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196 Cards in this Set
- Front
- Back
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tx: digoxin
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CHF, a-fib (2nd line)
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mech: class 1 anti-arrhythmics
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block Na
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mech: class 1 antiarrhythmics that block Na and K; affect both atrial, ventricular arrhythmias; prolong QT interval; increased APD; high affinity for nonresting channels between 1B and 1C; slow phase 0 and phase 3; prolong refractory period
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class 1A (Quinidine, Amiodarone, Procainamide, Disopyramide; quinidine is the prototype)
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mech: class 1 antiarrhythmics for acute ventricular post-MI arrhythmias; rate of binding and release is rapid so no change in Vmax; lowered APD
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class 1B (Lidocaine, Mexiletine, Tocainide)
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mech: class 1 antirrrhythmics for last resort tachyarrhythmias; less specific for depolarizing cells (high affinity for nonresting sodium channel); very tight binding w/ slow release; Vmax way down, APD down; phase 0 depolarization w/ little effect on reploarization or length of refractory period
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class 1C (Flecainide, Encainide, Propefone)
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mech: class 2 anti-arrhythmics
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beta blockers (propanolol, esmolol, metoprolol, timolol)
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mech: class 3 anti-arrhythmics, prolong QT inverval
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block K - phase 3 (amiodarone, sotalol, ibutilide, dofetilide)
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mech: class 4 anti-arrhythmics, prolong PR interval
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block Ca (verapamil)
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tox: antiarrhythmic causing impotence
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class II - beta blockers
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tx: torsades de pointes, digoxin tox
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Mg
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tx: a-fib w/ rapid ventricular response
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verapamil; beta blockers
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mech: antiarrhythmic targetting AV node
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class 2, 4
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mech: presynpatic a2 agonist used for HTN
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clonidine
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tox: procainamide
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drug lupus, v-arrhythm, psychosis, depression
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tox: hydralazine
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drug lupus
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tox: amiodarone
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thyroid, hepato, skin discoloration, pulmonary fibrosis
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tox: lidocaine
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CNS, seizures
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tox: verapamil
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constipation, gingival hyperplasia, neg inotropy
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tx: adenosine
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stress CV vasodilator, fast antiarrhythmic for SV-tach
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tox: quinidine
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weakness, GI, tinnitus, dizziness
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tox: diuretic w/ ototoxicity
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loop diuretics
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tox: diuretic w/ dizziness and leg cramps
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triamterene
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tox: diuretic w/ somnolence
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acetazolamide
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tx: v-tach during MI
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amiodarone, lidocaine
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mech: digoxin
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lowers HR (blocks Na/K channel -> prolongs SA/muscle phase 4/0); increases contractility (increases uptake and SR release of Ca); slows AV conduction (vagus nerve stimulation)
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tx: IV NE extravasation
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phentolamine
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tox: alpha-1 antagonists
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hypotension
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what does the sympathetic system do to the PR interval?
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decreases it
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which EKG segment lies between S1 and S2?
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QT
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sx: child, fever, bilateral conjunctivitis, strawberry tongue, cervical lymphadenopathy, desquamation
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kawasaki disease (medium vessels, beware coronary artery aneurysms)
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which EKG segment is isoelectric and represents period when the ventricles are depolarized?
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ST
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which EKG segment covers the AV node?
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PR
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normal ejection fraction?
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55%
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which channel mediates sympathetic inotropic changes?
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Ca channels AND SR
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what is the x-intercept of venous return curve?
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mean systemic pressure
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blood flow to the brain is mediated by which metabolite?
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CO2
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which organ system is NOT controlled by local metabolites?
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skin
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mech: which neurotransmitter/receptor mediates slowing of the heart?
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Ach/muscarinic
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the low resistance pathways b/w myocardial cells that allow for the spread of APs are called
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gap junctions
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most common cause of SAH
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berry aneurysm (adult PKD or Ehlers)
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syndrome: hemangiomas seen in these two genetic disorders
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VHL, sturge-weber
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sx: vasculitis associated w/ HBV
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polyarteritis nodosa
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sx: vasculitis w/ asthma or allergies
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churg-strauss
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sx: vasculitis affecting the aortic arch
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takayasu arteritis (pulseless)
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sx: vasculitis spreading to neighboring nerves; leads to gangrene
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buerger disease
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sx: hereditary recurrent epistaxis or GI bleeding with telangiectasias
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osler-weber-rendu
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most common cause of death from kawasakis disease
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coronary artery aneurysm
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sx: vasculitis w/ immune complexes, transmural inflammation w/ fibrinoid necrosis
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polyarteritis nodosa
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sx: aschoff body
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rheumatic fever
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most common cause of mitral stenosis
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rheumatic fever
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syndrome: coarctation of aorta is associated w/ this genetic anomaly
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turner syndrome
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most common site for myxoma
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left atrium
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syndrome: rhabdomyomas commonly seen in which tumor syndrome?
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tuberous sclerosis (rhabdos can cause valvular obstruction)
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post-MI: 24h change in heart tissue?
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coagulative necrosis, neutrophils
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most common cause of death from rheumatic fever
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myocarditis
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sx: endocarditis associated w/ wasting diseases
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nonbacterial endocarditis
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sx: paradoxical embolism
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ASD
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sx: fibrous intimal thickening w/ endocardial plaques
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carcinoid syndrome
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sx: cystic medial necrosis
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marfans
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t/f: mitral annular calficiation is benign?
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true
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primary pacemaker in a-fib?
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random atrial cells
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syndrome: HOCM is associated w/
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friedrichs ataxia, gestational diabetes
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what enzyme degrades bradykinin?
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ACE (angioedema)
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mech: which sympathetic receptor uses IP3?
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alpha-1
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tx: paroxysmal supraventricular tachycardia
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adenosine
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tox: adenosine
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vasodilation, bronchospasm/chest burning, high grade AV block
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mech: which sympathetic receptor decreases cAMP to mediate its effects?
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alpha-2
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mech: which sympathetic receptor is spared by NE/EP?
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beta-2
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bicuspid aortic valve presents with:
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aortic stenosis in 60s (about 20 years earlier)
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sx: wide fixed splitting of S2
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ASD
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most common cause of chronic constrictive pericarditis
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TB
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sx: kussmaul's sign
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JVP rises with inspiration (constrictive pericarditis, RCM, tamponade)
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sx: pulsus paradoxus (cardio only)
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wide inspiratory reduction of BP (cardiac tamponade, pericarditis, cor pulmonale)
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sx: split S1 accentuated on inspiration
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RBBB (tricuspid valve delayed)
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sx: systolic ejection murmur
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aortic stenosis; HOCM (pulmonic stenosis)
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sx: late diastolic murmur ("rumble")
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mitral, tricuspid stenosis
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sx: early diastolic decrescendo murmur improved by amyl nitrite or leaning forward
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aortic regurge
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eq: fick CO
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CO = rate of O2 consumption/(arterial O2 - venous O2)
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mech: short-acting phosphodiesterase inhibitor used to increase cardiac contractility while decreasing pre/afterload
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milrinone (^ cAMP)
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mech: beta receptor antagonists
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lower HR (SA, AV nodes); lower contractility (work); vasodilate (block renin release)
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normal pressures in heart chambers
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RA: 5, RV: 25/5, PA: 25/10, LA: 12, LV: 130/10, aorta: 130/90
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large vessel vasculitis involves inflammation of which level of blood vessel?
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media
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mitral stenosis is worse when the OS is earlier or later?
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earlier (stiffer; higher pressures)
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ANP/BNP are markers for
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cardiac wall stress, hypertrophy
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dopamine receptor stimulation raises ___ and causes ___ of arterial beds
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cAMP, vasodilation (increases renal perfusion)
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sx: pleuritic chest pain, improves when leaning forward
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acute pericarditis (may follow infection or MI)
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mech: which sympathetic receptors vasoconstrict smooth muscle? which ones vasodilate skeletal muscle?
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alpha-1, beta-2
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tox: reflex tachycardia
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alpha blockers, vasodilators
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mech: arterial vasodilators
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hydralazine, minoxidil, diazoxide, Ca-channel blockers
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mech: short-acting balanced vaso/venodilator
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nitroprusside (maintains SV)
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mech: venodilators
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nitroglycerin, dinitrate (long-acting)
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in endocarditis, strep viridans binds to
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fibrin/platelet aggregates (requires surface to attach to)
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tx: promote vasoconstriction "challenge"
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ergonovine
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tx: HTN in diabetics
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ACE-I/ARB
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tx: HTN and BPH
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alpha-1 antagonists
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tx: HTN and coronary artery disease/CHF
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ACE-I, b1-blockers ?
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tx: HTN and osteoorposis
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HCTZ
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def: coronary steal phenomenon
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microvessel dilation during ischemia (adenosine, dipyridamole)
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mech: pure alpha agonist
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phenylephrine
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mech: irreversible alpha antagonist
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phenoxybenzamine
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mech: reversible alpha antagonist
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phentolamine
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sx: stable angina, coronary obstruction occludes ___% of artery to be symptomatic
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75%
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tox: antiarrhythmic w/ bradycardia, 2nd/3rd degree AV block
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verapamil
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mech: serotonin has what effect on vascular system?
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vasoconstricts
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mech: norepinephrine mostly hits this receptor
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alpha-1
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syndrome: long QT syndrome comorbidity
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neurosensory deafness
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most common site of atherosclerotic plaques
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abd aorta, then coronaries, popliteal, internal carotid, willis
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ANP/BNP create ___ to vasodilate
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cGMP (similar to NO?)
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most common paroxysmal tachycardia?
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PSVT (re-entrant impulse through AV node)
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tetralogy of fallot pts "duck walk" to create this hemodynamic change that improves hypoxemia:
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increase systemic vascular resistance, lowering R->L shunt
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tox: milrinone
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vasodilation
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compare acute MR to chronic MR
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acute leads to pulmonary probs (pulm edema); chronic causes cardiac probs (a-fib)
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eq: compliance
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volume/pressure; "stretchiness"
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sx: later presentation of upper/lower differential cyanosis
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PDA
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syndrome: long QT
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romano-ward, jervell/lange-nielsen (I(k) mutation)
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mt: HOCM
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beta myosin heavy chain; AD
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mt: arrhythmic right ventricular cardiomyopathy
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unknown Ca-binding SR protein
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sx: onion like concentric thickening of arteriolar walls w/ flea-bitten kidneys
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malignant HTN
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sx: hyaline arteriolosclerosis
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essential HTN, diabetes etc
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sx: endocarditis on both sides of valve
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libman-sachs endocarditis (hits the mitral, then tricuspid..?)
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tox: altered color perception
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digoxin
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tox: bronchoconstriction
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nonspecific beta antagonists
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skeletal muscles depend on __cellular Ca; smooth muscles depend on __cellular Ca
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intra, extra (explains Ca channel blocker differences)
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tox: serum level changes w/ HCTZ?
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hyper(urate, Ca, glc, LDL); hypo(K)
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sx: pulmonary siderophages
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heart failure/pulmonary edema
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most common cause of fatigue and new murmur in young adult
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bacterial endocarditis
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why might MVP improve in a ventricle w/ increased volume?
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elongated leaflets/chordae (connective tissue disorder)
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sx: accessory pathways w/ EKG delta wave
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Wolff-Parkinson-White
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which pacemaker is the fastest?
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SA node
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after vascular injury, intimal repair is done by this cell
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smooth muscle cell (thickening)
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which organ has the highest O2 demand?
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heart
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sx: ST elevations in leads V1-4
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LAD occlusion
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sx: ST elevations in leads V5-6
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LCX occlusion
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sx: ST elevation MI represents this type of ischemia
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transmural ischemia
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sx: ST depression MI represents this type of ischemia
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subendocardial ischemia
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sx: ST elevation in II, III, aVF, w/ bradycardia
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RCA occlusion
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tox: ebstein's anomaly
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lithium
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sx: ebstein's anomaly
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apical displacement of T valve leaflets, increased RV volume, atrialization of right ventricle (lithium association)
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tox: dilated cardiomyopathy
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anthracyclines (-rubicin - free radicals)
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sx: vasculitis w/ IgA, C3 deposition
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henoch-schonlein purpura
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what are 5-6 causes of dilated cardiomyopathy?
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alcohol, cocaine, iron (hemosiderosis), anthracyclines, infective, beriberi, genetic (dystrophin, mito)
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how soon after occlusion does myocardium stop beating? how long before damage is irreversible?
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<60s; 30min
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what happens to a MR murmur with handgrip?
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murmur becomes louder (increased arterial resistance)
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most common cause of native valve bacterial endocarditis?
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MVP, then rheumatic disease
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syndrome: associated w/ endocardial cushion defects?
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downs
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resting membrane potential of cardiac muscle?
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-90mV in muscle; nodal cells do not "rest"
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most common cause of aortic stenosis?
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degenerative, senile calcinosis of aortic leaflets
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sx: cytoplasmic lipofuscin pigment in heart
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normal in old age
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sx: acute-onset CVP elevation, w/ hypotension and tachycardia
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cardiac tamponade, tension pneumothorax, cardiogenic shock (pericarditis would have no JVP elevation)
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sx: repetitive, widened pulse pressure w/ high SV and heart murmur
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aortic regurge
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2 maneuvers that decrease venous return
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valsalva; standing (also venodilatory pharm)
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decreasing venous return will make MVP
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earlier, louder
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2 maneuvers that increase venous return
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valsalva release; squatting
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what maneuver makes S3 more audible?
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lie left lateral; expire (heart closer to chest)
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tox: digoxin
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hyperkalemia, brain (blurry vision, color disperception, HA, confusion), GI (nausea/vomit, diarrhea, abd pain), AV block (bradycardia, v-tach)
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mech: adenosine
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similarly to Ach, activates K channels, blocks Ca channels - slowing conduction; vasodilates locally
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mech: isoproterenol
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beta-1 > beta-2 AGONIST
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tox: torsades de pointes
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class 1A, 3 antiarrhythmics EXCEPT amiodarone
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post-MI, when does collagen start forming?
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2+ weeks
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post-MI, when do you start seeing coagulation necrosis?
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4+ hrs to days
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post-MI, when do you start seeing neutrophils?
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24+ hrs
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post-MI, when do you start seeing macrophages?
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5+ days
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most common congenital heart disease
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VSD
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post-MI, what do you see in under 4 hrs?
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normal tissue
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tox: vasodilators
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reflex tachycardia, edema
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sx: late-onset post-MI pericarditis
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dressler's syndrome (autoimmune)
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where is cardiac AP conduction velocity fastest? slowest?
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purkinje system, AV node
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sx: split S2 that becomes narrower on inspiration
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aortic stenosis
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why is the c wave so big?
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RV contraction
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sx: weak pulses w/ loud heart sounds; ejection click with murmur
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aortic stenosis
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decreasing venous return will make HOCM
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louder ..?
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decreasing venous return will make AS
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softer
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which ion conductance determines the resting membrane potential?
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K
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which channel mediates sympathetic increases in HR?
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If (Na) - faster depolarizations
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which channel mediates sympathetic increase in conduction velocity (through the AV node)?
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Ca channels - faster depolarization, shorter PR
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what is the order of channel opening in cardiac muscle cells?
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0: Na open; 1: Na close; 2: Ca/K open; 3: Ca close but VG-K open; 4: VG-K close? but resting K open
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what is the order of channel opening in cardiac pacemaker cells?
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0: Ca open; 3: VG-K open; 4: Na open
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which pacemaker AP phase mediates automaticity?
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Na, phase 4 (Ach and EP target here)
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sx: U waves
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hypokalemia, bradycardia
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EKG: rate mnemonic
|
300-150-100-75-60-50
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sx: torsades de points (v-tach w/ shifting sinusoidal waveforms)
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ANYTHING that prolongs QT interval
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sx: tetralogy of fallot
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pulmonary stenosis, RVH, overriding aorta, VSD
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syndrome: congenital heart diseases in digeorge?
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truncus arteriosus, TOF
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syndrome: congenital heart diseases from diabetic mother?
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transposition of great vessels
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sx: restrictive cardiomyopathy w/ eosinophilic infiltrate
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loffler's syndrome
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sx: hemosiderin-laden macrophages in lungs
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pulmonary edema (or paroxysmal noctural dyspnea)
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sx: EKG shows electrical alternans
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cardiac tamponade
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most common cause of infective myocarditis
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coxsackievirus
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tx: wegeners
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cyclophosphamide, corticosteroids (C as in C-ANCA)
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mech: neurotransmitter has vasodilatory effects at low doses, constriction effects at high doses?
|
dopamine
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mech: milrinone
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PPDE inhibitor; prolongs cAMP; increases Ca uptake
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000 still not sure what causes angioedema vs cough vs regular edema/swelling
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tx: malignant HTN
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nitroprusside, fenoldopam (renal), diazoxide
|
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tx: goal of stable angina therapy?
|
decrease myocardial O2 consumption w/ nitrates, b-blockers, and Ca channel blockers
|
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mech: verapamil
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slows HR, slows conduction, vasodilates coronary arteries
|
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which is more chronic: stunned or hibernating myocardium?
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hibernating
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