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Q2 > CV > Flashcards

CV Flashcards

1
Q

symptoms w/ EXERTION tend to occur w/ > x% stenosis

symptoms w/ REST tend to occur w/ > x% stenosis

A

> 75% (exertion)

> 85% (rest)

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2
Q

what’s the cap thickness that identifies rupture-prone fibrous caps?

A
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3
Q

atheroma (atherosclerotic lesion) consists of (4)

A
  1. cells: smooth muscle cells, chronic inflam cells (mac, lymphocytes)
  2. EMC molecules: collagen, proteoglycans
  3. intra/extracellular lipid deposits
  4. calcific deposits

HETEROGENOUS

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4
Q

ischemia to which wall causes sinus BRADYcardia and AV block?

A

inferior wall MI

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5
Q

cardiogenic shock (

A

when >40% LV infarct

mortality rate: >80%

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6
Q

LV free wall rupture (aMI complication)

A

4-7 days after
macrophages damages the tissue, weakening the wall
at the junction of preserved / infarcted tissue
risk factors: age, female, HT, first MI, poor coronary collateral circulation

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7
Q

acute papillary muscle rupture (aMI complication)

A

inferior MI

posterio-medial papillary muscle (b/c single blood supply from posterior descending artery)

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8
Q

LV aneurysm (aMI complication)

A

wall moves outward during systole (dyskinesis)
very rarely rupture
-> HF, arrythmia

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9
Q

what % of chest pain actually have STEMI?

A

15%

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10
Q

reperfusion: thrombolytics and PCI (percutaneous coronary intervention) should be done within what time of walking into the ED?

A

thrombolytic: within 30 min
angioplasty: within 90 min

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11
Q

“atypical” chest pain: common in which pt pop?

A

elderly, women

weakness, fatigue, heartburn, epigastric distress
RUQ pain (vs left)
nausea

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12
Q

acutely occluded coronary a (acute MI) changes in order

A
  1. metabolic changes (lactic acid)
  2. LV wall motion abnormality
  3. EKG changes
  4. chest pain
  5. enzyme release
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13
Q

Troponin level timeline

A

rise after 2-4 hrs
peak: 24 hrs
normal 7-10 days

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14
Q

CK-MB (creatinine kinase)

A

rise 4-6 hrs

peak: 24 hrs
* normal 72 hrs (3d) after: used to diagnose REINFARCTION

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15
Q

congenital aneurysms (4)

A

Cerebral (berry): circle of willis, r/f: smoking, HT
Marfan syndrome: fibrillin 1
Ehlers Danlos
Fibromuscular dysplasia

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16
Q

order the conduction velocity (slope of phase 0 in pacemaker AP graph): atria, ventricles, purkinje, AV node

A

purkinje > atria > ventricles > AV

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17
Q

what % of myocyte Na+ channels have to be open to go from absolute to relative refractory period?

A

25% Na+ channels have to be open

how many open depends on membrane potential

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18
Q

what % of myocyte Na+ channels have to be open to go from absolute to relative refractory period?

A

25% Na+ channels have to be open

how many open depends on membrane potential

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19
Q

rank the length of refractory period (phase 3): atria, ventricles, skeletal muscle

A

v > a > skeletal muscle

v has the longest refractory period to allow time to squeeze as much blood as possible

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20
Q

3 states of Na+ channel

A

resting (relative refractory period)
activated (open channel)
inactivated (absolute refractory period)

M gate: activation
H gate: inactivation - closed only during absolute refractory period

NaCB only binds during activated and inactivated states (not during resting cause not depolarizing)

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21
Q

what kind of tissue is accessory pathway (bundle of Kent)?

A

muscle tissue. so conduction is faster than via AV node, creating DELTA wave

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22
Q

LVH on EKG

A

tall QRS, “strain” pattern (disconcordant T in lateral leads) QRS widening

  • avL: R > 11mm
  • V5/6: R > 30mm
  • V1 S + V5/6 R > 35mm
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23
Q

what’s the most common cause of palpitation in hts w/ no structural abnormality

A

AVNRTachycardia

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24
Q

1 predictor of SUDDN CARDIAC DEATH & mortality

A

reduced EF

25
Q

mean interval btw MI and SCD in yrs

A

6.5 yrs

26
Q

mild-moderate-severe classes of HF: which class has the greater risk of SCD??

A

MILD

severe die from pump/heart failure, less often from SUDDEn death

27
Q

defib recommended for who?

A

coronary artery disease + EF

28
Q

amiodarone CANT substitute defib to save lives in reduced EF!

A

.

29
Q

Afib

A

AF increaes the risk of stokre by x5 vs no-AF. give warfarin.
these strokes are more deadly than non-AF strokes
the risk of stroke is similar in all types of non-acute AF (paroxysmal = persistent = long standing persitent = permanent)
#1 risk factor: prior CVA (stroke)
most prevalent pathologic arrhytmia
cause 15% of all strokes
thrombosis control, rate control, rhythm control
catheter ablation more effective than drug tx to restore sinus
aflut: ablation is the first-line tx

30
Q

catheter ablation can cure pathologic SVT (supraventricular tachycardia: AVNRT, AVRT, atrial tachy)

A

.

31
Q

differentials for STe

A

LBBB in V1 w/ wide QRS
hyperkalemia (missed dialysis)
pericarditis: in all leads w/ PR depression

aMI: “tombstone appearance”

32
Q

LBBB sign of MI which part of heart

A 
anterior/septal MI 
wide QRS
bunny ears anywhere 
look at V1 
- negative QRS: LBBB
- positive QRS: RBBB
33
Q

acute coronary syndrome (unstable angina, aMI, sudden death) due to rupture w/ x% stenosis?

A
34
Q

arteries affected by atherosclerosis in order

A

coronary > abdominal aorta > coronary arteries > popliteal > carotid

35
Q

bilateral shoulder pain is 2x more likely to be an MI than to 1 shoulder. heart problem until proven otherwise

A

.

36
Q

what is the biggest contributor to pulmonary edema (dyspnea, congestion symptoms)?

A

LVEDP

left ventricular end-diastolic pressure (due to high volume of blood in LV at ED)

37
Q

HF pts have pathologic range of what endogenous molecules (3)

A

NE (independent predictor of hospitalization & lifespan of HF pts)
AT II
Aldosterone

38
Q

what hormone cause LVH?

A

ATII increases growth factor

39
Q

cardiac amyloidosis

A

in restrictive cardiomyopathy
infiltrative in the interstitium
non-braching extracellular fibrils, homogenous waxy material in the insterstitium, congro red, apple green birefringence

40
Q

3 most common causes of cardiomyopathy/HF

A

coronary artery disease (MI), HT, idiopathic

41
Q

reversible cardiomyopathy (HF)

A

tachyarrhythmias
toxins (alcohol, cocaine)
thyroid problem

42
Q

what is the single largest expense for MEDICARE

A

heart failure

43
Q

s/s of HF

A

orthopnea (specific, less sensitive): can’t breath laying flat
pulsus alternans, rales, heart sound (s3)

44
Q

Marfan syndrome

A

mutation in fibrillin 1 (elastic tissue of medial wall)
autosomal dominant on chormosome 15
ascending aortic aneurysm -> aortic dissection, mitral regurgetation

45
Q

risk factors for aortic dissection (3)

A

HT, bicuspid aortic valve, Marfan

NOT inflammation (aortitis)

46
Q

approaches to vasculitis

A 
radiographic studies (angiogram) 
BIOPSY is definitive
47
Q

fibromuscular dysplasia

A

congenital cause of aneurysm

  • “string of beads”: renal artery, young women
  • dev defect of bv wall → irregular thickening of large/medium arteries
  • causes HT
48
Q

Fiedler’s myocarditis

A

Giant cell myocarditis: giants cells w/ lots of necrosis -> rapidly fatal
autoimmune (unknown cause)
young adults 20-50yo

49
Q

Toxic myocarditis

A

cause: catecholamines, chemo (Adriamycin: breast cancer chemo)
neutrophils, contraction bands

50
Q

Loeffler syndrome

A

endomyocardial fibrosis w/ eosionphilic infiltrate

-> restrictive cardiomyopathy

51
Q

for pts w/ normal lipid levels, repeat screening how often

A

5 yrs

52
Q

ATIII risk factors (3)

A

cigs
HT (140/90 or on HT med)
family history of premature CHD (M 45, F >55)
low HDL

53
Q

22q11.2 Deletion
DiGeorge Syndrome
(Velacardiofacial syndrome)

A

CHD in 75-80%
TOP, interrupted aortic arch, truncus arteriosus, VSD, arch anomalies
50% chance of transmission to offspring - screen for deletions!

54
Q

TIMI risk factors

A

age, DM, HT, angina
SBP (hypotension?), HR, weight
anterior STE, LBBB
time to Rx

vs HEART: history, EDG, age, risk factors, troponin

55
Q

early management of acute STEMI

A

relief of ischemic pain: nitrates, morphine
assessment/correction of hemodynamics (BP)
initiation of reperfusion (give fluids)
antithrombotic/fibrinolytic therapy
Beta-blockers
prevent recurrent ischemia/arrhythmia
O2 if hypoxic
anti-plts: aspirin, cloidogrel, abciximab/eptifibatide

56
Q

PCI indication

A

acute STEMI (

57
Q

indication for thrombolytics

A

only within 4 hrs of onset

58
Q

contraindication of thrombolytics

A 
dissection/tamponade 
ACTIVE GI/internal bleeding 
anything to do w/ head 
bleeding disorder (incl. thrombocytopenia) 
HT >180/100
metastatic cancer

torsade (Can’t perfuse)
after defibullator

59
Q

if STe in V4

A

RV failure (due to MI)

Q2 (6 decks)

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