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Cardiovascular
| 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) |
Created by:
Kyle Tiemeier
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