cvs Flashcards
1
Q
what is the portal vein composed off
A
The Superior Mesenteric Vein joins the
Splenic vein to form the Portal vein
2
Q
wha consists of femoral triangle
A
y near femoral
triangle (inguinal lig [sup], sartorius [lat],
adductor longus [med]
3
Q
popliteeal fossa pathologies
A
popliteal artery vein with tibial nerve, aneurysms and baker cyst
4
Q
aortic isthmus inury
A
Aortic isthmus (tethered by ligamentum
arteriosum) is more commonly ruptured
ascending aorta rare
5
Q
where is the coronary sinus located?
A
course through the coronary
sinus, which resides in the AV
groove on the posterior aspect of
the heart
6
Q
location of av node
A
AV node
• Right atrium near septal cusp of tricupsid
valve near coronary sinus
7
Q
how to treat a flutter
A
Isthmus between the IVC and
tricuspid annulus is site of ablation for A
Flutter
8
Q
2 manifestation of subclavian steal sbdrome
A
ischemia in the affected extremity (eg, exercise-induced fatigue, pain, paresthesias) or vertebrobasilar insufficiency (eg, dizziness, vertigo).
9
Q
what does the azygous vein drain
A
Posterior mediatinum immediately to the
right of the midline
10
Q
heart borders
A
Anterior surface: RV
• Inferior surface: RV + LV touching
central tendon
• Posterior surface: LA
11
Q
stab wound to vertebral body, ad pulmonary trunk
A
stab to rght veretebral body=IVC affected
2nd intercosal left sternal border, pulmonary trunk
12
Q
what embro structure gives rise to sinus venosus
A
cardinal veins
13
Q
what if there is cannulation above the inguinal ligament?
where does femoral artery lie?
A
Cannulation above the inguinal ligament can significantly ↑ the risk of retroperitoneal hemorrhage. femoral arterylies below the peritoneum
14
Q
Paracolic gutters
A
Right paracolic gutter (between ascending
colon and abdominal wall): fluid
accumulation > think GI organ issue
15
Q
pcwp cathether
A
ballon occludes bf through artery mesures lv/la pressure=endiastolic volue
16
Q
hw to access the left side of heart
A
CVCs must cross the
interatrial septum at the site of the
foramen ovale
17
Q
patents with ricuspid regugation leads to what complication
A
often leading to septic
pulm emboli.
18
Q
what is the crista terminalis
A
Crista terminalis: separates smooth sinus
venosus and pectinate muscles
19
Q
If i have a thrombus at the left venticle why do i have decreased CO?
A
LV mural thrombus: systolic dysfunction >
impaired apical wall movement
20
Q
what forms diphragmatic surface of heart
A
The inferior wall of the LV forms
most of the inferior
(diaphragmatic) surface of the
heart and is supplied by the PDA=av node
21
Q
papillary muscle rupture
A
The posteromedial
papillary muscle is supplied
solely by the PDA, making it
susceptible to ischemic rupture
22
Q
why posteromedial more common to rupture
A
it has single blood supply whereas the anterior one dual blood supply therefore PM more common
23
Q
what is the conus artery
A
early branch of RCA supplies Aner IV septum and conus of pulmonary artery
24
Q
a person with infantile thiamine deficiency presents with
A
2-3 months after birth
25
what is persistent foramen ovale
Failure or septum primum and septum
| secundum to fuse
26
what murmur does bicuspid stenosis have and what are the risks of bicuspid stenosis
• Early systolic, high frequency click
• Increased risk of stenosis, insufficienc
and infection
susceptible to infection
27
presntation of RF
MR early, MS late
28
compare acute heart rejection with chronic
```
Chronic rejection
• Scant inflammatory cells with interstitial
fibrosis
Acute transplant rejection
• Weeks after surgery
• Dense infiltrate of mononuclear cells
(mainly T cells)
• T cell sensitization against graft MHC Ag
Hyperacute
sudden cessation of blood flow
```
29
what are the cardiac complication of staph endocarditis
Perforate heart valves, rupture chordae
tendineae, send septic emboli to lung or
brain
30
what causes entrococcus
GU
instrumentation or catheterization
has been a/w enterococcal
endocarditis.
31
surgical procedures with strep nesieria
Bactermia after nasal polyp removal
32
what does strep viridans cause
deep wound infections, abdominal
abscesses and septicemia
Dextrans adhere to tooth enamel and
fibrin platelet aggregates
33
anterior uveitis caused by
HSV, Syphilis, Lyme disease
| • HLa B27
34
erythema nodsum caused by
GAS, S Aureus, cocci, histo, blasto,
| chlamydia, crohns, sarcoid
35
what is the function of subendothelial colalge in subacute BE
subendothelial collagen is important for
| platelet adhesion, not bacterial
36
how to prevent cathether induced infection
```
S Aureus and S epi are common
infections
Reduction in CVC infection
• Hand watching
• Chlorhexidine skin disinfection
• Sterile procedure
• Subclavian or internal jegular insertion >
femoral
• Remove ASAP
```
37
how do patients with coarctation of aorta die
HTNassoc
complications, incl LV
failure, ruptured dissecting AA,
and SICH.
38
what causes sudden intracranial spontaneus hemorhhage
AVM, ruptured cerebral aneurysms,
abuse of cocaine
• Can also be due to coaractation of the
aorta
39
what does an unstable arthersclerotic plaqye consist off
| what causes risk of rupture
```
eg, that w/ active inflammation,
a lipid-rich core, a/o a thin fibrous
cap)
Fibrous cap over athero plaque thins >
risk of rupture Larger lipid rich core of
athero > risk of rupture
```
40
how is calcification associated with rupture, and macrophages as well?
Macrophages secrete metalloproteinase
which thin fibrous cap of athero
Statins decrease inflammation of athero >
stabilzes plaque
• More calcification of coronary artery >
the greater the risk of rupture
41
Hibernating myocardium
```
Hibernating myocardium refers to
the presence of LV systolic
dysfxn due to ↓ coronary blood
flow at rest that's partially or
completely reversible by coronary
revascularization.
lowers
myocardial metabolism and function to
match blood flow preventing necrosis.
Disorganized contractile and
cytoskeletal proteins, altered adrenergic
contril and increased Ca2+ response >
decreased contraction. Coronary
revascularization and return of flow will
improve contractility and LV functio
```
42
what is ischemic preconditioning
Ischemic preconditioning: repeated brief
ischemic events protect myocardium from
subseqent prolonged ischemia
43
systemic embolization of endocarditis
erebral, pulmonary or
| splenic
44
how does diffuse proliferative gn look
which
is Chx by diffuse thickening of
the glomerular capillary walls w/
"wire-loop" structures on LM.
45
explain dermatomyositis
Extramuscular: interstitial lung disease,
| vasculitis and myocarditis
46
how does renal invovement of bacterial endocarditis present
septic emboli, or glomeularnephritis due to development of immune complex
47
what are cardiac manifestations of lupus
```
smallvessel
necrotizing vasculitis,
pericarditis, and Libman-Sacks
endocarditis (small, sterile
vegetations on both sides of the
```
48
carcinoid valvular manifestations
| what can carcinoid tumor ca secrete
TIPS(tricuspid insufficiency;/pulmonary stenosis)Can secrete histamine, serotonin and VIP
49
Hypertrophic cardiomyopathy-LVOT leads to rg
| type of murmur
exacceberate obstruction and cause rg
Harsh systolic crescendo decrescendo
murmur > worsens
with valsalva, standing up or nitro
50
what is Endocardial thickening and
noncompliant ventricular walls
what is Patchy fibrosis in the mural endocardium:
restrictive cmo
| chronic ischemic heart disease
51
Arrhythmogenic Right Ventricular
| Cardiomyopathy
Mutation of Ca binding sarcoplasmic
reticulum protein
• Progressive fibrofatty change in
myocardium
52
pain of pericarditis positional pain
```
may be exacerbated
by swallowing or coughing
inflammatory rxn to cardiac
muscle necrosis that occurs in the
adjacent pericardium.
```
53
location of acute pericarditis
Sharp, pleuritic pain that is exacerbated
by swallowing (suggests posterior
pericardium involvement) and radiating to
neck (suggest inferior pericardium
involvement)
54
condition for acute pericarditis to occur
Must have transmural necrosis
55
presnetation of dresseler syndrome
Fever, pleuritis, leukocytosis, pericardial
friction rub, new pericardial or pleural
effusion
56
viral myocarditis
lymphocytic interstitial inflammatory
| infilitrate
57
Hypersensitivity myocarditis
Interstitial inflammatory infiltrate or
mononuclear inflammatory cells and
eosinophils
58
signs of constrictive pericarditis
↑ JVP, pericardial knock,
pulsus paradoxus, and a
paradoxical ↑ in JVP w/
inspiration (Viral, surgery, radiation or TB
59
what is a sign of irreversbile myocardial infarction
mitochondrial vacoulization
irreversbile injury-Mitochondrial vacuoles and phospholipid
containing amorphous densities
revers
60
how does reversible injury look like
```
Myofibril relaxation
• Disaggregation of polysomes
• Disaggregatiuon of granular and fibrillar
elements of the nucleus
• Nuclear chromatin clumping
• Triglyceride droplet accumulation
(especially in hepatocytes)
• Glycogen loss ( rapid loss of cunction0
```
61
In acute mi what sort is changed
thinning, and fibrous healing of the infarcted zone of myocardium. Regional dysfunction of the infarcted myocardium causes volume overload for the remaining viable myocardium. The net result is usually eccentric hypertrophy, with enlargement of the LV cavity.
62
what is peripheral pulmonary artery stenosis
Pulmonary stenosis: innocent murmur due
to hypoplasia of branch pulmonary arteries
• Low grade, mid systolic, high pitch
blow murmur
63
systemic sclerosis associated diseases
Cor pulmonale, pericardial dz,
myocardial fibrosis and conduction system
disease
64
when do we see mitral valve calcificaition
Mitral valve calcification is usually around
the annulus, seen in women over 60, and
asymptomatic
65
wha cardiac pathology rheumatoid arthiritis can cause
Can cause pericarditis or myocarditis
66
what is ortner syndrome
MS > LA dilation > compresses L
recurrent laryngeal nerve (neurapraxia)
leading to hoarseness
67
where does recurrent laryngeal nerve innv
Innervates all laryngeal muscles except
| cricothyroid
68
what are other causes of hoarsness
```
Laryngeal edema
• Vascular disease
• Laryngeal mucosal disease (epi
sloughing)
• Vocal cord polyps
```
69
which drugs cause myocarditis
| viral myocarditis
loops, thiazides, ampicillin, azithromycin
| PAC
70
What causes syncope on aortic stenosis
and cyanosis on TOF
AR
excercise, causes vasodilation therefore decrease in blood flow no compensation in increased co
caused by infective endocarditis
71
mcc of cardiogenic shock in ami
From massive LAD MI
72
what are pericytes
Pericytes are pluripotent cells in
| postcapillary venules
73
explain details of artherosclerosis
```
Endothelial damage increases expression
of surface vascular celL adhesion
molecules allowing adhesion and migration
of monocytes into the intima. Macrophages
release PDGF, FGF, endothelin 1 and IL 1
causing migration/proliferation of
vascular smooth muscle cells within the
INTIMA. Smooth muscle cells synthesize
collagen, elastin and proteoglycans
forming the fibrous cap.
• Macrophages release MMP that
degrade the fibrous cap
increasing vulnerability to rupture
```
74
Where does Arthero first occur in teens
| what increases the likelihood of AS rupture
abdominal aorta
plaque stability rather
than plaque size or the degree of
luminal narrowing.(macrophages secrete metalloproteinases) decrease plaque sabuklity
75
function of Procollagen peptidase
cleaves terminal ends in ehler darlos
76
what causes onion skinning
rteriolar walls due to layers of smooth muscle cells and reduplicated basement membrane is seen in hyperplastic arteriolosclerosis, which can occur in severe chronic hypertension
77
what is malignant nephrosclerosis
```
fibrinoid
necrosis and hyperplastic
arteriolosclerosis ("onion-skin"
appearance). A MAHA can occur
due to erythrocyte fragmentation
and platelet consumption at the
narrowed arteriolar lumen.
```
78
symotoms of accelerated hypertension
Retinal hemorrhage, exudates or
| papilledema
79
thromboangities obliterans
| give histology of every vasuiliti
Vascultiis of Radial and Tibial arteries
• Thrombosing vasculitis that extends into
contiguous veins and nerves
80
what is leukocytoclastic vascutis
```
Leukocytoclastic vasculitis
• Microscopic polyangitis, microscoping
polyarteritis, hypersensitivity vasculitis
(RA)
• Segmental fibrinoin necrosis of small
vessels
• Similar to PAN
```
81
if a patient presents with TA can manifest as audible bruits, blood pressure discrepancies, pulse deficits, and distal ulcerations
it is generally large vessel involvement
82
histology of renal artery stenosis
crowded glouemerli due to atrophy since kidney shrinks
83
Aortic aneurysm in marfans syndrome
Fragmentation of elastic tissue and
separation of elastic and fibromuscular
components of tunic media, cleft like space
filled with amorphous extracellar matrix
84
aquired cause of marfans syndrome due to
Beta aminopropionitrile
85
epidemology of AAA
| characterised by
```
Over 60
• Smoking
• HTN
• Male
transmural inflammation
infrarenal abdominal aorta lacks vasa
```
86
pathogenesis of aortic dissection descendiong aorta
HTN is largest risk factor > vasa
vasorum occlusiong > decreased blood to
media > degenerates SM in media +
increased wall stiffness > tear
87
what is chronic venous insuff complication
Painful thromboses, stasis dermatitis, skin
ulcerations (common over medial
malleolus), poor wound healing and
superficial infections
88
Phlegmasia alba dolens
Phlegmasia alba dolens: result of
iliofemoral venous thrombosis in
peripartum women
89
celiac disease coagulopathy
Risk of hemorrhagic diathesis(vit k Deficiency)
90
hypothyrodism coagulopathy
associated with cerebral venous thrombosis
91
lymphedema
Obstruction of lympoid capillaries
• Marked swelling of dorsum of distal limb
• Initially soft and pitting but eventually
becomes firm and nonpitting > leads to
fibrosis of skin
92
what is the exact pathology of mvp
Proliferation of spongiosa in leaflets,
fragmentation of elastin fibers with
increase mucopolysaccharides and type 3
collagen deposition
93
how does rash spread in kawasaki
Rash on extremities that spreads
| centripetally to trunk
94
endocardial fibrosis =restrictive
characterized by thickening and fibrosis of
| apical endocardial surface
95
how to diagnose atrial myxoma
```
obstruction +constitutional symotoms
mucopolysaccharide
stroma and abn blood vessels w/
hemorrhaging.
Can met to the heart
• Will see pancytopenia, weakness, fatigue,
ecchymoses
```
96
how does ADHF presents
Sudden onset of SOB with orthopnea,
pulmonary edema, dilated heart > this
Acute Decompensated HF
97
how is coostochondritis classified dy/dx from pleural and pericardial
```
reproducible w/ palpation and
worsened w/ movement or
changes in position.
Pleural or pericardial pain
• Worsens with inspiration
```
98
what is the bp difference in aortic dissection
Aortic dissection
| • Usually a difference of > 10 in each arm Subendocardial granulomatous lesions with fibrinoid necrosis
99
RF histopath
Subendocardial granulomatous lesions with fibrinoid necrosis
100
WE have an MI with acute Mitral regurg, how do you differentiate between papillary muscle dysfunction and chordae tendinae
papillary muscle dysfunction is associated with ischemia which later resovles however chordae tendiae not associated with ischemia
myxomatous mitral valve disease (mitral valve prolapse), rheumatic fever, or endocarditis.
101
when thinking about mitral regurg think anatomically
anulus
paipillary muscle dysfunction and displacement
chordae tneinae
and the valve itself
102
chronic lymphedema
due to poor lymphatic drianage in malignancy
| never use diuretics
103
peripartumo CMO
```
Peripartum cardiomyopathy is a
relatively uncommon cause of
DCM that may be related to
impaired fxn of angiogenic GFs.
DCM involves compensatory
eccentric hypertrophy, which ↑
ventricular compliance and also
allows for temporary maintenance
of CO. Over time, ovewhelming
wall stress leads to LV failure w/
↓ EF and SSx HF
```
104
cardiac manifestation of lyme disease
complete AV conduction block
are likely to have dyspnea,
lightheadedness, or syncope.
105
how does thoracic aortic aneurysm present as
compression of different structures
106
explain aortic dissection and what is the predeposition of it
Aortic root disease
| predisposes to AD
107
myocardial stunning
When ischemia lasts less than 30
min, restoration of blood flow
leads to reversible contractile
dysfxn
108
pathophys of heart acting on ischemia
Heart will stop beating in 60 seconds
• Although there is still ATP around, ATP
in locations of high metabolic demand is
rapidly depleted and causes heart to stop
Ischemia less than 30 min > reversible
damage
109
a young patient comes with DCM what do u suspect
viral myocarditis
Direct viral injury and autoimmune
rxn > inflammation > dialtion and systolic
dysfunction
110
how can i atteunate or silence a murmur in HCOM
| talk about pathophsy of restrictive heart disease
```
Decreased preload or decreased
afterload increase obstruction and murmur
> standing up would make murmur louder
• Increaed preload or afterload will
make murmur quieter >
squatting
```
```
Diastolic HF is caused by ↓
ventricular compliance and is
characterised by normal LV EF,
normal LV EDV, and ↑ LV filling
pressures. HTN, obesity, and
infiltrative disorders
```
111
compare pressures of systolic hf and diastolic hf
```
Diastolic HF
• Normal EF
• Normal end diastolic volume
• Increased LV filling pressure
• Decreaed LV compliance
Systolic HF
• Decreased EF
• Increaed end diastolic volume
```
112
a person has a vsd what will be the oxygenation of the right heart
Right atrial SpO2 remains normal with VSDs of any size, unless tricuspid regurgitation is also present
113
pulse patterns een in HCOM
Bifid carotid pulse with brisk upstroke
| indicated HOCM
114
most likely pathways of paradoxical embolism
| when does paradoxical embolism occur
```
DVT through PFO, VSD, ASD or
pulmonary arteriovenous malformation to
brain
can facilitate
paradoxical embolism due to
periods of transient shunt reversal
(eg, during straining or
coughing).
```
115
what is associated with marfans
what is marfans habitus
talk about eissengmer syndrome
Early-onset CMD of the
| aorta predisposes to AD
116
when does murumur intesity of AORTIC REGURGTATION OCCUR, and mitral stenosis how does it vary with opening snap
```
The worse the stenosis, the higher the
residual pressure in the L atrium causes a
louder and earlier opening snap
presystolic accentuation
of the MS murmur disappears
```
117
explain how mitral stensosis causes tricuspid regurgtation
Right ventricular dilatation can occur in MS when the resulting pulmonary hypertension is severe enough to cause right heart failure. Tricuspid regurgitation can occur as a complication of right ventricular dilatation.
118
compare acute AR with chronic AR
impaired LV contracility late onset of AR
Small SV
LV Dilation
• Small SV and low PP
119
Talk about the murur of aortic stenosis,
| and aortic pressure gradient
```
st heart sound and
typically ends before the A2
component of the 2nd heart
sound.
Large difference in pressure between LV
and aortic pressure
• Crescendo decrescendo murmur (loudest
mid systole > large difference in pressure)
```
120
when is S3 normal and abnormal
Normal in children, young adults and
pregnancy
over 40, HF, restrictive
cardiomyopathy, high output states
121
when is s4 abnormal
Abnormal: younger adults, children,
ventricular hypertrophy, acute MI
Normal in healthy older adults
122
places with increased metastatic calcification
(especially in alkaline environement of
kidneys, lungs, arteries
and gastric mucosa
123
serotonin
Produced by platelets
| • Vasodilation and increased premeability
124
where is prostaglandin I@ secreted from
```
Prostacyclin (prostaglandin I2) is
synthesized from prostaglandin
H2 by prostacyclin synthase in
vascular endothelial cells. Once
secreted, it inhibits platelet
aggregation and causes
vasodilation to oppose the fxns of
thromboxane A2 and help
maintain vascular homeostasis.
```
Damaged endothelium decreased
PGI2 synthesis and TXA2 predominates >
occlusion
125
mitral valve regurg explain forward vs backward flow
```
Forward SV: blood in aorta
• Backward SV: blood into LA
• Amount of backward SV is related to
afterload (decreased afterload will decrease
backward SV)
Decreased HR > higher EDLVV > worse
backward SV
• Same as increase preload (if MR is
volume dependent)
• Increase contractility will wrosen
backward SV
```
126
explain the hormonal variations of raas in the raas system
```
Increase Renin from JG cells
• Angiotensin (made by liver) > ang 1
(renin) in sysemic circulation
• Ang 1 > ang 2 (angiotensin converting
enzyme) in the lung
• This means higher ang 2 than ang 1 in the
pulmonary vein
```
127
why edema is late in HF
```
In chronic heart failure,
increased lymphatic drainage
initially offsets factors favoring
edema, whereas acute changes
(eg, venous thrombosis, heart
failure decompensation) are more
likely to produce edema
```
128
explain pulsus paradoxus and its causes
MCC of pulses paradoxus in absence
| of pericardial disease
129
aortic stenosis variation in age, then marfans syndrome causing AR, where is MVP heard
```
Under 60 > think bicuspid aortic valve or
rheumatic heart disease
• Over 60 > calcification due to wear and
tear
Marfans
• Aortic dilation > AR
• Aortic dissection
MVP
• Mid systolic click @ cardiac apex
```
130
what is the most common cause of AR in a young patient
he most common cause of chronic AR in a young patient is a congenital bicuspid valve. Bicuspid valve is also a common cause of early-onset aortic stenosis.
131
a person comes with angina given nitroglycerin why pain improves
simple venous pooling of blood
132
what is athletes heart
```
There's predominant
eccentric hypertrophy w/ a
smaller component of concentric
hypertrophy, leading to an overall
↑ in LV mass, enlarged LV cavity
size, ↑ LV wall thickness, and ↓
resting HR.
```
133
sick sinus syndrome
```
ECG
typically demonstrates
bradycardia w/ sinus pauses
(delayed P waves), sinus arrest
(dropped P waves), and jxnal
escape beats.
Cardiovascular (CV) Pathophysiology
(Patp)
2
15650 Acute heart failure Pts w/ DHF have ↑ LV EDP and
```
134
one cause of TR regurg
```
Severe TR can lead to right-sided
HF, evidenced by JVD,
hepatomegaly, lower extremity
edema, and the absence of pulm
edema. Permanent PM placement
can cause TR b/c the RV lead
passes through the TV orifice and
can disrupt valve closure
```
135
triggeres of prizmental angina
```
Possible triggers are cigarette
smoking, cocaine/amphetamines,
and dihydroergotamine/triptans
Stimulates both alpha receptors and
serotonin receptor
```
136
what responses to precapillary sphincters
```
Precapillary sphincters
• Respond to NE and epi
• Dilate with histamine, hypoxia, high
CO2, and acidosis
Arterioles: dilate with alpha1 blockers and
CCB
```
137
why isorbide dinatrate has low bioavalibility
Isosorbide dinitrate has a low
bioavailability due to extensive
1st-pass hepatic metabolism prior
to release in systemic circulation
138
contraindications of nitrates
Avoid in hypertophic cardiomyopathy,
| RV infarct, and with Sildenafil
139
dynamic hocm obstruction which drugs avoided
which can be caused
by ↓ in cardiac preload a/o
afterload. Therefore, Rx that ↓
venous return or SVR
140
which drug is useful in hypertension with resting bradyardia
nifedipine is the most appropriate agent to manage hypertension as it has minimal effect on cardiac conduction. Dihydropyridines can cause reflex tachycardia in response to peripheral vasodilation and are therefore useful in hypertensive patients with resting bradycardia.
also pindolol
141
benefit of milirone
PDE3 inhibitor > increased cAMP >
vasodilation and increased cardiac
contractility
142
antiarrythmic drugs which have less use dependance
1C > 1A > 1B
• The more they are used, the longer the
drug binds
143
adverse effects of substance p
Mediated pain > topical capsaicin can
| cause depletion of Substance P
144
contraindications of ocps
```
OCPs are: prior Hx of TE event
or stroke, Hx of an oestrogendependent
tumour, women over
age 35yrs who smoke heavily,
hypertriglyceridaemia,
decompensated or active liver
disease (would impair steroid
meta), preg.
```
145
how do ocps work
```
Estrogen: suppresses GnRH
• Progesterone: decreases risk of
endometrial cancer and thickens cervical
mucus
• Adverse: breakthrough menstrual
bleeding, breast tenderness, weight gain,
DVT, PE, stroke and MI
```
146
amidarone effects
Corneal micro deposits
• Optic neuropathy
• Peripheral neuropathy
147
how does spirnolactone work
Block deleterious effect of aldosterone on
heart > regression of fibrosis and improved
ventricular remodeling
• Improves survival in CHF with low
EF
148
why nsaids cause hyperkalemia
So NSAIDs would inhibit prostaglandins ---> decrease renin levels ---> decrease aldosterone -----> decrease sodium reabsorption and potassium excretion -----> hyperkalemia
149
what drugs cause hyperkalemia
```
Non selective Beta blockers: no K into
cells
• ACE inhibitors: no aldosterone
• ARBs: no aldosterone
• K sparing diuretics
• Digoxin: inhibit Na/K pump
• NSAIDs: reduced renin and aldosterone
secretion
```
150
drugs causing sexual dysfunction
SSRI, TCA, thiazide, spironolactone,
| clonidine
151
mechanism of omega 3
decreased ffa to liver increase synthesis of enzyme
152
which drug lowers tags
omega/fibrates bile acid sequesterantsLowers LDL but increases TAG
153
Physical exam finding on cor pulmonale
Accentuation and splitting of S2, JVD,
| hepatomegaly
154
how to prevent skin necrosis
Tissue
necrosis is best prevented by local
injection of an α1 blocking drug,
such as phentolamine.
155
causes of orthostatic hypotension
* Diuretics
* Diabetes
* Parkinsons
* Hyperglycemia
156
other effects of alpha 2
Decreased lipolysis
• Decreased NE release
• Increased platelet aggregation
157
which drugs cause DILE
HEAPS ENTERACEPT
158
explain inhibitios of raas
Hyperuriceia in TZDS
mechanism of action of spirnolactone, and amiloride
which results in ↓
vasoconstriction and ↓ renal Na
and water retention
Hyperuricemia: increase reabsoprtion in
PCT
```
Add spironolactone to spare K in late
DCT and early collecting duct
• Causes downregulation of ENaC and
Na/K pumps
• Amiloride and triamterene block ENaC
on principal cells
```
159
how does omega 3 work
Omega 3 FA: decrease VLDL
| production,
160
what is the pathophys of thomboisis obliterans
we have vasuclitis and then results in thrombosis typically occurs in young smoker
161
clinical presentation of popliteal artery aneurysm
An aneurysm of the popliteal artery. Can present with obstruction and ischemic symptoms of the lower leg and foot.
162
what drug reduces the frequency of angina episodes
it is always a beta blocker
163
what drug reduces the frequency of angina episodes
it is always a beta blocker
Though β-blockers also inhibit adrenergic-mediated coronary vasodilation, the resulting increase in coronary vascular resistance is overcome by the reduction in heart rate, which improves coronary perfusion by prolonging diastole.
164
infective endocarditis when would u do a ct angiogram
if he has symptooms of pulmonary embolism
165
how do you diagnose HOCM
typically shows systolic anterior motion of the anterior mitral valve leaflet, asymmetrical septal hypertrophy, and septal wall thickness of >15 mm.
166
A person comes with HYpokalemia,HTN, what are the different possibilities
aldoesttonism, RAS, fibromuscular dysplasia
167
How to diagnose heparin induced thrombocytopeni
. This adverse event most commonly manifests with venous or arterial clotting 5–14 days following heparin administration;
168
explain pathophys of ASD
ostium secundum =excess apoptosis
| septum primum doesnt migrate work=failure of neurocrest apoptosis behind secundum
169
why in vsd no split
With ASD, you get the blood flow as you described leading to fixed splitting.
With VSD, you get wide splitting (not fixed) and there is delayed P2 . However it is not "fixed" because, over time the VSD allows the pressures in the LV and RV to equalize, such that there is not as much blood flowing into the RV as compared to the amount from the ASD. Im assuming the pressures dont normalize in the atrium as they would in the ventricles.
