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Unit 1

In 90% of people the AV node and Bundle of His receive blood supply from where? Right Coronary Artery
The U-wave if present may represent what? Repolarization of the Perkinje Fibers or Hypokalemia
The efficient ventricular conduction system delivers an impulse within what time frame? 0.12 sec.
How is CO calculated? Stroke Volume X HR
What is normal adult CO? 4-8 L/min
What is normal Cardiac Index? 2.8-4.2 L/min/m2
How do you calculate CI? CO/BSA
Determines the amount of stretch placed on the myocardial fibers? Preload
Is the peripheral resistance against which the Left ventricle must pump? After load
The ability to respond to alterations in CO? Cardiac Reserve
Can cause distended neck veins or liver enlargement as a result of resistance to blood flow? ↑ Right Atrial Pressure
The sympathetic nervous system is mediated by which receptor sites? Beta Adrenergic Receptors
The parasympathetic nervous system is mediated by which nerve? The Vagus nerve
These receptors are located in vascular smooth muscle? Alpha₁ Adrenergic Receptors
Decreased stimulation to Alpha₁ adrenergic receptors causes what? Vasodilation
When baroreceptors and/or chemoreceptors are stimulated where is this information sent? Vasomotor Center in the Brainstem
What are the two main factors influencing BP? CO X SVR
The difference between SBP and DBP? Pulse pressure
Refers to the average pressure in the arterial system that is felt by the organs in the body? MAP= (SBP+2DBP)/3
A MAP greater that what is needed to sustain life? >60 mmHg
Two important cardiac changes with aging? Less pacemaker cells and less ANS control (B cells)
Which is not considered a normal consequence of aging? HTN
Arterial stiffening is caused by what? Loss of elastin fibers
A condition caused by ischemia of the muscles? Intermittent Claudication
A specific question regarding any allergic reaction is important if there is a chance that a cardiac cauterization may be needed? Iodine dye
These drugs are contraindicated in patients taking nitrates? Sildenafil (Viagra)
Oral contraceptives and/or HRT can cause what in females? Blood clots and Heart disease
When obtaining postural BP, HR should not vary more that what? <20 bpm
BP in the lower extremities is expected to be ___________ than the upper extremities? 10 mmHg higher
What 3 things can cause extremity edema? Gravity, interruption of venous return, or Right sided Heart Failure
What causes JVD? Right sided Heart Failure
The term for palpable vibration? Thrill
When auscultating sounds like a buzzing or humming blood flow? Bruit
What causes splinter hemorrhages? Infective endocarditis
What is a reddish-blue discoloration of the lower extremities? Dependent Rubor
Regular rhythm but strength of pulse varies with each beat? Pulus Alternans (Heart failure or Cardiac Tamponade)
The difference between an apical pulse and a peripheral pulse? Pulse Deficit
This sound is known as a ventricular gallop and is associated by decreased compliance of the ventricles during filling? S₃
This sound is known as atrial gallop and is associated with atrial contraction? S₄
Are structured lifts of the chest wall in the precordial area that can be seen or palpated? Heaves
What is normal Troponin level? <0,5 mcg/L
Amino acid produced during protein catabolism that has been identified as a risk factor for cardiovascular disease? Homocysteine
Are useful in the diagnosis of myocardial injury and necrosis? Biomarkers
Elevation is specific for myocardial tissue? CK-MB
What is the biomarker of choice in the diagnosis of MI? Troponin
Is a protein produced by the liver during periods of acute inflammation? CRP (C-reactive Protein)
Patients must fast for what type of blood draw? Lipid panel
Have been found to have thrombogenic properties that increase the risk of clot formation at the site of intravascular lesions? Lp(a) [Lipoprotein (a)]
Provides information about the function of the Left ventricle during systole? EF (Ejection Fraction)
Causes pharmacologic stress on the heart while the patient is resting? Dobutamine (Dobutex)
Is used to assess the function of the Left side of the heart? Wedge Pressure
Is the gold standard in coronary imaging? Cardiac Catheterization
Is a measurement of preload and can be used to monitor the pressure in the right atrium? CVP
Is a neurotransmitter released from SNS nerves endings? Noreepinephrine (NE)
This neurotransmitter activates receptors located in the SA node, myocardium and vascular smooth muscle? NE
The smooth muscle of blood vessels has both of these receptors? Alpha and Beta adrenergic receptors
These receptors located in the peripheral vasculature cause vasoconstriction when stimulated by NE? Alpha- Adrenergic Receptors
Beta1- adrenergic receptors in the heart respond to NE and epinephrine with increase HR? Chronotropic
Beta1 receptors that increase for of contraction? Inotropic
Beta1 receptors that increase speed of conduction? Dromotropic
These receptors are activated primarily by epinephrine released from the adrenal medulla and cause vasodilation (coronary arteries, skeletal smooth muscle, and lungs)? Beta2 adrenergic receptors
What is one of the most significant CVD effects of aging? ↓ responsiveness of cardiovascular cells to SNS stimulation.
EDRF, helps maintain low arterial tone at rest, inhibits growth of the smooth muscle layer and inhibits platelet aggregation? Nitric Oxide
Local regulator that is an extremely potent vasoconstrictor? Endothelin (ET-1)
Angiotensin II ↑ BP by what 2 mechanisms? ↑ vasoconstriction and stimulates the release of Aldosterone from the adrenal cortex.
Antagonize the effects of ADH and Aldosterone? ANP and BNP secreted by cardiac cells.
What does EDRF stand for? Endothelium-Derived Relaxing Factor
What are 3 types of EDRF's? Nitric Oxide, Prostacyclin, and Endothelium Derived Hyperpolarizing Factor.
Activates B-Adrenergic receptors in peripheral arterioles of skeletal muscle, causing vasodilation? Epinephrine
What is HTN considered to be? SBP >140mmHg and DBP > 90mmHg
What is Pre-HTN considered to be? SBP 120-139 mmHg and DBP 80-89 mmHg
False HTN and occurs with advanced atherosclerosis? Pseudohypertension
Is an elevated BP without an identified cause and it accounts for 90%-95% of all cases of HTN? Primary HTN, Essential HTN, or Idiopathic HTN
Is an elevated BP wit a specific cause that can be identified and corrected? Secondary HTN
Unexplained Hypokalemia, abdominal bruit, variable BP with tachycardia, sweating, tremors, Hx of renal disease? Secondary HTN
Results in the increase conversion of angiotensin to angiotensin I? High Plasma Renin Activity (PRA)
Is a physiologic process that maintains constant cerebral blood flow despite fluctuations in BP? Auto-regulation
Elevated BP readings in a clinical setting? "White Coat Syndrome"
May occur after a marked rise in BP if the cerebral blood flow is not decreased by auto regulation? Hypertensive Encephalopathy
What is a classic symptom of PVD involving the arteries in the legs? Intermittent Claudication
What is the earliest manifestation of renal dysfunction? Nocturia
WHy is measuring K+ levels important in HTN? To rule out Hyperaldosteronism a cause of secondary HTN
These levels are determined to establish a baseline, because the levels often rise with diuretic therapy? Uric Acid Levels
Patients with HTN do not show a normal nocturnal dip in BP? "Nondippers"
Elevated BP readings in a clinical setting? "White Coat Syndrome"
What is the most frequent cause of secondary HTN in the US? Alcohol induced liver cirrhosis
What are the 2 main actions of antihypertensives? ↓ volume of circulating blood and ↓ SVR
Reduces SVR and BP by direct arterial vasodilation? Hydralizine (Apresoline)
These drugs may ↓ the effects of anti-hypertensives? ASA, NSAIDS, and oral contraceptives.
What is the most effective IV drug to treat HTN emergencies? Sodium Nitroprusside (Nitropress)
Unstable Angina (UA) and myocardial infarction (MI) are more serious manifestations of CAD and are termed this? Acute Coronary Syndrome
The earliest lesion of atherosclerosis and are characterized by lipid-filled smooth muscle cells? Fatty Streaks
Is the beginning of progressive changes in the endothelium of the arterial wall? Fibrous Plaque Stage
The final stage in the development of atherosclerotic lesions? Complicated Lesion Stage
Two factors that contribute to the growth and extent of collateral circulation? Inherited Predisposition and Chronic Ischemia
Have the highest incidence of coronary artery disease? White, middle aged men.
Are vehicles for fat mobilization and transport, and vary in composition? Lipoproteins
What should be LDL levels be at? <160
What should HDL levels be at? >40
What should Triglyceride levels be at? <150
What is considered HTN for a patient with DM or CKD? BP >130/80 mmHg
What are two catecholamines? Epinephrine and Norepinephrine
This has been shown to lower blood levels of Homocysteine? B complex Vitamins (B6, B12 and Folic Acid)
Is produced by the breakdown of the essential amino acid methionine, which is found in dietary protein? Homocysteine
FITT Formula? Frequency, Intensity, Type, Time
Are the most widely used lipid lowering drugs? Statin drugs
Which drug increases the risk for rhabdomyolosis when used with gemfibrozil (Lopid) or niacin? Simvastatin (Zocor)
Is chest pain that occurs only while the person is lying down and is usually relieved by standing or sitting? Angina Decubitus
(Variant Angina) often occurs at rest, usually in response to spams of a major coronary artery? Prinzmetal's Angina
Cardiac cells can withstand ischemic condition for how long before cellular death begins? Approx 20 min
Occurs when oxygen and nutrients supplied to the tissues are inadequate because of severe Left Ventricular failure? Cardiogenic Shock
This occurs 2-3 days after an acute MI as a common complication of infarction? Acute Pericarditis
Is pericarditis with effusion and fever that develops 4 to 6 weeks after MI? Dressler Syndrome
Are released into the blood from necrotic heart muscle after an MI? Serum Cardiac Markers
Is released into the circulation within 2hrs after and MI and peaks in 3-15hrs? Myoglobin
PCI? Percutaneus Coronary Intervention (Angioplasty)
What is the most serious complication of PCI? Dissection of Coronary Artery
What is the major complication with Fibrinolytic therapy? Bleeding
What is the most common artery used for bypass graft? Internal Mammary Artery (IMA)
TMR? Transmyocardial Revascularization
IV anti-platelet agents? Glycoprotein IIb/IIIa inhibitor
Harvest of radial artery for bypass graft use can cause what? Arterial Spasms
Which drug decreased the incidence of arterial spasms? Calcium Channel Blockers
Can manifest days to weeks after surgery and may remain a permanent disorder? Postoperative Cognitive Dysfunction (POCD)
What are the primary risk factors for HF? CAD and Advancing age
Are used for the treatment of HF in African Americans; this copackaged drug is only approved for use in this ethnic group? Isosorbide Dinitrate and Hydralazine (BiDil)
Have an extremely high risk (50%) for Ace inhibitor-related cough? Asians (David Kim)
Pro-inflammatory cytokines are released by cardiac myocytes in response to various forms of cardiac injury? TNF and IL-1
Is an increase in the muscle mass and cardiac wall thickness in response to over-work and strain? Hypertrophy
Are hormones produced by the heart to promote venous and arterial vasodilation? ANP and BNP
Is done in patients who develop unexplained new onset HF that is unresponsive to usual care? Endomyocardial Biopsy (EMB)
Is a recombinant form of BNP and causes both arterial and venous dilation? Nesiritide (Natrecor)
Does not increase SVR and is preferred for short treatment of ADHF? Dobutamine
Inhibit sodium reabsorption in the distal tubule, thus promoting excretion of sodium and water? Thiazides
These drugs act on the ascending loop of Henle to promote sodium, chloride, and water excretion? Loop Diuretics
Anti-hypertensives agent that relaxes the arteries and decrease the work of the heart? Hydralazine
Anti-aginal agent, relaxes the veins as well as the arteries? Isosorbide Dinitrate
What is the antidote to digoxin toxicity? Digibind
Is one in which the wall of the artery forms the aneurysms, with at least one vessel layer still intact? True Aneurysm
Is circumferential and relatively uniform in shape? Fusiform Aneurysm
Is pouchlike with a narrow neck connecting the bulge to one side of the arterial wall? Saccular Aneurysm
Is not an aneurysm but a disruption of all arterial wall layers with bleeding that is contained by surrounding anatomic structures? False Aneurysm of Psuedoaneurysm
Conservative therapy typically is indicated for small aneurysm less than what? 5cm
Surgical repair is done for aneurysms greater than what size? >5.5cm M and >5cm F
What does EVAR stand for? Endovascular Aneurysm Repair
Approx 60-70% of dissections involve this anatomical location? Ascending Aorta
Results from the creation of a false lumen (between the intima and media) through which blood flows? Dissection
During this time approximately half of all dissections in women younger than 40 y/o occur? Pregnancy
Beta Blocker that decreases BP and force of Left ventricular contraction? Esmolol
A chronic dissection would most likely be in what location? Descending Aorta
What is the clasic symptom of lower extremity PAD? Intermittent Claudication
Manifested as numbness or tingling in the toes or feet, may result from nerve tissue ischemia? Paresthesia
Blanching of the foot in response to leg elevation? Elevation Pallor
Redness of the foot? Reactive Hyperemia
Developement of redness when a limb is in a dependent position? Dependent Rubor
What are 2 drugs to treat intermittent claudication? Pletal and Trental
Is recommended as a first-line drug therapy for patients with intermittent claudication inhibits platelet aggregation and increases vasodilation? Cilostazol (Pletal)
Increases RBC flexibility and decreases blood viscosity?? Pentoxifylline (Trental)
The removal of the obstructing plaque? Atherectomy
Combines two procedures: ballon angioplasty and cold therapy? Cryoplasty
Opening the artery and removing the obstructing plaque? Endarterectomy
Opening the artery , removing plaque and sewing a patch to the opening to widen th lumen? Angioplasty
Six "P"s? Pain, Pallor, Pulselessness, Paresthesia and Poikilothermia.
Is a nonatherosclerotic , segmental, recurrent inflammatory vaso-occulsive disorder of the small and medium sized arteries and veins of the upper and lower and extremities? Thromboangiitis Obliterans (Buerger Disease)
Is an episodic vasospastic disorder of small cutaneous arteries, most frequently involving the fingers and toes? Raynaud's Phenomenon
Swollen, blue, painful legs; a very rare compplication may develop in a patient in the advanced stages of cancer?? Phelgmasia Cerulea Dolens
Which test is used to monitor therapeutic levels of warfarin (Coumadin)? INR
What is the antidote for Warfarin(Coumadin)?# Vitamin K
What type of anticoagulant drug is Warfarin?# Vitamin K Antagonist
What is normal INR value and therapeutic value?# 0.75-1.25 and 2-3
What type of anticoagulant is UH and LMWH? Indirect Thrombin Inhibitors
What is the antidote for UH? Protamine Sulfate
One serous side effect of heparin? Heparin Induced Thrombocytopenia (HIT)
A long term side effect of heparin use? Osteoporosis
Are classified as hirudin derivatives or synthetic thrombin inhibitors? Direct Thrombin Inhibitors
Is approved for prophylaxis or treatment of patients with HIT? Lepirudin
Is approved for HIT patients undergoing PCA? Bivalirudin
Is particularly useful for VTE treatment in patients with a Hx of HIT? Fondaparinux
Are smaller varicose veins that appear flat, less tortuous and blue-green in color? Reticular veins
Often referred to as spider veins; are very small visible vessels, generally less than 1mm in diameter that appear bluish black, purple or red? Telanglectasias
Is a condition in which the valves in the veins are damaged, which results in retrograde blood flow, pooling of blood in the legs and swelling? Chronic Venous Insufficiency (CVI)
Causes a brownish skin discoloration? Hemosiderin
is a continuous burning pain due to ischaemia of the lower leg. It begins, or is aggravated, after reclining and is relieved by sitting or standing. Rest Pain
Patchy mottling of the feet and toes in the presence of palpable pulses? "Blue Toe Syndrome"
Presence of back or flank ecchymosis? Grey Turners sign
Connective tissue disorders? Marfans or Ehlers Danlos Syndrome
Results from valvular destruction allowing retrograde venous blood flow? Chronic Venous Insufficiency
S3 and S4 heart sounds are auscultated/present with Left or Right sided HF? Left sided
Is an option for the patients with fluid overload and can rapidly remove extracellular and intravascular fluid volume? Ultrafiltration (UF)
Is a device that increases coronary blood flow to the heart muscle and decreased the workload through a process called counter pulsation? IABP
This drug decreases both preload and afterload, but can cause thiocynate toxicity? Nitroprusside (Nipride)
Is a recombinant form of BNP and causes booth arerial and venous dilation? Nesiritide (Natrecor)
An alternatic therapy that improves exercise capacity and decrease symptoms of cardiac insufficiency. Benefits or patients not willing to take prescription drugs? Hawthorn
Is a selective B-adrenergic agonist and works primarily on the B-receptors in the heart? Dobutamine
Inhibition of _______ increases cyclic adenosine monophosphate (cAMP) which enhances calcium entry into the cell and improves myocardial contractility? Phosphodiaesterase (Incor, Primacore)
Hemoglobin A1C should be less than what? <7%
Provided early evidence that certain behaviors and lifestyles contribute to developement of CAD? The Framingham Study
Statin drugs block synthesis of cholesterol by blocking this? HMG-CoA
What is the major route of elimination of cholesterol? Via bile in the liver
Vytorin is what 2 drugs? Zetia and Simvastatin
What is the main side effect of nitrates? Headaches
In an attempt to compensate for infarction muscle, the normal myocardium will hypertrophy and dilate? Ventricular Remodeling
Alpha Adrenergic Antagonist reduces sympathetic outlow from CNS, produces vasodilation and Decreases both SVR/BP? Clonidine (Catapres)
Created by: BOjangles1006