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180 Cards in this Set

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22q11
Truncus arteriosus, Tetralogy of Fallot
Tri 21
ASD, VSD, Septal defect, abnormal connection between all 4 chambers

Essentially, this describes endocardial cushion defect
Turners
preductal Coarctation of Aorta
Congenital Rubella heart abnormality?
PDA
Pulmonary Artery stenosis
Marfan's Syndrome
Aortic insufficiency
Anti platelet antibodies
ITP
Bamboo spine
Ankylosing Spondylitis
Anti histone AB
drug induced lupus
Hydralazine, Isoniazid, Procainamide
Painful raised lesions on palms, and fever
Infective endocarditis
dry eyes, dry mouth, arthritis
Sjogren's
TCA side effects
Coma, Convulsions, Cardiotoxicity
Hyperpyrexia and Respiratory Depression
Anti-seizure drugs
Lamotrigine, Carbemazapine, Valproic acid
Tetracycline range of use?
VACUM THe BedRoom
Vibrio Cholera
Acne
Chlamydia
Ureaplasma Urealyticum
M. Pneumoniae
Tularemia
H pylori
B Burgdorferi
R Ricketsii
VACUM THe BedRoom
Macrolides range of use
PUS
Pneumonia(Atypicals)
--legionella, Mycoplasma, Chlamydia pneumonia
URI
--Group A Strep
STD
--gonorrhea, chlamydia
2nd gen Cephalosporins
HEN PEKS
H. Flu
Enterobacter
Neisseria

Proteus
E.Coli
Klebsiella
Serratia Marascens
ALSO Gram positive cocci
Which brain structure responsible for extraocular movements during REM sleep?
PPRF
Paramedian Pontine reticular formation
SA and AV node is supplied by what artery?
RCA
What artery occlusion implies arrhythmias?
RCA - supplies SA/AV node
Posterior Descending arises from?
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
Most common coronary artery occlusion?
LAD
supplies what part of heart?
anterior interventricular spetum and anterior left ventricle
Coronary arteries fill during?
Diastole
Most posterior part of heart?
Left atrium
Most of anterior heart comprises of?
Right ventricle
left atrium enlargement can cause?
hoarseness due to recurrent laryngeal nerve compression or dysphagia due to esophageal nerve compression
Fick principle?
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
What is pulse pressure proportional to?
Stroke volume
Stroke Volume?
EDV - ESV
Mean arterial Pressure equations
MAP = CO x TPR
MAP = 2/3 Diastolic + 1/3 Systolic
What affects Stroke Volume?
Contractility, Afterload, Preload
Atrial pressure measures?
Preload
What else measures preload?
Jugular Venous Pressure, Central Venous Pressure, etc.
Nitroglycerin's CO influence
Venodilator, decreases preload
Hydralazine CO influence
Vasodilator(arteries) decreases afterload
ACE inhibitors, ARB's CO influence
decrease BOTH preload and afterload
What increases contractility
Catecholamines(increase Ca+2 pump in SR)
increase IC calcium
Decrease EC sodium
Digitalis(increase IC Na which increases IC Ca)
Digitalis MOA
increases IC Na which increases IC Ca+2

this increases contractility
Non dihydropyridine
Ca+2 channel blockers work primarily at heart

Diltiazem, Verapamil
Dihydropyridine
Ca+2 channel blockers work primarily at blood vessels

Nifedepine
Ejection fraction is an index of what?
ventricular contractility
what factors affect Resistance
directly proportional to length and viscosity
inversely proportional to radius to the fourth power
x intercept of the venous return curve equals what?
mean systemic pressure
dicrotic notch signifies what?
Closure of aortic valve
Will have S3 heart sound
Dilated cardiomyopathy
CHF
Mitral Regurg
left to right shunt(VSD, ASD, PDA)
Normal in children/pregnancy
Will have S4 heart sound
Aortic Stenosis
Chronic HTN causing left ventricular hypertrophy
Post-MI
hypertrophic cardiomyopathy
JVP acronym
At Carters Xing Vehicles Yield
ACXVY
QRS segment represents? 2 things...
ventricular depolarization and mitral valve closure
QT interval represents
mechanical contraction of ventricles
T wave
ventricular repolarization
PR interval
conduction delay through AV node
Which class of drugs increase PR interval?
Class II and IV
What masks atrial repolarization?
QRS complex
ST segment
isoelectric, ventricles depolarized
U waves caused by?
hypokalemia, bradycardia
Indicates recent MI
T-wave inversion
Speed of Conduction
Purkinje > atria > ventricles > AV node

Pacemakers?
SA > AV > Bundle of His/Purkinje ventricles
P wave
atrial depolarization
Fixed splitting is a/w?
ASD
Paradoxical Splitting a/w?
aortic stenosis or left bundle branch block
myocyte contraction occurs in what phase?
Phase 2
What phases absent in pacemaker potential?
Phase 1 and 2
Compare Phase 0 of myocyte vs pacemaker
myocyte - voltage gated Na+ channel

pacemaker - voltage gated Ca+ channel
What drugs inhibit Phase 0?
CCB's, Class IV in a PACEMAKER cell

also Class I
What drugs inhibit Phase 4?
Beta Blockers, Class II in a PACEMAKER cell
suppress slope of Phase 4
Describe effects of Class I drugs on myocyte action potential
Increase slope of Phase 0, thereby increasing effective refractory period

also increases threshold for firing in abnormal pacemaker cells
What drug is used for Wolf Parkinson White syndrome?
Procainamide and Amiodarone
Which anti-arrhythmic causes headaches and tinnitus?
Quinidine
What's the medical term for headache and tinnitus?
cinchonism
Which anti-arrhythmic commonly used post-MI?
Class IB - Lidocaine, Mexiletine, Tocainide
Which drug significant increases refractory period in AV node?
Class IC - Flecainide, Encainide, Propafenone
What do you treat beta blocker overdose with?
Glucagon
What drug can mask the signs of hypoglycemia?
Beta blockers
MOA of class II antiarrhythmics
decrease cAMP which decreases Ca+2 intracellularly
Which node is particularly sensitive to Class II antiarrhythmics?
AV node
Which beta blocker can cause dyslipidemia?
Metoprolol
What do you check with amiodarone?
PFT's, LFT's, TFT's
Pulmonary fibrosis, hepatotoxicity, hypo/hyperthyroidism
Why does amiodarone cause thyroid issues?
It is 40% iodine by weight
Which drugs cause photodermatitis?
SAT for a photo

Sulfonamides, Amiodarone, Tetracyclines
Class III drugs on myocyte AP?
Phase III
Class IV drugs on myocyte AP?
decreases slope of Phase 0, increases ERP

also increases PR interval
vs what EKG does Class I increase?
increases QT interval
Adenosine MOA
Increases K+ efflux, which hyperpolarizes cell.
Decreases Ca+2 intracellularly
Drug of choice for SVT
Adenosine
Which drug blocks Adenosine?
theophylline(used by COPD patients)
What do you use in digoxin toxicity?
K+ and Mg+2
Hypokalemia and Hypomagnesiumea
susceptible to arrhythmias
What underlying physiology governs the pacemaker cells of the AV and SA node?
Phase 4 spontaneous depolarization due to Na+ leak channels
What physiologically occurs during QRS complex?
Mitral valve closure
Focal myocardial inflammation with multinucleated giant cells
Aschoff bodies seen in rheumatic fever
Eosinophilic, cytoplasmic globules in liver near nucleus
mallory bodies of alcoholic liver disease
desquamated epithelial casts in sputum
Kirschmann Spirals seen with bronchial asthma
EKG leads
Demonstrate where each lead is
THIS IS START OF DAY 2
T waves a/w what?
Potassium levels
Flat T waves mean low potassium while spiked indicate high potassium
Drugs that prolongue QT
Macrolides, Chloroquine/Mefloquine, Haloperidol, Risperidone, Methadone,
How do you treat Torsades de Pointes?
Mg+2
What is characteristic of Wolf Parkinson White syndrome?
delta wave - pre-excitation of ventricle
What can this lead to?
Re-entry current leading to supraventricular tachycardia
Describe Torsades de Pointes on an EKG
shifting sinusoidal waveforms
What predisposes to Torsades de Pointes
anything that prolongues QT interval.
What is congenital long QT a/w?
severe congenital sensorineural deeafness
irregularly irregular
Atrial fibrillation
What else is characteristic of EKG?
no distinct P wave
Atrial Fibrillation is treated with?
beta blocker or CCB
Atrial fib predisposes to?
SVT due to excess of potential SA node calls to AV node which depolarizes ventricles too frequently
Rate control of Afib?
Digoxin, Beta blockers, CCB
Rhythm control of Afib?
Sotalol, Amiodarone
Class III Antiarrhythmics
Sawtooth appearance on EKG?
Atrial flutter
treatment?
Class IA, IC, III AntiAR
What bacterial infection can cause an AV block?
Burrelia Borgdorferi(Lyme Disease) can cause a 3rd degree AV heart block
Progressive lengthening of the PR interval until a beat is "dropped"
2nd degree AV heart block Type I
What is a first degree heart block?
simple prolonging of the PR interval
describe 2nd degree Type I AV heart block
Progressive lengthening of the PR interval until a beat is "dropped"
Differentiate 2nd degree AV block with 3rd degree AV block
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)
Which baroreceptor responds to increase AND ONLY INCREASE in BP?
Aortic arch
What nerve transmits this signal?
Vagus nerve
Which baroreceptor responds to BOTH increase AND decrease in BP?
Carotid sinus
What nerve transmits this signal?
Glossopharyngeal(CN IX)
Where are the receptors that respond to pH and PCO2?
Central chemoreceptors
What is notable about these chemoreceptors?
They do NOT respond to PO2
What chemical changes do the carotic and aortic bodies respond to?
decreased O2, increased CO2, and decreased pH
What chemoreceptors only respond to pH and PCO2?
Peripheral chemoreceptors
What receptors are responsible for the Cushing reaction?
Central Chemoreceptors
Cushing Triad
Bradycardia, HTN, Respiratory Depression

means cranial trauma, elevated ICP
What is the etiology of the Cushing reaction
Increased ICP constricts arterioles and leads to cerebral ischemia which causes HTN(sympathetic response) and reflex bradycardia
Describe wedge pressure findings in mitral stenosis
PCWP > LV diastolic pressure in mitral stenosis
What increases capillary permeability?
toxins, infections, burns
what chemomediators involved?
histamine, bradykinin
What increases in second degree heart block?
PR interval in Type 1 second degree heart block
Paroxysms of increased sympathetic tone
Phenochromocytoma - HTN
Elevated serum creatinine and abnormal urinalysis
HTN due to renal disease
abdominal bruit
renal artery stenosis
BP in arms > legs
coarctation of Aorta
Tachycardia, heat intolerance, diarrhea
hyperthyroidism
Hyperkalemia with HTN
renal disease/failure
HTN with abrupt onset in a patient younger than 20 or older than 50 and depressed K+ levels
Hyperaldosteronism
Central obesity, moon shaped face, hirsutism with HTN
Cushing syndrome
HTN in young individual with acute onset tachycardia
stimulant abuse
hypokalemia
Hyperaldosteronism/Renal artery stenosis
Drug of choice for essential HTN

***MEH
hydrochlorothiazide(diuretic), ACE inhibitors, ARBs or CCB's
Drug of choice for CHF

***MEH
Loop diuretics, ACE inhibitors, ARB's, beta blockers, and potassium sparing diuretics(low dose Spironolactone)
Spironolactone are aldosterone antagonists
Calcium in context of diuretics
LOOP diuretics LOSE calcium
Thiazide diuretics retain calcium
What kind of heart condition do you NOT use beta blockers?
decompensated CHF
but okay for COMPENSATED CHF

you don't want to make a failing heart slow down even more
Pregnancy safe HTN meds
Hydralazine, Labetalol, alpha methyldopa, Nifedepine
Absolute contraindication for ACE inhibitors/ARBS
hyperkalemia
Monday disease
Nitric oxide exposure in workplace -- develops tolerance over work week that is lost over weekend.
Nitroprusside MOA
similar to Hydralazine, increases cGMP which causes reduction of preload and afterload
Notable side effect?
Cyanide toxicity
Diazoxide MOA
hyperpolarizes cell by increasing potassium efflux
Notable side effect?
Hyperglycemia
Fenoldopam MOA
D1 agonist, relaxes renal vascular smooth muscle
What kind of receptor is D1?
S
Side effect
first dose orthostatic hypotension
alpha 1 blockers
or -zosins
Side effect
ototoxic(especially w/ aminoglycosides)
loop diuretics
Side effect
Hypertrichosis
minoxidil(rogaine)
Side effect
Cyanide Toxicity
Nitroprusside
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
Side effect
Bradycardia, impotence, asthma exacerbation
beta blockers
Side effect
Hypercalcemia, hypokalemia
Thiazide diuretics
Side effect
Cough
ACE inhibitors
FAMOUS due to ACE being part of bradykinin breakdown
Side effect
Avoid in patients with sulfa allergy
Loop diuretics, thiazide diuretics
Side effect acronym?
Loop - OH DANG
Thiazide - HyperGLUC
Side effect
possible angioedema
ACE inhibitors
What drugs can cause hyperkalemia?
ACE inhibitors, ARB's, K+ sparing(aldosterone antagonists)
onion skinning of arteries indicates what underlying etiology
malignant HTN
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
Will bind c. diff toxin
Cholestyramine
(Bile acid residue)
MAIN EFFECT of lowering triglycerides
fibrates
MAIN EFFECT of lowering LDL
-statins
Side effect profile of fibrates+statins
rhabdomyolysis and hepatotoxicity
Drug of choice to RAISE HDL
Niacin
What is associated with AAA vs what is associated with Aortic Dissection?
AAA ---> Atherosclerosis

Aortic Dissection ---> Marfan syndrome
tearing chest pain that radiates to the back(scapula)
aortic dissection
Drug of choice to treat?
Beta blocker - decreases slope of rise of blood pressure
V1-V4 MI
Anterior(LAD)
V1-V2 MI
Anteroseptal(LAD)
V4-V6 MI
Anterolateral(LCFX)
I, aVL
lateral(LCFX)
II, III, aVR
Inferior(RCA/PD)
Associated with ST elevation
Prinzmetal Angina
ST depression?
stable and unstable
5 deadly causes of acute chest pain
Aortic dissection
Unstable Angina
Myocardial Infarction
Tension Pneumothorax
Pulmonary Embolus
Patient is able to point to localize the chest pain using one finger
Musculoskeletal type of chest pain
Another presentation of this type?
Chest wall tenderness on palpation
Rapid onset sharp chest pain in 20 year old w/ dyspnea
spontaneous pneumothorax(doesn't get worse like tension)
CHEST PAIN with heavy meals improved by antacids
GERD
sharp pain lasting hours-day and is somewhat relieved by sitting forward
pericarditis
Chest pain in a dermatomal distribution
shingles/ VZV virus

Chest pain is initial symptom and the rash will follow later
Acute onset dyspnea, tachycardia and confusion
Pulmonary embolism
Pain begin the day following a new excercise program
Musculoskeletal pain
What kind of patients do not exhibit classic signs of MI?
Diabetics, older females
Levine's sign?
Patient describes pain as a clenching fist is diagnostic for MI
What is CK-MB useful for?
Diagnosing reinfarction on top of acute MI
ECG findings of TRANSmural infarct
ST elevation, Q waves
ECG findings of subendocardial infarct
ST depression
pain relief with leaning forward
pericarditis
MOA of Clopidogrel, Ticlopidine
Inhibits platelet aggregation by irreversibly blocking ADP receptors
Inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa binding by fibrinogen
Dilated Cardiomyopathy causes
Alcohol Abuse
wet Beriberi
Coxsacki B virus myocarditis
Chronic Cocaine use
Chagas Disease
Doxorubicin toxicity
balloon appearance on chest x-ray
dilated cardiomyopathy
Most common cause of myocarditis in US
Coxsackie B virus
other viruses that can cause myocarditis?
Echovirus
Influenza virus
diffuse interstitial cells of lymphocyte cells with myocyte necrosis
myocarditis due to viral infection
Loffler's syndrome
endomyocardial fibrosis with a prominent eosinophilic infiltrate
Difference from loffler's eosinophilic pneumonitis?
This one is a/w ascaris lumbricoides
What can cause dilated OR restrictive cardiomyopathy?
hemochromatosis
blurry yellow vision side effect
digoxin
also cholinergic effects-- nausea vomiting diarrhera and BRADYCARDIA
How do you treat digoxin toxicity bradycardia?
Atropine