UW Q and A Flashcards
Acute graft rejection (t, histo, rxn, Sx)
1-4 weeks posttransplant; end-myocardial biopsy-dense infiltrate of mononuclear cells of T-lym; sensitization against foreign MHC antigens; dyspnea on exertion/paroxysmal not dyspnea). Can be humoral rejection-direct immunofluorescence.
Histo of hypersensitivity myocarditis
Due to drug therapy, perivascular infiltration w/abundant eosinophils
Ischemic damage to the donor heart histo
Patchy necrosis w/granulation tissue
Chronic rejection of organ
scant inflammation cells, interest fibrosis, host T, B cells, abs. Months-years.
MAP during exercises why a modest increase
Because despite increased CO, SVR decreases due to arteriolar dilation in active muscles -local adenosine, K, ATP, CO2, lactate.
Collagen subtypes
Type 1: skin, bone, tendons, ligaments, dentin, cornea, BV, scar (infarct)-OsteogImp; 2- cartilage, vitreous h, null pulp-skew dysplasias; 3- skin, lungs, BV, BM, lymph, granulation-vast Ehlers-Danlos; 4- Basem member-Alport.
T for MI histo (0-4h, 4-12, 12-24, 1-3D, 3-7, 7-10, 10-14, 2-8w)
0-4 h: no, 4-12: wavy fibers, narrow, long myocytes; 12-24: hypereosinoph, shrunken nuclei; 1-3 D: coagulation near (no nuclei, striations), neutrophils infiltrate; 3-7 D: disintegrated of dead neutrophils, myofibers, Macrophage infiltr at borders; 7-10D: phagocyt of dead cells, granul tissue begins at margins; 10-14 D: granul w/neovascul; 2-8 w: collagen deposit, scar.
a1 agonists (phenylephrine, methoxamine)
vasoconstriction (renal, splanchnic as well>decr perf), mydriasis, incr intern urethral sphincter tone and prostate contraction, Increased BP>reflexive inc in vagal tone on heart> inh SA node, slowed AV cond, decr contract> decr HR.
a2 agonists
CNS mediated decr in BP, dear IOP, dear lipolysis, dear presynap NE release; inc plates aggreg.
Hibernating myocardium, CABG/PCI
chronic ischemia, prevents necrosis; reduced ca responsiveness, decreased expression, disorgan of contractile and cytoskel proteins, ch adrenerg control. > dear contract, LV syst dysf.
Ischemic preconditioning
brief repet ischemia w/reperfusion>greater time for salvage. Ex:Angina prior MI.
Reperfusion injury
Sx: arrhythmias, myoc stunning, myocyte injury, death.
LV P and V loop
Vertical-afterload; horiz-preload (decr=left shift, N=1 or EDV), contract (decr=right shift), SV-width. Compliance - lower line (4 (MV opens) to 1).
Isovolumetric contraction
1-LV contract, closure of MV, S1, EDV. 2- AV opens.
Ventricular ejection
Blood from LV>aorta. 3- AV closes, S2.
Isovolumetric relaxation
3 to 4- LV P falls.
Ventricular filling
4-MV opens. S3, S4 -b/w 1-4.
dyspnea on exertion (decr SV), chest tight, tachy, low voltage QRS (distance-fluid), beat to beat variation in QRS axis. E:?. CXR:?
Pericardial effusion. E: acute peric, injury (MI), tumor, RF w/uremia. CXR: enlarged, clear lungs.
CXR COPD
Hyperinflation (>10 posterior ribs), incr bronch markings, flat diaphragm.
CXR Pull edema
Patchy perihilar infiltrates
CXR pneumothorax
no peripheral lung markings, collapsed lung
CXR pleural effusion
costophrenic, cardiophrenic angles obscured, loss of diaphr contour, white-up. Fluid meniscus.
role of arginine in vasodilation
Acetylcholine, shear stress, bradykinin from endoth> Ca cat incr> eNOS> Arginine+O2>NO+citrulline. NO goes for GC in muscle to turn GTP>cGMP.
SE from dual chamber pacemaker
TR to RHF (SVC>RA>RV)
Myocyte relaxation pumps
Na-3Ca exchanger on T tubule, SERCA (Ca ATPase) on Sarc retic from cytoplasm where myofilaments.
Thiazide diuretics MOA
inhibit Na/Cl cotransp in DCT, decrease reabs.
RAAS
Blood volume/pressure drop>RAAS> renin (Angiotensinogen>Ang1)> ACE (ang1 to ang2). ANg2> vasoconstriction and aldosterone. Aldosterone> Na (3), H2O reabs incr, K (2) and H secretion (NaK ATPase -basal membrane).
ACE ink
decrease Ang2
Amiloride, triamterene
Inhibit Na epithel channel (ENaC), can’t enter principal cell (apical membr).
SLE Dx
Hemolytic anem, thrombcytop, leukop, low C3,4. ANA, Anti-dsDNA, antiSm.
Sick sinus syndrome
age degeneration of SA node in the right atrial wall> Brady with dropped p waves, escape beats (AVN). reduced CO>syncope.
His bundle
Interatrial septum. Causes Mobitz (1-prol, 2-dropped QRS, 3- diss.).
Skeletal muscles ca channels
Unlike others, here RyR and L type mechanically coupled (one opens another by conform change). Not dependent on extracell ca. not affected by verapamil.
Cardiac muscles ca channels
L type channels take few ca from extracell> bind to RYR> open them> Ca into intracell from SR.
Nutcracker effect
left renal vein runs between SMA and aorta, can be compressed. Longer, also gonadal vein directly comes from it (not IVC like right). Varicocele. hematuria, flail/abd pain.
MR, cardiac cycle, catheter of LH
high left atrial pressure (N=10), easy and large V wave.
AR, cardiac cycle, LH pressure
Backflow to LV>drop in aortic pressure. N=70-100. Increased LVEDP (N=120). Loss of aortic dicrotic notch, MV faster closes.
AS, LH pressure
LVP much higher than AP.
MS, LH pressure
LA Pr elevated, atrial kick just before MV closes.
femoral triangle, cannulation
lateral to medial: femoral nerve, artery, vein, deep ing LNs/vess. Artery (midway of ing lig, b/w AIS and pubic s.). Cannulation: 1 cm medial to pulsation, 1 cm below ing lig.
Digoxin toxicity
anorexia, nausea, vom, abd pain, fatig, conf, weakn, color vision changes. inhibits Na/K ATPase (K extracell incr).
Aspirin toxicity
Vertigo, tinnitus, vomit, diarrhea, if severe=coma, hyperpyrexiam pulmonary edema.
AVNRT
narrow QRS, regular, nonviable p- PSVT. Young.
ANP, BNP
activate GC(cGMP). Afferent vasodilation, efferent vasoconstriction- GFR incr. Decreases renin-ang2 (prox)-aldost (distal).
AVRT
Accessory conduction pathway
Familial DCM
Titin truncation mutation, incomplete penetrance -delayed/absent Sx.
histo of myxoma, Sx
amorphous ECM, hemoptysis, dyspnea positional murmur-mid-diastolic plop, left atrium, emboli.
Adenosine effect on AVN
hyper polarizes it and causes conduction delay
b blocker overdose
glucagon- increases cAMP for intracellular ca for contraction.
stable angina moa
stable plaque obstructing >70% lumen, demand supply mismatch, substernal chest pain.
unstable angina moa
ulcerated plaque partially obstructive thrombus
SVC, portal veins originate from
cardinal and vitelline veins
epinephrine effects, doses
increase HR (b1), SBP (b1+a1). Decreased DBP (b2) if b2>a1 at low= Vasodilation.
milrinone
pde-5 inhibitor- more cAMP>more Ca> contractility and venodilation by cAMP dependent kinase. Reduces pre, afterload, increases CO.
cardiovascular dysphagia
LA enlargement. Mid esophagus dysphagia.
aortocavitary fistula
from endocarditis, Aorta=120/80. RV=25/5, continuous flow from A>RV.
wernicke Korsakoff
ataxia, oculomotor abn, confusion, perm memory loss.
wet beriberi
cardiac also not PN only, fluid.
great saphenous vein
if multicoronary bypass, superficial, longest vein. Medial.
complications of MI
Acute: RVF-hypotension, Kussmaul, clear lungs. Acute/3-5 D: Papill.muscle rupture-Severe MR, fall leaflet, new murmur, severe pull.edema; IVS rupture- chest pain, new murmur, bivalent.failure, shock. 5D-2 W: Ventricular free wall-rupture-ChP, tamponade, shock, distant heart sounds. Months: LV aneurysm- subacute HF, stable angina.
carotid sinus hypersensitivity
shaving, rubbing a shirt collar, turn the head, vasovagal response, decreased SVR.
phenylephrine
a1 agonist, vasoconstriction, SVR incr, pressor-BP. Dear HR by barorecep reflex. Increased IP3.
PCWP
LV function-LV filling pressure, pressure in LA. Introduced to PA the/RH.
Dobutamine
b1, HR-Na funny, Contractility-cAMP>Ca. But decreased SVR by cAMP on smooth muscle cells-vasodilation> not strong pressor.
prevention of doxorubicin toxicity
Dexrazoxane (chelator prevents complex formations with topoisomerase and free radicals)
histology after MI time
4-24 h- hypereosinophilic myocytes w/shrunken nuclei. 1-3 D-neutrophils at borders. 3-10 D- neuter in center, 10-14D-collagenm neovascularization of granul. 2w-2m-scar.
fenoldopam
dopamine agonist, decreases BP by vasodilation the/cAMP increase. Renal perfusion, natriuresis. Hypertensive emergency.
AV node place, ablation
coronary sinus, interatrial septum
DVT Tx If contra to anticoagulant
IVC filter, L5-merging of common iliac veins to IVC.
