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180 Cards in this Set
- Front
- Back
- 3rd side (hint)
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22q11
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Truncus arteriosus, Tetralogy of Fallot
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Tri 21
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ASD, VSD, Septal defect, abnormal connection between all 4 chambers
Essentially, this describes endocardial cushion defect |
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Turners
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preductal Coarctation of Aorta
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Congenital Rubella heart abnormality?
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PDA
Pulmonary Artery stenosis |
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Marfan's Syndrome
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Aortic insufficiency
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Anti platelet antibodies
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ITP
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Bamboo spine
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Ankylosing Spondylitis
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Anti histone AB
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drug induced lupus
Hydralazine, Isoniazid, Procainamide |
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Painful raised lesions on palms, and fever
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Infective endocarditis
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dry eyes, dry mouth, arthritis
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Sjogren's
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TCA side effects
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Coma, Convulsions, Cardiotoxicity
Hyperpyrexia and Respiratory Depression |
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Anti-seizure drugs
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Lamotrigine, Carbemazapine, Valproic acid
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Tetracycline range of use?
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VACUM THe BedRoom
Vibrio Cholera Acne Chlamydia Ureaplasma Urealyticum M. Pneumoniae Tularemia H pylori B Burgdorferi R Ricketsii |
VACUM THe BedRoom
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Macrolides range of use
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PUS
Pneumonia(Atypicals) --legionella, Mycoplasma, Chlamydia pneumonia URI --Group A Strep STD --gonorrhea, chlamydia |
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2nd gen Cephalosporins
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HEN PEKS
H. Flu Enterobacter Neisseria Proteus E.Coli Klebsiella Serratia Marascens ALSO Gram positive cocci |
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Which brain structure responsible for extraocular movements during REM sleep?
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PPRF
Paramedian Pontine reticular formation |
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SA and AV node is supplied by what artery?
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RCA
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What artery occlusion implies arrhythmias?
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RCA - supplies SA/AV node
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Posterior Descending arises from?
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80% of time off RCA
20% of time off left CFX supplies what part of heart? |
posterior left ventricle
RCA does posterior LV and septum L CFX does lateral LV LAD does anterior LV and septum |
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Most common coronary artery occlusion?
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LAD
supplies what part of heart? |
anterior interventricular spetum and anterior left ventricle
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Coronary arteries fill during?
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Diastole
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Most posterior part of heart?
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Left atrium
Most of anterior heart comprises of? |
Right ventricle
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left atrium enlargement can cause?
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hoarseness due to recurrent laryngeal nerve compression or dysphagia due to esophageal nerve compression
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Fick principle?
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CO =
rate of O2 consumption / (Arterial O2 content - Venous O2 content) units? |
CO = mL blood/minute
O2 consumption = mL O2/minute O2 content = mL O2/mL blood |
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What is pulse pressure proportional to?
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Stroke volume
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Stroke Volume?
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EDV - ESV
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Mean arterial Pressure equations
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MAP = CO x TPR
MAP = 2/3 Diastolic + 1/3 Systolic |
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What affects Stroke Volume?
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Contractility, Afterload, Preload
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Atrial pressure measures?
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Preload
What else measures preload? |
Jugular Venous Pressure, Central Venous Pressure, etc.
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Nitroglycerin's CO influence
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Venodilator, decreases preload
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Hydralazine CO influence
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Vasodilator(arteries) decreases afterload
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ACE inhibitors, ARB's CO influence
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decrease BOTH preload and afterload
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What increases contractility
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Catecholamines(increase Ca+2 pump in SR)
increase IC calcium Decrease EC sodium Digitalis(increase IC Na which increases IC Ca) |
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Digitalis MOA
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increases IC Na which increases IC Ca+2
this increases contractility |
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Non dihydropyridine
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Ca+2 channel blockers work primarily at heart
Diltiazem, Verapamil |
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Dihydropyridine
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Ca+2 channel blockers work primarily at blood vessels
Nifedepine |
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Ejection fraction is an index of what?
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ventricular contractility
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what factors affect Resistance
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directly proportional to length and viscosity
inversely proportional to radius to the fourth power |
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x intercept of the venous return curve equals what?
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mean systemic pressure
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dicrotic notch signifies what?
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Closure of aortic valve
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Will have S3 heart sound
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Dilated cardiomyopathy
CHF Mitral Regurg left to right shunt(VSD, ASD, PDA) Normal in children/pregnancy |
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Will have S4 heart sound
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Aortic Stenosis
Chronic HTN causing left ventricular hypertrophy Post-MI hypertrophic cardiomyopathy |
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JVP acronym
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At Carters Xing Vehicles Yield
ACXVY |
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QRS segment represents? 2 things...
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ventricular depolarization and mitral valve closure
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QT interval represents
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mechanical contraction of ventricles
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T wave
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ventricular repolarization
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PR interval
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conduction delay through AV node
Which class of drugs increase PR interval? |
Class II and IV
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What masks atrial repolarization?
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QRS complex
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ST segment
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isoelectric, ventricles depolarized
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U waves caused by?
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hypokalemia, bradycardia
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Indicates recent MI
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T-wave inversion
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Speed of Conduction
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Purkinje > atria > ventricles > AV node
Pacemakers? |
SA > AV > Bundle of His/Purkinje ventricles
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P wave
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atrial depolarization
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Fixed splitting is a/w?
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ASD
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Paradoxical Splitting a/w?
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aortic stenosis or left bundle branch block
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myocyte contraction occurs in what phase?
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Phase 2
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What phases absent in pacemaker potential?
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Phase 1 and 2
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Compare Phase 0 of myocyte vs pacemaker
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myocyte - voltage gated Na+ channel
pacemaker - voltage gated Ca+ channel |
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What drugs inhibit Phase 0?
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CCB's, Class IV in a PACEMAKER cell
also Class I |
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What drugs inhibit Phase 4?
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Beta Blockers, Class II in a PACEMAKER cell
suppress slope of Phase 4 |
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Describe effects of Class I drugs on myocyte action potential
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Increase slope of Phase 0, thereby increasing effective refractory period
also increases threshold for firing in abnormal pacemaker cells |
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What drug is used for Wolf Parkinson White syndrome?
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Procainamide and Amiodarone
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Which anti-arrhythmic causes headaches and tinnitus?
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Quinidine
What's the medical term for headache and tinnitus? |
cinchonism
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Which anti-arrhythmic commonly used post-MI?
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Class IB - Lidocaine, Mexiletine, Tocainide
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Which drug significant increases refractory period in AV node?
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Class IC - Flecainide, Encainide, Propafenone
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What do you treat beta blocker overdose with?
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Glucagon
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What drug can mask the signs of hypoglycemia?
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Beta blockers
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MOA of class II antiarrhythmics
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decrease cAMP which decreases Ca+2 intracellularly
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Which node is particularly sensitive to Class II antiarrhythmics?
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AV node
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Which beta blocker can cause dyslipidemia?
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Metoprolol
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What do you check with amiodarone?
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PFT's, LFT's, TFT's
Pulmonary fibrosis, hepatotoxicity, hypo/hyperthyroidism |
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Why does amiodarone cause thyroid issues?
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It is 40% iodine by weight
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Which drugs cause photodermatitis?
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SAT for a photo
Sulfonamides, Amiodarone, Tetracyclines |
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Class III drugs on myocyte AP?
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Phase III
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Class IV drugs on myocyte AP?
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decreases slope of Phase 0, increases ERP
also increases PR interval vs what EKG does Class I increase? |
increases QT interval
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Adenosine MOA
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Increases K+ efflux, which hyperpolarizes cell.
Decreases Ca+2 intracellularly |
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Drug of choice for SVT
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Adenosine
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Which drug blocks Adenosine?
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theophylline(used by COPD patients)
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What do you use in digoxin toxicity?
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K+ and Mg+2
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Hypokalemia and Hypomagnesiumea
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susceptible to arrhythmias
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What underlying physiology governs the pacemaker cells of the AV and SA node?
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Phase 4 spontaneous depolarization due to Na+ leak channels
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What physiologically occurs during QRS complex?
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Mitral valve closure
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Focal myocardial inflammation with multinucleated giant cells
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Aschoff bodies seen in rheumatic fever
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Eosinophilic, cytoplasmic globules in liver near nucleus
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mallory bodies of alcoholic liver disease
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desquamated epithelial casts in sputum
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Kirschmann Spirals seen with bronchial asthma
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EKG leads
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Demonstrate where each lead is
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THIS IS START OF DAY 2
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T waves a/w what?
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Potassium levels
Flat T waves mean low potassium while spiked indicate high potassium |
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Drugs that prolongue QT
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Macrolides, Chloroquine/Mefloquine, Haloperidol, Risperidone, Methadone,
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How do you treat Torsades de Pointes?
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Mg+2
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What is characteristic of Wolf Parkinson White syndrome?
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delta wave - pre-excitation of ventricle
What can this lead to? |
Re-entry current leading to supraventricular tachycardia
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Describe Torsades de Pointes on an EKG
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shifting sinusoidal waveforms
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What predisposes to Torsades de Pointes
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anything that prolongues QT interval.
What is congenital long QT a/w? |
severe congenital sensorineural deeafness
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irregularly irregular
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Atrial fibrillation
What else is characteristic of EKG? |
no distinct P wave
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Atrial Fibrillation is treated with?
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beta blocker or CCB
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Atrial fib predisposes to?
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SVT due to excess of potential SA node calls to AV node which depolarizes ventricles too frequently
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Rate control of Afib?
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Digoxin, Beta blockers, CCB
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Rhythm control of Afib?
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Sotalol, Amiodarone
Class III Antiarrhythmics |
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Sawtooth appearance on EKG?
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Atrial flutter
treatment? |
Class IA, IC, III AntiAR
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What bacterial infection can cause an AV block?
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Burrelia Borgdorferi(Lyme Disease) can cause a 3rd degree AV heart block
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Progressive lengthening of the PR interval until a beat is "dropped"
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2nd degree AV heart block Type I
What is a first degree heart block? |
simple prolonging of the PR interval
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describe 2nd degree Type I AV heart block
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Progressive lengthening of the PR interval until a beat is "dropped"
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Differentiate 2nd degree AV block with 3rd degree AV block
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2nd degree has spontaneous dropped P waves(usually 2:1 P:QRS ratio) while 3rd degree has NO correlation of P to QRS waves(the atria/ventricles contract independently and without coordination)
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Which baroreceptor responds to increase AND ONLY INCREASE in BP?
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Aortic arch
What nerve transmits this signal? |
Vagus nerve
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Which baroreceptor responds to BOTH increase AND decrease in BP?
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Carotid sinus
What nerve transmits this signal? |
Glossopharyngeal(CN IX)
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Where are the receptors that respond to pH and PCO2?
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Central chemoreceptors
What is notable about these chemoreceptors? |
They do NOT respond to PO2
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What chemical changes do the carotic and aortic bodies respond to?
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decreased O2, increased CO2, and decreased pH
What chemoreceptors only respond to pH and PCO2? |
Peripheral chemoreceptors
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What receptors are responsible for the Cushing reaction?
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Central Chemoreceptors
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Cushing Triad
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Bradycardia, HTN, Respiratory Depression
means cranial trauma, elevated ICP |
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What is the etiology of the Cushing reaction
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Increased ICP constricts arterioles and leads to cerebral ischemia which causes HTN(sympathetic response) and reflex bradycardia
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Describe wedge pressure findings in mitral stenosis
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PCWP > LV diastolic pressure in mitral stenosis
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What increases capillary permeability?
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toxins, infections, burns
what chemomediators involved? |
histamine, bradykinin
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What increases in second degree heart block?
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PR interval in Type 1 second degree heart block
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Paroxysms of increased sympathetic tone
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Phenochromocytoma - HTN
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Elevated serum creatinine and abnormal urinalysis
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HTN due to renal disease
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abdominal bruit
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renal artery stenosis
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BP in arms > legs
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coarctation of Aorta
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Tachycardia, heat intolerance, diarrhea
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hyperthyroidism
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Hyperkalemia with HTN
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renal disease/failure
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HTN with abrupt onset in a patient younger than 20 or older than 50 and depressed K+ levels
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Hyperaldosteronism
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Central obesity, moon shaped face, hirsutism with HTN
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Cushing syndrome
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HTN in young individual with acute onset tachycardia
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stimulant abuse
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hypokalemia
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Hyperaldosteronism/Renal artery stenosis
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Drug of choice for essential HTN
***MEH |
hydrochlorothiazide(diuretic), ACE inhibitors, ARBs or CCB's
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Drug of choice for CHF
***MEH |
Loop diuretics, ACE inhibitors, ARB's, beta blockers, and potassium sparing diuretics(low dose Spironolactone)
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Spironolactone are aldosterone antagonists
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Calcium in context of diuretics
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LOOP diuretics LOSE calcium
Thiazide diuretics retain calcium |
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What kind of heart condition do you NOT use beta blockers?
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decompensated CHF
but okay for COMPENSATED CHF you don't want to make a failing heart slow down even more |
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Pregnancy safe HTN meds
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Hydralazine, Labetalol, alpha methyldopa, Nifedepine
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Absolute contraindication for ACE inhibitors/ARBS
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hyperkalemia
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Monday disease
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Nitric oxide exposure in workplace -- develops tolerance over work week that is lost over weekend.
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Nitroprusside MOA
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similar to Hydralazine, increases cGMP which causes reduction of preload and afterload
Notable side effect? |
Cyanide toxicity
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Diazoxide MOA
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hyperpolarizes cell by increasing potassium efflux
Notable side effect? |
Hyperglycemia
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Fenoldopam MOA
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D1 agonist, relaxes renal vascular smooth muscle
What kind of receptor is D1? |
S
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Side effect
first dose orthostatic hypotension |
alpha 1 blockers
or -zosins |
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Side effect
ototoxic(especially w/ aminoglycosides) |
loop diuretics
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Side effect
Hypertrichosis |
minoxidil(rogaine)
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Side effect
Cyanide Toxicity |
Nitroprusside
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Side effect
Dry mouth, sedation,severe rebound HTN |
Clonidine
alpha 2 agonist When is this drug used? |
End stage renal disease, doesn't decrease blood flow to kidney
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Side effect
Bradycardia, impotence, asthma exacerbation |
beta blockers
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Side effect
Hypercalcemia, hypokalemia |
Thiazide diuretics
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Side effect
Cough |
ACE inhibitors
FAMOUS due to ACE being part of bradykinin breakdown |
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Side effect
Avoid in patients with sulfa allergy |
Loop diuretics, thiazide diuretics
Side effect acronym? |
Loop - OH DANG
Thiazide - HyperGLUC |
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Side effect
possible angioedema |
ACE inhibitors
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What drugs can cause hyperkalemia?
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ACE inhibitors, ARB's, K+ sparing(aldosterone antagonists)
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onion skinning of arteries indicates what underlying etiology
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malignant HTN
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Side effect
Red, flushed face |
Niacin use
What can reduce this side effect? Other side effects are hyperglycemia and hyperuricemia |
aspirin before administration of Niacin
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Will bind c. diff toxin
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Cholestyramine
(Bile acid residue) |
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MAIN EFFECT of lowering triglycerides
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fibrates
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MAIN EFFECT of lowering LDL
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-statins
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Side effect profile of fibrates+statins
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rhabdomyolysis and hepatotoxicity
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Drug of choice to RAISE HDL
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Niacin
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What is associated with AAA vs what is associated with Aortic Dissection?
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AAA ---> Atherosclerosis
Aortic Dissection ---> Marfan syndrome |
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tearing chest pain that radiates to the back(scapula)
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aortic dissection
Drug of choice to treat? |
Beta blocker - decreases slope of rise of blood pressure
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V1-V4 MI
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Anterior(LAD)
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V1-V2 MI
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Anteroseptal(LAD)
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V4-V6 MI
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Anterolateral(LCFX)
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I, aVL
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lateral(LCFX)
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II, III, aVR
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Inferior(RCA/PD)
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Associated with ST elevation
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Prinzmetal Angina
ST depression? |
stable and unstable
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5 deadly causes of acute chest pain
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Aortic dissection
Unstable Angina Myocardial Infarction Tension Pneumothorax Pulmonary Embolus |
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Patient is able to point to localize the chest pain using one finger
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Musculoskeletal type of chest pain
Another presentation of this type? |
Chest wall tenderness on palpation
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Rapid onset sharp chest pain in 20 year old w/ dyspnea
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spontaneous pneumothorax(doesn't get worse like tension)
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CHEST PAIN with heavy meals improved by antacids
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GERD
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sharp pain lasting hours-day and is somewhat relieved by sitting forward
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pericarditis
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Chest pain in a dermatomal distribution
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shingles/ VZV virus
Chest pain is initial symptom and the rash will follow later |
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Acute onset dyspnea, tachycardia and confusion
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Pulmonary embolism
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Pain begin the day following a new excercise program
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Musculoskeletal pain
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What kind of patients do not exhibit classic signs of MI?
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Diabetics, older females
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Levine's sign?
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Patient describes pain as a clenching fist is diagnostic for MI
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What is CK-MB useful for?
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Diagnosing reinfarction on top of acute MI
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ECG findings of TRANSmural infarct
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ST elevation, Q waves
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ECG findings of subendocardial infarct
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ST depression
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pain relief with leaning forward
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pericarditis
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MOA of Clopidogrel, Ticlopidine
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Inhibits platelet aggregation by irreversibly blocking ADP receptors
Inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa binding by fibrinogen |
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Dilated Cardiomyopathy causes
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Alcohol Abuse
wet Beriberi Coxsacki B virus myocarditis Chronic Cocaine use Chagas Disease Doxorubicin toxicity |
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balloon appearance on chest x-ray
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dilated cardiomyopathy
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Most common cause of myocarditis in US
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Coxsackie B virus
other viruses that can cause myocarditis? |
Echovirus
Influenza virus |
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diffuse interstitial cells of lymphocyte cells with myocyte necrosis
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myocarditis due to viral infection
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Loffler's syndrome
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endomyocardial fibrosis with a prominent eosinophilic infiltrate
Difference from loffler's eosinophilic pneumonitis? |
This one is a/w ascaris lumbricoides
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What can cause dilated OR restrictive cardiomyopathy?
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hemochromatosis
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blurry yellow vision side effect
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digoxin
also cholinergic effects-- nausea vomiting diarrhera and BRADYCARDIA How do you treat digoxin toxicity bradycardia? |
Atropine
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