Ppal99 Dissecting The Usmle 1,2,3 Cardiac

Front 1

what sound do you hear during systole?

Back 1

S1:M/T close ⇨ IC ⇨Squishes blood out

Front 2

what sound do you hear during Diastole?

Back 2

S2: A/P close⇨ IR ⇨ Fills with blood

Front 3

how are heart sounds made?

Back 3

Heart sounds are always made by valves closing

Front 4

why are aortic and mitral close first?

Back 4

L side has higher pressure/resistance => aortic and mitral valves close first

Front 5

what happend venous return and regurgitation during Standing /Valsalva?

Back 5

⇩Regurg (⇩venous return)

Front 6

Standing /Valsalva:what is the effect on the murmur in HCM

Back 6

⇧HCM

Front 7

Standing /Valsalva:what is the effect on the murmur in AS?

Back 7

⇩AS

Front 8

Squat/Handgrip: what is the effect on regurgitation and venous return?

Back 8

⇧Regurg (⇧venous return)

Front 9

what does it mean when one hears louder murmur during Inspiration?

Back 9

=> hear Right problems louder (⇧blood volume on Right side)

Front 10

what does it mean when one hears louder murmur during Expiration

Back 10

=> hear L problems louder

Front 11

Soft S1

Back 11

=> M/T regurg (or mitral/tricuspid atresia- cyanotic)

Front 12

Loud S1

Back 12

=> M/T stenosis (or ventricle contracting harder)

Front 13

Soft S2

Back 13

=> A/P regurg (or aortic/pulmonic atresia - cyanotic)

Front 14

Loud S2

Back 14

=> A/P stenosis (or high pressure in front of valves: systemic or pulm HTN)

Front 15

Wide S2 splitting

Back 15

=> ⇧02, ⇧RV volume, delay- pulmonic valve opening

Front 16

Narrow S2 splitting

Back 16

=> ⇩02 ,⇩RV volume

Front 17

S3

Back 17

volume (dilated)

Front 18

S4

Back 18

pressure (hypertrophy)

Front 19

Pulse= what part of the EKG and what is a normal pulse?

Back 19

= QRS (2+ = normal):

Front 20

Pulsus Tardus

Back 20

AS

Front 21

Water-hammer

Back 21

AR

Front 22

Pulsus Alterans

Back 22

DCM

Front 23

Pulsus Bisferiens

Back 23

IHSS.

Front 24

Pulsus Paradoxus associated with what syndrome

Back 24

Cardiac Tamponade

Front 25

Irregularly Irregular

Back 25

A Fib

Front 26

Regularly irregular

Back 26

PVC

Front 27

Mid-systolic click
etiology
example
Tx

Back 27

hear valve buckling during systole
Mitral valve prolapse
Tx: weight gain

Front 28

Ejection click
etiology
diagnosis (2)

Back 28

force the valve open during systole
• Aortic stenosis
• Pulmonary stenosis

Front 29

Opening snap
etiology
dx (2)

Back 29

force the valve open during diastole
• Mitral stenosis
• Tricuspid stenosis

Front 30

explain physiological S2 splitting:

Back 30

normal on inspiration (b/c pulmonic valve closes later)
• Right side has lower pressure => pulmonary valve stays open longer
• 02 dilates pulm vv. => ⇧flow =>pulmonary valve stays open longer

Front 31

what are some of the causes of Wide S2 splitting:

Back 31

• Increase 02 (deep breath, ventilator)
• Increase RV volume (VSD, PR, lay down, dilated cardiomyopathy)
• Delay pulmonic valve opening (PS)

Front 32

Fixed wide splitting of S2

Back 32

ASD: L to R shunt

Front 33

Paradoxical S2 splitting:
etiology
DDx;

Back 33

aortic valve closes later
• Aortic stenosis
• LBBB

Front 34

Effects of pulmonary HTN give 2

Back 34

Cor pulmonale: RV failure
Eisenmenger's: (Reverse) L-R to R-L shunt
(become cyanotic, DVTs go Systemic)

Front 35

Radiating Sounds to Neck:

Back 35

AS

Front 36

Radiating Sounds to Axilla:

Back 36

MR

Front 37

Radiating Sounds to Back:

Back 37

PS

Front 38

Estrogen Synthesis:
Ovary/ Adipose/Placenta:E1:

Back 38

Ovary/ Adipose/Placenta:
20/80/ 0

Front 39

Estrogen Synthesis:
Ovary/ Adipose/Placenta: E2:

Back 39

80/ 20/0

Front 40

what does S3 mean: (3)

Back 40

SLOSH(S1) -ing(S2) in(S3)
1) Dilated ventricle (estrogen stretches mm apart, normal in teenage females)
2) Volume overload
3) decompensation (heart gives out)

Front 41

what does S4 mean?

Back 41

a(S4) STIFF(S1) wall(S2)
1) Hypertrophied ventricle
2) Pressure overload
3) Compensation (Ex: aortic stenosis - most common, aging)

Front 42

The Estrogen Connection

Back 42

Estrogen is a muscle relaxant => NM disease state

Front 43

example of increase estrogen situation and how does this connect to NM disease state?

Back 43

>>obesity, oral contraceptives, pregnancy, liver failure, p450 inhibition
Estrogen is a muscle relaxant => NM disease state

Front 44

what complication can estrogen lead to?

Back 44

S3, vasodilation, ⇩BP, hemorrhoids
• constipation, urinary retention
• reflux, relax gall bladder ~> gallstones
• ⇩osteoporosis, colorectal CA, LDL
• ⇧breast CA, endometrial CA, DVT
• Proteins:⇧ESR, Lipoproteins, TBG, Angiotensinogen, Factor 1

Front 45

Pre-eclampsia

Back 45

ischemia to placenta=> HTN (>140/ 90) + proteinuria (>300 mg/day)

Front 46

if there are symptoms of preeclampsia and <20 wks,

Back 46

If <20 wks, think hydatidiform mole

Front 47

complication of preeclampsia

Back 47

Mom gets cerebral hemorrhage/ ARDS ~> dies

Front 48

HELLP syndrome: define and what it stands for

Back 48

hepatic injury
Hemolysis
Elevated Liver enzymes
Low Platelets

Front 49

HELLP syndrome tx

Back 49

delivery

Front 50

when to do an immediate C/S?

Back 50

• HR below 60 bpm
• HR ⇩ >60 bpm
• HR <100 for 60 sec

Front 51

Eclampsia:
etiology
Sx
Tx

Back 51

>>HTN +seizures (shut down pump, Na is locked in cell but K can leak out)
Sx: headache, change in vision, epigastric pain
Tx: 4g Mg sulfate (seizure prophylaxis) ~> C/ S

Front 52

BP: RA

Back 52

resistance/ volume
0/8

Front 53

BP: RV

Back 53

resistance/ volume
16/8

Front 54

BP: pulmonary artery

Back 54

resistance/ volume
32/16

Front 55

BP: LA

Back 55

resistance/ volume
16/8

Front 56

BP: LV

Back 56

resistance/ volume
140/80

Front 57

BP: aorta

Back 57

resistance/ volume
120/80

Front 58

Lung has 2 blood supplies:

Back 58

• Bronchiole artery (1/ 3) = 4cc
• Pulmonary artery (2/3) = 5cc

Front 59

what is CVP? what is it equal to and it normal values?

Back 59

central venous pressure = average RA pressure (normal=3-5)

Front 60

DDX of high CVP

Back 60

heart failure, cardiac tamponade

Front 61

DDX of low CVP

Back 61

1st sign of hemorrhage

Front 62

Percent perfusion:
(total = ?)
Brain = ?
Heart = ?
Kidney = ?

Back 62

Percent perfusion:
(total = 5L/ min)
Brain: 20%
Heart: 20%
Kidney: 20%

Front 63

what is PCWP?
normal values and what is it equal to?
and what is used to measure it?

Back 63

indirect measure of LA pressure due to volume in lungs (normal = 8+4 = 12)
measured by Swan-Ganz catheter

Front 64

DDx when PCWP is high and etiology?

Back 64

volume problem (Ex: pulmonary edema, CHF)

Front 65

DDx when PCWP is low and etiology?

Back 65

resistance problem (Ex: hypoxia, fibrosis, Phen-Phen, ARDS)

Front 66

O2 saturation in each area:
RA
RV
PA
LA
LV

Back 66

RA: 75%
RV: 75%
PA: 75%
LA: 100% just came from lungs)
LV: 97% (thesbian veins drain deoxygenated myocardial blood into LV)

Front 67

what are the Blood Vessel in the following areas
Intima:
Media:
Adventitia:

Back 67

Intima: endothelium
Media: elastin, SM
Adventitia: CT (w / vasa vasorum)

Front 68

Cardiac Equations: give 3 equation for CO and 1 equation for SV

Back 68

CO = SV x HR (Note: can measure HR via pulse, SV via BP)
CO·= MAP/ TPR (MAP=BP)
CO = 02 consumption/ A02 diff - V02 diff
SV = EDV - ESV

Front 69

what part of CO = SV x HR increases during early exercise?

Back 69

CO = SV x HR: 5L/min
⇧SV: early exercise

Front 70

what part of CO = SV x HR increases during late exercise?
what is fat burning stage?

Back 70

⇧HR: late exercise (40-70% of max HR = fat-burning stage)

Front 71

Max HR (pulse): complications if one goes higher that max heart rate

Back 71

220-age (higher=> arrythmia)

Front 72

3 types of Angina

Back 72

Stable
Unstable
Variant ''Prinzmetal's

Front 73

Stable
define and tx (4)

Back 73

pain with exertion, relieved by rest (atherosclerosis)
Tx: ASA, Metoprolol, NGN, Statin

Front 74

Unstable
define and tx

Back 74

pain at rest (transient clots)
Tx: Add Heparin, Eptifibatide, Plavix, Cardiac Cath

Front 75

Variant ''Prinzmetal's"
define and tx

Back 75

intermittent pain - wakes you up (coronary artery spasm)
Tx: Diltiazem

Front 76

Leriche syndrome

Back 76

aorto-iliac claudication, butt hurts when they walk/ during sex

Front 77

what is Atherosclerosis and its risk factors

Back 77

Risk Factors: ⇧LDL, HTN, DM, smoking
1) Fatty Streak: lipid foam cells
2) Fibrous Plaque: necrotic core with cholesterol crystals
3) Clot

Front 78

HTN Terminology: >135/85

Back 78

Mild Hypertension:

Front 79

Moderate Hypertension:

Back 79

>155/100

Front 80

HTN Terminology: Severe Hypertension:

Back 80

>175/115

Front 81

Hypertensive Urgency: define and tx

Back 81

>200/110
(Tx: Slowly ⇩BP over several days)

Front 82

Hypertensive Emergency: define and tx

Back 82

plus end-organ damage
(Tx: Nitroprusside to ⇩BP by 1/4)

Front 83

Malignant Hypertension:

Back 83

plus papilledema

Front 84

HTN Treatment: what drugs you shouldn't mix

Back 84

Can't use β-blockers and Ca-channel blockers together

Front 85

HTN tx for pregnant women (3)

Back 85

First: Stop alcohol intake
Pregnant: Labetalol/Hydralazine/ α-Me-DOPA

Front 86

HTN tx for AA/Hispanics:
why?

Back 86

First: Stop alcohol intake
high salt diet ~> diuretics (⇩SV)

Front 87

HTN tx for Caucasians:
why?

Back 87

First: Stop alcohol intake
Caucasians: stress ~> β-blockers (⇩HR)

Front 88

HTN tx for BPH:

Back 88

First: Stop alcohol intake
BPH: α-blocker

Front 89

HTN tx for Angina:

Back 89

First: Stop alcohol intake
Angina: Nitroglycerin

Front 90

HTN tx for MI:

Back 90

First: Stop alcohol intake
MI: Esmolol

Front 91

HTN tx for CHF:

Back 91

First: Stop alcohol intake
CHF: ACE-I+ Spironolactone

Front 92

HTN tx for Peripheral Vascular Dz
why?

Back 92

Peripheral Vascular Dz: ca channel blockers (⇩SV, ⇧TPR)

Front 93

HTN tx for Atherosclerosis: (2)
why?

Back 93

Ca2+ channel blockers (⇩TPR) or thiazides

Front 94

HTN tx for Osteoporosis

Back 94

Osteoporosis: HCTZ (⇧Ca2+)

Front 95

HTN tx for Cocaine

Back 95

Cocaine Users: Phentolamine

Front 96

HTN tx for Opoid Withdrawal

Back 96

Opoid Withdrawal: Clonidine

Front 97

HTN tx for Asthma:

Back 97

Asthma: no β-blockers

Front 98

HTN tx for Pulmonary Edema: (2)

Back 98

Pulmonary Edema: Nitroglycerin or Furosemide

Front 99

HTN tx for Renal Failure:

Back 99

Renal Failure: ACE-I

Front 100

HTN tx for DM:

Back 100

DM: ACEI's

Front 101

HTN tx Gout:

Back 101

Losartan (pees out uric acid)

Front 102

HTN tx Pheochromocytoma:

Back 102

Phentolamine

Front 103

HTN tx Lupus:

Back 103

no hydralazine

Front 104

HTN tx scleroderma

Back 104

ACE-I

Front 105

Increase Digitalis Toxicity: Sx, physiology

Back 105

Sx Yellow vision, SVT, AV block
High Ca: Na/Ca pump
Low K: binds Na/K pump
(more pumps for dig to bind)

Front 106

Cinchonism:

Back 106

• Hearing loss
• Tinnitus
• Thrombocytopenia

Front 107

Mitral Stenosis is associated with what disease?

Back 107

Rheumatic fever

Front 108

what valvular problem does Endocarditis cause?

Back 108

MR

Front 109

Anasarca DDx: (5)

Back 109

• CHF
• cushing's
• Steroids
• Hypothyroid
• Low Albumin
(kidney /liver failure)

Front 110

describe each Murmur Grades:
Grade 1:
Grade 2:
Grade 3:
Grade 4:
Grade 5:
Grade 6

Back 110

Grade 1: barely audible
Grade 2: easily audible
Grade 3: pretty loud
Grade 4: palpable thrill
Grade 5: hear with stethoscope off the chest
Grade 6: hear across the room without a stethscope

Front 111

Heart Murmurs: what does a late murmur imply?

Back 111

Late murmurs ⇨bad prognosis

Front 112

bruit vs murmur

Back 112

turbulence in arteries
Murmur - turbulence across a valve (hole or stenosis)

Front 113

what is the importance of reynold's #?

Back 113

Reynolds# >2500 => murmur

Front 114

what are the SYSTOLIC MURMURS:

Back 114

M/T are closed=> Regurg= holosystolic
A/ Pare open=> Stenosis= ejection murmer

Front 115

what are the Holosystolic murmurs

Back 115

1) Tricuspid regurg
2) Mitral regurg
3) VSD

Front 116

Tricuspid regurg: most common in what kind of patient?

Back 116

Holosystolic murmurs endocarditis (IV drug abuser)

Front 117

Mitral regurg:
causes (2)
presentation
murmur

Back 117

mitral valve prolapse/ endocarditis, radiates to axilla, soft S1

Front 118

VSD:
what happens during expiration and why?

Back 118

increase on expiration (LV contracts harder)

Front 119

what are the Systolic Ejection murmurs

Back 119

Pulmonary stenosis
Aortic stenosis
Idiopathic Hypertrophic Subaortic Stenosis = IHSS = HCM

Front 120

Pulmonary stenosis: give two causes and how does it present

Back 120

congenital, carcinoid (local invasion), radiates to back

Front 121

MCC cause of Aortic stenosis:
young people
elderly

Back 121

aging (calcification) or bicuspid aortic valve

Front 122

drug contraindications for aortic stenosis

Back 122

Don't give β-blockers or ⇩Afterload drugs!

Front 123

life expentancy of AS
late murmurs prognosis and what is the managent of AS:

Back 123

4-yr life expectancy
late murmurs are bad
replace if area if valve < 1.5 ml

Front 124

AS: triad,
when is it heard louder/softer
presentation on PE (4)

Back 124

Triad: syncope, angina, exertional dyspnea
• hear louder on exp, leaning forward, making fist, BP cuff
• hear less with Valsalva, standing
• pulsus tardus "delayed carotid upstroke"- takes the pulse a little while to get there
• radiates to neck, delayed carotid upstroke
• palpable thrill in suprasternal notch

Front 125

Idiopathic Hypertrophic Subaortic Stenosis = IHSS = HCM: etiology

Back 125

sudden death in athletes, AD
• IV septum is thick on top, thin on bottom => flops down
• muscle fibers are disarrayed
• "closing (septum occlusion) following opening of aortic valve"

Front 126

Idiopathic Hypertrophic Subaortic Stenosis = IHSS = HCM treatment

Back 126

Tx: β-blocker (HR/ contractility), drink water (SV), no sports, Echo for family

Front 127

Idiopathic Hypertrophic Subaortic Stenosis = IHSS = HCM
CXR: and vasalva maneuver

Back 127

• CXR: banana shape
• hear louder with Valsalva (less volume => hear flop louder)

Front 128

pulsus bisferiens

Back 128

>>feel two peaks on pulse
>>Idiopathic Hypertrophic Subaortic Stenosis = IHSS = HCM

Front 129

Amyloid: ESR levels and give the different amyloid proteins

Back 129

⇧ ESR
AA, AB, AB2, AE, AF

Front 130

AA

Back 130

Any chronic disease

Front 131

AB

Back 131

Brain (Alzheimer's)

Front 132

AB2

Back 132

β-2 microglobulinemia (renal failure)

Front 133

AE

Back 133

Endocrine (medullary CA of thyroid)

Front 134

AF

Back 134

Familial (MEN2)

Front 135

Diastolic Murmurs:

Back 135

A/Pare closed=> Regurg= blowing
M/T are open=> Stenosis= rumble

Front 136

decrescendo

Back 136

Diastolic Blowing

Front 137

Disorganization Muscle:

Back 137

HCM

Front 138

Disorganization Bone:

Back 138

Paget's

Front 139

Aortic regurg: most common cause of AR and tx

Back 139

aging or collagen diseases
(Tx: ⇩Afterload)

Front 140

De Musset's sign

Back 140

head bobbing, AR

Front 141

Wide pulse pressure

Back 141

AR, (⇧systolic P, ⇩diastolic P)

Front 142

Water-hammer pulse

Back 142

AR, bounding "thumping" pulse

Front 143

Austin Flint murmur

Back 143

suction => 2° mitral regurg

Front 144

Quincke's pulse

Back 144

see pulse in nail bed

Front 145

Pulmonic regurg: how is it acquired?
name of the 2° regurge?

Back 145

congenital
Graham-Steell murmur (suction=> 2° tricuspid regurg)

Front 146

what are the 2 things that can cause a Diastolic Rumble:
pathophysiology

Back 146

thick atrium squeezes hard=> whirlpool effect
ie. Tricuspid stenosis and Mitral stenosis

Front 147

Tricuspid stenosis:
what diseases/syndrome one would see a tricuspid stenosis?

Back 147

rheumatic fever, carcinoid syndrome

Front 148

Mitral stenosis:
what disease and pathogenesis
presentation
PE

Back 148

rheumatic fever=> emboli, hemoptysis, loud S1

Front 149

tx of tricuspid and mitral stenosis

Back 149

(Tx: No inotropics)
o Monitor progression of disease by murmur duration

Front 150

Continuous murmur: define and examples

Back 150

"to/fro, machine-like"
A-V Fistulas: connection between an artery and vein
1) Congenital: PDA
2) Osler-Weber-Rendu
3) Von Hippel-Lindau
4) Iatrogenic: dialysis fistula, stab femoral vessels

Front 151

A-V Fistulas

Back 151

connection between an artery and vein

Front 152

Congenital: PDA: what will keep it open or closed?

Back 152

Alprostadil (PG-E 1 will keep it open
• Indomethacin will close it

Front 153

Osler-Weber-Rendu: describe and tx

Back 153

AVM in lung/gut/brain; sequester platelets/telangiectasias
(fx: embolize)

Front 154

Von Hippel-Lindau:presentation and increased risk

Back 154

AVM in head/retina=> renal cell CA risk
"can only see Hippo's eyes/ head"

Front 155

Iatrogenic cause of AVM

Back 155

dialysis fistula, stab femoral vessels

Front 156

Hear while breathing only =>

Back 156

pleuritis

Front 157

rub that is heard when hold breath =>
presentation and how to is it relieved?

Back 157

pericarditis (knife-like pain relieved by leaning forward)

Front 158

Cardiomyopathies Dilated: what is the dysfunction/problem

Back 158

volume problem, systolic dysfunction

Front 159

Cardiomyopathies Dilated Ex:

Back 159

"ABCD HIV"
Ex: Coxsackie B, Chagas, HIV, Doxorubicin, Alcohol

Front 160

Restrictive Cardiomyopathies: define and examples

Back 160

restricts actin/myosin, ⇩ filling, diastolic dysfunction
Collagen vascular diseases
Amyloidosis
Hemochromatosis

Front 161

how can Collagen vascular diseases cause restrictive cardiomyopathy

Back 161

fibrosis

Front 162

Amyloidosis: lab

Back 162

stains Congo red, Echo Apple-green bifrinngence, twisted β-sheet
two types: primary and secondary

Front 163

1° Amyloidosis

Back 163

(AD): big organs, ⇧protein causes intracranial hemorrhage

Front 164

2° Amyloidosis

Back 164

(chronic disease): Scleroderma, asthma, Wegener's

Front 165

Hemochromatosis:
etiology
stain
tranferrin levels

Back 165

1° (AR: HLA-A3, A6): duodenum absorbing too much Fe
• 2°: multiple blood transfusions (sickle cell anemia, thalassemias)=> Fe deposit in organs
Prussian blue stain,
⇧transferrin (>50%)

Front 166

Hemochromatosis infections

Back 166

⇧ Infection w / Fe-loving bugs: Listeria, Yersinia, Vibrio

Front 167

Hemochromatosis tx

Back 167

Tx: Deferoxamine + weekly Phlebotomy (16 units PRBC)

Front 168

Bronze pigmentation:

Back 168

Fe deposit in skin folds

Front 169

Bronze cirrhosis:

Back 169

Fe deposit in liver

Front 170

Hemosiderosis:

Back 170

Fe overload in bone marrow

Front 171

Bronze diabetes:

Back 171

Fe deposit in pancreas

Front 172

Constrictive cardiomyopathy ie

Back 172

Cardiac Tamponade: trauma, cancer

Front 173

Cardiac Tamponade presentation

Back 173

Beck's Triad: distant heart sounds, JVD, hypotension
• Pressure equalizes in all 4 chambers, muffled heart sounds, no pulse or BP
• Kussmaul's sign, pulsus paradoxus (⇩>10mm Hg BP w/ insp), pericardial knock

Front 174

Cardiac Tamponade EKG:

Back 174

electrical alternans

Front 175

Cardiac Tamponade Echo:

Back 175

small compressed heart

Front 176

Cardiac Tamponade tx:

Back 176

Tx: Dobutamine (⇧contractility), Pericardiocentesis, Pericardial window if recurrent

Front 177

Hypertrophic cardiomyopathy: define, ie and tx

Back 177

asymetric hypertrophy of IV septum, relatives have 25% risk
Ex: IHSS (heart hyperthropies on the inside)
Tx: Hydration/ β-blocker

Front 178

Cyanotic Congenital Cardiac Anomalies: (9)

Back 178

" Hi PEAT5"
Transposition of the Great Arteries
Tetrology of Fallot
Total Anomalous Pulmonary Venous Return
Truncus Arteriosus
Ebstein's Anomaly
Aortic atresia
Pulmonary atresia
Tricuspid atresia
Hypoplastic left heart

Front 179

Li Effects Mom:

Back 179

Nephrogenic DI

Front 180

Li Effects Baby

Back 180

Ebstein's anomaly

Front 181

Transposition of the Great Arteries:
presentation at birth
etiology
x-ray

Back 181

cyanosis at birth
• Aorticopulmonary septum did not spiral
• X-ray: egg-shaped heart

Front 182

Transposition of the Great Arteries: tx

Back 182

Alprostadil (PGE1 to keep PDA open until surgery)

Front 183

Tetrology of Fallot: when do symptoms appear

Back 183

>1 mo, fatal without surgery

Front 184

what is Tetrology of Fallot:

Back 184

Overriding Aorta
Pulmonary Stenosis
RV hypertrophy
VSD (L toR shunt)

Front 185

presentation of Tetrology of Fallot:

Back 185

Squat after running
"Tet spells"
Turn blue when crying

Front 186

Overriding Aorta:

Back 186

aorta sits on IV septum over the VSD and pushes on PA

Front 187

Pulmonary Stenosis

Back 187

>>"Tet spells" - determines prognosis
>>Turn blue when crying (reverse L to R shunt with exhalation)

Front 188

RV hypertrophy on an x-ray

Back 188

=> boot-shaped heart

Front 189

Total Anomalous Pulmonary Venous Return: pathogenesis and x-ray

Back 189

all pulmonary veins to RA, snowman x-ray

Front 190

Truncus Arteriosus

Back 190

spiral membrane not developed=> one A/P trunk, mix blood

Front 191

Ebstein's Anomaly

Back 191

tricuspid sitting lower than normal, Mom's Li increases risk

Front 192

Aortic atresia

Back 192

blood can't get out of the heart

Front 193

Pulmonary atresia

Back 193

no blood to lungs

Front 194

Hypoplastic left heart

Back 194

small LV, low BP, weak pulse,⇧HR, AS, MS

Front 195

Tricuspid atresia: what happends to RA during contraction? how do they survive?

Back 195

RA contracts harder, has FO /VSD

Front 196

how does the heart contract?

Back 196

Mitral closes ~> (IC) ~>systolic ejection of blood~>Aorta opens ~> Aorta closes ~> (IR) ~> Mitral opens

Front 197

Isovolumetric Contraction (IC): describe

Back 197

• needs to overcome aortic diastolic pressure of 80
• 81 -120: blood enters the aorta
• 121: blood flows through the aorta (LV and recoil of aorta)

Front 198

Stroke volume: define each, what factor affects it
SV
EDV
ESV

Back 198

EDV - ESV
Note: EDV and ESV always change in the same direction
SV: how much you pumped out
EDV: total volume (⇧ with volume or deep breath) "preload"
ESV: what's left after contraction (⇩by increased contractility: digoxin, dobutamine)

Front 199

Pulse Pressure

Back 199

= Systolic - Diastolic
( 40 = 120-80)

Front 200

Ejection Fraction: define
normal
Low
High

Back 200

SV /EDV
Normal: 50-80%
Low(< 45%): at least 40% of myocardium is dead
High: Athletes (low pulse => in good shape)

Front 201

MAP: formula systole and diastole

Back 201

= 1/3 systole+ 2/3 diastole

Front 202

complication of Slow HR:

Back 202

spends more time in diastole

Front 203

complication Fast HR

Back 203

spends more time in systole (⇧contraction ~> ⇩flow in
coronary aa. ~> clot&die

Front 204

MAP can be approximated by:

Back 204

systolic+diastolic/2= 120+80/2

Front 205

Wolff-Parksinson-White:
etiology
EKG
who most commonly has it

Back 205

delta wave on EKG
• Most common SVT in teenagers
• Bundle of Kent accessory conduction that bypasses AV node

Front 206

Pulm. Fibrosis:
drugs that can cause it
sx (3)

Back 206

"BBAT"
Sx: insp crackles, ground-glass CT, low saturation w/ walking
• Busulfan
• Bleomycin
• Amiodarone
• Tocainide

Front 207

pulmonary fibrosis tx

Back 207

Tx: Steroids

Front 208

Wolff-Parksinson-White:
tx
CI

Back 208

Tx: Procainide, Phenytoin, quinidine (block Na/Ca)
• No "ABCD": Adenosine, β-block, CCB, Digoxin

Front 209

drugs that can cause Torsade: (4)

Back 209

"ASQP"
Amiodarone
Procainamide
Quinidine
Sotalol

Front 210

3 drugs that can cause Gray Skin:

Back 210

• Chloramphenicol
• Amiodarone
• Deferoxamine

Front 211

Class 1:MOA and usage

Back 211

Na+ channel blockers -block ventricular arrhythmias

Front 212

what are the Class 1?
effects on AP

Back 212

''Queen Proclaims Disco" (prolongs AP)
Quinidine
Procainamide
Disopyramide

Front 213

Quinidine
SE (6) ears, platelets, liver, heart
MOA

Back 213

blocks Ca2+
anti-cholinergic
cinchonism
platelet hapten
⇧p450
Torsade

Front 214

Procainamide
MOA
SE and how does it do this?

Back 214

blocks Ca2+ and K+ (via NAPA)
NH4+ ~> GABA
causes SLE

Front 215

Class 1B drugs:
MOA and AP effects
examples

Back 215

>>shortens AP
"i don't Like Mexican food That caused Pain"
Lidocaine
Tocainide
Mexiletine
Phenytoin

Front 216

Lidocaine
what tissue does it affect
solubility
t1/2

Back 216

only acts on ischemic tissue, fat soluble, quickest t1/2

Front 217

Tocainide

Back 217

lung fibrosis

Front 218

Phenytoin
MOA
effects if infused too quickly
SE (5) gums, hair, disease, liver, baby

Back 218

blocks ca2+
gingival hyperplasia
hirsutism
SLE
fetal hydantoin
⇧p450
hypotension if infused too quickly

Front 219

Mexiletine

Back 219

bad Gl upset

Front 220

Class Ic:
MOA (2)
drugs

Back 220

blocks 90% Na+ channels => die, (no effect on AP)
"Flee (the alligator) Eats Props"
Flecainide
Encainide
Propafenone

Front 221

what are the Class II antiarrythmic drugs
MOA?

Back 221

β-blockers (slows conduction)
β1: 'A BEAM"; begin with A-M (not L,C)
• Atenolol
• Butexolol
• Esmolol
• Acebutalol
• Metoprolol

Front 222

Atenolol:
class
MOA and duration

Back 222

Class II
partially stimulates β-receptor, long acting

Front 223

Butexolol: class and tx

Back 223

Class II
tx glaucoma "Big Tex Tim treats glucoma"

Front 224

Esmolol: class and tx

Back 224

Class II
tx thyroid storm (shortest acting) "short Eskimos"

Front 225

Acebutalol: class, contraindications

Back 225

Class II
partially stimulates β receptor
(Avoid w/ acute MI, angina, arriythmias)

Front 226

β1+2 drugs

Back 226

begin with N -Z (and L,C)
• Timolol
• Propanolol
• Nadolol
• Sotalol
• Pindalol

Front 227

Timolol: class and tx

Back 227

β1+2
tx glaucoma

Front 228

Propanolol: class and tx
duration
contraindications

Back 228

β1+2
tx tremor, tx panic attacks (longest acting => not in kids or old)

Front 229

Nadolol : class and tx

Back 229

β1+2
tx glaucoma

Front 230

Sotalol:
class
unique feature

Back 230

β1+2
also blocks K

Front 231

Pindalol: class and usage

Back 231

β1+2
use for DM

Front 232

α1+β1:

Back 232

α1+β1:
• Labetalol
• Carvedilol

Front 233

Labetalol
class
tx

Back 233

α1+β1
tx A Fib

Front 234

Carvedilol
class
tx (2)
t1/2

Back 234

α1+β1
tx hypertensive crisis,
tx chronic CHF
longer t1/2

Front 235

Class III antiarrythmics: MOA , AP and conduction effects and examples

Back 235

K+ channel blockers (affects all of your cells; prolongs AP, slows conduction)
" B SAND"
Amiodorone
Sotalol
NAPA
Bretylium
Dofetilide

Front 236

Amiodarone
SE (4) skin, eyes, lungs, liver

Back 236

>>gray skin, cornea deposits, pulm fibrosis, ⇧p450
>>''kicks your lungs-in the Ass"

Front 237

Class III antiarrythmics also β blocker

Back 237

Sotalol

Front 238

Opens PDA:

Back 238

Alprostadil (PGE1)

Front 239

Closes PDA:

Back 239

Indomethicin

Front 240

what drugs causes Digoxin Toxicity:
what drugs cause torsade?

Back 240

Digoxin: "ASQV"
• Amiodarone
• Spironolactone
• Quinidine
• Verapamil

Torsade:
"ASQP" amiodranone, sotalol, quinidine and procainamide

Front 241

Class IV antiarrythmics MOA, cardiac and AP effects

Back 241

Ca2+ channel blockers => block atrial arrhythmias (shortens AP)

Front 242

Class IV antiarrythmics: name all

Back 242

Verapamil
Diltiazem
Nimodipine
Nifedipine
Nicardipine
Amlodipine
Femlodipine

Front 243

Verapamil:
class
preference
SE

Back 243

Class IV antiarrythmics
very cardioselective,
digoxin toxicity

Front 244

Diltiazem
class
preference
tx
SE

Back 244

Class IV antiarrythmics
cardioselective,
tx A Fib
leg edema

Front 245

Nimodipine
class
tx

Back 245

Class IV antiarrythmics
tx vasospasm after SAH
"Nemesis the spider hemorrhage"

Front 246

Nifedipine
class
preference

Back 246

Class IV antiarrythmics
vasoselective

Front 247

Amlodipine
class
SE

Back 247

Class IV antiarrythmics
ankle edema

Front 248

Other Anti-Arrhythmics

Back 248

"MEAD"
Adenosine
Digoxin
Epinephrine
Magnesium

Front 249

Adenosine
tx (2)
MOA

Back 249

tx SVT, bronchospasm (slows AV node)

Front 250

Digoxin
MOA
effects on the heart
SE (1) head

Back 250

tx ⇩HR, delirium
(slows AV node- stimulates vagus,
⇧contractility -Na/K pump block)

Front 251

Epinephrine

Back 251

⇧HR, ⇧contractility

Front 252

p450-dependant drugs: what does it mean?

Back 252

level will rise if you inhibit inhibit p450

Front 253

name all the p450 dependent drugs

Back 253

"Women's DEPT"
Warfarin
Digoxin
E2
Phenytoin
Theophylline