Cardiovascular

Description:	Cardiovascular
Category:	USMLE
Created by:	Kyle Tiemeier on 2008-12-20

Question	Answer
Wolf-Parkinson-White Syndrome	Accessory conduction pathway to ventricles. Produces delta wave on QRS, may shorten P-R interval -> tachycardia
Torsades des pointes	Leads to Vfib. Causes: Congenital long QT (K chanel mutations): Jervell&Lange-Nielson Synd. (Deaf,AR), Romano-Ward Synd. (AD) HypoKalemia/Magnesmia, Bradycardia, K-blocking drugs (Quinidine, procainamide) Erythromicin, Haloperidol, Methadone
Atrial Flutter	High & organized SA rhythm, too fast for ventricular refractory time. Saw-toothed P wave & fixed ratio of SA: AV conduction (ie 3:1)
Atrial Fibrilation	disorganized quivering atria (600 bpm). Few will trigger AV node-> irregularly irregular rhytm.
1st Degree AV Block	Prolonged PR (>.2 sec). Due to high vagal tone, AV ischemia, Dig, beta blockers, CCBs, MIs
2nd Degree AV Block/Mobitz I/Wenckenbach	Progressive AV delay/PR lengthening until a beat is dropped.
2nd Degree AV Block/Mobitz II	Beat dropped without change in PR interval. Due to post-AV node conduction problems.
3rd Degree AV Block	No Atrial-Ventricular conduction. P & QRS complexes are independent. Ventricular rhythm ~40-60
Aortic arch & Carotid Sinus Baroreceptors	AORTIC ARCH: Vagus->Medulla->lower sympathetic tone. CAROTID SINUS (high or low bp): GLOSSOPHARYNGEAL->medulla->increase/decrease sympathetic tone.
Carotid, Aortic & Central Chemoreceptors	Carotid & Aortic: Low PO2 (<60), pH, High PCO2. Central: Low pH & high PCO2 only-> Cushing Rx (Increased ICP->cerebral ischemia -> hypertension & reflex bradycardia)
Vascular Pressures	RA:<5, RV <25/5, Pulmonary: <25/10, PCWP/LA:<12, LV:<130/10
Congenital R->L Shunts	#1 Tetralogy of Fallot. #2 Transposition of the great arteries. #3 Truncus Arteriosus. #4 Tricuspid Atresia. #5 Total Anomalous Pulmonary Venous Return.
22q11	DiGeorge Syndrome: Truncus arteriosus, T of F + Parathyroid, Thymus aplasia
Congenital Rubella	ASD, VSD, PDA, Pulm artery stenosis
Turners	Coarctation
Marfan	Aortic insufficiency
Diabetic mother	TGA
Atheroma	Plaques in blood vessels
Corneal Arcus	Lipid deposits on cornea (hyperlipidemia)
Monckenberg Arteriosclerosis	Medial calcification of arteries, esp. radial & ulnar. Benign
ARTERIOLOsclerosis	Hyaline thickening of small arteries. Essential HTN. Malignant HTN: Onion-skin
ATHEROsclerosis	Fibrous plaques & atheromas in elastic artery intima.
Location of Atherosclerosis	AA > Coronaries > Popliteals > Carotids
MI Day 1	4 Hrs+: Coagulative Necrosis, contraction bands. Dark mottling. Tetrazolium Stain pale.
MI Day 2-4	Coagulative necrosis. Inflammation: neutrophils & dilated vessels(hyperemic). ARRHYTHMIA RISK
MI Day 5-10	Macrophage-mediated tissue removal. Yellow-brown. Soft. RUPTURE RISK
MI Week 7	Fibrovascular tissue. VENTRICULAR ANEURYSM RISK
MI Protein Markers	Troponin (4 hrs-1 week)> CK-MB (Cardiac & Skeletal muscle, rises later) > AST (Cardiac, skeletal muscle & liver)
MI Complications	Arrythmia (early), LV Failure->PE, Cardiogenic shock, Wall/papillary rupture, Aneurysm (low CO, arrythmia, embolus), Fibrinous pericarditis, Dressler's Syndrome (AI)
Dilated Cardiomyopathy Etiology	Alcohol, Beriberi, Coxackie B, Cocaine, Chaggas, Doxorubicin. Genetic: Mitochondrial OxPhos protein, Cardiac Dystrophin.
Hypertrophic Cardiomyopathy	1/2 are AD, Familial(beta-myosin, myosin binding protein, troponin T), Friedrich's Ataxia. Tx w/ Beta blocker or non-dihydropyridine CCB (Verapamil).
Restrictive/obliterative Cardiomyopathy	Sarcoid, Amyloid, Hemachromatosis, fibroelastosis (Radiation, pediatric endocardial fibroelastosis)
Bacterial Endocarditis Sx	FROM JANE Fever, Roth Spots, Osler Nodes, Murmur, Janeway lesion, Anemia, Nail bed hemmorhage, Emboli
Bacterial Endocarditis Complications	Chordae rupture, glomerulonephritis, suppurative pericarditis, emboli.
Libman Sacks Endocarditis	Vegetations on both sides of valve. Mitral regurg> Mitral Stenosis. SLE->LSE
Rheumatic Heart Disease Findings	Anitschkow's Cells (activated histiocytes), Aschoff Bodies (giant cell granuloma), Migratory Polyarthritis, Erythema marginatum, Elevated ASO. Acute: Myocarditis. Chronic: Mitral > Aortic >>Tricuspid.
Cardiac Tamponade	Elevated JVD, pulsus paradoxus & electrical alternans, hypotension.
Serous Pericarditis	SLE, RA, Viral, Uremia
Fibrinous Pericarditis	Uremia, MI, Rheumatic Fever
Hemorrhagic Pericarditis	TB, Malignancy (melanoma)
Syphilitic Heart Disease	Aortic calcifications, aneurysm & valve incompetence
Wegner's Granulomatosis	NEcrotizing granulomas in Lung & URT, Necrotizing glomerulonephritis. Dx: c-ANCA, CXR. Tx:Cyclophosphamide & Corticosteroids
Microscopic Polyangitis	Wegners like, minus granulomas. P-ANCA
Primary Pauci-Immune Crescentinc Glomerulonephritis	Renal vasculitis, lack of antibodies
Churg-Strauss Syndrome	Granulomatous vasculitis w/ eosinophilia. Lungs, heart, skin, kidneys, nerves. P-ANCA
Sturge-Webber Disease	Port-Wine Stain on face, Intracerebral Arterio-venous malformation
Henoch-Schonlein Purpura	Skin Rash(palpable purpura), Joints arthralgia, GI abdominal Pain. Post- URI. IgA & C3 Deposition
Buerger's Disease	Smokers. Nodular phlebitis, raynauds, gangrene. Medium vessels.
Kawasaki Disease	CRASH & Burn: Conjunctivitis, Rash (truncal), Adenopathy (cervical), Strawberry tongue, Hand & Feet swelling/desquamation & Fever
Polyarteritis Nodosa	Cutaneous eruptions @ different stages, neuro dysfunction, fever, HTN (renal artery involvement), GI. Hep B Seropositive-associated. Tx: corticosteroids, cyclophosphamide.
Takayasu Arteritis	"Pulseless disease" Thickening aortic arch. Elevated ESR. Asian females 40+. Fever, arthritis, night sweats, Myalgial, skin, occular, weak pulse
Temporal Arteritis	Focal granulomatous inflammation. Elderly females. Unilateral HA, jaw pain, impaired vision. Elevated ESR. Tx: High dose Steroids.
ANCA + Vasculitides	C: Wegener's. P: Microscopic Polyangitis, Primary Pauci-Immune Crescentic Glomerulonephritis, Churg-Strauss Syndrome,
Acute AFib	Binge Alcohol, Sympathetic stimulation, Pericarditis
Phenoxybenzamine	Irreversible Alpha blocker (pheochromocytoma tx)
Class 1A Antiarrhythmic	Use Effect: Increases AP, ERP, QT interval. USE: Atrial & Ventricular arrhythmias, esp reentrant & ectopic SVT & ventricular tachycardia.
Class 1B Antiarrhythmic	Use Affect ischemic/depolarized Purkinje & ventricular tissue. Use: Acute ventricular arrhythmia (esp post-MI), Dig-induced arrhythmias.
Class IC Antiarrhythmic	Use Ventricular tachs ->VFib, intractable SVT. A last resort reatment.
Class 2 Antiarrhythmic	Use Beta Blockers lower cAMP -> lower Ca current. Suppress abnormal pacemakers by slowing phase 4. Increase PR interval. USE: VTach, SVT, slow ventricular rate in AFib/Flutter.
Class 3 Antiarrhythmic	Use Increase AP, ERP, QT. Last resort tx.
Class 4 Antiarrhythmic	Use Slow AV node conductance, increase ERP, PR. Use: Prevent nodal arrhythmias (SVT).
Class 1A Antiarrhythmic	Drugs Quinidine, Amiodarone, Procainamide, Disopyramide (Queen Amy Proclaims Disco's Pyramid) SE: HyperK. Quinidine SE: HA, tinnitus, thrombocytopenia, torsades de pointes (long QT). Procainamide (SLE-like syndrome)
Class 1B Antiarrhythmic	Drugs Lidocaine, Mexiletine, Tocinide. SE: Local anesthesia, CNS stimulation/depression, CV depression. HyperK.
Class 1C Antiarrhythmic	Drugs Flecainide, Encainide, Propafenone. SE: Proarrhythmic (CI'd post-MI), prolongs AV ERP. HyperKHyperK
Class 2 Antiarrhythmic	Drugs Propanolol, Esmolol, Metoprolol, Atenolol, Timolol. SE: Asthma, bradycardia, AV block, CHF, mask hypoglycemia sx.
Class 3 Antiarrhythmic	Drugs Sotalol (TdP, excessive Beta block) Ibutilide (TdP), Bretylium (arrhythmia & HypoTN), Amiodarone (Pulm Fibrosis, Hepatotoxicity, Hypo/HyperThyroid, loads of others)
Class 4 Antiarrhythmic	Drugs Verapamil, Diltiazem. SE: Constipation, flushing, edema, CHF, AV block, TdP.
Adenosine	K Efflux-> hyperpolarization. Use:
Potassium	Depress ectopic pacemakers in hypokalemia (ie-dig toxicity)
Magnesium	Treates Dig-toxicity & TdP
Antihypertensives during Pregnancy	Methyldopa (Anti-Rh hemolytic anemia) & Hydralazine (drug-induced lupus)