Kaplan -Cardiovascular Flashcards
Feb 22nd around noon stopped at question 19
A fluid filled neck mass (cystic hygroma), high arched palate, broad chest and pedal edema are associated with what sndrome and what two cardiovascular abnormalities?
Turner’s syndrome;
preductal coarctation (femoral pulse < brachial, notched ribs) and bicuspid aortic valve
what kinds of vessels of the circulatory system have the most blood in them when a person is at rest/ supine?
veins and venules
what is the heredity of familial hypercholesterolemia
autosomal dominant
what is the underlying condition associated with Libman-Sacks endocarditis
SLE
how exactly is SLE diagnosed
at least 4 of the following 11 criteria: (RASH OR PAIN)
Rash (malar or discoid), Arthritis, Soft tissues/ serositis, Hematologic disorders (cytopenia), Oral/ nasopharyngeal ulcers, Renal disease and Raynaud’s phenomenon, Photosensitivity and Positive VDRL/RPR, Antinuclear antibodies, Immunosuppresants (treatment, not symptom), Neurologic disorders (seizures / psychosis)
what is Wolf-Parkinson white syndrome and what drug is contraindicated in these patients
WPW is a pre-excitation syndrome in which bundles of Kent bypass the AV node (delta waves seen on EKG)
digoxin is contraindicated because it enhances accessory conduction pathways which can cause v. fib in WPW patients
for vessels in parallel, what will removing one of the vessels do to resistance
increase resistance (for parallel: 1/Rtotal= 1/R1 + 1/R2 + 1/R3)
Coronary blood flow is driven by pressure changes in which part of the circulatory system? what part(s) of the ventricular cycle (isovolumetric contraction/ ejection/ isovolumetric relaxation/ filling)
aortic pressure drives coronary artery filling
isovolumetric contraction is associated with a sharp drop in coronary blood flow
what are the normal values for pulmonary artery pressure and pulmonary wedge pressure
pulmonary artery pressure= 25/8
PCWP < 12 normally
when Swan-Ganz catheter shows that left ventricular BP is much higher than aortic BP and you also observe a systolic murmur what disease do you suspect?
what character does the murmur have?
aortic stenosis
cresc. decresc. systolic ejection murmur following ejection click that is loudest at the base of the heart and radiates to the carotids
rheumatoid arthritis is associated with which kind of cardiomyopathy and why
restrictive cardiomyopathy: amyloid-associated protein deposits in the myocardium leading to decreased compliance and decreased diastolic filling
in compensated coarctation what happens to blood flow above and below the coarctation?
what happens to resistance above and below the coarctation?
since it is compensated blood flow must be normal above and below
pressure= flow x resistance
therefore, to maintain flow at a higher pressure (above coarctation) resistance must increase
what does a larger vessel arteriorvenous fistula do to cardiac output
increases cardiac output (by roughly the same amount as the flow through the fistula)
what are some common toxicities of digoxin
dysrhythmias due to increase atrioventricular conduction (such as premature ventricular contractions), nausea/ vomiting, dizziness, dyspnea, agitation, ocular disturbances (halos, scotomas, blurred vision)
what are the histologic features of infarcted myocardium 2 days post-MI
on H&E stain there will be lost of neutrophils, necrosis, and contraction bands
what are the three types of creatinine kinase and what do they measure
CK-MB measures myocardial damage
CK-MM measures skeletal muscle damage
CK-BB measures brain tissue damage
in the setting of trauma with multiple injuries what kind of creatinine kinase measurement would you use to try to determine if there was cardiac contusion (hint: not simply creatinine kinase-MB)
CK-MB to total CK ratio (CK-MB should be greater than the other CK’s if there is a focal cardiac insult)
which is more specific for cardiac injury CK-MB or troponin I
troponin I
which better allows for determination of reinfarction, CK-MB or troponin I
CK-MB since it normalizes within ~3 days
which can indicate cardiac damage AST or ALT?
AST; AST increase with normal ALT suggests cardiac abnormality rather than liver since AST is found in liver and heart, but ALT is only found in liver
name some drugs that prolong QT
sotolol, disopyramide, procainimide, quinidine, TCA’s (“some drugs prolong Q T”)
what joints are usually the first to be affected by gout and what blood pressure medication can cause gout
MTP (metatarsophalangeal) and big toe;
thiazides have gout as a side effect because they can cause hyperuricemia
what kinds of substances are stained by a trichrome stain
erythrocytes=orange
muscle=red
collagen=blue
what is the first step in atherosclerotic plaque formation
endothelial injury:
endothelial injury leads to release of free radicals that oxidize LDL as well as decreases in NO which is anti-atherosclerotic
what is the most common cause of acute endocarditis
Staph aureus
what is the most common valvular abnormality in IV drug users and its accompanying murmur
tricuspid insufficiency; holosystolic murmur heard best at the 4th intercostal space on the left parasternal border
what is another (more descriptive) name for Churg-Strauss disease
eosinophilic granulomatosis with polyangitis
what are the three clinical phases of Churg-Strauss
- prodrome of allergic rhinitis or asthma
- eosinophilic phase: eosinophilia in multiple organs
- vasculitic phase: vasculitis of medium and small vessels, fever, malaise, weight loss
what is Wegener’s granulomatosis, its symptoms and its characteristic autoantibody
granulomatosis with polyangitis: a vasculitis of small vessels that affects mainly the respiratory tract (sinusitis, rhinitis, otitis media, hemoptysis)
c-ANCA positive
what is a lethal complication that can arise 5 days post MI?
1 month post-MI?
5 days post-MI ventricular wall rupture can occur
1 month post-MI ventricular aneurysm can occur due to weakened, but intact fibrosed area of myocardium
in a patient with atrial fibrillation and ventricular tachycardia, what drug would you use to both decrease HR and decrease conduction through AV node; finally, what other effect does this drug achieve
digoxin stimulates the vagus nerve, decreases AV node conduction and SA node conduction
digoxin: a cardiac glycoside that directly inhibits NaK ATPase and indirectly inhibits NaCa exchanger to increase intracellular Ca and thereby increases contractility (for CHF)
what is mean systemic filling pressure and what is a normal value
MSFP= the pressure within the circulatory system if the aorta and great vessels are clamped allowing pressure to redistribute throughout the system
normal MSFP is +7mmHg
what are the indications for digoxin use
atrial fibrillation and mild to moderate CHF
what kinds of drugs, when combined with digoxin can lead to new arrhythmias
K+ wasting diuretics because they can cause hypokalemia or hypomagnesemia (or K+ sparing diuretics can cause hyperkalemia, which also causes arrhythmia)
stimulation of the vagus and glossopharyngeal nerves will cause the body to perceive what hemodynamic imbalance
what control center receives the impulse
hypertension;
nucleus solitarius
measuring JVD serves as a proxy for what hemodynamic value
central venous pressure
what cardiac abnormality can arise secondary to rheumatoid arthritis and describe it
amyloidosis of the heart; AA amyloid protein deposition on the heart that appears speckled pink on gross pathology and apple-green birefringence on Congo red stain
in renal artery stenosis, what is the mechanism by which the body senses an imbalance and responds (include GFR and Na+ in your answer)
renal artery stenosis causes a decrease in GFR, which causes lower sodium chloride to reach the macula densa. as a result the juxtaglomerular apparatus cells secrete renin
what kind of drug is alpha-methyldopa and what is it used for
alpha-methyldopa is a selective alpha2 agonist that causes decreased sympathetic outflow by stimulating alpha2 receptors
used for gestational hypertension
what complication might you see in the lung as a result of S. aureus endocarditis?
what about in the eye?
pulmonary abscess (septic emboli from the heart lodge in the lungs) Roth spots seen on fundoscopic exam
prerenal azotemia, splenic abscess and stroke are likely to arise from endocarditis of which valve
mitral (these systemic lesions are more indicative of a left-sided endocarditis, as opposed to lung involvement with tricuspid endocarditis)
what happens to the heart as a result of coarctation (what region of the heart and what phenomenon)
left ventricular hypertrophy
which vessel has the greatest wall cross-sectional area to lumen cross-sectional area ratio
arterioles
a high left atrial pressure at the same time point as the dicrotic notch suggests what valvular disease and what kind of murmur is it associated with
mitral regurgitation
associated with a holosystolic, high-pitched “blowing murmur”
what are the normal values for total cholesterol, HDL, LDL
cholesterol 60 mg/dL
LDL 100-129 mg/dL
acute pericarditis is commonly preceded by what kind of illness
viral URI
what does an arteriovenous fistula do to CO and PVR
cardiac output increases (by roughly the flow through the arteriovenous fistula)
peripheral vascular resistance decreases
the sphenopalatine artery (responsible for epistaxis) arises from which branch of the ECA
the maxillary artery
why would an anemic patient have a wider pulse pressure
anemia causes an increased CO (via increased HR and SV). Increased stroke volume causes a larger difference between SBP and DBP, hence a wider pulse pressure
there is no space between the epicardium (visceral serous pericardium) and ______; there is no space between the parietal serous pericardium and ________
epicardium is adherent to the heart
parietal serous pericardium is adherent to the fibrous pericardium
(thus the pericardial space is between the epicardium (visceral serous pericardium) and the parietal serous pericardium
