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Cardiology

FA review round 3

QuestionAnswer
Which adrenergic receptor is stimulated by NE? Beta-1
What is the effect of NE stimulating B-1 adrenergic receptor? Increased Ca2+ influx into the cell
What is the result on myocytes when B-1 stimulation by NE, causes more Calcium to enter the cell? Increases myocyte contractility
What parameter is increased by NE B-1 stimulation on a myocyte, among heart rate, contractility, and velocity? Increased myocyte contractility
What is a cause for increased heart rate? Increase firing rate of SA node due to increased inward Na+ current during phase 4 of nodal AP
Which channels are involved in AV nodal conduction velocity? Voltage-gated Ca2+ channels
Which phase of the nodal action potential establishes the automaticity of the pacemaker cells? Phase 4
How the Phase 4 of the Nodal action potential established? Influx of Na+ ions into the myocytes that causes the "funny" current, or If.
What are common risk factors of S. viridans-induced infective endocarditis? Pre Existing valve disease, HF, IV drug use, poor dentition, hemodialysis, male sex, and implantable devices such as catheters
What is Eisenmenger syndrome? Untreated Left to right shunt, which permanently reverses into Right-to-Left shunt, leading to cyanosis and hypoxemia
Which cholesterol type is increased by the use of Niacin? HDL
What are the most common adverse effects of Niacin? Flushing and increased risk of gout
Flushing and increased risk for gout, are adverse effects associated with which antihyperlipidemic drug? Niacin
What is the main result or targeted purpose of Niacin as an antihyperlipidemic drug? Reduced hepatic triglycerides and VLDL cholesterol levels
What are some clinical characteristics of Pericarditis? Chest pain relieved by leaning forward, a pericardial rub, and a diffuse ST-segment elevations on ECG
What is the most significant ECG finding of Pericarditis? Diffuse ST-segment elevations
What are the most common causes of acute pericarditi? Viral infection, which is often due to Coxsackie B virus
Which virus sthe most often causative pathogen of pericarditis? Coxsackie B virus
What is Granulomatous Chronic arteritis? Inflammation of the large vessels and commonly the temporal artery and surrounding vessels
What are the most common symptoms and signs of GCA? Unilateral headache, jaw claudication, and/or transient loss of vision
What muscular condition is strongly associated to GCA? Polymyalgia rheumatica
How is Polymyalgia Rheumatica clinically presented? Shoulder, neck, and hip pain and stiffness, especially in the morning
What is Variant Angina? Coronary artery spaces, which causes intermittent chest pain
What is the severe consequence of Systemic infection? Distributive shock with hypotension
What are the effects of Distributive shock on hemodynamic parameters? Decreased - Systemic vascular resistance Increased - Cardiac output Variable = CVP and and PCWP
What is the effect of non-selective Beta blockers on heart rate, contractility, and Renin release? All are decreased
Is the use of atenolol, cause a increase or decrease in contractility? Decrease
What is a common cause of MR in post-MI patients? Papillary muscle rupture
How ar the aultation findings of MR described? Decrescendo murmur obscuring the S1, best heard at the apex of the heart
Which heart chamber is enlarged by Mitral regurgitation? Left atrium
Why is the Left Atrium enlarged in patients with MR? Due to blood entering the left atrium during systole
Mitral regurgitation. Systolic or diastolic murmur? Systolic murmur
How is AV Nodal Reentrant Tachycardia manifested on the ECG? Tachycardia with narrow QRS complex without P waves or with inverted P waves.
What is the cause of AVNRT? Reentry circuit at the AV node
What cardiac rhythm or arrhythmia is due to reentry circuit at the AV node? AV Nodal Reentry Tachycardia (AVNRT)
What are some hemodynamic effects of Mitral Stenosis? Diastolic murmur and elevated left atrial pressure
What chamber pressure is most notably elevated in MS? Left atrial pressure
What is the MCC of MS? Rheumatic heart disease
What causes Rheumatic heart disease? Antibody cross-reactivity between the bacterial antigen and the mitral valve
What is molecular mimicry? One of the leading mechanisms by which infectious or chemical agents may induce autoimmunity
What condition is known to produce disease by the principle of "molecular mimicry"? Rheumatic heart disease
What are the main two mediators for vasodilation? Nitric oxide and Adenosine
Increase in NO and Adenosine would indicate --> Artery vasodilation
Hypertension is a common cause for which two cardiac conditions? Left ventricular hypertrophy and non-systolic heart failure
What is a common cause for non-systolic heart failure? Hypertension
What murmur is diagnosed by a mid systolic crescendo-decrescendo at the base of the heart? Aortic stenosis
What is the feature regarding pulse in AS? Weak pulses with delayed peaks
What is pulsus parvus et tardus? Weak pulses with delayed peaks
What condition is associated with Pulsus parvus et tardus? Aortic stenosis
How do fibrates decrease Triglyceride levels? Upregulating lipoprotein lipase though increased PPAR-gamma activity
How do fibrastes help elevate HDL levels? Increasing Apolipoproteins A-I and A-II
What are the factors that cause benign or innocent heart murmurs? Turbulent blood flow in the pulmonary outflow tract of the right ventricle
Which heart chamber is most associated with the pathogenesis of benign heart murmurs? Right ventricle
What is often caused by turbulent blood flow in the pulmonary outflow tract of the RV? Benign or innocent murmurs
What are 3 common causes of chronic aortic regurgitation? Valve calcification, dilated aortic root, and rheumatic heart disease
What are the changes in pressure and size of the heart chambers in a person with long-standing aortic regurgitation? Ventricular dilation and eventually a rise in LV end-diastolic pressure
What are the physical consequences of chronic AR? Pulmonary edema and signs of systolic heart failure
What are the common complications of long-stand varicose veins? Chronic venous insufficiency and stasis dermatitis
What is a underlying condition that can lead to Stasis dermatitis? Varicose veins
What type of medications are the first line of treatment for patients with an MI? Beta blockers
Why are beta blocker contraindicated in patients addicted to cocaine? Unopposed alpha-receptor effects and vascular smooth muscle contraction
Is beta-blockers + cocaine associated with Vascular SM contraction or dilation? Vascular smooth muscle contraction
What are 3 actions known to increase Preload? 1. Abrupt squatting 2. Passive leg raising 3. Volume expansion
Does abrupt standing increase or decrease preload/or afterload? Increase preload
What is the right combination of passive leg raising and sudden standing, among decrease/increase and preload/afterload? Increase preload
What heart sound is accentuated with an increase in preload? S3
What is a S3 heart sound? Diastolic heart sound heard in the states of volume overload and/or ventricular enlargement
Which type of heart failure, systolic or diastolic, is associated with S3? Systolic heart failure
Which vasculitis is strongly associated with Hepatitis B infection? PAN
What infectious pathogen is associated with development of PAN? Hepatitis B virus infection
What type of hypersensitivity is PAN? Type III hypersensitivity
Which organ is spared in PAN from illness or symptoms? Lungs
What are the physical effects on the heart due to Rheumatic Heart disease? Murmur and Left Atrial enlargement
What pathogen is the most common cause of Rheumatic Heart disease? Group A B-hemolytic streptococcal throat infection
What is the auscultation description mitral stenosis? Opening snap with mid-diastolic rumble
What common complications of bacterial endocarditis? Septic emboli that are lodged in the brain, spleen, kidney, and gut
Which leads are affected with ST-segment elevation in a Left Circumflex artery infarct? Leads I, aVL, V5, and V6.
Which artery is suspected to be occluded by ST-elevation of leads I, aVL, V5, and V6? Left Circumflex artery
What are the main mediators of coronary artery vasodilation? Nitric oxide and Adenosine
What is the typical presentation of Aortic dissection? Sudden-onset of chest pain and back, and widened mediastinum on X-ray of the chest
What is the most common association of Aortic dissection? Severe hypertension
What are some common causes of Non-systolic heart failure? Long-standing, uncontrolled hypertension or aortic stenosis
What are complication seen in a person with diastolic heart dysfunction? Pulmonary hypertension and dyspnea due to passive transmission of the elevated left heart filling pressure proximally into the pulmonary circulation
What are two main causes of Aortic stenosis in patient with Turner syndrome? Bicuspid aortic valve, and coartation of aorta
What medication may be used to prevent the flushing adverse effects of Niacin therapy? Aspirin
Does Digoxin toxicity cause hyperkalemia or hypokalemia? Hyperkalemia
What causes hyperkalemia adversity due to Digoxin therapy? Inhibition of the Na+/K+ ATPase
What is a common antiarrhythmic that may cause AV block, especially a 3 AV block? Verapamil
Why is Verapamil often the cause of a 3 AVB? Its MOA decrease Ca2+ conduction during phase 0 of the nodal action potential, leading to a delay atrial depolarization rate, which case uncoordinated firing of AV and SA nodes
Which nodal action potential phase is affected by Verapamil? Phase 0
Which ion is blocked by Verapamil? Calcium
What are the hemodynamic effects due to Digoxin? Increase ejection fraction and decrease in heart rate
What are the most common toxicity effects of Digoxin? Visual disturbances, nausea, vomiting, diarrhea, and arrhythmias
List of first line anti-hypertensives: Thiazide diuretics, ACE inhibitors, ARBs, and calcium channel blockers
Which first line antihypertensive are know to worsen hyperlipidemias? Thiazide diuretics
What is the pharmacodynamic effect produced by competitive inhibitors as per described in a Lineweaver-Burk plot? Increase in Km and maintained of Vmax, leading to a steeper slop but the same y-intercept.
Does the y-intercept increase, decrease, or remains the same in a Lineweaver-Burk plot when comparing a drug with a competitive inhibitor? y-intercept remain the same
What are auscultation findings of Aortic Stenosis? Mid-to-late peaking systolic murmur at the RUSB
What action is known to DECREASE the intensity of Aortic Stenosis murmur? Valsalva maneuver
Which heart murmur is known to systolic and with a mid-to-late auscultative description? Aortic stenosis
What is the mode of action of Sildenafil? PDE-5 inhibitor that prevents metabolism of cGMP
Is cGMP serum concentration increased or decreased with PDE-5 inhibitors (Sildenafil)? Increased
What is the structural consequence of Hypertrophic cardiomyopathy? Left Ventricular (LV) hypertrophy, leading to an increase oxygen demand which may lead to chest pain
What chamber hypertrophy causes increase oxygen demand in HCM? Left ventricle
What does "ARVC" stand for? Arrhythmogenic Right Ventricular Cardiomyopathy
What is the underlying mechanism of ARVC? Myocardial cell apoptosis of the RV, leading to fibrofatty replacement and eventual thinning , dilation, and predisposition to fatal arrhythmias
Which heart chamber is affected in ARVC? Right ventricle
Which condition is characterized by myocardial cell apoptosis of the right ventricle, which then is replaced by fibrofatty tissue? ARVC
What is the cause of Osler nodes in PSGN? Immune complex deposition in the tissues
What does an abnormal S3 indicate? Ventricular volume overload associated with systolic heart failure or high-output states (thyrotoxicosis, anemia)
What are the main characterizes of a PDA? Wide pulse pressure and a continuous machine-like murmur
Which TORCHES infection associated with PDA development in neonate? Rubella
What are the most significant physical features of congenial rubella? PDA, deafness, blindness, and cardiac abnormalities
What is the structure of Rubella virus? Positive single-stranded virus of the genus Rubivirus
What are the main factors of Eisenmenger syndrome? Cyanosis and hypoxemia
What is the most common and severe complication of Infective Endocarditis? Septic emboli that may lodge in the brain, spleen, kidney, and gut.
What is the main pathogenesis of TOGV? Left ventricle to empty into the pulmonary artery, and with the right ventricle emptying into the aorta
What is the typical CXR description of the heart in Transposition of the Great vessels? "egg on a string"
What concurrent heart defect is associated with TOGV? VSD
Auscultation description of Pulmonary regurgitation: Diastolic, decrescendo murmur best heard at the left second intercoastal space along the sternal border
How long after initial MI event, can a Lateral Free wall Left ventricular rupture, can occur? Within 2 weeks
What is the most significant development after Lateral free wall LV rupture after MI? Cardiac tamponade
Which type of medication should be avoided if possible in patients with bilateral RAS? ACE inhibitors and ARBs
Bilateral RAS patients are mainly depending on which enzyme to maintain GFR and overall renal function? AT II
What is the featured heart rate of Cardiac Tamponade? Pulsus paradoxus
What condition is most associated with Pulsus paradoxus? Cardiac tamponade
What are adverse effects of Hydralazine? Reflex tachycardia, leading to increased myocardial oxygen demand and angina in CAD patients
Which protein (enzyme) is upregulated by Fibrates to decrease TG levels? Increased PPAR-alpha activity
How is lipoprotein lipase upregulated by fibrates? Increased PPAR-alpha activity
What causes V-FIB? Abnormal reentrant circuits within damaged myocardium
What causes a Tension pneumothorax? One-way trapped valve and no capability of escape for air trapped the pleural space
What are common signs of Tension pneumothorax? Hypotension, tachycardia, and mediastinal shift away from the affected side
What is most immediate after an MI, Lateral free ventricular rupture or papillary muscle rupture? Papillary muscle rupture
What are the main consequences on heart dynamics in a patient with chronic Aortic regurgitation? Ventricular dilation and eventually rise in LVED pressure
Holosystolic murmur obscuring S1 and best heard at the apex Mitral regurgitation
What represents the start in the LV Volume Vs Pressure loop? Mitral valve opening
Created by: rakomi
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