March 31 - Cardio

Question 1

Migratory thrombophlebitis

Answer 1

Also called trousseau syndrome. Seen with hypercoagulability of malignancy, esp with adenocarcinoma. Redness and pain that extends linearly and migrates

Question 2

Aortic regurg murmur

Answer 2

Mild: early diastolic murmur
Severe: holodiastolic murmu

Question 3

Complications of MI

Answer 3

First 4 days: arrhythmia, fibrinous pericarditis
Days 5-10: free wall rupture, papillary rupture, septal rupture. At this point, coag necrosis and inflammatory cells have had time to do significant damage
Weeks later: Dressler syndrome, aneursym, thrombus formation

Question 4

Cardiac output: two formulas

Answer 4

CO=HR x SV

CO=O2 consumption/AV O2 difference

Question 5

Hypertrophic cardiomyopathy genetics

Answer 5

AD with variable expression

Often caused by a single point missense mutation in sarcomere proteins.

Question 6

HCM murmur

Answer 6

Outflow obstruction murmur: systolic ejection murmur identifical to aortic stenosis (differentiate by maneuvers)
Systolic anterior motion of mitral valve, over time, can lead to mitral regurgitation with murmur

Question 7

Heart borders on CXR

Answer 7

R border: RA
L inf border: LV
L sup border: LA

Question 8

Pulmonary HTN due to LHF pathogenesis

Answer 8

Increased pulmoanty capillary and arterial pressures secondary to pulmonary venous congestion results in endothelial damage. NO decreases and endothelin increases resulting in increased tone. Remodeling of vasculature occurs over time leading to medial hypertrophy and intimal thickening and fibrosis

Question 9

ASD auscultation

Answer 9

Wide fixed split S2

Question 10

Eisenmenger syndrome pathogenesis

Answer 10

Start with L to R shunt. Increased flow through pulm arteries results in medial hypertrophy and increased pulmoanry vascular resistance over time. If PVR exceeds SVR, shunt reverses to R to L

Question 11

Digoxin for afib

Answer 11

Used for rate control. Decreases ventricular rate by increasing vagal tone

Question 12

Statin MOA

Answer 12

Inhibits HMG CoA reductase, the rate limiting enzyme in cholesterol synth. Results in increased hepatocyte expression of LDL receptor, increasing cholesterol uptake

Question 13

Milrinone

Answer 13

PDE-3 inhibitor, increases cAMP. Used as inotrope in HF. Side effect is systemic vasodilation

Question 14

Kussmaul sign

Answer 14

Paradoxical rise in JVP during inspiration seen in constrictive pericarditis

Question 15

Dofetilide

Answer 15

clsas III antiarrhythmic