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Cardiology

FA complete review

QuestionAnswer
What structures are originated from the Endocardial cushion? Atrial septum, membranous interventricular septum; AV and semilunar valves
The primitive pulmonary vein gives to --> Smooth part of the Left atrium
The left horn of the sinus venosus gives rise to the: Coronary sinus
What structure is derived from the right horn of the sinus venosus? Smooth part of the right atrium
What veins give rise to the Superior vena cava (SVC)? Right common cardinal vein and right anterior cardinal vein
The Bulbus cordis gives rise to the: Smooth parts (outflow tract) of left and right ventricles
What gives rise to the Ascending aorta and pulmonary trunk? Truncus arteriosus
At what week of development does the heart beat spontaneously? Week 4
Another name for Kartagener syndrome? Primary ciliary Dyskinesia
Defect in left-right Dynein leads to: Dextrocardia
What is the cause of the Patent Foramen Ovale? Failure of septum primum and septum secundum to fuse after birth
What is a common complication in PFO? Paradoxical emboli
What is Paradoxical emboli? Venous thromboemboli that enter systemic arterial circulation
Where does VSD is most commonly occuring? Membranous septum
What are some conotruncal abnormalities associated with failure of neural crest cells to migrate? 1. Transposition of great vessels 2. Tetralogy of Fallot 3. Persistent truncus arteriosus
What is the percentage of oxygen saturation in blood in umbilical vein? 80%
What is the PO2 in Umbilical vein? 30 mmHg
The ductus venosus provides bypassing of: Hepatic circulation
What is the postnatal derivative of the Allantois? Median umbilical ligament
What is the Urachus? Part of allantoic duct between bladder and umbilicus
The Notochord becomes the ____________________ after birth. Nucleus pulposus
Which fetal structure gives rise the the Medial umbilical ligaments? Umbilical arteries
The fetal umbilical vein becomes the ____________________________ after birth, and it contains the ______________________. Ligamentum teres hepatis (round ligament); Falciform ligament.
What coronary artery supplies the right ventricle? Right (acute) marginal artery
What areas are irrigated by the PDA? -AV node - Posterior 1/3 of interventricular septum - Posterior 2/3 walls of ventricles - Posteromedial papillary muscle
What areas are irrigated by the LAD? - Anterior 2/3 of interventricular septum - Anterolateral papillary muscle - Anterior surface of the left ventricle
The LCX supplies: Lateral and Posterior walls of the left ventricle and anterolateral papillary muscle.
What is the most posterior part of the heart? Left atrium
What are possible complications of Left atrium enlargement? 1. Dysphagia (compression of the esophagus) 2. Hoarseness (compression of the Left recurrent Laryngeal nerve)
What is a branch of the Vagus nerve, that causes hoarseness upon compression by the left atrium? Left Recurrent Laryngeal Nerve
The pericardial cavity is between which Pericardium layers: Parietal and Visceral layers
Pulse pressure = Systolic pressure - Diastolic pressure
Which conditions are seen with increased pulse pressure? Hyperthyroidism, aortic regurgitation, aortic stiffening (isolated systolic hypertension in elderly), obstructive sleep apnea (increase sympathetic tone), anemia, exercise (transient)
A decrease in pulse pressure is seen with: Aortic stenosis, cardiogenic shock, cardiac tamponade, advanced heart failure (HF).
What condition can cause a decrease in Diastole? Increase in heart rate
Less filling time (diastole) ---> Decreased CO
How is CO maintained in late stages of exercises? Increased heart rate only (SV plateaus)
MAP = CO x TPR
SV = EDV - ESV
CO = SV x HR
CO = rate of O2 consumption -------------------------------------------------------- (arterial O2 content - venous O2 content)
Which conditions decrease Contractility? - B1-blockade (decrease cAMP) - HF with systolic dysfunction - Acidosis - Hypoxia/Hypercalcemia - Non-dihydropyridine Ca2+ channel block
What condition increase Contractility? 1. Catecholamine stimulation via B1 receptor 2. Increase intracellular Ca2_+ 3. Decrease in extracellular Na+ 4. Digitalis
What value can approximate Preload? Ventricular EDV
Preload depends on: Venous tone and circulating blood volume
Venous vasodilators ---> Decrease preload
What is a very common venous vasodilator? Nitroglycerin
Afterload can be approximated by: MAP
What is a common arterial vasodilator? Hydralazine
Arterial vasodilators ---> Decrease Afterload
Which type of medications can decrease both preload and afterload? ACE inhibitors and ARBs
In relation to afterload pressure, how is LV hypertrophy developed? Chronic hypertension (increase MAP)
Increase in all the following lead to myocardial O2 demand increase: Contractility, Afterload, Heart rate, and Diameter of ventricle
An increase of diameter of ventricle means = Increase wall tension
How is Ejection Fraction affected in Systolic HF? Decrease
What anatomical structure has the highest cross-sectional area and lowest flow velocity? Capillaries
What structure account for most of TPR? Arterioles
Viscosity depends mostly on ____________________. Hematocrit
What conditions increase viscosity? Hyperproteinemia states (multiple myeloma), polycythemia
What condition leads to a decrease in viscosity? Anemia
Resistance in series is added : R t = R1 + R2 + R3......
Total resistance of vessels in parallel are added in: 1/Rt = 1/R1 + 1/R2 +1/R3......
What are common examples of things that Increase Inotropy? Catecholamines, digoxin (+), and exercise
An increase in Inotropy causes an ____________________ shift in the Cardiac function curve. Increase
What are examples of activities that cause a negative Inotropy change? HF with reduced EF, narcotic overdose, and sympathetic inhibition.
Changes in Inotropy basically mean: Changes in contractility --> change in preload
What are some things that cause an increase in venous return? Fluid infusion, sympathetic activity
Acute hemorrhage and spinal anesthesia (-) are examples of actions that cause: A decrease (downward shift) in the Venous return curve
The use of vasopressors cause what changes in the Cardiac and vascular function curves? Increase in in TPR
What are examples of things that cause a decrease in TPR? Exercise, and AV shunt (-)
Compensatory changes in the Cardiac and Vascular function curves: HF decreases inotropy -----> fluid retention to increase preload and maintain CO
What is the ultimate goal of reinforcing changes in the Sterling curve? Maximize CO
What specific changes will maximize CO? Exercise to increase inotropy and a decrease in TPR.
What changes accompany an increase in Contractility? Increased SV and EF, and a decrease in ESV
An increase in Afterload is seen with which other changes? Increase in Aortic pressure and ESV, and a decrease in SV.
Increase in preload also indicates an increase in: Stroke volume
Isovolumetric contraction: Period between mitral valve closing and Aortic valve opening
Which phase of the Pressure-Volume Loop is characterized with the highest O2 consumption? Isovolumetric Contraction
What closedure indicate Isovolumetric relaxation? Period between aortic valve closing and mitral valve opening
To which ventricle is the Pressure-Volume loop directed? Left Ventricle
What causes the S1? Mitral and Tricuspid valve closure
Where is the S1 the loudest? Mitral area
What caused the S2? Aortic and pulmonary valve closure
Best area to auscultate for an S2 is ---> Left upper sternal border
At what stage of the Pressure volume loop is the S3 found? In early diastole during rapid ventricular filling phase
What pathological heart sound is associated with increased filling pressures? S3
What conditions are typical of showing a S3? Mitral regurgitation and HF; especially in DCM.
Which population is normal to develop and S3? Children, young adults, and pregnant woment
The "atrial kick" is referred to the _______. S4
Which abnormal heart sound is found at late diastole? S4
What is the best way to listen to a S4? At apex of heart with patient in left lateral decubitus positon
Why is there an S4 in HCM? Left atrium must push against still LV wall
In the JVP, which wave represents atrial contraction? a wave
In the JVP, the c-wave depicts? RV contraction
Patient with AFIB, is probably missing which wave in the JVP tracing? a wave
Increase in Right Atrial pressure due to filling against Tricuspid valve, is indicated in JVP with: v-wave
Which condition depicts a prominent y-descent in the JVP? Constrictive Pericarditis
Absent y-descent on JVP is often seen in patients with: Cardiac tamponade
What is the direct effect of inspiration? Drop in intrathoracic pressure
Normal splitting is due to: Delayed closure of pulmonic valve
What conditions are seen with Wide Splitting? Pulmonic stenosis, RBBB
Wide splitting is due to: Delay RV emptying
What can increase the intensity of Wide Splitting? Inspiration
What kind of split is associated with ASD? Fixed split
The ASD causes: Left-to-right shunt ---> Increase in RA and RV volumes ---> Increase flow through the pulmonic valve, regardless of respiration.
What is the cause of the conditions that cause Paradoxical splitting? Delay aortic valve closure
What are some conditions associated with Paradoxical splitting? Aortic stenosis, LBBB
In which type of splitting the order order of valve closure is reversed? Paradoxical splitting
Which sounds occurs first in Paradoxical splitting? P2
What action can "eliminate" Paradoxical splitting? Inspiration
Inspiration causes: Increase venous return to right atrium
What bedside maneuver can be performed to increase the volume reaching the Right atrium? Inspiration
Inspiration increases the intensity of ________ heart sounds Right
Hand grip causes an: Increase in afterload
Which murmurs are increased in intensity by Hand grip? MR, AR, and VSD
How is Preload affected by Valva Phase II and Standing up? Decrease
What actions can increase the intensity of Hypertrophic cardiomyopathy murmur? Valsalva II and Standing up
What happens to Preload, Afterload and venous return with Rapid Squatting? All three increase
What murmurs are intensified with Rapid squatting? AS, MR, and VSD
HCM murmur decreases intensity with? Rapid Squatting
Which are the Systolic murmurs? 1. Aortic/Pulmonary stenosis 2. Mitral/Tricuspid regurgitation 3. VSD, MVP, HCM
Which are the Diastolic murmurs? 1. Aortic / Pulmonic regurgitation 2. Mitral/Tricuspid stenosis
Which are the 3 Holosystolic Murmurs? TR, VSD, and MR
Which 3 murmurs are best heard in the Left Sternal border? AR, PR, and HCM
Crescendo-decrescendo systolic ejection murmur and soft S2 + Ejection click Aortic Stenosis
Which murmur radiates to the carotids? Aortic Stenosis
What is "Pulsus parvus et tardus"? Pulses are weak with a delayed peak
What characteristic pulse is associated with Aortic Stenosis? Pulsus parvus et tardus
Holosystolic, high-pitched "blowing murmur" Mitral/Tricuspid regurgitation
Loudest at apex and radiates toward axilla Mitral regurgitation
What murmur is due to RV dilation? Tricuspid regurgitation
What are the MCC of MR? Ischemic heart disease (post-MI), MVP, and LV dilation
Late systolic crescendo murmur with midsystolic click Mitral valve prolapse
What is the MCC of MVP? Sudden tensing of chordae tendineae
When is MVP the loudest? Just before S2
What are some conditions associated with the development of MVP? Myxomatous degeneration (Primary or secondary connective tissue disease such as Marfan or Ehlers-Danlos syndrome), Rheumatic fever, chordae rupture
Holosystolic , harsh-sounding murmur VSD
VSD is best hear te the _______________ area. Tricuspid
High-pitched "blowing" early diastolic decrescendo murmur Aortic regurgitation
Long diastolic murmur, hyperdynamic pulse, and head bobbing are seen in: Aortic regurgitation
What are the MCC of Aortic regurgitation? Aortic root dilation, bicuspid aortic valve, endocarditis, rheumatic fever
Untreated AR may lead to ----> Left Heart Failure
Which murmur follows an Opening Snap? Mitral Stenosis
What is the cause of the Opening Snap in MS? Abrupt halt in leaflet motion in diastole, after rapid opening due to fusion a t leaflet tips
What is a common and highly specific sequelae on untreated Rheumatic fever? Mitral Stenosis
Chronic MS causes _________________________, leading to hoarseness and dysphagia. LA dilation
What is the MCC of PDA? Congenital rubella or prematurity
Continuous machine-like murmur Patent ductus arteriosus
Phase 0 is in myocardial AP: rapid upstroke and depolarization
What channels are open in Phase 0 in myocardial AP? Voltage gated Na+ channels
Initial repolarization in cardiac muscle AP? Phase 1
The inactivation of voltage-gated Na+ channels, and the beginning of voltage-gated K+ opening, in cardiac muscle Phase 1
Phase 2 of Myocardial AP is: Plateau; Ca2+ influx through voltage-gated Ca2+ channels balance K+ efflux
What occurs with the Ca2+ influx to myocyte? Triggers Ca2+ release from Sarcoplasmic reticulum and myocyte contraction.
Phase 3 of Myocardial action potential is known as: Rapid repolarization
Which is the Resting potential phase in cardiac AP? Phase 4
High K+ permeability through K+ channels Phase 4
Why does rapid repolarization occurs? massive K+ efflux due to opening of voltage-gated slow K+ channels and closedure of voltage-gated Ca2+ channels.
Which action potential cell type, has a "platuem" ? Cardiac muscle
What ion is required by cardiac muscle in order to produce contraction? Calcium
The sentence "Ca2+-induced Ca2+ release" most relates to which type of muscle Action Potential? Cardiac muscle contraction
How are Cardiac myocytes electrically coupled to each other? Gap junctions
What value is normal for cardiac muscle Effective Refractory period? 200 msec
Where does the pacemaker action potential occurs? SA and AV nodes
In Pacemaker AP, which ion voltage channel opening is responsible for Phase 0 (upstroke)? Calcium
How are the Fast voltage-gated Na+ channels in Pacemaker AP? Permanently inactivated
Which phases are missing in Pacemaker AP? Phase 1 and Phase 2
Phase 3 in Pacemaker AP is known as: Repolarization
Inactivation of Ca2+ channels and increased activation o K+ channels ---> K+ efflux. Describes? Phase 3 of Pacemaker AP
Phase 4 in Pacemaker AP is due to: slow spontaneous diastolic depolarization due to If
What is the roles of If channels? Slow, mixed Na+/K+ inward current
Which phase accounts for the AUTOMATICITY of SA and AV nodes? Phase 4
What in the Pacemaker AP determines the heart rate? The slope of Phase 4 in the SA node
What would ACh/Adenosine cause to heart rate? Decrease the rate of diastolic depolarization leading to decreased HR
What substances can be used to increase rate of Pacemaker AP depolarization and increase heart rate? Catecholamines
What are the divisions of the Left Bundle branch? Left anterior and Left Posterior fascicles
Which "pacemaker" is inherent dominance with slow phase of upstroke? SA node
Which artery supplies the AV node? RCA
What is the rates of the pacemaker? SA node > AV node > bundle of His/Purkinje/ ventricles
Which pacemaker has the fastest speed of conduction? Purkinje > atria > ventricles > AV node
What wave in the ECG represents atrial depolarization? P-wave
The PR interval represents? Time from start of atrial depolarization to start of ventricular depolarization
Ventricular depolarization in the ECG is represented with: QRS complex
T-wave on ECG represents: ventricular repolarization
What conditions lead to creation of a U wave in the EKG? Hypokalemia and bradycardia
Torsades de pointes: Polymorphic ventricular tachycardia, characterized by shifting sinusoidal waveforms on ECG
What is the most severe complication of Torsades de Pointes? Ventricular fibrillation
What are the main causes of Torsades de Pointes? Drugs, hypokalemia, decreased Mg2+, and congenital abnormalities
What is the MC treatment for Torsades de Pointes? Magnesium sulfate
What antiarrhythmics are related to development of Torsades de pointes? Class IA and III
Which kind of antibiotics often have Torsades de pointes as a SE? Macrolides
Person on Haloperidol should be monitored for which ECG abnormality? Torsade de Pointes
Ondansetron is often used to control chemotherapy-induced emesis, but it can cause ____________________ in ECG. Torsade de Pointes
What are the two most common disorders that cause and abnormally long QT interval? 1. Romano-Ward syndrome 2. Jervell and Lange-Nielsen syndrome
What is the most common cause of death in patients with Congenital long QT syndrome? Torsade de Pointes
What is the the main clinical difference in a patient with Romano-Ward syndrome and one with Jervell and Lange-Nielsen syndrome? Jervell and Lange-Nielsen syndrome have sensorineural deafness.
ECG pattern of pseudo-right bundle branch block and ST elevations in V1-V3. Brugada syndrome
What kind of population is MC to be affected by Brugada Syndrome? Asian males
What is the best treatment for Brugada syndrome? Implantable cardioverter-defibrillator (ICD)
What is the MC type of ventricular pre-excitation syndrome? Wolff-Parkinson-White syndrome
ECG delta wave is characteristic of which syndrome? Wolff-Parkinson-White syndrome
Abnormal fast accessory conduction pathway from atria to ventricle (bundle of Kent) bypasses the rate-slowing AV node? Wolff-Parkinson- White syndrome
What is a severe complication of WPW syndrome? SVT
What is a associated disease with the development of 3rd degree AV block? Lyme disease
What is the function of ANP? Increase blood volume and atrial pressure
ANP causes: Vasodilation and decreased Na+ reabsorption at the renal collecting tubule
What are the effects on the efferent and afferent arterioles by ANP? Dilates afferent renal arterioles and constricts efferent renal arterioles
What substance promotes and contributes the "aldosterone escape"? ANP
BNP is secreted by ventricular myocytes in response to? Increased ventricular tension
What is good negative predictive value for diagnosis HF? Elevated BNP levels
Aortic arch receptors transmit via? Vagus nerve to solitary nucleus of medulla
Aortic arch receptors respond to: a decrease or increase in Blood pressure
Carotid sinus receptors transmit via the: Glossopharyngeal nerve to solitary nucleus of medulla
What is the normal pressure in the Right Atrium? < 5 mm Hg
What is the normal pressure in the Right Ventricle? 25/5 mm Hg
What area in the heart has a pressure of 25/10 mm Hg? Pulmonary vein
What is the normal pressure of PCWP? 4-12 mm Hg
What is the normal pressure seen in a healthy Left atrium? < 12 mm Hg
What is the recorded pressure in the Left ventricle? 130/10 mm Hg
What is autoregulation in relation to blood circulation? Blood flow to an organ remains constant over a wide range of perfusion pressures
What heart factors determine autoregulation? Local metabolites (vasodilatory); adenosine, NO, CO2, and decreased Oxygen.
What factors determine autoregulation in the lungs? Hypoxia causes vasoconstriction
What is unique about pulmonary vasculature ? During hypoxia causes vasoconstriction so teha only well-ventilated areas are persuasive.
In most orgasn, except the lungs, hypoxia causes? Vasodilation
What is the most important factor in skin autoregulation? Sympathetic stimulation to control temperature.
What are local metabolites, used by skeletal muscle, that determine blood autoregulation? Lactate, adenosine, K+, H+, and CO2.
Pc (capillary pressure) causes: pushes fluid out of capillary
What force is in charge of pushing fluid into capillary? Pi (interstitial fluid pressure)
Heart failure causes edema due to changes in what Starling force? Increased capillary pressure
Which syndromes are characterized by a decrease in plasma proteins? Nephrotic syndrome, liver failure, and protein malnutrition
A decrease in plasma colloid osmotic (oncotic) pressure is represented by: rr c (pi c); which pulls fluid into capillary
What is the cause of Persistent truncus arteriosus? Truncus arteriosus fails to divide into pulmonary truck and aorta due to lack of aorticopulmonary septum formation
What kind of septum defect is often seen with Persistent truncus arteriosus? VSD
Failure of the aorticopulmonary septum to spiral D-Transposition of great vessels
Tricuspid atresia requires of ________________________ to survive. VSD and ASD
What is the MCC of Tetralogy of Fallot? Anterosuperior displacement of the infundibular septum.
What is the MCC of childhood cyanosis? Tetralogy of Fallot
What are the main four symptoms seen in ToF? 1. Pulmonary infundibular stenosis 2. Right Ventricular hypertrophy 3. Overriding aorta 4. VSD
What is the main determinant of prognosis in ToF? The degree of Pulmonary stenosis
Pulmonary stenosis in ToF causes: 1. Forces R-to-L flow across the VSD --> RVH
Why does squatting help cyanosis in a ToF patient? It increases SVR and decreases the Right to Left shunt
What condition is characterized by the Pulmonary veins draining into the right heart circulation? Total anomalous pulmonary venous return
What kind of anomaly is associated with Lithium use during pregnancy? Ebstein anomaly
What conditions are associated with Ebstein anomaly? Tricuspid regurgitation and Right HF
Ebstein anomaly is: Displacement of tricuspid valve leaflets downward into RV, artificially "atralizing" the ventricle.
Right-to-Left shunts cause "blue ______________" babies
Left-to-Right shunts cause "blue _______________" kids
Right to left shunts produce ---> ________________ cyanosis Early
Left to right shunts produce -----> _______________ cyanosis Late
VSD oxygen saturation is: Increased in RV and pulmonary artery
What is the MC congenital heart defect? VSD
What congenital heart defect is due to abnormal interatrial septum? ASD
What anatomical areas of the heart have increased O2 saturation in ASD? RA, RV and pulmonary artery
Which Left to Right shunt defect has a Loud S1; wide, fixed split S2? ASD
Ostium secundum defects are most common cause of: ASD
What is an uncorrected Left-to-Right shunt complication? Eisenmenger syndrome
Why is there development of Pulmonary arterial hypertension in an uncorrected L-to-R shunt? The increased pulmonary blood flow due to the ASD, VSD, or PDA, cause pathologic vascular remodeling, leading to Pulmonary HTN.
What is the compensation mechanism for Eisenmenger syndrome? Right Ventricular hypertrophy, which causes the "functional" reversal of the shunt.
What are some clinical complications of Eisenmenger syndrome? Late cyanosis, clubbing, and polycythemia
What condition is associated with Turner syndrome? Coarctation of the aorta
Hypertension in the upper extremities and weak, delayed pulse in lower extremities? Brachial-Femoral delay seen in Coarctation of the aorta
Notched ribs appearance on CXR? Coarctation of aorta
What are some complications of Coarctation of the aorta? HF, cerebral hemorrhage (berry aneurysms), aortic rupture, and possible endocarditis.
What congenital cardiac defects are associated with Fetal alcohol syndrome? VSD, PDA, ASD, and tetralogy of Fallot
Congenital rubella is seen with: PDA, pulmonary artery stenosis, and septal defects
Infant of diabetic mother often develops? Transposition of the great vessels
A patient with Williams syndrome is associated with which congenital heart defects? Supravalvular aortic stenosis
The 22q11 syndromes are associated with: Truncus arteriosus and tetralogy of Fallot
What differentiates hypertensive urgency from Hypertensive emergency? Emergency shows evidence of acute end-organ damage
What are examples of acute end-organ damage in hypertension? Encephalopathy, stroke, retinal hemorrhages and exudates, papilledema, MI, HF, aortic dissection, kidney injury, microangiopathic hemolytic anemia, eclampsia.
Plaques or nodules composed of lipid-laden histiocytes in skin? Xanthomas
Eyelid xanthoma is known as: Xanthelasma
What are Tendinous xanthoma? Lipid deposit in tendon, especially Achilles
What is the MC reason for appearance of Corneal arcus in a young patient? Hypercholesterolemia
What are the two types of Arteriosclerosis? Hyaline arteriosclerosis and Hyperplastic arteriosclerosis
What is and associated diseases of Hyaline arteriosclerosis? Thickening of vessel walls in essential hypertension or diabetes mellitus
Hyperplastic arteriolosclerosis? "Onion skinning" in severe HTN with proliferation of smooth muscle cells
What types of vessels are affected by Arteriosclerosis? Small arteries and arterioles
Form of arteriosclerosis caused by buildup of cholesterol plaques. Atherosclerosis
Atherosclerosis pathogenesis: Endothelial cell dysfunctin ---> macrophage and LDL accumulation ---> foam cell formation --> fatty streaks --> smooth muscle cell migration, proliferation, and extracellular matrix deposition --> fibrous plaque --> complex atheromas.
Which type of aortic aneurysm is associated with Atherosclerosis? Abdominal aortic aneurysm
What condition is related with palpable pulsatile abdominal mass? Abdominal aortic aneurysm
What type of aortic aneurysm is associated with cystic medial degeneration? Thoracic aortic aneurysm
What are risk factors are associated with Thoracic aortic aneurysm? Hypertension, bicuspid aortic valve, connective tissue disease (Marfan syndrome).
What area is at most risk of an traumatic aortic rupture? Aortic isthmus
Where is the aortic isthmus? Proximal descending aorta just distal to origin of the Left Subclavian artery.
Longitudinal inteama tear of the aorta foring a false lumen? Aortic dissection
What are the associated clinical features seen in a patient with presenting aortic dissection? Tearing chest pain, of sudden onset, radiating to the back +/- markedly unequal BP in arms.
What is the Stanford type A aortic dissection? Proximal; involves the Ascending aorta
What is the treatment for Stanford A dissection? Surgery
What is the treatment for Stanford B dissection? B-blockers, followed by vasodilators
What area is involved in a Stanford B aortic dissection? Distal; involves descending aorta and/or aortic arch.
Chest pain due to ischemic myocardium secondary to coronary artery narrowing or spasm; no myocyte necrosis Angina
What is the MCC of Stable angina? Secondary to atherosclerosis
What is the MCC of Variant (Prinzmetal) angina? Secondary to coronary artery spasm
What are common triggers of Variant angina? Ca2+ channel blockers, nitrates, and smoking cessation.
Type of angina that is due to thrombosis with incomplete coronary artery occlusion: Unstable angina
Free wall rupture: Produces tamponade; 5-14 days after initial MI
What is a key characteristic of Papillary muscle rupture? Mitral regurgitation
Chronologically, usually which occurs first as a Post MI complication, Papillary Muscle rupture or Ventricular free wall rupture? Papillary Muscle rupture
What post-MI complication is seen with friction rub? Postinfarction fibrinous pericarditis
What are the common findings seen in Dilated cardiomyopathy? HF, S3, systolic regurgitant murmur, dilated heart on echocardiogram, ballon appearance of heart on CXR.
Which viral agent often causes DCM? Coxsackie B virus
Which are some common causes of DCM? Chronic alcohol abuse, wet Beri beri, Coxsackie B virus, chronic cocaine use, Chagas disease, Doxorubicin toxicity, hemochromatosis, sarcoidosis, peripartum cardiomyopathy.
Dilated cardiomyopathy is seen with __________________ dysfunction. Systolic
What kind of hypertrophy is associated in DCM? Eccentric (added in series)
Hypertrophic cardiomyopathy is autosomal ___________________ inheritance. Dominant
Marked ventricular hypertrophy, often septal predominance. Myofibrillar disarray and fibrosis. Hypertrophic cardiomyopathy
What is the mutation that causes HCM? B-myosin heavy-chain mutation
Sudden death in young athletes? Hypertrophic cardiomyopathy
What are the common findings in Hypertrophic Cardiomyopathy? S4, systolic murmur.
Which two cardiomyopathies have diastolic dysfunction? Hypertrophic and Restrictive
What is Loffler syndrome? A common cause of Restrictive cardiomyopathy, seen with endomyocardial fibrosis with a prominent eosinophilic infiltrate
What cardiomyopathy is most associated with amyloid deposition? Restrictive/Infiltrative cardiomyopathy
What are the main 3 signs of Left Heart failure? Orthopnea, Paroxysmal nocturnal dyspnea, and Pulmonary edema
What are the 3 main signs of Right Heart failure? Hepatomegaly (nutmeg liver), Jugular venous distension, and Peripheral edema
What's orthopnea? Shortness of breath when supine
What is Paroxysmal nocturnal dyspnea? Breathless awakening from sleep
What are "HF cells"? Seen in LHF pulmonary edema; made up of hemosiderin-laden macrophages
What are common causes for an Hypovolemic shock? Hemorrhage, dehydration, and burns
What are the MCC of Cardiogenic Shock? Acute MI, HF, valvular dysfunction, and arrhythmia
Obstructive shock is due to: Cardiac tamponade, pulmonary embolism
Sepsis, anaphylaxis, and CNS injury are common causes of __________________ shock. Distributive shock
What is the main change in Hypovolemic shock? A decrease in PCWP (preload)
Cardiogenic and obstructive shock main deficit is due to a decreased: Cardiac output
Which type of shock has the greatest decrease in SVR (afterload)? Distributive shock
What is the most common cause of Dry Distribute shock? CNS injury
How is the skin in Hypovolemic, Cardiogenic, and Obstructive shock? Cold and clammy
What is the treatment for cardiogenic shock? Inotropes and diuresis
FROM JANE: Fever Roth spots Osler nodes Murmur Janeway lesions Anemia Nail-bed hemorrhage Emboli
What is the most common organism to cause Subacute bacterial endocarditis? viridans streptococci
What is a common heart sequelae of dental procedures Subacute bacterial endocarditis
Which type of bacterial endocarditis has a gradual onset? Subacute
What are Osler nodes? Tender raised lesions on finger or toe pads
Small, painless, erythematous lesions on palm or sole Janeway lesion
What are Roth spots? Round white spots on retinal surrounded by hemorrhage
HACEK include: Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, and Kingella.
FROM JANE describes the MC symptoms of _________________. Bacterial endocarditis
What is the most commonly involved valve in bacterial endocarditis? Mitral valve
Which valve develops bacterial endocarditis in an IV user? Tricuspid valve
Rheumatic fever is a consequence of: Pharyngeal infection with group A B-hemolytic streptococci
Which type of valves are affected the most in Rheumatic fever? High-pressure valves (mitral >>> aortic >> tricuspid)
What is the early lesion of Rheumatic fever? Mitral regurgitation
Untreated MR due to Rheumatic Fever may turn into: Mitral stenosis
What is the major criteria mnemonic of Rheumatic fever? JONES
What does JONES criteria encloses? Joint (migratory polyarthritis) O (carditis) Nodules in skin (subcutaneous) Erythema marginatum Sydenham chorea
What kind of Erythema is associated with RF? Marginatum
What two histological findings are characteristic of Rheumatic fever? Aschoff bodies and Anitschkow cells
What are Aschoff bodies? Granuloma with giant cells in Rheumatic fever
What are the Anitschkow cells? Enlarged macrophages with ovoid, wavy, rod-like nucleus in Rheumatic fever
What titers are elevated in RF? ASO titers
Rheumatic fever is considered a type ______ hypersensitivity reaction. II
What condition is due to antibodies of M protein cross-react with self antigens? Rheumatic fever
What is the main treatment for Rheumatic fever? Penicillin
Inflammation of the pericardium is known as: Pericarditis
What is the clinical presentation of Pericarditis? Sharp pain, aggravated by inspiration, and relieved by siting up and leaning forward
What condition is commonly seen with friction rub? Pericarditis
What is the common findings on the ECG of pericarditis? Widespread ST-segment elevation and/or PR depression
Which are common autoimmune disorders that cause pericarditis? SLE, rheumatoid arthritis
Inflammation of myocardium leads to: Global enlargement of heart and dilation of all chambers
What is the major cause of sudden cardiac death in adults over 40 years old? Myocarditis
What is the term used for inflammation of the myocardium? Myocarditis
What is the typical presentation of arrhythmias in a patient with myocarditis? Tachycardia out of proportion to fever
Which are the most common viral causes of myocarditis? Adenovirus, coxsackie B, parvovirus B19, HIV, and HHV-6
What histological finding is highly indicative of viral myocarditis? Lymphocytic infiltrate with focal necrosis
What drugs are often associated with myocarditis development? Doxorubicin and cocaine
What is a cardiac tamponade? Compression of the heart by fluid leading to a decrease in Cardiac output.
Which condition is seen with equilibration of diastolic pressures in all four chambers? Cardiac tamponade
What triad is known to describe some symptoms of cardiac tamponade? Beck triad
What are the components of the Beck triad? Hypotension, distended neck veins, distant heart sounds
What characteristic pulse is seen in Cardiac tamponade? Pulsus paradoxus
What are the findings of ECG in cardiac tamponade? Low-voltage QRS and electrical alternans
What is the pulsus paradoxus? decrease in amplitude in systolic BP by > 10 mm Hg during inspiration
What conditions are commonly seen with pulsus paradoxus? Cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, and croup.
What is Syphilitic heart disease? Tertiary syphilis disrupts the vasa vasorum of the aora with consequence atrophy of vessel walls and dilation of aorta and valve ring.
What are some consequences of Syphilitic heart disease? Aneurysm of the ascending aorta or aortic arch, aortic insufficiency.
What condition is seen with "tree bark" appearance of aorta? Syphilitic heart disease
What are the two main Large vessel vasculitis? 1. Giant cell (temporal) arteritis 2. Takayasu arteritis
What is the MC population to develop Giant cell arteritis? Elderly females
What are the most typical symptoms of Giant cell arteritis? Unilateral headache, possible temporal artery tenderness, and jaw claudication
What condition is associated with possible irreversible blindness? Giant cell (temporal) arteritis
Which artery is involved in the possible development of irreversible blindness in Giant cell arteritis? Ophthalmic artery
What is a strong and common muscular association to Giant cell arteritis? Polymyalgia rheumatica
What are the vessels most commonly affected by Giant cell arteritis? Branches of Carotid artery
Vasculitis seen with Focal granulomatous inflammation and increased ESR? Giant cell (temporal) arteritis
What is the treatment in GCA to prevent blindness? High-dose corticosteroids
What is referred as the "Pulseless disease"? Takayasu arteritis
What population is often seen with Takayasu arteritis? Asian females < 40 years old
What is referred as weak upper extremity pulses? "Pulseless disease"
What is the MC treatment for Takayasu arteritis? Corticosteroids
What vascular structures are most commonly affected in Takayasu arteritis? Aortic arch and proximal great vessels
What lab result is shared/common in Takayasu and Giant cell arteritis? Increased ESR
Granulomatous narrowing and thickening of aortic arch and proximal great vessels? Takayasu arteritis
What are the 3 MC Medium-vessel vasculitis? 1. Polyarteritis nodosa (PAN) 2. Kawasaki Disease 3. Buerger disease
What is another name for Kawasaki disease? Mucocutaneous lymph node syndrome
What is another way to refer to Buerger disease? Thromboangiitis obliterans
What is the most common population to develop PAN? Middle-aged men
What is a commonly associated infection with PAN? Hepatitis B
Which arteries are usually affected in PAN? Renal and visceral arteritis
Which vessels/arteries are spared in PAN? Pulmonary arteries
What is the pathological changes seen in PAN? Transmural inflammation of arterial wall with fibrinoid necrosis of the renal and visceral vessels
What vascularity is seen or described with different sates of inflammation coexinging in different vessels? Polyarteritis nodosa (PAN)
What is a common arteriogram in a patient with PAN? Innumerable renal microaneurysms and spams
What is the treatment of PAN? Corticosteroids and Cyclophosphamide
Cyclophosphamide is used to treat which vascularity? Polyarteritis nodosa (PAN)
What are the most significant symptom of PAN? Systemic - fever, weight loss, and headache GI: abodominal pain, melena Other: HTN, neurologic dysfinction, cutaneous eruptions, and renal damage
Which population is commonly affected by Kawasaki disease? Asian children < 4 years old
What is the common mnemonic used to describe the most significant features of Kawasaki disease? CRASH and BURN
What is a common complication of Kawasaki disease? Coronary artery aneurysms
Coronary artery aneurysms are often seen as an complication of which vasculitis? Kawasaki disease
What is the treatment for Kawasaki disease? IV immunoglobulin and aspirin
What does CRASH and BURN stand for in Kawasaki disease? C- Conjunctival injection R- Rash A- Adenopathy S- Strawberry tongue H- Hand-foot changes Burn- Fever
What is the rash seen in Kawasaki disease? Polymorphous ---> desquamating
Which lymph nodes are most affected in Kawasaki? Cervical (adenopathy)
What is the simple term to describe Oral mucositis in Kawasaki disease? Strawberry tongue
What changes are seen in Kawasaki by "Hand-foot changes" description? Edema and erythema
What population is most affected by Buerger disease? Heavy smokers, males < years old
What is the vessel pathology or changes in Buerger disease? Segmental thrombosing vasculitis with vein and nerve involvement
Buerger disease involves the ______ and ______, along with arteries. Vein and Nerve
What key phenomenon is seen in Buerger disease? Raynaud phenomenon
What is the clinical presentation of Buerger disease? Gangrene, autoamputation of digits, and superficial nodular phlebitis
What is the reason of the clinical symptoms of Buerger disease? Intermittent claudication of affected vascular structures
What is the treatment for Buerger disease? Smoking cessation
Which are the Small-vessel vasculitis? 1. Granulomatosis with polyangiitis (Wegener) 2. Microscopic polyangiitis 3. Behcet syndrome 4. Eosinophilic granulomatosis with polyangiitis 5. Immunoglobulin A vasculitis
What is the triad of Wegener disease? - Focal necrotizing vasculitis - Necrotizing granulomas in the lung and upper airway - Necrotizing glomerulonephritis
What are the Granulomatosis with polyangiitis upper respiratory tract symptoms? Perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis
What are lower respiratory tract symptoms seen with Wegener disease? Hemoptysis, cough, dyspnea
What type of renal features are seen with Wegener disease? Hematuria and red blood cell casts
What antibodies are positive in Granulomatosis with polyangiitis? PR3-ANCA/c-ANCA
CXR- large nodular densities + c-ANCA positive. Dx? Wegener disease
What is the treatment of Wegener disease? Cyclophosphamide, corticosteroids
What is another name for MPO-ANCA/p-ANCA? Anti-myeloperoxidase
What vasculitis p-ANCA positive? Microscopic polyangiitis
What is Microscopic polyangiitis? Necrotizing vasculitis commonly involving lungs, kidneys, and skin with pauci-immune glomerulonephritis and palpable purpura.
What is the cutaneous involvement of Microscopic polyangiitis? Palpable purpura
What are the most commonly involved organs in Microscopic polyangiitis? Lung, kidneys, and skin
Which small vessel vasculitis is characterized by the absence of granulomas? Microscopic polyangiitis
How to distinguish between Microscopic polyangiitis and Granulomatosis with polyangiitis? Microscopic polyangiitis has no NASOPHARYNGEAL involvement.
What population is commonly affected with Behcet syndrome? Turkish an eastern Mediterranean descent
Immune complex vasculitis? Behcet syndrome
What vasculitis is associated with HLA-B51? Behcet syndrome
Clinical features of Behcet syndrome? Recurrent aphthous ulcers, genital ulcerations, uveitis, erythema nodosum.
What viral infections are associated with development of Behcet syndrome? HSV or Parvovirus
What is a common name of Eosinophilic granulomatosis with polyangiitis? Churg-Strauss syndrome
p-ANCA (+) and increased levels of IgE level. Most common vasculitis? Churg-Strauss syndrome
Granulomatous, necrotizing vasculitis with eosinophilia? Churg-Strauss syndrome
What is the most common neurological manifestations of Churg-Strauss syndrome? Wrist/foot drop
What kind of kidney involvement is seen in Eosinophilic granulomatosis with polyangiitis? Pauci-immune glomerulonephritis
What is another name of IgA vasculitis? Henoch-Schonlein purpura (HSP)
Vasculitis secondary to IgA immune complex deposition? Immunoglobulin A vasculitis
What glomerular condition is associated with HSP? IgA nephropathy
Berger disease is associated with _______________ vasculitis. Immunoglobulin A vasculitis.
What is the classic triad of Immunoglobulin A vasculitis? 1. Skin: palpable purpura on buttocks/legs 2. Arthralgias 3. GI: abdominal pain
What is the GI complication is often resulting in IgA vasculitis? Intussusception
What is the most common precipitating factor of IgA vasculitis? URI
What is the MC heart tumor? Metastasis
What is the most common primary heart tumor of adults? Myxoma
Where is the MC location for a myxoma? Atria (Left atrium MC)
What is a common associated symptom of myxoma? Multiple syncopal episodes
What is the common auscultation finding of a Myxoma? Early diastolic "tumor plop" sound
Myxoma histology is described as: Gelatinous material, myxoma cells immersed in glycosaminoglycans
"ball valve" obstruction in atrium. Dx? Myxoma
What is the most frequent primary cardiac tumor in children? Rhabdomyomas
What Autosomal Dominant disorder is associated with Rhabdomyomas? Tuberous Sclerosis
What is the common histological description used in Rhabdomyomas? Hamartomatous growths
What is the Kussmaul sign? Increase in JVP on inspiration instead of a normal decrease
What are some common conditions that exhibit Kussmaul sign? Constrictive pericarditis, restrictive cardiomyopathies, right atrial or ventricular tumors
What is another named for Hereditary hemorrhagic telangiectasia? Osler-Weber-Rendu syndrome
What is an AD inherited disorder of blood vessels? Osler-Weber-Rendu syndrome
What are the most significant clinical features of Osler-Weber-Rendu syndrome? 1. Blanching lesions (telangiectasias) on skin and mucous membranes 2. Recurrent epistaxis 3. Skin discolorations, 4. Arteriovenous malformations (AVMs) 5. GI bleeding 6. Hematuria
List of medications used for Primary (essential) hypertension: Thiazide diuretics, ACE inhibitors, ARBs, dihydropyridine Ca2+ channel blockers
What kind of Calcium channel blockers are used in the treatment of essential HTN? Dihydropyridine Ca2+ channel blockers
Hypertension with Heart failure (HF) is commonly treated with: Diuretics, ACE inhibitors/ARBs, B-blockers (compensated HF), aldosterone antagonists
B-blockers are completely contraindicated in HTN with HF treatment in patients presenting with what kind of shock? Cardiogenic
B-blockers in treating HTN with HF are to be used carefully in pts with: Decompensated heart failure (HF)
In HF, ARBs may be combined with what? Neprilysin inhibitor (sacubitril)
What is a commonly used Neprilysin inhibitor in combination with Valsartan? Sacubitril
Which antihypertensive medications are protective against diabetic nephropathy? ACE inhibitors and ARBs
What does ARBs stand for? Angiotensin II receptor blockers
What kind of beta-blockers can be used in treatment of HTN in a person with asthma? Selective B-blockers
Which kind of B-blocker category should be avoided in a Asthmatic person? Non-selective B-blocker
Why are non-selective beta-blockers not used in asthmatic patients? They induce bronchoconstriction
Hypertension in asthma should avoid two types of medications: 1. Non-selective B-blockers 2. ACE inhibitors
Why are ACE inhibitors to be avoided in Asthma patients? To prevent confusion between drug or asthma-related cough
What are the antihypertensives used in pregnancy? Hydralazine, Labetalol, methyldopa, and Nifedipine
What are the dihydropyridine Calcium channel blockers? Amlodipine, Clevidipine, Nicardipine, Nifedipine, and Nimodipine
Where do dihydropyridine Calcium channel blockers work on? Vascular smooth muscle
Which Ca2+ Channel blockers work on the vascular smooth muscle? Dihydropyridine
Which are the two most common Non-dihydropyridine Ca2+ channel blockers? Diltiazem and Verapamil
Where do Non-Dihydropyridine Calcium channel blockers act on? Heart
Verapamil and Diltiazem are: Non-dihydropyridine Calcium channel blockers
What is the MOA of Calcium channel blockers? Block voltage-dependent L-type calcium channels of cardiac and smooth muscle
What is the result of calcium channel blockade by Calcium channel blockers? Decrease muscle contractility
What are the clinical uses of non-dihydropyridine Ca2+ channel blockers? Hypertension, angina, atrial fibrillation/flutter
With the exception of Nimodipine, what are the general clinical uses for dihydropyridine CCBs? HTN, angina (including Prinzmetal), Raynaud phenomenon
What medication is used to treat Raynaud phenomenon? Dihydropyridine calcium channel blockers
What is the most important clinical use for Nimodipine? Subarachnoid hemorrhage
Why is Nimodipine used in SAH? Prevent cerebral vasospasm
Which dihydropyridine Calcium channel blockers are used in Hypertensive urgency or emergency? Nicardipine and Clevidipine
What are the associated adverse effects of Non-dihydropyridine CCBs? Cardiac depression, AV block, hyperprolactinemia, constipation, gingival hyperplasia
What is a common oral/buccal side effect of Verapamil therapy? Gingival hyperplasia
Prolonged use of Diltiazem can cause what hormonal imbalance? Hyperprolactinemia
What is the general mechanism of action of Hydralazine? Increase cGMP ----> smooth muscle relaxation
Hydralazine has a greater vasodilatory effect on arteries or veins? Arteries
The arterial vasodilation caused by Hydralazine causes what to the afterload? Reduction
Hydralazine potential reflex tachycardia is often prevented with coadministration of a ___________________. B-blocker
What are the two main uses for hydralazine? Severe (acute) hypertension
What are the adverse effects seen with Hydralazine? 1. Compensatory tachycardia 2. Fluid retention, headache, angina 3. SLE-like syndrome
SLE-like syndrome is an adverse effect of: Hydralazine
What are the common medication used to treat Hypertensive emergency? Clevidipine, Fenoldopam, Labetalol, Nicardipine, or Nitroprusside
What is an associated toxicity seen with Nitroprusside therapy in HTN emergency? Cyanide toxicity
What is the MOA of Nitroprusside? Short acting; Increase cGMP via direct release of NO
Quick acting and the increase of cGMP via direct release of Nitric monoxide, descries the mode of action of _______________. Nitroprusside
Dopamine D1 receptor agonist used in Hypertensive emergency. Fenoldopam
What is the function of Fenoldopam? Vasodilation of coronary, peripheral, renal , and splanchnic arteries due to Dopamine D1 stimulation.
Which dopamine receptor is stimulated by Fenoldopam? D1
What is a common antihypertensive used postoperative? Fenoldopam
What are the MC nitrates? Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate
What is the MOA of nitrates? Vasodilate by increase NO in vascular smooth muscle ---> increase in cGMP and smooth muscle relaxation.
Which vessels (vein or artery) are more affected with Nitrates? Veins
The vasodilation caused by nitrates causes a ________ in preload. Decrease
Hydralazine decreases the _________________, while Nitrates decrease the __________________. Hydralazine --> decrease afterload Nitrates ----> decrease preload
What are the 3 main uses of Nitrates? Angina, Acute coronary syndrome, and Pulmonary edema
What is "Monday disease"? Development of tolerance for the vasodilating action during the work week and loss of tolerance over the weekend
What are the effects of the "loss" of tolerance over the weekend seen in Monday disease? Tachycardia, dizziness, headache upon exposure
Mine worker complains of palpitations, headache, and N/V on several Monday mornings last month. Dx? Monday Disease
What condition contraindicates the use of Nitrate on a patient? History of Right ventricular infarction
What are some Adverse effects of Nitrates? Reflex tachycardia (tx with Beta blockers), hypotension, flushing and "Monday disease".
What is the ultimate goal of Antianginal therapy? Reduction of myocardial O2 consumption (MVO2)
What are the determinants of MVO2? End-diastolic volume, Blood pressure, Heart Rate, and Contractility
What therapeutic combination has the greatest decrease in MVO2? Nitrates + B-blockers
What antiarrhythmic type causes an increase in Ejection time? B-blockers
What calcium channel blocker has similar effect to B-blockers? Verapamil
When is Ranolazine used? Angina refractory to other medical therapies
What is the MOA of Ranolazine? Inhibits the LATE phase of Sodium current thereby reducing diastolic wall tension and oxygen consumptions
How is HR and Contractility affected by Ranolazine? Unaffected
What is an important adverse ECG effect of Ranolazine? QT prolongation
Selective PDE-3 inhibitor? Milrinone
Milrinone is an ___________________________________. Selective PDE-3 inhibitor
What is accumulated in the use of Milrinone? cAMP
What is the ultimate effect/result of the use of Milrinone on Cardiomyocytes? Increase inotropy and chronotropy
What is the ultimate result of the use of Milrinone on vascular smooth muscle? General vasodilation
What is the main clinical use for Milrinone? Short-term use in acute decompensated HF
What are the two classes of Lipid-lowering agents that decrease the most LDL levels? 1. HMG-CoA reductase inhibitors 2. PCSK9 inhibitors
What is the MOA of Statins? Inhibit conversion of HMG-CoA o mevalonate,a cholesterol precursor
Which type of lipid-lowering agent as proven to decrease mortality in CAD patiens? HMG-CoA reductase inhibitors
What are the main side effects of Statin therapy? 1. Hepatotoxicity 2. Myopathy
Myopathy is often an adverse effect of Statin therapy, especially when co-administered with? Fibrates or Niacin
What are common Bile acid resins? Cholestyramine, Colestipol, and Colesevelam
What is the MOA of Bile acid resins? Prevent intestinal reabsorption of bile acids
What are the associated side effects of Bile acid resins? 1. Decrease absorption fat-soluble vitamins 2. GI upset
What is the mode of action of Ezetimibe? Prevents cholesterol absorption at small intestine brush border
What is the main type of lipid decrease when using Fibrate? Triglycerides
What are some commonly referred Fibrates? Gemfibrozil, Bezafibrate, and Fenofibrate
What are the MOA of fibrates? 1. Upregulate LPL --> Increase TG clearance 2. Activates PPAR-a to induce HDL synthesis
What kind of lipid lowering drug acts by activating the PPAR-a ? Fibrates
Upregulation of the LPL is seen with the use of ____________. Fibrates
What are the most common adverse effects of fibrate therapy? 1. Myopathy (increase risk with statins), 2. Cholesterol gallstones
A person with cholesterol gallstones is very likely to be using ____________, as a lipid lowering agent. Fibrates
What is the method by which cholesterol gallstones appear in fibrate therapy? Via inhibition of cholesterol 7a-hydroxylase
What is the mode of action of Niacin? Inhibits lipolysis in adipose tissue
What enzyme activity is inhibited by Niacin? Hormone-sensitive lipase
What are the associated adverse effects associated with Niacin? Flushed face, hyperglycemia, and hyperuricemia
What arthritic-condition is possibly developed in long term Niacin therapy? Gout due to hyperuricemia
What two substances are overly secreted as an adverse effect of Niacin? Uric acid and glucose
What lipid lowering agent reduces hepatic VLDL levels? Niacin
MOA of PCSK9 inhibitors? Inactivation of LDL-receptor degradation --> increased removal of LDL from bloodstream
Common adverse effects of PCSK9 inhibitors Myalgias, delirium, dementia, and other neurocognitive defects
What are the benefits of Fish oil and marine omega-3 fatty acids therapy? Slightly increase in HDL and slight decrease in Triglycerides
Which lipid lowering agents work on the liver directly? Statins and PCSK9 inhibitors
Adipose lipolysis is done by __________, a common lipid lowering agent. Niacin
Which lipid lowering agents are categorized as LPL-upregulators? Fibrates
Where do Bile acid resins and Ezetimibe exert their actions? Intestinal lumen
Which lipid-lowering drugs are referred as Mevalonate synthesis agents? Statins
Which 2 types of lipid lowering agents work in the Blood? Niacin and Fibrates
Which lipid lowering agent is categorized as "cholesterol absorption" agent? Ezetimibe
Which type of lipid lowering medication is said to be a "LDL-receptor degradation"? PCSK9 Inhibitors
Which are some common PCSK9 inhibitors? Alirocumab and Evelocumab
Most common cardiac glycoside? Digoxin
What is the direct inhibition in the MOA of Digoxin? Inhibition of NA+/K+ ATPase
What is the INDIRECT inhibition of Digoxin mode of action? Inhibition of Na+/Ca2+ exchanger
The increased levels of Ca2+ concentration by the use of Digoxin, ultimately cause? Positive inotropy
Besides the positive inotropic effects of Digoxin, what is another mechanism of action displayed by such cardiac glycoside? Stimulation of Vagus nerve to decrease Heart rate
Stimulation of the Vagus nerve causes ---> Decrease heart rate (bradycardia)
Positive inotropy by Digoxin means = Increase cardiac contraction
What is the most common type of arrhythmia treated with Digoxin? Atrial fibrillation
Why is Digoxin used to treat AFIB? Decrease conduction at AV node and depression of SA node
What are some significant adverse effects of Digoxin? 1. Cholinergic effects (N/V, diarrhea) 2. Blurry yellow vision, 3. Arrhythmias 4. AV block 5. Hyperkalemia
Hyperkalemia in the setting of Digoxin toxicity indicates --> Poor prognosis
What are some factors that predispose to Digoxin toxicity? 1. Renal failure (decrease excretion) 2. Hypokalemia 3. Drugs: 3a. Displace Digoxin binding site, and, 3b. Decreased clearance (verapamil, amiodarone, quinidine)
What are 3 common drugs that predispose to Digoxin toxicity due to its interaction leading to a decrease clearance rate of digoxin? Verapamil, Amiodarone, and Quinidine
Why does hypokalemia increase the risk of Digoxin toxicity? Creates environment permissive for Digoxin binding at K+-binding site on Na+/K+ ATPase.
What is the treatment and antidote to Digoxin toxicity? Slowly normalize K+, cardiac pacer, anti-digoxin Fab fragments (antidote), and Mg2+.
What is the main function of Sodium channel blockers? 1. Slow or block conduction in depolarized cells 2. Decrease slope 0 depolarization
Which cells are especially preferencial to Sodium channel blockers? Depolarized cells
A depolarized cell has a less ____________ charge _________. Negative; Inside
What is meant by Na+ channel blocker been State dependent? Selectively depress tissue that is frequently depolarized
What is the most basic and clear manifestation of a tissue been frequently depolarized? Tachycardia
What are the Class IA sodium channel blockers? Quinidine, Procainamide, Disopyramide
What phase is affected by Na+ channel blockers? Slope of phase 0 (I Na)
Which Na+ channel blocker has the strongest blockage/change in slope 0 of the actin potential? Class IC
What is the magnitude order, from weakest to strongest, sodium channel blockage of slope 0? Class IB < Class IA <<Class IC
Which type of Na+ channel have the most significant increase in AP duration? Class IA
Which sodium channel blocker category has some Potassium channel blocking effects? Class IA
What are the clinical uses of Class IA sodium channel blockers? Atrial and ventricular arrhythmias, especially SVT and V-TACH
What are the two most significant arrhythmias treated with Class IA Na+ channel blockers? SVT and V-TACH
What are the associated adverse effects of Quinidine? Cinchonism (headache and tinnitus)
What are the components of Cinchonism? Headache and Tinnitus in patients on Quinidine
What is the most important adverse effect of Procainamide antiarrhythmic? reversible SLE-like syndrome
Reversible SLE-like syndrome is seen with the use of __________. Procainamide
What is the specific adverse effect seen with Disopyramide? Heart failure
What are some adverse effects seen with all Class IA Sodium channel blockers? Thrombocytopenia, torsades de Pointes due to Incrased QT interval
The increase in QT interval induced by sodium channel blockers is responsible for the development of: Torsades de pointes
Which are the main 2 Class IB sodium channel blockers? Lidocaine and Mexiletine
Which is a common anti-convulsive that may be consider a Class IB Na+ channel blocker? Phenytoin
What is the effect on AP with Class IB sodium channel blockers? Decrease
What tissue is preferably affected by Class IB sodium channel blockers? Ischemic or depolarized Purkinje and ventricular tissue.
Ischemic or depolarized Purkinje or ventricular tissue, is best targeted by which Na+ channel blocker class? Class IB
What are the two most common arrhythmias treated with Class IB sodium channel blockers? - Acute ventricular arrhythmias - Digitalis-induced arrhythmias
A patient develops a fast arrhythmic heart rate after a mistakenly doubling the dosage of digitalis. What is a common drug used to treat that arrhytmia? Class IB Na+ channel blockers
What class of Na+ blocker is best for Post-MI ventricular arrhythmias? Class IB
What are the two most common Class IC Na+ channel blockers? Flecainide and Propafenone
Flecainide and Propafenone are: Class IC Sodium channel blockers
In which tissue do Class IC sodium channel blockers have their strongest effect? Significantly prolongs ERP in AV node and accessory bypass tracts
What is the most significant change by using Class IC Na+ channel blockers? Prolongation of ERP
What are the adverse effects associated with Class IC sodium channel blockers? Proarrhythmic, especially post-MI
A patient with a recent Hx of and MI, should never be treated with what class of Na+ channel blockers? Class IC
What can be use as last resort in refractory V-Tach? Class IC Sodium channel blockers
What are the Class II antiarrhythmics? B-blockers
What phase is affected by the use of B-blockers? Decrease slope of phase 4
Which cardiac node (AV or SA) is more sensitive to the actions/effects of B-blockers? AV node
What ECG change is seen by the use of a beta-blocker? Increase in PR interval by stimulating the AV node.
Which a very short acting beta blocker? Esmolol
What is the MOA of Beta blockers? Decrease SA and AV nodal activity by decreasing cAMP, and decrease in Ca2+ currents
Which type of currents are decreased in activity by the use of Class II antiarrhythmics? Calcium ion currents
cAMP is __________________ by the use of beta blockers. Decreased
Arrhythmic uses of Beta-blockers 1. SVT 2. Ventricular rate control for AFIB and A-flutter
What sort of antiarrhythmics are used to control the ventricular rate of AFIB/AFLUTTER? B-blockers
May mask signs of hypoglycemia B-blockers
What are the important adverse respiratory effects seen with B-blockers? Exacerbation of COPD and asthma
Which Beta blocker is known to cause dyslipidemia? Metoprolol
What is an important and specific adverse effect of Propranolol? Exacerbate vasospasm in vasospastic angina
What is the risk of administering B-blockers to a patient with Pheochromocytoma? Unopposed alpha-1 - agonism
What type of antiarrhythmic is must be avoided in a patient with a cocaine addiction? B-blockers
Why are B-blockers contraindicated in a patient with cocaine overdose/abuse? Unopposed alpha-1 - agonism
What is the treatment of B-blocker overdose? Saline, atropine, and glucagon.
Decrease slope of phase 4 depolarization is seen with: B-blockers
Which are the non-selective beta blockers? Carvedilol and Labetalol
What are the 4 most important Class III antiarrhythmics? Amiodarone, Ibutilide, Dofetilide, and Sotalol
What channel is blocked by Class III antiarrhythmics? Potassium channels
Which two arrhythmias are treated by all Class III antiarrhythmics? Afib and A flutter
V-Tach can be treated with which 2 Potassium channel blockers? Amiodarone and Sotalol
What 3 features of the AP and ECG are increased by K+channel blockers? AP duration, ERP, and QT interval
Which are the specific adverse effects of Sotalol? Torsades de pointes and excessive B-blockade
Which two K+ channel blockers are associated with development of torsades de pointes? Sotalol and Ibutilide
What is the reason by which Amiodarone can have Class I, II, III, and IV antiarrhythmic properties? Lipophilic
Which antiarrhythmic is said to be a "lipid lover"? Amiodarone
Markedly prolonged repolarization is seen with? Class III Potassium channel blockers
Which function tests are to be monitored in a patient on Amiodarone? Pulmonary (PFTs), Hepatic (LFTs), and Thyroid (TFTs)
What are the main 3 adverse effect of Amiodarone, that require function test revision? Pulmonary fibrosis, hepatotoxicity, and hypo-or hyperthyroidism
What are the ocular side effects of Amiodarone therapy? Corneal deposits
Reason to which the ocular and skin adverse effects of Amiodarone? It acts as a hapten
What is the cutaneous manifestations of Amiodarone adverse effects? Blue-gray skin deposits resulting in photodermatitis
What are two common calcium channel blockers? Diltiazem and Verapamil
What are class IV antiarrhythmics? Calcium channel blockers
What is the mechanism of action of Calcium channel blockers? Decrease conduction Velocity, Increase ERP, and Increase PR interval
What are the common adverse effects of Ca2+ channel blockers? Constipation, flushing, edema, cardiovascular effects
Calcium Channel blockers cause: 1. Slow rise of action potential 2. Prolonged repolarization at AV node
What is the MOA of Adenosine? Increase K+ out of cells --> hyperpolarizing the cell and decrease Calcium current, decreasing AV node conduction
What is the drug of choice used to diagnose SVT? Adenosine
What medications or compounds can blunt the effects of Adenosine? Theophylline and caffeine
What are the most common side effects of Adenosine? Flushing, hypotension, chest pain, sense of impending doom, and bronchospasm
What is the action exerted by Ivabradine? Prolongs the slow depolarization (phase IV)
How does Ivabradine prolong phase IV? Selectively inhibiting "funny" sodium channels (I f)
When is Ivabradine used? In patients unable to tolerate B-blockers and those with HF with reduced Ejection fraction
What are characteristic adverse effects seen with Ivabradine? Luminous phenomena/ visual brightness, HTN, and bradycardia
Created by: rakomi
 

 



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