First Aid Cardio

Front 1

what supplies blood for the SA and AV nodes?

Back 1

most of the time its the RCA

Front 2

when do coronary arteries fill?

Back 2

during diastole

Front 3

what 3 things affect SV

Back 3

Contractility, Afterload, preload

SV CAP

Front 4

how does digitalis increase contractility

Back 4

it inhibits the Na/K pump so that intracellular Na builds up and decreases the action of the Na/Ca pump that extrudes Ca and brings in Na

Front 5

how do catecholamines increase contractility

Back 5

increase the activity of the Ca pump on the SR so that more Ca is taken up and then able to be released on the next contraction

Front 6

an example of a drug that is a vasodilator and decreases the afterload

Back 6

hydrAlAzine----decrease Afterload (Arterial)

Front 7

what does the starling curve show

Back 7

that the force of contraction is proportional to the initials length of the cardiac muscle fibers

Front 8

Romano Ward syndrome

Back 8

mutation in the K channel protein that delays Ik channel current

leads to QT prolongation

Front 9

Jervell and Lange-Nielsen Syndrome

Back 9

Mutation in the K channel protein that delats the Ik channel current

leads to QT prolongation

Front 10

lyme disease can result in what heart condition (conduction related)

Back 10

3rd degree heart disease

Front 11

three things that the peripheral (carotid and aortic bodies) chemoreceptors respond to

Back 11

drop in PO2, Increase in PCO2, drop in blood pH

Front 12

central chemoreceptors respond to what and DO NOT respond directly to what

Back 12

changes in ph and CO2 which are influenced by arterial CO2. DO NOT directly respond to PO2

Front 13

what is the cushing reaction and what is responsible for it

Back 13

an increase in ICP constricts arterioles leading to cerebral ischemia which lead to HTN which leads to reflex bradycardia

central chemoreceptors are responsible for it

Front 14

cushing triad

Back 14

HTN, bradycardia and respiratory depression

Front 15

what is the O2 extraction from blood of the heart and how does this play with an increase in O2 demand of the heart

Back 15

the O2 extraction is 100%
so an increase in O2 demand is met by increasing the coronary blood flow not by increase the extraction (which would be impossible since its 100% duh)

Front 16

what are the five T's of right-to-left shunts that produce blue babies

Back 16

Tetralogy
Transposition
Truncus Tricuspid
TAPVR

Front 17

what is the most common congenital heart defect and what is it associated with (an assoc. cause)

Back 17

VSD
Assoc. with Fetal Alcohol Syndrome

Front 18

ostium primum and secundum

which is most common and which is associated with Downs

Back 18

ostium secundum is most common

primum associated with Downs

Front 19

what is an associated cause of a PDA (congenital cause)

Back 19

congenital rubella

Front 20

what is Eisenmengers syndrome

Back 20

due to uncorrected VSD, ASD, or PDA that causes compensatory right ventricular hypertrophy which results in progressive pulmonary HTN. the new HTN then reverses the shunt from L to R to R to L and you get cyanosis later in life

Front 21

what produces a boot shaped heart on Xray and what is it due to

Back 21

tetralogy of fallot

d/t the R ventricular hypertrophy

Front 22

what is transposition of the great vessels associated with (mothers problem)

Back 22

maternal diabetes

Front 23

what are the two types of coarctations of the aorta and what are their locations

Back 23

Infantile type----before the ducuts arteriosus....INfant IN close to heart (proximal to duct)

Adult type---after the duct...aDult, Distal to Duct

Front 24

what is infantile and adult coarctation assoc. with (seen on xray for adults) and what do adults present with

Back 24

infantile associated with Turner syndrome

adult associated with NOTCHED RIBS (seen on xray) and they present with HTN in the upper extremities and weak pulses in the lower extremities

Front 25

what is coarctation of the aorta associated with (think of Brandon)

Back 25

bicuspid aortic valve

Front 26

hear a continuous machine like murmur? what is it

Back 26

PDA

Front 27

PDA can result in what later in life

Back 27

cyanosis in the lower

Front 28

Monckeberg vs arteriolosclerosis vs atherosclerosis

Back 28

monckberg: calcification of the MEDIA of the arteries (NO BLOOD FLOW OBSTRUCTION)

arteriolosclerosis: HYALINE thickening of small arteries

atherosclerosis: fibrous plaques and atheromas in the INTIMA of arteries

Front 29

what is an ebstein anomaly

Back 29

in utero exposure to lithium (for treating bipolar) that leads to
1) apical displacement of tricuspid valve
2) decrease volume of right ventricle
3) atrialization of right ventricle

Front 30

what is a good predicting sign of an aortic dissection

Back 30

tearing chest pain that radiates down the back

Front 31

three types of angina

Back 31

stable, prinzmetals variant, unstable/crescendo

hey angie (angina), whaz SUP!!!!!!!!

Front 32

stable angina is secondary to what and shows what on ECG and is arises d/t what

Back 32

atherosclerosis, ST depression arises d/t exertion or emotional stress

Front 33

prinzmetals variant angina is secondary to what, shows what on ECG and how do you Rx it

Back 33

secondary to coronary spasm, ST elevation (d/t being a COMPLETE blockage), Rx with nitro or CCB

Metal rock makes you SPASM!!!!!

Front 34

unstable/crescendo angina cause, ECG results and Rx

Back 34

thrombosis, but no necrosis, ST depression Rx with nitro

Front 35

most commonly involved artery with a MI

Back 35

LAD

da widow-maker!!!!!

Front 36

gold standard for Dx of MI in the first 6 hours

Back 36

ECG

Front 37

most sensitive and specific marker for MI?? (gold standard)

Back 37

Troponin I

Front 38

what marker can be used to Dx an MI that occurs days after an initial MI because its levels rise and fall within 1.5 days (peaking at 24hours)

Back 38

CK-MB

Front 39

what is dresslers syndrome

Back 39

autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post MI)

Front 40

most common cardiomyopathy and etiologies, systolic or diastolic

Back 40

Dilated Cardiomyopathy (all 4 chambers enlarged), systolic

Alcohol abuse, wet Beriberi, Coxsackie B virus, Cocaine use, Chagas disease, Doxorubicin, peripartum

ABCCCD and a P

Front 41

hypertrophic cardiomyopathy
genetics (HY), type of murmur, Rx, systolic or diastolic

Back 41

L ventricle hypertrophy, Autosomal dominant (mutations in sarcomere proteins), systolic murmur S4, Rx with B blockers or non-dihydropyridine CCBs (verapamil) diastolic

Front 42

restrictive/obliterative cardiomyopathy
causes, classic ECG finding, systolic or diastolic

Back 42

sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelestosis, lofflers syndrome (pg 83 pathoma); low-voltage EKG with diminished QRS amplitude; diastolic

Front 43

eccentric vs concentric hypertrophy, cause and types of cardiomyopathies assoc.

Back 43

eccentric---volume overload, seen with aortic regurge, seen in dilated cardiomyopathy
EEEEcentric------sEEEries (fibers added in series)

concentric---pressure overload, seen with aortic stenosis and systemic HTN, seen in hypertrophic cardiomyopathy; fibers added in parallel

Front 44

how does paroxysmal dyspnea occur in CHF

Back 44

patient lies down, this increases venous return and exacerbates the problem

Front 45

intraavleolar hemorrhage in CHF is caused by what and marked by the presence of what?

Back 45

caused by microhemorrhages from an increase in pressure in the pulmonary capillaries rupturing them

hemosiderin-laden macrophages (heart failure cells)

Front 46

nutmeg liver is seen in what disease state?

Back 46

CHF (right sided heart failure) due to an increase in central venous pressure leading to an increase resistance in portal flow.

Front 47

most common cause of right sided heart failure?

Back 47

left sided heart failure

Front 48

paradoxical problem with low CO in CHF and the kidneys

Back 48

kindeys get lower flow, this activates the RAAS system leading to an increase in Na and water retention further exacerbating the CHF problem (fluid overload)

Front 49

DOC for treating CHF

Back 49

ACE inhibitors

Front 50

Sx's for bacterial endocarditis? 8 of em, and which is more common?

Back 50

FROM JANE

Fever (most common)
Roths spots
Osslers nodes (tender lesions on palms and toes)
Murmur
Janeway lesions (nontender lesions on palms and soles)
Anemia
Nail-bed hemorrhage (splinter hemorrhages)
Emboli

Front 51

bacteria causing large vegetations in endocarditis? tell me a little about it as well

Back 51

staph auerus, HIGH virluent, common in IV DRUG USERS, TRIcuspid valve affected

dont TRI drugs!!!!

Front 52

bacteria causing small vegetations in endocarditis? a little about it as well

Back 52

strep viridans, LOW virulence, sequela of dental work, MOST COMMON OVERALL,

Front 53

bacteria assoc. with endocarditis that hits prosthetic valves and one that deals with the intestines (what disease specifically?)

Back 53

strep epidermidis hits prosthetic valves

strep bovis from colon cancer

Front 54

what is libman-sacks endocarditis

Back 54

sterile vegetations that occur on both sides of the heart valve, assoc. with SLE


SLE causes LSE

Front 55

Sx's of rheumatic heart disease

Back 55

FEVERSS

Fever
Erythema marginatum
Valvular damage
ESR (increases)
Red hot joints (migratory polyarthritis in large joints)
SubQ nodules
Sydenham chorea

Front 56

cause of rheumatic heart disease and valve most commonly involved

Back 56

group A Beta Hemolytic strep, mitral valve

Front 57

most common cause of death in the acute phase of rheumatic fever and what is seen microscopically

Back 57

myocarditis, aschoff bodies (granuloma with giant cells) and anitschkow cells (activated histiocytes)

Front 58

what is the underlying cause of rheumatic heart disease (answer is not group a strep)

Back 58

molecular mimicry, the bacterial M protein resembles human tissue.

Front 59

what leads to a "tree bark" appearance of the aorta?

Back 59

tertiary syphilis leading to calcification of the aortic root

Front 60

most common cardiac tumor in adults? in kids? associated with what in kids?

Back 60

myxomas in adults, rhabdomyomas in kids and assoc. with tuberous sclerosis

Front 61

wegeners granulomatosis: triad, sx's, marker, Rx

Back 61

triad: focal necrotizing vasculitis, nectrotizing granulomas in LUNG and UPPER AIRWAY, nectrotizing glomerulonephritis

Sx's: hemoptysis, hematuria, perforated nasal septum

c-ANCA is the strongest marker

Rx with cyclophosphamide and corticosteriods

Front 62

p-ANCA is associated with what?

Back 62

microscopic polyangitis and churg-strauss syndrome

Front 63

what is the most common form of childhood systemic vasculitis? triad? follows what illness and results in what other systemic organ problem?

Back 63

henoch-schonlein purpura
triad: skin, joints, GI (skin rash on butt and legs, arthralgia, intestinal hemorrhage)
follows an URT infection and results in IgA nephropathy

Front 64

kawasaki disease, Sx's (most serious too), Rx

Back 64

necrotizing vasculitis in kids

see: fever, conjunctivitis, "strawberry tongue", may develop coronary aneurysms (MOST serious)

rx with IVIG and aspirin

Front 65

polyarteritis nodosa, 30% of pts are seropositive for what?

Back 65

Hep B

Front 66

Takayasu's arteritis, known as what?, what is it, Sx's

Back 66

known as pulseless disease
is granulomatous thickening of aortic arch and/or proximal great vessels
FAN MY SKIN On Wednesday
Fever
Arthritis
Night sweats
MYalgia
SKIN nodules
Ocular disturbance
Weak pulses in upper extremities

Front 67

most common vasculitis affecting medium and large arteries? Sx's? population hit the most

Back 67

Temporal arteritis (giant cell arteritis)

Sxs of TEMPoral arteritis are near TEMPles: headache, jaw claudication, impaired vision

elderly females

Front 68

B blockers are contrindicated in what

Back 68

decompensated CHF

Front 69

Hydralazine MUT

Back 69

moa: increase cGMP to produce relaxation of smooth muscles and arteriole vasodilation

U: 1st line for HTN in preggos, frequently given with B blocker to prevent reflex tachy

T: compensatory tachy, lupus like syndrome

Front 70

Nifedipine, verapamil, diltiazem

class, MUT

Back 70

CCB's

M: block voltage-dependent L-type Ca channels reducing muscle contractility, for vascular smooth muscle use nifedipine, for the heart use verapamil (V for Ventricle)

U: HTN, angina, arrythmias (not nifedipine), prinzmetals angina, reynauds

T: cardiac depression, AV block, peripheral edema, flushing

Front 71

nitroglycerine, isosorbide dinitrate MUT

Back 71

M: release NO, increase cGMP to produce smooth muscle relaxation, hit VEINS more than arteries, decrease PRELOAD

U: angina, keeping a boner

T: reflex tachy, hypotension

Front 72

nitroprusside can cause what toxicity?

Back 72

cyanide

Front 73

niacin MT

Back 73

M: decrease lipolysis in adipose tissue and decrease hepatic VLDL secretion

T: red, flushed face, hyper glycemia, hyperuricemia

Front 74

Bile acid resins MT

Back 74

M: prevent intestinal reabsorption of bile acids, liver must use cholesterol to make more

T: taste like crap and cause GI discomfort

Front 75

ezetimibe MT

Back 75

M: prevent cholesterol reabsorption at small intestine brush border

T:

Front 76

Fibrates (gemfibrozil, clofibrate, bezafibrate, fenofibrate) MT

Back 76

M: upregulate LPL to INCREASE TG clearance

T: myositis, hepatotox

Front 77

digoxin MUT

Back 77

M: binds Na/K ATPase and indirectly inhibits Na/Ca pump. this increase [Ca] and increases inotropy

U: CHF, a fib,

T: cholinergic (nausea, vomit, diarrhea, blurry yellow vision); ECG (increase PR, decrease QT, T wave inversion); worsened by renal failure, hypokalemia, quinidine (decreases digoxin clearance)

Front 78

Class IA antiarrhythmics 3 of em
MOA

Back 78

Quinidine, Procainamide, Disopyramide

the Queen PROclaims Disos Pyramide

MOA: increase AP duration, increase ERP, increase QT interval

Front 79

Class IB antiarrhythmics 3 of em

MOA?affect what tissue? best time to use?

Back 79

Lidocaine, Mexiletine, Tocainide

I'd Buy LIDy's MEXIcan Tacos

MOA: decrease AP duration

hit purkinje and ventricular tissue the most

Best post-MI

Front 80

Class IC antiarrhythmics 3 of em

no effect on what? when NOT to use?

Back 80

Flecainide, Encainide, Propafenone

Chipolte's Food has Excellent Produce

No effect on AP duration

Contraindicated post-MI

Front 81

what condition will increase the tox for all Class I antiarrythmics?

Back 81

hyperkalemia

Front 82

Class II antiarrythmics 5 of em MUT

Back 82

propranolol, esmolol, metoprolol, atenolol, timolol

M: decrease cAMP, decrease Ca currents, decrease slope of phase 4 in abnormal pacemakers (AV node in particular)

U: v tach, SVT, slow ventricles during a fib, a flutter

T: impotence, exacerbate asthma

Front 83

Class III antiarrhythmics 5 of em

MUT

Back 83

satalol, ibutilide, bretylium, dofetilide, amiodarone (K channel blockers) BAIDS

M: increase AP duration, increase ERP, increase QT interval

T: amiodarone: pulmonary fibrosis, hepatotox, hypo/hyperthyroidism BE SURE TO CHECK: PFT, LFT, TFT

Front 84

Class IV antiarrhythmics 2 of em

MUT

Back 84

Verapamil, diltiazem

M: decrease conductance velocity, increase ERP, increase PR interval

U: Prevent nodal arrhythmias

T: constipation, flushing, edema, CV effects (CHF, AV block, sinus node depression

Front 85

DOC for Dx'ing/abolishing SVT and duration?? (MOA too)

Back 85

adenosine (increase K out of cell)

very short acting (15 seconds)

Front 86

stills murmer

Back 86

benign pediatric murmur in kids 2-8 years old, mid-systolic murmur of musical quality heard at apex and left sternal border

Front 87

a wide pulse pressure and a "blowing murmur" indicate what?

Back 87

aortic regurg, their head may even bob

Front 88

class IB works on what type of tissue best? major S/E?

Back 88

ISCHEMIC!!!!

CNS symptoms

Front 89

what drug prolongs the AP duration more than any other antiarrhythmic drug?

Back 89

amiodarone

Front 90

3 classic signs of aortic dissection?

Back 90

substernal pain radiating to the back
severe HTN
asymmetric upper extremity pulses

Front 91

associate churg-strauss with this disease and what ANCA

Back 91

asthma
p-ANCA

Front 92

what population is hit with takayasus arteritis?

Back 92

asian females

Front 93

how long does stable angina last?

Back 93

30 seconds to thirty minutes

Front 94

does hypercalcemia increase digoxin tox?

Back 94

YES!!

Front 95

digoxin hits the Na/K pump....it also stimulates something, what is it and what could that produce?

Back 95

the vagus nerve (parasympathetics) and this could lead to AV block

Front 96

remember that right upper quadrant pain in the presence of edema, venous stasis and JVD is a sign of liver congestion and thus Right sided heart failure

Back 96

know it!

Front 97

does digoxin have any effect on mortality CHF patients?

Back 97

NOOOOO!!!!!!!

Front 98

three DOC's for CHF that increase survival

Back 98

ACE inhibitors, spironolactone, metoprolol

Front 99

holosystolic "blowing" murmur is what? heard best where?

Back 99

VSD. Tricuspid area

Front 100

DOC to convert SVT??? second line drug?

Back 100

adenosine first

Beta blocker (propranolol) second

Front 101

3 bugs associated with IV drug abusers with endocarditis

Back 101

Staph areus
Pseudomonas
Candida