New-ish material
What are the roles of the peripheral vessels? (hint: there are 3)
1. Regulate blood distribution for the delivery of nutrients and oxygen to tissue
Which Cardiomyopathies have systolic dysfunction, which have diastolic?
Systolic: Dilated and Arrhythmogenic RV Cardiomyopathies
Diastolic: Hypertrophic and Restrictive Cardiomyopathy
What are the S1 and the S2 sounds?
S1: mitral valve closing
S2: aortic valve closing
define atherosclerosis
chronic inflammatory condition that leads to the build up of plaque in arteries and eventually narrowing
What does turley include in every prayer and showed us a music video of
always be humble and kind
Describe 4 clinical presentations for pulmonary embolism?
Pleuritic Chest Pain
Hemoptysis (BONUS: what does this mean?)
Cough
Syncope
tachypnea
bronchospasm
JVD
Your patients physical examination shows:
crackles, S3 Gallop, Murmur, JVD, hepatomegaly, peripheral edema, and HOTN
What cardiomyopathy does he most likely have?
Dilated Cardiomyopathy
formula for wall stress
P x r / 2h
What is primary prevention and secondary prevention
Primary Prevention: trying to prevent development of disease
secondary prevention: preventing worsening of disease
name 2 difference or similarities / implications for a bioprosthetic vs a mechanical valve
mechanical: lasts a long time and requires anti-coagulant with warfarin
bioprosthetic: lasts 10-15 years, don't need anticoagulants, can be delivered percutaneously, ROSS procedure
What is a paradoxical embolism and why is it paradoxical?
Venous Clot --> right heart --> AV shunts to left side --> systemic circulation --> stroke and maybe MI
why paradoxical? clot forms on the venous side and ends up clotting on the arterial side
describe what happens with hypertrophic cardiomyopathy WITH LVOT obstruction. hint: there are 4 things to describe, just describe 3
1. ejection of blood through narrowed LVOT more rapid than normal
2. creates Venturi Forces which abnormally draws the anterior mitral valve leaflet toward the septum
3. leaflet abuts hypertrophied septum causing transient obstruction of BF into the aorta
4. Exaccerbated during exercise and low filling volume
Transient Myocardial Ischemia: finish this process:
Ischemia--> decrease BF --> decreased ATP -->
___ ---> ____
decreased ventricular relaxation and decreased EDV
describe Variant Angina and silent angina
variant angina: angina that can occur randomly or rapidly
silent angina: angina that could be asymptomatic
what are the facing leads, opposite leads, and blood supply for an Anterior MI?
Facing: V1-V4
Opposite Leads: none
blood supply: LAD
Pronounce Pheochromocytoma and give mechanism as well as at least 2 clinical presentations
Mechanism: adrenal medulla tumor --> excess Epi and NE. increased NE and Epi --> increase SNS --> increase HR and contractility --> increase vasoconstriction --> increase in BP
Clinical Presentations: paroxysmal HTN, headaches, excessive diaphoresis, palpitations, tachycardia, hyperglycemia
define Cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, and dilated cardiomyopathy
Cardiomyopathy: heterogenous group of diseases that lead to progressive CHF and associated morbidity / mortality
DCM: LV or Bi-V dilation and impaired contraction that is not explained by abnormal loading conditions or CAD
HCM: asymmetric hypertrophy of interventricular septum not caused by pressure overload with disarray myocyte alignment and associated fibrosis
RCM: non-dilated and rigid ventricles with impaired diastolic filling with normal or near normal EF
Describe 3 back flow failure symptoms for both right sided and left sided HF
Right: JVD, hepatomegaly/ascites, splenomegaly/ascites, BiLateral Peripheral edema, cool and pale clammy skin
Left: pulmonary edema, dry cough, inspiratory crackles, paroxysmal nocturnal dyspnea, orthopnea
what are the 5 classes of lipoproteins
hint: one of these are defined as a primary carrier of exogenous TG and cholesterol
chylomicrons (defined), VLDL, IDL, LDL, HDL
difference between unstable angina, NSTEMI, and STEMI
Unstable Angina: >90% occlusion, ischemia, unstable plaque, ST depresssion or TWI, NO biomarkers
NSTEMI: >90% occlusion, subendocardial infarction, unstable plaque, ST depression or TWI, Yes biomarkers
STEMI: 100% occlusion, transmural infarction, unstable plaque, ST elevation, YES biomarkers
You have an anxious young patient in the middle of Essential Hypertension hyperkinetic phase. What medication would you want to give him?
Years later, he is passed the hyperkinetic phase, what would you want to switch him to?
explain reasoning
1. Beta Blocker (high Q) in younger individuals cardiac output has a bigger impact on BP
2. Vasodilator because pressure is now the primary cause (as we get older TPR begins to have a bigger impact on BP)
What unique ablation technique is a possible surgery treatment for HCM and describe it.
Septal Ablation (alcohol ablation) alcohol is infused into the septal perforator artery that supplies hypertrophied area --> causes a small controlled MI, then remodeling
describe ARNI, ACE inhibitors, and ARBs. What makes ARNI so good?
ARNI: angiotensin receptor-neprilysin inhibitor: combines ARB's with Neprilysin. Neprilysin increases ANP and BNP which counter angio 2 and aldosterone = goooood
ACE inhibitor: angiotensin converting enzyme inhibitor: inhibits RAS and increases bradykinin
ARB: angio 2 receptor blocker: same effect as ACE inhibitors except bradykinin
Describe the atherosclerosis evolution Hint: 8 steps
1. Damage to the endothelium + accumulation of lipoproteins in intima
2. oxidation of LDL via ROS + Inflammatory enzymes trap LDL and stimulate endothelium to release LAMs
3. Endothelium releases LAMs mono/T-lymphocytes via diapedesis
4. monocytes differentiate into macrophages
5. macrophages imbibe LDL and form foam cells that release PDGF
6. SMC migrates into intima
7. SMC divide and increase extracellular matrix w/ collagen / elastin / proteoglycan
8. further calcification, fibrosis
list 7 phases of cardiac cycle and what is the name of the diagram we had to memorize
1. atrial systole
2. isovolumetric contraction
3. rapid ejection
4. reduced ejection
5. isovolumetric relaxation
6. rapid filling
7. reduced filling
wiggers diagram