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Cardiology 1.1

UWORLD Cardio Review

QuestionAnswer
Defective type 1 collagen Osteogenesis imperfecta
What organs/tissues are made of Collagen type 1? Dermins, Bones, Tendons, Dentin, Cornea, blood vessels, and scar tissue.
Cartilage, vitreous humor, and nucleus pulposus Type 2 cartilage
What organs/tissues are made of Collagen type 3? Skins, lungs, intestines, blood vessels, bone marrow, lymph nodes and granular tissue
Basement membrane is made of Collagen type _______. Collagen type 4
Alport syndrome Autoimmune disease against to collagen type 4
Defective collagen 4 synthesis. Dx? Goodpasture Syndrome (RPGN)
What is the cause of Decompensated heart failure? Left-ventricular Systolic/Diastolic dysfunction.
What are unique characteristics of CXR decompensated heart failure? 1. Cephalization of Pulmonary vessels 2. Peripheral Alveolar edema 3. Blunting of costovertebral angles
Where does a Pulmonary artery catheter to diagnose? Pulmonary HTN
The pressure recorded at the end of a pulmonary artery catheter, it closely resembles? Left PCWP
What is the MC site for Aortic rupture? Aortic ISTHMUS
How is the IVC formed? Junction of the Right and Left common iliac veins at the L4-L5.
At vertebral level is the IVC formed? L4-L5
The _________ is formed by the junction or joining of the _________ and _________ ___________________ veins. IVC: Right and Left Common Iliac veins.
A 3 AV Block is due to dysfunction of? Complete dysfunction of the PURJINKE fibers.
What node or area has the lowest conduction? AV Node
45-55 bpm is seen commonly at: AV Node
The ________ node has a velocity of __________________ bpm. SA; 60-100 bpm
What is the approximate pressure of the right atrium? 1-6 mm Hg
the right ventricle has an approximate pressure of ______________ mm Hg. 15-30
What is the approximate pressure of PCWP? 6-12 mm Hg
A pressure of 9 mm Hg, mostly would indicate which location? Pulmonary artery prior entrance to Left Atrium
What is the approximate pressure of the normal Left ventricle (LV)? 90-140/6-12
How many days after an MI, is a Left free wall rupture commonly seen? 5-14 days
After 9 days of MI, the patient is a risk of development of? Left Free Wall rupture
How is Left Free Wall rupture clinically manifested? Sudden onset of chest pain, profound shock and rapid death
Why is the Left Free wall prefered than the right? The rupture is seen in the left due to higher pressure than the right.
The ______________ flow is the _________________ to the power of _____. blood flow; radius; 4
Resistance is ________________________ proportionately to blood flow. Inversely
The reduction of the ____________ by factor of _______, leads to a _________ decrease of original _____________ size. radius; 16; 50%; radius
What proteins is produced by Strep Viridans, that help to colonize dental and heart valves? Dextrans
The MCC of Subacute Bacterial Endocarditis is? Infection by Strep Viridians
Common procedure associated with S. viridans infection, leading to Subacute Bacterial endocarditis? Dental procedures
Strep Viridans is an ________-hemolytic and _________________ _________________. alpha; bacitracin-resistant
What is the MCC of Rheumatic Heart disease? Streptococcus pyogenes
What murmur is acutely developed in Rheumatic Heart disease? Mitral Regurgitation (MR)
Holosystolic murmur with radiation to the AXILLA and best heard at the APEX of the heart. Mitral Regurgitation (MR)
Mitral Stenosis (MS) is a ____________________ murmur, with a _____________ at the beginning of _______________. Diastolic; OPENING SNAP; DIASTOLE
Low-pitch and mid-systolic rumbling, diastolic murmur, and long secuela of rheumatic fever disease. Mitral Stenosis (MS)
Aortic Stenosis (AS): Associated bicuspid Aortic valve. Radiation carotids. Crescendo-decrescendo
crescendo-decrescendo Aortic Stenosis (AS)
What is the mutation seen in Pulmonary HTN? BMPR2 gene
What does a BMPR2 gene mutation causes? Excessive proliferation of endocardial and smooth muscle proliferation, which is the 1st hit in Pulmonary HTN pathogenesis.
What is the second "hit" in the 2-hit hypothesis of Pulmonary HTN pathogenesis? D2 activation
Asymmetric ventricular septal hypertrophy is seen in which cardiomyopathy? HYPERTROPHIC
Hypertrophic cardiomyopathy causes: dynamic left ventricular outflow tract obstruction
What pathology causes the "pushing" toward to the INTERVENTRICULAR SEPTUM by the anterior mitral leaflet. Hypertrophic cardiomyopathy
Blood reaching the heart defines the principle of _____________ Preload
What decreases preload? Why? 1. Sudden standing 2. Valsalva (straining) 3. Nitroglycerin Less blood reaches the heart
What actions increase preload? Pathogenesis? 1. Squatting 2. Sustained handgrip 3. Passive leg raise More blood reaches the RIGHT atrium
A _____________________ infusion increases the ____________________. Phenylephrine; AFTERLOAD
Increased afterload leads to a : 1. Increase in End Systolic Volume (ESV) 2. Decrease in Stroke Volume (SV)
Afterload is due to: 1. increased vascular resistance (HTN) 2. Semilunar valve damage
Which are the SEMILUNAR valves: Aortic and Pulmonary valves
The Atrioventricular valves are: Mitral (bicuspid) and Tricuspid valves
Damaged Aortic valve will lead to a probable increase in: Afterload
What are the main reasons for increased Preload? 1. Fast filling time 2. Increased venous return
Increased preload causes: Increased End Diastolic Volume (EDV) and increased stroke volume.
Hypothyroidism is a cause of: decreased Preload
Afterload increased is seen with ___________________________. Handgrip
A sustained ______________________, raises both ___________________ and ________________, but the _________________ effects are dominant. Handgrip; afterload and preload; Afterloads
Increase in afterload leads to a decrease in intensity of which murmur? Hypertrophic cardiomyopathy
Which murmurs increase with Expiration? Left sided murmurs, such as Aortic regurgitation
Murmurs that increase with INSPIRATION are _____________ sided Right
Where is Aortic regurgitation best heard? Left-sternal border, at the 4th/5th intercostals, and by sitting up and leaning forward.
MCC of aortic stenosis Calcific degeneration of the aortic valve
Harsh, systolic murmur, best heard at the 2nd intercostal with carotid radiation? Aortic Stenosis (AS)
MTHFR deficiency? Most common cause of elevated levels of HOMOCYSTEINE
What vitamin cofactors are used in the Folic and Methionine cycles? Vitamin B12 and Vitamin B6
What type of diseases or condition increase the risk of developing Infective endocarditis? Rheumatic Fever disease, Prosthetic valves, and congenital heart disease, as these cause damage to heart valves.
What is Beck's Triad? The triad of symptoms seen with Cardiac TAMPONADE 1. hypotension 2. Pulsus paradoxus 3. Muffled heart sounds
What are common disorders that lead to developing a cardiac tamponade? Malignancy and Radiation therapy, Viral and Bacterial infections, medication (INH/hydralazine), and connective tissue diseases such as SLE and RA.
Where is DIGOXIN cleaved in the body? Kidneys
It is fine to assume ______________________ in the elderly, leading to increased risk of intoxication with a renal metabolism drug. mild kidney deficiency
Digoxin side effects in the cardiac, GI, and Neurological systems? Cardiac --> arrhythmias due to Hyperkalemia GI --> Nausea, vomiting, abdominal pain Neuro --> Yellow-vision, fatigue, weakness
Hypokalemic patient is at increased risk of __________________ toxicity. Digoxin
Digoxin's clearance is decrease as it interacts with: Verapamil, quinidine, and amiodarone
What is the treatment for Digoxin toxicity? 1. Normalize K+ level, 2. Cardiac Pacer, 3. ANTI DIGOXIN Fab-fragments, 4. Mg2+
How does digoxin treat Heart Failure (HF)? Increase contractility
What is the action of Digoxin that helps the treatment of Atrial fibrillation? Decrease conduction of the AV node and depression of the SA node
Overdose of Beta blockers is treated with? Glucagon
Glucagon: Raises heart rate and contractility, without any adrenergic effects
What is Digoxin's direct MoA? Inhibition of the Na+/K+ - ATP pump, leading to increased [Na]
What is DIgoxin's INDIRECT effect? Inhibition of the Na+/Ca2+ exchange, leading to an increase in [Ca2+]
The resultant decrease in AV conduction by digoxin causes: An increase in PS (parasympathetic) vagal tone ( decreased HR)
A CT of the heart depicts the _________________ as the most anterior part of the heart. Right Ventricle
Which chamber of the heart is most likely to be injured in a knife wound directly in the anterior chest? Right Ventricle
Which chamber is in closest proximity to the esophagus? Left Atrium
Dysphagia and hoarseness of the voice may be due to enlargement of the ____________, leading to ____________________ of the _____________ and ___________________, respectively. Left Atrium; COMPRESSION; Esophagus; Left recurrent Laryngeal nerve
Which muscles are penetrated in a anterior chest knife wound? Pectoralis major, Transverse Thoracic muscle, and Pericardium
Sterile thrombi (platelet) on cardiac valve Non-bacterial Thrombotic Endocarditis (NBTE)
NBTE is associated with malignancies and inflammatory diseases such as: SLE, antiPhospholipid syndrome, and sepsis.
A damaged cardiac muscle lead to a decreased _________________, which activates 3 neuronal responses: Cardiac Output; 1. SNS activation --> Increased HR and contractility + Vasoconstriction 2. Renin-Angiotensin activation --> Vasoconstriction + Increased extracellular volume 3. ADH secretion --> Increased extracellular volume
The long term neuronal activations and its immediate physiologic responses help to maintain _________________________. Blood pressure
What are the numbers for hypertensive Crisis? Persistent DIASTOLIC pressure exceeding 130 mm Hg
Onion-like concentric thickening of arteriolar walls of vasculature, describes histology seen in what cardiac pathology? Hypertensive crisis with Diastolic hypertension
Hyperplastic arteriosclerosis is associated with: Hypertensive crisis
What is dystrophic calcification? Damaged or necrotic tissue in setting of normal calcium levels
What is a hallmark of all types of necrosis? Dystrophic calcification
Dystrophic calcification + Hypercalcemia --> Metastases
Mitral regurgitation (MR) is a _________________ murmur best heard at the heart's _____________, and associated with _______ gallop. Holosystolic; Apex: S3
A functional MR is successfully treated if there is a reduction of _________________________________ after treatment. LV preload (LVEDV)
What is a complication shared by Infective endocarditis and severe mitral regurgitation? Chordae tendinae rupture
Decreased ventricular COMPLIANCE + elevated LV pressures. Dx? Diastolic Heart Failure
What are common causes of DHF? HTN, obesity, and infiltrative disorders such as Amyloidosis and Sarcoidosis.
What type of Heart failure is most often secondary to myocardial hypertrophy? Diastolic Heart Failure
Systolic Heart failure (SHF) is mostly secondary to: Isquemia/MI or dilated cardiomyopathy
What function (levels) are preserved or normal in Diastolic HF? Preserved EF, and normal EDV
How is EF and EDV in Systolic HF? reduced EF and increased EDV
What does an increase EDV mean? Increased filling volume of ventricle; Increase in venous return --> overly stretched cardiac muscle fibers (DCM)
Increased preload causes an _____________________ in _________ & ______. Increase in Stroke Volume and EDV
Formula for Stroke Volume: SV = EDV - ESV
Main decrease in Diastolic HF? Decrease in COMPLIANCE
Main decrease in Systolic HF? Decrease in CONTRACTILITY
Most common cause of Right heart failure? Left Heart failure
Isolated cause of right heart failure is known as: Cor pulmonale
What is Cor pulmonale? isolated right HR due to pulmonary cause
What drugs have shown decrease mortality in HF patients? ACE-inhibitors, ARBs, Beta-blockers (except on acute Decompensated HF), and Spironolactone.
Thiazides and Loop diuretics are mainly used in HF for? symptom relief
What are the 3 most characteristic symptoms of Left HF? 1. Orthopnea 2. Paroxysmal Nocturnal Dyspnea 3. Pulmonary edema
What is orthopnea? It is an highly associated symptom of? Shortness of breath when supine (laying down, face up); Highly associated with LHF
Breathless awakening from sleep? Associated symptom of? Paroxysmal Nocturnal Dyspnea; Association with Left Heart Failure
Pulmonary edema seen Left HF, is associated with what cells? Found in which organ? Hemosiderin-laden macrophages or known as "HF" cells found in the LUNGS
What are the 3 main symptoms that indicate Right HF? 1. Hepatomegaly (nutmeg liver) 2. Jugular venous distention (JVD) 3. Peripheral Edema
Left HF is associated with ____________________ edema, while Right HF is associated with _______________________ edema. Pulmonary Edema; Peripheral Edema
Increased central venous pressure leads to development of ______________________ seen in RHF. Hepatomegaly
RHF increases venous pressure, which lead to occurrence of? JVD and Peripheral edema
Increased pulmonary venous pressure is causal of _______________ edema seen in ________________ failure. Pulmonary edema; Left Heart failure
What EKG changes are seen in TRANSMURAL MI? ST elevation + Q-wave formation
What is the common pathogenesis of Transmural MI? 1. Fully obstructive thrombus 2. Ruptured atherosclerotic coronary artery plaque
STEMI: Transmural MI; ST elevation
NSTEMI: Subendocardial MI; ST depression
EKG changes shared by STEMI and NSTEMI? Hyperacute (peaked) T waves, T-wave inversion, new LBBB, pathologic Q- waves
Distal LAD MI is seen in which EKG leads the best? V3 - V4
Distal LAD indicates what location? anteroapical
The anteroseptal area of the heart is the ___________ area, and its MI is recorded best with leads ________________. LAD; V1 - V2
STEMI seen best in EKG leads II, III, and aVF? RCA (inFerior) MI
LCX STEMI is seen best in ___________________ EKG recordings. I, and aVL (Lateral)
PDA STEMI is seen in leads? what is characteristically seen with PDA STEMI R-waves in V1 -V3? V7-V9; ST depression in V1-V3 with tall R-waves.
Diltiazem and Verapamil are: Non-dihydropyridine Calcium channel blockers
Side effects of Non-dihydropyridine Ca-channel blockers? Constipation, bradycardia, AV block
What is the cause of AV block development in usage of Verapamil? Non-dihydropyridine ca-channel blockers, have negative chronotropic effects and a decrease sinus rate.
What are the 2 most common Non-dihydropyridine Calcium channel blockers? Verapamil and Diltiazem
What is the MoA of Verapamil and Diltiazem? Exert action on L-type Ca2+ channels during Phase 0 and decrease conductance velocity.
What are some disorders or conditions for which Diltiazem and Verapamil are used for? HTN, angina, Supraventricular arrhythmias (A-flutter, A-fib, and PSVT)
What type of channels are used by Non-dihydropyridine antiarrhythmics? L-type Calcium channels
On what phase do non-dihydropyridine Ca2+ channel blockers work? Phase 0
Decreased conduction velocity, increase ERP, and increase PR interval, describes the mechanism of action of? Class IV antiarrhythmics (Calcium channel blockers)
What are the Class IV antiarrhythmics? Calcium channel blockers (Verapamil and Diltiazem)
Changes seen in Action potential in Class IV antiarrhythmics? Slow rise of Action potential, Prolonged repolarization at AV node, and decreased threshold potential
Markedly prolonged repolarization is seen in what kind of antiarrhythmics? Class III - Potassium channel blockers
What are some Class III antiarrhythmics? Amiodarone, Ibutilide, Sotalol, Dofetilide
What are the main side effects of Sotalol? Torsades de Pointes and excessive Beta-blockade
The use of Ibulitide is associated with possible development of _________________________ (fatal arrhythmia) Torsades de Pointes
Pulmonary fibrosis, Hyper/Hypothyroidism, and liver dysfunction, are associated side effects of which antiarrhythmic? Class III antiarrhythmic - K+ channel blocker AMIODARONE
What K+channel blocker acts as an HAPTEN? What does it cause? Amiodarone; results in development of blue/gray deposits in skin leading to photodermatitis, and to corneal deposits.
Increased AP duration, Increased ERP, Increased QT interval, is the mechanism of action seen in? Class III antiarrhythmics
Decreased slope of Phase 0 depolarization is seen in: Class I antiarrhythmics: Na + channel blockers
Class I antiarrhythmics have a preference for: tissue that is frequently depolarized
Depolarized cells in heart will be affected with preference by what antiarrhythmics? Sodium channel blockers (Class I)
Class IA antiarrhythmics? Quinidine, Procainamide, and Disopyramide
Class IB antiarrhythmics? Lidocaine and Mexiletine
Flecainide and Propafenone are? Class IC antiarrhythmics
What side effect is seen with Quinidine? Cinchonism
What is cinchonism? Side effect of Class I antiarrhythmic QUINIDINE; it is tinnitus induced by Quinidine
Reversible SLE-like syndrome is seen with the use of: Procainamide
Development of HF is often associated with __________________, a Class ____ antiarrhythmic. Disopyramide: I
Antiarrhythmic: 1. Quinidine 2. Procainamide 3. Disopyramide SE: 1. Cinchonism 2. reversible SLE-like syndrome 3. Heart failure
What SE effects are seen in all Na-channel blockers? Thrombocytopenia and increased risk of Torsades de pointes
Why is there in and increased risk for Torsades de pointes in the use of Class I antiarrhythmics? Increased QT interval
Main two arrhythmias treated with Class IA antiarrhythmics? SVT and V-Tach (atrial and ventricular arrhythmias)
What seizure medication may be considered a Class IB antiarrhythmic? Phenytoin
What type of tissue has Class IB antiarrhythmic preference? Ischemic or depolarized Purjinke and ventricular tissue
Digoxin overdose, lead to the development of arrhythmias. What class of antiarrhythmic is classically used to treat the arrhythmia? Class IB antiarrhythmic, such as Lidocaine.
Patient with chronic AFIB is treated with Digoxin. Few days after starting medication is admitted to local ER, and EKG shows sustained VTACH. What drugs is commonly used. Lidocaine is often used to treat Digoxin-induced arrhythmias. Common treatment of AFIB is digoxin.
What kind of drugs are the LAST RESORT to treat SVT and AFIB? Class IC antiarrhythmics
What are the associated side effects of Class IC antiarrhythmics? Proarrhythmic especially in post- MI
Class IC antiarrhythmics are contraindicated in what type of patients? Structural and ischemic heart disease patients
What type of antiarrhythmic is used as__________________ RATE CONTROL of AFIB and AFLUTTER? VENTRICULAR; Beta blockers (Class II)
Beta blockers cause a decrease in cAMP and Calcium current which is manifested with: Decreased SA and AV nodal activity
In use of Beta blockers, the ______ node is found to have greater sensitivity causing an increased _________ interval. AV node; PR
AV node beta blocker stimulation leads to: Increased PR interval
Why are B-blockers, such as propranolol, to be used very carefully in diabetic patients? May mask signs of hypoglycemia
Impotence is associated the toxicity of ___________ antiarrhythmic. Class II
The chronic use of B-blockers may lead to: 1. Exacerbation of ASTHMA and COPD 2. CNS --> sedation and sleep alterations 3. Cardio --> HF, AV block and bradycardia
A __________________ drug addict cannot be given ______________, as it would cause UNOPPOSED ________________________. COCAINE; B-blocker; alpha-1 agonist
What are common treatments for B-blocker toxicity? Saline, atropine, glucagon
What MEN2A - associated malignancy is cannot be treated with purely B-blockers? Pheochromocytoma (cause unopposed a-1 agonism)
What is a distinctive side effect of metoprolol? Dyslipidemia
What B-blocker may exacerbate vasospasm in Prinzmetal angina? Propranolol
Which are the non-selective B-blockers? Labetalol and Carvedilol
Which B-blockers have both alpha and beta antagonistic effects? Non-selective B-blockers (Labetalol and Carvedilol)
Where are B-1 receptors found? Cardiac tissue and Renal Juxtaglomerular cells
Stimulation of B-1 receptors lead to a decreased level of ___________ cAMP
Which are the Adrenergic receptors? alpha-1, alpha-2, B-1 and B-2
M1, M2, and M3 are? Cholinergic receptors
The ultimate result of the Carotid Sinus massage is to _______________________. Decrease heart rate
Massaging the Carotid sinus initially increases ______ tone, leading to a ____________ inhibition of the _____________. This results in _______ conduction through the _____________ causing a prolongation of _________________ of _______ node, causing ultimately a decreased ________________. PS; temporary; SA node; slow; AV node; Refractory Period of AV Node; Heart Rate
What is the result of the slow conduction through the AV node seen in Carotid Sinus massage? Prolongation of the Refractory period of AV node.
MC site of clot causing sudden loss of vision? Retinal artery
Occlusion of the _______________ artery causes sudden loss of vision. Retinal
The ophthalmic artery branches off the ________________ ___________. Internal Carotid
Path of Ocular artery Internal Carotid --> Ophthalmic artery --> retinal artery
Development of AFIB is due to: The loss of AV function
In AFIB, the AV function is lost, thus it is replaced by: SA node, resulting in irregular pattern and rapid impulses.
What is a varicocele? Tortuous formation of renal vein due to increased renal pressure.
Which side renal vein is most commonly seen with varicocele development? Left Renal vein
Causes of Varicoceles? Renal vein stenosis, leading to retrograde blood flow.
Retrograde blood flow of the left renal vein, is associated with development of ____________________, due to ___________________. Varicocele: Left Renal vein stenosis
What is the "Nutcracker" effect? Pain elicited by a varicocele.
Pain in the flank and gross hematuria, HTN, and very tender scrotum. Nutcracker effect indicating possible Varicocele.
Varicocele Hx in a patient may be associated with: Low sperm production and low sperm quality, leading to infertility.
"Bag of worms" description of the scrotum. Dx? Varicocele
Which vein on the Left side becomes more commonly tortuous leading to development of varicocele? Gonadal (spermatic) vein
Crescendo - Decrescendo, harsh systolic ejection murmur Aortic Stenosis (AS)
Best heard at 2nd intercostal space, radiation to the carotids. Associated commonly with old age. Aortic Stenosis (AS)
Bicuspid aortic valve is a common cause of___________________ murmur. Aortic Stenosis (AS)
What are the most common causes of Aortic Root Disease? associated with what syndrome? 1. Aneurysmal dilation 2. Aortic Regurgitation 3. Aortic Dissection Associated with Marfan syndrome
Collective cardiovascular syndrome, causing damage to aortic valve such as thickening, stiffness, dilaton. Aortic Root Disease
Mid-systolic click and eventual late-systolic murmur MVP
Where is an MVP best heard? Apex of heart
VSD is a ________murmur, commonly seen in __________ syndrome. It is required in neonates with ________________ for survival. Systolic; Down Syndrome: Transposition of Great Vessels.
Dobutamine uses the _____ pathway and increases the level of ______ and ____________. Gs; cAMP and adenylyl cyclase
Dobutamine shows stronger affinity to which type of Beta receptors? B1 receptors have stronger affinity to dobutamine than B2.
What are the cardiac effects of Dobutamine? Affects cardiac muscle causing positive chronotropy and increases inotropy.
What is chronotropy? Action of affecting the heart rate. Positive refers to accelerate HR. Negative chronotropy meas lowering HR.
What is the action of Aldosterone inhibitors? Increased renal Na+ reabsorption
Where in the RAAS does renin enter ? Enzyme that works in conversion of Angiotensinogen into AT 1
ACE: Enzyme in charge of converting AT 1 into AT II
What antihypertensives work on AT II? ARBs
What stimulates the release of Renin? 1. Decreased Renal blood flow (RBF) 2. Sympathetic stimulation
What drugs have the suffix -pril? Examples. The ACE inhibitors such as CaptoPRIL, or LisinoPRIL.
What is a common serious side effects of ACE inhibitors.? 1st dose syncope
The co-administration of _________________ with new start on ACE inhibitors, increase the risk of developing ___________________, thus it must be prevented by starting with ____________. Diuretics; 1st dose syncope; low doses
BUN of 36 and Cr of 5.3 is started with low doses of Captopril. Why? Patients with chronic renal failure, may develop ACE inhibitor - induced 1st dose syncope. It is prevented by staring with low dosages.
On the jugular venous tracing, which wave represents Right Atrial contraction? a-wave
The x-descent on JV tracing represents which cardiac contraction moment? Right-atrial relaxation.
X-decent depicts RA ___________________ and the a-wave indicates RA _____________________. Relaxation; Contraction
Which feature on JV tracing represents the PASSIVE RA emptying after the TV has opened? y-descent
Continuous blood inflow of the venous blood represented with the "v-wave" on the JV tracing.
The pressure (building) on the TV during Right Ventricular contraction is depicted with the ______-wave, on the jugular venous tracing. c-wave
Patient with chronic AFIB is missing which JV tracing feature? a-wave
Constrictive Pericarditis is associated with: Stepper y-descent on JV tracing.
What part of the JV tracing represents the Atrial Portion? From end of y-decent, all a-wave to the benging of c-wave
x, v and y points on JV tracing are part of the __________________ portion. Ventricular
Which part represents Ventricular Diastole? From v-wave to the end of y-descent.
the area covered from x-descent to start of v-wave on JV tracing is? Ventricular systole
Atrial Diastole is enclosed in JV tracing by? Max point at a-wave to max point of c-wave.
The first half (minimum to max point) of a-wave represents? Atrial systole
Thickened and calcified pericardium describes what type of cardiac condition? Constrictive Pericarditis
Triad of progressive dyspnea, peripheral edema, and ascites, plus absent y-descent on JV tracing? Constrictive Pericarditis
Hx of TB and radiation to the chest, and cardiac surgery are risk factor for the development of ___________________. Constrictive Pericarditis
Systolic pressure decreased > 10 mmHg on inspiration Pulsus Paradoxus
Pulsus paradoxus is most commonly associated with? Cardiac tamponade
What part of the respiratory cycle is associated with Pulsus Paradoxus? Inspiration
What is the second most common cause of Pulsus paradoxus? severe COPD and ASTHMA, and constrictive pericarditis
First line of treatment for HTN in DM patients? Second? ACE inhibitors, as these are protective of the kidneys. Second line are the ARBs.
What is an advantage of ARBs over ACE inhibitors? ARBs do not cause increase levels of bradykinin, thus no edema or cough
MC side effect of ACE inhibitors? Cough and angioedema due to increased levels of Bradykinin
Granulomatous inflammation of the media (vessel) Morphological transformation of vessel structure seen in: 1. Takayasu's Arteritis 2. Temporal (Giant Cell) arteritis
Microscopic polyangiitis, Microscopic polyarteritis, and Hypersensitive vasculitis, are _________________________ vasculitis, seen in the first _______________ wit _____________________________. Leukoclastic; 24 hours; Fragmented Neutrophils
What are the two most common large vessel vasculitis? Temporal (Giant cell) arteritis and Takayasu's arteritis
Unilateral headache associated vasculitis? Temporal (Giant cell) arteritis
Ophthalmic artery occlusion is seen as irreversible complication of _________________________ arteritis. Temporal (Giant cell) arteritis
Temporal arteritis is often associated with: 1. Polymyalgia rheumatica 2. Increased ESR 2. Unilateral headaches 4. Affects females > males
What is the treatment of Giant cell arteritis? Why is the treatment before ophthalmic artery biopsy? High dose glucocorticoids prior to Ophthalmic artery biopsy in order to prevent irreversible blindness.
Granulomatous thickening and narrowing of aortic arch and proximal great vessels? Takayasu's arteritis
"Pulseless disease" otherwise known as: Takayasu's arteritis
Asian female 44 years old, almost absent radial and brachial pulses bilaterally, complains of night sweats, arthralgias, and vision problems. Dx? Treatment? Takayasu's arteritis is treated with corticosteroids
Increased ESR is a lab result seen in which type of vasculitis? Large cell vasculitis
What viral agent is highly associated with PAN? Hepatitis B virus
In Polyarteritis nodosa (PAN), which vessels are affected, and which are spared? PAN mostly sees affected medium sized vessels, involving the renal and visceral, while sparing the pulmonary arteries.
Corticosteroids and ___________________ are drugs used in the treatment of PAN. Cyclophosphamide
Which medium sized vasculitis is seen with different stages of inflammation coexisting in same vessel? Polyarteritis Nodosa (PAN)
CRASH and burn, mnemonic of? Kawasaki Disease
Kawasaki Disease is a _________ size vasculitis, affecting primarily ____________ _______________ of less than 4 years old. Medium; Asian children
Another name for Kawasaki Disease? Mucocutaneous Lymph Node Syndrome
Kawasaki Disease main clinical manifestations: Conjunctiva injection, Rash (desquamating), Adenopathy (cervical), Strawberry tongue (oral mucositis), Hand and Foot changes, Fever
What is the treatment of Kawasaki disease? IV immunoglobulin and aspirin
Common name of Thromboangiitis obliterans? Buerger disease
Buerger disease is strongly associated with ______________________, with segmental thrombosing vasculitis ________________ and _________________ involvement. smoking; vein and nerve.
Raynaud phenomenon is often present in __________________ disease. Buerger
What is the product of lipid peroxidation? Lipofuscin
In what organ is lipofuscin is often found? Description. Lipofuscin is found in the HEART. It is found in aging cells seen in malnutrition and cachexia and is of yellow-brown color.
Systolic Ejection click, loudest in base of heart, soft S2 Aortic Stenosis (AS)
Which channels are preferred to bind Lidocaine? Inactive Na+ channels and rapidly dissasiociates
Exercise in the Frank-Starling Curve will cause an _______________ in cardiac output and increase in ____________________. Increase; inotropy
No change in normal path of Cardiac output, but negative inotropy? Myocardial Infarct
Negative Inotropy and a decrease in TPR, Dx? Hemorrhage
Change in inotropy means changes in contractility
What conditions cause positive inotropy? Catecholamines, exercise, digoxin
What disorders cause negative inotropy? Heart failure, narcotic OD, and sympathetic inhibition
Fluid infusion, sympathetic activation Increase in Venous return
What can cause a decrease in venous return? Acute hemorrhage
What causes a decrease in TPR? increase TPR? Exercise decrease TPR; Vasopressors increase TPR.
Anterior leaflet of the mitral valve push toward the interventricular hypertrophied septum, Dx? Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy is associated with _____ sound. S4
Holosystolic, high-pitch, "blowing murmur" best heard at the apex of heart, Dx? Mitral Regurgitation (MR)
What murmur is associated with radiation to the axilla? Mitral Regurgitation (MR)
What two diseases are often cause of secondary development of MR? Rheumatic Fever and Infective endocarditis
A reduced Preload and Afterload is accomplished by what medication? Nitroprusside
Nitroprusside decreases ______________________ and ________________. Preload and Afterload
What vessel and blood flow characteristics increase risk of developing atherosclerosis? Vessels that branch and twist constantly, which produce TURBULENT flow.
Which are the two most susceptible vessels for developing atherosclerosis? Lower abdominal aorta and coronary arteries
When is Hibernating myocardium present? LV dysfunction due to reduced coronary blood flow.
What can prevent the effects on IV NE on vasculature? Phentolamine injection (alpha-1 blocker)
What are the extravasation effects of IV NE? Blanching of the vein, and leads to vasoconstriction.
How is the flow of a fistula between the aortic root and the Right ventricle? Continuous blood flow from the Aortic root to the RV.
WHat is the MCC of Enterococcal Endocarditis? Genitourinary instrumentation such as CYSTOSCOPY or CATHETERIZATION.
Bacteria that grows on hypertonic (6.5%) saline and bile, PYR +, and causes NO (gamma) hemolysis. Entococcal bacteria
What are the two common species of Enterococcal bacteria often cause Endocarditis? E. faecalis and E. faecium
Effects of cardiac physiological forces after an MI: 1. Reduced blood pressure 2. Increased distended Jugular vein --> Elevated Central Venous Pressure 3. Decreased PCWP with decreased filling pressures.
Why is the central venous pressure elevated after an MI? There's a backflow of blood, as the heart inability of heart to push blood forward.
Medial degeneration of aorta? Aortic aneurysm
Myxomatous changes with pooling of proteoglycans in the media layer of large arteries found in cystic medial degeneration, produces a predisposition to? Aortic dissection
Pulsatile abdominal mass Abdominal Aortic Aneurysm
Where is the abdominal aortic aneurysm most commonly located? Infrarenal (distal to the origin of renal arteries)
Defective fibrillin-1 glycoprotein Marfan Syndrome
The ingestion of sweat peas is associated to development of __________________ syndrome. Marfan Syndrome
What enzyme is important in the cross linking of elastic fibers, involved in Marfan syndrome? LYSYL OXIDASE
Chronic, repetitive endothelial injury causes ---> Atherosclerosis
Foam cell formation and fatty streaks and endothelial cell damage is part of pathogenesis of which pathology? Atherosclerosis
Thoracic Aortic aneurysm has a association to? Tertiary syphilis
Hyperplastic arteriosclerosis most commonly involves which arteries? Renal arteries
"Onion-skinning" of the renal arteries + Malignant Hypertension, often indicate what diagnosis? Hyperplastic Arteriosclerosis
How else is Malignant Hypertension known? Accelerated hypertension
rapid microvascular damage with necrosis in the walls of small arteries and arterioles + intravascular thrombosis, Dx? Malignant Hypertension
What type of heart failure is often a complication of malignant HTN? Left Heart Failure
What is the clinical presentation of Stable Angina? Exertional chest pain relieved by rest or nitroglycerin
What level of vessel occlusion is required to develop Stable Angina? 70% occlusion
Atherosclerosis is most often associated with _____________ angina. Stable
Secondary to coronary Vasospasm Prinzmetal (Variant) Angina
Stable angina depicts an ___________________, and Prinzmetal angina shows a ______________________, on EKG. ST depression seen in Stable angina ST elevation seen in Variant angina
HTN and hypercholesterolemia are NOT associated risk factors of ____________ angina. Prinzmetal (Variant) Angina
ST elevation and T-wave inversion with no cardiac enzymes, indicates? Unstable Angina
What is the MC treatment of Variant Angina? Ca2+ blockers, nitrates, and smoking cessation.
What is the most common risk factor of Prinzmetal angina? Smoking
Chest pain not relieved with rest or nitrates Unstable angina
Order of worsening anginas: Stable< Variant (Prinzmetal) < Unstable
Cocaine, EtOH, and triptans are triggers of which kind of angina? Prinzmetal (Variant) Angina
Atherosclerotic plaque is made by the _____________________, which releases _______________________, in order to breakdown __________. Fibrous cap; METALLOPROTEINASES; collagen
B-1 receptors use the _________ pathway. Gs
Common ARTERIOLAR vasodilators? Hydralazine and Minoxidil
Side effect of arteriolar vasodilators, such as Hydralazine? Reflex Tachycardia
Pathogenesis of Reflex tachycardia Stimulation of baroreceptors cause a reflex sympathetic stimulation , leading to increased HR, contractility, and CO.
What are the two main SE of arteriolar vasodilators? 1. Reflex activation sympathetic system 2. Peripheral edema by activation of RAAS axis
Stiff heart is commonly seen in ______________________ cardiomyopathy. Restrictive
What kind of diseases demonstrate a increased ventricular cavity size? Ischemic heart disease and dilated cardiomyopathy
Poor ventricular wall compliance leads to impaired Left ventricular filling, such describes? Diastolic dysfunction
What condition depict left dynamic outflow tract obstruction? 1. Left Hypertrophic cardiomyopathy
A right dynamic flow obstruction is seen in: Tetralogy of Fallot
What is the common presentation of Peripheral Arterial disease (PAD)? fatigue, leg pain, discolored with exertion, and poor distal pulses
What is a common drug used in PAD? Citalozol
MoA of Citalozol? Phosphodiesterase inhibitor, that inhibits platelet aggregation and acts a direct arterial vasodilator.
What substances are to be raised in order to cause inhibition of platelet aggregation in the treatment of PAD? Protein Kinase A
Only cells capable of synthesize collagen in atherosclerosis Vascular Smooth Muscle cells (VSMC)
The VSMCs are responsible for producing what structure? Fibrous cap
Metalloproteinases are releases or secreted by the _______________, which was produced by the _______________. Fibrous cap; VSMC
Common condition seen in patient with Malignant HTN? Persistent Diastolic Hypertension
Persistent Diastolic HTN >130 mm Hg
A complication of Malignant HTN is Hypertensive Encephalopathy, which can be accompanied by: Retinal hemorrhages, exudates, or papilledema.
Verapamil can decrease the conduction velocity of the: SA and AV nodes
Embryological deficit or error, in the development of ToF Anterior and Cephalad deviation of the Infundibular septum
VSD, overriding aorta, pulmonary stenosis, symptoms seen in ToF
Kid that squats in order to feel relieved from fatigue or weakness, borned with early cyanosis. Dx? Tetralogy of Fallot
Squatting : Increases PRELOAD, leading to an increase in Peripheral vascular resistance
What are the cardiac abnormalities seen in SLE? SEROSITIS, which is characterized by: 1. Pleurisy, 2. Pericarditis, 3. Peritonitis
What lipid lowering agent is used to reduce LDL and triglycerides? Niacin
Most common and characteristic side effect of Niacin therapy Cutaneous flushing due to Prostaglandins
How is the flushing caused by Niacin may be prevented? Pre-treatment with Aspirin
Mechanisms of action of Niacin: 1. Inhibits hormone-sensitive Lipase --> inhibit lipolysis 2. Reduction of VLDL synthesis
Gout or gout-like symptoms are seen with use of _____________. Niacin
Besides flushing of face, what other side effects are seen with Niacin therapy? Hyperglycemia and Hyperuricemia
Which lipid-lowering agent increases the risk of developing cholesterol gallstones? Fibrates
Decreased fat soluble vitamin absorption is seen as a side effect of _________________________ therapy in lipid lowering treatment. Bile acid resins
What enzyme is inhibited by statins? HMG-reductase
What product is prevented from synthesis by actions of statins? Mevalonate
What are the most important side effects seen statin therapy? Hepatotoxicity and Myopathy
Side effects of statins are seen even more pronounced by co-administration with? Niacin and Fibrates
Why are cholesterol gallstones formed in Fibrate therapy? Inhibition of cholesterol 7a-hydroxylase
Which kind of lipid-lowering agent has similar LDL, HDL, and TG profile as statins? PCSK9 inhibitors
Alirocumab and Evolucumab PCSK9 inhibitors
Which lipid lowering agents decrease the most LDL? Statins and PCSK9 inhibitors
All kind of lipid lowering agents, which are known to cause focal and nonfocal neurological deficits as a side effect? PCSK9 inhibitors
Using Naproxen in Niacin therapy may help to reduce the risk of: Red, flushing face
How is TG clearance achieved in Fibrate therapy? Upregulation of LPL
Besides the upregulation of LDL to increase TG clearance by fibrates, this lipid-lowering agent has another MoA, which is? Activation of PPAR-alpha to induce HDL synthesis
Activation of PPAR-a --> Fibrate therapy MoA
Fibrates' activation of PPAR-a is to ____________________, and the upregulation of _________, is to ______________________. make more HDL; LPL; get rid of Triglycerides
Which lipid-lowering agent type, forces the liver to use more cholesterol to synthesize bile acid? Bile acid resins
Bile acid is made of ________________________ cholesterol
Actions of PGI2 opposes those of ___________________ Thromboxane A2
Prostacyclin (PGI2): is produced by _____________. It ________________ and INHIBITS _______________________, leading to increased vascular ______________. Prostacyclin H2 by Prostacyclin synthase; vasoDILATES; Inhibits platelet aggregation; Increase vascular permeability
If PGI2 produces vasodilation arteries and does not allow plt aggregation, then Thromboxane A2: Vasoconstriction and stimulates clotting.
What is a common vitamin K dependent factor made in the liver, and involved in the coagulation cascade? Protein C
Protein C function Inactivation of factors 5a and 8a
Myosin binding to Protein C mutation is seen: Hypertrophic cardiomyopathy
Activated Protein C participates in Anticoagulation by cleaving factors 5a and 8a
Inactive Protein C is part of the ____________________ process Coagulation
Thrombotic skin necrosis after administration of Warfarin. Suspect what Hypercoagulability disorder? Protein C or S deficiency
Inability to inactive factors 5a and 8a is seen in __________________, leading to increased risk of _____________________ events. Protein C or S deficiency; Thrombotic
Common cause of Secondary (functional) Mitral Regurgitation Decompensated HF
Signs of LOW PERFUSION in Decompensated Heart failure include: 1. Cold Extremities 2. Low urine Output 3. Altered mental status 4. Poor response to IV diuretics 5. Prerenal azotemia
What are some signs/clinical manifestations of CONGESTION seen in acute Decompensated HF? Increased JDV, Peripheral Edema, S3, Orthopnea, Rales, and weight gain
Decompensated HF seen with Low Perfusion and High congestion? Wet and Cold HF
Decompensated HF seen with High Perfusion and Congestion? Wet and Warm HF
Increasing the CONGESTION in HF, means making Decompensated HF more _______. Wet
Increasing the HF PERFUSION status, means labeling Decompensated HF more and more ___________. Warm
In the LV Pressure vs LV volume loop graph, the changes seen in Aortic stenosis, resemble the most those seen with: Increased AFTERLOAD
When is the maximum intensity of AS? At maximum level of gradient between the LV and the Aorta pressures
Mutation to the Potassium-channel protein is seen in which congenital disorder? Congenital Long QT syndrome
What occurs to the movement of K+ in Long QT syndrome? Reduction in K+ - efflux, producers prolongation of the ACTION POTENTIAL leading to elongation of the QT interval.
What are risk of complication seen in Long QT syndrome? Ventricular arrhythmias such as Torsades de Pointes and VTACH
What color do Psammoma bodies stain? Dark purple
Rheumatic heart disease occurrence of dysphagia is mostly seen because of: Left atrium compression of the Esophagus.
The _______________ is the most __________________ heart chamber, as seen in a CT scan. Left Atrium; POSTERIOR
In relation to a CT view of the heart, describe the anatomical(cardinal) position of the heart chambers. Right Ventricle -- NORTH (most anterior chamber) Left Atrium --SOUTH (most posterior chamber) Right Atrium -- WEST Left Ventricle -- EAST
The esophagus compression by LA enlargement causes dysphagia, but the LA can also compress the __________________ provoking _________________. Recurrent Left Laryngeal Nerve; hoarseness of the voice.
Arginine and nitric oxide synthase, produce? Nitric Oxide
Pretreatment with which amino acid, has been beneficial in Stable angina? Arginine as it may cause Vasodilation
Nitric Oxide (NO) is made by: ARGININE and NO synthase
Hypotension, muffled heart sounds, elevated JVD Beck's Triad
Becks triad + Pulsus paradoxus Cardiac Tamponade
X-ray of heart described as" Water bottle" Cardiac Tamponade
Anatomical point for Pericardiocentesis? Paraxiphoid area
Ultrasound finding in Cardiac Tamponade Late diastolic collapse of the right atrium, due to primordial fluid
Pericardial rub described in auscultation, most commonly seen in? Cardiac tamponade
Aortic Regurgitation, Mitral Stenosis, and Continuous PDA Diastolic Murmurs
Decrescendo at LUSB indicates: Aortic Regurgitation, most likely of valvular origin
What valvular condition predispose development of AR? Bicuspid aortic valve, and Rheumatic Heart disease
Marfan Syndrome is associated to ___________________ conditions, that predispose to the development of ___________ best heard at the ____________. Aortic Root disease; Aortic Regurgitation; RUSRB
Mitral Stenosis auscultation description: OPENING SNAP followed by mid-systolic rumble with presystolic accentuation.
Mitral Stenosis --_____________________________. Aortic Stenosis -- ____________________________. ASD --________________________________. OPENING SNAP - MR EJECTION CLICK -- AS WIDE & FIXED S2 SPLIT --ASD
Machine-like sound murmur PDA
Radiation to Carotids murmur Aortic Stenosis (AS)
Radiation to the Axilla murmur Mitral Regurgitation (MR)
Very small crescendo - decrescendo, best heard at mid-sternal border Hypertrophic cardiomyopathy
Mid Systolic click + late systolic murmur MVP
Holosystolic murmur best heard at Left sternal border VSD
Midsystolic murmur with a wide-fixed S2 split ASD
Systolic Murmurs: AS, MR, IHSS, MVP, ASD, and VSD
What disorders are associated to cause Restrictive Cardiomyopathy? Amyloidosis, Sarcoidosis, and Hemochromatosis
Spironolactone effect on cardiac functions: Increase ventricular ejection fraction
Which diuretic increases the ventricular EF? Spironolactone
Spironolactones effect on ventricular EF, is due to: ventricular remodeling
What drugs cause Coronary "Steal"? Adenosine and Dipyridamole
When is Coronary Steal seen in cardiac muscle? MI as blood flow is limited and perfusion is affected.
The use of adenosine in Coronary Steal, causes: No change in blood flow, and an increase in perfusion.
62 yo male, hypertensive, seen with a palpable pulsating abdominal mass. Dx? Abdominal Aortic aneurysm
Transmural inflammation and matrix degeneration within wall of aorta, leading to weakening and expansion of aorta, specifically below the renal arteries. Most common Dx? Abdominal Aortic aneurysm
Focal intimal tear, tearing chest pain, with radiation to the back? Aortic Dissection
Overall increase in heart rate and contractility, leads to an increase in: Myocardial oxygen consumption
tPA: Converts PLASMINOGEN into PLASMIN
What is the role of Plasmin? Breakdown of CLOTS
What are some tPA- analogues? Alteplase, Teneplase, and Streptokinase.
Pulsus Paradoxus occurs during ___________________ Inspiration
What are Korotkoff sounds? Sounds recorded while taking BP
Low frequency sound just before S1 at the end of diastole. S4
Murmur that radiates to the axilla best heard at the heart's apex. Mitral Regurgitation (MR)
The joining of the Cardinal veins create the ________________. Superior Vena Cava (SVC)
What vessels during embryology form the IVC? Right and Left common Iliac veins at the L4-L5 level.
Patient develops endocarditis after surgical repair of a prosthetic valve. Which organism is associated with that infective endocarditis? Staph epidermidis
Orthopnea is a classic symptom of ____________________________. Left-sided Heart failure
Common complication 2-4 days after MI Pericarditis
Sharp, pleuritic pain, increased by swallowing and relieved by leaning forward. Pericarditis
Diastolic decrescendo murmur, widened pulse pressure and abrupt carotid distension Aortic Regurgitation (AR)
"Head-bobbing" Aortic Regurgitation (AR)
Which artery is commonly accessed to reach the lower extremity? Common Femoral artery
Cannulation of the Common Femoral artery increases the risk of ___________________________. Retroperitoneal hemorrhage
Baroreceptors of the neck stimulate which cranial nerve? CN 9 Glossopharyngeal
The ______________ baroreceptors are associated with cranial nerve _________. Aortic; 10
What normal changes are expected in normal aging? 1. Decreased LV chamber size 2. "S"-shaped Ventricular Septum 3. Accumulation of Lipofuscin
When is AR seen with the highest intensity? Just after A2
AR is best heard right after ________________________. Expiration
Created by: rakomi