Tuesday wk 2 Cardio 1 Flashcards
__ rejection is common in heart transplantation
usually is __ mediated w/in 4 wks
dense infiltration of __ cells, mostly __ cells
T cells directed against graft __ antigens
sx include SOB/PND
patchy necrosis w granulation tissue indicates __ damage to donor heart
perivsacular infiltrate w abundant eosinophils indicates __ mycoarditis, usually __ related
scant inflamm w interstital fibrosis is seen in __ reject
acute
cell
mononuclear, T
MHC
ischeic
hypersensitivity, drug
chronic
stable angina is fixed atheromatous obstruction of coronary arteries occuluding __% of CSA
ulcerated atherosclerotic plaque w partially occlusive thrombus indicates __ angina or subendocardial __
chest pain is a single __
coronary artery vasospasm seen in __ angina
transmural ischemia w __ elevation on ECG
not assc w __, but does respond to N_ and C__
75
unstable, infarct
episode
Prizmental
ST segment
plaques, nitro, CCB
low freq, late diastolic sound just before S1 indicates __ heart sound
indicates reduced ventricular __, such as w HTN, AS, HCM
sudden rise in __ pressure w atrial contraction
this is __ dysfxn
ventricular gallop just after s2 is __ heart sound
rapid filling of __ in diastole
assc w m__ and __ HF, volume __ and HO __
S4
compliance
end diastolic
diastolic
S3
ventricles
MR, systolic, overload, cardiac states
congenital coarctation of the aorta affects region __ to LSCA
in infancy, may have __ of LE progressing to HF/shock
in child/adult, sx of LE __ and __ discrepancy
congenital is assc w __ syndrome
DiGeorge Syndrome assc w interrupted __
poor LE __, RDS, and __
also T__
Down syndrome assc w __ cushion defects
such as OP __ and regurg __ valves
Marfan assc w cystic __ necrosis/dissection and MVP
distal
cyanosis
claudication, BP
turner
aortic arch
pulses, cyanosis
Tet of Fallot
endocardial
ASD, AV
medial
__ is class 3 antiarrhthmic
mostly ___
can cause __ due to dec production of TSH
or _ due to inc TSH synth
or __ thyroiditis w release of preformed TSH
other SE
sinus B__ and heart block
can prolong __
IPF inc \_\_ leading to hepatitis \_\_ neuropathy and deposits skin \_\_ peripheral \_\_
Amiodrane, iodine
hypothyroid
hyperthyroid
destructive
bradycarida
QT
LFT
optic
discoloration
neuropathy
__ assc w endothelial cells, VSMCs and luekocytes
chronic hemodynamic stress/hyperlipidemia leads to __ cell injury
inc expression of __ inc adherence of monos/T cells
releases cytokines/GF to promote __ into intima
VSMC release ECM proteins like __ to form the fibrous cap
macros/MMP promote __ and potential for release
disruption can lead to __
atherosclerosis endothelial, VCAM VSMC collagen MI
remodeling
serum sickness is assc w infections like __ and drugs like __
midsystolic click w mid-late systolic murmur at apex is __ murmur
sudden tensing of __, due to malalignment of the valve
Squatting inc __ and LV volume, so leaflets are in normal alignment
will __ MVP
usually sporadic disorder w __ degen of CT
Secondary MVP assc w __/__/__
proliferation of __ in valve leaflets, fragmented _ fibers and inc in mucopolysaccharide/T3 collagen
HepB, penicillin
MVP
chordae tendinae
venous return
dec
myxomatous
EDS/Marfan/OI
spongiosa, elastin
inspiration __ VR to right heart
__ VR to left heart
inc __ murmurs, dec __ murmurs
Valsalva/standing __ preload/afteload
inc __/__ murmur, dec others
squatting inc __/__
passive leg raise in p__
majority of murmurs __
MVP/HCM __
handgrip inc A__
inc A/M/V
dec H/A
inc
dec
Rh, LH
dec
MVP/HCM
preload/afterload
preload
inc
dec
afteroload
AR/MR/VSD
HCM, AS
central lines threaded into __
derived from common __
all veins in developing embryo drain into the __, and eventully RH
__ vein forms portal system
__ veins form systemic venous circ
__/__ derived from truncus arteriousus
NCC migration __ via twisting of truncal/bulbar ridges
SVC
cardinal veins
sinus venosus
vitelline
cardinal
AA, PA
separates
young pt, sudden onset palpitations has PSVT__
reentrant impulse bw slow/rapid conducting segents of __
vagal maneuver like __ massage, Valsalva, __ immersion improve it
carotid sinus travels to __ nucleus via CN 9
efferents travel in __nerve carrying PNS input to SA node
inc __ tone to slow __ by AV node, prolonging refractory period
use __ filter in pt predisposed to DVT but contraindicated for anticoags
on CT, found on pt __ of AA
should be below __ and next to __
paroxysmal supraventricular tacchycardia AV node carotid sinus, cold water vagal vagus PNS, conduction
IVC
right
duodenum, R kidney
cardiac cath access __ artery in leg or __ artery in arm
arterial puncutre above the __ inc risk of retroperitoneal hemorrhage
bleeding here cannot be __
becomes the __ in the pelvic cavity
hemorrhage into thing muscles produces __ syndrome w severe pain and absent distal pulse
in cardiac pacemaker cells, phase 0 depolarization mediated by influx of __
phase 4 mediated by ___
differs from cardio__ and __ fibers, which depolarize from __
common femoral, radial
inguinal ligament
controlled
external iliac
compartment
CA
Na
myocytes, perkinje
Na
best indicator for Mitral stenosis severity is length bw S2 (A2 caused by __ closre) and __
as it worsens, LA pressures rise, causing valve to open ___
presystolic __ occurs due to inc __ flow w LA contraction
transposition of GA caused by linear development of __ septum
aorta is __ connected to RV
PA is posterior and connected to __
incompatable w life unless there is another __
failed conotruncal __ results in truncus arteriosus
echo shows single __ trunk overlying VSD
Aortic valce, opening snap
sooner
accentuation, transvalvular
aorticopulmonary
anterior
LV
shunt
septation
arterial
meds w neg chronotropic effect B blockers M/A nondihydropyridine CCB V/D Cardiac glycoside D A/S cholinergic agonist P/R
BB titrated to HR of __
when used w nondihydropyridines, there is an added __ effect on HR, AV node conduction and myocardial contractility
can lead to sinus __ and hypo__
metoprolol, atenolol verapamil, diltiazam digoxin amiodarone, sotalol pilocarpine, rivastigmine
55-60
neg
bradycarida, hypoTN
Isovolumetric contraction is spot __
closing of __ valve as LV contracts, __ inc
no blood leaves bc __ closed
Ventricular ejection is point _
__ valve opens as LV pressure rises
Isovolumetric relaxation occurs bw __ and __
closing of __ as pressure drops, no blood enters
Ventricular filling bw __ and __
opening of __ as ventricular pressure falls below __
in MS, opening snap occurs at point __ due to halting of leaflet motion
diastolic rumble then occurs as blood flows across __ valve in bw __A
A
mitral, pressure
A/M
B
aortic
C and D
AV
D and A
mitral valve, atrium
D
stenotic, D and A
__ endocarditis occurs in elderly man usually w manipulation of GI/GU tract
typically __ hemoltyic, catalase __ gram positive cocci that can grow in hypertonic saline/bile
tx w A__ and __
in left heart cath, passive filling of LA w blood from pulm veins should be timed w __ systole
LA pressure max is around __ mmHg
in MR, LA pressure will be markedly __, w an early/large V wave
Enterococci
gamma, neg
ampicilin, aminoglycosides
LV
10
inc
AR, there is a loss of __ notch and rapid __ in aortic pressure during diastole w elevated __/__ pressures
__ shows discordance in LV/aortic pressures
__ causes inc LA pressures, w peak at time of atrial kic
In isolated MS, cardiac/pulm pressures proximal to mitral valve are ___
diastolic pressure in the LV should be __
if elevated, indicates __ dysfxn as well
dicrotic aortic, dec
LA/Aortic
AS
MS
high
normal
aortic valve
Rheumatic HD always affects __ valve, but can lead to combined aortic __/__
early diastolic murmur indicates __
sx occur as __ inc
more advanced cases produce a __ murmur, mild cases is __ diastolic murmur
usually due to aortic root __, and best heard at RSB or _ aortic valve
mitral
regurg, stenosis
AR
volume
holodiastolic, early
dilation, bicuspid
W__ caused by AV accessory pathway
instead of using AV node, extra conduction pathway called accessory __ or bundle of Kent, directly connects atria to ventricles w preexcitation
ECG: short ___, wide __, and __ wave
can lead to AV __ tacchycarida
cardiac myocyte degen seen w __ block
congenital __ due to mutation in genes encoding for cardiac Na/K channels
Afib caused by rapid electrical impulses in __
A flutter caused by reentrant circuit near __ annulus
WPW
bypass tract
PR, QRS, delta
reentrant
conduction
long QT syndrome
pulm veins
TC
Strep viridians commonly initiates __
can cause bacterial __
adhere to tooth enamel/fibrin aggregates due to insoluble extracellular __ dextrose
pt w aortic valve endocarditis can lead to __ bw aortic root and RV
bc pressure is always higher in the Aorta, blood flow will go from aorta to RV ___
dental carries
endocarditis
polysaccharides
aortocavitary fistula
continuously
__ error occurs when no difference is obtained when a difference truly exists
blinding dec __ bias
subacute bacterial endocarditis can be complicated by __
look for __ asses on autopsy
IE most commonly affects __ valve
__ is big RF for IE
platelets/fibrin will deposit secondary to __ and turbulent BF
deposits colonized by __
__ valve is another RF
Beta
observer
embolic stroke friable mitral MVP injury microorganisms
mechanical
In pt w suspected VSD, dx w ___
small VSD produces __ murmur at LLSB
larger VSD can present w F__, __ failure
can lead to __ syndrome, with reversal of shunt following inc __
migratory thrombophlebitis may indicate __ adenoca
specifically of P/C/L
H__ state bc adenocarcinomas produce __ like substance
echo
holosystolic
FtT, heart
eisenmenger, pvr
visceral
pancreas, colon, lung
hypercoagulable, thromboplastin
w LHF, inc permeability of capillary wall leads to disruption of capillary __ and alveolar __ layer
alveolar hemorrhage results, w RBC phagocytosed by __
use __ stain
golden cytoplasmic granules in macros that turn blue indicate __ macros
caused elevation in __
biventricular pacemaker w _ leads involves left heart
first 2 into __/__ and third goes from RA to __ which resides in the AV groove on __ aspect of heart
__ catheters go into PA
endothelial, epithelial macros Prussian blue hemosiderin laden PCWP
3
RA/RV
coronary sinus, posterior
swanz ganz
occlusion of the RCA affects p__ wall of LV
elevated leads __ and __ and __
occlusin of proximal LAD can cause A__ transmural ischemia
elevate leads __
occlusion of LCX can produce L__ wall of LV transmural ischemia
st elevatins in V_ and _
also _ and _
posteroinferior
2, 3, avF
anteroseptal
V1-V4
lateral
V5, 6
1 and avL
IE rf include __ abnorms and cx promoting __/__
leads to chronic __ inflamm and scarring
initial process in IE is dirsuption of __ surface
usually w __ to blood flow
focal adherence of __ and platelets w formation of fibring platelet __
microorgs then colonize and activae __ system
valvular
bacteremia/fungemia
valvular
endocardial
turbulence, fibrin, nidus
coagulation
Familial hypercholesterolemia caused by __ mutation in LDL receptor
high __ and premature __
homozygous has __ in childhood
Southern blot to detect \_\_ dna \_\_ from cells restriction \_\_ digests DNA gel electrophoresis separates \_\_, w larger frags moving slower DNA \_\_ to identify target
AD
LDL, atherosclerosis
CAD
mutations extracted endonuclease size probe
upon standing, venous return __ w dec ventricular filling/CO
drop in __ evokes baroreflex
inc __ tone inc PVR via A1 and HR/contractility via B1 receptors
A1 ags T/D used for BPH can result in orthostasis
also via __ depletion, and __ dysfxn
dec
BP
SNS
Terazosin, doxazosin
volume, autonomic
A1 agoist M/P __ HR, __ cardiac contractility and __ SVR
A1 antags __ HR and __ SVR
A2 ags C __ HR and SVR
B agonist I __ HR, contractilit and __ SVR
B1 antag M/A dec __/__
midodine, phenylephrine, dec, dec, inc
inc, dec
clonidine, dec
isopretenerol, inc, dec
metoprolol, atenolol, HR/contractility
Type __ collagen is found in MI
seen in D, B, T/L, scar tissue
type __ in cartilage, vitreous humor, NP
type __ in Skin, lungs, intestines, bv, granulation tissue
type 4 in __
1
dermis, bone, tendon/ligament
2
3
4
inc contractility inc volume of blood __
seen bw line __ and __ on graph
LV end diastolic volume correlates to LV ___
LV end systolic volume is larger w dec __
ventricular afterload seen at point __
expelled
B and C
preload
contractility
B
spontaneous episodes of nighttime/rest angina w ST elevation indicate __ angina
sudden vasospasm of coronary artery leading to brief ___
usually around ___ plaques
seen w smoking, C/A, triptns
Dihydroergotamine is ergot for __
constricts vasc smooth muscle via __ and __ agonist properties
tx w vasodilators like N and D CCB
prizmental
myocardial ischemia
atherosclerotic
cocaine, amphet
migraines
Alpha, serotonin
nitrates, dihydropyridine CCB
