CV-Rx

Question 1

What type of hypersensitivity is polyarthritis nodosa (PAN)?

Answer 1

type 3

PAN is immune complex mediated vasculitis

Question 2

asymmetric pulse in upper extremities: what cardiac condition should I think?

Answer 2

aortic dissection

• region proximal to dissection has higher blood flow. Thus. for example, dissection after brachiocephalic trunk but before left subclavian may result in higher pulse in right upper extremities than left side

Question 3

What is serious complication of aortic dissection?

Answer 3

cardiac tamponade

• blood travel back to pericardium as aorta ruptre

Question 4

AV node defect vs. AV node bypassing tract: how each is related to what cardiac conditions?

Answer 4

• AV node defect: first or second degree blck
• third degree is really messed up, not necessarily limited to AV node defect. Third degree block is associated with Lyme disease
• AV node bypassing tract: Wolf-Parkinson syndrome.
  => BYPASSING AV node generates delta wave as transduction does NOT get slowed down by AV node

Question 5

What type of coarctation is common in Turner?

Answer 5

Juxtaductal coarctation: right in between L.subclavian and PDA

• Juxta-: near, thus juxtaductal: near PDA
• another coarctation type is postaductal, distal to PDA, which is not common form

Question 6

What is first line treating ventricular tachycardia if defibrilation fails?

Answer 6

amiodarone

• use of amiodarone for V Tech is not illustrated in sketchy, but clearly mentioned in FA

Question 7

MOA of nitrate?

Answer 7

nitrate undergoes conversion into NO
-> increased cGMP -> vasodilation

*it’s not de novo production of NO, nitrate ITSELF becomes NO

Question 8

Etiology of septic emboli in bacterial endocarditis?

Answer 8

septic emboli from tricuspid valve (if IV drug user/ S.aureus) is dislodged to pulmonary artery

• septic emboli is also cause of osler nodes/ Janeway lesions

Question 9

Pathophysiology of Roth spot in bacterial endocarditis?

Answer 9

septic emboli

• same as Janeway lesions or Osler nodes

Question 10

Defect in His-Perkinje system results in what cardiac abnormlaity?

Answer 10

2nd degree blcok

Question 11

AV node defect results in what cardiac abnormlaity?

Answer 11

1st degree block

• AV node defect -> inappropriate delay by AV node AT CONSISTENT DEGREE

Question 12

Independent contraction of atria and ventricles results in what cardiac abnormlaity?

Answer 12

3rd degree block (complete block)

Question 13

Bypassing AV node results in what cardiac abnormlaity?

Answer 13

Wolf-Parkinson-White syndrome

Question 14

What infection should I think for 3rd degree block?

Answer 14

Lyme disease

Question 15

Which viruses are associated with viral endocarditis that result in DCM? what is mechanism?

Answer 15

• coxsackievirus, adenovirus, HIV, influenza virus

- DIRECT CYTOTOXICITY via viral entry into myocardiocytes,

Question 16

How does statin inhibit HMG-CoA reductase?

Answer 16

competitive inhibitor

: no change in Vmax, increased Km (decreased affinity)

Question 17

SLE induced endocarditis vs. bacterial endocarditis

: how would vegetation look differently? (2)

Answer 17

Libman sacks- two sided

SLE induced endocarditis: SMALL non-bacterial, verrucous (warty) vegetation
bacterial endocarditis: LARGE friable vegetation

• this makes sense: bacterial endocarditis is septic emboli formed on top of fibrin coated damaged valve. so it becomes big

Question 18

Apart from drugs that decrease renal clearance of digoxin (VAQ- verapamil, amiodarone, quinidine), what other drugs can increase digoxin toxicity?

Answer 18

drugs that can lead to hypokalemia ( ex: furosemide)

-> decrease potassium leads to more digoxin action on Na+/K+-ATPase => more toxicity

Question 19

What is usage of esmolol as antiarrythmic?

Answer 19

esmolol is SHORT ACTING

esmolol can be used to test if patient can tolerated beta blockers. Even though pt cannot tolerate it, its side effects will wear off quickly