Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
227 Cards in this Set
- Front
- Back
blood supply to the SA and AV nodes
|
RCA
|
|
chamber of the heart that can compress the esophagus and recurrent laryngeal nerve
|
L atrium
|
|
blood supply to apex of the heart and the IV septum
|
LAD
|
|
artery that determines coronary dominance
|
posterior IV artery
|
|
MAP = ?
|
MAP = CO x TPR
MAP = 2/3(diastole) + 1/3(systolic) |
|
do venodilators (eg.nitroglycerin) affect preload or afterload
|
decrease preload
|
|
do vasodilators (eg. hydralazine) affect preload or afterload
|
decrease afterload
|
|
normal ejection fraction
|
55%
|
|
which vessels account for the majority of peripheral resistance
|
arterioles
|
|
what does inotropy refer to
|
the contractility of the heart
|
|
what is S1
|
closure of the AV valves
|
|
what is S2
|
closure of the aortic and pulmonary valves
|
|
what is S3
|
rapid filling of the ventricles during early diastole
|
|
when is S3 normal
|
in children and pregnancy
|
|
what is S4
|
contraction of the atria in late diastole associated with ventricular hypertrophy
|
|
what does physiologic splitting of S2 refer to
|
the aortic valve closely slightly before the pulmonary valve because of pressure differences (have patient hold breath while auscultating over the pulmonic auscultation area to hear)
|
|
does splitting increase with inspiration or expiration
|
splitting increases with inspiration
|
|
what is paradoxical splitting
|
pulmonary valve closes before aortic valve
|
|
what conditions will have paradoxical splitting
|
aortic stenosis and LBBB
|
|
what condition hs fixed splitting
|
ASD
|
|
what conditions have wide splitting
|
pulmonic stenosis and RBBB
|
|
which murmurs are heard during systole
|
aortic stenosis
pulmonic stenosis mitral regurgitation tricuspid regurgitation |
|
which murmurs are heard during diastole
|
aortic regurgitation
pulmonic regurgitation mitral stenosis tricuspid stenosis |
|
holosystolic, high-pitched "blowing" murmur
|
mitral/tricuspid regurgitation
|
|
crescendo-decrescendo systolic ejection murmur
|
aortic stenosis
|
|
which heart murmur is associated with a pulsus parvus et tardus
|
aortic stenosis
|
|
late systolic crescendo murmur with a midsystolic click
|
mitral valve prolapse
|
|
heart murmur with a very large pulse pressure
|
aortic regurgitation
|
|
continuous machinery-like murmur
|
PDA
|
|
MOST common cause of PDA
|
congenital rubella
|
|
what causes the plateau in a cardiac action potential
|
due to calcium influx
|
|
which channels are absent in pacemaker action potentials
|
fast sodium channels
|
|
which channels control the upstroke in a cardiac action potential and in a pacemaker action potential
|
cardiac action potential: upstroke mediated by sodium channels
pacemaker action potential: upstroke mediated by calcium channels |
|
which part of the heart has the fastest speed of conduction of the APs
|
Purkinje cells
|
|
inverted T wave suggests what
|
recent MI
|
|
difference prognostically between ST elevation and ST depression
|
ST elevation: MI
ST depression: angina |
|
U wave suggests what
|
hypokalemia
|
|
peaked T waves suggest what
|
hyperkalemia
|
|
predisposing condition for torsades de pointes
|
Long QT
|
|
what heart condition has a delta wave on ECG
|
WPW
|
|
in WPW, what's the name of the accessory conduction pathway that bypasses the AV node going directly from atria to ventricle
|
Bundle of Kent
|
|
PR interval progressively increases until a beat is dropped
|
2nd degree heart block- Mobitz type I (Wenckebach)
|
|
atria and ventricles beat independently of each other
|
3rd degree heart block
|
|
hormone release from the atria in response to increased blood volume and atrial pressure
|
ANP
|
|
which nerve sends parasympathetic fibers to the aortic arch
|
vagus nerve
|
|
which nerve sends parasympathetic fibers to the carotid sinus
|
glossopharyngeal nerve
|
|
Cushing's triad
|
HTN, bradycardia, respiratory depression
|
|
which receptors are especially important in maintaining high pressure during hemorrhage
|
baroreceptors
|
|
best way to measure L atrial pressure
|
pulmonary wedge pressure
|
|
only area of body that vasoconstricts in response to hypoxia
|
pulmonary vasculature
|
|
important metabolites that regulate blood flow in the heart
|
adenosine and NO
|
|
An S3 in older women suggests what pathologic condition
|
CHF
|
|
VSD, ASD, and PDA are examples of which type of shunt
|
L -> R shunt
|
|
MOST common congenital heart anomaly
|
VSD
|
|
an uncorrected L->R shunt leads to pulmonary HTN and eventually reverses the shunt from L->R to R->L
|
Eisenmenger's syndrome
|
|
treatment for Eisenmenger's
|
heart/lung transplant
|
|
4 conditions seen in Tetralogy of Fallot
|
Pulmonary stenosis
RVH Overriding aorta VSD ("PROV") |
|
how does tetralogy of fallot appear on imaging
|
the heart will appear boot-shaped
|
|
failure of the AP septum to align causes what congenital heart disease
|
tetralogy of fallot
|
|
only way life is compatible in someone with transposition of the great arteries
|
if they also have a shunt
|
|
what congenital heart defect is caused by a failure of the AP septum to spiral/twist
|
transposition of the great arteries
|
|
a mother with untreated diabetes puts a fetus at risk for what congenital heart defect
|
transposition of the great arteries
|
|
Turner syndrome is associated with what congenital heart defect
|
PREductal coarctation of the aorta
|
|
notching of the ribs is associated with what heart defect
|
POSTductal coarctation of the aorta
|
|
heart defect characterized by HTN in the upper extremities and hypotension in the lower extremities
|
coarctation of the aorta
|
|
what congenital heart defect is caused by ectopic tissues
|
coarctation of the aorta
|
|
what normally maintains the patency of the ductus arteriosus
|
prostaglandin E
|
|
DOC to close a patent DA
|
indomethacin
|
|
DiGeorge syndrome is associated with what congenital heart defects
|
Tetralogy of Fallot > Truncus Arteriosus
|
|
endocardial cushion defects cause heart defects in what condition
|
Down syndrome
|
|
pulmonary stenosis and PDA are heart defects seen in what maternal condition
|
rubella
|
|
3 PE signs of hyperlipidemia
|
xanthelasmas in the eyelids
arcus senilis in the corneas tendon xathomas in the achilles tendon |
|
which type of arteriosclerosis is characterized by calcifications in the media layer of the arteries rather than the intima
|
Monckeberg arteriosclerosis
|
|
first step in atheroslcerotic plaque formation
|
foam cells form a fatty streak
|
|
MOST common location of atherosclerosis
|
abdominal aorta
|
|
patient presents with 10/10 tearing chest pain radiating to the back; xray shows mediastinal widening
|
abdominal aortic dissection
|
|
cause of Prinzmetal's angina
|
coronary artery spasm
|
|
which form of angina will have ST elevation
|
Prinzmetal's angina
|
|
difference between angina and MI on an ECG
|
MI: ST elevation
angina: ST depression |
|
major difference between stable and unstable angina
|
stable angina: occurs only during exertion and is relieved with rest
unstable angina: occurs at rest |
|
MOST common vessel occluded in an MI
|
LAD > RCA > circumflex
|
|
morphology after the heart within 24 hours of an MI
|
coagulative necrosis and contraction bands
|
|
morphology of the heart 2-4 days after an MI
|
hyperemia, neutrophilia reaches max
|
|
morphology of heart 5-10 days after an MI
|
central yellow-brown softening (macrophages)
|
|
how long after an MI is the heart MOST at risk for free wall rupture, tamponade, papillary muscle rupture, or an IV septal rupture
|
5-10 days after MI
|
|
how long after an MI is the heart MOST at risk for a ventricular aneurysm
|
7 weeks after MI
|
|
morphology of heart 7 weeks after an MI
|
artery has recanalized and necrotic area has become gray-white in color; scar formation is complete
|
|
MOST specific cardiac marker for an MI
|
troponin I
|
|
when does troponin I peak after an MI
|
12 hours
|
|
when does CK-MB peak after an MI
|
1 day
|
|
what type of MI will have ST depression
|
subendocardial infarcts
|
|
which ECG leads correspond to the LAD
|
V1-V4
|
|
which ECG leads correspond to the LCX
|
V4-V6
|
|
patient presents with sudden onset of high fever and trouble breathing; PMH is remarkable for an MI 5 weeks ago; PE reveals pleuritis and pericardial effusion; troponin I and CK-MB are within range
|
Dressler's syndrome
|
|
causes (8) of dilated cardiomyopathy
|
alcohol, beriberi, coxsackievirus B, cocaine, chagas disease, doxorubicin, hemochromatosis, and postpartum
|
|
mode of inheritance for familial hypertrophic cardiomyopathy
|
autosomal dominant
|
|
MOST common cause of sudden death in young, seemingly healthy athletes
|
hypertrophic cardiomyopathy
|
|
which valve usually becomes obstructed in hypertrophic cardiomyopathy
|
mitral valve
|
|
signs of CHF
|
dyspnea on exertion, cardiac dilation, pulmonary edema, paroxysmal nocturnal dyspnea, orthopnea, hepatosplenomegaly, edema in the LE, JVD
|
|
Morphologic cells that suggests CHF
|
"heart failure cells" (hemosiderin-laden macrophages)
|
|
PE findings in someone with bacterial endocarditis
|
Roth spots (white spots on retina)
Oslers nodes (lesions on fingers and toes) Janeway lesions (erythematous lesions on palms and soles) Splinter hemorrhages (on nail beds) Murmur (usually involving mitral valve) Fever |
|
MOST common valve involved in bacterial endocarditis linked to IV drug abuse
|
tricuspid valve
|
|
pathogenesis in acute vs. subacute bacterial endocarditis
|
acute (S. aureus): large vegetations form on previously normal valves
subacute (S. viridans): small vegetations form on congenitally abnormal or diseased valves |
|
which type of endocarditis is linked to complications of dental surgery
|
subacute endocarditis
|
|
MOST common cause of acute bacterial endocarditis
|
S. aureus
|
|
MOST common cause of subacute bacterial endocarditis
|
S. viridans
|
|
MOST common cause of subacute bacterial endocarditis involving a prosthetic valve
|
S. epidermidis
|
|
DOC for bacterial endocarditis
|
penicillin G
|
|
patient presents with a high fever; PE is remarkable for splinter hemorrhages in the nail bed, erythematous lesions on the palms and soles, and round white spots in the retina; patient also has a butterfly-like rash on both cheeks; auscultation of the heart reveals a systolic, blowing murmur; PMH is remarkable for SLE; what is her presenting condition
|
Libman-Sacks endocarditis
|
|
MOST common valve affected in rheumatic fever
|
mitral valve (MVP and then mitral stenosis)
|
|
MOST common causative organism of rheumatic fever
|
S. pyogenes
|
|
morphologic features of rheumatic fever
|
Aschoff bodies (giant cell granulomas) and Anitschkow's cells (histiocytes)
|
|
what type hypersensitivity is rheumatic fever
|
type II (antibodies against M protein)
|
|
female teenager presents with jerky dance-like movements, pain in her joints, and a fever; several weeks she had a "sore throat" which she waited to go away on its own without medical intervention; PE is remarkable for erythema marginatum, migratory polyarthritis, and a diastolic murmur
|
rheumatic fever
|
|
heart condition in which all 4 chambers have the same diastolic pressures
|
cardiac tamponade
|
|
patient presents with acute chest pain that doesn't radiate; nitric oxide doesn't relieve the pain; PE is remarkable for JVD, diminished heart sounds over all 4 auscultation areas, and pulsus paradoxus; BP is 70/35 and HR is 130
|
cardiac tamponade
|
|
what conditions (5) is pulsus paradoxus seen in
|
cardiac tamponade
asthma obstructive sleep apnea pericarditis croup (parainfluenza virus) |
|
what is pulsus paradoxus
|
exaggerated decrease in amplitude of the pulse during inspiration (>10mmHg difference)
|
|
what layer of the aorta is damaged in tertiary syphilis
|
vasa vasorum
|
|
pulsus tardus et parvus is seen in what valvular insufficiency
|
aortic stenosis
|
|
what is pulsus tardus et parvus
|
the pulse is delayed from the heart beat and slower than expected
|
|
what is pulsus bisferiens
|
the pulse has a "double-peak" during palpation
|
|
what 2 conditions may have pulsus bisferiens
|
aortic stenosis and cardiomyopathy
|
|
what is pulsus alternans
|
the pulsus switches between strong and weak
|
|
what condition is pulsus alternans seen in
|
L-sided heart failure
|
|
what is pulsus bigeminus
|
2 heartbeats followed by a long pause
|
|
what condition is pulsus bigeminus seen in
|
cardiomyopathy
|
|
MOST common heart tumor in adults
|
L atrial myxoma
|
|
MOST common heart tumor in children
|
rhabdomyoma
|
|
what is Kussmaul's sign
|
increase in JVD during inspiration
|
|
do emboli commonly form from varicose veins
|
No, varicose veins are superficial veins
|
|
cause of Raynaud's disease
|
arteriolar vasospasm triggered by cold temperatures or stress
|
|
symptoms of Wegener's granulomatosis
|
necrotizing vasculitis, granulomas in the lung and upper airways causing hemoptysis, and glomerulonephritis causing hematuria
|
|
patient presents with hemoptysis and shortness of breath; PE is remarkable for perforation of the nasal septum and mastoiditis; UA reveals hematuria; serology reveals antibodies confirming the presumed diagnosis
|
Wegener's granulomatosis
|
|
what antibodies are found in Wegener's granulomatosis
|
c-ANCA
|
|
treatment of Wegener's granulomatosis
|
cyclophosphamide and corticosteroids
|
|
2 conditions that have p-ANCA antibodies
|
microscopic polyangiitis and Churg-Strauss syndrome
|
|
patient presents with recurrent asthma attacks and numbness in his hands and feet; PE reveals eosinophilia and skin lesions; PMH is remarkable for recurrent sinusitis; test for parasites come back negative; serology for an antibody confirms the presumed disease
|
Churg-Strauss syndrome
|
|
characterized by vascular disorders, port-wine stains, AV malformations, seizures, glaucoma, and mental retardation
|
Sturge-Weber disease
|
|
MOST common cause of vasculitis in children
|
Henoch-Schonlein purpura
|
|
Henoch-Schonlein purpura commonly follows what illness
|
upper respiratory infection
|
|
classic triad of Henoch-Schonlein purpura
|
rash on legs and butt
joint pain intestinal hemorrhage |
|
kidney condition linked to Henoch-Schonlein purpura
|
IgA nephropathy
|
|
vasculitis strongly linked to smoking
|
Buerger's disease
|
|
vasculitis high at risk for gangrene and autoamputation of the digits
|
Buerger's disease
|
|
MOST common vasculitis in children
|
Kawasaki disease
|
|
vasculitis linked to coronary aneurysms
|
Kawasaki disease
|
|
treatment for Kawasaki disease
|
IV immunoglobulins and aspirin
|
|
vasculitis characterized by fever, conjunctivitis, strawberry tongue, lymphadenitis, and a desquamative skin rash
|
Kawasaki disease
|
|
vasculitis associated with HBV
|
polyarteritis nodosa
|
|
treatment of polyarteritis nodosa
|
cyclophosphamide and corticosteroids
|
|
which arteries are commonly spared in polyarteritis nodosa
|
pulmonary arteries are spared
|
|
vasculitis characterized by granulomatous thickening of the aortic arch
|
Takayasu arteritis
|
|
vasculitis seen in Asian children
|
Kawasaki disease
|
|
vasculitis seen in Asian adults
|
Takayasu arteritis
|
|
patient presents with fever, joint pain, muscle aches, and night sweats; PE is remarkable for skin lesions, changes in visual acuity, and weak/absent pulses in the upper extremities
|
Takayasu arteritis (aka pulseless disease)
|
|
vasculitis MOST commonly affecting the large arteries rather than small ones
|
Temporal arteritis
|
|
MOST common artery affected in temporal arteritis
|
carotid artery
|
|
patient presents with a 12 hour history of unilateral severe headache; during the PE the patient claims to lose vision in the eye of the affected side and starts complaining of pain in her jaw on the affected side
|
temporal arteritis
|
|
treatment of temporal arteritis
|
high dose steroids
|
|
vascular tumors linked to pregnancy
|
pyogenic granuloma
|
|
vascular tumor in the neck linked to Turner syndrome or fetal hydrops
|
cystic hygroma
|
|
painful vascular tumor found under the fingernails; they arise from smooth muscle cells
|
glomus tumor
|
|
vascular tumors found in AIDS patients that are commonly mistaken for Kaposi sarcoma; caused by the bacteria bartonella henselae
|
bacillary angiomatosis
|
|
lethal vascular tumor in the liver; linked to vinyl chloride, arsenic, and thorotrast exposure
|
angiosarcoma
|
|
vascular tumor found in women post-radical mastectomy
|
lymphangiosarcoma
|
|
difference in age distribution between strawberry and cherry hemangiomas
|
strawberry hemangioma: infants (regress)
cherry hemangioma: elderly (do NOT regress) |
|
antihypertensive class of drugs that is protective against diabetic nephropathy
|
ACE inhibitors
|
|
MOST common class of drug given to delay cardiac remodeling after MI
|
ACE inhibitors
|
|
major SE of hydralazine
|
lupus-like syndrome
|
|
MOA of hydralazine
|
increases cGMP causing smooth muscle relaxation -> vasodilation
|
|
why is hydralazine usually combined with a B-blocker
|
to prevent reflex tachycardia caused by hydralazine
|
|
1st line therapy for HTN during pregnancy
|
hydralazine
|
|
calcium channel blocker contraindicated in CHF
|
verapamil
|
|
MOA of nitroglycerin
|
causes the release of nitric oxide which increases cGMP leading to smooth muscle relaxation
*more so venodilation (decreasing preload) |
|
drug that causes "Monday disease"
|
nitroglycerin
|
|
MOST common DOC for malignant HTN
|
nitroprusside
|
|
SE of nitroprusside
|
cyanide toxicity
|
|
MOA of nitroprusside
|
increases cGMP causing direct release of nitric oxide
|
|
MOA of fenoldopam
|
D1 agonist
|
|
MOA of diazoxide
|
opens K+ channels causing hyperpolarization and relaxation of the vascular smooth muscle
|
|
class of the drug with the strongest effect on lowering LDL
|
statins
|
|
SE of statins
|
hepatotoxicity and rhabdomyolysis
|
|
SE of niacin (3)
|
flushing, hyperglycemia, hyperuricemia
|
|
treatment for the flushing induced by niacin
|
pretreat for flushing with aspirin
|
|
DOC to lower both triglycerides and raise HDL
|
fibrates (gemfibrozil, clofibrate, etc...)
|
|
MOA of fibrates
|
upregulate capillary LPL which increases clearance of triglycerides
|
|
MOA of niacin
|
inhibits lipolysis and reduces hepatic VLDL secretion
|
|
drug that decreases LDL but has no effect on HDL or triglycerides
|
ezetimibe
|
|
SE of bile acid resins (cholestyramine)
|
decreased absorption of fat-soluble vitamins, GI discomfort, and cholesterol gallstones
|
|
MOA of digoxin
|
inhibits the Na+/K+ ATPase which increases intracellular sodium-- this leads to reduction in calcium excretion (via inhibiting the NCX sodium-calcium exchange)-- thus more calcium remains in the sarcoplasm which increases contractility
|
|
antidote for digoxin overdose
|
normalize K+
lidocaine magnesium anti-digoxin Fab antibodies (aka digibind) cardiac pacer |
|
this class of anti-arrhythmics increases the AP duration and increases QT interval, and are especially useful against reentrant and ectopic tachycardias
|
class IA
|
|
which drugs are class IA anti-arrhythmics
|
quinidine, procainimide, and disopyramide
|
|
anti-arrhythmic with a SE of lupus-like syndrome
|
procainimide
|
|
SE specific to quinidine but not other class IA anti-arrhythmics
|
cinchonism (headache, tinnitus, vertigo)
|
|
SE common to all class IA anti-arrhythmics
|
thrombocytopenia and torsades de pointes (secondary to increased QT interval)
|
|
this class of anti-arrhythmics decreases AP duration and has no effect on QT interval, and are especially useful in post-MI and digoxin-induced arrhythmias
|
class IB anti-arrhythmics
|
|
which drugs are class IB anti-arrhythmics
|
lidocaine, mexiletine, tocainide
|
|
this class of anti-arrhythmics has no effect on AP duration or QT interval, but does prolong refractory period in AV node; useful in V-tach and refractory tachyarrhythmias
|
class IC anti-arrhythmics
|
|
which drugs are class IC anti-arrhythmics
|
flecainide, encainide,and propafenone
|
|
which class of drugs are class II anti-arrhythmics
|
B-blockers
|
|
shortest acting class II anti-arrhythmic
|
esmolol
|
|
B-blocker linked to dyslipidemia
|
metoprolol
|
|
SE of B-blockers
|
impotence, exacerbation of asthma, sleep disturbances (nightmares), AV block, bradycardia, CHF, masks symptoms of hypoglycemia
|
|
heart medication contraindicated in diabetics
|
B-blockers (masks signs of hypoglycemia)
|
|
which drugs are class III anti-arrhythmics
|
K+ channel blockers (sotalol, amiodarone, ibutilide, bretylium, dofetilide)
|
|
SE of amiodarone
|
pulmonary fibrosis
hepatotoxicity thyroid dysfunction corneal and skin deposits photodermatitis constipation cardiovascular depression |
|
which anti-arrhythmic has properties from all 4 classes of anti-arrhythmics
|
amiodarone
|
|
which drugs are class IV anti-arrhythmics
|
calcium channel blockers
(verapamil and diltiazem only-- nifedipine has affects on vascular smooth muscle, not the heart) |
|
DOC for supraventricular tachycardia
|
adenosine
|
|
DOC for torsades de pointes
|
magnesium sulfate
|
|
kidney condition strongly linked to bacterial endocarditis
|
glomerulonephritis
|
|
chest xray shows situs inversus of the heart; what's the underlying condition
|
Kartagener's
|
|
3 drugs that improve SURVIVAL odds in someone with CHF
|
ACE inhibitors
spironolactone metoprolol |
|
3 congenital heart defects that require a PDA to stay alive
|
preductal coarctation
transposition tricuspid atresia |
|
congenital heart defect associated with an ASD and a PDA
|
tricuspid atresia
|
|
ALL trisomies have which congenital heart defect
|
VSD
|
|
what is a paradoxical embolus
|
In someone with an ASD, a DVT may break off and when entering the heart may go against the gradient into the L side of the heart, travel to the brain, and cause a stroke
|
|
Do you have to close a large or small VSD immediately
|
large
|
|
specific gene mutation causing HOCM
|
beta myosin heavy chain gene
|
|
heart condition strongly associated with multiple silent MI's
|
HOCM
|
|
MOST common cause of death in HOCM
|
reentry arrhythmias
|
|
amyloid deposits are found in which type of cardiomyopathy
|
restrictive cardiomyopathy
|
|
which type of coarctation is renin increased and the patient appears half blue (in the lower half of the body)
|
preductal
|
|
which type of coarctation is NOT linked to cyanosis and requires collateral circulation
|
postductal coaractation
|
|
DOC to maintain a patent DA
|
alprostadil
|