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145 Cards in this Set
- Front
- Back
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What supplies inferior portion of LV
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80%- PD arises from RCA, supplies posterior septum- right dominant
20%- PD aries from CFX |
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MC Coronary artery occlusion
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LAD
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Most posterior part of heart
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LA
enlargement can cause compression of esophageal nerve- dysphagia or recurrent laryngeal nerve- hoarseness |
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Supplies RV
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Acute marginal artery, off RCA
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Supplies posterior LV
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CFX
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SA and AV nodes supplied by
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RCA
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Venodilators
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ex nitroglycerin
dec preload |
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Vasodilators
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ex hydAlAzine
dec Afterload (Arterial) |
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Digitalis
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inc contractility of heart
inc intracellular Na which results i inc Ca |
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EF
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SV/EDV= EDV-ESV / EDV
nmlly over 55% |
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Viscosity inc in
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polycythemia, hyperproteinemic states- MM, hereditary spherocytosis
depends most on hct |
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Operating point of heart
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CO = venous return
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S2 splitting
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aortic valve closes before pulmonic
inspiration inc this difference |
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Wide splitting
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associated with pulmonic stenosis or RBBB
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Fixed splitting
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associated with ASD
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Paradoxical splitting
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associated with Aortic stenosis of LBBB
A2 delayed so P2 sound occurs first on inspiration, P2 moves closer to A2 |
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ASD murmur
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presents with pulm flow murmur- inc flow through pulm valve, and diastolic rumble- inc flow across tricuspid
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VSD murmur
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pansystolic murmur heard in tricuspid area
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Heard at left sternal border
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Diastolic murmur- AR, PR
Systolic murmur- Hypertrophic cardiomyopathy |
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Hand grip
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inc systemic vascular resistance
inc MR, VSD systolic murmurs |
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Valsalva
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dec venous return
most murmurs dec instensity INC MVP, hypertrophic cardiomyopathy murmurs |
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Rapid squatting
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inc venous return, inc afterload
DEC MVP, hypertrophic cardiomyopathy murmurs |
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MVP murmur
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dec preload causes click and murmur to move closer to S1 heart sound- anxiety, valsalva, standing
inc preload causes click and murmur to move closer to S2 heart sound- reclining, squatting, hand grip |
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Pulsus parvus et tardus
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pulses weak compared to heart sounds
AS cres decres systolic ejection murmur, radiates to carotids/apex |
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AR murmur
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high pitched blowing diastolic murmur, wide pulse pressure, when chronic can present with bounding pulses and head bobbing
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Congenital rubella
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cataracts, deafness, PDA
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Speed of conduction
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Purkinje > atria > ventricles > AV node
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Pacemakers
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SA > AV > bundle of His/Purkinje/ventricles
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AV node delay
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100 ms delay, AV delay, allows time for ventricular filling
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ECG
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P wave- atrial depol
PR interval- conduction delay through AV node (nml < 200) QRS complex- vent depol (nml < 120) QT interval- mechanical contraction of ventricles ST segment- isoelectric, ventricles depol T wave- vent repol |
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T wave inversion
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recent MI
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Peaked T wave
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hyperkalemia
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U wave
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hypokalemia, bradycardia
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Torsades de points
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v tch, shifting sinusoidal waveforms on ECG, can progress to v fi
anythng that prolongs QT interval can predispose to this |
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Congenital long QT syndromes
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most often due to defects in cardiac Na or K channels
can present wiht severe congenital sensorineural deafness Jervell and Lange-Nielsen syndrome |
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A fib
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irregularly irregular, no P waves
tx beta blocker ca channel blocker, digoxin prophylaxis against thromboembolism with warfarin |
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A flutter
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sawtooth, flutter waves
use class IA, IC, III antiarrhythmics |
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1st degree AV block
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prolonged PR interval >200 ms
asymptomatic |
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Mobitz type 1
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2nd degree AV block
pregressive lengthening of PR interval until beat dropped- p wave with no qrs to follow |
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Mobitz type 2
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2nd degree AV block
sporadic dropped beats pathologic may progress to 3rd degree |
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3rd degree AV block
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atria and ventricles beat independently of each other
atrial rate is faster tx with pacemaker lyme dse can cause it |
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V fib
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no identifiable waes
fatal arrhythmia without immediate CPR and defib |
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Atrial natriuretic peptide
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released from atria in response to inc BV and atrial pressure
causes vasc relaxation, constricts efferent renal arterioles, dilates afferent arterioles- cGMP mediated, promotes diuresis, contributes to escape from aldosterone mechanism |
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Carotid massage
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baroreceptor
inc pressure in carotid artery inc stretch, inc afferent baroreceptor firing, dec HR |
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Cushing rxn
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ass with baroreceptors
hypertension, bradycardia, resp depression |
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Baroreceptors
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respond to severe hemorrhage
hypotension causes vasoconstriction, inc HR, inc contractility, inc BP |
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Chemoreceptors
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peripheral- respond to dec po2, inc pco2, dec pH of blood
central- respond to ph and pco2 of brain interstital fluid which is influenced by arterial CO2 |
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Aortic arch receptors
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transmits via vagus nerve to medulla
responds only to INC BP |
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Carotid sinus receptors
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transmits via glossopharyngeal nerve to solitary nucleus of medulla
responds to INC AND DEC in BP |
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Largest AV O2 deff
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Heart because extraction of O2 is always about 100%
inc O2 demand is met by inc coronary blood flow |
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Highest blood flow per gram tissue
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Kidney
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Largest share of systemic CO
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Liver
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PCWP
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good approx of LA pressure
in MS, PCWP > LV diastolic pressure |
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Hypoxia in lungs causes
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vasoconstriction
pulm vasc unique so that only well ventilated areas are perfused |
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Left to right shunts
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late cyanosis, blue kids
VSD > ASD > PDA |
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Right to left shunts
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early cyanosis, blue babies
TOF, Transposition of great vessels, Truncus arteriosus, Tricuspid atresia, Total anomalous pulm venous return (TAPVR) |
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Eisenmenger's syndrome
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Uncorrected VSD, ASD, PDA
causes compensatory pulm vasc hypertrophy, results in pulm htn, shunt reverses to R to L!! causing late cyanosis- clubbing and polycythemia |
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TOF
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caused by anterosuperior displacement of infundibular septum
Pulm stenosis, RVH, overriding aorta, VSD PROVe |
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Tet spells
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cyanotic spells that TOF pts suffer from
squat to compress femoral aa, inc SVR, dec R to L shunt, directing more blood from RV to lungs |
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Transposition of great vessels
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RV to aorta and LV to pulmonary trunk
not compatible with life unless there is a shunt to allow adequate mixing of blood- VSD, PDA, patent FO due to failure of AP septum to spiral |
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Infantile coarctation of aorta
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preductal- aortic stenosis proximal to insertion of ductus arteriosus
INfantile IN close to heart Ass with Turners |
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Adult type coarct of aorta
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aDult Distal to Ductus
postductal, ass with notching of ribs due to collateral circ htn in upper limbs, weak pulses in lower extremities |
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Cardiac defect in infact of diabetic mother
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Transposition of great vessels
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Corneal arcus
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lipid deposit in cornea, non specific- arcus senilis
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Atherosclerosis
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fibrous plaques and atheromas in intima of arteries
dse of elastic aa and large and med sized muscular aa abd aorta > coronary artery > popliteal > carotid |
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Arteriolosclerosis
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hyaline thickening of small aa in essential htn or dm
hyperplastic onion skinning in malignant htn |
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Monckeberg
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calcificaiton in media of aa, esp radial or ulnar
benign pipestem aa, does not obstruct blood flow |
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AAA
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ass with atherosclerosis
in male smokers > 50 yo |
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Throacic AA
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ass with htn, cystic medial necrosis- Marfans
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Tearing chest pain radiating to back
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aortic dissection
mediastinal widening on chest x ray |
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Angina
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CAD narrowing > 75%
stable- atherosclerosis, ST dep, retrosternal chest pain with exertion prinzmetals- coronary artery spasm at rest, ST elevation unstable/crescendo- chest pain at rest, ST dep |
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Coronary steal syndrome
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vasodilator may aggravate ischemia by shunting blood from area of critical stenosis to area of higher perfusion
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Coronary artery occlusion
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LAD > RCA > CFX
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Cardiac troponin I
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RIses after 4 hrs and is elevated for 7-10 days, more specific than other protein markers
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CK MB
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In myocardium and also skeletal muscle
Useful in dx reinfarction on top of acute MI because only is elevated for 2-3 days after initial infarct, if elevated again means reinfarction |
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In first6 hours after mi what is test of choices
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Ecg gold standard
St elevation- transmural St depression- subendocardial Q waves- transmural |
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Anterior wall mi
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Lad, q waves in v1-4
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Anteroseptal mi
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Lad, qwaves in v1-2
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Anterolateral mi
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Lcx, q waves in v4-6
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Lateral wall mi
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Lcx, q waves in I, aVL
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Inferior wall mi
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Rca, q waves in II, III, aVF
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Post infarction fibrinous pericarditis
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Frictioj rub
3-5 days post MI |
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Dressler's syndrome
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Autoimmune phenomenon resulting in fibrinous pericarditis several weeks post MI
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Causes of dilated (congestive) cardiomyopathy
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Chronic alcohol abuse, wet beriberi, coxsackie b virus myocarditis, chronic cocaine use, Chaga's disease, Doxorubicin toxicity, hemochromatosis, peri partum cardiomyopathy
S3, dilated heart on ultrasound, balloon appearance on chest X-ray Eccentric hypertrophy- sarcomeres added in series, systolic dysfunction ensues |
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Hypertrophic cardiomyopathy
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Hypertrophied IV septum, outflow tract obstruction, 50% familial AD, ass with Fredreichs ataxia, S4, diastolic dysfunction, concentric hypertrophy- sarcomeres added in parallel
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Tx hypertrophic cardiomyopathy
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Beta blocker or non dihydropyridine ca channel blocker- ex verapamil
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Restrictive cardiomyopathy
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Diastolic dysfunction ensues
Causes include sarcoidosis, amyloid, post radiation fibrosis |
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Lofflers syndrome
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Endomyocardial fibrosis with prominent eosinophilia infiltrate
Causes restrictive cardiomyopathy |
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Right heart failure most often results from
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Left heart failure
Isolated rhf most likely due to cor pulmonale |
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Tx chf
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Ace inhibitors, beta blockers, angiotensin receptor blockers, spironolactone reduce mortality
Thiazides or loop diuretics used for symptomatic relief |
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Hemosiderin laden macrophages
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Heart failure cells
In lungs, sign of pulmonary edema in lhf |
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Sign of right heart failure
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Hepatomegaly- nutmeg liver, ankle, sacral edema, jugular venous dissension
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Signs of left heart failure
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Pulmonary edema, paroxysmal nostril dyspnea, orthopnea
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Acute bacterial endocarditis
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Staph aureus- high virulence
Large vegetarians on previously normal valve, rapid onset |
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Subacute bacterial endocarditis
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Viridans strep- low virulence
Smaller vegetation on congenitally abnormal or diseased valves |
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Marantic/thrombotic endocarditis
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Aseptic endocarditis, secondary to malignancy, hyper coag state or lupus
S Boris in colon ca S epidermis in prosthetic valves |
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Aschoff bodies
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Granulomas with giant cells
In rheumatic fever Also ass with anitschkows cells- activated histiocytes And elevated ASO titer |
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Rheumatic fever
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Immune mediated, type II hs, antibodies to M protein
Fever, erythema marginatym, valvular damage- vegetation and fibrosis, inc ESR, Red hot joints- migratory polyarthritis, subq nodules, St Vitus' dance- chorea |
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Acute pericarditis
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sharp pain worse with inspiration, better with sitting up and leaning forward
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Pulsus paradoxus
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dec in amplitude of systolic BP by 10 mm Hg during inspiration
seen in severe cardiac tamponade, asthma, obstructive sleep apnea, pericarditis and croup |
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Cardiac tamponade
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compression of heart by fluid in pericardium, leading to dec CO
equilibration of diastolic pressures in all 4 chambers hypotension, JVD, distant heart sounds, inc HR, pulsus paradoxus |
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Syphilitic heart dse
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tertiary syphilis disrupts vasa vasorum of aorta, leads to dilation of aorta and valve ring, tree barking appearance- calcification
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Kussmaul's sign
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inc in jugular venous pressure on inspiration
sign of cardiac tumor causing obstruction |
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Varicous veins
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dilated tortuous superficial veins due to chronically inc venous pressure
predispose to poor wound healing and varicose ulcers |
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Raynaud's dse
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dec blood flow to skin due to arteriolar vasospasm, in response to cold temp or emotional stress
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Raynaud's phenomenon
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when secondary to mixed connective tissue disease, SLE, CREST syndrome
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Wegener granulomatosis
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c ANCA, focal necrotizing vasculitis, necrotizing granulomas in lung and upper airway, necrotizing glymerulonephritis
tx cyclophosphamide, corticosteroids |
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Churg Strauss syndrome
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asthma, sinusitis, palpable purpura, wrist/foot drop, can also involve heart GI kidneys, p ANCA, granulomatous vasculitis with eosinophilia
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Henoch Schonlein pupura
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MC childhood systemic vasculitis
follows URIs, palpable purpura on buttocks/legs, arthralgia, GI sx, IgA immune complexes, ass with IgA nephopathy |
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Takayasus arteritis
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large vessel vasculitis, pulseless dse, asian females < 40 yo, granulomatous thickening of aortic arch, prox great vessels
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Polyarteritis nodosa
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med vessel vasculitis, young adults, Hep B seropositive in 30% pts, immune complex med, involves renal and visceral vessels, NOT pulm aa
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Kawasaki dse
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asian children < 4yo, strawberry tongue, hand foot erythema, desquamation, tx IV immunoglobulin and aspirin
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Glomus tumor
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benign, painful red blue tumor under fingernails, arises from modified smooth muscle cells of glomus body
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Bacillary angiomatosis
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benign capillary skin papule in AIDS pts, caused by Bartonella henselae infxns, mistake for Kaposi's sarcome
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Kaposi's sarcome
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endothelial malignancy of skin associated with HHV 8 and HIV
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Ca channel blockers on vascular smooth muscle
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Nifedipine > diltiazem > verapamil
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Ca Channel blockers on heart
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Verapamil > diltiazem > nifedipine
Verapamil = Ventricle |
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Pindolol and acebutolol
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partial beta agonists
contraindicated in angina |
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Niacin
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inhibits lipolysis in adipose tissue
reduces hepatic VLDL secretion into circulation inc HDL SE hyperglycemia, hyperuricemia, red flushed face |
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Ezetimibe
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cholesterol absorption blockers
prevent cholesterol reabsorption at small intestine brush border dec LDL |
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Fibrates
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Upregulate LPL, inc TG clearance
dec TG SE myositis, hepatotox |
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Hydralazine
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inc cGMP, smooth muscle relaxation, vasodilates arterioles>veins, dec afterload
1st line for htn in pregnancy with methyldopa |
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Malignant htn tx
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Nitroprusside- inc cGMP via release of NO, can cause CN TOX
Fenoldopam- D1 receptor agonist, relaxes renal vasc smooth muscle Diazoxide- K channel opener, can cause hyperglycemia |
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Nitrates- ntiroglycerin, isosorbide dinitrate
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Vasodilate by releasing NO in smooth muscel, dilates veins > arteries, dec preload
aphrodisiac and erection enhancer tx angina, pulmonary edema relex tachy, flushing, HA, Monday disease in industrial exposure |
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DIgoxin
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cardiac glycoside, direct inhib of Na K ATPase leads to indirect inhib of Na/Ca antiport
inc intracell Ca, Positive inotropy, stim vagus nerve |
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Digoxin in CHF tx
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inc contractility
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Digoxin in a fib tx
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dec conduction at AV node and depression of SA node
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Antidote for dig tox
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slowly normalize K, lidocaine, cardiac pacer, anti dig Fab fragments, Mg2+
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Nesiritide
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recomb B type natriuretic peptide
inc cGMP and vasodilation tx acute decompensated heart failure |
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Class IB antiarrhytmics
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Lidocaine, Mexiletine, Tocainide, Phenytoin
Best Post MI and in dig induced arrhythmias |
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Dig tox
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NVD blurry yellow vision
inc PR, dec QT, scooping, T wave inversion, arrhythmia, hyperkalemia |
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Class IC antiarrhythmics
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Flecainide, propafenone
IC is Contraindicated Post MI no effect on AP duration refractory tachyarrhythmias |
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Amiodarone
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K channel blocker- class III antiarrhythmic
inc AP duration, inc ERP, inc QT interval need to check PFTs, LFTs, TFTs tox- pulm fibrosis, hepatotox, hypo/hyperthyroidism, photodermatitis, blue gray skin deposits |
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Class IV antiarrhythmics
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Verapamil, diltiazem, Ca channel blockers, dec conduction velocity, inc ERP, inc PR interval
used in prevention of nodal arrhythmias ex SVT |
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Adenosine
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inc K out of cells, hyperpolarize cells and dec Ica, DOC in dx / abolishing SVT
very short ccting- 15 s tox flushing hypotension chest pain effects blocker by theophylline |
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Magnesium
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effective in torsades de pointes and digoxin tox
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Nicardipine
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ca channel blocker
Used post SAH |
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Ticlopidine SE
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neutropenia and TTP
bleeding |
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Cilostazol
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phosphodiesterase inhibitor used for peripheral artery disease
inc cAMP, reversibly inhib platelet aggregation, vasodilator tx pt with intermittent claudication from vascular dse with this |
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DOC for v fib in acute resuscitation
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Amiodarone
structurally similar to thyroid hormone SE hyper/hypothyroidism, pulm fibrosis, non sight threatening corneal deposits can convert a fib with systolic dysfunction |
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Meds that have mortality benefit in CHF
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beta blockers, ACE inhib, ARBs, spironolactone
implantable cardioverter defibrillator has benefit in ischemic cardiomyopathy with EF < 35% |
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Best initial therapy for MS
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preload reduction with Na restriction and diuretic
most effective MS therapy- balloon valvuloplasty |
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Metal heart valve
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maintain lifelong anticoag with warfarin
only pts in which you routinely maintain target INR above 2-3, target at least 2.5-3.5 |
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Best medical therapy for pre eclampsia, eclampsia, torsade de pointes
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Magnesium sulfate
prevents seizure in eclampsia dec ACh in motor nerve terminals, slows SA node impulse formation rate and prolongs conduction time reduces uterine contractility |
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Wolff Parkinson White syndrome
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short PR interval
best tx with procainamide or amiodarone if SVT or VT develops |
