Thursday Wk 2 Cardio 6 Flashcards
venous blood flows from __ veins to __ veins
blood from deep veins travels __ and drains via IVC
__ normally prevent backflow
w inc intraluminal pressure, dilation of veins occurs w __ flow (varicose veins)
this incompetence results in __ and venosus stasis dermatitis
leakage of __ into tissues leads to Fe deposition and discoloration
most commonly seen w obstructed VR O/P, problems w venous valves D__
superficial, deep
valves
upward
obstructed
ischemia
RBC
obesity/pregnancy, DVT
carotid sinus __ occurs w pressure to the carotid sinus
carotid sinus is dilation of __ near bifurcation of CCA
reflex has affarent limb traveling to medullary centers via the __ nerve
efferent limb is __ nerve carrying PNS fibers
inc firing leads to inc __ output
this results in dec __ via VD and dec __ via dec SV
pt gets brady__ and hypo__
Coronary dominance determined by artery supplying __
majority is __ w right dominance
some left dominent via __
some are __
AV nodal artery branches off __ coronary artery
hypersensitivity ICA glossopharyngeal vagus PNS bp, CO cardic, TN
PDA
right coronary
LCX
codominant
dominant
Potassium sparing diuretics A/T block ENaC inhibiting Na uptake
Aldo antags E/S inhibit apical ENaC and BL N/KATPase
__ are preferred in CHF bc they prevent aldosterone induced cardiac remodeling
this occurs in late __ and cortical __
HF leads to reduced __ and inc ventricular __ pressure
blood pressure initially __ causing activation of SNS/RAAS/ADH
fxn to inc Chrono/inotropy which inc __ fluid and peripheral __
inc afterload results from excessive __
impairs CO, leading to poor ___
High RAAS inc fluid __ and CHF
cardiac tissue __
amiloride, triamtere
eplerenone, spironolactone
Aldo antags
distal tubule, collecting duct
CO, filling
falls
extracellular, vasoconstriction
vc
renal perfusion
retention
remodels
FS relationship says that as cardiac muscle is stretched, __ is inc
VR curve shows changes w __ pressure
when it intersects x axis indicates no __
shifts to left w __ and right w less fluid
TPR affects __ of lines
when inc, slopes __
Excitation contraction coupling occurs w influx of __ into myocytes
RR of SR inc Ca release, binding to troponin
this moves __ so actin/myosin interact
last step is myocyte __
Ca is pumped out via __exchange pump or SR __ pump
Na/Ca pump uses __ to pump 1 Ca out for 3 Na in
Ca ATPase uses ___
CO right atrial venous return inc fluid slope, dec
Ca
tropomyosin relaxation Na/Ca, Ca ATPase gradient ATP
Calmodulin is important in __ contraction bc no troponin is present
inc cardiac mucle, it is not involved in __
mean arterial pressure is measured via __ circ
PCWP aka __ for left atrial/left ventricle EDP
Nitrates primarily dilate __
this inc peripheral venous __ to reduce cardiac preload
LVEDV and __ dec
some __ dilation occurs, reducing afterload
smooth muscle
excitation contraction
central arterial
PAOP
veins
capacitance
pressure
arterial
severe HTN w end organ damage indicates HTN __
sx include P, Acute __, and E
drug of choice is F__ a D1 receptor agonist
activates __ to inc cAMP
results in __ and drop in BP
renal vasodilation inc __ w diuresis and natriuresis
H__ is arteriole vasodilator
results in reflex __ activation, inc HR/contractility
emergency papilledema, kindye injury, encephalopathy Fenoldapam AC vasodilation perfusion
Hydralazine
SNS
__ has significant risk of systemic thromboembolism
pt must have __ to tx
thrombus forms w __ enlargement, __ of blood flow, and atrial __/__
__ is most common site of thrombus formation
A fib
anticoags
LA, stasis, fibrosis, inflammation
LAA
Diastolic HF occurs w normal __ and __ but inc LV filling pressure
due to dec __ such as impaired relaxation or inc wall stiffness (amyloid)
dec LV compliance leads to inc __ w normal LV EDV
decompensation occurs when pressure is transmitted to __
HDL is involved in __ cholesterol transport
removes cholesterol from __ and transports to __ for metabolism
direct pathway, HDL delivers CE to scavenger receptor __ on liver
indirect pathway, HDL transfers cholesterol to / receptors
LVEDV and CO
compliance
pressures
pulm circ
reverse
peripheral tissues, liver
SCARB1
LDL/VLDL
HDL can be raised by __ measures or by use of __
__ used to prevent pancreatitis in pt w high TG
ischemia can result in __ due to apoptosis/necrosis
can form __ by parenchymal/endothelial/lueks
mitochondrial __ permeability
inflammation attracts __ for injury
activation of __ pathway
when cells in heart, brain, skeletal muscle are injured, release of __ across damaged membrane
nonpharm, statins
Fibrates
cell death free rads membrane PMN complement
CK
it pt w systolic HF, long term use of __ is correlated w survival
reduce myocardial __ and __ and cardiac __
lowers peripheral resistance by removing __ hormones
avoid in __ HF bc it impairs CO
other drugs that can be used are A__, A__, A___
normal PTT indicates normal ___ pathway
abnormal __ indicates problem in the __ pathway
bleeding time correlates w ___ function
BB
O2 demand, HR, contractility
VC
unstable
ACEI, ARB, aldo antags
intrinsic
extrinsic
platelet
NO2 primarily vasodilates the large ____
precapillary sphincters regulate blood flow from __ to capillaries
relax/contract in respnse to __/__
small arteries and arterioles are primary site of action for __ drugs and P__
large arteries regulate blood pressure due to _ in walls
w LV diastolic dysfxn, high __ filling pressure transmits pressure to __ circ
results in pulm __ as endothelium is damaged
dec NO but inc __ results in vasoconstriction
inc tone results in __ and PAH
veins arterioles NE/E CCB, prazosin smooth muscle
diastolic, pulm
congestion
endothelin
remodeling
cardiac catheterization for AR shows very high __/__ pressures, steep __ decline and no dicrotic notch
AR murmur occurs immediately after __ w peak intensity at AV closure
constitutional sx, MS murmur, SOB w large pedunculated mass in the LA indicates __
made of scattered cells w M__ stroma, abnormal BV and hemorrhage
large amount of __ are released, resulting in angiogenesis and hemorrhage
release of __ results in const symptoms
myxoma is pedunculated and G___
present w emboli or __ sx due to valve obs
Aortic/LV, diastolic
A2
cardiac myxoma
mucopolysaccharide
VEGF
IL6
gelatinous
cardiac
Nitrates upregulate __ which dec intracellular Ca
this activates myosin light chain __, and dephosphorylation relaxes VSM
if myosin is __ it can bind to actin for muscle contraction
complete AV canal defect results in failed endocardial __
results in __ ASD, and VSD and single __ valve
LtR shunt w AV regurg leads to inc __ blood flow and sx of __
murmur is __ regurg and inc P venous__
Mutation in __ a gene for mitochondrial iron homeostasis and resp fxn leads to Friedrich Ataxia
assc w __ degen and HCM
cGMP
phosphatase
phosphorylated
fusion
ostium primum, AV
pulm, HF
Aortic, return
frataxin
spinocerebellar
SE of ACEI include A/C/hyper__
inc K is not a problem unless on __ sparing diuretic
A/T/S
Metoprolol is selective __ blocker
B2 blockers/nonselective blockers can result in __
other hyperKalemia inducing meds include C/N
I is a thiazide diuretc
angioedema, cough, kalemia
Potassium
Amiloride, triamtere, spironolactone
B1
hyperkalemia
cardiac glycoside, NSAID
indapamide
inc cGMP in vascular smooth muscle leads to __
can be extreme w Nitrate and __ inhibs
receptor downregulation is T__
one complication of excessive alcohol consumption is A___
also seen w long standing __/__/___
due to inc __ tone
high QRS voltage indicates LV __
varying R-R interval indicates __ rhythm
vasodilation
PDE
tachylplaxis
A fib
HTN, HF, hyperthyroid
SNS
hypertrophy
irregularly, irregular
__ is volume of plasma cleared of drug per time
determines dose __ to maintain steady state conc (Css)
Maintenance dose = Css * __
Bioavailability
clearance
rate
clearance
half life eq is (__ * .7)/CL
elimination is achieved in __ half lives
Loading dose is (Vd x __)/Bioavalability
in pt w renal/hepatic failure, __ remains unchanged, but maintenance dose is affected
Vd
4-5
Css
loading dose
Sudden cardiac death is usually due to __ in athletes
results in V __/__
HCM presents w massive myocardial __ in septal region
endocardial thickening and noncompliant ventricular walls indicates __ cardiomyopathy
Chronic __ HD leads to patchy fibrosis of the mural endocardium
HCM
fib/tachycardiac
restrictive
ischemic
femoral triangle from lateral to medial
femoral triangle formed by __ superiorly, __ medially and __ laterally
Congenital long QT syndrome due to mutations in __ channel that dec outflow
__ is state of chronic myocardial ischemia
both myocardial metabolism/fxn have been __ to match dec BF
prevents myocardial __
dec expression of __/__ proteins, adrenergic control and reduced Ca responsiveness
dec __ w LV systolic dysfxn
w restoration of flow, myocardium has improved __
FN, FA, FV, lymphatics
inguinal ligament, adductor longus, sartorius
outward K
myocardial hibernation dec necrosis cytoskeletal/contractile contractility
fxn
__ conditioning is a process w repetitive anginal episodes delay cell death after coronary occlusion
reperfusion injury presents w __ and myocyte injury
dystrophic __ affects aging aortic valve
hallmark of cell __/__
occurs in all types of __ w normal calcium levels
result of endothelial/fibroblast death w chronic __ stress and atherosclerosis
often __ but can stiffen valves w calcific __
ischemic
arrhythmia
calcification
injury/death
necrosis
hemodynamic
benign, AS
metastatic calcification is assc w __ levels
cutaneous, strawberry appearing capillary hemangioma aka __ hemangioa
unencapsulated aggregates of __
can be on Skin, __ tssue, MM or L/S/K
initially __ w child, but regress before puberty
high Ca
juvenile
capillaries
Subq, mucus membranes
liver, spleen, kidney
grow
PDA can present w __ pulse pressure and __ pulses
may have metabolic __
aortic stenosis has soft __ due to reduced mobility of aortic leaflets
may have __ w reduced ventricular compliance
it pt w MS and AS/AR, think __ as cause
wide, bounding
acidosis
S2
S4
rheumatic heart disease
Paroxysmal Afib can be tx w rate control strategies like __/__ or rhythm control via S/F/A
__ has less TdP potential than others
R is antianginal agent that inhibits inward flowng __ channels
may block __ channels, w slight inc in QT
no __ potential
BB/CCB
Amiodarone
Ranolazine, Na
K
TdP
HCM has LVOT obstruction that worsens w low __/___
therefore, avoid vasodilators like __ CCB, N and __ inhibs
also D___
neg inotropic agents like BB, __ CCB and D reduce LVOT obstructiion
preload/afterload
dihydropyridine, nitrates, ACEI
diuretics
nondihydropyridine, disopyramide
DILE can occur in pt w P/H/I
Procainamide is metabolized via hepatic __
slow acetylators are __ likely to get DILE
antihistone antibodies are specific for __
anti-dsDNA ab are __ seen in DILE
procainamide, hydralazine, isoniazid
acetylation
DILE
not
