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Cardio_Kaplan
Question | Answer |
---|---|
Global measure of systolic function | Stroke Volume |
Mitral valve stenosis associated with? | Rheumatic fever |
Late diastolic rumbling murmur | Rheumatic fever - mitral valve stenosis |
What is the cause of the scarring of the valves in Rheumatic fever? | M protein - Ag's similar to heart and joints so when make Ab's agnst Grp A strep, make Ab's against heart (own tissue) - Antigenic Mimicry |
MC symptom in Rheumatic Fever? | Polyarthritis |
MV valvular lesion in Rheumatic Fever? | Mitral Regurgitation (MS takes 10 yrs to develop) |
High pitched blowing diastolic murmur in right 2nd ICS? | Aortic regurgitation |
Long QT interval seen in what? | Torsades de pointes |
How are afferent firing and HR related? | inversely - if decrease afferent firing, increase HR and vice versa |
Positive rate of change of pressure? | isometric contraction |
When is a sarcomere the longest and when is it the shortest in the cardiac cycle? | longest at end of diastole. shortest at end of systole. |
Vessels that have highest drop in pressure? What is this due to? | arterioles - have highest resistance |
How is velocity and cross-sectional area related? | inversely |
What happens when CN 9 and 10 are stimulated? | decreases sympathetic tone and increases parasympathetic tone leading to bradycardia w/ hypotension |
What causes the wide pulse pressure in arteriosclerosis? | decreased compliance - increase SBP and decrease DBP |
What has the highest ratio of wall cross-sectional area to lumen cross-sectional area? | arterioles |
What increases within an hour after exercise? | VEGF - for endothelial cells to survive |
What happens when you remove a circuit from parallel resistance? | increase total resistance of circuit |
Net filtration pressure eqn? | (Pc-Pi) - (Pi c - Pi i) = (cap hydrostatic - interstitial hydrostatic) - (capillary osmotic - interstitial osmotic) |
What changes occur when a kidney is removed? | increase TPR, no change in arterial pressure, decrease total RBF |
Where is the mean linear velocity of RBC the lowest? | capillaries - low velocity allows time for oxygen to diffuse to tissues |
What happens when the sympathetic nervous system is activated? | constrict veins and venules will increase MCFP (mean circulatory filling pressure) which will increase venous return and cardiac output |
What's given for A fib. after initial stabilization (e.g. w/ Diltiazem) and initial anticoag w/ Heparin? | Warfarin |
SE of metoprolol? | dyslipidemias (b1 receptor causes increase lipolysis) |
What is a SE of WPW and A fib patients if give Digoxin? | Ventricular fibrillation |
MOA of cocaine? | block reuptake of NE |
SE and class of atenolol? | bradycardia and 3rd degree AV block - selective B1 blocker |
SE of Doxorubicin? | Dilated cardiomyopathy |
SE of Bleomycin? | Pulmonary toxicity |
If a patient given drug X which causes increase BP and reflex bradycardia, then given drug Y which increases HR but not BP, then given drug X again and BP is increased without an increase in HR, what is drug X and Y? | X = alpha-1 agonist = NE (vasoconstricts causing increase BP with reflex bradycardia) Y = M2 blocker on heart = Atropine (increase HR but not BP) X again = will increase BP but no reflex bradycardia b/c of Atropine |
What drugs can cause long QT syndrome? | class 1a and class 3 antiarrhythmics - also quinidine, procainamide, sotalol, amiodarone, disopyramide, dofetilide, phenothiazines, TCA |
MOA of Amlodipine? | Class 4 CCB that inhibits calcium influx across vascular smooth muscle more than cardiac muscle |
What happens when a patient is given Epinephrine then Phentolamine? | Epinephrine reversal - Epi (a1, a2, b1, b2) inc VC (a1) which inc BP. When given Phentolamine (a1, a2 blocker), b1 and b2 receptors enhanced causing VD (b2) which will dec BP |
DOC for pregnant women with chronic HTN (DBP >100 mmmHg)? | Methyldopa |
MOA of Digoxin and what used for? | decreases conduction through AV node and depresses SA node - treats A fib esp when vent rate increased and indicated for CHF and A flutter |
Tx for atrial arrhythmias without evidence of heart failure? | BB (Esmolol and Metoprolol) and CCB (Verapamil and Diltiazem) |
Tx for diabetic nephropathy and hyperuricemia? | ACEI - controls HTN and slows renal disease |
Drug that will maintain PDA? | PGE1 analog Alprostadil |
MOA of Minoxidil? | decrease SBP and DBP and opens K ATP channels on vascular smooth ms and pancreatic B cells |
Lab findings for Niacin (B3) and SE? | decrease VLDL, LDL, TG and increase HDL. MC SE = facial flushing (tx w/ ASA) |
MOA of Losartan? | inhibits Angiotensin II at ATI receptor (AT II = Na+ retaining hormone in PCT and DCT) --> increase renal Na+ excretion |
MOA of Amiodarone? | class III w/ Ia properties - blocks K+ channels, prolongs repol, widens QRS, prolongs QT interval --> torsades |
Amiodarone is used to treat? | refractory V. tach and SVT |
How does increasing the sympathetic system at the arterioles increase BP? | NE released enhancing a1 R stimulation - Gq -> PIP2 hydrolysis via PLC -> IP3 & DAG -> IP3 diffuses thru cytoplasm releasing Ca2+ which binds calmodulin -> complex + MLCK -> P myosin light chains -> M + A interact -> sm ms contraction -> inc BP |
What does increasing cAMP do? | muscle relaxation via B2 R (Epi) -> via protein kinase A inactivates MLCK -> prevents M + A interaction -> sm ms relaxation |
What does increasing cGMP do? | relaxes and VD by dephosphorylating (deactivating) myosin light chains |
Systolic anterior motion (SAM) of mitral valve indicates what pathology? | Hypertrophic Cardiomyopathy |
Tx of HCM | Metoprolol, Atenolol, Propranolol |
What are the SE of carbonic anhydrase inhibitors (Acetazolamide)? | hypokalemia, metabolic acidosis, alkaline urine |
Which diuretics increase urine K+? | all except K+-sparing diuretics |
How do CA inhibitors cause metabolic acidosis? | decrease HCO3- reabsorption |
What symptoms occur when a patient has low serum K+ concentration? | arrhythmias and paralysis |
What happens when a patient has high serum K+ concentration (> 6.0 mEq/L)? | peaked T waves, wide QRS, arrhythmias |
MOA of PDE5 inhibitors? | prevent cGMP breakdown by inhibiting cGMP phosphodiesterase |
What do PDE5 inhibitors (sildenafil) treat? | erectile dysfunction (inc blood flow in corpus cavernosum), pulmonary arterial HTN (inc pulmonary artery relaxation) |
Drug associated with inducing gout? | HCTZ (HyperGLUC: hyperGlycemia, hyperLipidemia, hyperUricemia, hyperCalcemia) |
What patients should not be given HCTZ? | Patients with sulfa allergy and with diabetes mellitus |
Symptoms of CHF? | fatigue, exertional and nocturnal dyspnea, S3 gallop |
Tx of CHF to prevent ventricular remodeling? | ACEI - dec AT II levels which dec NE levels -> circle of sympathetic and RAAS activation blocked |
What does an excess in nitric oxide cause and how is it treated? | Methemoglobinemia. Treat w/ high flow O2 and methylene blue. |
What symptoms will nonselective beta blockers (i.e. propranolol) mask? | tachycardia and hypoglycemia - b2 inc glucagon release & glycogenolysis to inc glucose -> block results in hypoglycemia -> beta blockers bind adrenoreceptors blocking NE & Epi -> inhibit sympathetic response (tachycardia) |
What are the functions of a1 and b1 receptors? | a1 - inc arterial pressure (BP), b1 - inc inotropic state (contractility) and SV |
SE of Digoxin? | arrhythmia, paroxysmal atrial tachycardia w/ 2:1 block, blurry yellow vision, vent tachyarrhythmia, torsades (inc K+) |
Which beta blockers are B1 selective and which are nonselective? Exceptions? | A thru M = B1 selective. N thru Z = beta nonselective. Except C (Carvedilol) and L (Labetolol). |
Beta-1 selective blockers are indicated for which group of patients? | asthmatics |
What electrolyte imbalance increases the risk of Digoxin toxicity? Which drugs should be avoided in these patients? | hypokalemia. diuretics. |
Patients w/ PCKD should be given what drug? | ACEI - dec ang II (overproduced in these pxs due to inc renin prod) - result is dec BP & increase renal blood flow via efferent arteriole thus is renoprotective for HTN pxs. |
What patients should avoid Verapamil (1st gen CCB)? | CHF pxs b/c of negative inotropic effects |
Which drugs are CI in angina due to its high myocardial O2 consumption? | Partial beta-agonists - Pindolol and Acebutolol |
Which drugs decrease myocardial oxygen requirements during exertion and stress? How? | Beta blockers - reduce HR, myocardial contractility, and BP |
What drug is used to treat ventricular arrhythmias and can cause SLE-like syndrome? | Procainamide (class 1a) - stabilizes cardiac membranes and depresses AP phase 0 |
How does nitroglycerin work? | dilates arteries and veins which decrease resistance reducing arterial BP thus decreasing LVEDV and LVESV. |
MOA of Digoxin? | inhibits Na+/K+ ATPase -> indirect inhibition Na+/Ca2+ exchanger/antiport -> inc Ca2+ -> positive inotropy. Also stimulates vagus nerve. |
MOA of thiazide and thiazide-like diuretics? | inhibits NaCl reabsorption in early distal tubule, reducing diluting capacity of nephron -> dec Ca2+ excretion |
What drug affects the afferent arteriole and should not be given in pxs w/ renal failure? | NSAIDs - dec PG production - PG dilates afferent arteriole (inc RBF, inc GFR, FF constant) |
Hi serum CKMB indicates what kind of infarct? | MI (subendocardial infarct) rather than angina b/c in angina there is not sufficient myocardial damage for release of CKMB |
What effect does an increase in adenosine have on the heart? | increases coronary blood flow |
How does aortic stenosis affect coronary blood flow? | high peak systolic pressure compresses coronary vessels more than normal causing systolic BF to dec and coronary diastolic BF to inc |
What happens to arteries and arterioles when BP is increased? | hypertrophy of vessels causing inc thickness of vessel wall w/o much change in vessel radius inc wall-to-lumen ratio of vessel - loss of arterioles occurs from inc BP |
Px with fever, positional chest pain noted on leaning forward, and friction rub w/ diffuse ST elevations | Dressler syndrome (autoimmune) - fibrinous pericarditis |
ST elevations with (+) cardiac enzymes | Transmural MI |
Px w/ trauma from a knife wound is most likely to experience what heart condition? | Right heart failure from AV fistula -> inc venous return to heart -> inc resting CO -> inc venous hydrostatic pressure -> inc JVP -> S3 heart sound -> RVH -> dec compliance RV -> right heart failure |
What supplies the anterior part of the LV and anterior 2/3 of interventricular septum? | Left anterior descending artery |
What supplies the posteroinferior part of LV and posterior 1/3 of interventricular septum, RV, posteromedial papillary ms in LV and AV and SA nodes? | Right coronary artery |
What supplies the lateral wall of the left ventricle? | left circumflex coronary artery |
What would give a normal EKG reading but produces pain during physical labor? | Stable angina |
What would give a normal EKG reading but occurs at rest? | Prinzmetal's variant angina |
MC manifestation of coronary artery disease? | Angina pectoris |
Subendocardial ischemia with ST-segment depression? How relieved? | Stable angina. Resting or nitroglycerin. |
Vasospasm with transmural ischemia and ST-segment elevation? What drugs does it respond to? | Prinzmetal's angina. Nitroglycerin and CCB (vasodilator). |
Patient with BP of 160/50 indicates what? | wide pulse pressure - aortic insufficiency (AR) - retrograde flow from aorta to LV - vol overload of LV inc SV (Frank Starling) |
MCC of acute aortic regurgitation? | infective endocarditis |
What happens in CHF? | activate RAAS -> Na+ and H2O retention -> inc hydrostatic pressure -> edema -> S3 -> CHF -> inc venous return -> inc RA pressure |
Consequence of mural thrombus to systemic circulation? | stroke from thromboembolism |
Blowing diastolic murmur, large SV, wide pulse pressure? | aortic regurgitation |
Severely anemic patient will develop what kind of symptoms? | tachycardia, inc SV (inc SBP), wide PP, cold hands, inc arteriolar diameter (dec DBP) |
Patient has a wide pulse pressure and a HR of 30-45 bpm. This suggests what pathology? | Complete heart block |
Bedridden patient w/ sudden chest pain and dyspnea? | pulmonary embolus arising from femoral vein thrombosis |
Patient has decreased ankle pulse and increased peripheral vascular resistance. This suggests what pathology? | arteriosclerotic occlusive disease |
Patient w/ bicuspid aortic valves has midsystolic murmur radiating to neck. This indicates what pathology? | aortic stenosis |
Px w/ perihilar infiltrates has ankle edema, dyspnea, low BP and inc BUN. Pathology? | CHF |
Pathogenesis of atherosclerotic disease? | injury to endothelial lining of vessels |
Patient presents w/ worsening chest pain that occurs at rest or w/ minimal exertion. ST depression on EKG. Pathology and pathogenesis? | Unstable angina - thrombosis of coronary artery w/ disrupted atherosclerotic plaques |
Px presents w/ aphasia, hemiparesis, paresthesias, loss of vision, and loss of consciousness that resolves within 24 hours. This suggests what pathology? | Transient ischemic attack - brief, reversible episode of neuro dysfxn due to focal ischemia (occlude 1 artery by thrombus or embolus) |
4-8 weeks post MI, patient is at risk of what MI complication? | ventricular aneurysm |
Px on autopsy w/ a blood clot appeared to have alternating white lines on microscopy. This indicates patient developed this when? | Premortem thrombus |
What is the difference btwn Goodpasture's ds and Wegener's granulomatosis? | Goodpasture's not associated w/ nasal symptoms whereas Wegener's is. |
Patient w/ Marfan's has defect in? | fibrillin |
Patient is an elderly w/ ring-like calcifications. This patient has what disease process? | Monckeberg arteriosclerosis |
Patient presents with tendon xanthomas. Labs indicate increased LDL above 190 mg/dL and cholesterol levels. This indicates what disease? Pathophysiology? | Familial hypercholesterolemia (type II) - receptor mediated endocytosis is defective |
Patient w/ heart transplant is at risk for what serious complication? | graft vascular disease (graft arteriosclerosis) |
Px presents w/ hamartomas, adenoma sebaceum, ash leaf spots, cardiac rhabdomyomas and renal angiomyolipomas. This suggests what pathology? | Tuberous sclerosis |
Px w/ sudden cardiac death. What is the underlying factor? | Ischemic heart ds -> ventricular fibrillation |
Amyloid protein associated with acute phase reactant (i.e. Rheumatoid arthritis) | AA protein |
Amyloid protein seen in familial and old fogies | AF |
Amyloid protein associated with light chain and lymphoma | AL |
Amyloid protein associated w/ the endocrine system | AE |
What does an increase in AST alone indicate? | myocardial infarction |
What is a frequent fatal complication that can occur the 1st week after MI? | rupture of free LV wall |
What is a common complication that occurs in pxs w/ beta thalassemia major? | CHF from accumulated iron of frequent blood transfusions |
Px w/ thickened blunted cardiac valve leaflets w/ fibrous bridging btwn valve leaflets and calcifications has what pathology? | Acute rheumatic fever |
Young px presents w/ ejection click/systolic click. What is pathology? | bicuspid aortic valve (aortic stenosis) |
Px experiences repeated episodes of exercise-induced substernal chest pain. What is the pathology and pathophysiology? | stable angina pectoris - gradual loss of myocytes - small patches of fibrosis and vacuolization of damaged myocytes typically in subendocardial locations which are poorly perfused |
Px has history of being IV drug abuse user. Px at risk of what pathology which is commonly caused by what bacteria? | Acute bacterial endocarditis - Staph aureus |
Duodenal atresia seen commonly in which pxs? Pathophysiology? | Down's - inadequate migration of neural crest cells |
Pathophysiology of aortic stenosis? | MCC by calcification of normal or bicuspid valves |
Opening snap | Mitral stenosis |
How is HDL (good cholesterol) increased? | exercise, wine, estrogen |
Where is HDL synthesized? | liver and SI |
Functions of HDL? | removes cholesterol from plaques for disposal in liver |
What are diet-derived triglycerides? | chylomicrons |
What do CMs need to be synthesized in the intestinal epithelium and for assembly and secretion? | apo-B48 |
What transports liver-synthesized triglyceride in the blood and requires apo-B100 for assembly and secretion? | VLDL |
What causes turbidity in plasma? | hypertriglyceridemia |
What transports cholesterol in blood? | LDL |
Increased LDL due to decreased LDL receptors describes what? | type II hyperlipoproteinemia |
Premature CAD and stroke, tendon xanthomas, and xanthelasma describe what? | familial hypercholesterolemia (type II hyperlipoproteinemia) |
Deficiency of apoE and increased liver uptake of chylomicron remnants and IDL describes what? | type III hyperlipoproteinemia (familial dysbetalipoproteinemia) |
Palmar xanthomas in flexor creases and increased risk for CAD describes what? | familial dysbetalipoproteinemia ("remnant disease") |
Increased VLDL and the MC lipid disorder describes what? | type IV hyperlipoproteinemia (familial hypertriglyceridemia) |
What are the acquired causes of type IV hyperlipoproteinemia? | excess alcohol intake, progesterone in OCP, DM |
Eruptive xanthomas (yellow, papular lesions) and increased risk for CAD and peripheral vascular disease describes what? | type IV hyperlipoproteinemia (familial hypertriglyceridemia) |
Deficiency of apo B-48 and B-100 with deficiency of CM, VLDL, and LDL, and decrease in serum cholesterol and triglyceride describe what? | apolipoprotein B deficiency (abetalipoproteinemia) |
Marked decrease in vitamin E, malabsorption from chylomicrons accumulating in villi, and ataxia, hemolytic anemia with thorny RBCs (acanthocytes) describes what? | abetalipoproteinemia |
What is the formula for CO? | rate of O2 consumption/(arterial O2 content - venous O2 content) |
What is the formula for MAP? | CO * TPR |
What is another formula for MAP? | 2/3 diastolic pressure + 1/3 systolic pressure |
What is the formula for pulse pressure? | systolic pressure - diastolic pressure |
What is proportional to SV? | pulse pressure |
What is the formula for SV? | CO/HR = EDV-ESV |
During exercise, CO increases initially as a result of what? | increase in SV |
After prolonged exercise, CO increases as a result of what? | increase HR |
If HR is too high (e.g. ventricular tachycardia), what happens? | diastolic filling incomplete and CO decreases |
What is SV affected by? | CAP = contractility, afterload, preload |
When is SV increased? | increase preload, decrease afterload, or increase contractility |
Contractility (and SV) increase with what? | catecholamines (inc activity of Ca2+ pump in SR), inc intracellular Ca2+, decrease extracellular Na+ (dec Na+/Ca2+ exchanger activity), digitalis (inc intracellular Na+ resulting in inc Ca2+) |
Contractility (and SV) decrease with what? | B1 blockade, HF, acidosis, hypoxia/hypercapnea, non-dihydropyridine Ca2+ channel blockers |
SV increases in what events? | anxiety, exercise, and pregnancy |
What does a failing heart have? | decrease SV |
Myocardial O2 demand is increased by what? | inc afterload (~arterial pressure), inc contractility, inc HR, inc heart size (inc wall tension) |
What does preload equal? | ventricular EDV |
What does afterload equal? | MAP (proportional to peripheral resistance) |
Example of venodilators? | nitroglycerin |
Example of vasodilators? | hydralazine |
What do venodilators decrease? | preload |
What do vasodilators decrease? | afterload |
What does preload increase with? | exercise (slightly), blood volume (overtransfusion), and excitement (sympathetics) |
What is force of contraction proportional to? | initial length of cardiac muscle fiber (preload) |
What stimulates the contractile state of myocardium? | circulating catecholamines, digitalis, sympathetic stimulation |
What inhibits the contractile state of myocardium? | pharacologic depressants, loss of myocardium (MI) |
What is the formula for EF? | SV/EDV = EDV-ESV/EDV |
What is EF an index of? | ventricular contractility |
What is the normal EF? | >=55% |
What is resistance directly proportional to? | viscosity |
What is resistance inversely proportional to? | radius to the 4th power |
What accounts for most of TPR and regulates capillary flow? | arterioles |
What does viscosity depend mostly on? | hematocrit |
Viscosity increases in what? | polycythemia, hyperproteinemic states (e.g. multiple myeloma), hereditary spherocytosis |
What does an isolated decrease in CO indicate? | decrease contractility that is not due to decrrease preload (VR unchanged) - action of negative inotropic drug and to myocardium inhibiting contraction such as MI |
On the venous return curve, what does the x-intercept mean? | mean systemic pressure |
In the phases of the left ventricle of the cardiac cycle, what is the period of isovolumetric contraction? | period between mitral valve closure and aortic valve opening; period of highest O2 consumption |
In the phases of the left ventricle of the cardiac cycle, what is the period of systolic ejection? | period between aortic valve opening and closing |
In the phases of the left ventricle of the cardiac cycle, what is the period of isovolumetric relaxation? | period between aortic valve closing and mitral valve opening |
In the phases of the left ventricle of the cardiac cycle, what is the period of rapid filling? | period just after mitral valve opening |
In the phases of the left ventricle of the cardiac cycle, what is the period of reduced filling? | period just before mitral valve closure |
Loudest at apex and radiates toward axilla? | mitral regurgitation |
Loudest at tricuspid area and radiates to right sternal border? | tricuspid regurgitation |
Is often due to ischemic heart disease, mitral valve prolapse, or LV dilation? | MR |
Is due to RV dilation or endocarditis? | TR |
Crescendo-decrescendo systolic ejection murmur following ejection click (EC)? | aortic stenosis |
LV>>aortic pressure during systole? | aortic stenosis |
Where does aortic stenosis radiate to? | carotids/apex |
Pulses weak compared to heart sounds is called what? | pulsus parvus et tardus |
What is aortic stenosis often do to? | age-related calcification |
Holosystolic, harsh-sounding murmur loudest at tricuspid area? | VSD |
Late systolic murmur with midsystolic click? | mitral prolapse |
What is the most frequent valvular lesion loudest at S2? | mitral prolapse |
What can mitral prolapse predispose to? | infective endocarditis |
Wide pulse pressure when chronic refers to what? | aortic regurgitation |
High-pitched "blowiing" diastolic murmur describes what? | aortic regurgitation |
Follows opening snap? | mitral stenosis |
Delayed rumbling late diastolic murmur? | mitral stenosis |
What is the pressure during diastole in mitral stenosis? | LA>>LV |
What does mitral stenosis often occur secondary to? | rheumatic fever |
Continuous machine-like murmur describes what? | PDA |
Where is PDA loudest at? | S2 |
Irregularly irregular with no discrete P waves describes what? | atrial fibrillation |
"Sawtooth" appearance describes what? | atrial flutter |
How do you treat atrial fibrillation? | warfarin (Coumadin) |
What is used in atrial flutter? | class IA, IC, or III antiarrhythmics |
What is the PR interval in 1st degree AV block? | >200 msec |
What is the PR interval in 2nd degree AV block (Mobitz type 1 (Wenckebach))? | progressive lengthening of PR interval until a beat is "dropped" |
What do dropped beats not preceded by a change in the length of the PR interval? | Mobitz type II |
How is Mobitz type II often found? | 2:1 block where 2 P waves to 1 QRS response |
Atria and ventricles beat independently describes what? | 3rd degree (complete) AV block |
Coarctation of the aorta can result in what? | aortic regurgitation |
Antiarrhythmic that inhibits cyp3A4? | amiodarone |
In neonates, blood flows how in PDA? | aorta to pulmonary artery |
What are the blood oxygen tension values in PDA? | only pulmonary artery is increased (aorta, vena cava and LV are normal) |
What can myomectomy do? | complete heart block |
Where is right bundle branch block seen? | ventricular hypertrophy or if conduction delayed through right bundle |