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Cardiovascular: 4/12-4/15 > CV- FA > Flashcards

CV- FA Flashcards

1
Q

C-ANCA targets what? what about P-ANCA?

A

C-ANCA: neutrophil proteniase 3

P-ANCA: neutrophil myeloperoxidase

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2
Q

weak pulse, fever, night sweats, myalgia, ocular disturbances. Diagnosis?

A

Takayasu

  • Takayasu: PULSLESS disease
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3
Q

Rapid acting beta blokcer?

A

esmolol

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4
Q

Brugada syndrome

  • inheritance pattern
  • most commonly affected group
  • ECG findings
A
  • autosomal dominant
  • asian male
  • ST elevation on V1-V3, pseudo right bundle branch block
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5
Q

Aortic stenosis vs. Aortic regurgitation: at which location is murmur heard?

A
  • AS: aortic area, RIGHT 2nd intercoastal
  • AR: LEFT sternal border, 3rd/4th intercoastal
  • this rule applies same for PS and PR
  • PS: pulmonic area, LEFT 2nd intercoastal
  • PR: left sternal border
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6
Q

Three heart manifestations of Marfan

A
  • Aortic dissection
  • Thoracic aortic aneurysm
  • MVP
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7
Q

What is dextrocardia?

A

Heart in right side of chest

Kartgener syndrome

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8
Q

Ranolazine

  • MOA
  • indication
  • major side effect
A
  • inhibit late stage Na+ channel -> decrease wall tension, no effect on contractility or HR
  • refractory angina
  • QT prolongation
  • BUT does NOT cause Torsades (this is UWORLD question)
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9
Q

BNP (B type natriuretic peptide)

  • where is it released? in response to what?
  • How is it used clinically
  • What is name of recombinant form?
A
  • BNP is released from VENTRICLE in response to increased VENTRICULAR TENSION (HF)
  • BNP test can be used for HF diagnosis.
    Very good NEGATIVE predictive value, meaning
    negative BNP test means no HF (ruling out)
  • HF -> increased ventricular volume -> increased BNP
  • Nesiritide (recombinant form) can be used for HF patient
  • diuresis -> reduce congestion
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10
Q

MI diagnosis

  • what is gold standard for first 6 hrs
  • troponin I
  • CK-MB
A
  • ECG gold standard for first 6 hrs
  • Troponin I: specific, peaks at 24 hrs, last 7-10 days
  • CK-MB: less specific, peaks at 16-24 hrs, last only for two days => useful for re-infarction
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11
Q

Pt with osteopenia wants to avoid development of osteoporosis. what lipid lowering drug should be avoided?

A

cholestyramine

GI upset and malabsorption of fat soluble viatamins
-> less vitamin D -> less Ca2+ absorption

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12
Q

Kussmaul signs vs. Kussmaul respiration

  • how is it different?
  • example for each? 3 for Kussmaul signs and 1 for Kussmaul repisration
A
  • Kussmaul sign: increase in JVP in respiration, meaning that there is defect in heart filling
    => constrictive heart pathology
    1. pericarditis
    2. cardiac temponade
    3. RA or RV tumors (bulky tumors inhibiting filling)
  • Kussmaul respiration:
    rapid/deep breathing= hyperventilation
    seen in DKA
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13
Q

Three drugs that increase digoxin toxicity? by what mechanism?

A
  • Quinidine
  • Amiodarone
  • Verapamil

Decrease renal clearance of digoxin

  • Antiarrythmics; 1A, 3, 4
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14
Q

Hydralazine is co-administered with what drug? why?

A

to prevent reflex tachy, beta blocker is given

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15
Q

Contraindications for hydralazine? why?

A

angina and CAD
reflex tachy will overload heart

  • hydralazine is normally indicated for
  • hypertension
  • HF
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16
Q

Triad of Cushing reaction? explain why

A
  • hypertension
  • bradycardia
  • respiratory depression

increased ICP -> CNS vascular constriction

  • > brain ischemia -> pCO2 -> central chemoreceptor to increase perfusion-> increased blood pressure
  • > increased blood pressure sensed by baroreceptor
  • > reflex bradycardia and respiratory depression
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17
Q

What cardiac condition show PR depression on ECG?

A

pericarditis (I have no fucking clue)

In pericarditis, widespread ST elevation will be also seen

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18
Q

Describe how cardiac output is changed over the course of exercise

  • early phase
  • late phase
A
  • early phase: both HR and SV increases
  • late phase: only HR is increased, while SV stays constant
  • SV plateaus
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19
Q

What does inverted T wave on ECG mean?

A

recent MI

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20
Q

What two heart sounds are present in dilated cardiomyopathy? explain

A
  • Systolic regurgitant murmur: dilated ventricle, blood flows back to atrium during systole
  • S3: same reason of regurgitant murmur. Dilated ventricle, blood flows back to atrium during systole. In next round of filling, extra blood in atrium makes S3 sound
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21
Q

What causes closure of foramen ovale after birth?

A

increased LA pressure

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22
Q

Which two beta blockers are safe for treating pheocytochroma? Why?

A

carvedilol and labetalol

  • these are non-selective alpha and beta blocker.

Other beta blockers are not safe for pheo, as selective beta blockade can result in unopposed alpha stimulation.

  • Pheocytochroma is treated with alpha antagonist first (Phenoxybenzamine, irreversible alpha antagonist), followed by beta blocker (non-selective) to suppress reflex tachy
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23
Q

An infant is found to have a PDA and tetralogy of Fallot at birth. What treatment would you recommend until surgery is possible?

A

Prostaglandins E1 and E2 to keep PDA opened

=> Keeping PDA opened will reduce pulmonary stenosis effect in tetralogy of Fallot

*this is also true for transposition of great vessels. keeping PDA opened will allow communication between pulmonary artery and aortic artery.

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24
Q

Which class of antiarrhythmics can be used to treat digitalis (digoxin) induced arrythmia?

A

class 1B

  • class 1B is also used for post MI ventricular arrythmia
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25
Q

Tricuspid pressure wave- x descent and y descent

  • in which condition is X descent prominent? what about the condition where X descent is absent?
  • in which condition is y descent prominent? what about the condition where y descent is absent?
A
  • prominent x descent
    1. tricuspid valve insufficiency: blood leaking into ventricle, more dramatic decrease in x descent
    2. right HF: less RV pressure, more downward shift of tricuspid valve leaflet
  • absent x descent: tricuspid valve regurgitation
  • prominent y descent: constrictive pericarditis
    => more squeezing, more RA emptying into RV
  • absent y descent: cardiac temponade
    => less RA blood initially, thus less RA emptying into RV
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26
Q

Familial hypertrophic cardiomyopathy

  • inheritance pattern
  • what gene is associated?
A
  • autosmal dominant

- beta-myosin heavy chain mutation

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27
Q

cyanotic lower extremities, while upper extremities are normal. diagnosis?

A

PDA
: PDA inserts into aorta after 3 branches for upper extremities and brain

  • this is called differential cyanosis
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28
Q

Ebstein anomaly: explain how tricuspid is messed up

A

tricuspid VALVE DISPLACEMENT

: valve leaflets DOWNWARD into RV, atrializing ventricle

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29
Q

Explain histologic finding on Buerger disease

A

segmental THROMBOSING vasculitis

  • way to remember: another name for Buerger is thromboangitis obliterans. so THROBOSING
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30
Q

ECG finding of atrial fibrillation?

A

no p wave, irregular RR interval

FA p.278

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31
Q

Define Monckeberg sclerosis

A

calcification in MEDIA and INTERNAL ELASTIC LAMINA

intima NOT affected. Thus, NO OBSTRUCTION (clinically silent). just vascular stiffening.
X-ray: calcified blood vessels

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32
Q

Which pressure parameter is useful for estimating preload?

A

PCWP (also good indicator of LA pressure)

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33
Q 
Which coronary arteries are susceptible to obstruction? 
( from most likely to least likely)
- circumflex
- left anterior descending
- right coronary artery
A

LAD >RCA > circumflex

  • this makes sense: the bigger artery is, the more likely it is going to be obstructed.`
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34
Q

What two congenital heart defects are associated with DiGeorge syndrome?

A
  • truncus arteriosus

- tetralogy of Fellot

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35
Q

Which nucleus of medulla receives vagus nerve signal from aortic baroreceptor?

A

solitary nucleus

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36
Q

What step in embryology is impaired in

  • tetralogy of Fellot
  • transposition of great vessels
  • truncus arteriosus
A
  • tetralogy of Fellot: deviation of intrafundibular septum
  • transposition of great vessels: impaired spiraling of aorticopulmonary septum
  • truncus arteriosus: absence of aorticopulmonary septum
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37
Q

List all vasculitis that show granuloma

A
  • giant cell
  • takayasu
  • wegner (granulomatosis with polyangitis)
  • churg-strauss (eosiniphilic granulomatosis with polyangitis)
  • note that none of medium sized vasculitis (PAN, kawasaki, buerger) show granuloma
38
Q

ECG finding in cardiac temponade?

A

low voltage QRS with electrical alterations (heart swinging within pericardial fluid)

39
Q

Which ion can be infused to reverse digoxin toxicity?

A

Mg2+

40
Q

Dihydropyridine (amlodipine) side effect on mouth?

A

gingival hyperplasia

41
Q

What is direct effect of ANP on renal tubule?

A

it inhibits Na+ reabsorption

*also vasodilation in general

42
Q

Compare order of pacemaker rates of

  • SA node
  • AV node
  • bundle of His/Purkinje/ventricles
A

SA > AV> bundle of His/Purkinje/ventricles

  • this is pacemaker rates, not conduction rate
  • this makes sense that bundle of His/Purkinje/ventricles rarely (or very slowly) produce own pacemaker
43
Q

Right sided HF may show what finding in physical exam?

A

hepatomegaly (nutmeg liver)

may also show cardiac cirrhosis (rare, extreme case)

44
Q

In patient with aortic stenosis, how splitting is affected during inspiration?

A

aortic stenosis -> LEFT SIDE problem -> pardoxical

PARADOXICALLY, inspiration DECREASES split time

45
Q

How does valvular defect changes in rheumatic fever over time?

A

early lesion: mitral regurgitation

late lesion: mitral stenosis (kinda like old and tear principle)

46
Q

maternal diabetes. what congenital heart defect?

A

transposition of great vessels

47
Q

What general condition results in decreased pulse pressure? examples (4)?

A

decreased blood pumped by LV

  • aortic stenosis
  • cadiogenic shock
  • HF
  • cardiac temponade
48
Q

What condition results in increased pulse pressure? examples?

A

aortic regurgitation

blood flowing back during systole, resulting in great decrease in diastolic pressure

49
Q

What is Williams syndrome? what congenital cardiac defect is associated with it?

A

“elfin” facial characteristics and exhibits an unusually cheerful demeanor

supravalvular aortic stenosis

50
Q

ECG findings in

  • subendocardial infarction
  • transmural infarction
A
  • subendocardial infarction: ST depression

- transmural infarction: ST elevation

51
Q

How is cardiac contractility affected by metabolic acidosis?

A

decreased

  • this makes sense: acidosis -> more H+ into cell, more K+ pumped out to cell -> prolonged hyperpolarized state
52
Q

Patient with hypertension in upper extremities and weak pulses in lower extremieties. What imaging study will be helpful? why

A

chest x-ray for notched ribs

aortic coarctation -> blood back up and collateral arteris erdode ribs

53
Q

Signs of atrial fib is noticed on ECG. What medication is promptly needed? why?

A

warfarin: LONG TERM anticoagulation

a fib, predisposes to cardiac embolism (stasis), which leads to systemic embolism (may be fatal embolic stroke)

54
Q

most common infection in culture negative bacterial endocarditis?

A

coxiella burnetii (most common)

also HACEK
H- Hemophilus
A- Aggregatibacter
C- Cardiobacterium
E- Eikenella
K- Kingella
55
Q

How is pressure-volume loop is affected with increased contractility?

A

increased contractility means stronger squeezing force.

=> less ESV (end systolic volume)

56
Q

first line for supraventricular tachy?

A

adenosine

57
Q

Describe how VSD and MR/TR murmur is similar and different

A

BOTH are holocystolic murmur

MR/TR: high pitched, blowing murmur
VSD: harsh-sounding murmur

58
Q

median umbilical ligament is derived from what prenatal structure? what about medial umbilical ligament?

A

mediaN umbilical ligament: derived from allaNtosis

mediaL umbilical ligament: derived from umbiLical artery

59
Q

Which parts (2) of aorta is susceptible to calcification/ aneurysm?

A
  • ascending aorta

- aortic arch

60
Q

given systolic pressure and diastolic pressure, how to calculate MAP?

A

MAP= 1/3 systolic P + 2/3 diastolic P

61
Q

Which type of cardiomyopathy is peripartum cardiomyopathy?

A

dilated cardiomyopathy

  • peripartum: last month of pregnancy to up to 6 months postpartum
  • think like this: womb gets dilated during pregnancy, so does heart
62
Q

nucleus pulposus is derived from what embryological structure?

A

Notochord

  • Notochord -> Nucleus pulposus
  • nucleus pulposus is inner core of vertebral disc
63
Q

patient with angina takes a vasodilator. How may this actually aggravate his ischemia?

A

coronary steal syndrome
: vasodilation shunts blood to well perfused area, reducing blood flow to post-stenotic region

  • refer to note p.43
64
Q

Which hematologic/GI disorder can cause both dilated and restrictive cardiomyopathy?

A

hemochromatosis

65
Q

which beta blocker can cause dyslipidemia

A

metoprolol

66
Q

What congenital heart defects are associated with alcohol exposure in utero?

A
  • ASD
  • VSD
  • PDA
  • tetralogy of Fallot
67
Q

Which beta blocker should be avoided in prinzmetal angina? why?

A

propanolol

=> it may exacerbate vasospasm

68
Q

verapamil vs. diltiazem: both are non-dihydropyridines. which one has more specificity to cardiac muscle?

A

verapamil

69
Q

How does hypoxia/hypercapnia change heart contractility?

A

decrease

just like effect of acidosis
hypercapnea/hypoxia -> acidotic state
-> more K+ flux out of cell -> hyperpolarization

70
Q

chest X-ray finding in tetralogy of Fellot?

A

boot shaped heart due to RV hypertrophy

71
Q

Diastolic heart dysfunction: how below values get changed?

  • EF (ejection fraction)
  • EDV (End diastolic volume)
  • EDP (End diastolic pressure)
A
  • EF (ejection fraction): no change
  • EDV (End diastolic volume): no change
  • EDP (End diastolic pressure): increased
72
Q

Which two heart valves are derived from the endocardial cushions of the outflow tract?

A

aortic and pulmonic

  • focus on word OUTFLOW TRACT
73
Q

Catchecoleamine increased HR by changing slope of which phase of pacemaker action potential?

A

phase 4, which gives automaticity through funny current

74
Q

Aortic dissection: How to treat type A and type B differently?

A

type A: involve ascending aorta (also may be arch), needs surgery

type B: only involve descending aorta, sugery is not indicated. Just treat with B-blocker and then vasodilators (to reduce pressure that can further damage dissection)

75
Q

Down syndrome: what congenital cardiac defect?

A

endocardial cushion defect

: ASD, VSD

76
Q

widened S1/S2 split vs. fixed split: compare etiology

A

widened: delaying RV emptying- pulmonary stenosis, right bundle branch block
* unlike fixed, widened one still has more delayed splitting during inspiration.

fixed: ASD

*ASD is the only condition that gives S1/S2 split.
VSD is holocystolic murmur

77
Q

Transposition of great vessels is incompatible with life unless

A

unless there are shunts present

- PDA, VSD, ASD, patent ovale

78
Q

Location of infarct?

  • V1-V2
  • V3-V4
  • V5-V6
  • I, aVL
  • II,III,aVF
  • V7-V9
A
  • V1-V2: LAD
  • V3-V4: LAD (distal)
  • V5-V6: LAD and LCX
  • I, aVL: LCX
  • II,III,aVF: RCA
  • V7-V9: PDA
79
Q

Four arteries most susceptible for artherosclerotic burden (most common to less common order)

A

abdominal aorta > coronary artery > popliteal > carotid

80
Q

Edema and wavy fibers can be seen in histology how long after MI?

A

4-12 hrs

81
Q

How exactly S.epidermis forms vegetation on prosthetic valves or IV catheters

A

biofilms

: EXTRACELLULAR POLYSACCHARIDE matrix

82
Q

How exactly S. virdians form vegetation in subacute bacterial endocarditis?

A

DEXTRANS (from sucrose) binds to fibrin-platelet aggregates on PREVIOUSLY DAMAGED valves

83
Q

MOA of nitrate?

A

nitrate is converted to NO

NO -> increased cGMP -> increased MLCP (myosin light chain phosphatase) -> vasodilation

84
Q

Is Turner syndrome associated with MVP?

A

nope

Turner is bicuspid aortic valve and coarctation of aorta

  • Diseases I need to think for MVP is connective tissue diseases- Marfan and Ethlers-Danlos
85
Q

evolocumab and alirocumab

  • MOA
  • indication
  • side effects
A
  • PCSK9 inhibitor -> inhibition of LDL receptor degradation
  • effective LDL lowering
  • neurocognitive effects: dementia, derilum
86
Q

Effect of cholestyramine in

  • LDL
  • HDL
  • triglyceride
A
  • LDL: low
  • HDL: slightly high
  • triglyceride: slightly HIGH
87
Q

Two medication options for HCM?

A
  • beta-blocker
  • verapamil (non-dihydropyridine CCB)
  • bottomline: to reduce work stress for thickened cardiac muscle
88
Q

Three medications for antianginal therapy?

A
  • beta blocker
  • note: pindolol and acebutolol has partial beta agonist activity, so these are contraindicated
  • nitrate
  • verapamil
  • bottomline: decrease heart work (so myocardial O2 consumption)
  • hydralazine is NOT indicated (due to reflex tachy)
89
Q

What is target of fibrates?

A

upregulates lipoprotein lipase: increase TG clearance

vs. niacin: which targets hormone sensitive lipase to inhibit lipolysis

90
Q

how to treat two types of aortic dissection differently?
A type
B type

A
  • A type: surgery
  • B type: medication, beta-blocker then vasodilators
    => to reduce pressure

Cardiovascular: 4/12-4/15 (6 decks)

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