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1
Q

decreased femoral to brachial blood pressure ratio

A

coarctation of the aorta

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2
Q

fixed wide splitting of S2

A

in patients with ASD

-

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3
Q

precordial continuous machine-like murmur that occurs both in systole and diastole

A

patent ductus arteriosus

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4
Q

bifid carotid pulse with brisk upstroke (sike and dome)

A

hypertrophic obstructive cardiomyopathy

-left entricular outflow tract obstruction during sytole

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5
Q

holosysolic murmur that is loudest over the left mid sternal border

A

VSD

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6
Q

which organ is least vulnerable to infgarction

A

liver

  • dual blood supply from portal vein and hepatic artery
  • exception is during in transplanted liver-can develop biliary tree infarction and organ failure bc collateral blood supply is severed during transplantation
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7
Q

persistenet fever, strawberry tongue, desquamation, bilateral conjunctivitis, erythema of mouth, edema of hands and feet ,generalized urticarial rash beginning on extremities and moving to trunk

A

kawasaki
-strawberry tongue seen in scarlet fever as well but persistent fever and bilateral conjunctivitis more suggestive of kawasaki

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8
Q

exertional dyspnea, lower extremity edema and hoarseness

A

ortner syndrome-mitral stenosis leading to rleft atrial enlargment that compresses the left recurrent laryngeal nerve

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9
Q

skin and mucosal telangiectasia with recurrent nosebleeds

A

osler weber rendu syndrome
hereditary hemorrhagic telangiectasia
lips, orpharynx, resp tract, GI tract, urinary tract
can affect brain, liver sleep and present with Gi bleed, epistaxis and hematuria

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10
Q

segmental, transmural, necrotizing inflammation of medium to small sized arteries

A

polyarteritis nodosa
renal involement is oftenprominent
-lung rarely involved
1/3 have palpable purpura

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11
Q

best indicator of degree of mitral stenosis

A

A2-Os interval

-sshorter interval=more severe stenosis

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12
Q

truncus arteriosus gives rise to

A

ascending aorta and pulmonary trunk

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13
Q

bulbus cordis gives rise to

A

smooth parts (outflow tracts) of left and right ventricles

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14
Q

left horn of sinus venosus gives rise to

A

coronary sinus

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15
Q

right horn of sinus venosus

A

smooth part of right atrium

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16
Q

right common cardinal vein and right anterior cardinal vein

A

superior vena cava

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17
Q

failure of septum primum and septum secundum to fuse after birth

A

patent foramen ovale

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18
Q

defects resulting from abnormal neural crest cell migration to truncus/bulbus

A

transposition of the great vessles, tetralogoy of fallot, persistent truncus arteriosus

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19
Q

vitelline forms what vein

A

portal system veins

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20
Q

cardinal forms waht vein

A

systemic veins

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21
Q

what part of the aorta is most susceptible to injury in BAT

A

isthmus of the aorta (tethered to ligamentum arteriosum)

between l subclavian branch and where pul artery crosses over

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22
Q

fetal erythropoiesis occurs in

A 
Young Liver Synthesizes Blood 
Yolk sac (3-8weeks)
Liver (6 weeks-birth)
Spleen (10-28 weeks)
Bone Marrow (18weeks to adult)
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23
Q

3 fetal shunts

A

ductus venosus: shunts blood from umbilical vein to IVC, bypassing hepatic circulation
foamen ovale: blood reaching the heart via IVC is directed through the foramen ovale to aorta bypass pulm circulation
ductus arteriosus: shunts blood coming from SVC to RA to RV to pulm artery straight to aorta

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24
Q

how does foramen ovale close

A

breath–>decrease pulm resistance–>increase LA pressure vs RA–> closure of foramen ovale

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25
Q

how does ductus arteriosus close

A

increase O2 in baby and decrease prostaglandin from placental separation leads to closure of ductus arteriosus

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26
Q

fossa ovalis

A

remnant foramen ovale

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27
Q

nuclues pulpulsus comes from

A

notochord

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28
Q

medial umbilical ligament comes from

A

umbilical arteries

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29
Q

ligamented teres heaptis

A

is contained in falciform ligament and si derived from the umbilical vein

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30
Q

V1 V2 V3 V4

A

left anterior descending artery

interventricualar septum of anterior wall

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31
Q

V5 V6 I aVL

A

left circumflex (lateral wall of lateral ventricle)

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32
Q

II III aVF

A

posterior descending artery

-branch off right main in 80% of ppl

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33
Q

right marginal

A

supples right ventricle

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34
Q

pulse pressure is proportional to….. and inversely proportional to….

A

pulse pressure is proportional to SV and inversely proportional to arterial compliance

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35
Q

TPR highest in

A

arterioles

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36
Q

highest total cross sectional area with lowest flow velocity

A

capillaries

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37
Q

organ removal effect on hemodynamics

A

increases TP and decreases CO

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38
Q

how are cardiac myocytes electrically coupled to each other?

A

gap junctions

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39
Q

what are If channels

A

create automaticity in pacemaker cells, mixed Na/K current leading to slow depolarization

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40
Q

what determines HR in pacemaker cells?

A

slope of phase 4 (If current)

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41
Q

speed of conduction fastest to slowest

A

Purkinje (fastest)
atrial muscle
ventricular muscle
AV node (slowest)

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42
Q

AV node blood supply

A

RCA

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43
Q

long QT with sensorineural deafness

A

jervell and lange nielsen syndrome
autosomal recessive disorder of myocardial repolaization
-deacreased outward K-syncope, sudden cardiac death, torsades

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44
Q

brugada syndrome

A

psuedo RBBB with ST elevations in V1-3
increased risk for ventricular tachyarryhtmia and SCD
tx: implantable cardiac defribillator

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45
Q

abnromal fast accessory pathway bypassing the AV node leading to premature ventricular depolarization

A

wolf parkinson white syndrome
-characteristic delta wave with wide QRS and shortened PR interval
may result in reentrant circuit with supraventricular tachycardia

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46
Q

first degree heart block

A

prolonged PR interval

benign and asymptomatic, no treatment necessary

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47
Q

progressive PR lengthening until a beat is dropped -p with no subsequent QRS

A

2nd degree Mobitz type I

-regularly irregular

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48
Q

dropped beats that are not preceded by a change in length of the PR interval

A

Mobitz type II
-may progress to 3rd degree block
pacemaker may be indicated

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49
Q

atria and ventricles beat independently of one another, faster atrial rate than ventricualr rate

A

3rd degree complete heart block

may be caused by Lyme disease

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50
Q

ANP/BNP

A

released from atrial mycotes due to increased blood volume and atrial pressure
-causes vasodilateion and decreased Na absorption, vasodilates afferent renal a and constricts efferent renal a
-blocks renin
bnp similar action but with longer half life

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51
Q

aortic arch baroreceptor

A

aortic arch–>vagus–>solitary nucleus of medulla

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52
Q

carotid sinus baroreceptor

A

carotid bifurcation–>glossopharyngeal nerve–>solitary nucleus of medulla

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53
Q

central chemoreceptors do not respond directly to

A

PO2

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54
Q

failure of aorticopulmonary septum to form

A

truncus arteriosus

-most have VSD

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55
Q

failure of the aorticopulmonary septum to spiral

A

transposition of the great vessels

-requires surgical intervention

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56
Q

anteriorsuperios displacemnt of the infundibular septum

A

tetralogy of fallot

  1. pulm stenosis
  2. RVH
  3. overriding aorta
  4. VSD
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57
Q

mst common congenital heart defect

A

VSD

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58
Q

ostium primum

A

rarer ASD; associated with Down’s syndrome
usually involve other cardiac abnormalities
-celft in anterior leaf of MV or septal leaf of TV

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59
Q

ostium secdundum

A

are more common ASD defects and usually isolated

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60
Q

differential cyanosis

A

cyanosis in lower extremities, PDA

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61
Q

hypertension in upper extremities and weak delayed pulse in lower extremities

A

coarctation of the aorta

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62
Q

bicuspid aortic valve

A

accelerates normal aging-premature calcific aortic stenosis

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63
Q

cardiac anomaly in infant of diabetic mother

A

transposition of the great vessels

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64
Q

marfan syndorme associated with

A

MVP, thoracic aortic aneurysm and dissection, aortic regurgitation

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65
Q

prenatal lithium exposure

A

ebstein anomaly

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66
Q

turner sndrome

A

coarctation fo the aorta, bicuspid aorti c valve

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67
Q

williams syndrome

A

supravalvular aortic stenosis

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68
Q

22q11 syndromes

A

truncus arteriosus, tetralogy of fallot

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69
Q

fetal alcohol syndrome

A

VSD, PDA, ASD, tetralogy of fallot

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70
Q

corneal arcus

A

lipid deposit in cornea

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71
Q

xanthoma

A

plaque or nodule of lipid laden histiocytes in skin -xanthelasma -in eyelid

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72
Q

tendinous xanthoma

A

lipid deposit in tendon-especially achilles

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73
Q

hyaline arteriosclerosis

A

in essential hypertension or diabetes

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74
Q

concentric onion skinnning/hyperplastic arteriosclerosis

A

in malignant hypertension

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75
Q

decreased left chamber size, sigmoid shaped ventricular septum with accumulation of alpha lipfiscin in cytoplasm

A

normal aging

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76
Q

athersclerosis most commonly effects

A

abdominal aorta>coronary artery> popliteal artery>carotid artery >circle of willis

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77
Q

cystic medial degeneration aneurysm

A

thoracic aneurysm, fragmentation of the elastic tissues-sepration of the components of the tunica media
-rf: HTN, marfan, tertiary syphilis

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78
Q

atherosclerotic aneurysm most commonly found in the

A

abdominal aorta

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79
Q

consumption of beta aminoproprionile (found in sweet peas)

A

get blockade of lysyl oxidase and unefficient crosslinking of elastin fibers leading to marfan like myxomatous degeneration

80
Q

most common cause of mitral stenosis

A

rheumatic fever

81
Q

most common cause of MVP

A

myxomatous degeneration

82
Q

most common cause of mitral regurg

A

post MI or complication of MVP

83
Q

most common cause of aortic stenosis

A

age related calcificaiton or congenital bicuspid valve, can also be caused by rheumatic fever only if pt has has MS

84
Q

ischemic precondition

A

increase resistance to ischmeia gained with prior repeated exposure to protect against future greater insults

85
Q

myocyte hibernation

A

with chronic hypoperfucsion mycytes have reversible loss of contactile funciton, decrease their energy metabolism but can be reversed with CABG or angioplasty (within hours to months deopending on the degree)

86
Q

myocyte stunning

A

less severe form of hibernation with brief ischemia repurfiusion episodes

87
Q

longitundinal intima tear

A

aortic dissection

-associated wtih hypertension, bicuspid valve, marfan

88
Q

ST elevations at rest with angina

A

prinzmetal (variant) angina due to vasospasm-can be caused by tobacco, cocaine, triptans

89
Q

ergononne test

A

alpha adrenergic given causes vasocontriction and induces cornoary vasospasm-a way to diagnose printzmetal vasospasm

90
Q

+/- ST depression and or T wave inversio nbut no increase in cardiac biomarkers

A

unstbale angina

91
Q

STEMI or NSTEMI with elevated cardiac biomarkers

A

MI

  • STEMI transmural
  • NSTEMI subendocardial
92
Q

sudden cardiac death most commonly due to

A

arrythmia-ventricular fibrillation

93
Q

commonly occluded cornoary artery

A

LAD>RCA>circumflex

94
Q

edema, hemorrhage, wavy fibers, contraction bands

A

first 4-24 hrs post MI

95
Q

formation of granulation tissue post MI

A

day 10 after macrophags have come (day 3) in and phagocytosed all of the necortic cells

96
Q

pericarditis post MI

A

risk days 1-3 when macrophages and inflammatory response is phagocytosing all of necrotic tissue
presnets with pericardial friction rub, short lived adn willr esolve with asa

97
Q

arrythmia, HF, cardiogeneic shock

A

biggest complication within first day post MI

98
Q

ventricular free wall rupture post MI

A

occurs when macrophages destory heart structure-biggest risk 3-14 days post MI

  • presents with cardiac tramponade, papillary muscle rupture, pulseless electrical activity
  • also at risk for pseudoaneurysm at this time of interventricular septum rupture
99
Q

true ventricular aneurysm post MI

A

2 weeks post MI, due to fibrosis , outward bulge during contraction associated with fibrosis

100
Q

granulation tissue at margins post MI

A

beigns at day 10

101
Q

colagen deposition/scar formation post Mi

A

begins 2 weeks to several months

at risk for dressler syndrome and true aneurysm formation

102
Q

autoimmune phenomenon resutling in fibrinous pericarditis

A

Dressler syndrome

-fever, pleuritis, leukocytosis, pleural/pericardial effusions

103
Q

pulseless electrical activity

A

free wall rupture

104
Q

diagnosing MI

A

in first 6 hrs EKG is gold standard
-cardiac troponin rise after 4 hrous and is elevated for 7-10 days, most specific, but for reinfarct must use CK-MB (levels normalize after 48 hours)

105
Q

CK-MB

A

used for diangosing reinfat

troponin levels may remain elevated for 7-10 days and are not accurate for reinfarction

106
Q

type of collagen in cardiac scar tissue

A

Type I collagen

107
Q

causes of dilated cardiomyopathy

A 
ABCDE 
alcohol abuse 
wet Beriberi
Chagas 
Coxsackie B virus 
Cocaine 
Doxorubicin
also 
-peripartum 
-hemochromatosis
108
Q

S3, balloon appearance on CXR

A

dilated cardiomyopathy, systolic dysfucntion

-swelling of sarcoplasmic reticulum followed by loss of myocardiocytes=myofibrillar dropout

109
Q

mitral regurgitation, S4, systolic murmur

A

hypertrophic cardiomyopathy
most commonly AD due to mutation in beta myposin heavy chain
associated with friedrish ataxia
diastolic dysfunction
-myofibrillary disarray and fibrosis
most common cause of death is ventriucular arrythmia

110
Q

asymmetric septal hypertrophy and systolic anterior motion of mitral valve

A

obstructive hypertrophic cardiomyopathy

111
Q

edomyocardia fibrosis with a prominent eosinophilic infiltrate

A

loeffler syndrome

a type of restrictive/infiltrative cardiomyopathy

112
Q

causes of restictive cardiomyopathy

A

sarcoid, amyloidosis, hemachromatossis (also dilated) loeffler, postradiation fibrosis

113
Q

low voltage EKG with nm EF and decreased LVEDV

A

restrictive cardiomyopathy

114
Q

increased JVP, kussmaul sign (increased JVP with inspr) pericardial knock, pulsus paradoxus

A

chronic constrictive pericarditis

115
Q

hemosiderin laden macrophages

A

“heart fialure cells”
leaky capillary in pulm vasculature and subsequent macrophage phagocytosis leads to accumulation of macrophages with iron in cytoplasm
Prussian Blue +

116
Q

coronary sinus dilation

A

sign of pulmonary HTN

-cornoary veins through cornary sinus and rain into RA, if flow obstructed they dilate

117
Q

fever, new murmur, Roth spots, janeway lesion, osler nodes, glomerulonephritis, splinter hemorrhae, septic arterial or pulmonary emboli

A 
bacterial endocardidtis 
-S. viridans-underlying valvular issue, dental procedures  
-S. aureus most virulint, IVDU 
-s bovis. colon cancer
-s epi biofilms on prosthetic valve 
tricuspid valve most commonly involves
118
Q

culture negative endocarditis

A

bartonella, coxiella (1), mycoplasma, histoplasma, chlamydia,
HACEK
Haemophilus Actinobacilliu Cardiobacterium Eikenela Kingella

119
Q

aschoff bodies

A

granuloma with gian cells in rheumatic fever

120
Q

anitschkow cells

A

enlarged macrophages with ovoid wavy rod like nucleus

121
Q

what type of reaction is rheumatic fever

A

Type II hypersensitivty
-not direct effet of the bacteria
antibodies to M protein corss react with slef antigen-moleuclar mimicry

122
Q

sharp pain aggravated by breathing in and relieved by sitting up and forward

A

acute pericarditis-pleuritic chest pain
may hear pericardial friction rub, widespread ST elevation and or PR depression
causes: viral, coxsackie, neoplasia, autoimmune, radiation therapy, UREMIA

123
Q

fibrous intimale thickening with right endocardial plaques associated with nausea, vomiting, flushing, diarrhea, abd cramping

A

carcinoid syndrome

-check urine 5 HIAA

124
Q

hypotension, distended neck veins, distant heart sounds

A

beck triad for
cardiac tamponade
-incrased HR, pulsus paradoxus,
equilibriuation of diastolic pressures in all 4 chambers,

125
Q

ECG: low voltage QRS and electircl alternans

A

cardiac tamponade

126
Q

pulsus paradoxus seen in

A

cardiac tamponade, chronic pericarditis, asthma, obstructive sleep apnea, croup

127
Q

pulus parvus et tardus

A

pulse of low magnitude with delayed pulse

-seen in aortic stenosis

128
Q

dicrotic pulse

A

pulse with 2 peaks in systole and one peak in diatole-seen with sever systolic dysfucntion

129
Q

disruption of the vasa vasorum of the aorta with atrophy of the vessel wall and dilatation of aorta and valve ring

A

seen in syphilic heart disease
-can result in aortic aneurysm or aortic insufficiencey
tree bark appearance of aorta

130
Q

pedunculated gelatinous mass in LA

A

myxoma

  • leads to valve obstruction causing positional dyspnea, syncopal episodes
  • mid diastolic rumble at apex
131
Q

most frequent primary cardiac tumors in children

A

rhabdomyoma

associated with tuberous sclerosis

132
Q

vinyl chloride and arsenic exposure associated wtih

A

hepatic angiosarcoma

-rare blood vessel malignancy

133
Q

radiation therapy and chronic post mastectomy lymphedema assocaited wtih

A

lymphangiosarcoma

134
Q

benign capillary skin papules commonly mistaken for Kaposi sarcome

A

bacillary angiomatosis caused by bartonella henselae in AIDS pts
has NEUTROPHIL infiltrate (kaposi has lymphatic)

135
Q

endothelial malignany of the skin, less mouth, IG tract, respiratory tract, often mistaken for bacillary angiomatosis

A

kaposi sarcoma
asocaited with HHV 8 and HIV
-has LYMPHOCYTIC infiltrate (vs bacillary angiomatosis has neutophil)

136
Q

benign capillary hemangioma of elderly that does not regress

A

cherry hemangioma

137
Q

cavernous lymphangioma of the neck

A

cystic hygroma

associated with Turners syndrome

138
Q

benign, painful red blue tumors underneath fingernail

A

glomus tumor

-arises from modified smooth muscle cells of the thermoregulatory glomus body

139
Q

polypod capillary hemangioma that can ulcerate and bleed

A

pyogenic granuloma

-associated with trauma and pregnancy

140
Q

benign capillary hemangioma of infancy, how does it grow?

A

strawberry hemangioma

-grows rapidly and progresses spontaneously by 5-8 years old

141
Q

granulomatous infilammation of the media with fragmentation of the interanl elastic lamina in the carotid

A

indicative of large vessel vasculitis

-temporal (giant cell) or Takayasu arteritis

142
Q

pulseless disease

A

takayasu arteritis
-weak upper extremity pulses
fever night seat myalgia ocular disturbances
incrased ESR
granulomatous thickening and narrowing of AORTIC arch

143
Q

granulomatous thickening nad narrowing of AORTIC ARCH

A

takayasu arteritis

-treat with corticosteroids

144
Q

temporal arteriitis

A

focal granulomatous infiltration of the media
elevated ESR
may lead to irreversible blindness due to opthalmic artery occlusion
associated with polymyalgia rheumatica
-most common branches off carotid
temporal artery biopsy

145
Q

polyarteritis nodosa
kawasaki disease
buerger disease

A

medium vessel vasculitis

146
Q

young adult with fever, weight loss, malaise, headache, abdominal pain, melena, HTN, neuro dysfunciton, cutaneous eruptions, renal damage, Hep B+

A

polyarteritis nodosa

  • immune complex mediated transmural inflammationp of medium vessels of arterial wall with fibrinoid necrosis
  • innumeroable renal microaneuryms and spasms
  • treat with corticosteroid and cyclophosphamide
147
Q

conjunctival injection, rash (polymorphous–>desquamating), adenopahty(cervical), strawberry tongue, hand and feet edema/erythema, fever

A

Kawasaki, asian kids under 4
medium vessel vasculitis
-may develop coronary artery aneuryssm
treat with IV ig and aspirin

148
Q

intermittened caludication that may lead to gangrene, superficial phlebitis, raynaud phenomenon

A

buerger disease
thromboangiitis obliterans
-seen in heacy smokers, males <40
autoamputation of digits

149
Q

granulomatosis with polyangiitis
microscopic polyangiitis
esosinophilic granulomatosis with polyangitis
henoch schonlein purpura

A

small vessel vasculitis

150
Q

focal necrotizing vasculitis, necrotizing granulomas in the llung and upper airway, necrotizing glomerulonephritis,

A 
granulomatosis with polyangitis 
pr3ANCA, c ANCA 
upper resp: perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis 
lower resp: hemptysis, cough, dyspnea 
renal: hematuria, red cell casts
151
Q

necrotizing vasculitis lung kidney skin with pauci immune glomerulonephritis and palpable purpura
NO nasopharyngeal involvement

A

microscopic polyangitis
-No granulomas (granulomatosis with polyangitis has granulomas in the lung)
MPO-ANCA/p ANCA (anti myeloperoxidase)

152
Q

astham, sinusitis, skin nodules or purpura, peripheral neuropathy (ie wrist drop)

A

eosinophilic granulomatosis with polyangitis Churg Strauss
-migratory transient pulm infiltates and paranasal sinus
MPO ANCA/p ANCA increase IgE

153
Q

palpapble purpura, athralgia, abd pain

A

henoch schonlein purpura
small vessel vasculitis
follows URI
-secondary to IgA immune ocmplex deposition
associated wtih IgA nephropathy (Berger disease)

154
Q

small cardiac valvular vegetation on either side of valve

A

lipman sachs endocarditis
verrucous endocarditis associated wtih SLE
valvular insiff/embolism

155
Q

mech of hydralizine

A

increases cGMP leading to smooth muscle relaxation

vasodilates arterioles>veins leading to afterload reduction

156
Q

hydralizine toxicity

A 
compensatory tachycardia (contraindicated in angina/CAD), fluid retention, ehadache, 
Lupus Like syndrome
157
Q

dihydropyridine calcium channel blockers

A 
amlodipine 
clevidipine nicardipine 
nifedipine 
nimodipine 
-act on vascular smooth muscle
158
Q

CCB used in hypertensive urgency or emergency

A

clevidipine

159
Q

toxicity of nondihyfropyridines

A

cardiac depression
AV block
hyperprolactinemia (verapimil)

160
Q

toxicity of dihydropyridines

A 
peripheral edema 
flushing 
dizziness 
constipation 
gingival hyperplasia
161
Q

nitroprusside

A

used in hypertensive emergency
short acting, increases cGMP and causes relase of NO
tox: cyanide toxicity give sulfure

162
Q

fenoldopam

A

Dopamine D1 agonist
-cornonary, splanchnic, renal, peripheral vasodilation used in hypertensive emergeny
increases natruresis **

163
Q

nitrates main effect

A

decrease cardiac preload by venous dilation

164
Q

nitroglycerin, isosorbide nitrate, isosorbide mononitrate mech

A

incrase NO in vascular smooth muscle increasing cGMP and decreasing Ca and myosin light chain kinase leading to venous dialtion»>arteriolar dilation

165
Q

toxicity of nitreates

A

reflex tachycardia, hypotension, flushing, headache
“monday disease” due to increased tolerance over the week and loos of tolerance over the weekend
-nitrate free period ie at night prevents tolerance
DO NOT USE WITH eretcile dysfunction meds-PDE2 inhibitors leads to hypotension

166
Q

statins

A

inhibit HMG CoA to mevalonate conversion
-increaase LDL receptors on liver membrane
decrease LDL

167
Q

toxicity of statins

A

hepatotoxicity, myopathy (Esp when used with fibrates-gemfibrozil, clofibrate, bezafibrate, fenofibrate)

168
Q

cholestyramine
colestipol
colesevelam

A

bile acid resins,
prevent intestinal absorption of bile acid-liver must use more cholesterol to make bile acid
decrease LDL, slightly increase triglycerides

169
Q

toxicity of cheolestryamine, colestipol, solesevelam

A

GI upset, decrease absorption of other fat soluble drugs and vitamins, cholesterol component of bile is increases so gallstone formation

170
Q

ezetimibe

A

prevent cholesterol absorption at small intestine brush border
-decreases LDL

171
Q

toxiticty of ezetimibe

A

rare increase in LFTs, diarrhea

172
Q

gemfibrozil
clofibrate
bezafibrate
fenofibrate

A

upregulate LPL and increase triglyceride clearance
activate PPAR alpha to induce HDL suynthesis
decrease triglycerides

173
Q

side effects of gemfibrozil, clofibrate, beafibrate, fenofibrate

A

myopathy (increased risk with statins) and cholesterol gallstones fue to increased cholesterol content of bile salts

174
Q

niacin

A

vit b 3
inhibits lipolysis in adipose tissue and reduces VLDL synthesis
-decreses LDL

175
Q

seide effects of niacin

A

flushing, red, -diminished with pre NSAID treatment
hyperglycemia-increases incsulin resistance
hyperuricemia

176
Q

digoxin

A

inhibits Na/K atpase (get increased Na in the cell and inhibits Na/Ca exchanger) increase Ca in cell–positive inotropy
also stimulates vagus nerve to deacrease HR
-increases contarctility and deacrases conduction at the AV node

177
Q

digoxin toxicity

A 
nausea 
vomitting
diarrhea 
color vision alterations/yello blurry vision 
arrythmias
heart block 
-can lead to hyperkalemia
178
Q

factors predisposing to digoxing toxicity

A

renal faulire
hypokalemia-permissive for digoxin binding at K on NA/K atpase
verapimil
amiodarone
quinidine (decreases digoxin clearance, displaces digoxin from binding sites on tissue)

179
Q

digoxin toxicity antidote

A

oral activated charcoal, treat hyperkalmeia -insulin, kayexalate, dialysis (not calclium gluconate) and dig antibodies

180
Q

class IA antiarrythmics

A 
Disopyramide
Quinidine 
Procainamide
-increase AP duration
-increase effective refractory period 
-increase QT interval 
int phase O depol 
used in both atrial and vent arrythmias, esp re entrant and ectopic SVT/VT
181
Q

side effects of class IA antiarrythmics

A

-cinchonism-headache with tinnitus
-thrombocytopenia
torsades
-heart failure (DIsopyramide)
-reversible SLE syndrome (Procainamide)
quinidine

182
Q

class IB antiarrythmics

A

lidocaine
tocainide
mexiletine
-preferentially affect ischemic or already depolarized purkinje
-decreases AP duration
-weak/no inhibition of phase 0 depol used in acute ventricular arrythmias post MI, digitalis induced arrythmias

183
Q

side effects of class IB antiarrythmics

A

lidocain tocainide mexiletine

-=CNS stimulation depression, cardiovascular depression

184
Q

class IC antiarrythmics

A

flecainide
prpafenone
-shorten AP duration
-increase effective refractory period in AV node and accessory bypass tracts
-strong inhibiton of phase 0 depolarization
used for SVTs, (a fib) and only as a last resort in vts

185
Q

side effects of Class IC antiarrhythmics

A

flecainide
propafenone
-proarrythmic and contraindicated in ischemic heart disease

186
Q

class II anti arrhythmics

A

beta blockers
metropolol
propranolol
esmolol
atenolol
timolol
carvedilol
-decrease SA and AV nodal activity via decrease cAMP–> decrease in Ca–>decreased contractility
-increase PR interval
also decrease slow depol in pacemaker cells
used for : SVT, rate controll for a fib and a flutter

187
Q

toxicity of class II anti arrhythmics

A 
impotence 
COPD exacerbatioun and asthma 
bradycardia, HF, AV block 
sedation
may mask signs of hypoglycemia 
metoprolol-dyslipiemia 
propranolol-can exacerbate vasospam in prinzmetal 
-cannot be given first for pheo/cocaine tox-causes unoopsed alpha 1 stimuation and hypertensive crisis
188
Q

treatment of beta blocker (class II antiarrhythmic) toxicity

A

glucagon (increase cAMP, increase Ca increase contractiility and HR)
atropine
saline

189
Q

class III antiarryhtmics

A 
K channel blockers 
amiodarone 
ibutilide 
dofetilide 
sotalol  
AIDS
selective for vascualr smooth muscle 
-increase AP duration 
-Increase ERP
-increse QT interval 
-no effect on QRS 
used in a fib, a flutter, v tach (amiodarone/sotalol)
190
Q

side effect of Class III anti arrhymthmics (K blockers)

A

Amiodarone

  • PFTs
  • LFTs
  • TFTs
  • acts as hapten-corneal deposits, blue/grey skin deposits (photodermatitis)
  • neuro effects
  • constipation
  • bradycardia, heart block, HF

Ibutilide
-torsades
Stoalol
-torsades, excessive beta blockade

191
Q

class Iv antiarrhythmic

A

ca channel blocker

-decrease conduction velocity
-increase PR interval
-increase ERP
negative inotrope
-used in prevention of nodal arrythmias (SVT), rate control in atrial fibrillation

192
Q

side effects of class IV antiarryhtmics

A 
constipation 
flushing 
edema 
cardiovascualr effects (HF, AV block, sinus node depression)
contraindicated in CHF
193
Q

adenosine

A

push K out of cell amking it hyperpolarized and decrease Ca current into cell
slows AV nodal conduction
-drug of coice for supraventricualr tachycardia
-very shrot acting
-blunted by theophylline and caffeine (adenosine receptor antagonists)
used in chemical stress test

194
Q

adenosine averse effects

A

flushing
hypotension
chest pain
sense of impeding doom

195
Q

Mg2+

A

effective in torsades and dig toxicity

196
Q

milrinon

A

phosphodiesterase inhibitor
increase in cAMP
increase intracell Ca–>increase contractility
IV only

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