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227 Cards in this Set

  • Front
  • Back
blood supply to the SA and AV nodes
RCA
chamber of the heart that can compress the esophagus and recurrent laryngeal nerve
L atrium
blood supply to apex of the heart and the IV septum
LAD
artery that determines coronary dominance
posterior IV artery
MAP = ?
MAP = CO x TPR

MAP = 2/3(diastole) + 1/3(systolic)
do venodilators (eg.nitroglycerin) affect preload or afterload
decrease preload
do vasodilators (eg. hydralazine) affect preload or afterload
decrease afterload
normal ejection fraction
55%
which vessels account for the majority of peripheral resistance
arterioles
what does inotropy refer to
the contractility of the heart
what is S1
closure of the AV valves
what is S2
closure of the aortic and pulmonary valves
what is S3
rapid filling of the ventricles during early diastole
when is S3 normal
in children and pregnancy
what is S4
contraction of the atria in late diastole associated with ventricular hypertrophy
what does physiologic splitting of S2 refer to
the aortic valve closely slightly before the pulmonary valve because of pressure differences (have patient hold breath while auscultating over the pulmonic auscultation area to hear)
does splitting increase with inspiration or expiration
splitting increases with inspiration
what is paradoxical splitting
pulmonary valve closes before aortic valve
what conditions will have paradoxical splitting
aortic stenosis and LBBB
what condition hs fixed splitting
ASD
what conditions have wide splitting
pulmonic stenosis and RBBB
which murmurs are heard during systole
aortic stenosis
pulmonic stenosis
mitral regurgitation
tricuspid regurgitation
which murmurs are heard during diastole
aortic regurgitation
pulmonic regurgitation
mitral stenosis
tricuspid stenosis
holosystolic, high-pitched "blowing" murmur
mitral/tricuspid regurgitation
crescendo-decrescendo systolic ejection murmur
aortic stenosis
which heart murmur is associated with a pulsus parvus et tardus
aortic stenosis
late systolic crescendo murmur with a midsystolic click
mitral valve prolapse
heart murmur with a very large pulse pressure
aortic regurgitation
continuous machinery-like murmur
PDA
MOST common cause of PDA
congenital rubella
what causes the plateau in a cardiac action potential
due to calcium influx
which channels are absent in pacemaker action potentials
fast sodium channels
which channels control the upstroke in a cardiac action potential and in a pacemaker action potential
cardiac action potential: upstroke mediated by sodium channels

pacemaker action potential: upstroke mediated by calcium channels
which part of the heart has the fastest speed of conduction of the APs
Purkinje cells
inverted T wave suggests what
recent MI
difference prognostically between ST elevation and ST depression
ST elevation: MI
ST depression: angina
U wave suggests what
hypokalemia
peaked T waves suggest what
hyperkalemia
predisposing condition for torsades de pointes
Long QT
what heart condition has a delta wave on ECG
WPW
in WPW, what's the name of the accessory conduction pathway that bypasses the AV node going directly from atria to ventricle
Bundle of Kent
PR interval progressively increases until a beat is dropped
2nd degree heart block- Mobitz type I (Wenckebach)
atria and ventricles beat independently of each other
3rd degree heart block
hormone release from the atria in response to increased blood volume and atrial pressure
ANP
which nerve sends parasympathetic fibers to the aortic arch
vagus nerve
which nerve sends parasympathetic fibers to the carotid sinus
glossopharyngeal nerve
Cushing's triad
HTN, bradycardia, respiratory depression
which receptors are especially important in maintaining high pressure during hemorrhage
baroreceptors
best way to measure L atrial pressure
pulmonary wedge pressure
only area of body that vasoconstricts in response to hypoxia
pulmonary vasculature
important metabolites that regulate blood flow in the heart
adenosine and NO
An S3 in older women suggests what pathologic condition
CHF
VSD, ASD, and PDA are examples of which type of shunt
L -> R shunt
MOST common congenital heart anomaly
VSD
an uncorrected L->R shunt leads to pulmonary HTN and eventually reverses the shunt from L->R to R->L
Eisenmenger's syndrome
treatment for Eisenmenger's
heart/lung transplant
4 conditions seen in Tetralogy of Fallot
Pulmonary stenosis
RVH
Overriding aorta
VSD

("PROV")
how does tetralogy of fallot appear on imaging
the heart will appear boot-shaped
failure of the AP septum to align causes what congenital heart disease
tetralogy of fallot
only way life is compatible in someone with transposition of the great arteries
if they also have a shunt
what congenital heart defect is caused by a failure of the AP septum to spiral/twist
transposition of the great arteries
a mother with untreated diabetes puts a fetus at risk for what congenital heart defect
transposition of the great arteries
Turner syndrome is associated with what congenital heart defect
PREductal coarctation of the aorta
notching of the ribs is associated with what heart defect
POSTductal coarctation of the aorta
heart defect characterized by HTN in the upper extremities and hypotension in the lower extremities
coarctation of the aorta
what congenital heart defect is caused by ectopic tissues
coarctation of the aorta
what normally maintains the patency of the ductus arteriosus
prostaglandin E
DOC to close a patent DA
indomethacin
DiGeorge syndrome is associated with what congenital heart defects
Tetralogy of Fallot > Truncus Arteriosus
endocardial cushion defects cause heart defects in what condition
Down syndrome
pulmonary stenosis and PDA are heart defects seen in what maternal condition
rubella
3 PE signs of hyperlipidemia
xanthelasmas in the eyelids
arcus senilis in the corneas
tendon xathomas in the achilles tendon
which type of arteriosclerosis is characterized by calcifications in the media layer of the arteries rather than the intima
Monckeberg arteriosclerosis
first step in atheroslcerotic plaque formation
foam cells form a fatty streak
MOST common location of atherosclerosis
abdominal aorta
patient presents with 10/10 tearing chest pain radiating to the back; xray shows mediastinal widening
abdominal aortic dissection
cause of Prinzmetal's angina
coronary artery spasm
which form of angina will have ST elevation
Prinzmetal's angina
difference between angina and MI on an ECG
MI: ST elevation
angina: ST depression
major difference between stable and unstable angina
stable angina: occurs only during exertion and is relieved with rest
unstable angina: occurs at rest
MOST common vessel occluded in an MI
LAD > RCA > circumflex
morphology after the heart within 24 hours of an MI
coagulative necrosis and contraction bands
morphology of the heart 2-4 days after an MI
hyperemia, neutrophilia reaches max
morphology of heart 5-10 days after an MI
central yellow-brown softening (macrophages)
how long after an MI is the heart MOST at risk for free wall rupture, tamponade, papillary muscle rupture, or an IV septal rupture
5-10 days after MI
how long after an MI is the heart MOST at risk for a ventricular aneurysm
7 weeks after MI
morphology of heart 7 weeks after an MI
artery has recanalized and necrotic area has become gray-white in color; scar formation is complete
MOST specific cardiac marker for an MI
troponin I
when does troponin I peak after an MI
12 hours
when does CK-MB peak after an MI
1 day
what type of MI will have ST depression
subendocardial infarcts
which ECG leads correspond to the LAD
V1-V4
which ECG leads correspond to the LCX
V4-V6
patient presents with sudden onset of high fever and trouble breathing; PMH is remarkable for an MI 5 weeks ago; PE reveals pleuritis and pericardial effusion; troponin I and CK-MB are within range
Dressler's syndrome
causes (8) of dilated cardiomyopathy
alcohol, beriberi, coxsackievirus B, cocaine, chagas disease, doxorubicin, hemochromatosis, and postpartum
mode of inheritance for familial hypertrophic cardiomyopathy
autosomal dominant
MOST common cause of sudden death in young, seemingly healthy athletes
hypertrophic cardiomyopathy
which valve usually becomes obstructed in hypertrophic cardiomyopathy
mitral valve
signs of CHF
dyspnea on exertion, cardiac dilation, pulmonary edema, paroxysmal nocturnal dyspnea, orthopnea, hepatosplenomegaly, edema in the LE, JVD
Morphologic cells that suggests CHF
"heart failure cells" (hemosiderin-laden macrophages)
PE findings in someone with bacterial endocarditis
Roth spots (white spots on retina)
Oslers nodes (lesions on fingers and toes)
Janeway lesions (erythematous lesions on palms and soles)
Splinter hemorrhages (on nail beds)
Murmur (usually involving mitral valve)
Fever
MOST common valve involved in bacterial endocarditis linked to IV drug abuse
tricuspid valve
pathogenesis in acute vs. subacute bacterial endocarditis
acute (S. aureus): large vegetations form on previously normal valves

subacute (S. viridans): small vegetations form on congenitally abnormal or diseased valves
which type of endocarditis is linked to complications of dental surgery
subacute endocarditis
MOST common cause of acute bacterial endocarditis
S. aureus
MOST common cause of subacute bacterial endocarditis
S. viridans
MOST common cause of subacute bacterial endocarditis involving a prosthetic valve
S. epidermidis
DOC for bacterial endocarditis
penicillin G
patient presents with a high fever; PE is remarkable for splinter hemorrhages in the nail bed, erythematous lesions on the palms and soles, and round white spots in the retina; patient also has a butterfly-like rash on both cheeks; auscultation of the heart reveals a systolic, blowing murmur; PMH is remarkable for SLE; what is her presenting condition
Libman-Sacks endocarditis
MOST common valve affected in rheumatic fever
mitral valve (MVP and then mitral stenosis)
MOST common causative organism of rheumatic fever
S. pyogenes
morphologic features of rheumatic fever
Aschoff bodies (giant cell granulomas) and Anitschkow's cells (histiocytes)
what type hypersensitivity is rheumatic fever
type II (antibodies against M protein)
female teenager presents with jerky dance-like movements, pain in her joints, and a fever; several weeks she had a "sore throat" which she waited to go away on its own without medical intervention; PE is remarkable for erythema marginatum, migratory polyarthritis, and a diastolic murmur
rheumatic fever
heart condition in which all 4 chambers have the same diastolic pressures
cardiac tamponade
patient presents with acute chest pain that doesn't radiate; nitric oxide doesn't relieve the pain; PE is remarkable for JVD, diminished heart sounds over all 4 auscultation areas, and pulsus paradoxus; BP is 70/35 and HR is 130
cardiac tamponade
what conditions (5) is pulsus paradoxus seen in
cardiac tamponade
asthma
obstructive sleep apnea
pericarditis
croup (parainfluenza virus)
what is pulsus paradoxus
exaggerated decrease in amplitude of the pulse during inspiration (>10mmHg difference)
what layer of the aorta is damaged in tertiary syphilis
vasa vasorum
pulsus tardus et parvus is seen in what valvular insufficiency
aortic stenosis
what is pulsus tardus et parvus
the pulse is delayed from the heart beat and slower than expected
what is pulsus bisferiens
the pulse has a "double-peak" during palpation
what 2 conditions may have pulsus bisferiens
aortic stenosis and cardiomyopathy
what is pulsus alternans
the pulsus switches between strong and weak
what condition is pulsus alternans seen in
L-sided heart failure
what is pulsus bigeminus
2 heartbeats followed by a long pause
what condition is pulsus bigeminus seen in
cardiomyopathy
MOST common heart tumor in adults
L atrial myxoma
MOST common heart tumor in children
rhabdomyoma
what is Kussmaul's sign
increase in JVD during inspiration
do emboli commonly form from varicose veins
No, varicose veins are superficial veins
cause of Raynaud's disease
arteriolar vasospasm triggered by cold temperatures or stress
symptoms of Wegener's granulomatosis
necrotizing vasculitis, granulomas in the lung and upper airways causing hemoptysis, and glomerulonephritis causing hematuria
patient presents with hemoptysis and shortness of breath; PE is remarkable for perforation of the nasal septum and mastoiditis; UA reveals hematuria; serology reveals antibodies confirming the presumed diagnosis
Wegener's granulomatosis
what antibodies are found in Wegener's granulomatosis
c-ANCA
treatment of Wegener's granulomatosis
cyclophosphamide and corticosteroids
2 conditions that have p-ANCA antibodies
microscopic polyangiitis and Churg-Strauss syndrome
patient presents with recurrent asthma attacks and numbness in his hands and feet; PE reveals eosinophilia and skin lesions; PMH is remarkable for recurrent sinusitis; test for parasites come back negative; serology for an antibody confirms the presumed disease
Churg-Strauss syndrome
characterized by vascular disorders, port-wine stains, AV malformations, seizures, glaucoma, and mental retardation
Sturge-Weber disease
MOST common cause of vasculitis in children
Henoch-Schonlein purpura
Henoch-Schonlein purpura commonly follows what illness
upper respiratory infection
classic triad of Henoch-Schonlein purpura
rash on legs and butt
joint pain
intestinal hemorrhage
kidney condition linked to Henoch-Schonlein purpura
IgA nephropathy
vasculitis strongly linked to smoking
Buerger's disease
vasculitis high at risk for gangrene and autoamputation of the digits
Buerger's disease
MOST common vasculitis in children
Kawasaki disease
vasculitis linked to coronary aneurysms
Kawasaki disease
treatment for Kawasaki disease
IV immunoglobulins and aspirin
vasculitis characterized by fever, conjunctivitis, strawberry tongue, lymphadenitis, and a desquamative skin rash
Kawasaki disease
vasculitis associated with HBV
polyarteritis nodosa
treatment of polyarteritis nodosa
cyclophosphamide and corticosteroids
which arteries are commonly spared in polyarteritis nodosa
pulmonary arteries are spared
vasculitis characterized by granulomatous thickening of the aortic arch
Takayasu arteritis
vasculitis seen in Asian children
Kawasaki disease
vasculitis seen in Asian adults
Takayasu arteritis
patient presents with fever, joint pain, muscle aches, and night sweats; PE is remarkable for skin lesions, changes in visual acuity, and weak/absent pulses in the upper extremities
Takayasu arteritis (aka pulseless disease)
vasculitis MOST commonly affecting the large arteries rather than small ones
Temporal arteritis
MOST common artery affected in temporal arteritis
carotid artery
patient presents with a 12 hour history of unilateral severe headache; during the PE the patient claims to lose vision in the eye of the affected side and starts complaining of pain in her jaw on the affected side
temporal arteritis
treatment of temporal arteritis
high dose steroids
vascular tumors linked to pregnancy
pyogenic granuloma
vascular tumor in the neck linked to Turner syndrome or fetal hydrops
cystic hygroma
painful vascular tumor found under the fingernails; they arise from smooth muscle cells
glomus tumor
vascular tumors found in AIDS patients that are commonly mistaken for Kaposi sarcoma; caused by the bacteria bartonella henselae
bacillary angiomatosis
lethal vascular tumor in the liver; linked to vinyl chloride, arsenic, and thorotrast exposure
angiosarcoma
vascular tumor found in women post-radical mastectomy
lymphangiosarcoma
difference in age distribution between strawberry and cherry hemangiomas
strawberry hemangioma: infants (regress)
cherry hemangioma: elderly (do NOT regress)
antihypertensive class of drugs that is protective against diabetic nephropathy
ACE inhibitors
MOST common class of drug given to delay cardiac remodeling after MI
ACE inhibitors
major SE of hydralazine
lupus-like syndrome
MOA of hydralazine
increases cGMP causing smooth muscle relaxation -> vasodilation
why is hydralazine usually combined with a B-blocker
to prevent reflex tachycardia caused by hydralazine
1st line therapy for HTN during pregnancy
hydralazine
calcium channel blocker contraindicated in CHF
verapamil
MOA of nitroglycerin
causes the release of nitric oxide which increases cGMP leading to smooth muscle relaxation

*more so venodilation (decreasing preload)
drug that causes "Monday disease"
nitroglycerin
MOST common DOC for malignant HTN
nitroprusside
SE of nitroprusside
cyanide toxicity
MOA of nitroprusside
increases cGMP causing direct release of nitric oxide
MOA of fenoldopam
D1 agonist
MOA of diazoxide
opens K+ channels causing hyperpolarization and relaxation of the vascular smooth muscle
class of the drug with the strongest effect on lowering LDL
statins
SE of statins
hepatotoxicity and rhabdomyolysis
SE of niacin (3)
flushing, hyperglycemia, hyperuricemia
treatment for the flushing induced by niacin
pretreat for flushing with aspirin
DOC to lower both triglycerides and raise HDL
fibrates (gemfibrozil, clofibrate, etc...)
MOA of fibrates
upregulate capillary LPL which increases clearance of triglycerides
MOA of niacin
inhibits lipolysis and reduces hepatic VLDL secretion
drug that decreases LDL but has no effect on HDL or triglycerides
ezetimibe
SE of bile acid resins (cholestyramine)
decreased absorption of fat-soluble vitamins, GI discomfort, and cholesterol gallstones
MOA of digoxin
inhibits the Na+/K+ ATPase which increases intracellular sodium-- this leads to reduction in calcium excretion (via inhibiting the NCX sodium-calcium exchange)-- thus more calcium remains in the sarcoplasm which increases contractility
antidote for digoxin overdose
normalize K+
lidocaine
magnesium
anti-digoxin Fab antibodies (aka digibind)
cardiac pacer
this class of anti-arrhythmics increases the AP duration and increases QT interval, and are especially useful against reentrant and ectopic tachycardias
class IA
which drugs are class IA anti-arrhythmics
quinidine, procainimide, and disopyramide
anti-arrhythmic with a SE of lupus-like syndrome
procainimide
SE specific to quinidine but not other class IA anti-arrhythmics
cinchonism (headache, tinnitus, vertigo)
SE common to all class IA anti-arrhythmics
thrombocytopenia and torsades de pointes (secondary to increased QT interval)
this class of anti-arrhythmics decreases AP duration and has no effect on QT interval, and are especially useful in post-MI and digoxin-induced arrhythmias
class IB anti-arrhythmics
which drugs are class IB anti-arrhythmics
lidocaine, mexiletine, tocainide
this class of anti-arrhythmics has no effect on AP duration or QT interval, but does prolong refractory period in AV node; useful in V-tach and refractory tachyarrhythmias
class IC anti-arrhythmics
which drugs are class IC anti-arrhythmics
flecainide, encainide,and propafenone
which class of drugs are class II anti-arrhythmics
B-blockers
shortest acting class II anti-arrhythmic
esmolol
B-blocker linked to dyslipidemia
metoprolol
SE of B-blockers
impotence, exacerbation of asthma, sleep disturbances (nightmares), AV block, bradycardia, CHF, masks symptoms of hypoglycemia
heart medication contraindicated in diabetics
B-blockers (masks signs of hypoglycemia)
which drugs are class III anti-arrhythmics
K+ channel blockers (sotalol, amiodarone, ibutilide, bretylium, dofetilide)
SE of amiodarone
pulmonary fibrosis
hepatotoxicity
thyroid dysfunction
corneal and skin deposits
photodermatitis
constipation
cardiovascular depression
which anti-arrhythmic has properties from all 4 classes of anti-arrhythmics
amiodarone
which drugs are class IV anti-arrhythmics
calcium channel blockers

(verapamil and diltiazem only-- nifedipine has affects on vascular smooth muscle, not the heart)
DOC for supraventricular tachycardia
adenosine
DOC for torsades de pointes
magnesium sulfate
kidney condition strongly linked to bacterial endocarditis
glomerulonephritis
chest xray shows situs inversus of the heart; what's the underlying condition
Kartagener's
3 drugs that improve SURVIVAL odds in someone with CHF
ACE inhibitors
spironolactone
metoprolol
3 congenital heart defects that require a PDA to stay alive
preductal coarctation
transposition
tricuspid atresia
congenital heart defect associated with an ASD and a PDA
tricuspid atresia
ALL trisomies have which congenital heart defect
VSD
what is a paradoxical embolus
In someone with an ASD, a DVT may break off and when entering the heart may go against the gradient into the L side of the heart, travel to the brain, and cause a stroke
Do you have to close a large or small VSD immediately
large
specific gene mutation causing HOCM
beta myosin heavy chain gene
heart condition strongly associated with multiple silent MI's
HOCM
MOST common cause of death in HOCM
reentry arrhythmias
amyloid deposits are found in which type of cardiomyopathy
restrictive cardiomyopathy
which type of coarctation is renin increased and the patient appears half blue (in the lower half of the body)
preductal
which type of coarctation is NOT linked to cyanosis and requires collateral circulation
postductal coaractation
DOC to maintain a patent DA
alprostadil