cards Flashcards
decreased femoral to brachial blood pressure ratio
coarctation of the aorta
fixed wide splitting of S2
in patients with ASD
-
precordial continuous machine-like murmur that occurs both in systole and diastole
patent ductus arteriosus
bifid carotid pulse with brisk upstroke (sike and dome)
hypertrophic obstructive cardiomyopathy
-left entricular outflow tract obstruction during sytole
holosysolic murmur that is loudest over the left mid sternal border
VSD
which organ is least vulnerable to infgarction
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
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
kawasaki
-strawberry tongue seen in scarlet fever as well but persistent fever and bilateral conjunctivitis more suggestive of kawasaki
exertional dyspnea, lower extremity edema and hoarseness
ortner syndrome-mitral stenosis leading to rleft atrial enlargment that compresses the left recurrent laryngeal nerve
skin and mucosal telangiectasia with recurrent nosebleeds
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
segmental, transmural, necrotizing inflammation of medium to small sized arteries
polyarteritis nodosa
renal involement is oftenprominent
-lung rarely involved
1/3 have palpable purpura
best indicator of degree of mitral stenosis
A2-Os interval
-sshorter interval=more severe stenosis
truncus arteriosus gives rise to
ascending aorta and pulmonary trunk
bulbus cordis gives rise to
smooth parts (outflow tracts) of left and right ventricles
left horn of sinus venosus gives rise to
coronary sinus
right horn of sinus venosus
smooth part of right atrium
right common cardinal vein and right anterior cardinal vein
superior vena cava
failure of septum primum and septum secundum to fuse after birth
patent foramen ovale
defects resulting from abnormal neural crest cell migration to truncus/bulbus
transposition of the great vessles, tetralogoy of fallot, persistent truncus arteriosus
vitelline forms what vein
portal system veins
cardinal forms waht vein
systemic veins
what part of the aorta is most susceptible to injury in BAT
isthmus of the aorta (tethered to ligamentum arteriosum)
between l subclavian branch and where pul artery crosses over
fetal erythropoiesis occurs in
Young Liver Synthesizes Blood Yolk sac (3-8weeks) Liver (6 weeks-birth) Spleen (10-28 weeks) Bone Marrow (18weeks to adult)
3 fetal shunts
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
how does foramen ovale close
breath–>decrease pulm resistance–>increase LA pressure vs RA–> closure of foramen ovale
how does ductus arteriosus close
increase O2 in baby and decrease prostaglandin from placental separation leads to closure of ductus arteriosus
fossa ovalis
remnant foramen ovale
nuclues pulpulsus comes from
notochord
medial umbilical ligament comes from
umbilical arteries
ligamented teres heaptis
is contained in falciform ligament and si derived from the umbilical vein
V1 V2 V3 V4
left anterior descending artery
interventricualar septum of anterior wall
V5 V6 I aVL
left circumflex (lateral wall of lateral ventricle)
II III aVF
posterior descending artery
-branch off right main in 80% of ppl
right marginal
supples right ventricle
pulse pressure is proportional to….. and inversely proportional to….
pulse pressure is proportional to SV and inversely proportional to arterial compliance
TPR highest in
arterioles
highest total cross sectional area with lowest flow velocity
capillaries
organ removal effect on hemodynamics
increases TP and decreases CO
how are cardiac myocytes electrically coupled to each other?
gap junctions
what are If channels
create automaticity in pacemaker cells, mixed Na/K current leading to slow depolarization
what determines HR in pacemaker cells?
slope of phase 4 (If current)
speed of conduction fastest to slowest
Purkinje (fastest)
atrial muscle
ventricular muscle
AV node (slowest)
AV node blood supply
RCA
long QT with sensorineural deafness
jervell and lange nielsen syndrome
autosomal recessive disorder of myocardial repolaization
-deacreased outward K-syncope, sudden cardiac death, torsades
brugada syndrome
psuedo RBBB with ST elevations in V1-3
increased risk for ventricular tachyarryhtmia and SCD
tx: implantable cardiac defribillator
abnromal fast accessory pathway bypassing the AV node leading to premature ventricular depolarization
wolf parkinson white syndrome
-characteristic delta wave with wide QRS and shortened PR interval
may result in reentrant circuit with supraventricular tachycardia
first degree heart block
prolonged PR interval
benign and asymptomatic, no treatment necessary
progressive PR lengthening until a beat is dropped -p with no subsequent QRS
2nd degree Mobitz type I
-regularly irregular
dropped beats that are not preceded by a change in length of the PR interval
Mobitz type II
-may progress to 3rd degree block
pacemaker may be indicated
atria and ventricles beat independently of one another, faster atrial rate than ventricualr rate
3rd degree complete heart block
may be caused by Lyme disease
ANP/BNP
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
aortic arch baroreceptor
aortic arch–>vagus–>solitary nucleus of medulla
carotid sinus baroreceptor
carotid bifurcation–>glossopharyngeal nerve–>solitary nucleus of medulla
central chemoreceptors do not respond directly to
PO2
failure of aorticopulmonary septum to form
truncus arteriosus
-most have VSD
failure of the aorticopulmonary septum to spiral
transposition of the great vessels
-requires surgical intervention
anteriorsuperios displacemnt of the infundibular septum
tetralogy of fallot
- pulm stenosis
- RVH
- overriding aorta
- VSD
mst common congenital heart defect
VSD
ostium primum
rarer ASD; associated with Down’s syndrome
usually involve other cardiac abnormalities
-celft in anterior leaf of MV or septal leaf of TV
ostium secdundum
are more common ASD defects and usually isolated
differential cyanosis
cyanosis in lower extremities, PDA
hypertension in upper extremities and weak delayed pulse in lower extremities
coarctation of the aorta
bicuspid aortic valve
accelerates normal aging-premature calcific aortic stenosis
cardiac anomaly in infant of diabetic mother
transposition of the great vessels
marfan syndorme associated with
MVP, thoracic aortic aneurysm and dissection, aortic regurgitation
prenatal lithium exposure
ebstein anomaly
turner sndrome
coarctation fo the aorta, bicuspid aorti c valve
williams syndrome
supravalvular aortic stenosis
22q11 syndromes
truncus arteriosus, tetralogy of fallot
fetal alcohol syndrome
VSD, PDA, ASD, tetralogy of fallot
corneal arcus
lipid deposit in cornea
xanthoma
plaque or nodule of lipid laden histiocytes in skin -xanthelasma -in eyelid
tendinous xanthoma
lipid deposit in tendon-especially achilles
hyaline arteriosclerosis
in essential hypertension or diabetes
concentric onion skinnning/hyperplastic arteriosclerosis
in malignant hypertension
decreased left chamber size, sigmoid shaped ventricular septum with accumulation of alpha lipfiscin in cytoplasm
normal aging
athersclerosis most commonly effects
abdominal aorta>coronary artery> popliteal artery>carotid artery >circle of willis
cystic medial degeneration aneurysm
thoracic aneurysm, fragmentation of the elastic tissues-sepration of the components of the tunica media
-rf: HTN, marfan, tertiary syphilis
atherosclerotic aneurysm most commonly found in the
abdominal aorta
consumption of beta aminoproprionile (found in sweet peas)
get blockade of lysyl oxidase and unefficient crosslinking of elastin fibers leading to marfan like myxomatous degeneration
most common cause of mitral stenosis
rheumatic fever
most common cause of MVP
myxomatous degeneration
most common cause of mitral regurg
post MI or complication of MVP
most common cause of aortic stenosis
age related calcificaiton or congenital bicuspid valve, can also be caused by rheumatic fever only if pt has has MS
ischemic precondition
increase resistance to ischmeia gained with prior repeated exposure to protect against future greater insults
myocyte hibernation
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)
myocyte stunning
less severe form of hibernation with brief ischemia repurfiusion episodes
longitundinal intima tear
aortic dissection
-associated wtih hypertension, bicuspid valve, marfan
ST elevations at rest with angina
prinzmetal (variant) angina due to vasospasm-can be caused by tobacco, cocaine, triptans
ergononne test
alpha adrenergic given causes vasocontriction and induces cornoary vasospasm-a way to diagnose printzmetal vasospasm
+/- ST depression and or T wave inversio nbut no increase in cardiac biomarkers
unstbale angina
STEMI or NSTEMI with elevated cardiac biomarkers
MI
- STEMI transmural
- NSTEMI subendocardial
sudden cardiac death most commonly due to
arrythmia-ventricular fibrillation
commonly occluded cornoary artery
LAD>RCA>circumflex
edema, hemorrhage, wavy fibers, contraction bands
first 4-24 hrs post MI
formation of granulation tissue post MI
day 10 after macrophags have come (day 3) in and phagocytosed all of the necortic cells
pericarditis post MI
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
arrythmia, HF, cardiogeneic shock
biggest complication within first day post MI
ventricular free wall rupture post MI
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
true ventricular aneurysm post MI
2 weeks post MI, due to fibrosis , outward bulge during contraction associated with fibrosis
granulation tissue at margins post MI
beigns at day 10
colagen deposition/scar formation post Mi
begins 2 weeks to several months
at risk for dressler syndrome and true aneurysm formation
autoimmune phenomenon resutling in fibrinous pericarditis
Dressler syndrome
-fever, pleuritis, leukocytosis, pleural/pericardial effusions
pulseless electrical activity
free wall rupture
diagnosing MI
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)
CK-MB
used for diangosing reinfat
troponin levels may remain elevated for 7-10 days and are not accurate for reinfarction
type of collagen in cardiac scar tissue
Type I collagen
causes of dilated cardiomyopathy
ABCDE alcohol abuse wet Beriberi Chagas Coxsackie B virus Cocaine Doxorubicin also -peripartum -hemochromatosis
S3, balloon appearance on CXR
dilated cardiomyopathy, systolic dysfucntion
-swelling of sarcoplasmic reticulum followed by loss of myocardiocytes=myofibrillar dropout
mitral regurgitation, S4, systolic murmur
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
asymmetric septal hypertrophy and systolic anterior motion of mitral valve
obstructive hypertrophic cardiomyopathy
edomyocardia fibrosis with a prominent eosinophilic infiltrate
loeffler syndrome
a type of restrictive/infiltrative cardiomyopathy
causes of restictive cardiomyopathy
sarcoid, amyloidosis, hemachromatossis (also dilated) loeffler, postradiation fibrosis
low voltage EKG with nm EF and decreased LVEDV
restrictive cardiomyopathy
increased JVP, kussmaul sign (increased JVP with inspr) pericardial knock, pulsus paradoxus
chronic constrictive pericarditis
hemosiderin laden macrophages
“heart fialure cells”
leaky capillary in pulm vasculature and subsequent macrophage phagocytosis leads to accumulation of macrophages with iron in cytoplasm
Prussian Blue +
coronary sinus dilation
sign of pulmonary HTN
-cornoary veins through cornary sinus and rain into RA, if flow obstructed they dilate
fever, new murmur, Roth spots, janeway lesion, osler nodes, glomerulonephritis, splinter hemorrhae, septic arterial or pulmonary emboli
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
culture negative endocarditis
bartonella, coxiella (1), mycoplasma, histoplasma, chlamydia,
HACEK
Haemophilus Actinobacilliu Cardiobacterium Eikenela Kingella
aschoff bodies
granuloma with gian cells in rheumatic fever
anitschkow cells
enlarged macrophages with ovoid wavy rod like nucleus
what type of reaction is rheumatic fever
Type II hypersensitivty
-not direct effet of the bacteria
antibodies to M protein corss react with slef antigen-moleuclar mimicry
sharp pain aggravated by breathing in and relieved by sitting up and forward
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
fibrous intimale thickening with right endocardial plaques associated with nausea, vomiting, flushing, diarrhea, abd cramping
carcinoid syndrome
-check urine 5 HIAA
hypotension, distended neck veins, distant heart sounds
beck triad for
cardiac tamponade
-incrased HR, pulsus paradoxus,
equilibriuation of diastolic pressures in all 4 chambers,
ECG: low voltage QRS and electircl alternans
cardiac tamponade
pulsus paradoxus seen in
cardiac tamponade, chronic pericarditis, asthma, obstructive sleep apnea, croup
pulus parvus et tardus
pulse of low magnitude with delayed pulse
-seen in aortic stenosis
dicrotic pulse
pulse with 2 peaks in systole and one peak in diatole-seen with sever systolic dysfucntion
disruption of the vasa vasorum of the aorta with atrophy of the vessel wall and dilatation of aorta and valve ring
seen in syphilic heart disease
-can result in aortic aneurysm or aortic insufficiencey
tree bark appearance of aorta
pedunculated gelatinous mass in LA
myxoma
- leads to valve obstruction causing positional dyspnea, syncopal episodes
- mid diastolic rumble at apex
most frequent primary cardiac tumors in children
rhabdomyoma
associated with tuberous sclerosis
vinyl chloride and arsenic exposure associated wtih
hepatic angiosarcoma
-rare blood vessel malignancy
radiation therapy and chronic post mastectomy lymphedema assocaited wtih
lymphangiosarcoma
benign capillary skin papules commonly mistaken for Kaposi sarcome
bacillary angiomatosis caused by bartonella henselae in AIDS pts
has NEUTROPHIL infiltrate (kaposi has lymphatic)
endothelial malignany of the skin, less mouth, IG tract, respiratory tract, often mistaken for bacillary angiomatosis
kaposi sarcoma
asocaited with HHV 8 and HIV
-has LYMPHOCYTIC infiltrate (vs bacillary angiomatosis has neutophil)
benign capillary hemangioma of elderly that does not regress
cherry hemangioma
cavernous lymphangioma of the neck
cystic hygroma
associated with Turners syndrome
benign, painful red blue tumors underneath fingernail
glomus tumor
-arises from modified smooth muscle cells of the thermoregulatory glomus body
polypod capillary hemangioma that can ulcerate and bleed
pyogenic granuloma
-associated with trauma and pregnancy
benign capillary hemangioma of infancy, how does it grow?
strawberry hemangioma
-grows rapidly and progresses spontaneously by 5-8 years old
granulomatous infilammation of the media with fragmentation of the interanl elastic lamina in the carotid
indicative of large vessel vasculitis
-temporal (giant cell) or Takayasu arteritis
pulseless disease
takayasu arteritis
-weak upper extremity pulses
fever night seat myalgia ocular disturbances
incrased ESR
granulomatous thickening and narrowing of AORTIC arch
granulomatous thickening nad narrowing of AORTIC ARCH
takayasu arteritis
-treat with corticosteroids
temporal arteriitis
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
polyarteritis nodosa
kawasaki disease
buerger disease
medium vessel vasculitis
young adult with fever, weight loss, malaise, headache, abdominal pain, melena, HTN, neuro dysfunciton, cutaneous eruptions, renal damage, Hep B+
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
conjunctival injection, rash (polymorphous–>desquamating), adenopahty(cervical), strawberry tongue, hand and feet edema/erythema, fever
Kawasaki, asian kids under 4
medium vessel vasculitis
-may develop coronary artery aneuryssm
treat with IV ig and aspirin
intermittened caludication that may lead to gangrene, superficial phlebitis, raynaud phenomenon
buerger disease
thromboangiitis obliterans
-seen in heacy smokers, males <40
autoamputation of digits
granulomatosis with polyangiitis
microscopic polyangiitis
esosinophilic granulomatosis with polyangitis
henoch schonlein purpura
small vessel vasculitis
focal necrotizing vasculitis, necrotizing granulomas in the llung and upper airway, necrotizing glomerulonephritis,
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
necrotizing vasculitis lung kidney skin with pauci immune glomerulonephritis and palpable purpura
NO nasopharyngeal involvement
microscopic polyangitis
-No granulomas (granulomatosis with polyangitis has granulomas in the lung)
MPO-ANCA/p ANCA (anti myeloperoxidase)
astham, sinusitis, skin nodules or purpura, peripheral neuropathy (ie wrist drop)
eosinophilic granulomatosis with polyangitis Churg Strauss
-migratory transient pulm infiltates and paranasal sinus
MPO ANCA/p ANCA increase IgE
palpapble purpura, athralgia, abd pain
henoch schonlein purpura
small vessel vasculitis
follows URI
-secondary to IgA immune ocmplex deposition
associated wtih IgA nephropathy (Berger disease)
small cardiac valvular vegetation on either side of valve
lipman sachs endocarditis
verrucous endocarditis associated wtih SLE
valvular insiff/embolism
mech of hydralizine
increases cGMP leading to smooth muscle relaxation
vasodilates arterioles>veins leading to afterload reduction
hydralizine toxicity
compensatory tachycardia (contraindicated in angina/CAD), fluid retention, ehadache, Lupus Like syndrome
dihydropyridine calcium channel blockers
amlodipine clevidipine nicardipine nifedipine nimodipine -act on vascular smooth muscle
CCB used in hypertensive urgency or emergency
clevidipine
toxicity of nondihyfropyridines
cardiac depression
AV block
hyperprolactinemia (verapimil)
toxicity of dihydropyridines
peripheral edema flushing dizziness constipation gingival hyperplasia
nitroprusside
used in hypertensive emergency
short acting, increases cGMP and causes relase of NO
tox: cyanide toxicity give sulfure
fenoldopam
Dopamine D1 agonist
-cornonary, splanchnic, renal, peripheral vasodilation used in hypertensive emergeny
increases natruresis **
nitrates main effect
decrease cardiac preload by venous dilation
nitroglycerin, isosorbide nitrate, isosorbide mononitrate mech
incrase NO in vascular smooth muscle increasing cGMP and decreasing Ca and myosin light chain kinase leading to venous dialtion»>arteriolar dilation
toxicity of nitreates
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
statins
inhibit HMG CoA to mevalonate conversion
-increaase LDL receptors on liver membrane
decrease LDL
toxicity of statins
hepatotoxicity, myopathy (Esp when used with fibrates-gemfibrozil, clofibrate, bezafibrate, fenofibrate)
cholestyramine
colestipol
colesevelam
bile acid resins,
prevent intestinal absorption of bile acid-liver must use more cholesterol to make bile acid
decrease LDL, slightly increase triglycerides
toxicity of cheolestryamine, colestipol, solesevelam
GI upset, decrease absorption of other fat soluble drugs and vitamins, cholesterol component of bile is increases so gallstone formation
ezetimibe
prevent cholesterol absorption at small intestine brush border
-decreases LDL
toxiticty of ezetimibe
rare increase in LFTs, diarrhea
gemfibrozil
clofibrate
bezafibrate
fenofibrate
upregulate LPL and increase triglyceride clearance
activate PPAR alpha to induce HDL suynthesis
decrease triglycerides
side effects of gemfibrozil, clofibrate, beafibrate, fenofibrate
myopathy (increased risk with statins) and cholesterol gallstones fue to increased cholesterol content of bile salts
niacin
vit b 3
inhibits lipolysis in adipose tissue and reduces VLDL synthesis
-decreses LDL
seide effects of niacin
flushing, red, -diminished with pre NSAID treatment
hyperglycemia-increases incsulin resistance
hyperuricemia
digoxin
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
digoxin toxicity
nausea vomitting diarrhea color vision alterations/yello blurry vision arrythmias heart block -can lead to hyperkalemia
factors predisposing to digoxing toxicity
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)
digoxin toxicity antidote
oral activated charcoal, treat hyperkalmeia -insulin, kayexalate, dialysis (not calclium gluconate) and dig antibodies
class IA antiarrythmics
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
side effects of class IA antiarrythmics
-cinchonism-headache with tinnitus
-thrombocytopenia
torsades
-heart failure (DIsopyramide)
-reversible SLE syndrome (Procainamide)
quinidine
class IB antiarrythmics
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
side effects of class IB antiarrythmics
lidocain tocainide mexiletine
-=CNS stimulation depression, cardiovascular depression
class IC antiarrythmics
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
side effects of Class IC antiarrhythmics
flecainide
propafenone
-proarrythmic and contraindicated in ischemic heart disease
class II anti arrhythmics
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
toxicity of class II anti arrhythmics
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
treatment of beta blocker (class II antiarrhythmic) toxicity
glucagon (increase cAMP, increase Ca increase contractiility and HR)
atropine
saline
class III antiarryhtmics
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)
side effect of Class III anti arrhymthmics (K blockers)
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
class Iv antiarrhythmic
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
side effects of class IV antiarryhtmics
constipation flushing edema cardiovascualr effects (HF, AV block, sinus node depression) contraindicated in CHF
adenosine
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
adenosine averse effects
flushing
hypotension
chest pain
sense of impeding doom
Mg2+
effective in torsades and dig toxicity
milrinon
phosphodiesterase inhibitor
increase in cAMP
increase intracell Ca–>increase contractility
IV only
