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Cardiology

FA Key Notes

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"
Created by: rakomi