My heart is getting BIIIIIG🏋️♂️💪
In restrictive cardiomyopathy, these chambers of the heart are dilated
What are the left and right atria?
Slide 22; SLO 6
This enzyme breaks down triglycerides in chylomicrons and VLDL into free fatty acids
What is lipoprotein lipase (LPL)?
Slide 13; SLO 4
Before the administration of tPA for an ischemic stroke, this needs to be ruled out
What is a brain bleed?
Slide 33; SLO 3
MOA of fibrinolytics??
These 2 drugs are first line treatments for stable angina
What are nitrates and beta blockers?
Quick hits
Which beta blocker should be avoided in Prinzmetal angina? WHY??
This direction of shunts can lead to cyanosis when severe
What are right to left shunts?
Slide 9; SLO 2
Morphologically, this type of cardiomyopathy is characterized by severe thinning of the right ventricular wall because of myocyte replacement by fatty infiltration and some fibrosis
What is arrhythmogenic right ventricular cardiomyopathy?
Slide 14; SLO 4
What is the inheritance pattern of this type of cardiomyopathy??
What are the proteins affected by the gene mutations??
This plasma protein moves cholesteryl esters from HDL to other lipoproteins in exchange for triglycerides
What is Cholesteryl Ester Trasnfer Protein (CETP)?
Slide 22; SLO 5
This is the MOA of heparin
What is binding to antithrombin III and factor Xa?
Slide 9; SLO 1
What is the reversal agent for heparin OD??
What do LMWH and FPX bind to / inactivate??
Is heparin or LMWH/FPX safe in renal failure??
Remember that "-parin" is in the names of LMWH and FPX
This is the MOA of Ranolazine
What is blocking the late Na+ current?
Quick hits
Prolonged left to right shunting can eventually reverse, resulting in this disorder
What is Eisenmenger syndrome?
Slide 8; SLO 1
In dilated cardiomyopathy secondary to iron overload, a marked accumulation of this can be seen on a stain
What is hemosiderin?
Slide 4; SLO 3
What stain is used??
What is the most common mutation associated with this type of cardiomyopathy?? Gain-of-function or loss-of-function mutation?? What about associated viral infections??
Diastolic or systolic failure??
As VLDL -> IDL -> LDL, these are the apolipoproteins associated with each stage
Hint: 3 -> 2 -> 1
B-100, E, CII -> B-100, E -> B-100
Slides 13, 14, 16; SLO 4
Remember that ApoB-100 has a lower binding affinity for the LDL receptor than ApoE
This anticoagulant is used especially in patients with mechanical heart valves
What is warfarin?
Slide 15; SLO 1
Rapid reversal agent for warfarin?? Slower reversal agent?? MOA?? How do we prevent skin necrosis??
Remember CYP2C9 interactions
This is the "Post-MI big 5"
What are Aspirin, P2Y12 inhibitor, Beta blocker, ACEi/ARB, and a high intensity statin?
Quick hits
Which drug class should be used in patients with a reduced ejection fraction??
Label these cardiac disorders based on the direction of the shunt:
- Ventricular Septal Defect
- Pulmonary Atresia with Intact Ventricular Septum
- AV Canal Defect
- Atrial Septal Defect
- Tetralogy of Fallot
- Tricuspid Atresia
- Patent Ductus Arteriosus
- Transposition of the Great Arteries
Left to Right Shunts:
- VSD
- PDA
- ASD
- AV Canal Defect
Right to left Shunts:
- Tetralogy of Fallot
- Transposition of the Great Arteries
- Tricuspid Atresia
- Pulmonary Atresia with Intact Ventricular Septum
Slides 3 and 9; SLOs 1 and 2
This is the most frequently involved sarcomeric protein mutation seen in hypertrophic cardiomyopathy
What is the Beta-Myosin heavy chain?
Slide 17; SLO 5
What are the other 2??
What is the inheritance pattern of these 3 mutations??
Are these gain-of-function or loss-of-function mutations??
Diastolic or systolic failure??
According to the Frederickson Classification of hyperlipidemias, this class is associated with an isolated increase in VLDL
What is type 4?
Slide 27; SLO 6
This antiplatelet is a prodrug that first has to be metabolized by CYP2C19 to become an active compound
What is Clopidogrel?
Slide 27; SLO 2
MOA of Clopidogrel??
Do not combine with CYP2C19 inhibitors (omeprazole)
Along with hypotension, these are 3 other contraindications for nitrate use
Hint: 1 is a drug, 2 are cardiac problems
What are PDE-5 inhibitors, right ventricular MI, hypertrophic cardiomyopathy?
Quick hits
The murmur associated with this cardiac defect is best heard at the lower left sternal border during systole and increases in intensity during valsalva
What is hypertrophic cardiomyopathy?
Slide 27; SLO 4
What other murmur gets louder during valsalva?
These are the 3 forms of restrictive cardiomyopathy
What are Amyloidosis, Endomyocardial fibrosis, and Loeffler endomyocarditis?
Slide 21; SLO 7
Which is associated with multiple myeloma?? Peripheral hypereosinophilia and thrombus formation?? Nutritional deficiencies / inflammation related to helminthic infections?? The formation of beta-pleated sheets??
Diastolic or systolic dysfunction??
ApoC-II: structural protein of VLDL, IDL, LDL; the sole ligand for LDL receptor (LDLR).
ApoE: truncated form made in intestinal cells; component of chylomicrons; does NOT bind LDLR
ApoB-100: primary structural protein of HDL; activates lecithin:cholesterol acyltransferase (LCAT), facilitating cholesterol esterification and RCT
ApoA-I: activates lipoprotein lipase (LPL) on endothelial surface → TG hydrolysis from chylomicrons and VLDL
ApoB-48: inhibits LPL and hepatic uptake of TG-rich remnants
ApoC-III: mediates hepatic clearance of chylomicron remnants and IDL via LDLR and LRP
ApoB-100: structural protein of VLDL, IDL, LDL; the sole ligand for LDL receptor (LDLR).
ApoB-48: truncated form made in intestinal cells; component of chylomicrons; does NOT bind LDLR
ApoA-I: primary structural protein of HDL; activates lecithin:cholesterol acyltransferase (LCAT), facilitating cholesterol esterification and RCT.
ApoC-II: activates lipoprotein lipase (LPL) on endothelial surface → TG hydrolysis from chylomicrons and VLDL.
ApoC-III: inhibits LPL and hepatic uptake of TG-rich remnants
ApoE: mediates hepatic clearance of chylomicron remnants and IDL via LDLR and LRP.
Slide 7; SLO 2
These 2 drugs are used to treat heparin-induced thrombocytopenia type 2
What are Argatroban and Bivalirudin?
Slide 18; SLO 1
Also used during PCI
These types of beta blockers should be avoided in those with stable angina
What are partial agonists (Pindolol and Acebutolol)?
Quick hits
May increase HR and worsen angina
This congenital defect is described as having an "egg on a string" appearance on a chest X-ray
What is Transposition of the Great Arteries?
Slide 12; SLO 2
What needs to be present to keep the baby alive??