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151 Cards in this Set
- Front
- Back
supplies the SA and AV nodes
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RCA
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where are most coronary artery occlusion
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LAD
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when do coronary arteries fill
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diastole
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most posterior portion of the heart
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left atrium
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CO = SV x HR
what happens if HR is too high though |
doesn't give heart enough time to fill and decreases CO
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MAP = CO x TPR
calculate |
2/3 diastolic pressure + 1/3 systolic pressure
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pulse pressure
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systolic pressure - diastolic pressure
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what happens to contractility with decreased extracellular sodium
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increased due to decreased activity of Na/Ca exchanger
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what does digitalis due to contractility
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increases due to increased intracellular Na via Na/K ATPase block, resulting in increased Ca
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how does acidosis decrease contractility
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H displaces Ca on myofibrils
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what do venodilators (nitroglycerin) do to preload
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decrease
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what is the force of contraction proportion to
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prelaod (initial length of cardiac muscle fiber)
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index of ventricular contractility
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EF
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what determines viscosity of blood
what 3 situation is it increased |
hematocrit:
polycythemia hyperproteinemic state (MM) hereditary spheroccytosis |
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what does S1 correlate with
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mitral and tricuspid valves closing
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what does S2 correlate with
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aortic and pulmonic valves closing
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extra heart sound associated with increased filling pressure
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S3
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extra heart sound associated with ventricular hypertrophy
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S4
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what does a wave correlate with in JVP
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atrial contraction
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what does c wave correlate with in JVP
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RV contraction (closed tricuspid valve bulging into R atrium)
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what does v wave correlate with in JVP
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increased RAP due to filling against closed tricuspid valve
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what does x descent correlate with in JVP
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pulmonic valve opening
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what does y descent correlate with in JVP
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tricuspid valve opening
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what increases S2 split (A2 - P2)
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inspiration - drop in intrathoracic pressure increases capacity of pulmonary circulation, pulmonic valve closes later to accommodate while arotic valve closes earlier because decreased blood return to heart
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associated with fixed S2 splitting during inspiration and expiration
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ASD
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associated with paradoxial splitting in which inspiration causes S2 split to decrease
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conditions that delay LV emptying:
aortic stenosis LBBB |
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associated with wide S2 splitting
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conditions that delay RV emptying:
pulmonic stenosis RBBB |
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in general, these heart sounds intensify with inspiration
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right-sided heart sounds
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pulses parvus et tarus
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pulses weak compared to heart sounds - aortic stenosis
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heart sound associated with congenital rubella
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PDA
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which phase of the ventricular action penitential is associated with myocyte contraction
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phase 2 (plateau) - Ca influx triggers Ca release from SR and myocyte contraction
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which ion is involved in the upstroke (phase 0) of SA/AV node actional potential
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Ca channels, instead of fast Na channels like ventricles
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what determines the HR in the SA/AV node
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slope of phase 4 (I-f Na channel)
ACh/adenosine decrease depolarization and HR, catecholamines increase depolarization and HR |
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speed of conduction through the heart in decreasing order
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purkinje > atria > ventricles > AV node
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part of the EKG that is associated with conduction delay through AV node
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PR interval
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part of EKG associated with atrial depolarization
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P wave
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ECG associated with ventricle contraction
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QT interval
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normal time QRS complex takes (ventricular depolarization)
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< 120 msec.
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normal time during PR interval
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< 200 msec.
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associated with U wave
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hypokalemia
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what can congenital long QT syndromes also present with
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congenital sensorineural deafness (Lange-Nielsen syndrome)
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associated with accessory conduction pathway from atria to ventricle (bundle of Kent) that bypasses AV node
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Wolff-Parkinson-White syndrome
*ventricular preexcitation syndrome |
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associated with characteristic delta wave on ECG and may result in reentry current leading to supraventricular tachycardia
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ventricular preexcitation syndrome
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irregularly irregular pulse with no discrete P waves in between irregularly spaced QRS complexes
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Atrial fibrillation
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treatment of Atrial fibrillation
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Ca channel blocker or B blocker
Warfarin prophylaxis against thromboembolism |
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Atrial flutter
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rapid succession of atrial depolarization waves (P waves) - multiple P waves in between QRS complex
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PR interval is prolonged > 200 msec.
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AV block (1st degree heart block)
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differentiate Mobitz type I and II 2nd degree heart blocks
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type I - progressive lengthening of the PR interval until a QRS complex is dropped
type II - normal PR intervals with a QRS drop randomly |
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3rd degree heart block
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atria and ventricles beat independently of each other, atrial rate is faster than the ventricular rate
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infection associated with 3rd degree heart block
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lyme disease
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completely erratic rhythm with no identifiable waves
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ventricular fibrillation
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released from the atria in response to increased blood volume and atrial pressure
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ANP
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associated with vascular ralaxation, constriction of efferent renal arteriole and dilation of the afferent promoting diuresis
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ANP
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responds only to increased BP via the vagus nerve to the medulla
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aortic arch
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responds to increased and decreased BP via slossopharyngeal nerve to solitary nucleus
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carotid sinus
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cushing triad associated with increased ICP
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hypertension, bradycardia, respiratory depression
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large AV O2 difference because O2 extraction is always 100%
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heart - increased O2 demand is met by increased coronary blood flow, not by increased extraction
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when is the pulmonary capillary wedge pressure greater than LV diastolic pressure
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mitral stenosis
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what does hypoxia do in the lungs that is different than other organs
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causes vasoconstriction so that only well-ventilated areas are perfused, usually causes vasodilation in other organs
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most common cause of early cyanosis in newborn
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tetralogy of Fallot
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most common congenital cardiac anomaly
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VSD
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associated with loud S1; wide, fixed split S2
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ASD
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three causes for late cyanosis, "blue kids"
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left-to-right shunts:
VSD ASD PDA |
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5 causes for right-to-left shunts (blue babies)
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Tetralogy of Fallot
Transposition of great vessels Truncus arteriosus Tricuspid atresia Total anomalous pulmonary venous return |
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Eisenmenger's syndrome
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L - R shunts eventually reverse to R -L shunts due to increased pulmonary resistance leading to late cyanosis (clubbing and polycythemia)
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which heart problems is eisenmenger's syndrome associated with
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uncorrected VSD, ASD, PDA
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associated with boot-shaped heart, cyanotic spells with the patient learning to squat to improve symptoms
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Tetralogy of Fallot
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4 components of Tetralogy of Fallot
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pulmonary stenosis
RVH Overriding aorta VSD |
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this heart defect is due to failure of the aorticopulmonary septum to spiral
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transposition of great vessels
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differentiate infantile vs. adult type coarctation of the aorta
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infantile - stenosis preductal
adult - stenosis postductal |
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associated with notching of the ribs, HTN in upper extremities, and weak pulses in lower extremities
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adult type coarcation of the aorta
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used to keep PDA open, such as in conditions such as transposition of great vessels
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PGE2
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used to close PDA
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indomethacin
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heart defects associated with 22q11 syndromes
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truncus arteriosus
tetralogy of fallot |
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heart defects associated with down syndrome
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ASD
VSD AV septal defect |
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heart defects associated with congenital rubella
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septal defects
PDA pulmonary artery stenosis |
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heart defect associated with turner syndrome
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coarctation of the aorta
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heart defect associated with infant with diabetic mother
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transposition of great vessels
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Monckeberg
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calcification in the media of the arteries, especially radial or ulnar
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arteriolosclerosis
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hyaline thickening of small arteries in essential HTN or DM
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atherosclerosis
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fibrous plaques and atheromas form in intima of large, elastic arteries
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most common places for atherosclerosis
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abdominal aorta > coronary artery > popliteal artery > carotid artery
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longitudinal intraluminal tear associated with HTN or medial necrosis
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aortic dissection
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patient presents with tearing chest pain radiating to the back and CXR with mediastinal widening
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aortic dissection
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Angina associated with ST elevation of ECG
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Prinzmetal's variant (coronary artery spasm)
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differentiate stable and unstable angina
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stable - chest pain with exertion
unstable - worsening chest pain at rest or with minimal exertion *both show ST depression on ECG |
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associated with thrombosis with no necrosis
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unstable angina
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sudden cardiac death
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death within 1 hour of onset of symptoms, usually due to lethal arrhythmia
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most common places for coronary artery occlusion
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LAD > RCA > circumflex
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LM after first 2-4 hours of MI
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No visible changes
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time table associated with dark mottling, pale with tetrazolium stain
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first day after MI
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time table associated with acute inflammation, hyperemia, coagulative necrosis, and neutrophil emigration
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2-4 days after MI
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time table in which risk for free wall rupture, tamponade, papillary muscle rupture, and IV septum rupture due to macrophage degredation showing central yellow-brown softening
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5-10 days after MI
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time table associated with ventricular aneurysm showing gray-white area where occlusion was
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7 weeks after MI
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heart failure cells
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hemosiderin-laden macrophages in the lungs due to increased pulmonary capillary pressure
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signs and symptoms associated with bacterial endocarditis
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Bacteria FROM JANE:
fever roth's spots osler's nodes - raised lesion on finger or toe pads murmur - new janeway lesions - erythematous lesion on palm or sole anemia nail-bed hemorrhages emboli |
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most frequently involved valve in bacterial endocarditis
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mitral valve
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what is tricuspid valve endocarditis associated with
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IV drug
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organism associated with large vegetations on previously normal valves, rapid onset (acute)
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S. aureus
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organism associated with subacute, smaller vegetations on congenitally abnormal or diseased valves
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strep viridans (sequela of dental procedures)
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bacterial endocarditis organism associated with colon cancer
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S. bovis
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bacterial endocarditis organism associated with prosthetic vavles
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S. epidermidis
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wartlike, sterile vegetations occurring on both sides of the valve are associated with what autoimmune disease
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SLE (libman-sacks endocarditis)
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most affected valve in rheumatic fever
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mitral valve > aortic >> tricuspid
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type II hypersensitivity due to antibodies against M protein
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rheumatic fever
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associated with aschoff bodies (granuloma with giant cells), activated histiocytes, and elevated ASO titeres
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rheumatic fever
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equilibration of diastolic pressure in all 4 chambers
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cardiac tamponade
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associated with hypotension, increased JVP, distant heart sounds, increased HR, and pulsus paradoxus
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cardiac tamponade
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associated with exaggerated decrease in amplitude of pulse during inspiration
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pulsus paradoxus: cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup
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associated with tree bark appearance of the ascending aorta
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tertiary syphilis
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most common primary cardiac tumor in adults, where are they usually found
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myxomas - left atrium
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most frequent primary cardiac tumor in children, association
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rhabdomyomas
tuberous sclerosis |
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most common heart tumor
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metastases from melanoma or lymphoma (secondary)
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causes for kussmaul's sign (increased JVP on inspiration)
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constrictive pericarditis
RH failure cardiac tamponade cardiac tumor |
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predisposes to poor wound healing and ulcer on legs
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varicose veins
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cause of varicose veins
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chronically elevated venous pressure
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associations with raynaud's phenomenon
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secondary to mixed CT disease, SLE, or CREST syndrome
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necrotizing vasculitis, necrotizing granulomas in lung and upper airway, and necrotizing glomerulonephritis
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Wegener's granulomatosis
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associated with hemoptysis, hematuria, perforation of nasal septum, chronic sinusitis, dyspnea
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wegener's granulomatosis
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associated with c-ANCA
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wegener's granulomatosis
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associated with p-ANCA, like wegener's but lacks granulomas
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polyarteritis nodosa
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granulomatous vasculitis with eosinphilia, most often presents with asthma, sinusitis, skin lesions, and peripheral neuropathy
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Churg-Strauss syndrome
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vasculitis limited to the kidney, associated with ANCA
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pauci-immune crescentic glomerulonephritis
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congenital vascular disorder that affects capillary-sized blood vessels, associated with port-wine stain on face, seziures, and early-onset glaucoma
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sturge-weber disease
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this condition is associated with triad of: skin, joints, and GI
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henoch-schonlein purpura
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palpable purpura on buttocks and legs that manifests after URI, associated with IgA immune complexes and abdominal pain
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henoch-schonlein purpura
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cause of intermittent claudication, superficial nodular phlebitis, cold sensitivity, and thrombosing vasculitis that may lead to gangrene and autoamputation of digits
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smoking - thromboangiitis obliterans
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associated with fever, conjunctivitis, strawberry tongue, lymphadenitis, desquamative skin rash
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Kawasaki disease
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vasculitis associated with coronary aneurysms in children
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Kawasaki disease
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immune complex-mediated transmural vasculitis with fibrinoid necrosis
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polyarteritis nodosa
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granulomatous thickening of aortic arch, associated with increased ESR, primarily affects asian females < 40 year of age
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Takayasu's arteritis
*pulseless disease |
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focal, granulomatous inflammation affecting branches of carotid artery in elderly females
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temporal arteritis
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benign capillary skin papules found in AIDS patients caused by bartonella henselae
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bacillary angiomatosis
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highly lethal malignancy of the liver, associated with vinyl chloride, arsenic, and thorotrast exposure
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angiosarcoma
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vascular tumor associated with poast-radical mastectomy
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lymphangiosarcoma
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endothelial malignancy of the skin associated with HHV-8 and HIV
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kaposi's sarcoma
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drugs that are contraindicated in patients with decompensated CHF
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B-blockers
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DOC for HTN in patient with DM
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ACE inhibitors/ARBs
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drugs associated with smooth muscle relaxation via cGMP mechanism, vasodilates arterioles > veins
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hydralazine
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antihypertensive drug associated with lupus-like syndrome
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hydralazine
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antihypertensive drug contraindicated in angina/CAD due to compensatory tachycardia reflex
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hydralazine
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Ca channel blocker more associated with vascular smooth muscle relaxation
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nifedipine > diltiazem > verapamil
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Ca channel blocker more associated with working on the heart
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verapamil > diltiazem > nifedipine
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drugs that dilate the veins >> arteries, and therefore decrease preload
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nitroglycerin, isosorbide dinitrate
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Monday's disease
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nitroglycerin: development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend; results in tachycardia, dizziness, and headache on reexposure
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drug that can cause cyanide toxicity
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nitroprusside
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antihypertensive drug that dilates both veins and arteries
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nitroprusside
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D1 receptor agonist associated with malignant HTN treatment
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fenoldopam
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K channel opener that relaxes vascular smooth muscle, can cause hyperglycemia due to decreased insulin release
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diazoxide
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partial B-agonists that are contraindicated in angina
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pindolol
acebutolol |
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determinants of MVO2 (myocardial O2 consumption)
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end diastolic volume
blood pressure heart rate contractility ejection time |