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Terms in this set (189)
The following changes are associated with which condition?
Decrease in left ventricular chamber apex to base dimension
Sigmoid shaped ventricular septum,
myocardial atrophy with increased collagen deposition, and accumulation of cytoplasmic lipofuscin pigment within cardiomyocytes.
Progressive congestive heart failure and ventricular dilation with diffuse subendocardial vacuolization and fibrosis are seen in which condition?
Chronic ischemic heart disease
A patient with hyperhomocysteinemia and a homozygous mutation in methylene tetrahydrofolate is at risk for developing what condition due to an impariment in converting homocysteine into what?
Elevated levels of plasma homocysteine are an independent risk factor for thrombotic events. MTHFR deficiency leads to homocysteine not being covered into methionine
Transsulfuration converts homocysteine in which product reduce the likely hood of thrombotic events
In B12 and folate deficiency which product is elevated?
Methylmalonyl-CoA is elevated in which megaloblastic anemia?
B12 deficiency only
Individuals with left dominant circulation have the posterior descending artery coming off of which coronary artery?
Left main coronary artery
When are left ventricular gallops S3 and/or S4 best heard with a stethoscope over the cardiac apex?
When the patient is in the left lateral decubitus position and at end expiration
What are the three components of the Wolff-Parkinson White triad?
1. Shortened PR interval
2. Widened QRS
3. Delta wave
A patient presents with a blowing diastolic decrescendo murmur best heard at the left sternal border in the third of fourth intercostal space with bounding femoral and carotid pulses ("water-hammer"pulses). What is the most likely diagnosis?
Patients with this condition has a characteristic arterial pulse a samples amplitude (pulses parvus) with a delayed peak and slower upstroke of the arterial pulse (pulses tardus)
Systolic hypertension in the upper extremities with delayed or diminished femoral pulses (brachial femoral delay)
Coarctation of the aorta
Some patients may experience de Musset sign (head bobbing) with this condition due to transfer of momentum form the large LV stroke volume to the head and neck
Head bobbing seen in aortic regurgitation is due to??
Widened pulse pressure (pulse pressure= systolic arterial pressure-end diastolic arterial pressure)
Organ susceptibility to infarction after occlusion of a feeding artery is ranked from greatest to largest how?
CNS> myocardium> kidney> spleen> liver (because it has a dual blood supply portal vein and hepatic artery)
This drug selectively inhibits the funny sodium channels during phase 4, prolonging the slow depolarization phase and slowing SA node firing. It has a negative chronotropic effect with no effect on cardiac contractility (inotropy) and/or relaxation (lusitropy)
Inhibit the L type channels responsible for phase 2 cardiomyocyte action potential and phase 0 nodal action potential depolarization. They slow sinus rate, prolong conduction through the AV node, and depress myocardial contractility
Verapamil and diltiazem (non-dihydropyridine Ca channel blockers)
Act by blocking sodium channels and inhibiting phase 0 depolarization of the myocardial action potential. They slow actin potential conduction velocity but do not significantly affect heart rate
Class 1 anti arrhythmic drugs
Block K channels including slow delayed rectifier K channels prolonging repolarization, action potential duration, and the refractory period. They have no specific role in the management of CHF
Class III anti arrhythmic
Inhibits the Na/K exchanger in myocardial cells increasing intracellular Na. Rising intracellular Ca improving myocardial contractility and left ventricular systolic function. It is also used for ventricular rate control in arteriole fibrillation as it decreases atrioventricular nodal indication by increasing parasympathetic vagal tone.
This pattern of necrosis develops after irreversible ischemic injury in most tissues except the brain. Tissue architecture is preserved but cells become a-nucleated.
This pattern of necrosis develops after focal bacterial infections that stimulate mucky recruitment. It is also seen with CNS infarcts due to lack of substantive supporting stroma
This pattern of necrosis is seen in acute pancreatitis and leads to saponification
This pattern of necrosis is seen with TB infection and leads to a cheesy tan white gross appearance with granulomas on histology
A patient presents with skin and mucosal telangiectasias as well as recurrent severe nose bleeds. What is the most likely etiology of this patients condition?
Osler-Weber-Rendu syndrome a AD inheritance of congenital telangiectasia to the skin and mucus membranes
Neurofibromas, optic nerve gliomas, Lisch nodules and cafe au lait spots are seen in which condition?
Von Recklinghausen's disease chromosome 17
Patients develop bilateral cranial nerve VIII schwannomas and mutliple meningiomas in this condition
NF2 chromosome 22
Congenital neurocutaneous disorder characterized by the presence of cutaneous facial angiomas as well as leptomeningeal angiomas.This condition is associated with mental retardation, seizures, hemiplegia, and skull radiopacitites. Skull radiographs may show "Tram track' calcifications
Sturge Weber syndrome
AD condition characterized by the presence of capillary hemangioblastomas in the retina and or cerebellum as well as congenital cysts and or neoplasms in the kidney, liver, and pancreas. Patients are also at increased risk for renal cell carcinoma which can be bilateral
Von Hippel Lindau disease
This AD condition presents with cortical and subepedymal hamartomas as well as cutaneous angiofibromas (adenoma sebaceous), visceral cysts, and a variety of other hamartomas as well as renal angiomylipomas and cardiac rhabdomyomas
An early diastolic decrescendo murmur is characteristic of?
Pre-systolic murmurs that may disappear with atrail fibrillation
Mitral or tricuspid valve stenosis
Mid systolic click that occurs earlier with inspiration is characteristic of which murmur?
Mitral valve prolapse
The carotid arteries are derived from which aortic arch?
Aortic arch 3
A child presents with a new holosystolic murmur with interstitial fibrosis with central lymphocytes and macrophages as well as giant cells on myocardial biopsy. ASCHOFF bodies are also present. Plump macrophages with abundant cytoplasm and central, slender chromatin ribbons called Anitschkow or caterpillar cells are often seen. What is the child suffering from?
Acute rheumatic fever
A 75 year old patient presents with heavy calcifications of the aortic valves with no prior health issues. What is the underlying etiology of this finding?
Dystrophic calcification affecting an aging aortic vavle. Dystrophic calcification is considered a hallmark of cell injury and death occurring in all types of necrosis
The time course of this MI complication happens acutely and will present with hypotension, clear lungs, and Kussmaul sign (elevated JVP)
Right ventricular failure
The time course of this MI complication happens within 3-5 days and presents with acute, severe pulmonary edema, severe mitral regurgitation with flail leaflet
Papillary muscle rupture
The time course of this MI complication is within 3-5 days and presents with a new holosystolic murmur, stepped-up oxygen level between right atrium and ventricle
Interventricular septum rupture/defect
The time course of this MI complication is within 5-14 days and presents with a pericardial tamponade, jugular venous distension, and distant heart sounds. A patient may have hemoperricardium and cardiac tamponade and have profound hypotension and shock.
Free wall rupture
The mechanism of action of this drug is to activate gauntlet cyclase and promote the conversion of guanosine triphosphate to cyclic guanosine monophosphate cGMP. Increased levels of cGMP lead to decreased intracellular calcium (reduces the activity of myosin light chain kinase) and activation of myosin light chain phosphatase promoting myosin light chain dephospho rylation and vascular smooth muscle relaxation.
IV vasodilators such as nitroglycerine and sodium nitroprusside
This is the most prevalent collagen in the human body and is the primary collagen in mature scars such as a healed MI
Type 1 collagen
7 days post MI what type of collagen is present?
Type III collagen similar to what is seen in granulation tissue, skin, lungs, intestines, blood vessels and bone marrow
What property of skeletal muscle makes it resistant to non-dihydrocalcium channel blockers such as verapamil
Skeletal muscle is not dependent on extracellular calcium influx so calcium channel blockers do not affect skeletal muscle contractility
This gram positive cocci synthesizes dextran from sucrose allowing it to adhere to tooth enamel and to fibrin platelet aggregates on damaged heart valves.
Streptococci viridans such as strep mutants and Strep sanguinis
The afferent limb of the carotid sinus carries parasympathetic impulses via the?
Glossopharyngeal nerve CN IX
The efferent limb of the carotid sinus carries parasympathetic impulses via the?
Vagus nerve X
What are the four classes of drugs that have bene shown to sportive long term survival in patients with heart failure due to left ventricular systolic dysfunction
1. beta blockers
2. Ace inhibitors
3. angiotensin II receptor blockers
aldosterone antagonist (spironolactone, eplerenone)
Amiodarone, sotalol, and dofetilide belong to which class of drugs. What is the mechanism of action of these drugs?
Class III anti arrhythmic drugs that predominately block potassium channels and inhibit the outward potassium currents during phase 3 of the cardiac action potential thereby prolonging depolarization and total action potential duration.
Chronically elevated venous pressure in the lower extremities can lead to incompetent venous valves. This commonly manifest as?
(Brownish color is venous stasis dermatitis and is associated with extravasation of RBCs into the tissue leading to iron deposition)
The intimal tears in stanford type A and B dissections usually begin in which two locations respectively?
Type A--> Sinotubular junction
Type B--> Left subclavian artery
This test is commonly employed to determine if the means of two populations are equal
Two sample T test
This is used to model the linear relationship between a dependent variable and a independent variable
This is a measure of the strength and direction of a leaner relationship between variables
This is most appropriately used with categorical data and can be used to evaluate whether the expected frequency of an occurrence is consistent with the observed frequency of that occurrence "goodness of fit"
Chi square test
Epidemiologic method of analyzing pooled data from several studies, thereby increasing the statistical power beyond that f the individual studies
Migratiry thrombophlebitiis should raise suspicion for?
This agent increases PVR, increases systolic BP, decreases pulse pressure and decreases HR
Complex adrenergic agent whose physiologic effects are primarily the result of beta adrenergic receptor agonism. It increases the HR and contractility with little effect on PVR. used in the treatment of cardiogenic shock
Traumatic aortic rupture is most often used by the rapid deceleration that occurs in motor vehicle collisions. The most common site of injury is?
The aortic isthmus (proximal descending aorta just distal to the origin of the left subclavian artery)
What effect does carotid massage have on the body?
Carotid sinus massage causes reflex parasympathetic stimulation of the SA node, atrial myocytes, and AV node, resulting in a transient decrease in HR and CO. Increased afferent firing from the carotid sinus which in turn, increases vagal parasympathetic tone slows conduction through the AV node and prolongs the AV node refractory period, helping to terminate reentrant tachycardia.
Differential diagnosis occurs when unoxygenated blood is delivered distal to the left subclavian artery. This is seen in which congenital heart defect?
Patent ductus arteriosus (PDA)
Describe Eisenmenger syndrome
This syndrome occurs when large septal defects (left to right shunts) reverse to (right to left shunts) due to an increase in pressure in the right heart
Which amino acid synthesizes nitric oxide via endothelial intro oxide synthase?
These two substances work in concert to ensure vascular homeostasis
Prostacyclin and thromboxane A2
Vasodilator that inhibits platelet aggregation and increases vascular permeability
Prostaglandin that enhances platelet aggregation and causes vasoconstriction
Why do we administer IV fluids in patients in hypovolemic shock?
IV fluids increase the intravascular and left ventricular end diastolic volumes. The increase in preload stretches the myocardium and increases the end diastolic sarcomere length leading to an increase in stroke volume and cardiac output. IV FLUIDS WILL REDUCE SYMPATHETIC ACTIVATION AND THEREFORE DECREASE TOTAL PERIPHERAL RESISTANCE AND MYOCARDIAL CONTRACTION VELOCITY.
Describe the lesion most often underlying stable angina
Fixed atheromatous obstruction of one or more coronary arteries occluding at least 75% of the luminal cross sectional area!!!
What is the best indicator of the severity of mitral regurgitation
The best indicator of severe MR with left ventricular volume overload is the presence of an S3 gallop. In cases of severe MR, the left ventricular S3 gallop reflects an increased rate of left ventricular filling due to a large volume of regurgitant flow re-entering the ventricle during mid diastole.
A mid systolic click is characteristic of which heart murmur
mitral valve prolapse caused by the sudden tensing of the chord tendineae as they are pulled taut but eh valve leaflets ballooning into the left atrium
The indicator of severity of mitral stenosis is?
The S2 opening snap interval which is a diastolic time interval between the closure of the aortic valve A2 and the abrupt halting of leaflet motion during opening of a stenotic mitral valve (opening snap)
This vein originates from the medial side of the food, courses anterior to the medial malleolus and then travels up the medial aspect of the leg and thigh. It drains into the femoral vein within the region of the femoral triangle a few centimeters inferolateral to the pubic tubercle
Great saphenous vein
What is the formula for maintenance dose of a drug ? (How much drug should be given per hour to maintain a therapeutic steady state plasma concentration)
Cpss (stead state plasma concentration) x CL (clearance)
Non bacterial thrombotic endocarditis is a form of non infectious endocarditis characterized by deposition of sterile platelet thrombi on cardiac valves. It is commonly associated with what?
Advanced malignancy, chronic inflammatory disorders such as (lupus and antiphospholipid syndrome)
How do you calculate true positives?
(sensitivity!!!! ) x (number of people with the disease)
How do you calculate false negatives ?
(1-sensitivity!!!) x( number of people with the disease)
What aspect of a test determines the proportion of patients that are correctly classified as true positives?
SENSITIVITY OF A TEST
What is the most common cause of death 2-3 days post MI?
Ventricular arrhythmias such as ventricular fibrillation
Which of the following components of the cardiovascular system is most susceptible to the effects of nitroglycerin
SinceLarge veins NOT ateries
What effect does ARB therapy have on bradykinin levels?
Since ACE function remains intact wit the use of ARBs bradykinin levels are not significantly affected.
This occurs when the aorta is anteriorly positioned and connected to the right ventricle and a posteriorly positioned pulmonary artery connected to the left ventricle.This leads to the pulmonary and systemic circulations being abornoally separate and existing as 2 parallel circuits
transposition of the great arteries
Infants with a deficiency in this vitamin appear normal at birth but present with fulminant cardiac syndromes with cardiomegaly, tachycardia, cyanosis, dyspnea and vomiting at age 2-3 months.
Infantile Berberi due to thaimine deficiency
Adults with a deficiency in this vitamin have symmetrical peripheral neuropathy of the distal extremities with resulting sensory and motor impairments.
A patient presents with petechial hemorrhages, gingival swelling, weakened immune responses, and impaired wound healing. What vitamin is most likely deficient in this patient
Ascorbic acid (VITAMIN C)
A patient presents with dementia, dermatitis and diarrhea. What vitamin is this patient most likely deficient in?
A deficiency in this vitamin is characterized by night blindness, xerophthalmia, and vulnerability to infection (especially measles)
Rentinol (vitamin A)
What is the order of cardiac conduction velocity from fastest to slowest
Purkinje system, atrial muscle, ventricuar muscle and AV node is the slowest
PARK AT VENTRUE AVENUE
The pathogenesis of atherosclerosis is though to begin with
In the pathogenesis of atherosclerosis which cells simulate medial smooth muscle cells to migrate into and proliferate in the intima
Platelets and monocytes
Persistent lymphedema with chronic dilation of lymphatic channels predisposes to the development of lymphagiosarcoma (a rare malignant neoplasm of the endothelial lining of lymphatic channels). This cancer is associated with which procedure?
Radical mastectomy with axillary lymph node dissection for breast cancer
Which heart murmur is most likely to lead to an elevated pulmonary capillary wedge pressure?
Mitral stenosis leads to an increase in the LA pressure that is reflected as elevated PCWP during pulmonary artery cathetherization. Left ventricular filling may be normal, resulting in an increased pressure gradient between the LA and LV during diastole.
Arterial puncture above the inguinal ligament increases the risk of what kind of hemorrhage?
Retroperitoneal hemorrhage as this portion of the vessel lies directly inferior to the peritoneum
Mutations in the transthyretin gene increase the tendency of TTR to misfold leading to what kind of HF?
Infiltrative cardiomyopathy that may lead to diastolic heart failure
Petechiae, splinter hemorrhages roth spots, Janeway lesions, and Osler nodes are all indicative of?
The most common underlying valvular disease predisposing to the development of endocarditis in developed countries is?
Mitral valve prolapse
When strep gallolyticus endocarditis is cultured in the blood what should be worked up?
Work up for colonic malignancy with colonoscopy. Every patients with S. gallolyticus bacteria with or without endocarditis should be examined for Gi tract malignancy
identify A-E in the following picture
A- superior vena cava
B- ascending aorta
C- pulmonary trunk
E- descending aorta
Overdose of this drug presents with nonspecific GI symptoms such as anorexia, nausea, vomiting and neurologic findings such as fatigue, confusion, and weakness. Changes in color vision are a more specific but rarer finding
What is the most serious complication of digoxin toxicity?
Life threatening arrhytmias
What is the formula for the blood flow?
Ventricular after load is increased when there is increased systemic blood pressure against which ventricle has to generate force during isovolumic contraction to open eh aortic valve. What would the pressure volume loop show?
Elevated pressures during the isovolumetric ventricular contraction phase before the aortic valve opens
Left end systolic volume refers to the volume of blood remaining in the ventricular cavity after myocardial contraction. It would increased in states of decreased cardiac contractility. What would the pressure volume loop show?
The pressure volume loop would be narrow with a shift in the isovolumetric relaxation line to the right
LV end diastolic volume and pressure occur at point A, which represents the volume of blood in the left ventricle after closure of the mitral valve. LV end diastolic volume determines the stretch of myocardial fibers at end diastole and corresponds to LV preload. What would the pressure volume loop show?
An increase in preload lol
Increasing the contractility of a heart using a drug like digoxin would lead to which effect on the pressure volume loop?
Increase the effective stroke volume or ejection fraction
Short PR interval
Widening of the QRS interval
Slurred and borad upstroke of the QRS complex (DELTA WAVE) signifies what on an ECG?
Wolf Parkinson White syndrome
Patients with this condition have an extra conduction pathway also known as at the accessary bypass tract or bundle of kent that directly connects the atria t the ventricles allowing impulses to bypass the AV node and causes early excitation of the ventricles
Wolf Parkinson White syndrome
Mutations in frataxin are associated with which heart condition
Hypertrophic cardiomyopathy (Freiderichs ataxia)
A patient presents with flushing, watery diarrhea, bronchospasm, and valvular fibrosis on the right side and NOTHING ON THE LEFT SIDE. What is the next best step for treating this patient?
urine 5-hydroxyindoleacetic acid test (urine 5 HIAA) and CT/MRI of abdomen and pelvis to localize the tumor
This drug increases K conductance and causes a transient conduction delay though the AV node and is used for acute termination of paroxysmal supra ventricular tachycardia
What effect will we see on an ECG after administration of a beta blocker?
Prolonged PR interval
Absence of P waves, irregularly irregular rhythm with varying R-R intervals
What is holiday heart syndrome?
A delay in intraventricular conduction due to fascicular or bundle branch block can lead to what changes on an ECG?
Prolongation of the QRS interval
During transesophageal echocardiography what structures are located anteriorly and posteriorly to the probe if the probe is initially facing the back of the heart
Anteriorly--> Left atrium
Posteriorly--> Descending aorta
Pericardial fluid accumulation with late diastolic collapse of the right atrium due to displacement of pericardial fluid with ventricular expansion will be on echocardiography in a patient with which condition
Pulsus paradoxus refers to a condition in which there is an exaggerated drop in systolic blood pressure >10mm Hg during inspiration. This physical finding is an important finding in which condition?
This is due to bowing of the inter ventricular septum toward the left ventricle, decreasing left ventricular end diastolic volume and stroke volume. This results in a decreased systolic pulse pressure during inspiration.
A rapidly rising pulse (hyperkinetic pulse) due to the rapid ejection of a large stroke volume against a decreased after load is mostly seen in which conditions?
AorAortic regurgitation and high output conditions such as thyrotoxicosis, and AV fistulas
Pulsus parvus et tardus is a palpable slow rising low amplitude pulse due to diminished stroke volume and prolonged LV ejection time. This is mostly seen in which condition?
Myocardial oxygen extraction exceeds that f any other tissue or organ in the body. The most deoxygenated blood in the body lies in which vessel?
PD3 inhibitors lead to an increase in intracellular cyclic cAMP concentration which promotes intracellular Ca influx and increases cardiac contractility. An increase in cAMP concentration in the vascular smooth muscle cells also causes systemic vasodilation which limits the use of milrinone and inamrinone in severely hypotensive patients
Milirinone and inamrinone
What are Korotkoff sounds?
Blood flow sounds that are observed while taking a blood pressure
What are the three positive waves in the jugular venous tracing?
A- right atrial contraction
C- bulging of the tricuspid valve during right ventricular contraction
V- continued inflow of venus blood
Statins may cause myopathy when combined with which class of medication?
Fibrates (gemfibrozil) because they impair the hepatic clearance of statins increasing the risk of severe myopathy
The major determinant of whether or not a coronary artery plaque will cause ischemic myocardial injury is ?
The rate at which t occludes the involved artery. A slowly developing occlusion would allow for formation of cholera's that could prevent myocardial necrosis
Where are beta 1 adrenergic receptors found?
In cardiac tissue and on renal juxtaglomerular cells but not in vascular smooth muscle. Therefore, selective blockage of the B1 receptor (with atenolol) leads to decreased cAMP levels in cardiac and renal tissue without significantly affecting cAMP levels in vascular smooth muscle
Alleviates fast sodium blockade that causes ventricular arrhythmias and a widened QRS interval in TCA overdose
An inactivating mutation in the BMPR2 gene can lead to endothelial dysfunction and smooth muscle proliferation. A second insult (infection, drugs, ion channel defects) are then thought to activate the disease process which involves increased endothelin (vasoconstrictor) and decreased NO. Accentuation of the pulmonary component of the second heart sound P2 may be heard on auscultation
Idiopathic pulmonary HTN
Autosomal dominant with variable penetrance
Refers to a state of chronic myocardial ischemia in which both myocardial metabolism and function are reduced to match a concomitant reduction in coronary blood flow (due to moderate/severe flow-limiting stenosis). This new equilibrium prevents myocardial necrosis.
Phenomenon in which brief repetitive episodes of myocardial ischemia followed by repercussion, protect the myocardium from subsequent prolonged episodes of ischemia.
Usually occurs after repetitive activity and involves the upper costal cartilage at the costochondral or costosternal junctions. The pa is typically produced with palpation and worsened with movement or changes in position (horizontal arm flexion). Patients typically do not have palpable warmth, sweeping, or erythema
Which drugs are CYP450 inhibitors and increase the concentration of drugs that are metabolized by the livers CYP450?
Ritonavir (protease inhibitors)
What drugs are CYP450 inducers and decrease the concentration of drugs metabolized by the CYP450 enzyme in the liver
A 6 day old presents with a loud "blowing" holosystolic murmur at the mid to power left sternal boarder and no symptoms. The murmur is usually not detectable at birth, but becomes audible around age 4-10 days as pulmonary vascular resistance continues to decline permitting significant left to right shunting
Rare tumor associated with exposure to carcinogens such as arsenic thorotrast, and polyvinyl chloride. Tumor cells express CD31 (PECAM 1) which is an endothelial cell marker
benign, painful, red-blue tumor formed from arteriovenous shunts
found under the fingernails
derived from smooth muscle cells of glomus body
involved in temperature regulation which can shunt blood towards or away from the superficial skin
a type of benign capillary malformation that presents as a purplish colored birthmark on the face and neck
also known as nevus flammeus
and no proliferation
thought to result from
neural deficiency of sympathetic innervation of the blood vessels
↑ vascular endothelial growth factor (VEGF) inducing vasodilation
Port wine stain
pedunculated capillary hemangioma
easily ulcerates and bleeds
associated with trauma and pregnancy
regress post-partum with ↓ estrogen
benign tumor of liver and spleen
risk of rupture with ↑ size
can also be found in the brain and retina with Von-Hippel-Lindau syndrome
lymphangioma of the neck
responsible for the "webbed-neck" in Turner's syndrome
A holosystlic murmur that increases in intensity with inspiration (Carvallo sign)
Calcium efflux from cardiac cells prior to relaxation is primarily mediated by?
Na/Ca exchange pump and sarcoplasmic reticulum Ca-ATPase pump (SERCA)
This is an autosomal dominion disorder resulting from mutations in cardiac sarcomere proteins encoding sarcomere genes. Common mutations include single point missense mutations in genes for beta-myosin heavy chain and myosin binding protein C. This leads to asymmetric ventricular septal hypertrophy and variable, dynamic left ventricular outflow tract obstruction. Systolic anterior motion of the mitral valve toward the inter ventricular septum can cause eccentric mitral regurgitation and exacerbate LVOT obstruction
Stimulates alpha two adrenoceptors in the brainstem resulting in reduced sympathetic outflow from the CNS, leading to a decrease in peripheral vascular resistance, heart rate and blood pressure.
Elevated capillary hydrostatic pressure and decreased plasma oncotic pressure (less albumin in vessels) will lead to what state?
Excess accumulation of transudative fluid int eh interstitial tissues
Occlusion of which artery would be expected to result in anteroseptal transmural ischemia with ST elevations in leads V1-V4
Occlusion of which artery can result in transmural ischemia of the inferior wall of the left ventricle producing ST elevation in leads II III and aVF as well as possible sinus node dysfunction
Right coronary artery
What class of drugs are effective in treating patients with both BPH and HTN?
Alpha 1 blockers such as: Doxazosin,Prazosin, and Terazosin
These anti hypertensives may cause peripheral edema, dizziness or lightheadedness
Calcium channel blockers (Amlodipine, nifedipine)
Where are the left ventricular leads in a biventricular pacemaker placed?
Left ventricular leads in biventriuclar pacemakers course through the coronary sinus, which resides in the atrioventricular groove on the posterior aspect of the heart.
Symptomatic management of peripheral artery disease (PAD) includes a graded exercise program and this drug that is a phosphodiesterase inhibitor that inhibits platelet aggregation and acts as a direct arterial vasodilator.
When one hormone allows another to exert its maximal effect it is known as?
When the combined effect of 2 drugs equal the sum of their individual effects it is termed?
When the combined effected exceeds the sum of the individual drug effects, the interacted is called?
Selective peripheral dopamine 1 receptor agonist. It is given intravenously to lower blood pressure in hypertensive emergency, especially in patients with renal insufficiency. It uses arteriolar dilation, increases real perfusion and promotes diuresis and natriuresis
Scattered cells within mucopolysaccharide storm is consistent along with angiogenesis, weight loss, and fever due to increase production of IL-6
These anti hypertensives raise serum calcium uric acid glucose, cholesterol, and triglyceride levels while lowering serum sodium, K, and Mg levels
Thiazide diuretics (chlorthalidone)
Blanching of a vein into which NE is being infused together with induration and pallor of the tissues surrounding the IV site are signs of NE extravasation and resulting vasoconstriction. Tissue necrosis is best prevented by local injection of?
Alpha 1 blocking drug such as phentolamine
Vasculitis of medium sized arteries that affects young children (usually age <5 years). It occurs most commonly in patients of Asian ethnicity and is characterized by fever for greater than 5 days, bilateral non-exudative conjunctival infection, cervical lymphadenopathy, mucositis (strawberry tongue), edema of the hands and feet, and rash
What can we give an infant to accelerate the closure of a PDA?
Indomethacin or ibuprofen
This is a short acting balanced venous and material vasodilator that decreases both preload and after load. Since these changes are balanced, stroke volume is maintained
The most common complication of a bicuspid aortic valve is?
Which medication for CHF is most likely to cause hyPOkalemia?
What is acetazolamide and on what part of the nephron does it act?
Carbonic anhydrase inhibitor that acts on the proximal ovulated tubule
What is mannitol and on what part of the nephron does it act?
Osmotic diuretic that acts on the PCT and the descending loop of henle
Loop diuretics act on which portion of the nephron?
thick ascending loop of henle
thiazide diuretics act where in the nephron
early distal convoluted tubule
A patient who is showing signs of lung cancer presents with right sided face and arm swelling and engorgement of subcutaneous veins on the same side of the neck. Which vein is most likely obstructed in this patient?
A patient with lung cancer presents to the clinic with dyspnea, bilateral facial and upper limb swelling, and a positive pembertons sign (raising your arms to touch your face and seeing the presence of congestion and cyanosis in only one minute)
Superior vena cava syndrome
Jervell and Lange-Nielsen syndrome autosomal recessive disorder characterized by profound bilateral sensorineural hearing loss and congenital long QT syndrome predisposing children to ventricular arrhythmias and sudden cardiac death. A genetic defect in which of the following is most likely to be present in these patients?
Mutations in genes coding of voltage gated potassium channels
The primary anti ischemic effect of this medication is mediated by VENODILATION (NOT ARTERIAL ASHLEY!!!1) with a decrease in left ventricular end diastolic volume and wall stress resulting in decreased myocardial oxygen demand and relief of angina symptoms
A linear skull fracture at the junction of the frontal, parietal, temporal, and sphenoid bones (at the pterion) is most worrisome for severing which artery?
The middle meningeal artery which is a brach of the maxillary artery
What are the most important factors involved in coronary blood flow auto regulation?
Adenosine and NO
Has both beta adrenergic blocking and class III anti arrhythmic K+ channel blocking properties and is occasionally used in treatment of atrial fibrillation. Major side effects include bradycardia, pro arrhythmia, and torsades
A patient presents with a pulsating, central abdominal mass and is diagnosed with abdominal aortic aneurysm (AAA). The patients condition is caused by what mechanism?
oxidative stress, vascular smooth muscle apoptosis, and CHRONIC TRANSMURAL INFLAMMATION (not focal intima tear because this is aortic dissection)
What arteries become occluded in retinal artery occlusion?
Internal carotid which branches off to the ophthalmic artery and the retinal artery
Supine hypotension syndrome is characterized by hypotension, pallor, sweating, nausea, and dizziness that occur when a pregnant woman lies supine on her back. What is the cause of this?
SHS is due to the gravid uterus compression and obstructing the inferior vena cava. This reduces the venous return (preload), which subsequently lowers the cardiac output leading to hypotension.
Irreversible myocardial cell injury in a patient is seen through what ultrastructural change?
Appearance of vacuoles and phospholipid containing amorphous densities within mitochondria
Beta blockers lower blood pressure via which two mechanisms?
1. Reducing myocardial contractility
2. Decreasing renin release by the kidney
Cutaneous strawberry type capilllary hemangioma are common benign, congenital tumors which are composed of unencapsulated aggregates of closely packed, thin walled capillaries. How do these vascular tumors change over the lifetime of a child?
First increase in size and then regress
Why do patients taking nitrates need to have a nitrate free period when taking this drug?
To avoid tolerance development
Before starting a patient on an HMG CoA reductase inhibitor (statin) what blood work should be drawn?
The intensity of this murmur increases when the patient sits up or moves forward
Supine dyspnea that is relieved by sitting up is indicative for what kind of heart failure?
Left sided heart failure because the most prominent extra cardiac effects of left sided HF occur in the lungs.
The likelihood of plaque rupture is related to plaque stability rather than plaque size or the degree of luminal narrowing. Plaque stability largely depends on the mechanical strength of the fibrous cap. Inflammatory macrophages in the intimal may reduce plaque stability by secreting this substance which degrades extracellular matrix proteins
What effect to AV shunts have on pressure volume loops?
AV shunts increase cardiac preload by increasing the rate and volume of blood flow back to the heart. This is reflected on the ventricular pressure-volume loop by elongation of the diastolic filling segment and higher end diastolic volume. Because AV shunts allow blood to bypass the arterioles, total peripheral resistance is reduced thus decreasing the after load on the heart as well.
Patients who have overdosed on beta blockers should be treated with glucagon which increase HR and contractility independent of adrenergic receptors how?
Increasing cAMP in cardiac myocytes
Vasodilators and diuretics are contraindicated in which patient population?
Patients with hypertrophic cardiomyopathy HCM
Cigarette smoking, cocaine/amphetamines, and dihydroergotamine/triptans may initiate what kind of reaction in a patient with Prinzmetal angina?
A patient with chest pain
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CHAPTER 18 PATHO- TAKEN FROM http://thepoint.lww.c…
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