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Dr. Mel - Cardiovascular > UWorld 2017 > Flashcards

UWorld 2017 Flashcards

1
Q

Digoxin indications

A

For ventricular rate control in Afib: increases parasymp vagal tone, decreases AV nodal conduction
For HF: inhibits Na/K ATPase, positive inotropic

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2
Q

Causes of angioedema

A

Mast cell activation: HS I (IgE) or direct activation; ass w/ pruritus + urticaria
Excess bradykinin: ACE inh or C1 inh deficiency; No pruritus/urticaria

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3
Q

Prinzmetal angina

A

Triggers: cigarette smoking, cocaine/amphetamines, dihydroergotamine/triptans
Dihydroergot (vasoconstriction by alpha-adren agon + serotonin agon)
Ttt: tobacco/drug cessation, vasodilator (nitrates, CCB)

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4
Q

ECG changes in occlusion of different arteries

A

RCA: transmural isch of inf wall of LV, ST elev in II+III+aVF + sinus node dysfunction
Proximal LAD: anteroseptal transmural isch, ST elev in V1-V4
LCX: transmural isch of lat wall of LV, ST elev in V5-V6 +/- I and aVL

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5
Q

Severity of Mitral regurgitation

A

Holosystolic murmur
Audible left S3: high regurgitant volume (severity) + LV overload
Intensity of murmur does not correlate w/ severity

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6
Q

Beta1-adrenergic receptors

A

In cardiac tissue + juxtaglomerular cells
Not in vascular smooth muscle
Selective B1-recept blockade: decreased cAMP in cardiac+renal tissue

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7
Q

Daily long-acting nitrates

A

Need to have nitrate-fee period every day

Avoid tolerance to the drug

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8
Q

Mitral valve prolapse

A

Midsystolic click + mid-late systolic murmur of MR

Defect in mitral valve connective tissue proteins that predispose to degen of leaflets + chordae tendineae

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9
Q

Pressures in RA, RV, PA

A

Diastolic RV = RA = central venous pressure = 1-6 mmHg

Diastolic Pulm Art press = 6-12 mmHg

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10
Q

Major risk factors for Ao dissection + Ao aneurysm

A

Hypertension: intimal tear leading to Ao diss

HTN, db, hypercholest: major risk factors for atherosclerosis that predisposes to Ao aneurysm

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11
Q

Drug interaction of Nitrates + PDE inhibitors

A 
PDE inh (tadalafil): erectile dysfct, pulm HTN
Nitrates+PDEinh: increased intracellular cGMP, vasodilation, profound hypotension
Absolutely CI together
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12
Q

Nonvalvular heart failure

A

Congestive HF: dilated CM or chronic ischemic H ds; dilation of 1-2 V + systolic dysfct
Diastolic dysfct: HTN H ds w/ concentric V hypertrophy, hypertrophic CM w/ asymmetric septal hypertrophy

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13
Q

Atherosclerotic plaque rupture

A

Rupture related to plaque instability rather than size or degree of luminal narrowing
Stability depends on mechanical strength of fibrous cap
Inflammatory macrophages in intima secrete metalloproteinases so reduce stability

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14
Q

Cause of symptoms/signs in AR

A

By abnormally large (wide) pulse pressure

Nocturnal palpitations, head pounding w/ exertion

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15
Q

Cough secondary to ACE inh

A

Dry, nonproductive, persistent

Accumulation of bradykinin, substance P, prostaglandins

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16
Q

Circulation in heart vs other organs

A

Heart perfused during diastole
Myocardial oxygen extraction very high (60-75% at rest): blood in coronary sinus is most deoxygenated
Myocardial oxygen demand + coronary blood flow: tightly coupled; O2 use increased several-fold during exercise by increased coronary blood flow

17
Q

Left atrial enlargement

A

Left recurrent laryngeal nerve impigement

Neurapraxia: left vocal cord paresis + hoarseness

18
Q

ACEinh + ARBs in systolic HF

A

Improve hemodynamics
Inhibit chronic AngII-mediated cardiac remodeling
Reduce mortality

19
Q

Indicated + CI medications in Hypertrophic CM

A

Indicated: negative inotropic agents (beta blockers, nondihydro CCBs, disopyramide) reduce LVOT obstruction and symptoms
Avoid: vasodilators (dihydro CCBs, nitrogl, ACE inh) decrease SVR then afterload + LV volumes
Avoid: diuretics decrease preload so greater obstruction

20
Q

Congenital QT prolongation syndrome

A

Unprovoked syncope in asymptomatic young person
Romano-Ward sd or Jervell+Lange-Nielsen sd
Mutation in K+ channel protein: delayed rectifier current of action pot

21
Q

Atherosclerotic plaques dev

A 
#1 large elastic arteries (Ao, carotid, iliac)
#2 large or medium musc arteries (coronary, popliteal)
In body: abdo Ao > coronary art > popliteal art > internal carotid art > circle of Willis
22
Q

Beta blockers and AMI

A

Reduce HR, CO and myocardial O2 demand
Non-cardioselective BB: bronchospasm if asthma/COPD
Cardioselective BB: esp on B1 recept (Metoprolol)

23
Q

Nitrates function

A 
Venodilators: increase periph venous capacitance, reduce preload + LVED volume and pressure
Arteriolar dilation (modest effect): decrease SVR + afterload
24
Q

Nitroprusside function

A

Short-acting balanced venous + arterial vasodilator

Decrease preload + afterload: so stroke volume maintained

25
Q

Causes of angina

A

Asymptomatic: atherosclerotic plaque obstr <75%
Stable: fixed atherosclerotic plaque obstr >=75%
ACS (unstable, MI, sudden cardiac death): acute plaque change w/ superimposed thrombosis
Unstable or subendocardial infarction: ulcerated atherosclerotic plaque w/ partially obstr thrombus
Transmural MI: ruptured atherosclerotic plaque w/ fully obstr thrombus

26
Q

Intracellular changes of nitrates

A

Nitrates to NO then activate guanylate cyclase, increase intracellular cGMP
Myosin light-chain dephosphorylation
Vascular smooth relaxation

27
Q

Abciximab MOA

A

Blocker of GP IIb/IIIa receptor (platelet to fibrinogen)

Glanzmann thrombasthenia: deficiency/defective GP IIb/IIIa

28
Q

Ttt when AFib w/ rapid ventricular response

A 
#1: CCBs and Beta blockers
#2: digoxin (esp when systolic dysfct)
29
Q

Digoxin toxicity

A 
Cardiac arrhythmias
GI (N/V)
Neuro (confusion, weakness)
Visual symptoms, color vision alterations
Hyperkalemia
30
Q

Chronic aortic stenosis + concentric LV hypertrophy

A

Atrial contractions contributes to LV filling

If AFib, reduced LV preload and CO: systemic hypotension + acute pulm edema

31
Q

Synthesis of NO

A

From arginine by nitric oxide synthase

Arginine supplementation: role in ttt to improve vasodilation (stable angina)

32
Q

Non-dihydro CCB + Beta blocker

A

Additive negative chronotropic effect

Severe bradycardia + hypotension

33
Q

Carotid sinus massage

A

Increase in parasympathetic tone
Temporary inh of SA node, slow conduction in AV node, prolongation of AV node refractory period
For termination of paroxysmal SVT

34
Q

Isoproterenol

A

Beta-1 and beta-2 adr recept agonist
Increased myocardial contractility
Decreased systemic vascular resistance

35
Q

ACE inhibitors cause hypotension

A

If volume depletion of HF: first-dose hypotension

Avoid this by initiating at low dosages

36
Q

Ventricular hypertrophy

A

Concentric: due to increased afterload (chronic HTN, Ao stenosis)
Eccenctric: due to volume overload

37
Q

Restrictive cardiomyopathy

A

By infiltrative ds (amyloidosis, sarcoidosis, hemochromatosis)
Ventric hypertrophy + impaired filling: Diastolic HF

38
Q

Dobutamine

A

Beta-adren agonist: B1 > B2 and a1
B1: increased cAMP and cytosolic Ca
So increased myocardial contractility

Dr. Mel - Cardiovascular (3 decks)

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