Macrolides, anti-malarials (chloroquine, mefloquine), haloperidol, risperidone, methadone, protease inhibitors, Class Ia and III anti-arrhythmics

-some fluoroquinolones

prolonged PR interval; >200 msec (> 1 5mm box - the big box w/ 5 smaller boxes in it)

-asymptomatic

2nd Degree Block Mobitz Type I

(Wenckebach)

progressive lengthening of the PR interval until a beat is "dropped" (P wave NOT followed by a QRS complex)

-usu asymptomatic

"no warning" - dropped beats are NOT preceded by a change in length of PR interval

*pathologic

-normal PR intervals w/ no QRS following a P wave here and there (ratio usu 2:1 = 2 P waves to 1 QRS complex)

atria and ventricles beat independently of each other.  P waves bear no relation ot QRS complexes

-QRS complex is still narrow b/c ventricular depolarization is still coordinated

-look for P waves "hidden" on/in other waves

Tx - pacemaker

Cushing Triad

(**not related to Cushing's syndrome/dz)

Triad: HTN, bradycardia, respiratory depression

PaPH: ↑ intracranial pressure constricts arterioles → cerebral ischemia → ↑ P_CO2 detected by central chemoreceptors → sympathetic response is HTN → reflex bradycardia

(↑ P_CO2 detected in brain causes cerebral vasodilation)

Tetralogy of Fallot?

most important determinant of prognosis?

Cause?

What do pts commonly do to improve symptoms?

1. Pulmonary Stenosis - **most important determinant
2. RVH - "boot shaped" heart on xr
3. Overriding aorta
4. VSD - usu large and unrestrictive; early cyanosis due to R→L shunt across VSD

-anterosuperior displacement of infundibular septum

-Squat (↑ TPR)

Calcification in the media of arteries, esp. radial or ulnar

"pipestem"

-usu benign, does NOT obstruct flow, intima NOT involved

Loffler's syndrome

(*do NOT confuse w/ Loffler's eosinophilic pneumonitis - ascaris lumbricoides)

Endomyocardial fibrosis w/ a prominent eosinophilic infiltrate

-causes a restrictive/obliterative cardiomyopathy

differentiate from endocardial fibroelastosis (congenital, thick fibroelastic endocardium of young children - also causing restrictive cardiomyopathy)

"LMNOP"

• Loops
• Morphine (DOC for 'air hunger', also peripheral vasodilatory action)
• Nitrates
• O₂
• _{Positioning (let blood pool in legs) or Pressors (Dobutamine)}
  

"FEVERSS"

• Fever
• Erythema marginatum
• Valvular damage
• ESR ↑ (CRP too)
• Red-hot joints (migratory polyarthritis)
• SubQ nodules
• St. Vitu's dance (chorea; of face, tongue, & upper limb)

-also can see pancarditis, prolonged PR interval

Electrical Alternans

(QRS complexes have varying amplitudes - "alternating")

*specific but not sensitive

-asthma, obstructive sleep apnea, croup, severe obstructive lung dz (exaggerated inspiration: incr. R sided filling, decr. L side filling)

-constrictive pericarditis, restrictive cardiomyopathy

Characteristic arterial findings:

Marfan's vs 3° Syphillis vs Buerger's dz

Marfan's: cystic medial necrosis (myxomatous changes, "basket weave"/fragmentation of elastic tissue, mucinous ground substance)

Syphilis: endarteritis obliterans of vasa vasorum (fibrointimal prolif., plasma cell infiltrate and lymphocytic; "tree barking of aorta")

Buerger's: thromboangitis obliterans (usu in tibial and radial aa); *heavy smokers

Most Common Primary Cardiac Tumors:

adults vs children

(we all know metastatic are mc overall)

Adults: myxomas (usu LA, "ball-valve", mult. syncopal episodes)

Children: rhabdomyomas (can be assoc. w/ Tuberous Sclerosis)

Polypoid capillary hemangioma that can ulcerate and bleed

*assoc. w/ trauma and pregnancy

Cavernous lymphangioma of the neck and lateral chest wall

*assoc. w/ turner syndrome; and also down syndrome neonates

*DOC for incr. HDL

MOA: inhibits lipolysis in adipose tissue; reduces hepatic VLDL secretion into circulation (via ↓ ApoB-100 syn.)

SE: flushing w/ IR; hepatotoxicity w/ SR or ER; hyperglycemia (due to insulin resistance), hyperuricemia

1. Renal failure (decr. excretion)
2. hypokalemia (permissive for digoxin binding at K binding site on Na/K ATPase)
3. quinidine (decreases digoxin CL; displaces digoxin from tissue-binding sites)

*sign of digoxin toxicity - blurry yellow vision, change in color perception