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What two conditions cause turbulent blood flow?
- Decreased blood viscosity
- Increased blood velocity.
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What is Wolff-Parkinson-White syndrome, what is seen in the ECG?
- An alternative conduction from the atria to the ventricle, resulting in early partial depolarization of the ventricles
- Delta wave is seen right before the R wave
- This may result in reentry current, leading to supraventricular tachycardia.
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What are the two types of escape beats?
- Junctional: usually AV node, produce normal QRS complexes
- Ventricular: ectopic ventricular focus (often purkinje fibers), abnormal QRS complex.
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Torsades de pointes is a type of?
Ventricular tachycardia.
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What is the most common cause of atrial fibrillation (in the US)?
Hypertension.
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What is hypertension defined as?
Sustained systole >140 mmHg and/or diastole >90 mmHg.
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What are some risk factors for HTN?
- Black
- Obesity
- Oral contraceptives
- Smoking
- Excessive EtOH intake
- Family history
- advanced age.
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The CV disease risk doubles for each __ increase in pressure?
- 10 mmHg systolic
- 5 mmHg diastolic.
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Pheochromocytoma presents with triad of?
- Hypertension
- Diaphoresis
- Tachycardia.
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What is Monckeberg's arteriosclerosis?
- Benign
- Medial calcification of Medium sized Muscular arteries.
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What are the two types of arteriolosclerosis?
- Hyaline: essential HTN, deposits of proteins in tunica intima - increased thickness of intima
- Hyperplastic: malignant HTN, hyperplasia of basement membrane and smooth muscle - onion skinning.
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What is the most common cause of myocarditis?
Viral: Coxsackie B, Rubella, Cytomegalovirus.
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What is the gold standard for diagnosing myocarditis?
Biopsy showing lymphocytic infiltrates with edematous myocardial interstitium.
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Acute endocarditis usually infects, is caused by?
- Normal heart valves
- S. Aureus of IV drug abuse.
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Subacute endocarditis usually infects, is caused by?
- Previously damaged heart valves
- Streptococcus viridans.
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What are some clinical features seen in infective endocarditis?
- Janeway's lesions: non-painful hemorrhages on palms and soles
- Osler's nodes: painful nodules on fingers and toes
- Roth's spots: retinal seeding
- Splinter hemorrhages: beneath fingernails
- Valvular involvement: mitral>aortic>tricuspid.
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What is marantic endocarditis?
- Also known as: Non-bacterial thrombotic endocarditis (NBTE)
- Paraneoplastic syndrome from mucin secreting tumor
- Complication: Sterile peripheral emboli
- Poor prognosis.
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What is Libman-Sacks Endocarditis (LSE), caused by?
- Autoantibody damage to valves
- Systemic Lupus Erythematosus (SLE)
- Usually asymptomatic.
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How does carcinoid syndrome affect the heart?
Increased serotonin levels cause thickening, contraction, and decreased mobility of right-sided valves.
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What is the most common cause of non-ischemic cardiomyopathies?
Dilated cardiomyopathy: 90%.
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What are the etiologies of cardiomyopathy?
- Most common: idiopathic
- Coxsackie B virus, alcohol, thiamine deficiency, Chagas, etc.
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What is the clinical presentation of dilated cardiomyopathy?
- Decreased Ejection Fraction (EF)
- JVD
- edema.
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What is the most common cause of sudden cardiac death in young athletes?
Hypertrophic cardiomyopathy.
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What is the presentation for hypertrophic cardiomyopathy?
- Dyspnea
- Syncope
- S4 cardiac gallop
- May have cardiomegaly.
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Diagnosis of hypertrophic cardiomyopathy?
- Xray: dilated LA
- Echocardiography: asymmetric hypertrophy, Mitral valve regurgitation, and diastolic dysfunction.
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What are three causes of restrictive cardiomyopathy?
Amyloidosis, sarcoidosis, Loeffler's endomyocarditis (most common worldwide).
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What are the two major causes of Left-sided heart failure?
- Systolic dysfunction: Increased afterload, impaired contractility
- Diastolic dysfunction: Impaired filling, compliance, or relaxation.
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Atherosclerotic aneurysms are associated with, found in?
- Hypertension (atherosclerotic disease, CAD)
- Abdominal aorta (less vasa vasorum infrarenally).
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Syphilitic (aortitis) anuerysms are characterized by?
- Medial necrosis and obliterative endarteritis of the vasa vasorum
- Usuall involves ascending aorta and aortic root.
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Rheumatic fever is caused by, usually affects?
- Group A B-hemolytic streptococci
- Children age 5-10
- Multisystem inflammatory disease.
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What are the Jones major criteria for diagnosing rheumatic fever?
- STREP
- S: Sydenham's chorea
- T: Transient migratory arthritis
- R: Rheumatic subcutaneous nodules
- E: Erythema marginatum
- P: Pancarditis.
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The most serious complication of rheumatic fever is?
Acute rheumatic heart disease.
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Acute rheumatic heart disease can be divided into what three conditions?
- Fibrinous pericarditis
- Myocarditis: Aschoff's bodies (fibrinoid and collagen material) surrounded by macrophages (anitschkow's cells) and multinucleated giant cells (aschoff cells)
- Endocarditis: may lead to mitral or aortic insufficiency or stenosis.
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What are the most common hemodynamic changes in the heart (leading to murmurs)?
- Increased flow
- Decreased valvular area
- Regurgitation
- Dilated chambers
- shunting.
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What are three complications of aortic stenosis?
- Aortic Stenosis Complications
- A: angina
- S: syncope
- C: CHF (dyspnea).
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A widened pulse pressure is seen in what condition?
Aortic regurgitation.
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What is the most common primary cardiac tumor in adults?
- Cardiac myxoma
- Usually benign.
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What is the most common primary cardiac tumor in children?
- Cardiac rhabdomyoma
- Associated with tuberous sclerosis.
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What is Virchow's triad of risk factors for DVT?
- Stasis of blood flow
- Hypercoagulability
- Vasuclar damage.
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What are the 5 causes of shock?
- Hypovolemic
- Cardiogenic
- Septic
- Anaphylactic
- Neurogenic.
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What are the three presentations of IHD?
- Angina pectoris
- Chronic IHD
- MI.
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What three drug classes are used to treat angina pectoris?
- Nitrates
- B-blockers
- Ca channel blockers.
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What is prinzmetal's angina?
- Aka variant angina
- intermittent angina at rest, not related to exercise, stress, BP
- can be induced with ergoline (method of dx)
- Due to coronary artery vasospasm.
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What is the presentation of MI?
Prolonged (>30-45 min), crushing chest pain not relieved by nitroglycerin or rest.
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What are the two types of MI?
- Nontransmural: NSTEMI, St depression seen ECG, partial occlusion of coronaries
- Transmural: STEMI, full thickness wall necrosis, complete occlusion of coronaries.
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When is an infarcted area of the myocardium at its softest, what risk does it present?
- 7-10 days
- Aneurysm, rupture of papillary wall.
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When to troponin levels rise after an MI?
4-6 hours after pain begins, lasts for 7-10 days.
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When do levels of CK-MB rise, why is it the test of choice in the first 24 hours post MI?
- 4-6 hours after pain, lasts for three days
- Because if the levels rise again, it signals a new MI.
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Mnemonic to remember when enzymes peak?
- 1/2 T-CAL 123
- Troponin: day .5
- CK-MB: day 1
- AST: day 2
- LDH: day 3.
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What are the classes and MOAs of diuretics?
- Osmotic: goes into tubule, cannot be reabsorbed, increases osmotic pressure
- Carbonic-anydrase inhibitors: inhibit conversion of HCO3- to CO2, inhibiting HCO3- reabsorption
- Loop: inhibits Na-K-2Cl channel
- Thiazide: inhibits Na-Cl symporter
- Potassium sparing: Spironolactone: competitive inhibitor of aldosterone receptor - Amiloride and Triamterene: Direct inhibitors of Na+ channels in collecting duct.
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Example of Osmotic diuretic?
Mannitol.
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Example and side effect of CAI?
- Acetazolamide
- Acidosis (acidazolamide).
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Example and side effect of loop diuretics?
- Furosemide (lasix), ethacrynic acid
- OH DANG
- O: ototoxicity
- H: hypokalemia, hypercalciuria
- D: dehydration
- A: allergy to sulfa
- N: Nephritis
- G: gout.
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Example and side effects of thiazide diuretics?
- Hydrochlorothiazide
- HyperGLUC
- G: hyperglycemia
- L: hyperlipidemia
- U: hyperuricemia
- C: hypercalcemia.
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What are two centrally acting sympathoplegics, MOA?
- Methyldopa: BP med during pregnancy
- Clonidine: Rebound HTN
- alpha-2 agonists: decrease central sympathetic outflow (brain stem).
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Drugs that end in -zosin are?
- Alpha-1 antagonists (mainly at arterioles)
- Block vasoconstriction and decrease SVR.
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What are the two types of Ca channel blockers, MOA?
- Vasoselective: dihydropyridines: Nifedipine, amlodipine
- Nonselective: also decrease contractility - diltiazem, verapamil
- Block L-type Ca channels, inhibiting intake of Ca into arteriolar SMC, inhibiting contraction.
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What is nitroprusside?
Spontaneous releaser of NO, used IV in hypertensive emergencies.
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What causes drug-induced lupus?
Hydralazine.
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How does Minoxidil work?
Opens K+ channels in arteriolar SMC, hyperpolarizing and preventing contraction.
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What are the drugs of choice for prinzmetals (variant) angina?
Ca channel blockers.
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What is streptokinase, how does it work?
- Fibrinolytic
- Indirectly activates plasminogen
- (non fibrin specific).
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