Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Cardiology Pathology
for BOD
| Question | Answer |
|---|---|
| Left Anterior Descending Artery Supplies... | Anterior Wall & Some Septal Wall (Has "Diagonal Branches") |
| Left Circumflex Artery Supplies... | Lateral Wall (Has "Marginal Branches") |
| Right Coronary Artery Supplies... | Inferior Wall (Usually PDA off of it, which Supplies Infra-Septal and Inferior Wall) |
| Heart Blocks (1st, 2nd, 3rd Degree) | 1st Degree: Consistent PR delay (>200 ms), No Skipped Beats. 2nd Degree: Increasingly lengthen PR w/ occasional PVC. 3rd Degree: Junctional (narrow) escape rhythm with complete AV. block |
| Alpha Receptors | Epi > NE (no isopreternol). Vasoconstriction, Mydriasis, Splenic Contraction. Gq --> PL-C --> DAG + IP3. DAG--> PKC + MAPK (Vasoconstrict, ^BP). IP3 --> Ca from SR (^ Cardiocontractility). |
| Beta Receptors | Iso > Epi > NE. Cardiostimulation, Bronchodilation, Vasodilation, Metabolic Acidosis. Gs --> Adenylyl Cyclase --> cAMP --> PKA --> Ca from SR --> Contractility |
| Epinepherine | Alpha Receptors: Vasoconstriction Beta Receptors: Vasodilation |
| Norepinepherine | Alpha Receptors (Mostly): Vasoconstriction Beta-1 Receptors (Cardiac): Cardiostimulation |
| Ispopreternol | Beta Receptors: Vasodilation and cardiostimulation |
| Ergotoxin | Blocks NE's Vasoconstriction (alpha) Blocks Epi's Vasoconstriction (alpha) Does NOT block Epi's Vasodlation (Beta) Alpha Blocker (The First!) |
| Dichloroisopreternol | Beta Blocker (The first!) |
| Dopamine | Inotropine (Similar to NE) Increase force of contraction Vasodilates renal arteries (but alpha effects & vasoconstriction at high doses) Indicated for shock with oliguria (increase CO via Beta Receptors & Increase renal blood flow via DA-ergic effects) |
| Dobutamine | (+) isomer: Beta-1 Agonist + Alpha-1 Antagonist (-) isomer: Alpha-1 agonist For: Short term for CHF, MI (increase CO, SV w/o HR increase) |
| Blood Vessels | Alpha-1 & Alpha-2 (Constrict to ^^BP). Beta-2 (Dilate in Skeletal muscle arterioles) |
| Bronchi | Alpha-1 (Constrict). Beta-2 (Relaxes) |
| Heart | Beta-1 & Beta-2 (increase HR, increase contractility). Target for beta-blockers! |
| Nerve Endings | Alpha-2 (neg feedback to lower NE Release). Beta-1 & Beta-2 (on nerve endings. Increase NE Release) |
| Mast Cells | Beta-2 (less histamine release) |
| Second Messengers for Alpha-1, Alpha-2, Beta-1, Beta-2 Receptors | A1 (IP3 + DAG). A2 (less cAMP). B1+B2 (more cAMP). |
| Ritodrine | B2 agonist. Delays uterine contraction att erm. |
| Salbutamol | B2 agonist. For asthma |
| Methoxamine & ****PHENYLEPHRINE***** | A1 agonist (vasoconstriction) |
| Alpha-Methylnorepinepherine & Clonidine | Alpha-2 agonist (neg feedback to stop vasoconstriction) |
| Butoxamine | B2 antagonist |
| Labetolol & Metoprolol | B1 antagonist |
| ***Propanolol*** | B1 & B2 antagonist |
| Yohimbine | A2 antagonist |
| Prazosin | A1 antagonist (for HTN) |
| ***Phentolamine*** | Short-acting A1/A2 antagonist (for shock) |
| ***Phenoxybenzamine*** | Long-Acting A1 & A2 antagonist (for shock) |
| Cocaine | Sympathomimetic. Blocks NET (more NE in synapse). Increase O2 demand (A + B adrenergic effect) w/ less O2 delivery. Result: ischemia, infarction, arrhythmia. Chronic: dilated or hypertrophic cardiomyopathy, atherosclerosis, myocarditis, necrosis. |
| Platelet Aggregation | Expose subendothelial Matrix. Thromboxane A2 + ADP recruit + activate platelets to form plug). |
| Anti-Platelet Drug Targets | Platelet Surface ADP Receptor P2Y12 (CLOPIDOGREL & PRASUGREL) & GPIIB/IIIa Receptors (ABCIXIMAB). Platelete dense granules: ThrombaxaneA2 (ASPIRIN via Cyclooxygenase inhibition. Irreversible) & ADP (CLOPIDOGREL + PRASUGREL). |
| Endothelial Cell Drug Targets (ANti-Clotting) | |
| ***Aspirin*** (Acetyl Salicyclic Acid) | Acetylates serine in COX-1. Irreversible inhibition. (Cannot become TxA2 which normally causes vasoconstriction and platelet agg). Toxicities: GI discomfort, bleeding, antiinflamm, Hypercapnia, Glucose intolerance, poison (reps alk, met acidosis, RD) |
| ***Clopidogrel*** (Plavix) | P2Y12 Antagonist. Prodrug (CYP2C19 activates). (Omeprazole is a CYP2C19 inhibitor). Used to prevent occlusion after stunting coronary vessels. |
| ***Prasugrel*** (Effient) | P2Y12 antagonist. Prodrug. MOre potent than plavix, more bleeding. Does not use CYP2C19, but DOES use Cyp3A5 + 2B6. |
| Ticagrelol (Brilanta) | Direct (no CYP450) reversible inhibitor of P2Y12 |
| Abciximab, Tirofiban, Eptifibatide, Lamifiban | GPIIb/IIIa antagonist (block receptor). Inhibit platelet aggregation BUT risk intrinsic platelet activation & thrmbocytopenia (low platelet count). Used, bu limited. |
| Anticoagulants (note, different from antiplatet, these are anti-clotting) | Normally: tissue injury --> TF expressed, Phospholipid complex forms, Activates thrombin, Fibrin polymerization and clot formation |
| Pro-coagulation from Thrombin (IIa) | ADP, TXA2, Va, VIIa, XIa, TAFI (thrombin-activated thrombolysis inhibitor) |
| Anti-coagulation from Thrombin (IIa) | Prostocyclin, NO, tPA, Protein C+S (activate by IIa will inactivate Va, VIIIa) |
| Heparin (Anticoagulant) | Inactivates ACTIVE clotting factors oof INTRINSIC pathway. WOrks by accelerating ATIII 1000x |
| HIT | Heparin-Induced Thrombocytopenia: combo of bleeding AND thrombosis (30% mortality): activated platelets, removed by spleen macrophages (thrombocytopenia). Plaetelets also procoaglunant (thrombosis). Treat with thrombin inhibitors. |
| LMWH (***enoxaprin*** dalteparin, ___parin) | Low molecular weight heparin: more predictable effects, can give subQ, more bioavailable, longer half life, less HIT, less osteoporosis. does NOT inhibit IIa. |
| Thrombin Inhibitors (***Hirudin (leech derivative), Lepirudin, Argatroban, Bivalirdivin, **Rivaroxaban***(oral), ***Apixaban*** (oral) | Use for HIT (inactivates soluble and clot-bound IIa. WOrks if ATIII is deficient). |
| Warfarin | Oral anticoag. Inhibits FORMATION of active (acts @ IX, X, II). Prevents gamma carboxylation by inhib. vit K epoxide reductase. Takes ~1 week to kick in (circ clotting factors long 1/2 life). Monitor INR (2-3). CYP2C9. More vit K may lower INR. Teratogen. |
| Fibrinolysis (tPA, streptokinase, Reteplase, Tenecteplase) | tPA from endothelial cells, activates plasmin to degrade clot (more D-dimer in blood). Give for acute MI, thrombotic stroke, arterial thromboses, PE, DVTs, occlude catheters and shunts. Bleeding risk! Streptokinase: risk allergic rxn. Not fibrin-specific |
| Rose Criteria (is pain cardiac?) | 1. Substernal Chest Pain 2. Temporal Relation to Stimulus (Exercise/Stress) 3. Relieved with discontinuation of stimulus 4. Relieved with Nitrates |
| Virchow's Triad | 1. Hypercoaguability 2. Hemodynamic Changes (stasis/turbulence) 3. Endothelial cell injury/Dysfunction.......THROMBUS!!! |
| Risk Factors (For Pretty much Everything) | Male, Old, Smoker, HTN, Dislipidemia, Atherosclerosis, Family History |
| AAA (Abdominal Aortic Aneurism) | Saccular (one side) + Fusiform (all the way around. True (ALL layers) vs. False (Confined by adventitia but can still easily rupture) |
| Vasculitis | High ESR, High CRP, GIant cell arteritis, Sup temporal artery, common in elderly, often unilateral. Can go blind. Multinucleited giant cells. |
| Large Vessel Vasculitis | Giant cell arteritis if >50 YO, Takayasu if < 50 YO |
| Medium Vessel Vasculitis | Polyarteritis Nodosa (w/o MCLN) Lawasaki (w/ MCLN) (MCLN = mucocutaneous lymph node syndrome) |
| Small Vessel Vasculitis | Many! Immune complexes in vessels or paucity of vasc IgG |
| ST Depression | More global ischemia, cormobidities, coronary disease, hypertension, hyperlipidemia. A chronic thing. |
| Angina: General Treatment Strategies | 1. Nitrates 2. Calcium Channel BLockers 3. Beta Blockers |
| Nitrates (Glyceryl Trinitrate/Nitroglycerine) | Venous capicitanse (more preload, less O2 demand). Release NO in vasc smooth muscle cells. Kidney excretion. Relzx blood vessel. Dosage! (vein-->arteries). Met by mito lad dehy. NO --> cGMP --> relax smooth muscle |
| Calcium Channel Blockers ***Verapamil***, ***NIfedipine***, Dilitiazem | Inhibit calcium entry. Verapiml + Dilitiazem suppress conduction (@ nodes) so less HR, more vasodilation, less contractility. Nifedipine, Nicardapine, Minodipine do NOT have effect on Conduction (vasodilator, less contractility). |
| Beta Blockers | Less contractility, less renin/angiotensein so lowers BP, anti-arrhythmic, less exercise tachycardia |
| 1st Generation (Blanket) Beta Blockers | ***Propanolol*** (etc) |
| 2nd Generation (B1) Beta Blockers (Cardioselective) | Atenolol, ***Metoprolol*** etc |
| 3rd Generation (Vasodilating) Beta Blockers | Pindolol, ***Carvedilol*** etc |
| Mixed alpha/beta blocers | Labetalol |
| 9 min half life beta blocker | Esmolol (to lower BP in ER) |
| Giant Cell Temporal Vasculitis | Large Vessel. Granulomatous vasculitis of aorta and extra cranial branches of carotid. Patients >50. May lead to blindness. Associated w/ polymyalgia rheumatica |
| Takyatsu Arteritis | Involves aortic arch and branches by granuloomatous arterities. Thickened intima. Female. Patients < 50 |
| Polyarteritis Nodosa | Lesions of dif ages. 30% associated w/ HepB. Necrotizing inflammation w/o glomerulnephritis. Nodules on arterial wall, skin, viscera. Immune complex disease. Fibrinoid necrosis |
| Kawasaki Disease | Kids <4 yo, most common acquired heart disease in children. smooth muscle in arterial wall. Arteritis associated w/ MLNS |
| Wegener Granulomatosis | Granulomatous inflam. Resp tract, kidney , sinus, nasal mucosas. Necrotizing glomeruonephritis common. C-ANCA (anti-neutrophil cytoplasmic antibiodies) Low Ig. |
| Churg-Strauss Syndrome | Eosinophilia, Asthma, Granulomas. Glomerunophritis. p-ENCA |
| Microscopic Polyangitis/arteritis | Lesions of the same age. Nec glomeruonephritis common. Pulm capillaries involved. C-ANCA. Leads to hemorrhage. |
| Granulmoatous Vasculitis (Temporal Arteritis) | Intima Prolif, breaks in elastic stain. Biopsy need not be (+), elevated SED rate and CRP |
| Buerger Disease | Thromboangitis obliterans (in extremeties. Ven thromboses. With Tobacco!) |
| Rheumatic Fever | Pharyngitis, Skin absess (impetigo), group A strep pharyngitis precedes it. Antigen-mimic (M protein). Give prophylatic penicillin |
| Jones Criteria | 2 Major or 1 Major + 2 Minor. Required: Evidence of Strep. Major: Carditis, Polyarteritis, Chorea, Erythema Marginatum, SubQ nodules. Minor: Fever, Arthralgia, Previous Rheum fever/heart disease, ESR up, CRP up, leukocytosis, PR interval up (heart blo |
| Fibrinous Pericarditis | From: End Stage Renal Disease, MI, Dressler's Syndrome (after MI), Radiation Pericarditis, Virus, Trauma, Drugs. UREMIA. "Bread & Butter." See fat, organization, fibrin (pink/amorphous) |
| Fibrous Pericarditis | Stiff, can't contract. TB, fungal, pericarditis, tumor, radiation, no-resolving fibrillin. Fibroblastic prolif. Create brididges pericardium to epicardium. KUSMALL sign: JVD |
| 4 Factors Influencing Cardiac Performance | 1. Preload (venous return) 2. Afterload (TPR) 3. Cotnractility 4. HR |
| Digitalis, Digoxin (longer), OUabain (shorter) | More contractility vía more intracellular sodium (inhibit the na/k atpase. Stops calcium extrusion. so more pumping. |
| DAD | Delayed after depolarization...more contractility, V. tach (toxicity of digitalis). |
| Beta Blockers in CHF | Metoprolol - B1 selective Carvedilol - Non selective |
| Systolic HF | "Fat and Short" P(V) curve |
| Diastolic HF | "Tall and Skinny" P(V) Curve |
| FACES | Heart failure symptoms: Fatigue, Angina, Congestion (Chest), Edema, SOB |
| NYHA Classification | I: Mid II Mild (slight limitation III Moderate (marekd limitation) IV: severe |
| ACC/AHA Classification: | A: High risk B: Asymptomatic LV dysfunction C: Past/current HF Sx D: End Stage HF |
| EAD (early after depolarizations) | Phase 2: prolonged or Phase 3 prolonged. Can mediate torsade de Pointes (polymorphic VT) |
| DAD (delayed after depolarization) | Impaired calcium handling (Na/Ca exchanger up, then depolarizing current). Occurs w/ digitalis and idiopathic c VTs. Sensitive to adenosine, Calcium channel blockers, beta blockade. |
| Class 1 Anti-Arrhythmics | Block Entry of Na (Phase 0). 1b (RAPID i.e. LIDOCAINE). 1a (med ie QUINIDINE). 1c (longer ie econide and flecanide). |
| Class 2 Anti-Arrhythmics | Beta Blockers -Main effect on L-type calcium channels and If phase 4 in nodal cells. PROPANOLOL: anti-arrhythmic, inhibits exercise tachycardia, alleviates angina, lowers renin. Use for increased sympathetic activity. |
| Class 3 Anti-Arrhythmics | K Blockers (slow depolarization) Amioderone, Sotalol, Bretylium. Prolong repolarization (may see EADs). Also photosensitivity with AMiderone. |
| Class 4 Anti-Arrhythmics | Ca Channel Blockers. 4a: L-type Ca block. Shorten repolarization (verapamil, dilitiazem). Depress phase 0 in SA cells, shorten plateau. 4B: K channel openers (ADENOSINE). SLOWING of AV conduction. DO NOT USE IN ASTHMA. for paroxysmal supra vent. tach. |
| Automaticity Arrhythmia? | Use Beta Blocker, Calcium Channel Blocker |
| Triggered Arrhythmia (EADs/DAD's)? | Use Beta blockers, Calcium Channel Blockers |
| Conduction (reentry) Arrythmias? | Sodium and Calcium blockers. |
| Imaging | X-ray, Cath, Nuclear, Echo, CTA, MR |
Created by:
JuliaR10
Popular Medical sets