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96 Cards in this Set
- Front
- Back
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What molecule regulates coronary blood flow?
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Nitric oxide
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What agent is associated with dental work endocarditis?
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S viridans
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What agent is associated with R sided endocarditis
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S aureus
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What agent is associated with GI lesions
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S. bovis
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What drugs cause increased threshold for action potential
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Class IA
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What drugs lead to shortened action potential
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Class IB due to mild Na blockade
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What drugs lead to prolonged repolarization
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IA, IC, III
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What drugs lead to slowed diastolic depolarization
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Class IV, calcium channel blockers
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What antiarrythmic drugs should you administer when you see myocardial ischemia
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Class IB like Lidocaine
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What are side effects for Amiodarone?
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Check pulmonary fibrosis, hepatotoxicity, hypo/hyperthyroidism
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What is holosystolic blowing murmur at apex that radiates toward axilla?
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Mitral regurg
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Ejection click murmur radiating to carotid apex/carotid? Pulses weak compared to heart sounds. Syncope.
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Aortic stenosis. Due to calcific stenosis or bicuspid
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Late systolic crescendo murmur with midsystolic click?
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Mitral prolapse. Most frequent valvular lesion. Myxomatous degeneration, rheumatic fever, chordae rupture.
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Immediate blowing diastolic mumru? Heard at Left sternal border?
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Aortic regurg. Head bobbing and bounding pulses.
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What murmur follows opening snap during diastole?
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Mitral stenosis. Occurs 2ndary to rheumatic fever.
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What does nitroglycerine do?
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Venodilator decreasing preload
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What drugs affect small arteries and arterioles?
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Calcium channel blockers and prazosin (alpha-1 adrenergic blocker)
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What affects tension of precapillary sphincters?
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Dilate with low O2, acidosis, increased CO2, NE and epinephrine
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How do nitrates and PDE inhibitors both operate by?
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increase cGMP and mediate smooth muscle relaxation
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What does an S3 gallop characterize?
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Dilated/congestive cardiomyopathy, rapid filling
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What is wide, fixed S2 signal for?.
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ASD - think pulm HTN in the long run
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Side effects of digoxin?
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AV block and V tach. Increased Potassium. N/V. Diarrhea. blurry yellow vision
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Treating digoxin toxicity
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charcoal; bringing in K with insulin/dialysis
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What are changes of heart related to diastolic function?
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Normal cavity size, normal EF, increased EDP
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What is good treatment for emergent PSVT? Side effects?
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Adenosine. See flushing, chest burning, SOB
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Side effects of verapamil
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Gingival hyperplasia, constipation
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Side effects of digitalis
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Fatigue, blurry vision, N/V, diarrhea, abdominal pain, delirium
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Side effect of nitroglycerin
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Throbbing headache
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What can you treat Raynaud's with?
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Calcium blockers
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What is side effect of ACEis
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angioedema from increased kinins
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Which drugs increase QT interval?
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Class IA like quinidine, procainamide, disopyramide.
Class III - amiodarone, sotalol |
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Which drug class is contraindicated in structural abnormalities/post MI?
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IC - felcainide, encainide, propafenone.
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Mechanism of Class II beta blockers?
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decrease cAMP, decrease Ca currents. decrease slope of phase 4. Affects AV node - good for a fib and a flutter.
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Mechanism of K channel blockers, Class III?
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Increase AP, Increase ERP. Bad: Increase QT interval.
Sotalol, ibutilide, bretlium, dofetilide, amiodarone |
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Mechanism of Ca channel blockers?
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Primarly affects AV nodal cells. Increase ERP, increase PR. for preventing nodal arrhythmias.
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What cell other than macrophages play a key role in the development of atherosclerotic plaques?
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Platelets releasing PDGF
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What is used for CABG if LAD alone is injured? What about for others?
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LAD alone - left internal mammary (internal thoracic)
others - great saphenous gotten from just under pubic tubercle |
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What can precipitate A fib? What is the EKG sign?
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no p waves. Precipitated by etoh, pericarditis, increased sympathetic tone
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What is derived from common cardinal veins?
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SVC
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What protein defect can lead to hypertrophic cardiomyopathy?
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Beta myosin
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What is ductus arteriosus derivative of?
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Sixth aortic arch
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What is the sign of acute pericarditis?
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friction rub
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What are signs of chronic pericarditis?
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Kussmaul's sign
Pericardial knock Pulsus paradoxus (drop in bp systolic from inspiration - also related to cor pulmonale) |
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What shows severity of mitral stenosis with auscultation?
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S2 - opening snap time interval.
Also if presystolic accentuation of left atrial contraction is gone, suggests a fib. |
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Other manifestations for PAD?
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skin atrophy, skin shininess
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How to fix anemia if it gives <3 problems?
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Blood transfusion
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Hypertrophy correlates to what genetic process?
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Increasing myosin RNA
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Amiodarone causes what lung finding?
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Interstitial pneumonitis
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Fastest conduction in heart?
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Purkinje system
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Are atrial fibers faster conductors or ventricular?
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Atrial
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Site of action for sildenafil?
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Corpus cavernosa
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Auscultation findings for tetralogy of fallot?
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Thrill, midsystolic murmur
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Relationship of blood flow and MAP?
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direct
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Findings for mitral stenosis?
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Diastolic, 4cm LSB left lateral decubitus
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Action of endothelin?
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Vasoconstrictor
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Action of ANP and BNP?
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vasodilation: Decrease preload and do diuresis --> activate GC leads to increased cGMP
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EKG signs for LV infarction?
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I and V3-V6. LV failure expect transudate.
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Hemosiderin macrophages are seen with?
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chronic LV failure
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Nitrate administration special caveats?
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Not at night to avoid tolerance devo.
Also with beta blocker to avoid reflex tachycardia |
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Reperfusion injury etiology?
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[see increased CK from membrane damage]
1) O2 radicals 2) mito damage 3) neutrophil inflammation 4) complement activation |
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What increases with COPD to counteract higher venous pressures?
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Increased lymphatic drainage
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Key before administering ACEis?
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Watch for first dose hypotension. Low Na, volume, bp, high renin/aldo, CKD, CHF.
be careful with those above |
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Non selective Beta blockers can maks what?
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Hypoglycemia. Don't have epinephrine/NE response.
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Signs of LAD blockage on EKG?
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anteroseptal. V1-V4
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Signs of LCX infarction on EKG.
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Transmural and lateral wall. V5, V6 maybe I and aVL
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Signs of RCA infarction on EKG?
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II, III, avF
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MR murmur presents where?
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LSB
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Vegetations in bacterial endocarditis deposit what?
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Fibrin
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What causes myxomatous degeneration?
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MVP like with Marfan
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How to accentuate a VSD on auscultation?
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Increase afterload. Like with hand grip.
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Exercise doesn't cause a giant increase in BP by?
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decreasing SVR
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Signs of MI after 4-12 hours?
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Early coagulative necrosis, edema, hemorrhage, wavy fibers
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Signs of MI after 12-24 hours?
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Coag and marginal contraction band necrosis
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Signs of MI after 1-5 days?
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Coag necrosis and neutrophils
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Signs of MI after 5-10 days?
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MACs
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Signs of MI after 10-14 d?
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Granulation neovascularization
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Signs of MI after 2 wks?
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Collagen/scar
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Proven by RALES trial to decrease mortality with CHF?
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Spironolactone. Stops aldosterone remodelling.
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With a fib, what determines ventricular contraction rate?
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AV refractory period
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W/o ATP why do cardiac cells swell?
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high Ca accumulation.
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Use of fatty acid oxidation inhibitors for angina?
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Less Oxygen use per one ATP synthesized. Also decreases potentially toxic fatty acid metabolite production.
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Jervell and Lange-Nielsen syndrome?
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Long-QT with neurosensory deafness associated.
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What combo increases risk of myopathy with statins?
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Adding a fibrate
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What leads to thicker heart with decreased LV cavity size?
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Longstanding HTN
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Hemochromatosis on heart?
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Dilated cardiomyopathy
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PAthway of endothelial injury and inflammation?
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Starts with endothelial cell. Monocytes and lymphocytes move in. Denudation. Collagen - platelets. Growth factors, SMC move and proliferate. Permeability allows LDL in.
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Nitrate action on muscle?
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increase cGMP. decrease Ca. Myosin dephosphorylation.
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Characteristic underlying collagen changes and dissecting hematoma?
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Myxotamous changes = cystic medial degeneration. Like with Marfan
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Most common causes of SVC syndrome?
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Bronchogenic carcinoma
Non-Hodgkin lymphoma |
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Most specific sign of LV failure?
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Orthopnea
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Thromboangiits obliterans (Buerger's disease)?
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smokers - affecting tibial and radial arteries. Thrombosing
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Granulomatous vasculitides of larger vessels?
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Large cell, Takayasu
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Symptoms of Kawasaki disease?
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Fever, conjunctivitis, lymphadenopathy, strawberry tongue, edema, rash. Coronary aneursysm
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Irreversible cardiac cell damage?
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Mitochondrial vacuolization
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Augmenting murmur of LVH with HCM?
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Decreasing venous return = Valsalva or sudden standing
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HSP?
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PALPABLE PURPURA. Joint pains. GI bleeding. Hematuria. from IgA
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