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101 Cards in this Set

  • Front
  • Back
what supplies blood for the SA and AV nodes?
most of the time its the RCA
when do coronary arteries fill?
during diastole
what 3 things affect SV
Contractility, Afterload, preload

SV CAP
how does digitalis increase contractility
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
how do catecholamines increase contractility
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
an example of a drug that is a vasodilator and decreases the afterload
hydrAlAzine----decrease Afterload (Arterial)
what does the starling curve show
that the force of contraction is proportional to the initials length of the cardiac muscle fibers
Romano Ward syndrome
mutation in the K channel protein that delays Ik channel current

leads to QT prolongation
Jervell and Lange-Nielsen Syndrome
Mutation in the K channel protein that delats the Ik channel current

leads to QT prolongation
lyme disease can result in what heart condition (conduction related)
3rd degree heart disease
three things that the peripheral (carotid and aortic bodies) chemoreceptors respond to
drop in PO2, Increase in PCO2, drop in blood pH
central chemoreceptors respond to what and DO NOT respond directly to what
changes in ph and CO2 which are influenced by arterial CO2. DO NOT directly respond to PO2
what is the cushing reaction and what is responsible for it
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
cushing triad
HTN, bradycardia and respiratory depression
what is the O2 extraction from blood of the heart and how does this play with an increase in O2 demand of the heart
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)
what are the five T's of right-to-left shunts that produce blue babies
Tetralogy
Transposition
Truncus Tricuspid
TAPVR
what is the most common congenital heart defect and what is it associated with (an assoc. cause)
VSD
Assoc. with Fetal Alcohol Syndrome
ostium primum and secundum

which is most common and which is associated with Downs
ostium secundum is most common

primum associated with Downs
what is an associated cause of a PDA (congenital cause)
congenital rubella
what is Eisenmengers syndrome
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
what produces a boot shaped heart on Xray and what is it due to
tetralogy of fallot

d/t the R ventricular hypertrophy
what is transposition of the great vessels associated with (mothers problem)
maternal diabetes
what are the two types of coarctations of the aorta and what are their locations
Infantile type----before the ducuts arteriosus....INfant IN close to heart (proximal to duct)

Adult type---after the duct...aDult, Distal to Duct
what is infantile and adult coarctation assoc. with (seen on xray for adults) and what do adults present with
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
what is coarctation of the aorta associated with (think of Brandon)
bicuspid aortic valve
hear a continuous machine like murmur? what is it
PDA
PDA can result in what later in life
cyanosis in the lower
Monckeberg vs arteriolosclerosis vs atherosclerosis
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
what is an ebstein anomaly
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
what is a good predicting sign of an aortic dissection
tearing chest pain that radiates down the back
three types of angina
stable, prinzmetals variant, unstable/crescendo

hey angie (angina), whaz SUP!!!!!!!!
stable angina is secondary to what and shows what on ECG and is arises d/t what
atherosclerosis, ST depression arises d/t exertion or emotional stress
prinzmetals variant angina is secondary to what, shows what on ECG and how do you Rx it
secondary to coronary spasm, ST elevation (d/t being a COMPLETE blockage), Rx with nitro or CCB

Metal rock makes you SPASM!!!!!
unstable/crescendo angina cause, ECG results and Rx
thrombosis, but no necrosis, ST depression Rx with nitro
most commonly involved artery with a MI
LAD

da widow-maker!!!!!
gold standard for Dx of MI in the first 6 hours
ECG
most sensitive and specific marker for MI?? (gold standard)
Troponin I
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)
CK-MB
what is dresslers syndrome
autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post MI)
most common cardiomyopathy and etiologies, systolic or diastolic
Dilated Cardiomyopathy (all 4 chambers enlarged), systolic

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

ABCCCD and a P
hypertrophic cardiomyopathy
genetics (HY), type of murmur, Rx, systolic or diastolic
L ventricle hypertrophy, Autosomal dominant (mutations in sarcomere proteins), systolic murmur S4, Rx with B blockers or non-dihydropyridine CCBs (verapamil) diastolic
restrictive/obliterative cardiomyopathy
causes, classic ECG finding, systolic or diastolic
sarcoidosis, amyloidosis, postradiation fibrosis, endocardial fibroelestosis, lofflers syndrome (pg 83 pathoma); low-voltage EKG with diminished QRS amplitude; diastolic
eccentric vs concentric hypertrophy, cause and types of cardiomyopathies assoc.
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
how does paroxysmal dyspnea occur in CHF
patient lies down, this increases venous return and exacerbates the problem
intraavleolar hemorrhage in CHF is caused by what and marked by the presence of what?
caused by microhemorrhages from an increase in pressure in the pulmonary capillaries rupturing them

hemosiderin-laden macrophages (heart failure cells)
nutmeg liver is seen in what disease state?
CHF (right sided heart failure) due to an increase in central venous pressure leading to an increase resistance in portal flow.
most common cause of right sided heart failure?
left sided heart failure
paradoxical problem with low CO in CHF and the kidneys
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)
DOC for treating CHF
ACE inhibitors
Sx's for bacterial endocarditis? 8 of em, and which is more common?
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
bacteria causing large vegetations in endocarditis? tell me a little about it as well
staph auerus, HIGH virluent, common in IV DRUG USERS, TRIcuspid valve affected

dont TRI drugs!!!!
bacteria causing small vegetations in endocarditis? a little about it as well
strep viridans, LOW virulence, sequela of dental work, MOST COMMON OVERALL,
bacteria assoc. with endocarditis that hits prosthetic valves and one that deals with the intestines (what disease specifically?)
strep epidermidis hits prosthetic valves

strep bovis from colon cancer
what is libman-sacks endocarditis
sterile vegetations that occur on both sides of the heart valve, assoc. with SLE


SLE causes LSE
Sx's of rheumatic heart disease
FEVERSS

Fever
Erythema marginatum
Valvular damage
ESR (increases)
Red hot joints (migratory polyarthritis in large joints)
SubQ nodules
Sydenham chorea
cause of rheumatic heart disease and valve most commonly involved
group A Beta Hemolytic strep, mitral valve
most common cause of death in the acute phase of rheumatic fever and what is seen microscopically
myocarditis, aschoff bodies (granuloma with giant cells) and anitschkow cells (activated histiocytes)
what is the underlying cause of rheumatic heart disease (answer is not group a strep)
molecular mimicry, the bacterial M protein resembles human tissue.
what leads to a "tree bark" appearance of the aorta?
tertiary syphilis leading to calcification of the aortic root
most common cardiac tumor in adults? in kids? associated with what in kids?
myxomas in adults, rhabdomyomas in kids and assoc. with tuberous sclerosis
wegeners granulomatosis: triad, sx's, marker, Rx
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
p-ANCA is associated with what?
microscopic polyangitis and churg-strauss syndrome
what is the most common form of childhood systemic vasculitis? triad? follows what illness and results in what other systemic organ problem?
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
kawasaki disease, Sx's (most serious too), Rx
necrotizing vasculitis in kids

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

rx with IVIG and aspirin
polyarteritis nodosa, 30% of pts are seropositive for what?
Hep B
Takayasu's arteritis, known as what?, what is it, Sx's
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
most common vasculitis affecting medium and large arteries? Sx's? population hit the most
Temporal arteritis (giant cell arteritis)

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

elderly females
B blockers are contrindicated in what
decompensated CHF
Hydralazine MUT
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
Nifedipine, verapamil, diltiazem

class, MUT
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
nitroglycerine, isosorbide dinitrate MUT
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
nitroprusside can cause what toxicity?
cyanide
niacin MT
M: decrease lipolysis in adipose tissue and decrease hepatic VLDL secretion

T: red, flushed face, hyper glycemia, hyperuricemia
Bile acid resins MT
M: prevent intestinal reabsorption of bile acids, liver must use cholesterol to make more

T: taste like crap and cause GI discomfort
ezetimibe MT
M: prevent cholesterol reabsorption at small intestine brush border

T:
Fibrates (gemfibrozil, clofibrate, bezafibrate, fenofibrate) MT
M: upregulate LPL to INCREASE TG clearance

T: myositis, hepatotox
digoxin MUT
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)
Class IA antiarrhythmics 3 of em
MOA
Quinidine, Procainamide, Disopyramide

the Queen PROclaims Disos Pyramide

MOA: increase AP duration, increase ERP, increase QT interval
Class IB antiarrhythmics 3 of em

MOA?affect what tissue? best time to use?
Lidocaine, Mexiletine, Tocainide

I'd Buy LIDy's MEXIcan Tacos

MOA: decrease AP duration

hit purkinje and ventricular tissue the most

Best post-MI
Class IC antiarrhythmics 3 of em

no effect on what? when NOT to use?
Flecainide, Encainide, Propafenone

Chipolte's Food has Excellent Produce

No effect on AP duration

Contraindicated post-MI
what condition will increase the tox for all Class I antiarrythmics?
hyperkalemia
Class II antiarrythmics 5 of em MUT
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
Class III antiarrhythmics 5 of em

MUT
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
Class IV antiarrhythmics 2 of em

MUT
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
DOC for Dx'ing/abolishing SVT and duration?? (MOA too)
adenosine (increase K out of cell)

very short acting (15 seconds)
stills murmer
benign pediatric murmur in kids 2-8 years old, mid-systolic murmur of musical quality heard at apex and left sternal border
a wide pulse pressure and a "blowing murmur" indicate what?
aortic regurg, their head may even bob
class IB works on what type of tissue best? major S/E?
ISCHEMIC!!!!

CNS symptoms
what drug prolongs the AP duration more than any other antiarrhythmic drug?
amiodarone
3 classic signs of aortic dissection?
substernal pain radiating to the back
severe HTN
asymmetric upper extremity pulses
associate churg-strauss with this disease and what ANCA
asthma
p-ANCA
what population is hit with takayasus arteritis?
asian females
how long does stable angina last?
30 seconds to thirty minutes
does hypercalcemia increase digoxin tox?
YES!!
digoxin hits the Na/K pump....it also stimulates something, what is it and what could that produce?
the vagus nerve (parasympathetics) and this could lead to AV block
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
know it!
does digoxin have any effect on mortality CHF patients?
NOOOOO!!!!!!!
three DOC's for CHF that increase survival
ACE inhibitors, spironolactone, metoprolol
holosystolic "blowing" murmur is what? heard best where?
VSD. Tricuspid area
DOC to convert SVT??? second line drug?
adenosine first

Beta blocker (propranolol) second
3 bugs associated with IV drug abusers with endocarditis
Staph areus
Pseudomonas
Candida