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24 Cards in this Set

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  • Back
Captopril, enalapril, fosinopril
Indications: HTN, diabetic neuropathy, MI, and Heart failure.
Large Fistula involving a major artery (such as the aorta, subclavian a. femoral a, common carotid a., or iliac a.) --> ?
Results in Increased Cardiac Output. The inc in cardiac output caused by the fistula is roughly equal to the blood flow thru the fistula.
A stimulant that causes HTN and tachycardia by blocking NE uptake --> accumulation of NE in the synapse causing greater stimulation of the postsynaptic R's.

Alpha 1 adrenergic Rs mediate Systemic vasoconstriction
Beta 1 adrenergic R's --> increase in HR and inotropy
Pulsatile abdominal mass in a 45yo with a hx of diabetes and HTN. Etiology?
Classic presentation of an Abdominal Aortic Aneurysm = almost always due to severe atheresclerosis.
Foci of calcification can occur within the atherosclerotic plaques indicating severe ather. dz.
Berry aneurysms
1) congenital weakness of vessels can produce berry aneurysms esp in cerebral vessels in the circle of Willis.

2) also assoc. with adult polycystic disease
Diff in systolic P btw the upper and lower parts of the body
1. Aortic coarctation

Neither aortic regurgitation, cardiac tamponade, heart failure nor hypovolemia cause a diff in systolic pressure btw the upper and lower parts of the body.
Amyloid proteins
1. AA - Acute Phase reactant
- Produced by the liver during inflammatory reactions with chronic infections and Rheumatoid Arthritis

2. AF - Familial and old foggies
- its a prealbumin protein. Assoc with familiar amyloidsosis syndromes. Distributed within peripheral nerves and kidney.

3. AL - Light Chain
- a protein composed of Ig light chains. assoc with Myeloma and B cell malignant lymphomas. Neoplastic cells produce this protein which depostis in the heart, GI tract, kidney, spleen and tongue.

4. AE - Endocrine
- a peptide hormone precursor associated with Medullary carinoma of the thyroid and pancreatic islet cell adenomals. Its found locally in the neoplasm, not systemic distribution.
What artery is freq damaged in knee dislocations?
Popliteal artery.

Popliteal a. emerges from the superficial Femoral a (SFA) exits the adductor hiatus and divides into the:
1) anterior tibial
2) Posterior tibial
3) peroneal arteries of the leg

Popliteal a. freq injured in knee dislocations.
Complication of Heart transplants
Graft vascular disease aka Graft arteriosclerosis. This complication develops years after transplantation and is due to intimal thickening of the coronay arteris.
- Usually asymptomatic b/c the transplanted heart is denervated --> so no chest pain
Beta Receptors
Beta 1 R's predominate in the heart.

- Beta blockers (Atenolol, metoprolol, esmolol)

Beta 2 R's predominate in the lung.
Catecholamines as Drugs and their R's
1. Epinephrine is an agonist at A1, A2, B1, and B2 R's.
- Phentolamine (a diff drug) is an antagonist at alpha 1 and A2 R's. Thus, after the admin of Phentolamine, Epi can stimulate only Beta R's which would produce a decrease in BP. This is called Epinephrine Reversal.

2. NE - agonist for A1, A2 and B1 R's.
- Propanolol is a non-selective Beta antagonist. After admin of propanolol, NE can stimulate only alpha R's --> which cause vasoconstriction --> inc BP

3. Phenylepinephrine = A1 agonist.
1. A1 R's in the vasculature - stimulation causes Vasoconstriction --> Inc BP

2. B2 R's - predominant in the heart.
Sympathetics stimulate inc the HR and contractility
Beta blockers --> dec HR

3. B1 - predominant in the lung
Varicose veins
Varicose veins: Dilated, tortuous, superficial veins with incompetent valves.
- develop with agen in men
- puberty, pregnancy, menopause related in women.
- Are aggravagte by increased venous pressure in the legs.
(Eg. standing at a cash register) - the venous pump doesnt work and the P in the leg veins increases.
- venous pressure also increases chronically during pregnancy b/c hte fetus compressese the large veins in the abdomen.
Aortic Dissection
A tearing, excruciating chest pain radiating to the back = aortic dissection
- pt presents with extreme signs of distress (diaphoresis)
- Aoritc insufficiency with its assoc. Diastolic murmur freq. develops.
- mediastinal widening is often seen on CXR.
HTN = most common predisposing factor.

Marfan's also assc with Aortic disection
Heart findings in a severely anemic pt (Hb <7.5g/dL).
In severe anemia,
- resting CO is increased w/ an increase in both HR and SV.
- the inc in SV causes a widening of the Pulse pressure (b/c greater amts of blood are ejected during each systole, the blood pressure rises and falls to a greater extent)
Umbilical arteries arise from which fetal vessels?
Iliac arteries.

The paired umbilical arteries arise from the iliac arteries. They supply unoxygenated fetal blood to the placenta.

The signle umbilical vein takes the newly oxygenated fetal blood from the placenta to the liver and then to the IVc via the ductus venosus.
Beta blockers indicated for Angina
Atenelol, Metoprolol, Nadolol and Propranolol

- Beta adrenergic blcoking agents prevent angina by decreasing myocardial oxygen requirements during exertion and stress thru the reduction of HR, myocardial contractility and BP.
Beta blockers with intrinsic sympathomimetic activity
Acebutolol and Pindolol

Not recommended for angina
Antihypertensive drugs
1. Metoprolol - great drug. However, also know to cause Dyslipidemia

2. Guanfacine - a centrally acting alpha2 R agonist
3. Prazosin - peripherally acting Alpha 1 R blocking agent
Both guanfacine and prazosin, due to their side-effect profiles, are used in pts unresponsive to other anti-htn therapies.
Taussig-Bing malformation
Aorta arises from the a morphologic Right ventricle. The pulmonary artery overrides a ventricular septal defect.

- considered a variant of Transposition of the great arteries.
Polyarteritis nodosa
Vessel wall showing FIbrinoid necrosis with a mixed inflammatory infiltrate containing neutrophils, eosninophils and mononuclear cells.
PNodosa is a vasculitis affecting small or medium sized arteries with a predilection for
1) GI tract and kidney (causing hematuria, albuminuria, or renal failure)
Temporal arteritis
aka Giant cell arteritis b/c of the Large focal granulomatous inflammation (w/ giant cells).
- Cranial arteris most commonly involved.
- Process can be patchy --> thus requires biopsying 2-cm length sof EACH temporal artery.
- Untreated --> involves opthalmic a. --> irrev. blindness.
Embyrologic derivations of the heart
1. Primitive atrium - gives rise to trabeculated parts of the R and L atrium
2. Primitive ventricle - traabeculated regions of R & L ventricles

3. Sinus venosus - give rise to smooth portions of the R & L atrium. Also result in Coronary sinus and oblique vein.

4. Bulbus cordis - smooth parts of R & L ventricles.

5. Trucus arteriosus - proximal portion of the aorta & pulm artery.
Carcinoid heart disease
is Caused by serotonin-producing carcinoids in the liver or lungs.
Fibrosis of the endocardium ensues.
- affecting Rt. heart in the case of Hepatic carcinoids
- Left heart for pulmonary carcinoids.

Thickening & rigidity of valvular leaflets are characteristic gross findings.