Term
|
Definition
| SE-->cause hypotension & agranulocytosis; fast metabolizers get Torsades; slow metabolizers get Lupus |
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Term
|
Definition
| Best drug for Acute MI & fast ventricular fibrillation; no effect on SA & AV node no affect on SVT |
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Term
|
Definition
| 1) Neurology-->slow speech, feel numb, 2) GI upset, & diarrhea |
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Term
|
Definition
| Neg. inotropic durg, strong Na blocker, has beta-blocker properites, contraindicated in anyone that has abnormal heart |
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Term
|
Definition
| Lidocaine & propafenone; more effective when HR inc. Exercise pts if worried about toxicity |
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Term
|
Definition
| most effective w/ v-tachy and v-fib w/ pts w/ abnormal heart & CHF |
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Term
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Definition
| 4 Major Toxicity: 1) Liver; 2) Eyes; 3) Lungs--pulmonary firosis; 4) Thyroid--either hyper or hypothyroidism |
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Term
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Definition
| Renally excreted; racemic misture; beta-blocker; |
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Term
|
Definition
| SE-->asthma, slowing Heart BEat, prolong AT interval--> lead to Torsade |
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Term
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Definition
| risk of SE is highest when HR is slow |
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Term
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Definition
| chemical version (IV) of Sotalol, used fro chemical cardioversion, when pts doesnt' want to get shocked; Works w/in 5 mins. prlongs QT interval |
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Term
|
Definition
| beta-blocker, unique feature is that it is used in atril fib w/ related to hyperthyroidism |
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Term
|
Definition
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Term
|
Definition
| IV drug; 10-25 sec; selectively blocks AV node; gvn to pts w/ SVT arrythmias |
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Term
|
Definition
| 1)Gvn to heart failure; 2) if pts don't tolerate beta-blockers; ca channel blocker |
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Term
| Aortic Dissection-DeBakey I |
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Definition
| proximal, extends all the way down, surgical emergency |
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Term
| Aortic Dissection-DeBakey II |
|
Definition
| descending; distal, Type A-meical emergency |
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Term
|
Definition
| emobolism from carotid artery, lost of vision |
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Term
| Rapair of Abdominal Aortic Aneurysms |
|
Definition
| 5.5 com is the best threshold for repair |
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Term
|
Definition
| occlusion of distal aorta; buttock claudication; impotence in men |
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Term
|
Definition
| Rise in serum TG, interference w/ absorp of digoxin, warfarin, thiazide diuretics, beta-blockers, thyroid and thyroxine preparations |
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Term
|
Definition
| Gemfibrozil & Fenofibrate |
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Term
|
Definition
| CI in combo w/ statins, inc. risk of rhabdomyolysis |
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Term
|
Definition
| tx of choice for pts w/ kidney dz |
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Term
|
Definition
| CI w/ kidney dz; gvn to pts w/ statins |
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Term
|
Definition
| Metaoblized by kindey; b/c many SE, it has limited use |
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Term
|
Definition
| Excrted by renal and liver; most powerful statin; use in small dose w/ asian population; |
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Term
|
Definition
| excrted by CYP450 in liver; |
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Term
|
Definition
| metabolized by the kidney; given to AIDS pts b/c doesn't interact w/ protease inhibitors |
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Term
|
Definition
| selectively inhibits the intestinal absorption of CH; localized at brush border of small intestine |
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Term
|
Definition
| 1)dec in the delivery of intestinal ch to the liver 2) Reduc of hepatic ch stores and inc. in clearance of ch from the bood |
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Term
|
Definition
| good combo to use low doese of statin while getting max effectiveness |
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Term
|
Definition
| PG syn inhibitor given to close patent ductus arteriosus |
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Term
|
Definition
| means there is an atrial septal defect |
|
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Term
|
Definition
| 1) membranous- 70%; 2) Muscular 30% |
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|
Term
| Tx of coarctation of the aorta in neonates |
|
Definition
| Neonates-PG infusion, surgery |
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Term
|
Definition
| 1) VSD 2) Subpulmonic plumonic stenosis 3) Overriding Aorta 4) RV hypertrophy due to pulmonic stenosis |
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|
Term
| Common cause of neonatal cyanosis |
|
Definition
| transposition of the great arteries |
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Term
|
Definition
| arterial switch operation to correct-arteries are cut above semilunar valves & repositioned correctly |
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Term
|
Definition
| severe pulmonary vascular obstruction from chronic L to R shunting, w/ reversal fo the orginal shunt (now R to L) w/ systemic oxygen desaturation & hypoxia; pulmonary arteriolar media hypertrophy and intimal proliferation; thrombosis |
|
|
Term
| CF of Eisenmenger Syndrome |
|
Definition
| inc P2 component; prominent jugular a wave; absent murmur since shunt lessens |
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|
Term
| Sign of nausea & vomiting in ACS |
|
Definition
| n/v occur in predom RCA infaraction, serves parasymp; better prognosis bc it serves only inferior wall of the heart |
|
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Term
|
Definition
| Univalent inhibitor of Thrombin; only inactivates the active site |
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Term
|
Definition
| bivalent Thrombin inhibitor, it binds to the active site and exo-1 (site where it binds fibrinogen) |
|
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Term
|
Definition
| 1) RBBB 2) RV overload 3) Pulmonic Stenosis 4) VSD 5) PDA |
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Term
|
Definition
|
|
Term
|
Definition
| Aortic/pulmonary stenosis |
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Term
|
Definition
| Severe calcified aortic/pulmonary stenosis |
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|
Term
| Descrescendo murmur right after S2 |
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Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| 1) MR/ TR; 2) VSD; 3) ASD; 4) Coarcation of Aorta (heard on the back) |
|
|
Term
| Systolic Diamond Shapted Murmor (crescendo-decresendo) |
|
Definition
| AS/PS; Tetrology of Fallot |
|
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Term
|
Definition
| 1)PDA; 2) Coaraction of Aorta |
|
|
Term
| ECG of Digitalis Toxicity |
|
Definition
| Wenckeback (Mobitz Type I) 2nd degree heart block |
|
|
Term
| What is the major Clinical diff btwn Constrictive Pericarditis & Restrictive Pericarditis? |
|
Definition
| Constrictive Pericarditis only see JVD; in Restrictive (Tamponade) see JVD AND Pulsus Paradoxus |
|
|
Term
| Proximal Right Coronary Occlusion |
|
Definition
| affect SA node; slow HR; affects the Right Ventricle |
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|
Term
|
Definition
| AV node dysfunc; spares the Right Ventricle |
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|
Term
|
Definition
| Complete Heart block; take out the septum |
|
|
Term
| 2 Causes of Complete Heart Block |
|
Definition
| 1) Distal RCA occulusion; 2) Proximal LAD occulusion |
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|
Term
| Clicinal Presentation of Papillary Muscle Dys |
|
Definition
| Mitral Regurgitation; pulmonary congestion; Reduced CO |
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Term
| Imp. symptom of Endocarditis |
|
Definition
| Neurologic Abnormaliites (put only present in small %); caused by emboli to the CNS |
|
|
Term
| Common Bacteria causing Endocarditis? |
|
Definition
| Stahylococci (gram-pos. cocci) |
|
|
Term
| Sign. of S. Bovis in Endocarditis? |
|
Definition
| Look in colon for pathology b/c that is where they originate from |
|
|
Term
| Pathogen Causing PV Endocarditis ( < 60 dys vs. > 60 days)? |
|
Definition
| Prosthetic Valve Endocarditis= < 60 dys= gram-neg, S. aureus, & fungal; > 60 days, pathogen are simlir to NVE |
|
|
Term
| How can Endocarditis cause Heart Block? |
|
Definition
| In Heart Block, peri-annular infection, affect the conduction sys; particular of aortic valve |
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Term
|
Definition
| Janeway lesions are non-tender, often haemorrhagic (bleeding into the skin), and occur mostly on the palms and soles including the thenar and hypothenar eminences (at the base of the thumb and little finger respectively). They tend to last days to weeks before healing totally. They are more commonly seen in acute endocarditis, when bacteria such as Staphylococcus aureus |
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Term
|
Definition
| Osler nodes are red-purple, slightly raised, tender lumps, often with a pale centre. Pain often precedes the development of the visible lesion by up to 24 hours. They are typically found on the fingers and/or toes. They can occur at any time during the course of endocarditis (usually subacute) and last from hours to several days. |
|
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Term
|
Definition
| TEE--> Trans-Esoophageal, 95 % senstitive |
|
|
Term
| When to Rx w/ antibiotic prophylaxis to prevent Endocarditis? |
|
Definition
Prophylaxis w/ Antibiotics:
1) Prosthetic Cardiac Valves or Prosthetic material 2) Previous episode of Endocarditis 3) Congential Heart Dz 4) Cardiac Transplat w/ valvulopathy |
|
|
Term
|
Definition
| anti-inflammatory; inhibits cytokines; useful for acute pericarditis |
|
|
Term
| Common Viral Infection of Pericarditis? |
|
Definition
| Echovirus & Coxsackievirus B |
|
|
Term
| Causes of Hemmorrhagic Pericarditis |
|
Definition
| 1) Tb 2) Malignant 3) Trauma 4) Aorti Dissection |
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|
Term
| How does the ECG look in Pericarditis? |
|
Definition
| ST elevation w/ PR depression |
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Term
|
Definition
set of findings on physical examination in people with large collections of fluid around their heart (pericardial effusions)
Dullness to percussion, egophony, and bronchial breath sounds may be appreciated at the tip of the left scapula when the effusion is large enough to compress the left lower lobe of the lung, causing consolidation or atelectasis. |
|
|
Term
| When is Pulsus Paradoxus seen? |
|
Definition
| 1)COPD 2)Asthma 3) Tamponade |
|
|
Term
| Signifacne of protein > 0.5 in pericardial fluid |
|
Definition
| usually means that it is bad, neoplasitc, rather than viral |
|
|
Term
| Pressure changes in Constrictive vs. Restrictive Pericarditis? |
|
Definition
| Constrictive-diastolic; Restrictive-sytolic (PP) |
|
|
Term
| How much % stenosis is one vessel dz, 3-triple? |
|
Definition
|
|
Term
| What kinds of plaques are the most likely to rupture |
|
Definition
| Plaques that have the most amount of cholesterol and least amount of calcium are more likely to rupture |
|
|
Term
| 3 ways to boost sensitivity & specificity of stress test |
|
Definition
| 1) Use ABCDE; 2) Use of pre-test pop. w/ >.4; 3) Imaging |
|
|
Term
| Difference btwn ischemia and infarct |
|
Definition
| Ischemia=restriction of blood flow; infarct=cell death; necrosis |
|
|
Term
| When is a nuclear stress test done? |
|
Definition
| 1)To distinguish from ischemia/infarct 2) On ppl that have already experienced an infarct |
|
|
Term
| Wat modality is used to image Calcium, & what is it a good marker of? |
|
Definition
| Calcium is a good marker of athersclerotic plaque, and use CT to detect calcium |
|
|
Term
| Clinical Manifestations of Heart Failure? |
|
Definition
| Most of the symptoms and clinical manifestations of heart failure are going to be due to congestion or poor perfusion. |
|
|
Term
|
Definition
| Bnp is brain naturetic peptide. it is produced in the ventricles in response to volume and pressure overload; < 100 no Heart FAilure; > 400=Heart Failure |
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|
Term
| What do you give a patient that develops a cough w/ ACE inhibitor? |
|
Definition
| Give patient ARB (Angiotensin Receptor Blocker) |
|
|
Term
| When is ACE inhibitor and ARB contraindicated, & what do you give pt w/ HF? |
|
Definition
| Pt w/ renal dz should be given hydralazine and nitrates |
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|
Term
| When do you give Spironolactone? |
|
Definition
| spironolactone, which is indicated in patients that have Class 3 or Class 4 HF, these are aldosterone antagonists, again renin-angiotensin-aldosterone. |
|
|
Term
| What are Hydrocholorothaizide, Chlorthalidone, Metolazone? |
|
Definition
| Mild diuretics hydrochlorothiazide, chlorthalidone, or metolazone. These block sodium reabsorption in the loop of Henle in the distal convoluted tubules |
|
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Term
|
Definition
| 1) Pre-renal azotemia; 2) Skin Rashes; 3) Neutropenia; 4) Thrombocytopenia; 5) Hyperglycemia; 6) Inc. Uric Acid 7) Hepatic Dysfunc |
|
|
Term
| MOA & SE of Loop Diuretics? |
|
Definition
| The mechanism of action of the loop diuretics is they inhibit chloride reabsorption in the ascending limb of the loop of Henle. This results in natriuresis, kaliuresis, and metabolic alkalosis. |
|
|
Term
| What improves survival in pts w/ HF? |
|
Definition
| ACE inhibitors have been shown to improve survival in HF patients. Diuretics have not been shown to improve survival, but ACE inhibitors not only do you feel better, but you live longer. |
|
|
Term
|
Definition
| 1)Angioedema; 2) Hypotension; 3) Renal Insufficiency; 4) Rash; 5) Cough |
|
|
Term
|
Definition
Spironolactone/ Eplerenone
“K sparing Diuretics”
Improve mortality in patients with CHF due to effects on RAA system and aldosterone inhibition.
Indicated in Class III-IV CHF.
Side effects: hyperkalemia with both. Gynecomastia with spironolactone. If this occurs, then use eplerenone. |
|
|
Term
| What makes HF live longer, what makes them feel better? |
|
Definition
| Digoxin & Lasix=feel better; ACE inhibitors & beta-blockers=live longer |
|
|
Term
|
Definition
| Digoxin has a positive inotropic effect. What digoxin does, it increases intracellular Ca and increases the actin-myosin cross-bridge formation. So it increases intracellular Ca, it makes you squeeze more. It does this because it binds to the Na/K+ ATPase, inhibits the Na pump, increases intracellular Na, and increases Na/Ca exchange. |
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|
Term
| Which one reduces afterload/preload--Hydral/Nitrates |
|
Definition
| Hydralizine=reduc. of afterload; Nitrates=reduction of preload |
|
|
Term
| When are positive inotropic agents given/ beta-agonists |
|
Definition
| only useed in acute inpatinet (hospital); w/ shock or low perfusion states |
|
|
Term
|
Definition
| Atrial Flutter is reentry w/in the atria |
|
|
Term
| What is AIVR & when is it seen? |
|
Definition
| AIVR-->Accelerated idioventricular rhythm; seen in pts who are post myocardida infarction & have AV conduction block, welcomed b/c it is a sign of reperfusion |
|
|
Term
|
Definition
| 1st degree AV Block-->prolongation of the normal delay btwn atrial and ventricular depolarization; PR interval is lengthened > 5 small boxes |
|
|
Term
| What is the major difference btwn Mobits Type 1 and Mobitz Type II block |
|
Definition
Mobitz Type /i--AV delay gradually increases w/ each beat until an impulse is completely blocked; results from impaired conduction in the AV node; block is transient
--Mobitz Type II--> sudden intermittent loss of AV conduction; usually caused by conduction block beyond the AV node (bundle of His or Purkinje system, more dangerous, tx w/ pacemaker |
|
|
Term
| How do you fix AV disassociation? |
|
Definition
| Fix AV disassociation by giving Atropine (inhibit PNS) |
|
|
Term
| What are Verapamil & Diliatiazem, and what are they used for? |
|
Definition
Class IV; calcium channel blockers; not used as tx for sinus Tachy; slow the ventricular response durign atrial flutter or fibrillation by causing inc. conductioin block of atrial impulses in the AV node
are used to control the ventricular rate in pts in whom fultter or fibrillation cannot be converted to sinus rhythm |
|
|
Term
| What cuaes IVT and how do you tx it? |
|
Definition
| Idiopahtic Ventricular Tachycardia is caused by delayed afterdeporlizations; tx w/ Verapamil & Dilitiazem |
|
|
Term
| How do you tx Sinus Tachy/Supraventricular Tachy |
|
Definition
| Adenosine is given for SVT--causes transient block of AV nodal conduction |
|
|
Term
| What are Class III Antiarrhtymic Drugs, and how do they work? |
|
Definition
| Class III-Potassium Channel Blockers-Prolongs the action potential duration & refractory period (SAI)-Sotalol, Amiodarone & Ibutilide |
|
|
Term
| What are Class IV antiarrythmic Drugs, and how do they work? |
|
Definition
| Class IV-Calcium Channel Blockers-Modify inward current through L-type calcium channels |
|
|
Term
| What is Sotalol used for? |
|
Definition
Atrial flutter & fibrillation & Ventricular Tachy & fibrillation
SE-->QT interval elongation=torsade de pointes |
|
|
Term
| What is Torsade de pointes (TdP) |
|
Definition
| TDP-->polymorphic ventricular tachycardia, caused by early afterdepolarizations (are associated w/ prolonged QT interval) |
|
|
Term
| When would Amiodarone be admin? |
|
Definition
| Amiodarone can be used for atrial tachy. but its the tx of choice for ventricular arrhythmia, recurrent ventricular tachy & fibrillation w/ pts who have struc. heart dz |
|
|
Term
| What drug is used for chemical cardioversion? |
|
Definition
| Ibutilide--> tx atrial flutter & fibrillation, chemical cardioversion |
|
|
Term
| How do Fibric Acid Derivatives work? |
|
Definition
Fibric Acid derivatives stimulate PPAR-alpha
1) Makes apo-A, which inc. HDL
2) Enhances activity of LPL-->dec. TG
3) Enhances beta-oxidation of FA |
|
|
Term
| Which Statins are contraindicated on a pts receiving a macrolide, which is the drug of choice? |
|
Definition
Pts on marcolide should be
Not be given
1) Simvastatin
2)Atorvastatin
3) Lovastatin
4) Fluvastatin (?)
Should be on: Rosuvastatin |
|
|
Term
| Bc of the SE of Statins, when would you stop the drug? |
|
Definition
| if liver enzymes are greater than 3x upper limit of normal, you want to stop. For the muscle enzymes, >10x without complaints or if with complaints and >5x normal, you should stop the drug |
|
|
Term
| Clinical Presentation of pt w/ ASD? |
|
Definition
Dyspnea • Fatigue • Respiratory infections • Atrial arrhythmias - fibrillation
• May escape detection until adulthood since murmur not prominent and little symptoms |
|
|
Term
|
Definition
| associated w/ pulmonary stenosis |
|
|
Term
|
Definition
Holt–Oram syndrome is a disorder that affects bones in the arms and hands (the upper limbs) and may also cause heart problems.
ASD & VSD |
|
|
Term
|
Definition
Holt–Oram syndrome is a disorder that affects bones in the arms and hands (the upper limbs) and may also cause heart problems.
ASD & VSD |
|
|
Term
|
Definition
| Characteristic signs and symptoms may include birth defects such as congenital heart disease, defects in the palate, most commonly related to neuromuscular problems with closure (velo-pharyngeal insufficiency), learning disabilities, mild differences in facial features, and recurrent infections. Infections are common in children due to problems with the immune system's T-cell mediated response that in some patients is due to an absent or hypoplastic thymus |
|
|
Term
|
Definition
| Supravalvular aortic Stenosis & pulmonary artery stenosis t is characterized by a distinctive, "elfin" facial appearance, along with a low nasal bridge; an unusually cheerful demeanor and ease with strangers; developmental delay coupled with unusual (for persons who are diagnosed as developmentally delayed) language skills; and cardiovascular problems, such as supravalvular aortic stenosis and transient hypercalcaemia |
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