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Aorta lies anterior and to the right of the pulmonary artery - embryological defect?
- Tranposition of great vessels
- AP doesn't spiral (failure of NC migration)
- SEPTATION defect of the truncus arteriosus
Action of NO on muscle
- Increase in cGMP - decreases intracellular Ca - decreases activity of MLCK
- Causes myosin dephosphrylation and SM relaxation
Carotid massage in a patient with BP of 110/70 and HR of 160 now has a BP of 120/80 and HR of 75.
Prolonging AV node refractory period
What determines coronary blood flow?
What happens to coronary blood flow during exercise?
- Duration of diastole
- Exercise: HR increases and time for coronary blood flow to the heart is reduced.
- Adenosine from ATP increases coronary blood flow by vasodilation
Study when exposure and outcome are measured simultaneously, no time period separates the two.
Cause of rheumatic fever?
- Autoimmune reaction
- Antigenic similarity between the bacterial antigens and self antigens in the heart and CNS cause anti-self antibodies
- Anti-self antibodies causes RF
LV and RV wall thickness normally
Catalase (-) and able to grow in 6.5% saline
- Enterococcus (E.facium)
- GU procedures (located in the bladder) and UTIs
Catalase (-) and can grow in bile, but not saline
- Non-enterococci (S.bovis)
- Gut procedures (e.g. colonoscopy)
Patients with HT and chronic ischemic myocardial failure, what is the most effective long-term treatment?
- ACE inhibitors prevent LVH and remodelling that occurs with myocardial failure
- (constant remodelling can cause diminished contractile function)
- Intracellular ATP depletion, glycogen loss, relaxation of myofibrils
- Due to oxygen free radicals
What attempts to maintains CO in aortic regurg?
- Increase in preload: allows more blood to be pumped into circulation to balance the amount coming in via the defect
- Eccentric hypertrophy (dilated heart)
- Constrictive pericarditis: thickening and calcification of the pericardium
- Sx: ascites, peripheral edema, dyspnea (prolonged atrial contraction on JVP wave)
Coronary sinus dilation
- Pulmonary hypertension
- All veins drain into the coronary sinus which then drains into the RA
- Coronary sinus dilates when RA dilates
- Positive ionotropic agent: increases cardiac contractility: increases CO and decreases ventricular filling
- Positive chronotropic effect: increases HR and myocardial oxygen consumption
Carcinoid syndrome manifestations in the heart
- Right-sided endocardial fibrosis - progresses to pulmonic stenosis and restrictive cardiomyopathy
- Measure of 5HT and 5-hydroxylindoacetic acid
- 5HT and bradykinin are inactivatd in the lung by endothelial monoamine oxidase, hence only R heart fibrosis
Graft vascular disease
- Years after a heart transplant
- Intimal thickening of the coronary arteries without artheroma formation and inflammation
- Proliferation of fibroblasts and myocytes causing stenosis
- No chest pain as denervated.
- Affecting small to medium muscular arteries
- Fibrinoid necrosis and transmural inflammation
- Associated with Hep B/C
Complication of posterior wall transmural infarcts?
Complication of anterior wall MI after 5 weeks?
- Ventricular aneurysm
- Thin fibrous scar forming aneurysm (weakening of the wall). Blood stasis forms a thrombus (fibrous plaque of fat and cholestrol) within an aneurysm.
Paradoxical movement of the LV: bulging out during systole and inwards during diastole. Cause?
MI due to occulusion of LAD
Which calcium channel blocker should be avoided in CHF?
Which one should be used?
Supplemental O2, thrombolytic therapy (e.g. tenecteplase)
Density and cross-sectional area in hypertensive patients.
Density of capillaries and arterioles decrease; hence, cross sectional area decreases.
- Can keep the PDA open
Marfan's syndrome - heart condition?
- Aortic dissection
- Cystic medial necrosis
Accumulation of Fe in B-thal.
Decreased globin chains - undergo more hemolysis (intravascular and extravascular) - require blood transfusions = Fe overload
Levels increasing after exercise
- Adenosine - within minutes to dilate the arterioles and increasing blood flow to the muscles
- VEGF - after hours by endothelial cells - endothelial proliferation and growth of new capillaries
Drug used to tx hypertensive patient with ADPKD
ADPKD: impairs glomeruli filtration causing secretion of renin
Leptomeningeal angiomatosis and nevus flammeus
nevus flammeus = port-wine stain
Cerebellar angiomas and retinal angiomatosis
AV fistulas on P-V loops
- Bypasses arterioles (= high resistance vessels)
- No resistance = decreased afterload
- Increases flow into veins directly from arteries
- Increases preload
Aschoff bodies (macrophages with cytoplasm) and Anitschkow cells (chromatin ribbons)
ACE inhibitors used for CHF - why?
- Inhibits Ang-II mediated LVH and remodelling
- Doesnt decreased contractile function
Aortic and mitral regurg present with what extra sound?
S3 (extra blood filling in the LV)
Cardiac failure stimulates what enzyme in the liver and the lung?
- Liver: Renin (Angiotensinogen - Ang I)
- Lung: ACE (Ang I - Ang II)
Chronic mitral regurg
- Dilation of LA, thinning of walls, and increased LA compliance
- Helps to buffer regurg volume
- Prone to A-fib and arterial embolism
- Cause: myxomatous degeneration or MVP
Acute mitral regurg
- LA has not compensated to dilate; hence, increased pressure backs up to the lungs = acute pulmonary edema
- Causes: Valve rupture, chordae tendinae, endocarditis
What controls coronary blood flow when there's an increase in BP?
NO and adenosine
Bacteria from the oral cavity would adhere where on the heart to cause endocarditis?
S.aureus would adhere where on the heart to cause endocarditis?
- Need valvular damage: fibrin-platelet aggregates
- Intact endothelium
Prinzmental's angina - dx and dx drug test
- Dx: nocturnal episodes of chest pain with transient ST elevations
- Dx test: Ergonovine: provokes the vasospasm
Diptheria toxoid vaccine prevents infection - how?
- Makes circulating IgG against the exotoxin B subunit
- AB exotoxin: B subunit binds and allows penetration of A into the cell to inhibit ribosomal function
Amyloid deposition in the heart, liver, kidneys, GI
- Secondary amyloid (AA)
- Ventricle walls thicken: restrictive cardiomyopathy and CHF
Elevated serum cardiac enzymes with heart pain
- Transmural infarct
- n.b. Angina doesn't cause increase in serum enzymes
What does jugular venous distention measure?
- Venous hypertension
- RA pressure = central venous pressure
Prolonged hypertension decreases what factor?
- Arteriolar density (# of arterioles)
- H.T. increases chronic blood flow and arterioles constrict to regulate the blood flow (i.e. increases BP)
- Eventually constricted arterioles get reabsorbed.
Adverse effects of niacin (inhibits LDL and VLDL production)
- Tachycardia (reflex)
- Hyperuricemia, PUD
Types of shock, causes and parameter changes
- 1. Cardiogenic (heart failure)
- CO decreases, HR and BP increases
- 2. Septic (endotoxin-mediated)
- BP decreases, HR and CO increases
- 3. Neurogenic (spinal cord injury)
- HR increases, CO and BP decreases
- 4. Hypovolemic
- HR and BP increase
Which B-blockers are not used for angina?
- Partial ones: acebutolol, pindolol
- Have partial SNS activity so don't decrease HR and contractility as effectively
Chronic congestive heart failure and nutmeg liver appearance
- Blood stasis in central veins and central sinusoids of hepatic lobules
- Central hemorrhagic necrosis
- Mottled appearance of a liver
- n.b. does not occur with acute RHF
Aortic stenosis - deposits?
- Calcium phosphate = due to dystrophic calcification
- Calcifications of the valves
Femoral arteries branch from?
Umbilical arteries branch from?
- External iliac - travels inferiorly to the inguinal ligament
- Internal iliac
Unstable angina - underlying cause?
- Recurrent episodes of angina not responding to nitro
- Doesn't have to show ST changes
- Slowly developing thrombus
- may or may not occur over an area of arteriosclerosis
n.b. stable angina develops over an area of arteriosclerosis
Aortic stenosis - changes in the LV with oxygen and work?
- Increased LV contractility
- Increased O2 consumption
- More adenosine made to increase coronary blood flow
- Decreases O2 left in the LV
Test for 2 nominal variables (concrete numbers)
MoA of glucagon for B-blocker overdose
- (B cell receptor) G protein receptor - increases cAMP in smooth muscle and increasing intracellular Ca+2 during muscle contraction
- B agonists have the same mechanism to tx asthma
- Increases HR and contractility
Most common site of motor vehicle injury on the aorta due to aortic rupture?
- Aortic isthmus: branch between the ascending and descending aorta
- Distal to where left subclavian leaves the aorta
Complication of this?
- LV free wall rupture
- Complication: Cardiac tamponade causes severe hypotension
Embryological cause of cyanotic heart diseases
Abnormal migration of NC cells through truncus arteriosis and bulbus cordis
Acute pericarditis vs. cardiac tamponade vs. constrictive pericarditis
- Acute: chest pain and frictional rub, better when sitting up
- Tamponade: Beck's traid
- Constrictive: progressive, takes months - years to produce sx like tamponade; seen with white scars/calcifications around the heart, + Kussmaul's sign **
Malignant HT values
- Necrotizing arteriosclerosis with wall necrosis and fibrin wall deposition
Mitral valve prolapse - pathology?
- Myxomatous degeneration of the valves
- mucopolysaccharide material
In which vessel is the blood flow the lowest?
Capillaries (due to highest cross-sectional area)
Microscopy of myxoma
- Scattered mesenchymal cells in a myxoid background
- Benign tumor of the mitral valve
Class IB anti-arrythmetics
MoA of minoxidil
- Opens K+ ATP channels causes hyperpolarization and vasodilation
- Opening K+ channels doesn't allow for Ca+2 channels to be open, therefore, decrease insulin release
How does aortic dissection most commonly occur
- Uncontrolled prolonged hypertension
- (n.b. artherosclerosis predisposes to AA aneurysm)
- Restrictive cardiomyopathy due to fibrosis around the heart
- Myocyte necrosis and eosinophilic infiltrate
- Causes: eosinophilic ribonuclease + eosinophilic major basic protein
- Restrictive cardiomyopathy
- Red extracellular deposits
Most effective anti-artherosclerotic agent
Inhibits PDGF and lipoprotein oxidation
Patient is bedridden and develops swelling of the leg that is painful when risen or moved.
- Thrombophlebitis (venous stasis)
- No inflammation, no DIC
Essential hypertension, 1st manifestation seen?
Renal retention of excess sodium
In artherosclerosis, which cell type does not proliferate?
- (SM cells proliferate, platelets aggregate to endothelial injury, monocytes and T cells are there too)
Varicose veins can lead to what skin condition
- Venous stasis
- Hemosiderin deposition and dermal fibrosis with brown discolouration and rough skin
How do plaques cause aneurysms
Compression of the media, causing atrophy. Media thins and allows for wall dilation.
Features of fatty streaks on the aorta
- Lipid cells mixed with T cells
- Can predispose to plaques
- Most often seen in young children
Endarteritis obliterans of the vaso vasorum
Calcified, medium-vessel arterial branches found
- Mockenberg medial calcific sclerosis
- Incidental finding
What cholestrol level carries a low risk for artherosclerosis?
Total cholestrol <200mg/dl
Segmental involvement of medium-sized arteries, with aneurysmal dilation in the kidney + abdominal pain and melena
- Polyarteritis nodosa
- Hep B
Skin lesions that when pressed cause them to blanch. Association?
- Spider telangiectasias (purpura dont blanch)
- Association: Cirrhosis due to hyper-estreginism