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48 Cards in this Set
- Front
- Back
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What's the normal length of the PR interval? And the QRS complex?
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PR should be <200 msec
QRS should be <120 msec |
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Prominent Q waves on EKG... what is it?
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Recent or old transmural MI
- Q waves are seen 1-3 days after acute MI |
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Inverted T waves on EKG... what is it?
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Recent MI (1-3 days ago)
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What's the defect in the most common type of long QT syndrome?
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Decrease in K channel activity
- Can affect ears/hearing as well (Jervell and Lange-Nielsen syndrome) |
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PR interval >200 msec, otherwise normal EKG... what is it?
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1st degree AV block
- Asymptomatic |
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Progressive lengthening of PR interval until a beat is dropped... what is it?
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2nd degree AV block, Mobitz type I (Wenckebach)
- Usually asymptomatic |
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Normal EKG but with some P waves not followed by QRS complexes... what is it?
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2nd degree AV block, Mobitz type II
- Often found as 2:1 block (2 P waves to 1 QRS) - Can progress to 3rd degree (complete) block |
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EKG with P waves bearing no relation to QRS complexes... what is it?
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3rd degree (complete) AV block
- Usually treated with pacemaker - Can be caused by Lyme disease |
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What is the Cushing triad?
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HTN, bradycardia, respiratory depression
- Occurs with increased ICP, which causes constriction of arterioles, leading to cerebral ischemia, leading to sympathetic response (HTN), leading to reflex bradycardia |
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How is autoregulation of blood flow in the heart maintained?
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Local metabolites--O2, adenosine, NO
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How is autoregulation of blood flow in the brain maintained?
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Local metabolites--CO2 (pH)
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How is autoregulation of blood flow in skeletal muscle maintained?
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Local metabolites--lactate, adenosine, K
- At rest, sympathetic stimulation plays a role |
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How is regulation of blood flow in the skin maintained?
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Sympathetic stimulation (temperature control)
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Loud S1; wide, fixed split S2... what is it?
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ASD
- Causes left-to-right shunt |
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What congenital heart defects are associated with the 22q11 syndromes?
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Truncus arteriosus
Tetralogy of Fallot |
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What congenital heart defects are associated with Down syndrome?
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Endocardial cushion defects (ASD, VSD, AV septal defect)
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What congenital heart defects are associated with congenital rubella?
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Septal defects, PDA, pulmonary artery stenosis
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What congenital heart defect is associated with Turner's syndrome?
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Coarctation of the aorta
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What congenital heart defect might you expect in the infant of a diabetic mother?
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Transposition of great vessels
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Calcification in the media of the arteries, especially radial or ulnar; "pipestem" arteries... what is it?
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Monckeberg arteriosclerosis
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How does stable angina manifest on an EKG?
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ST depression
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How does Prinzmetal's variant of angina manifest on EKG?
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ST elevation
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How does unstable angina manifest on EKG?
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ST depression
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What are the first gross changes that occur post-MI, and when can you see them?
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1-2 hours: contraction bands visible
4 hours: early coagulative necrosis 24 hours: neutrophil infiltration begins |
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How do you diagnose an MI within 6 hours? What about after 6 hours?
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- In first 6 hours: EKG
- After 4 hours: cardiac troponin I rises and stays elevated for 7-10 days; more specific than other markers - CK-MB and AST are less specific markers |
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How would a transmural infarct show up on EKG? What about a subendocardial infarct?
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Transmural- ST elevation, Q waves
Subendocardial- ST depression |
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Fibrinous pericarditis post-MI... when does it occur, and what is the etiology?
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1. Postinfarction fibrinous pericarditis: 3-5 days post-MI, during acute inflammation phase; hear friction rub
2. Dressler's syndrome: autoimmune phenomenon resulting in fibrinous pericarditis several weeks post-MI |
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What is Dressler's syndrome?
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Fibrinous pericarditis due to autoimmune phenomenon, occurring several weeks post-MI
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What kind of cardiomyopathy results from chronic cocaine use?
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Dilated cardiomyopathy
- Other causes of DCM: chronic alcohol use, wet beriberi, coxsackie B myocarditis, Chagas disease, hemochromatosis, peripartum cardiomyopathy |
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What cardiomyopathy is associated with Friedreich's ataxia?
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Hypertrophic cardiomyopathy
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What are some causes of restrictive/obliterative cardiomyopathy?
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- Sarcoidosis
- Amyloidosis - Post-radiation fibrosis - Endocardial fibroelastosis (thick fibroelastic tissue in endocardium of young children) - Loeffler's syndrome (endomyocardial fibrosis with a prominent eosinophilic infiltrate) - Hemochromatosis (can also cause dilated CM) |
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Endomyocardial fibrosis with a prominent eosinophilic infiltrate, resulting in restrictive cardiomyopathy... what is it?
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Loeffler's syndrome
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Thickened endocardial plaques involving the valves of the right side of the heart... what is it?
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Endocarditis of carcinoid syndrome (not seen on the left side b/c 5-HT is inactivated in the lung)
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What are Anitschkow's cells?
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Activated histiocytes seen in Aschoff bodies (cardiac granulomas) of rheumatic heart disease
- Large amount of clear cytoplasm surrounding a rod-shaped nucleus ("caterpillar cell") |
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"Tree bark" appearance of aorta, with calcification of the aortic root and ascending aortic arch... what is it?
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Syphilitic aortitis
- Tertiary syphilis disrupts the vasa vasorum of the aorta leading to necrosis of the media |
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What systemic syndrome is associated with rhabdomyomas of the heart?
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Tuberous sclerosis
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Hemoptysis, hematuria, perforation of nasal septum, chronic sinusitis, otitis media... what is it, and how would you treat it?
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Wegener's granulomatosis (necrotizing vasculitis with granulomas, affecting small vessels in the lung, upper airway, and kidneys)
- Tx: cyclophosphamide, corticosteroids |
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Disease that presents like Wegener's granulomatosis, but that lacks granulomas... what is it?
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Microscopic polyangiitis
- Has p-ANCA (Wegener's has c-ANCA) |
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Fever, conjunctivitis, "strawberry tongue", lymphadenitis, desquamative skin rash... what is it, and how would you treat it?
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Kawasaki disease (acute, self-limiting necrotizing vasculitis in kids)
- Tx: IV Ig, aspirin |
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Immune complex-mediated transmural vasculitis with fibrinoid necrosis, with concomitant hepatitis B infection in 30% of pts... what is it, and how would you treat it?
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Polyarteritis nodosa
- Involves renal and visceral vessels - Tx: corticosteroids, cyclophosphamide |
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Fever, arthritis, night sweats, myalgia, skin nodules, ocular disturbances, weak pulses in the upper extremities... what is it?
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Takayasu's arteritis (granulomatous thickening of aortic arch and/or proximal great vessels)
- Seen in Asian women <40 - Assoc. with an elevated ESR |
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What is a pyogenic granuloma, and when is it seen?
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- Polypoid capillary hemangioma that can ulcerate and bleed
- Seen in trauma and pregnancy |
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What is a glomus tumor?
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Benign, painful, red-blue tumor under fingernails
- Arises from smooth muscle cells of glomus body |
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Where are angiosarcomas located and when are they seen?
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- Highly lethal malignancies of the liver
- Assoc. with vinyl chloride, arsenic, and ThO2 (thorotrast) exposure |
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How would you treat a digoxin overdose?
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- Slowly normalize K
- Lidocaine - Cardiac pacer - Anti-dig Fab - Give Mg |
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What are the potential toxicities of amiodarone?
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MAJOR: pulmonary fibrosis, hepatotoxicity, hypo- or hyper-thyroidism
Others: corneal deposits, skin deposits (blue/gray) --> photodermatitis, neurologic effects, constipation, bradycardia, heart block, CHF - Remember: when using amiodarone, check PFTs, LFTs, and TFTs! |
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What are the toxicities of the class IV anti-arrhythmics (Ca channel blockers)?
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= Verapamil and diltiazem
- Constipation, flushing, edema, CHF, AV block, sinus node depression |
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How does adenosine work, and what is used for?
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Causes transient block of AV node conduction; very short-acting (half life = 15 seconds)
- Increases K efflux --> hyperpolarization, decreased Ca influx - Effects blocked by theophylline |
