Term
| Systolic murmur heard at the aortic area |
|
Definition
AS
Flow murmur
AV sclerosis |
|
|
Term
| Systolic ejection murmur hear at pulmonic area |
|
Definition
Pulmonic stenosis
Flow murmur (ASD) |
|
|
Term
| Diastolic murmur at left sternal border |
|
Definition
|
|
Term
| Systolic murmur at left sternal border |
|
Definition
| hypertrophic cardiomyopathy |
|
|
Term
| pansystolic murmur at tricuspid area |
|
Definition
|
|
Term
| Diastolic mumur at tricuspid area |
|
Definition
|
|
Term
| systolic murmur at mitral area |
|
Definition
|
|
Term
| diastolic murmur at mitral area |
|
Definition
|
|
Term
|
Definition
| CO X TPR = 2/3DBP + 1/3SBP |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Mitral valve closing
heard best at mitral area |
|
|
Term
|
Definition
Aortic and pulmonic valves closing
Head loudest at left sternal border |
|
|
Term
|
Definition
early diastole
due to high filling pressures and dilated ventricles, but normal in children and pregnant chicks |
|
|
Term
|
Definition
late diastole due to high atrial pressures
assoc. w/ ventricular hypertrophy b/c LA has to push against stiff LV wall |
|
|
Term
|
Definition
| Pulmonic Stenosis or RBBB- delayed RV emptying |
|
|
Term
|
Definition
| ASD- increase in flow across the pulm valve |
|
|
Term
|
Definition
AS or LBBB- delayed LV emptying
On inspiration, the later P2 and earlier A2 move closer together and obscure the split |
|
|
Term
|
Definition
| A2 is heard before P2 and gap widens on inspiration b/c inspiration decreases intrathoracic pressure and increases the capacity of the pulm circulation, so P2 is later. A2 is earlier b/c this causes a drop in the return to the heart |
|
|
Term
|
Definition
|
|
Term
| Heard best at apex and radiates to the axilla |
|
Definition
|
|
Term
|
Definition
| caused by Hypokalemia, bradycardia |
|
|
Term
| V-tac characterized by shifting sinusoidal waveforms on ECG |
|
Definition
|
|
Term
|
Definition
| Accessory conduction p'way from atria to the ventricle bypassing the AV node causing the ventricles to depolarize early. May lead to a reentry current leading to SVT Shows up as a delta wave on ECG Called Wolff-Parkinson-White syndrome |
|
|
Term
|
Definition
WPW syndrome- bypass tract that causes early ventricular depolarization.
Q wave is buried in the delta wave. |
|
|
Term
| Wolff-Parkinson-White syndrome |
|
Definition
Accessory conduction p'way causes early partial ventricular depolarization.
AKA ventricular pre-excitation syndrome |
|
|
Term
|
Definition
Atrial flutter
a rapid succession of identical, back-to-back atrial depolarization waves |
|
|
Term
|
Definition
attempt to convert to sinus rhythm
use class IA, IC, or II antiarrhythmics |
|
|
Term
| irregularly irregular ECG pattern and tx |
|
Definition
|
|
Term
| Asx widening of PR interval (> 200 ms) |
|
Definition
|
|
Term
| Asx progressive lengthening of PR interval until the beat is "dropped" |
|
Definition
| 2° AV Block, Mobitz type I = Wankebach |
|
|
Term
| Dropped beats that are not preceded by lengthening of PR interval |
|
Definition
2° AV block, Mobitz Type II
Can progress to 3° block |
|
|
Term
Atria and ventricles contract independent of each other = P waves bear no relation to QRS complexes.
Tx? |
|
Definition
3° AV block
Tx w/ a pacemaker |
|
|
Term
| Erratic rhythm with no identifiable waves |
|
Definition
| V-fib, may be fatal w/o immediate CPR and defibrillation |
|
|
Term
| Aortic Arch Baroreceptors |
|
Definition
| transmits via the vagus nerve to the medulla in response to ↑ BP |
|
|
Term
|
Definition
| Transmits to the medulla via the glossopharyngeal nerve in response to ↑ and ↓ BP |
|
|
Term
| Carotid and Aortic bodies (peripheral chemoreceptors) |
|
Definition
| respond to ↓ PO2 (< 60 mm Hg) and ↑ PCO2, and ↓ pH of the blood |
|
|
Term
|
Definition
Respond to pH and pCO2 of brain interstitial fluid which is influenced by arterial pCO2.
Responsible for the Cushing Triad: HTN, bradycardia and respiratory respiratory depression |
|
|
Term
|
Definition
HTN, bradycardia and respiratory depression
controlled by the central chemoreceptors |
|
|
Term
|
Definition
| PCWP > LV diastolic pressure |
|
|
Term
| Frequency of Left-to-right shunts |
|
Definition
|
|
Term
| MC congenital cardiac abnormality |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Most important determinant for prognosis in Tetralogy of Fallot |
|
Definition
| Degree of Pulmonary stenosis |
|
|
Term
| Failure of aorticopulmonary septum to spiral |
|
Definition
| Transposition of great vessels |
|
|
Term
|
Definition
Post ductal/Adult-type of Coarctation of the aorta
Due to collateral circulation formation |
|
|
Term
| HTN in the upper extremiteis w/ weak pulses in the lower extremities |
|
Definition
| Post-ductal coarctation of the aorta |
|
|
Term
| Congenital Cardiac defect associated w/ 22q11 syndromes |
|
Definition
| truncus arteriosis and Tetralogy of Fallow |
|
|
Term
| Continuous "Machine-like" murmer |
|
Definition
|
|
Term
| Pharmacological interventions for PDA |
|
Definition
| Indomethacin closes it, PGE keeps it open. |
|
|
Term
Congenital Cardiac abnormality associated w/
Down Syndrome |
|
Definition
| ASD, VSD, AV septal defect (endocardial cushion defects) |
|
|
Term
| Congenital Cardiac abnormality assoc. w/ congenital rubella |
|
Definition
| septal defect, PDA, pulmonary artery stenosis |
|
|
Term
| Congenital Cardiac abnormality assoc. w/ Turner's syndrome |
|
Definition
|
|
Term
| Congenital Cardiac abnormality assoc. w/ Marfan's syndrome |
|
Definition
| Aortic insufficiency (late complication) |
|
|
Term
| Congenital Cardiac abnormality assoc. w/ offspring of a diabetic mother |
|
Definition
| transposition of the great vessels |
|
|
Term
| Mönickeburg Arteriolosclerosis |
|
Definition
| Calcification of the media of the arteries, not the intima |
|
|
Term
|
Definition
arteriolosclerosis
hyaline thickening of small arteries in essential HTN |
|
|
Term
| "Tearing" CP radiating to the back |
|
Definition
|
|
Term
|
Definition
| Angina, claudication or asx |
|
|
Term
| order of frequency of atherosclerosis locations |
|
Definition
| Abdominal Aorta > coronary artery > popliteal artery |
|
|
Term
| Types of Angina, causes and assoc. ECG changes |
|
Definition
1. Stable- retrosternal CP on exertion 2° atherosclerosis, ST depression
2. Prinzmetal's variant- occurs at rest 2° coronary artery spasm, ST elevation
3. Unstable/crescendo- thrombosis, but no necrosis, ST depression |
|
|
Term
|
Definition
Pale infarcts happen in solid tissues w/ single blood supple (heart, kidney and spleen)
Red infarcts occur in loose tissues w/ collaterals (Liver, lung, intestine) or following reperfusion |
|
|
Term
|
Definition
| MI first day pale w/ tetrazolium stain |
|
|
Term
|
Definition
| MI days 3-7, hyperemia surrounding pale necrotic infarct |
|
|
Term
|
Definition
| Wavy fibers- MI fisrt 24 hrs |
|
|
Term
|
Definition
| Contraction band necrosis, MI first 24 hrs |
|
|
Term
|
Definition
neutrophil emigration, necrotic myocytes, hemorrhage
MI 2-4 days |
|
|
Term
|
Definition
Pigment laden macrophages, lymphocytes, fibroblast proliferation w/ collagen deposition
MI 5-10 days |
|
|
Term
| When post-MI are you at greatest risk for free wall rupture, tamponade, pappillary muscle rupture, ventricular septal rupture? |
|
Definition
| 5-10 days b/c the infarct is maximally soft and yellow |
|
|
Term
| When post-MI are you at greatest risk for ventricular aneurysm |
|
Definition
|
|
Term
| Dx of MI w/ enzyme levels |
|
Definition
Troponin (specific) peak in 2 days and ↓ baseline in 5-7d
CK MB (specific) peak in 1-1.5d and ↓ baseline w/i 4 days
AST (least specific) |
|
|
Term
|
Definition
ST elevation- transmural infarct
Q-wave- transmural infarct
ST-depression- subendocardial infarct |
|
|
Term
Potential complication of MI that presents as a
friction rub 3-5 d s/p MI |
|
Definition
|
|
Term
| Fibrinous pericarditis several weeks after MI |
|
Definition
| Dressler's Syndrome- Autoimmune phenomenon |
|
|
Term
|
Definition
| Hypertrophic Cardiomyopathy |
|
|
Term
Hypertrophic Cardiomyopathy
MOI and characteristics |
|
Definition
Auto-dominant
Beta myosin heavy chain gene |
|
|
Term
| Cause of Sudden death in young athletes |
|
Definition
| Hypertrophic cardiomyopathy |
|
|
Term
| Findings for hypertrophic cardiomyopathy |
|
Definition
Normal sized heart
S4
apical impulses
systolic murmers
Diastolic dysf(x) ensues |
|
|
Term
| Causes of dilated cardiomyopathy |
|
Definition
Alcohol Abuse
Beri Beri
Coxsackie B Virus myocarditis
Chronic Cocaine use
Chagas Dz
Doxorubicin Toxicity
Peripartum cardiomyopathy |
|
|
Term
| MC type of cardiomyopathy |
|
Definition
| Dilated/Congestive cardiomyopathy |
|
|
Term
| Findings of Dilated cardiomyopathy |
|
Definition
S3
Dilated heart on u/s
balloon apearance on cxr
Systolic dysf(x) ensues |
|
|
Term
| Causes of restrictive cardiomyopathy |
|
Definition
1. Sarcoidosis
2. amyloidosis
3. postradiation fibrosis
4. endoardial fibroelastosis (thick fibroelastic tissue in endocardium of young children
5. Hemochromotosis |
|
|
Term
| Type of cardiac dysf(x) in restrictive cardiomyopathy |
|
Definition
|
|
Term
|
Definition
| Hemosiderin-laiden macrophages in lungs b/c of the pulmonary edema that results from the LV failure |
|
|
Term
|
Definition
Rheumatic Heart Dz
Granuloma with ginant cells in cardiac muscle and subcutaneous nodules |
|
|
Term
|
Definition
Bacterial Endocarditis
Small erythemetous lesions on palms or soles |
|
|
Term
|
Definition
|
|
Term
|
Definition
Bacterial Endocarditis
Tender raised lesions on finger or toe pads |
|
|
Term
|
Definition
Rheumatic Heart Dz
Activated histiocytes |
|
|
Term
|
Definition
Bacterial Endocarditis
Round white spots on retina surrounded by hemorrhage |
|
|
Term
| Type of endocarditis assoc. w/ colon cancer |
|
Definition
|
|
Term
| Type of endocarditis assoc. w/ prosthetic valves |
|
Definition
|
|
Term
| Type of endocarditis assoc. w/ SLE |
|
Definition
| Liebman-Sacks endocarditis |
|
|
Term
| verrucous, sterile vegetations on both sides of the valve |
|
Definition
| Liebman-Sacks endocarditis |
|
|
Term
|
Definition
|
|
Term
| Equilibrium of pressure in all 4 chambers |
|
Definition
|
|
Term
| ↓ amplitude of pulse during inspiration |
|
Definition
Kussmaul's pulse/Pulsus paradoxus
Seen in: OSA, cardiac tamponade, asthma, pericarditis and croup |
|
|
Term
pericardial pain, friction rub, pulsus paradosux, distant heart sounds
ST elevation in multiple leads on ECG
|
|
Definition
|
|
Term
| Type of pericarditis seen in SLE, RA, viral infx, uremia |
|
Definition
|
|
Term
Type of pericarditis seen in
uremia, MI , Rheumatic fever |
|
Definition
Fibrinous Pericarditis
post-MI = Dressler's Syndrome |
|
|
Term
| Tree bark appearance of the aorta |
|
Definition
Appearance of aorta in Syphilitic Heart Dz
T. pallidium disrupt the vasa vasorum of the aortic root w/ consequent dilation and ring widening
may cause calcifications of the aortic root and ascending aortic arch
Could cause aneurysm of ascending aorta or aortic arch and aortic valve incompetence |
|
|
Term
|
Definition
MC tumor: metastases (melanoma and lymphoma)
1° Adults: cardiac myxoma
1º Children: rhabdomyomas (assoc. w/ tuberous sclerosis)
|
|
|
Term
| Presentation and MOI of Osler-Weber-Rendu syndrome |
|
Definition
nose-bleeds and skin discolorations
Auto-dominant inheritance
AKA hereditary hemorrhagic telangiectasia
|
|
|
Term
|
Definition
|
|
Term
| Anti-hypertensive that causes a positive Coomb's test |
|
Definition
|
|
Term
| Anti-hypertensive a/w dry mouth |
|
Definition
|
|
Term
| Anti-hypertensive a/w severe rebound HTN |
|
Definition
|
|
Term
| Anti-HTN drug a/w CN poisoning |
|
Definition
|
|
Term
| Anti-HTN drug a/w Lupus-like syndrome |
|
Definition
|
|
Term
| Anti-HTN drug a/w hypertrichosis |
|
Definition
|
|
Term
| Anti-HTN drug a/w hyperglycemia |
|
Definition
| Thiazide diuretics and diazoxide |
|
|
Term
| Anti-HTN drug a/w AV block |
|
Definition
|
|
Term
|
Definition
↑ cGMP and leads to smooth muscle relaxation
vasodilator in arteriole > veins |
|
|
Term
| 1st line tx of HTN in pregnancy |
|
Definition
| Hydralazine and methyldopa |
|
|
Term
|
Definition
| Opens K channels → hyperpolarizes and relaxation of sm. muscle cells |
|
|
Term
| Ca Channel blocker that works more on vascular sm. muscle |
|
Definition
Nifedipine and amlodipine
Dihydropyridine |
|
|
Term
| MOA of Ca channel blockers |
|
Definition
| block L-type Ca channels of cardiac and sm. muscle → reduced muscle contractility |
|
|
Term
| Ca Channel Blocker that primarily works on cardiac sm. muscle |
|
Definition
Verapamil and diltiazam
Non-dihydropyridine |
|
|
Term
| MOA of nitroglycerin and isosorbide dinitrate |
|
Definition
release NO in sm. muscle causing ↑ cGMP and sm. relaxation
Veins >> arteries |
|
|
Term
|
Definition
| Short acting; release of NO causing ↑ cGMP |
|
|
Term
|
Definition
| K channel opener → hyperpolarize and relax sm. muscle cells |
|
|
Term
|
Definition
| D1 receptor agonist → relaxes renal vascular sm. muscle |
|
|
Term
|
Definition
| inhibits lipolysis in adipose tissue as well as reduces VLDL secretion in to circulation |
|
|
Term
| MOA of cholestyramine, other examples, contraindications |
|
Definition
Prevents intestinal reabsorption of bile acids causing the liver to use cholesterol to make more
colestipol and colesevelam
contraindicated in pts w/ gallstones |
|
|
Term
| Drugs w/ the most affect on TGs and its MOA |
|
Definition
Fibrates (gemfibrozil, clofibrate, bezafibrate, fenofibrate)
upregulate LPL → ↑ TG clearance |
|
|
Term
| Pharmakodynamics of Cardiac Glycosides |
|
Definition
Digoxin:
75% bioavailability
20-40% protein bound
t1/2 = 40 hrs |
|
|
Term
Drug that may cause blurry yellow vision
|
|
Definition
|
|
Term
|
Definition
↑ inotropy by inhibiting Na/K ATPase which indirectely inhibits the Na/Ca exchanger thereby increasing intracellular Ca
Also stimulates vagus nerve → ↓ conduction of AV node and depression of SA node |
|
|
Term
| Anti-arrhythmic a/w SLE-like syndrome |
|
Definition
|
|
Term
| MOA and clinical effects of class I anti-arrhythmics |
|
Definition
State dependent: selective block depress tissue that is frequently depoloarized
Slow conduction in depolarized cells by blocking Na channels,
Decrease slope of phase 4
↑ threshold for firing in abnormal cells
|
|
|
Term
| Uses for Class IA anti-arrhythmics |
|
Definition
| atrial and ventricular arrhythmias, especially reentrant and ectopic SVT and ventricular tachycardia |
|
|
Term
| Anti-arrhythmic a/w inducing tosades de pointes |
|
Definition
|
|
Term
| Anti-arrhythmic a/w cinchonism |
|
Definition
quinidine (type IA anti-arrhythmic) - HA tinnitus
|
|
|
Term
| Anti-arrhythmic a/w thrombocytopenia |
|
Definition
|
|
Term
| Class IA antiarrhythmics and their clinical effects |
|
Definition
Quinidine, Procainamide, disopyramide
↑ AP duration, ↑ effective refractory period, ↑ QT interval
|
|
|
Term
| Class IB anti-arrhythmics and their clinical effects |
|
Definition
Lidocaine, Mexiletine, Tocainide (and phenytoin)
↓ AP
|
|
|
Term
| CLinical use for IB anti-arrhythmics |
|
Definition
| acute ventricular arrhythmias (especially post-MI) and in digitalis-induced arrhythmias |
|
|
Term
| Side effects of IB anti-arrhythmics |
|
Definition
| local anesthetic, CNS stimulation/depression and CV depression |
|
|
Term
| Class IC anti-arrhythmics and their clinical effects |
|
Definition
Flecainide, encainide, propafenone
No effect on AP |
|
|
Term
| Drugs that are contraindicated in people w/ structural abnormailities |
|
Definition
| IC anti-arrhythmics (flecainide, encainide and propafenone) |
|
|
Term
| Anti-arrhythmics that are pro-arrhthmic/arrythmogenic in post-MI pts |
|
Definition
| Class IC anti-arrhythmics (flecainide, encainide, propafenone) |
|
|
Term
| MOA for Class II anti-arrhythmics |
|
Definition
Beta blockers
↓ cAMP, ↓ Ca currents
Suppress normal pacemakers by ↓ the slope of phase 4
AV node particularly sensitive (↑ PR interval) |
|
|
Term
| Clinical use for Class II anti-arrhythmics |
|
Definition
slowing ventricular rate during atrial flutter and A-fib
v-tach, SVT |
|
|
Term
| Toxicity of Class II anti-arrhythmics |
|
Definition
Impotence
exacerbation of asthma
CV effects (bradycardia, AV blck, CHF)
CNS effects (sedation, sleep alterations)
May mask the signs of hypoglycemia
Metoprolol may cause dyslipidemia |
|
|
Term
| Class III anti-arrythmics and their clinical effects |
|
Definition
(K+ channel blockers) Sotalol, ibutilide, amiodarone
↑ AP duration, ↑ ERP (effective refractory period), ↑ QT interval |
|
|
Term
| Clinical use for Class III anti-arrhythmics |
|
Definition
| When other anti-arrhythmics fail |
|
|
Term
|
Definition
Class III anti-arrhythmic
Tosades de pointes
excessive beta block |
|
|
Term
|
Definition
Class III anti-arrhythmic
Torsades de pointes |
|
|
Term
|
Definition
Class III anti-arrhythmic
Pulm fibrosis
hepatotoxcity
Hypo/hyperthyroidism
corneal deposits
skin deposits -> photodermatitis
nerulogic effects
constipation
CV effects (bradycardia, heart block, CHF) |
|
|
Term
| Anti-arrhthmic that causes hepatotoxicity, thyroid toxicity and pulmonary toxicity |
|
Definition
|
|
Term
| Class IV anti-arrhythmics and their clinical effects |
|
Definition
Ca-channel blockers: verapamil and diltiazem
Primarily affect the AV node: ↓ conduction velocity, ↑ ERP and ↑ PR interval |
|
|
Term
| Clinical use for Class IV anti-arrhythmics |
|
Definition
Ca channel blockers
Nodal arrhythmias (SVT, e.g.) |
|
|
Term
| Toxicity of Class IV anti-arrhythmic |
|
Definition
Constipations
Flushing
edema
CV effects (CHF, AV block, sinus node depression) |
|
|
Term
|
Definition
| Torsades de pointes and digoxin toxicity |
|
|
Term
|
Definition
| Depresses ectopic pacemakers in hypokalemia (digoxin toxicity, e.g.) |
|
|
Term
| MOA and uses for Adenosine |
|
Definition
↑ K movement out of cells -> hyperpolarizing the cell and ↓ the current caused by Ca (ICa)
Drug of choice for diagnosing/abolishing AV nodal arrhythmias
Also used for chemically induced stress test
Very short acting (~15 sec) |
|
|
Term
|
Definition
|
|
Term
| Anti-arrhythmics that cause Torsades de Pointes |
|
Definition
Quinidine (class IA- Na channel blocker)
Sotalol and ibutalide (Class III- K channel blocker) |
|
|
