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Cardio Quiz Cards
Terms in this set (88)
Pathological findings 2-4 hours post MI
Neutrophil emigration to lyse dead myocardial cells
Pathological findings 4-24 hours post MI
Coagulative necrosis with contraction band formation
Pathological findings 1-3 days post MI
Extensive coagulative necrosis, acute inflammation w/ neutrophils
Pathological findings 3-14 days post MI
Granulation tissue at margins, macrophages, central yellow softening grossly
Pathological findings 2 weeks to several months post MI
Contracted scar formation (type 1 collagen) -> ventricular aneurysm risk
Common side effect of nonselective alpha receptor blockers for hypertension
Most common cause of rt. side heart failure
Left side heart failure, blood backs up in pulmonary circulation causing inc. pressure on rt. side heart
What electrolyte disturbances can lead to digoxin toxicity?
Hypercalcemia (+ inotrope), hypokalemia (K needed for dig binding to Na/K ATPase), hypomagnesemia
Common adverse effects of ACE inhibitors?
Hyperkalemia (indirectly block aldosterone action - reabsorption of Na, removal of K)
Symptoms of aortic regurgitation
Wide pulse pressure (high pulse pressure)
Aortic regurgitation physical exam finding
high pitched decrescendo diastolic murmur (blood flows back into l. ventricle after systole)
Aortic stenosis physical exam findings
crescendo-decrescendo systolic murmur -> radiates to the neck (carotid involvement)
Clinical: angina, syncope, and heart failure
Mitral valve prolapse physical exam findings
Usually young women, asymptomatic and benign
Crescendo/decrescendo systolic murmur with mid-systolic clicks
What drug class should be used for aortic regurgitation
Afterload reducers - hydralazine (increases cGMP = smooth muscle relaxation) and ACE inhibitors
MOA of Niacin
Decrease secretion of VLDL from hepatocytes into circulation
Lowers LDL and triglycerides, Raises HDL
Effects of hyperkalemia on an EKG
Flattened P waves, widening of QRS, Prolonged PR interval, peaked T waves
What diabetic condition is hyperkalemia often associated with?
Diabetic ketoacidosis - Kussmaul's respirations (blow off CO2), polyuria (osmotic effect hyperglycemia), accelerated ketogenesis (acidosis)
*K moves extracellularly b/c of H/K exchange and osmotic shift out of cells
What is the characteristic EKG pattern of a Mobitz type II AV block
Dropped QRS complexes - 2:1 or 3:1 P-to-QRS ratio w/ each contraction - often associated w/ scarring due to previous septal MI and syncope
What is characteristic EKG pattern of bundle branch blocks?
Elongated QRS w/ extra R waves (rabbit ear QRS)
What is the characteristic EKG pattern of a Mobitz type I AV block (Wenckebach)
PR interval that gets progressively longer between contractions until a QRS is dropped, then PR resets itself
What heart defect is associated with carcinoid syndrome?
Tricuspid valve regurgitation - serotonin produced by tumor causes stenosis of rt. side heart valves - carcinoid must have metastasized to liver
What are the most likely etiologies of constrictive pericarditis and common physical findings?
Mycobacterium tuberculous, connective tissue disease, past radiation - Kussmaul's sign - JVD on inspiration
Pulsus paradoxus - large decrease in systolic blood pressure w/ inspiration
Rub/Knock on auscultation
What clinical finding/test would indicate constrictive pericarditis?
Rt. atrial pressure tracings showing marked y descents
What drug has been shown to improve long term survival in anterior STEMI
ACE inhibitors (ant. STEMI = leads V3-V4)
What is seen on EKG that suggests cardiac necrosis?
Q waves - electrical silence in area of necrotic tissue
What area of the heart and vessel do V1-V2 leads correlate to?
Septal area - LAD artery
What area of the heart and vessel do V3-V4 leads correlate to?
Anterior - LAD artery
What area of the heart and vessel do I, aVL, and V5-V6 leads correlate to?
Lateral area - Left circumflex artery
What area of the heart and vessel do II, III, and aVF leads correlate to?
Inferior area - Right coronary artery
What area of the heart and vessel do V1-V3 posterior leads correlate to?
Posterior area - Posterior descending artery
What area of the heart and vessel do V7-V9 leads correlate to?
Posterior - posterior descending artery
What is the class and use of lidocaine in cardiac pharmacology
Class 1B antiarrhythmic - specifically acts on ischemic tissue - good for VENTRICULAR arrythmias in MI
Inhibit Na channels - decreasing phase 0 of myocardial act. potential - shortens repolarization time (shortens action potential)
What is the class and use of amiodarone?
Class III - K channel blocker
Prolongs repolarization/action potential - prolongs QT interval on EKG
Used in Afib A flutter and ventricular tachycardia
Side effects: pulmonary fibrosis, blue skin, visual impairment, hypo/hyperthyroid
What is the etiologic agent and symptoms associated with Chagas disease?
Trypansoma cruzi - immigrant pop.
Transmitted by bug feeds on face - periorbital edema/inflammation
Causes dilated CHF years later
Also can cause megacolon and weight loss
What is the most common cause of infectious myocarditis in the US?
Coxsackie B-4 virus
Treatment of choice for Chagas disease?
Nifurtimox - kills T. cruzi through byproducts of oxygen reduction (peroxide and superoxide anion)
First line therapy for hypertension in pregnancy and side effects
Hydralazine (w/ methyldopa) - direct vasodilator via NO
SE: Drug induced lupus - myalgias, arthralgias, erythema nodosum, lymphadenopathy
***Positive anti-histone antibodies = drug induced lupus
What antiarrhythmic can cause drug induced lupus and what is its MOA?
Class Ia - Na+ channel blocker - lengthens action potential
2 most common pathogens in prosthetic valve endocarditis
S. aureus (coagulase pos) and S. epidermidis (coagulase neg, novobiocin sensitive)
What are common clinical findings associated w/ prosthetic valve endocarditis?
recent surgery, Fever, new onset heart murmur, painless hemorrhagic lesions on palms and soles, microinfarcts in retina, painful subcutaneous lesions in distal fingers
What are the clinical findings associated with cardiac tamponade?
Fluid buildup in pericardial space
Hypotension, distended neck veins, distant heart sounds
Possible pulsus paradoxus (dec. systolic BP on inspiration)
Describe the murmur heard in mitral valve prolapse and manuever to intensify it
midsystolic click followed by high pitched late systolic murmur
Use valsalva manuever to decrease ventricular filling moving murmur closer to S1 (more prominent)
Listen at heart apex
Describe murmur heard in tricuspid regurgitation and manuever to intensify it
Holosystolic murmur heard over lower left sternal border in 5th intercostal space - increases w/ venous return (inspiration, leg raising, amyl nitrite)
What occurs with heart sounds in a patient with an atrial septal defect?
Fixed splitting of S2 on both inspiration and expiration
Systolic murmur heard in second intercostal space on left sternal border
Can lead to pulm hypertension = right to left shunt (eisenmenger's syndrome)
Describe the murmur heard in mitral stenosis, manuever to intensify it and clinical findings
Mid-diastolic rumbling murmur preceded by opening SNAP - heard at apex in left lat. decubitus position - increases w/ exercise
Clinical: heart failure, hemoptysis, Afib
hoarseness (compressed left recurrent laryngeal nerve due to atria), Shortness of breath - bronchi compressed
Describe the murmur of aortic regurgitation and manuever to intensify it
Decrescendo, diastolic blowing murmur heard at rt. 2nd intercostal space and lt. sternal border - increases w/ squatting and isometric handgrip
What is the most frequent cardiac tumor in children and what other condition is it associated with?
Rhabdomyomas - associated with tuberous sclerosis
What drugs are associated with the potential for the development of Mobitz type I AV heart block?
Calcium channel blockers
**Slow signaling through the AV node
What are common ADRs associated with digoxin, calcium channel blockers, and beta blockers?
Development of Mobitz type I AV block
Shortness of breath
What is the characteristic EKG finding associated with a right bundle branch block?
Splitting of the QRS complex into two r waves (rabbit ears) in leads V1, V2
Which artery branches around the levator scapulae muscle?
Dorsal scapular artery
What is the Chapman's point associated with the heart?
2nd intercostal space near sternum
What drug can be given to treat both hypertension and BPH? What is its MOA?
Terazosin (any -zosin drug)
Inhibit alpha 1 receptors causing smooth muscle relaxation
What class of drugs should not be combined with foods high in tyramine? What are the names of some drugs in this class?
MAO inhibitors (tyramine induces release of catecholamines which won't be metabolized)
Phenelzine and Tranylcypromine
Rasagiline and Selegiline
Describe the MOA of thiazide diuretics
Block the Na/Cl symporter in the distal convoluted tubule causing Na excretion
Increased water in collecting duct washes away K as well leading to a metabolic alkalosis
What metabolic condition can arise from overdose of thiazides?
Metabolic alkalosis - Increased H2O excretion = hypokalemia, Body responds by exchanging extracellular H w/ Intracellular K leading to alkalosis
What drugs can be used in a hyperkalemic crisis?
Calcium gluconate: reduce myocyte excitability
Beta adrenergic agonists (terbutaline/albuterol), Insulin, Sodium polystyrene sulfonate : reduce serum potassium levels
What does the a wave in a jugular venous waveform correspond to?
a wave = atrial contraction
What does the c wave in a jugular venous waveform correspond to?
C wave = ventricular contraction
What does the v wave in a jugular venous waveform correspond to?
V wave = atrial filling during systole
What pathologies are associated with an accentuated a wave in a jugular venous waveform?
Tricuspid (S4 sound), mitral, or aortic stenosis
Right side heart hypertrophy
What is a common bacteria associated with poor dental hygiene and heart murmurs?
Strep. mutans - gram positive cocci, catalase negative, alpha hemolytic normal flora of mouth
Poor dentition allows bacteria to enter blood stream and colonize heart valves
What is the difference between gestational hypertension and preeclampsia?
Gest. hypertension = just hypertension
Preeclampsia = Hypertension + Proteinuria
What does an ST depression indicate?
Subendocardial ischemia (not full thickness)
What does an ST elevation indicate?
Transmural ischemia - full thickness
Describe the murmur heard in hypertrophic cardiomyopathies
Systolic murmur heard best between apex and left sternal border
Radiates to suprasternal notch
Increases with standing, decreases with squatting (opposite of mitral regurg)
What size should an abdominal aortic aneurysm reach to require surgery?
> 5 cm in diameter
What drugs are known to cause an increase in warfarin action by decreasing its binding to plasma proteins?
What EKG finding characterizes third degree AV block?
No correlation between p waves and the QRS complex
What heart condition often progresses to third degree heart block?
Mobitz type II second degree AV block (2:1 or 3:1 p to qrs ratio)
What is Romano-Ward syndrome?
Congenital long qt syndrome caused by mutation in outward rectifying potassium channel
-pure cardiac symptoms (palpitations, seizure) - risk of sudden death due to torsades de pointes (ventricular tachycardia)
What is Jervell and Lange-Nielsen syndrome?
Congenital long qt syndrome caused by mutation in outward rectifying potassium channel
-cardiac symptoms (palpitations, seizure) + sensorineural hearing loss- risk of sudden death due to torsades de pointes (ventricular tachycardia)
What are the EKG findings for supraventricular tachycardia?
Rapid rate, regular rhythym
Narrow QRS with no p waves
What is the drug of choice for supraventricular tachycardia resistant to vagal manuevers?
Adenosine - increases potassium conductance out of cells = slows conduction velocity and increases AV node refractory period
What are signs of and the most common cause of death in Friedrich's Ataxia?
Trinucleotide repeat disorder (GAA) - affects mitochondria
Staggering gait, nystagmus, pes cavus (kyphoscoliosis), and hammer toes
Cause of death: Hypertrophic cardiomyopathy (interventricular septum)
What are two medications shown to improve mortality in heart failure?
What is a medication shown to decrease hospital stays but not decrease mortality in heart failure?
Digoxin - inhbits Na/K ATPase increasing Calcium concentration and contractility (positive inotrope)
Stimulates vagus nerve to decrease HR
What medication can be used to buy time prior to surgery for infants with transposition of the great vessels?
Alprostadil - prostaglandin E1 will help to maintain a patent ductus arteriosus allowing mixing of oxygenated and deoxygenated blood
What drug can be used to help close a patent ductus arteriosus?
Indomethacin (NSAID - blocks cyclooxygenase and prostaglandin synthesis)
What is the normal 02 sat for a fetus both total and when passing through the foramen ovale?
80% saturated total - 65% saturated when through the foramen ovale b/c blood is mixing with deoxygenated blood
What are the cardiac and respiratory complications of Marfans syndrome and what chromosome?
Chromosome 15 - fibrillin gene
Pectus excavatum = compromises respiratory function
Mitral prolapse, mitral regurgitation, aortic root dilation and dissection
Name the loop diuretics, the moa, and most likely side effect
Furosemide, ethacrynic acid (good for patient w/ sulfa allergy), and bumetanide
MOA: inhibit Na/K/2Cl cotransporter in thick ascending loop
Side effects: Ototoxicity (hearing loss)
What type of diuretic will increase serum Ca levels?
Thiazide diuretics - blocking the Na/Cl cotransporter in distal tubule causes inc. activation of Na/Ca cotransporter
Shortened QT interval
What genetic condition is Tetralogy of Fallot highly associated with?
DiGeorge Syndrome: Catch-22
How do flow murmurs respond to the Valsalva manuever?
Valsalva manuever decreases intensity of flow murmurs (aortic/pulmonary/mitral/tricuspid stenosis and regurgitation)
What type of amyloid is associated with multiple myeloma?
AL amyloid - overproduction of immunoglobulins form insoluble deposits that infiltrate the myocardium causing ventricular cavities to stiffen
**Restrictive ventricular filling and biatrial enlargement = acute decompensated heart failure and preserved ejection fraction
What is the order in which catecholamines are synthesized?
Dopamine - norepinephrine - epinephrine
What is the MOA of losartan?
Ang II receptor antagonist - blocks vasoconstriction and aldosterone secreting effects of Ang II.
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