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