inhibits platelet phosphodiesterase therefore inhibiting breakdown of cAMP (cAMP inhibits platelet aggregation)
direct arterial vasodilator

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119
Q

upper extremity hypertension and diminished lower extremity pulses indicates what diagnosis

A

coarctation of the aorta

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120
Q

what compensatory mechanism is seen in aorta coarctation which also causes the continuous murmur that can be auscultated over the back at the left paravertebral area

A

collateral blood flow

blood will travel retrograde through intercostal arteries into the descending aorta to bypass the defect

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121
Q

What receptor stimulates increased cAMP in juxtaglomerular cells

A

B1

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122
Q

most cases of infective endocarditis involve what valve

A

tricuspid

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123
Q

How does vancomycin cause red man syndrome (flushing, erythema, pruritis) when injected too quickly

A

vancomycin directly activates mast cells which release vasoactive mediators (ie histamine)

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124
Q

Prolonged beta blockade leads to upregulation of beta receptors and increased sensitivity to circulating ____, causing an enhanced beta adrenergic response on abrupt beta blocker cessation

A

catecholamines

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125
Q

In hypertensive emergency, end organ damage manifests in the kidneys as malignant nephrosclerosis, characterized by ___ necrosis and hyperplastic arteriosclerosis which has ____ appearance

A

fibrinoid

onion skin

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126
Q

What vascular changes result from administration of nitroprusside

A

balanced vasodilation of veins and arteries

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127
Q

what causes decreased systemic vascular resistance in hyperthyroidism

A

increased metabolic demand in peripheral tissues and direct effect of thyroid hormone on vascular smooth muscle causes peripheral vasodilation

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128
Q

what effects does hyperthyroidism have on diastolic, systolic, and pulse pressure

A

diastolic: decreased

systolic and pulse pressure: increased

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129
Q

What intracellular changes lead to vascular smooth muscle relaxation following nitrate administration

A

Nitric oxide –> guanylate cyclase –> increased cGMP –> dephosphorylation of myosin light chain –> vascular smooth muscle relaxation

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130
Q

what class I sodium channel blockers prolongs action potential , lengthens the action potential, and has no change on the action potential?

A

lengthens: 1A
shortens: 1B
no change: 1C

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131
Q

Explain coronary steal

A

inducing dilation of coronary arterial arteries excentuates myocardial ischemia because ischemic areas are already maximally dilated at rest and blood will flow to non ischemic areas

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132
Q

______ is a metalloprotease that cleaves and inactivates both ANP and BNP

A

neprilysin

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133
Q

Sacubitril, a neprilysin inhibitor, leads to increased levels of ___ and ____ and promotes beneficial effects in heart failure

A

ANP

BNP

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134
Q

ANP and BNP induce ____ and ____ by antagonizing the actions of RAAS and also protect against the deleterious myocardial remodeling and fibrosis that occur in heart failure

A

vasodilation

diuresis

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135
Q

Because neprilysin is responsible for inactivating ______ , inhibition of neprilysin further stimulates deleterious vasoconstriction and fluid retention

A 
angiotensin II
(neprilysin also breaks down ANP and BNP)
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136
Q

In treating heart failure, neprilysin inhibitors are combined with a _____ blocker to mitigate negative effects of neprilysin

A

angiotensin II receptor blocker

ex. sacubitril-valsartan

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137
Q

ST elevation in leads II, III, and a VF indicate myocardial ischemia to what region of the heart due to what artery occlusion

A

inferior wall of left ventricle

right coronary artery

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138
Q

ST elevations in leads V1- V4 indicate ischemia to what region of the heart due to what artery occlusion

A

anteroseptal

LAD

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139
Q

ST elevations in V5 and V6 indicate ischemia to what region of the heart and are due to occlusion of what coronary vessel

A

lateral wall of left ventricle

left circumflex artery

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140
Q

what effect does statin therapy have on LDL receptors

A

inhibited HMG-CoA reductase –> decreased cholesterol production –> increased LDL receptor expression –> increased uptake of circulating LDL

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141
Q

A significantly lower oxygen saturation in the left foot than the right arm of a neonate suggests what?

A

extracardiac right to left shunt across PDA

deoxygenated blood from pulm artery is flowing into aorta

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142
Q 
primary mitrovalve prolapse is characterized by myxomatous generation, aka deterioration of which: 
endocardium
myocardium
connective tissue
parietal pericardium
coronary vessles
A

connective tissue

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143
Q

Coronary autoregulation allows coronary blood flow to be primarily driven by myocardial oxygen demand over a wide range of perfusion pressures. It is mostly accomplished by alterations in vascular resistance via release of ____ and ____ in response to myocardial hypoxia

A

adenosine

nitric oxide

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144
Q

Rapid rise-rapid fall pulsation with each ventricular contraction that manifests as widened pulse pressure, rapid distension and collapse of carotid arteries (corrigan sign) and “to-and-fro” bruit over the femoral arteries (Duroziez sigh) is characteristic of what?

A

aortic regurgitation

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145
Q

what is the normal pressure in the left ventricle?

A

120/10

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146
Q

what is the normal pressure in the aorta?

A

120/80

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147
Q

What indirect effect to medications that increase systemic vascular resistance such as phenylepherine and norepinephrine have on heart rate

A

indirectly decrease heart rate

increase SVR –> baroreceptor –> CNS –> decrease heart rate

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148
Q

Stasis dermatitis is characterized by chronic erythema, fibrosis, and reddish-brown discoloration due to deposition of _____ (from breakdown of extravasated red cell)

A

hemosiderin

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149
Q

The classic auditory finding in patients with ______ is harsh, crescendo-decrescendo systolic ejection murmur heard best in the right second intercostal space with radiation to the carotids

A

aortic stenosis

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150
Q

Thoracic aorta aneurysm most commonly present with chest or back pain but compression of nearby structures as it expands can cause what symptoms?

A

dysphagia
hoarseness
cough
dyspnea

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151
Q

When using the femoral artery for cardiac catheterization, cannulation above the inguinal ligament can significantly increase risk of hemorrhage into what region

A

retroperitonium

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152
Q

clonidine MOA

A

alpha 2 agonist —> decreases presynaptic release of NE and decreases sympathetic outflow

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153
Q

during systole coronary vessels are compressed by surrounding muscle, as a result, what portion of the heart is most prone to ischemia and infarction

A

subendocardial left ventricle

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154
Q

Risk of left ventricular free wall rupture occurs how long following an MI

A

up to 2 weeks following an MI but usually happens within 5 days

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155
Q

QT prolongation caused by what drug, in contrast with other drugs, is associated with a very low risk of torsades de pointes

A

amiodarone

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156
Q

What 2 watershed zones in the colon are most susceptible to ischemia in cases of severe systemic hypotension

A

splenic flexure

rectosigmoid junction

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157
Q

A fib can be detected on ECG by an absence of organized _____

A

P waves

158
Q

How can mitral valve stenosis cause hoarseness

A

mitral stenosis –> enlarged left atria –> impingement of left recurrent laryngeal nerve (Ortner syndrome)

159
Q

what heart condition causes head bobbing

A

aortic regurgitation

160
Q

what heart toxicity is a side effect of doxorubicin use

A

dilated cardiomyopathy

161
Q

Where is the optimal cannulation site for the femoral site? (where should you enter/try to access the femoral vein for catheterization)

A

immediately medial to femoral artery (femoral nerve and artery are lateral to the femoral vein) and below the inguinal ligament

162
Q 
assign the following pressures to catheter locations in a normal, healthy heart: 
mean 6-12
15-30/1-6
mean 1-6
15-30/1-6
A

RA: mean 1-6
RV: 15-30/1-6
Pulmonary artery: 15-30/6-12
left atrial/PC wedge pressure/LVEDP: mean 6-12

163
Q

What is the single most important risk factor for the development of intimal tears leading to aortic dissection

A

hypertension

164
Q

What congenital heart defect causes cyanotic “tet” episodes during feeding or squatting

A

tetralogy of fallot

murmur disappears during these tets

165
Q

what are 3 major risk factors for development of abdominal aortic aneurysm

A

age >65
smoking
male sex

166
Q

in pacemaker cells, phase 0 depolarization is mediated by what ion

A

calcium

167
Q

What organism causes rheumatic fever

A

group A strep

168
Q

What are Aschoff bodies which are seen on histology of a myocardial biopsy in rheumatic heart disease

A

interstitial myocardial granuloma

169
Q

what are Anitschkow cells which are seen on histology of a myocardial biopsy in rheumatic heart disease

A

plump macrophages with abundant cytoplasm and central, slender chromatin ribbons

170
Q

During cardiogenic shock secondary to an MI, how are coronary perfusion pressure, central venous pressure, and pulmonary capillary wedge pressure effected

A

central venous pressure: increased
pulmonary capillary wedge pressure: increased
coronary perfusion pressure: decreased

171
Q

ANP and BNP have what effects on the following:
GFR
renin secretion
PCT Na resorption

A

GFR: increased
renin: decrease
Na reabsorption in PCT: decreased

172
Q

The common cardinal veins of the developing embryo drain directly into the sinus venosus (which drains into the primitive atrium), these cardinal veins ultimately give rise to the ______and other constituents of the systemic venous circulation

A

superior vena cava

173
Q

What cause of aortic stenosis is characterized by fusion of valve commissures due to repetitive inflammation

A

rheumatic valve disease

174
Q

What causes a harsh ejection type systolic murmur heard best at the base of the heart with radiation to the base of the neckq

A

aortic stenosis

175
Q

What should immediately be administered to neonates that are born cyanotic with tetralogy of fallot

A

prostaglandin E1 to prevent closure of the ductus arteriosus

176
Q

Atheroembolic disease typically occurs after an invasive vascular procedure due to mechanical dislodgement of ______

A

atherosclerotic plaque (–> showering of cholesterol-rich microemboli into circulation)

177
Q

Needle-shaped cholesterol clefts in vessels are diagnostic of what?

A

atheroembolic disease

178
Q

What organ is frequently damaged due to atheroembolic disease

A

kidney

also, skin, GI tract, and CNS

179
Q

Angina results from restricted coronary blood flow due to a fixed atherosclerotic lesion that obstructs > ____% of the coronary artery lumen

A

70

180
Q

The circulatory system is a continuous circuit, and therefore the _____of the left ventricle must closely match the _____ of the right ventricle

A

volume output
volume output
(blood flow per minute)

181
Q

How does an arteriovenous fistula allows blood to shunt from arterial circulation to venous circulation, what effect does this have on afterload, preload, and stroke volume

A

afterload: decreased (reduced systemic vascular resistance as blood bypasses high resistance of systemic arterioles)
preload: increased
stroke volume: increased

182
Q

The primary purposes of rate control are to minimize symptoms and what other preventative reason?

A

prevent tachycardia induced cardiomyopathy

183
Q

Diliazem MOA

A

nondihydropyridine calcium channel blockers

184
Q

How does anaphylactic shock effect central venous pressure, pulmonary capillary wedge pressure, cardiac index (left ventricular output), and, systemic vascular resistance

A

CVP: decreased
PCWP: decreased
LV output: increased (bc increased HR)
SVR: decreased

185
Q

What treatment for hyperlipidemia has a main side effect of flushing, warmth, and itching? What is released in response to this medication that causes these symptoms?

A

niacin

prostaglandins (primarily PGD2 and PGE2)

186
Q

Why are pharmacologic vasodilators (nitroprusside) helpful in mitral regurge?

A

they decrease systemic blood pressure –> decreased afterload –> increase forward flow –> reduce pulmonary congestion

187
Q

Lower extremity clubbing and cyanosis (but not in upper extremity) without pulse discrepancy is caused by a large patent ductus arteriosus with what complication

A

Eisenmenger syndrome
(reversal of shunt flow from left to right to right to left –> deoxygenated blood now being pumped through ductus arteriosus to the lower extremities)

188
Q

In patients with carotid sinus hypersensitivity, why might shaving result in syncope?

A

carotid sinus baroreceptors detect increased blood pressure –> increased parasympathetic tone and decreased sympathetic tone –> slows heart rate and induces vasodilation

189
Q

The inferior wall of the left ventricle forms most of the inferior surface of the heart and is supplied by the ______ artery

A

posterior descending

190
Q

Atrial left-to-right shunts (ie ASD) cause what change on auscultation

A

wide and fixed splitting of S2

191
Q

Decreased diastolic pressure and increased left ventricular diastolic pressure are consistent with what valvular malformation

A

aortic regurgitation

192
Q

The most common cause of alveolar hemosiderin-laden macrophages, indicating alveolar hemorrhage is what

A

chronic elevation of pulmonary capillary hydrostatic pressure in the setting of left-sided heart failure

193
Q

dofetilide MOA

A

class III antiarrhythmic, block potassium channel

194
Q

sotalol MOA

A

class III antiarrhythmic, blocks potassium channels

195
Q

What is the equation used to determine the flow based on the radius of a vessel or vice versa

A

flow = radius^4

196
Q

what equation can be used to determine the resistance in a vessel

A

resistance = (viscosity of blood x length of blood vessel)/ radius of vessel^4

197
Q

How does hypovolemic shock cause metabolic acidosis

A

reduced organ perfusion –> lactic acidosis (–> compensatory hyperventilation/respiratory alkalosis)

198
Q

in order to live with transposition of the great arteries, initial management includes maintaining a left-to-right mixing lesion via a patent _______ and a patent ______

A

ductus arteriosus

foramen ovale

199
Q

____ presents with sharp pleuritic chest pain that is relieved by sitting up and leaning forward

A

pericarditis

200
Q

Losartan MOA

A

ARB (angiotensin II receptor blockers)

201
Q

The ductus arteriosus is derived from the ___ aortic arch

A

sixth

202
Q

First aortic arch –> what adult derivative?

A

part of maxillary artery

203
Q

second aortic arch –> what adult derivative?

A

hyoid and stapedial artery

204
Q

third aortic arch –> what adult derivatives

A

common carotid artery and proximal internal carotid artery

205
Q

fourth aortic arch –> what adult derivative?

A 
aortic arch (left)
proximal right subclavian artery (right)
206
Q

sixth aortic arch –> what adult derivative?

A

proximal pulmonary arteries and ductus arteriosus (left)

207
Q

In response to artery stenosis, how does coronary autoregulation alter perfusion pressure and blow flow

A

perfusion pressure decreases

coronary blood flow remains near normal (due to autoregulation causing vasodilation)

208
Q

ANP and BNP activate __ to increase intracellular _____

A

guanylyl cyclase

cGMP

209
Q

phosphodiesterase inhibitors decrease the degradation of ____

A

cGMP

210
Q

elevated intracellular ____ levels lead to relaxation of vascular smooth muscle and vasodilation

A

cGMP

211
Q

During pregnancy what changes are seen in preload, afterload, stroke volume, and cardiac output

A

preload: increased
afterload: decreased
stroke volume: increased
cardiac output: increased

212
Q 
How are each of the following effected in cardiac tamponade?
central venous pressure
right atrial cavity size
left atrial pressure
stroke volume
A

CVP: increase
RA cavity size: decreased
LA pressure: increased
stroke volume: decreased

213
Q

what type of organism is borrelia burgdorferi (causes of lyme disease)

A

bacterial spirochete

214
Q

The likelihood of plaque rupture is related to plaque stability rather than plaque size or degree of luminal narrowing. Inflammatory macrophages in the intima may reduce plaque stability by secreting ____

A

metalloproteinases

degrade extracellular matrix proteins

215
Q

How is ejection fraction maintained despite apoptosis and necrosis due to normal aging?

A

myocyte hypertrophy

216
Q

What antiarrhythmics prolong the QRS duration with little effect on the QT interval

A

class 1C (flecainide)

217
Q

what is heard on auscultation of an atrial septal defect

A

systolic ejection murmur and wide and fixed splitting of S2

218
Q

Loss of cardiomyocyte contractility occurs within _____ after the onset of total ischemia. When ischemia lasts longer than ____ , ischemic injury becomes irreversible

A

60 seconds

30 min

219
Q

describe the course of the saphenous vein

A

origin: medial side of foot –> anterior to medial malleous –> medial leg and thigh –> drains into femoral vein just inferolateral to pubic tubercle

220
Q

what maneuvers increase the intensity of a hypertrophic cardiomyopathy murmur

A

decreasing preload or afterload: abrupt standing, valsalva strain phase

221
Q

what condition causes engorged pulmonary capillaries and intraalveolar, acellular, pink material that is more prominent at the base of the lungs

A

pulmonary edema

222
Q

How can chronic alcohol use lead to cardiogenic shock and acute respiratory failure

A

dilated cardiomyopathy –> exacerbation of heart failure and pulmonary edema

223
Q

Rank the sodium channel binding strength of class 1A, 1B, and 1C antiarrhythmics

A

1C>1A>1B

1C demonstrate the most use dependence due to slow dissociation, 1B have least use dependence

224
Q

The ____ composes a majority of the anterior surface of the heart and is at risk of injury with penetrating trauma at the mid- and lower- left sternal border

A

right ventricle

225
Q

The most common trigger for atrial fibrillation is aberrant electrical foci in what anatomic structure?

A

pulmonary veins (near their ostia into the left atrium)

226
Q 
How are the following affected by cardiac amyloidosis: 
ventricular wall thickness
diastolic relaxation
ventricle cavity size
atrial cavity size
A

ventricular wall thickness: increased
diastolic relaxation: decreased
ventricle cavity size: normal or decreased
atrial cavity size: increased

227
Q

isosorbide dinitrate MOA

A

nitrate: systemic vasodilation

228
Q

main adverse effects of nitrate therapy

A

headache, cutaneous flushing, lightheadedness, hypotension, reflex tachycardia

229
Q

How do QRS complexes generated by the HIS bundle differ from impulses generated from purkinje or system?

A

HIS is more narrow and purkinje generate wider QRS

230
Q

What arrhythmia is caused by wolf parkinson white pattern

A

atrioventricular reneentrant tachycardia due to accessory conduction pathway that bypasses the AV node

231
Q

In tetralogy of fallot, during tet episodes, what heart pressure changes cause cyanosis

A

increased Right ventricular outflow obstruction –> increased right ventricular pressure –> right to left shunting through VSD and less oxygenated blood

232
Q

What 4 channels/receptors are blocked by amiodarone

A

fast sodium channels
L-type calcium channels
beta receptors
potassium cahnnels

233
Q

two common mutations that cause hypertrophic cardiomyopathy include single point missense mutations in the genes for ____ and ____

A

beta myosin heavy chain and myosin-binding protein C

234
Q

Beta blockers mainly decrease conduction in what part of the heart? What effect does this have on ECG?

A

AV node

prolonged PR

235
Q

Congenital long QT syndrome is most often caused by genetic mutations in the ___ channel protein that predisposes to the development of life threatening ventricular arrhythmias (torsades)

A

potassium

236
Q

How does hypovolemia due to sodium and/or water loss such as vomitting and diarrhea effect hematocrit, albumin, and uric acid concentration

A

all increased (RBC and albumin trapped in intravascular space and hypovolemia triggers increased absorption of uric acid in the PCT due to increased Na absorption in the PCT)

237
Q

leads I and aVL correspond to the lateral limb leads on ECG, ST elevations in these leads indicate infarction of the lateral aspect of left ventricle which is supplied by the ____ artery

A

left circumflex

238
Q

The carotid sinus reflex has an afferent limb that arises from the baroreceptors and travels to vagal nucleus and medullary centers via the _______ nerve

A

glassopharyngeal nerve (IX)

239
Q

What is the most common mechanism of cardiac death due t acute myocardial infarction

A

ventricular fibrillation

240
Q

What is the most common pathogen to cause purulent pericarditis, particularly in the setting of a portal from the skin to the bloodstream (ir catheter) or pericardium (recent chest surgery)

A

staph aureus

241
Q

Metolazone MOA

A

thiazide diuretic

242
Q

Surgical closer of a patent ductus arteriosus causes what immediate changes to the left ventricular preload and afterload

A

LV preload: decreased

LV afterload: increased

243
Q

When the cells within the heart, brain, or skeletal muscle are injured, the enzyme ____ leaks across the damaged cell membrane and into circulation

A

creatinine kinase

244
Q

What 4 stimuli, plus shear forces, activate specific membrane receptors on endothelial cells leading to an increase in cytosolic calcium levels and result in vasodilation

A

acetylcholine
bradykinin
serotonin
substance P

245
Q

In order to cause vasodilation, endothelial nitric oxide synthase synthesizes nitric oxide from _____, NADPH, and O2

A

arginine

246
Q

In order to cause vasodilation, Nitric oxide is synthesized and diffuses into adjacent cells where it increases formation of ____

A

cGMP

247
Q

The posteriomedial papillary muscle is supplied soley by what artery, making it susceptible to ischemic rupture

A

posterior descending artery

248
Q

Papillary muscle rupture is a life threatening complication that typically occurs ____ days after MI and presents with acute mitral regurge and pulmonary edema

A

3-5

249
Q

______ demonstrates rapid and regular atrial activity in a sawtoothed pattern on ECG

A

atrial flutter

250
Q

Typical atrial flutter is caused by a large reentrant circuit that traverses what site which is the target site for ablation?

A

cavotricuspid isthmus of right atrium (area between the tricuspid valve and inferior vena cava of in the right atrium)

251
Q

What cause of mitral stenosis is characterized by diffuse fibrous thickening and distortion of the mitral valve leaflets along with commissural fusion at the leaflet edges

A

rheumatic fever

252
Q

_____ is a congenital cardiac defect associated with secondary hypertension and is a risk factor for cerebral aneurysm development

A

coarctation of the aorta

253
Q

what effect does dobutamine have on heart rate

A

increase

254
Q

The posterior surface of the heart is mostly formed by the ____ which when enlarged can cause external compression of the mid-esophagus with dysphagia (cardiovascular dysphagia)

A

left atumia

255
Q

How does adenosine terminate a reentrant circuit tachyarrhythmia

A

hyperpolarizes the nodal pacemaker and conducting cells to briefly block conduction through the AV node

256
Q

what are the most frequent adverse effects associated with adenosine (4)

A

flushing, chest burning (due to bronchospasm), hypotension, and high grade AV block

257
Q

On a normal jugular venous pulse wave tracing, what do the 3 positive waves indicate (in order: A, C, V)

A

A: atrial contraction
C: bulging of tricuspid valve into right atrium in early systole
V: passive increase in pressure and volume of right atrium as it fills in late systole and early diastole

258
Q

what do the troughs of the jugular venous pulse represent (in order: x-descent and y-descent)

A

x-descent: relaxation of the right atrium
y-descent: abrupt decrease in right atrial pressure during early diastole after the tricuspid valve opens and the right ventricle begins to passively fill

259
Q

The blood in the what vessel is the most deoxygenated blood in the body?

A

coronary sinus

myocardial oxygen extraction exceeds that of any other tissue or organ

260
Q

plaque like deposits of fibrous tissue on the right sided endocardium causing tricuspid regurge and right sided heart failure is pathognomonic for what syndrom

A

carcinoid syndrome

serotonin –> fibroblast growth

261
Q

Elevated 24 hour urinary _____ can confirm the diagnosis of carcinoid syndrome

A

5-hydroxyindoleacetic acid (end product of serotonin metabolism)

262
Q

A patient presenting with an new systolic murmur during an MI which resolves after treatment likely had damage to what structure

A 
papillary muscle (--> mitral regurge)
(timely restoration of blood flow can improve papillary muscle dysfunction and lead to resolution of the regurgitation)
263
Q

digoxin produces what cellular ion levels to improve myocyte contractility

A

inhibit Na-K ATP –> increased intracellular sodium –> decreased sodium-calcium exchanger activity –> increased intracellular calcium

264
Q

How can cardiac output be determined by using the rate of oxygen consumption

A

cardiac output = (rate of O2 consumption) / (arteriovenous O2 content difference)

265
Q

What holosystolic murmur increases in intensity with inspiration

A 
tricuspid regurge
(decreased intrathoracic pressure --> more blood to right heart and increased pulmonary vessel capacity --> decreased blood to left heart)
266
Q

subungual splinter hemorrhages (flame shaped hemorrhagic streaks in the nail bed) appear as a consequence of microembli due to what underlying pathology

A

infectious endocarditis

267
Q

what 2 physical exam findings on the hands indicate a diagnosis of infectious endocarditis

A 
subungual splinter hemorrhages (hemorrhagic streaks under nail beds)
Janeway lesions (small, macular, erythematous or hemorrhagic, nontender lesions on the palms and soles)
268
Q

what mechanism makes fenoldopam a useful agent in treating patients in hypertensive emergency with renal insufficiency

A

D1 agonist –> vasodilation of most arterial bed and particularily prominently causes renal vasodilation –> increased renal perfusion and natriuresis

269
Q

______ is characterized by an elevate heart rate with a regular rhythm and narrow QRS complexes due to an abnormal electrical impulse originating above the ventricles

A

supraventricular tachycardia

270
Q

Abdominal aortic aneurysm is associated with what changes to the wall of the aorta, leading to weakening and progressive expansion of the aortic wall

A

chronic transmural inflammation and extracellular matrix degradation

271
Q

Myxomatous degeneration with pooling of proteoglycans in the medial layer and an intact intima layer in a large artery is consistent with what diagnosis

A

aortic aneurysm

Marfan syndrome is a frequent cause of cystic medial degeneration in younger patients

272
Q

Mutation in ____ gene results in elastic tissue fragmentation which predisposes patients with Marfan syndrome to aortic aneurysms

A

fibrillin-1

273
Q

The most common site of injury of a traumatic aortic rupture is the aortic ____, which is tether by the ligamentum arteriosum and is relatively fixed and immobile compared to the adjacent descending aorta

A

aortic isthmus

274
Q

In unilateral renal artery stenosis, the contralateral kidney is exposed to high blood pressure that typically shows what changes of hypertensive nephrosclerosis

A

arteriolar wall thickening due to hyaline or hyperplastic arteriosclerosis (concentric smooth muscle cell proliferation in response to pressure (onion skinning ))

275
Q

In a graph showing the normal pattern of blood flow across the mitral valve, the first, larger wave (E wave) represents what? what does the second, smaller wave (A wave) represent?

A

Ewave: passive ventricular filling

A wave: atrial contraction

276
Q

If present, when is an S3 heart sound heard best

A

during passive ventricular filling of diastole

277
Q

Heart failure leads to transudative or exudative pleural effusion? which is characterized by low or high protein and lactate dehydrogenase

A

transudative

low protein and lactate dehydrogenase

278
Q

what type of pleural effusion has low glucose content

A

malignant or infectious pleural effusion due to consumption by bacteria, neutrophils, and/or malignant cells

279
Q

Class ____antiarrhythmics are potent sodium channel blockers that have increased effect at faster heart rates (use dependence)

A

class 1C

280
Q

What chemotherapy drug has a risk of cardiotoxicity that manifests as a decrease in myocardial contractility without cardiomyocyte destruction or myocardial fibrosis that is often reversible with discontinuation of therapy

A

Trastuzumab

281
Q

_____ is a chronic, large artery vasculitis that primarily involves the aorta and its branches

A

Takayasu arteritis

282
Q

Takayasu arteritis is more common in what patient population

A

women of reproductive age and asians

283
Q

Characteristic histopathology findings of Takayasu arteritis include mononuclear infiltrates and ______ of the vascular media, leading to arterial wall thickening and occlussion

A

granulomatous inflammation

284
Q

Clinical presentation of Takayasu arteritis

A

constitutional symptoms (fever, weight loss, fatigue)
arterio-occlusive symtpoms: claudication, BP discrepancies, bruits, pulse deficits
visual and neurologic deficits
arthralgias and myalgias
elevated inflammatory markers (ESR, CRP)

285
Q

Pathologic abnormalities in Takayasu arteritis closely resemble giant cell (temporal) arteritis, however, giant cell usually effects what type of patients in comparision with TA patients

A

giant cell: paients >50

TA: younger women of child bearing age

286
Q

What vein obstruction presents like superior vena cava syndrome but only on one side of the body (unilateral face and arm swelling)

A

brachiocephalic

287
Q

During exercise what change happens to the LV end diastolic volume, systemic vascular resistance, stroke volume and afterload

A

LVEDV: increased (increased venous return/preload)
SVR: decreased
SV: increased (increased preload and contractility)
afterload: increased (increased contractility and stoke volume –> increased systolic pressure)

288
Q

dobutamine MOA and second messenger

A 
B agonists (B1>B2)
Gs
289
Q

Heart failure with preserved ejection fraction develops due to what?

A

diastolic dysfunction (frequently occurs in setting of prolonged systemic hypertension which increased afterload and caused concentric hypertrophy)

290
Q

In hypovolemia, which of the following are increased or decreased: ANP, heart contractility, baroreceptor firing

A

ANP: decreased
heart contractility: increased
baroreceptor firing: decreased

291
Q

How do nitrates reduce angina?

A

vasodilation (predominantly venodilation)–> decreased preload –> decreased LVEDP –> decreased myocardial oxygen demand
(mild arterial dilation also slightly decreases SVR/afterload)

292
Q

What causes increased arterial resistance in heart failure

A

decreased cardiac output and inadequate oxygen delivery to tissues -> increased sympathetic output and increased RAAS activation

293
Q

_____ occurs 2-4 days following an MI and is an inflammatory reaction to cardiac muscle necrosis

A

peri-infarction pericarditis

presents as sharp pleuritic chest pain that may be exacerbated by swallowing or coughing

294
Q

What is the major pathologic contributor to atrial fibrisllation

A

atrial remodeling

295
Q

Why is the right ventricle more protected from ischemic damage than the left ventricle during an MI

A

RV has less muscle mass and afterload –> less O2 demand –> has large capacity to increase oxygen extraction during ischemia
low systolic pressure of RV –> coronary perfusion throughout cardiac cycle (LV only perfused during diastole)

296
Q

a decrescendo diastolic murmur at right upper sternal border and bilateral pulmonary crackles is caused by what valve disease

A

aortic regurge

297
Q

What complication of aortic dissection can cause jugular venous distention, hypotension, and reduced point of maximal impulse

A

tamponade (from dissection extending proximally into pericardium causing blood to fill pericardial space)

298
Q

what complication of aortic dissection can cause blood pressure asymmetry in upper extremities

A

extension of dissection plane into the subclavian artery

299
Q

How does SVR change in cardiogenic shock due to heart failure

A

increased (peripheral vasoconstriction to maintain blood pressure)

300
Q

How is pulmonary artery systolic pressure affected by cardiogenic shock due to left ventricular heart failure

A

increased
(LV systolic failure –> increased LVEDV which is transmitted backward to incease pulmonary capillary wedge pressure and pulmonary arterial pressure

301
Q

Does use of medications to raise HDL levels improve cardiovascular outcomes?

A

no, instead focus on lowering LDL cholesterol with HMG-CoA reductase inhibitor (statin)

302
Q

Adenosine activates ____ ion channels and inhibits ___ channels to what effect in the heart

A

activates potassium
inhibits L-type calcium
slow sinus rate and increase AV nodal conduction delay

303
Q

what is the most reliable auscultatory indicator of the degree of mitral stenosis

A

A2-opening snap interval (shorter interval indicates more severe)

304
Q

what is Kussmaul sign

A

a paradoxical rise in JVP with inspiration

305
Q

What medication is as effective as aspirin for preventing cardiovascular events and should be used in patients with aspirin allergy

A

Clopidogrel

306
Q

Clopidogrel irreversibly blocks the ___ component of ADP receptors on platelet surface and prevents platelet aggregation

A

P2Y12

307
Q

describe myocardial hibernation

A

in chronic myocardial ischemia, myocardial metabolism and function are reduced to match a concomitant reduction in coronary blood flow –> decreased contractility but revascularization and restoration of blood flow improves LV function

308
Q

describe ischemic preconditioning

A

brief repetitive episodes of myocardial ischemia prior to myocardial infarction can delay cell death after complete coronary occlusion and therefore provide greater time for myocardial salvage with coronary revascularization

309
Q

Total resistance for a group of vessels (R1, R2, R3) arranged in parallel is what?

A

1/total resistance = 1/R1 + 1/R2 +1/R3

310
Q

How is total resistance in vessels (R1, R2, R3) arranged in a circuit series calculated

A

total resistance = R1 + R2 + R3

311
Q

Digoxin toxicity typically presents with cardiac arrhythmias, nausea, vomiting, confusion, weakness, and visual symptoms. Elevated serum ____ is a sign of digoxin toxicity

A

potassium

312
Q

How do beta blockers improve symptoms of hypertrophic cardiomyopathy

A

decrease HR and LV contractility –> increase LV blood volume and reduce LV outflow obstruction

313
Q

what congenital heart defect is characterized by a continuous murmur heard best in the left infraclavicular region with maximal intensity at S2

A

patent ductus arteriosus

314
Q

The ____ valve is most frequently affected by infective endocarditis and ___ is the most common underlying valvular disease predisposing to the development of infective endocarditis

A

mitral

mitral valve prolapse (particularly when it is associated with coexistent mitral regurgitation)

315
Q

In patients with Tetralogy of Fallot, during a tet spell, squatting increases ____ which thereby increases pulmonary blood flow and improves oxygenation status

A

systemic vascular resistance (–> decreased right to left shunting)

316
Q

Granulomatosis with polyangitis is a ____ vessel vasculitis and _-ANCA positive

A

small

C

317
Q

Besides constitutional symptoms of fever, arthralgia, and weight loss, what 3 areas are usually symptomatic in granulomatosis with polyangitis

A 
upper airway (otitis media, nasal crusting/ulcer, rhinorrhea)
lower airway (hoarseness, cough, stridor, hemoptysis, pulmonary infiltrates)
kidney (rapidly progressive glomerulonephritis)
318
Q

What are histologic findings of granulomatosis with polyangitis

A

necrotizing arteritis with granulomatous inflammation (epithelioid histiocytes, multinucleated giant cells) and mixture of surrounding inflammatory cells

319
Q

what causes a presystolic sound on auscultation

A

left ventricular hypertrophy

S4

320
Q

Mitochondrial vacuolization is a sign of what?

A

irreversible cell injury (mito is permanently unable to generate ATP)

321
Q

adverse effect of class III antiarrhythmics (ibutilide, dofetilide, sotalol)

A

torsade de pointes

322
Q

Left ventricular gallops (S3 and/or S4) are best heard at the end of expiration, why?

A

decreased lung volume and and it brings the heart closer to the chest wall

323
Q

In a patient with left ventricular hypertrophy, A fib is especially dangerous, why?

A

in left ventricular hypertrophy, atrial contraction contributes significantly to left ventricular filling (loss of atrial contraction –> decreased LV preload –> hypotension)

324
Q

In aortic regurgitation, the characteristic decrescendo diastolic murmur is heard best when the patient is in what postural position

A

leaning forward

325
Q

The pressure tracing for aortic regurgitation is characterized by loss of the _____

A

aortic dicrotic notch

and steep diastolic decline in aortic pressure, and high-peaking systolic pressures

326
Q

In calcific aortic valve disease, fibroblasts differentiate into ____-like cells

A

osteoblast

aberrant bone matrix deposition with progressive valvular calcification and stenosis

327
Q

what effect do abrupt standing and valsalva straining have on on left ventricular blood volume

A

decrease

328
Q

Days to weeks post MI, _____ and other anti-inflammatory cytokines downregulate the inflammatory response and stimulate fibroblast migration and proliferation causing extensive type I and III collagen deposition

A

transforming growth factor beta

329
Q

Migratory superficial thrombophlebitis, Trousseau syndrome, should raise suspicion for _____

A

cancer

hypercoagulability

330
Q

Janeway lesions, nontender, macular, and erythematous lesions on palms and soles of feet are seen in what pathologic condition?

A 
infective endocarditis
(result of septic embolization from valvular vegetations)
331
Q

In dilated cardiomyopathy as seen following doxorubicin treatment, how are LVED pressure and RA pressure changed

A

both increased

332
Q

Alteplase MOA

A

tPA analog (triggers fibrinolysis and can restore myocardial perfusion in patients with ST elevation who cannot undergo timely percutaneous coronary intervention)

333
Q

What causes high output heart failure

A

decreased systemic vascular resistance (ie large arteriovenous fistula) –> increased venous return and increased CO

334
Q

What cells form the fibrous cap (composed of collagen, elastin, proteoglycans) of mature atheromas

A

vascular smooth muscle cells

335
Q

What causes decreased left ventricular chamber size, sigmoid shaped ventricular septum, increased collagen deposition, and accumulation of cytoplasmic lipofuscin pigment within cardiomyocytes?

A

normal aging

336
Q

stress-induce (takotsubo) cardiomyopathy is caused by a ___ surge in the setting of physical or emotional stress leading to systolic dysfunction and what characteristic finding on echocardiogram

A

catecholamine

balloon shape LV

337
Q

In the a VSD of a neonate, how are RA, RV, LA, nd LV pressures changed?

A 
RA: unchanged
RV: increased
LA: increased
LV: increased
(increased blood enters the RV from LV which then flows to LA and LV to increase their pressures as well)
338
Q

what murmur is heard in VSD

A

holosystolic murmur

339
Q

why can acetylcholine induce a angina in patients with vasospastic angina

A

normally acetylcholine -> NO release –> vasodilation; but in these patients who have endothelial dysfunction, they do not release NO therefore have vasoconstriction in response to acetylcholine

340
Q

In ascites due to right heart failure, how are the following affected: portal capillary oncotic pressure, portal capillary hydrostatic pressure, portal capillary permeability

A

portal capillary oncotic pressure: no change
portal capillary hydrostatic pressure: increased
portal capillary permeability: no change

341
Q

In left sided heart failure due to concentric hypertrophy of the LV due to HTN, how are the following affected: LV compliance, angiotensin II signaling, cardiac myosin heavy chain-beta expression

A

LV compliance: decreased
Angiotensin II: increased
cardiac myosin: increased

342
Q

What is the most common cause of claudication

A

atherosclerosis (specifically resulting from fixed stenoses caused by lipid filled intimal plaques that bulge into the arterial lumen)

343
Q

Aortic dissection develops when overwhelming hemodynamic stress leads to tearing of the aortic ______ with blood subsequently dissecting through the aortic media

A

intima

344
Q

A complete atrioventricular canal defect is comprised of an atrial septal defect, a VSD, and a common AV valve. It is the most common congenital cardiac anomaly associated with what genetic dissorder?

A

Down syndrome

345
Q

VSD is often not detectable at birth but becomes audible around 4-10 days as ____ declines

A

pulmonary vascular resistance (allows for significant left-to-right shunting)

346
Q

Digoxin is cleared by the _____

A

kidney

347
Q

glucagon second messenger in cardiac myocytes

A

adenylate cyclase –> cAMP

348
Q

isosorbide dinitrate MOA

A

venous dilator

349
Q

why should isosrobide dinitrate be avoided in treating hypertrophic cardiomyopathy

A

venous dilation –> decreased venous return –> decreased LV volume –> decreased cardiac output

350
Q

When would atropine be useful in treating a patient for acute MI

A

sinus bradycardia often occurs due to nodal ischemia and an increase in vagal tone triggered by infarction of myocardial tissue
enhance vagal tone can be counteracted by anticholinergic effects of atropine

351
Q

In chronic heart failure, what compensatory mechanism initially offsets factors favoring edema

A

increased lymphatic drainage

352
Q

What is the most common cause of pericarditis

A

viral infection

353
Q

Vegetations are caused by bacterial colonization and growth on a sterile ______ that forms on damaged/disrupted endothelial surface of valvular apparatus

A

fibrin-platelet nidus

354
Q

Using nitrates together with PDE inhibitors cause a profound systemic hypotension because they both increase intracellular ____ which causes vascular smooth muscle relaxation

A

cGMP

355
Q

Jervell and Lange-Nielsen syndrome is an autosomal recessive disorder characterized by profound bilateral sensorineural hearing loss and congenital long QT syndrome. The condition occurs secondary to mutations in genes that encode _____

A

voltage-gated potassium channels

356
Q

A slow growing, stable atherosclerotic plaque, as opposed to a fast growing plaque, allows for what compensatory mechanism to take place in order to reduce myocardial necrosis and scarring

A

collateral vessel growth

357
Q

What class of antibiotics can cause QT prolongation

A

macrolides (erythromyocin)

358
Q

what is the most common adverse effect of fibrinolytic therapy

A

hemorrhage

359
Q

Cardiovascular manifestations of lupus include what? (4)

A

accelerated atherosclerosis
small vessel necrotizing vasculitis
pericarditis
Libman-Sacks endocarditis

360
Q

what is Libman-Sacks endocarditis

A

small, sterile vegetations on both sides of the valve
the vegetations are composed of sterile platelet thrombi intertwined with strands of fibrin, immune complexes, and mononuclear cells

361
Q

A patient with pleuritic type chest pain radiating to the shoulder, a triphasic friction rub, diffuse ST elevation, and recent history of skin rash and joint pain likely has what type of pericarditis

A

fibrinous

can be due to lupus, MI, uremia, and other rheumatologic diseases

362
Q

What irreversible remodeling is preventable with surgically repairing an ASD

A

hypertrophy of the pulmonary arteries (–> pulmonary hypertension –> eisenmenger syndrome)

363
Q

Atherosclerosis develops most rapidly in areas with bends and branch points that encourage turbulent flow. What 2 areas tend to develop atherosclerosis earliest in life and have the highest overall atherosclerotic burden?

A

abdominal aorta

coronary arteries

364
Q

Chronic hypertension leads to increased local expression of the vasoconstrictors __ and ___ in the heart which likely have a prominent role in development of left ventricular hypertrophy (heart remodeling

A

angiotensin II

endothelin

365
Q

After birth, as the relative pressure in the pulmonary artery and aorta change, a patent ductus arteriosus murmur evolves from ___ only to _____ before the PDA closes and the murmur disappears

A

systolic

continuous

366
Q

Secondary mitral regurgitation is commonly causes by ____ which causes dilation of the mitral valve annulus and restricted movement of the chordae tenineae and subsequent regurgitation

A

decompensated heart failure –> increased left ventricular end diastolic volume

367
Q

Milrinone MOA

A

phosphodiesterase 3 inhibitor (–> increased cAMP –> calcium influx which increases contractility and reduced calcium myosin light chain kinase interaction which causes vasodilation and decreased preload and afterload)

368
Q

What happens to the S2 split on inspiration in pulmonary stenosis

A

widens

369
Q

_____ is a systemic vasculitis of medium sized muscular arteries that causes segmental fibrinoid necrosis, infiltration of vessel wall with mononuclear cells and neutrophils, and internal and external elastic laminae damage which may cause microaneuysms

A

polyarteritis nodosa

370
Q

polyarteritis nodosa typically attacks what organs

A 
kidneys
skin
neurologic system
GI tract
(lung is typically spared)
371
Q

alcohol induced cardiomyopathy causes what type of heart failure

A

dilated cardiomyopathy –> systolic dysfunction

372
Q

_______ is a protein produced by the liver, mutations in the TTR gene cause for it to misfold and produce amyloid protein that infiltrates the myocardium –> infiltrative cardiomyopathy

A

transthyretin

373
Q

During a transesophageal echocardiogram, what chamber of the heart lies in closest proximity to the probe

A

left atrium

374
Q 
Which of the following lies posterior to the esophagus and would be best visualized by a transesophageal echocardiogram: 
descending aorta
superior vena cava
pulmonary veins
pulmonary arteries
A

descending aorta

375
Q

Ion pump failure due to ATP deficiency during cardiac ischemia causes intracellular accumulation of ___ and ____ which draw free water into the cell causing cell and mitochondrial swelling

A

Na

Ca

376
Q

how does hypertrophic cardiomyopathy differ from hypertensive heart disease

A

hypertrophic cardiomyopathy: localized thickening predominantly affecting interventricular septum; also causes cariomyocyte disarray
hypertensive heart disease: uniform thickening of LV walls

377
Q

Peripartum cardiomyopathy is a rare cause of ____ cardiomyopathy that may be related to impaired function of angiogenic growth factors

A

dilated

378
Q

lipofuscin appears yellow-brown pigment contained within intracytoplasmic granules in myocardium which is composed of ______

A

lysosomal breakdown products including lipid polymers and protein complex phospholipids that result from free radical injury and lipid peroxidation (accumulate with age)

379
Q

syncope with diastolic dysfunction, hepatomegaly, and skin hyperpigmentation is suggestive of what disorder?

A

hereditary hemochromatosis

380
Q

Unlike the diffuse ventricular wall thinning that occurs in most dilated cardiomyopathies, what cause of cardiomyopathy results in localized apical wall thinning with large apical aneurysm development

A

Chagas disease

central and south america

381
Q

What is the GI manifestation of Chagas disease

A

destruction of myenteric plexus –> progressive dilation and dysfunction of esophagus and, less commonly, the colon

382
Q

what changes are seen in the myocardium 0-4 hours post MI

A

minimal change

383
Q

what changes are seen in myocardium 4-12 hours post MI

A

early coagulation necrosis, edema, hemorrhage, wavy fibers

384
Q

what changes are seen 12-24 hours post MI

A

coagulation necrosis and marginal contraction band necrosis

385
Q

how long post MI can you see neutrophilic infliltrate

A

1 day (1-5days)

386
Q

how long following an MI can you see macrophages

A

5 days (5-10 days)

387
Q

how long following an MI does granulation tissue and neovascularization start to form

A

10-14 days

388
Q

how long following an MI does collagen deposition and scar formation start to occur

A

2 wks (-2months)

389
Q

What is seen on histopathology of thromboangiitis obliterans (Buerger disease)

A

highly cellular, inflammatory intraluminal thrombi (containing neutrophils and multinucleated giant cells) in the arteries and veins with sparing of the vessel wall and internal elastic lamina

390
Q

What segmental, thrombosing vasculitis often extends contiguously into veins and nerves

A

thromboangiitis obliterans (Buerger disease)

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