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muscles of mastication
third pharyngeal pouch
Treacher Collins syndrome
marks the point of embroievagination of the thyroid gland
neural crest cells
excessive hairiness that results from the develop of
T/F flight or flight does NOT occur in the exhaustion stage in the general adaption syndrome (GAS)
T/F A person does NOT have a stress reaction unless stress exceeds coping ability
T/F Decrease in insulin during stress response prevent glucose from being taken up by the peripheral tissues so that more glucose will be available from CNS
T/F For catecholamine to be immunosuppressive their levels must be chronically elevates
T/F stress and negative emotion are associated with the production and INCREASED level of proinflammatory
T/F Studies have show a relationship between depression and a reduction in lymphocyte proliferation and NK cell activity
Exhaustion occurs when ____ is not successful
The hypothalamus is stimulated during the _____ of GAS
stimulation of gluconeogenesis
Helper T cells and monocyte-macrophage cells
depression of T cells and enhancement of B cells
Androgens appear to reduce a greater degree of immune cells apoptosis follow injury, creating greater immunosuppression in injured men than women
suppression of B and T cells
Acyclovir is phosphorylated by a virus encoded phosphokinase only within HSV infected cell
Establishment of latent infection
use hyper immune serum and active immunization
animals specifically pigs, horses, fowl
-thinner, drier, wrinkled, and
demonstrates changes in pigmentation
-Shortening & decreasing cap loops
-Fewer melanocytes & langerhans
-Atrophy of glands
-Change in hair color
-fewer follicles & thinner hair
Histamine, serotonin, prostaglandins, bradykinins
Type I hypersensitivity—activation of mast
cells, eosinophils, T lymphocytes, other
Occurs in the legs as a result of
venous stasis, edema, and vascular
Antimalarial drugs, lithium, NSAIDs, and beta-blockers tend to exacerbate this existing disorder.
Benign, self-limiting inflammatory disorder; Thought to be caused by a herpes like virus; Usually occurs during winter months; ID: Herald patch that's circular, demarcated, salmon-pink, approximately 3 to 4 cm in diameter, and usually located on the trunk.
-Nonscaling violet-colored, 2-
to 4-mm lesions
-Wrists, ankles, lower legs,
Inflammatory disease of the pilosebaceous
Inflammation of the skin that develops in
-Lesions: Erythematotelangiectatic, papulopustular, phymatous, and ocular
-Associated with chronic, inappropriate vasodilation
resulting in flushing and sensitivity to the sun
Papulosquamous d/o: Inflammatory, autoimmune disease with cutaneous manifestations.
-Autoantibodies and immune complexes cause tissue damage
Rare, chronic, blister-forming disease of the skin and oral mucous membranes
-Vulgaris - severe
-Foliaceus - chest & face (milder)
-Erythematosus - Varient of Foliaceus (SLE)
AKA: Boil, is an inflammation of the hair follicles from preceding folliculitis; which develops via spread through follicular wall into the surrounding dermis; S. aureus common causative organism
Collection of infected hair follicles
• Most often on the back of the neck, the upper back, and the lateral thighs. The lesion begins in the subcutaneous tissue and lower dermis as a firm mass that evolves into an erythematous, painful, swollen mass that drains through many openings.
Infection of the dermis and subcutaneous tissue; usually caused by strep B & staph
Dermatophyte infection of nails or
Palpable purpura progressing to
hemorrhagic bullae with necrosis and ulceration that result from immune complexes in small BV's
Malaria, yellow fever, dengue fever, filariasis, St. Louis encephalitis
Autoimmune T-cell–mediated inflammatory disease against hair follicles that results in baldness
Involves the conversion of plasminogen to plasmin, which can degrade host tissue.
High levels of circulating thyroid-stimulating immunoglobulins are found in more than 95% of these individuals
-Requires a serum sodium level less than 135 mEq/L
-Serum hypo-osmolality less than 280 mOsm/kg,
*Potassium levels are not considered a factor.
A man with a closed head injury has a urine output of 6 to 8 L/day.
-Electrolytes are within normal limits but his antidiuretic hormone (ADH) level is low.
-Although he has had no intake for 4 hours, there is no change in his polyuria.
Diabetic ketoacidosis (DKA)
A man has the following laboratory values: arterial pH 7.20; serum glucose 500 mg/dl; urine glucose and ketones positive; serum K+ 2 mEq/L; serum Na+ 130 mEq/L. He reports that he has been sick with the “flu” for 1 week.
-Decreased glucose use causes fatty acid use, ketogenesis, metabolic acidosis, and osmotic diuresis.
These cells are associated with touch receptors and function as slowly adapting mechanoreceptors when stimulated by deformation of the epidermis.
AKA: angiitis is an inflammation of the blood vessels. The initiating site of inflammation may be the blood, the vessel wall, or the adjacent tissue.
1) Decreased cell proliferation
2) Decreased blood supply
3) Depressed immune responses
These are from activated T cells, B cells, and macrophages that cause the skin changes and comorbidities occurring in psoriasis.
Is caused by the yeastlike fungus Candida albicans and normally can be found on mucous membranes, on the skin, in the gastrointestinal tract, and in the vagina.
Is a malignant tumor of the skin originating from melanocytes, or cells that synthesize the pigment melanin.
Is a vascular malignancy with four different presentations: 1) in association with drug-induced immunosuppressions, for example, after kidney transplantation, 2) an endemic form in equatorial Africa, 3) a classic form presenting on the lower legs of older men, and 4) in association with AIDS.
Release histamine and play a role in hypersensitivity reactions in the skin.
Secrete the connective tissue matrix and collagen.
This can be regulated by varying blood flow through the skin by opening and closing the arteriovenous anastomoses in conjunction with evaporative heat loss of sweat. The sympathetic nervous system regulates vasoconstriction and vasodilation through α-adrenergic receptors.
Should be covered with flat, nonbulky dressings that cannot wrinkle and cause increased pressure or friction. Spontaneous healing will occur more quickly when the ulcer is kept moist with an occlusive dressing.
These cells process the antigen and carry it to T cells that then become sensitized to the antigen releasing cytokines and chemokines leading to leukocyte infiltration and inflammation.
This can be either a type IV hypersensitivity to chemicals used in latex rubber processing or a type I immediate hypersensitivity with IgE antibodies formed in response to latex rubber protein.
Are mediated by IgE-stimulated release of histamine, bradykinin, kallikrein, or acetylcholine from mast cells or basophils, or both, which causes the endothelial cells of skin blood vessels to contract.
Means sclerosis of the skin, and the disease is associated with immune dysregulation and several autoantibodies. The disease is more prominent in women
Is a benign proliferation of cutaneous basal cells that produces smooth or warty elevated lesions. The pathogenesis is unknown. They are usually seen in older people and occur as multiple lesions on the chest, back, and face. The color varies from tan to waxy, yellow, flesh-colored, or dark brown-black.
Usually have depressed centers and rolled borders. Lesions are seen most often on people who live in regions with intense sunlight and on those areas of the skin most exposed—namely, the face and neck.
Arises as a consequence of ultraviolet-associated mutation in the TP53 tumor-suppressor gene leading to loss of keratinocyte repair functions and apoptosis resistance of DNA-damaged cells.
Is a dysplasia of the basal layer of the dermis or carcinoma in situ. It often is found on unexposed areas of the body and is demonstrated by flat, reddish, scaly patches. These lesions may enlarge to more than 1 cm in diameter.
Characterized by a small (less than 1 cm) lesion with regular edges and bristle-like hairs with a color change from skin tones to light brown.
Are similar to burns and include prostaglandins, thromboxanes, bradykinin, and histamine.
Drug used to inhibit prostaglandins
Women who develop may be secreting hormones associated with ovarian or adrenal disease, and such women should be evaluated for polycystic ovaries, adrenal hyperplasia, or adrenal tumors.
Is a fungal or dermatophyte infection of the nail plate that occurs in 2% to 18% of the population
Immersion in a warm-water bath (40° to 42° C [104° to 107.6° F]) until frozen tissue is thawed.
What is the most common cause of secondary hypertension?
Renal disease, specifically renal artery stenosis
According to the JNC seven findings, what two classes of recommended BP meds are given in a patient with angina?
Beta blockers and ACE inhibitors
What are four antihypertensive agents that are recommended for management of HF according to JNC seven guidelines?
What two antihypertensive medication classes are suggested for patients with cerebrovascular disease, according to JNC seven guidelines
ACE inhibitors and thiazide diuretics
What is the most common blood test ordered in a patient who is suspected of having occult heart failure?
BNP, or brain naturetic peptide
Name three causes of acute onset heart failure.
Acute myocardial infarction, Papillary muscle rupture
Name four causes of chronic heart failure.
Cardiomyopathies Infiltrated processes Hypertension
Valvular heart disease
What physical examination sign signifies cardio medley in a patient with heart failure?
What is the New York heart Association heart failure classification for a patient who has symptoms associated with moderate exertion?
Class II. The New York heart Association heart failure classification is as follows: class I no symptoms, class II moderate symptoms, class III symptoms with minimal exertion, class IV symptoms at rest
What type of new heart sound may occur in a patient with either angina or myocardial infarction and why does this occur?
New S4 is due to a stiff and left ventricle making ventricular filling more difficult
Name three ECG findings that may occur in a patient with angina.
ST segment depression, T-wave in version and T-wave flattening
What is the typical finding on a nuclear stress test for a patient who has angina but has not had a heart attack?
Decreased ventricular filling
A patient with well-controlled angina presents with the change in his symptom pattern with chest pain. These symptoms occur sooner than expected and last longer than usual. The diagnostic workup reveals no ECG findings and cardiac enzymes are negative. What is the diagnosis?
What is the most common pathologic mechanism for a patient who has an acute MI?
Rupture of an unstable plaque
What is the most common mechanism for a patient with acute MI who develops a new onset heart murmur?
Rupture of papillary muscle resulting in acute MIRAL regurgitation (typically, it's the posterior papillary muscle since it has a single artery supply from the R coronary artery)
Echo is the best test for diagnosis
How soon can they troponin I cardiac enzyme become elevated and how long does it stay elevated?
Rises in approximately 4 to 5 hours and can stay elevated for up to 14 days
What echocardiogram findings can be used to indentify in acute MI?
Ventricular wall hypo-kinesis or akinesis; may also see acute decrease in left ventricular ejection fraction
What is the typical heart rate in a patient who has supraventricular tachycardia?
Greater than 150 beats per minute
What is the significance of the large biphasic P. way in the lead V1 on the ECG?
Right and left atrial enlargement
What is the most common sustained cardiac arrhythmia?
What is the recommended treatment for a patient with premature atrial complexes?
Generally none as this is a self-limited condition
What is the differentiation between ventricular couplets and ventricular bigeminy?
Couplets are two PVCs in a row while bigeminy is a PVC alternating with a normal complex
What is the expected adverse outcome of the R on T phenomenon?
Ventricular tachycardia, this may occur because the PVC is firing on a very susceptible portion of the T. wave
Name the accepted treatments of Torsades de pointes.
Magnesium sulfate, overdrive pacing, and correction of any underlying cause or medication
What is the treatment of choice for third degree heart block?
What are the two lateral precordial heart leads?
V5 and V6
What are the three heart leads used in a patient suspected of having inferior wall damage?
Two, three, and aVf
What heart vessel is most commonly involved in a patient having a lateral wall myocardial infarction?
What is the most common heart vessel involved in a patient having an inferior wall myocardial infarction?
Right coronary artery
What is the most common heart vessel involved in a patient having an anterior wall myocardial infarction?
Left anterior descending artery
What is the most common symptom of left-sided heart failure?
Dyspnea – initially on exertion but will later progressed to occurring at rest
What is the most common symptom of ischemic heart disease?
What is the most common cardiac cause of dependent pitting edema?
Right-sided heart failure, though progressive left-sided heart failure can do this as well
What heart sound corresponds to the carotid pulse?
S-1 heart sound
What causes the S-1 heart sound?
Closure of the mitral the end tricuspid heart sound(Many Things Are Possible is the neumonic used to remember the closing sequence of the heart valves)
1) What are the causes of an accentuated S-1 heart sound?
Sinus tachycardia, mitral stenosis, increased cardiac output states such as severe anemia, hyperthyroidism and exercise
What is the effect of respiration on the S2 heart sound?
Widens the S2 because inspiration causes increased venous return to the right side of the heart which further delays closure of the pulmonic valve widening the split
What is the most common cause of fixed splitting of S2?
Atrial septal defect, caused by left to right shunting of blood in the atria resulting in equalization of blood in the chambers
What is the most common patient type in whom an S3 is normal?
Adults over 40 years of age who have a hyper dynamic circulation; pregnant women in their third trimester due to increased plasma volume
What is the most common heart sound that is initially heard in left ventricular failure?
What is the most common mechanism producing an S4 heart sound?
Atria contracting in the late diastole against a noncompliant or poor filling ventricle; ventricles do not fill well when hypertrophied or when pericardial fluid restricts filling or at times where there is a volume overload; left-sided S-4 sound increases with expiration
What is the most common reason for an opening snap?
What are the most common causes of a physiologic heart murmur?
Anemia – decreased viscosity of the blood along with an increase in the rate causes the blood flow to increase through these normally structured valves; other causes include fever which results in increased rates and force of contraction and hyperthyroidism
What are the most common causes of an innocent heart murmur?
Aortic systolic ejection murmur; this murmur is most commonly heard in children and usually classified as grade 1 or 2 and heard best in the second left intercostal space when the patient is supine
What causes a diastolic rumble?
A diastolic rumble is due to excessive blood rushing into the ventricle from the volume overloaded atria
What is the effect of squatting on heart valve sounds?
Squatting increases the left ventricular volume by increasing systemic vascular resistance. Squatting also increases venous return of blood to the right heart. Squatting will decrease the murmur of hypertrophic obstructive cardiomyopathy because when more blood is present in the heart the obstruction is lessened.
What is the effect of inspiration on heart murmurs?
Inspiration will increase the intensity of right-sided heart murmurs due to increased flow of blood into the right heart; this is due to an increase in negative intrathoracic pressure
What are the most common causes of left ventricular hypertrophy?
Essential hypertension calls his con centric hypertrophy due to increased afterload. Other causes include aortic stenosis, aortic regurgitation, and left to right shunts.
What is the most common cause of right ventricular hypertrophy?
Pulmonary hypertension; due to increased afterload of the right ventricle which may be calls by hypertrophy pulmonary vessels; other causes include pulmonic valve stenosis and left to right shunts
What are the most common causes of a pericardial friction rub?
Fibrous pericarditis secondary to viral pericarditis; it may also occurs server weeks after myocardial infarction, this is called Dressler’s syndrome; other causes include uremia rheumatic fever and lupus
What is the most common valvular cause of a narrow pulse pressure?
What is the effect of aging on heart rate?
Decreased heart rate due to decreased beta adrenergic response
What causes pulsus paradoxus to occur?
Restricted filling of the right ventricle along with concomitant reduction in the stroke volume of the left ventricle; less blood going into the right ventricle means less blood into the pulmonary circulation and less blood going to the left ventricle; inspiration results and even less blood going into the right ventricle and so on; resulting in decreased systolic blood pressure
Name the two most common mechanisms for pulsus paradoxus to occur.
Pericardial effusion and severe bronchial asthma with increased pulmonary pressure
Describe pulsus alternans.
A pulse that has a high volume be accompanied by a low amplitude beat; amplitude changes occur as a result of stroke volume changes in the heart due to decreased contractility
What is the most common cause of pulsus alternans?
Severe left ventricular failure as seen in severe congestive heart failure
What test is best to evaluate for left atrial enlargement?
Transesophageal echocardiogram; this is due to the posterior location of the left atrium
What are the two lipid tests that are most commonly used in the screening for coronary heart disease in an asymptomatic patient?
Total cholesterol and HDL levels; risk is based on a comparison ratio between these two levels; LDL is also important
What lipid fraction is most commonly used to follow in the management of coronary artery disease in a patient with known heart disease?
LDL; new guidelines suggest a level under 70 in patients with established disease
What is the primary effect of lipoprotein a?
What is the difference between Apoprotien A and Apoprotien B?
Apoprotien A is a good marker as it consists primarily of HDLwhile type B primarily accompanies LDL
What are ways to increase HDL cholesterol?
Exercise, moderate alcohol intake, estrogen, niacin, weight loss, and statin drugs
What do triglyceride levels over 1000 put a patient at risk for?
How does diabetes mellitus affect lipids?
Increase in total cholesterol especially LDL and triglycerides; decreases HDL
What are the lipid effects of nephrotic syndrome?
Increase in total cholesterol and LDL
What are the acute effects on lipids in a patient who has had an acute MI?
Cholesterol levels decreased by 40% after 48 hours and don’t return to baseline for another 2 to 3 months therefore measurements of lipids immediately after a myocardial infarction will be falsely low
What classes of antihypertensive medications adversely affect lipids?
Thiazide diuretics, if given in large dosages, increased triglyceride and cholesterol levels; beta blockers increased total cholesterol and decrease HDL
What are the lipid effects of taking corticosteroids?
Increase in total cholesterol
Which is the most common type of familial hypercholesterolemia?
Type II hyperlipidemia
How do statins work?
Decrease delivers ability to produce cholesterol and up regulate receptors that increase clearing of LDL from the blood
What are the most worrisome side effects of statin drugs?
Liver toxicity is the primary concern though myopathy can also occur
What is the mechanism of action for nicotinic acid?
Inhibits lipolysis in adipose tissue which decreases the release of fatty acids and subsequent synthesis of LDL
What are the side effects of nicotinic acid?
Flushing caused by prostaglandin mediated vasodilation; hyperglycemia and hyperuricemia are less common
How do bile acid resins work?
These agents by bile salts resulting in an increased uptake of cholesterol, specifically LDL, from the bloodstream
What are two coexisting physical exam findings in a patient with coarctation of the aorta?
Bicuspid aortic valve and rib notching
What are the blood pressure goals for a patient with diabetes?
At or less than 130/80
What are the most common side effects associated with Ace inhibitors?
Chronic cough and Angioedema
What is the most common location of a Pheochromocytoma?
Was considered to be the gold standard test for the evaluation of Reno vascular hypertension?
What is a high pitched diastolic decrescendo murmur that is heard early after A2 at the left sternal border?
What is the most common cause of aortic stenosis?
Senile degeneration of a bicuspid aortic valve
What is the classic triad of symptoms for a patient with aortic stenosis?
Exertional dyspnea, chest pain and syncope
Was the classic type of pulse associated with aortic stenosis?
Parvus and tardus (weak and delayed)
What mode of inheritance occurs and hypertrophic obstructive cardiomyopathy?
What clinical condition associated with dyspnea and acute pulmonary congestion occurs due to a sudden increase in the left ventricular end diastolic pressure and left atrial pressure?
Acute mitral regurgitation
What heart valve abnormality classically is the most common calls of cardiogenic pulmonary edema?
What disorder presents with sub sternal chest pain that worsens with inspiration and lying supine but lessens with setting up and leaning forward?
What are the classic ECG signs their associated with acute pericarditis?
Diffuse ST segment elevation and PR depression; also see in inverted T. waves in some instances
Excruciating, tearing chest pain that radiates into the jaw or back end is acute and onset is associated with what condition?
What drug class is the treatment of choice for costochondritis?
Nonsteroidal anti-inflammatory drugs or steroids
What are the minimum ST segment elevation criteria for diagnosing an acute MI?
ST elevation in two contiguous leads of the least .1 mm and limb leads and/or .2 mm in precordial leads
Disruption or rupture of an atherosclerotic plaque leading to platelet aggregation, the rhombus formation and occlusion of a coronary artery
What single medication is proven to be effective in both primary and secondary prevention of myocardial infarction?
What medications have been proven to be beneficial to improve long-term prognosis after an acute myocardial infarction?
Aspirin, beta blockers, ace inhibitors, statins
Other than supportive measures what is the definitive treatment class used for ST segment elevation myocardial infarction?
What disorder causes wide complex polymorphic ventricular tachycardia with QRS complexes that progressively change direction or axis and may be seen in the setting of prolonged QT interval?
Torsades de pointes
What is one of the most common risk factors for the development of ventricular fibrillation?
Left ventricular dysfunction secondary to coronary artery disease
What are the two most common presenting signs or symptoms for ventricular fibrillation?
Sudden cardiac death and/or syncope
What is the appropriate definition of what constitutes a significant Q wave?
What is the most sensitive the least specific enzyme used as a cardiac marker?
What cardiac enzyme stays present for the longest period of time after an acute MI?
What is the most common cause of death related to myocardial infarction?
What are the contraindications for the use of beta blockers in an acute myocardial infarction?
Which of the papillary muscles is most commonly affected following an acute myocardial infarction?
Posterior papillary muscle of the mitral valve due to its single vessel blood supply
A septal wall myocardial infarction leads to what complication within the heart?
Severe asthma, advanced congestive heart disease, peripheral vascular disease, type I diabetes, heart block, severe hypotension
A septal wall myocardial infarction leads to what complication within the heart?
Ventral septal defect
What are the most common causes of high output congestive heart failure?
Anemia, thyrotoxicosis, AV fistula
What are the most common causes of low output congestive heart failure?
Coronary artery disease/myocardial infarction, hypertension, valvular heart disease, cardiomyopathy
What’s the most common cause of right-sided congestive heart failure?
Left-sided congestive heart failure
What is the most common valve involved with infective endocarditis?
What are the retinal hemorrhages with central clearing seen in patients with infective endocarditis?
What are the tender nodules, seen on the tips of the fingers and toes, in patients who have infective endocarditis?
What is considered to be the gold standard finding in the diagnosis of infective endocarditis?
Valvular vegetations noted on echocardiography
What medication is considered to be the best alternative to use for endocarditis prophylaxis in a patient who is allergic to penicillin?
Clindamycin or Cephalexin
What is the most common infectious etiology for a patient with pericarditis?
Viral; Coxsackie B is the most common
What is the location of the majority of abdominal aortic aneurysms?
Name the common risk factors for the development of a deep venous thrombosis?
Pregnancy, use of oral contraceptives, immobility, surgery, trauma, neoplasm
What is the volume of blood in the ventricle at the end of diastole?
What does stroke volume times heart rate equal?
What is the relationship between stroke volume and end diastolic volume?
What percentage is considered normal for an ejection fraction?
60 to 80%
What type of cardiac enzyme rises within 4 to 6 hours, peaks in 12 to 20 hours and remains elevated for 2 to 3 days?
What are the two most common patient groups that have silent, no chest pain, and cardiac ischemia?
Diabetics and elderly
What is the description given for aortic stenosis?
Crescendo – decrescendo systolic flow murmur
When in the cardiac cycle does S3 occur?
What are some other reasons for ordering electro physiologic studies?
Used in the assessment of cardiac dysrhythmias and, or to treat dysrhythmias with ablation
What coronary artery when blocked is associated with the highest degree of mortality?
What condition is associated with a cold spot that reperfuses during the resting? On a thallium scan?
What is the most common initial ECG abnormality for a patient who has a positive stress test?
ST segment depression
What medical condition has a heart disease equivalent risk for myocardial infarction?
What is the LDL target for patients with known heart disease?
What is the physiologic effect of baroreceptor stimulation?
Increased heart rate and increased force of contraction when stimulated by volume depletion
What endocrine abnormality should be assessed in a patient with new onset atrial fibrillation?
What is the best position to examine a patient who has mitral stenosis?
Left lateral decubitus
What are the two cardinal physical exam features of mitral stenosis?
Opening snap end diastolic rumbling murmur
What will happen to the murmur associated with hypertrophic obstructive cardiomyopathy if the patient squats?
Murmur will decrease in intensity
What is a common cause of a continuous, machinery type murmur?
Congenital bicuspid aortic valve
What is the leading cause of death in women older than 50?
Coronary Artery Disease
What is the underlying cause of restrictive cardiomyopathy?
Diastolic dysfunction due to stiff heart musculature
What are classic EKG findings in a patient with pericarditis?
ST segment elevation and all leads
What is a classical physical examination finding in a patient with pericarditis?
Pericardial friction rub
What can calls muffled heart sounds, increased JVP pressure and pulsus paradoxus?
What are the three classes of cardiomyopathy?
Restrictive, hypertrophic and dilated
What new heart murmur would be calls by a myocardial infarction that resulted in rupture of the papillary muscle?
What is the cardiac neuro- hormone that is secreted by the ventricles due to increased stretch?
What is the diagnostic evaluation of choice for a patient with suspected aortic stenosis?
How long does troponin stay elevated following a myocardial infarction?
7 to 14 days
What is the most common pathogen in endocarditis in persons using IV drugs?
Gram (+) coxyi - Staph aureus
Tricuspid valve most commonly effected
Contains the blood vessels (which are provided blood during diastole)
Supplies blood to the R atrium, ventricle, and bottom portion of the L ventricle and back of septum; Supplies the SA (SA nodal artery) and the AV node
Divides into the circumflex and the L anterior descending artery
- Circumflex artery – supplies the left atrium and the side and back of L ventricle
- LAD (widow maker) supplies blood to the front and bottom of L ventricle
- Sino-Atrial (SA) node (superior/posterior R atrium)
- AV Node (inter atrial septum above ventricles)
- Bachmann’s Bundle: goes from SA node to L Atrium
· Anterior, Middle, and Posterior Internodal pathways causes depolarization
The “pacemaker of the heart”
Has the quickest depolarization (hence why it’s dominant); it will override other electrical currents
Has Ca to slow depolarization): inter atrial septum above the ventricles
Values prevent the backflow to the atria, and electrically insulate the ventricle from the atria (prevent electricity from going straight from the SA node to the ventricles)
Resting Potential of Cardiac cells
Prominent S3 gallop, bibasilar rales, DOE, 3-pillow orthopnea
Symptoms: Syncope, DOE, chest pain
MV repair (commissurotomy)
Normal: 2.5 – 4.0 cm2
Mild: > 1.5 cm2
Moderate: 1.0 – 1.5 cm2
Severe: < 1.0 cm2
Chronic aortic Regurgitation - Etiology
Acute Aortic Regurgitation - Etiology
Treat underlying pulmonary hypertension. CT surgery for severe progressive disease
Conduction Drug of Choice
Adenosine (slows conduction to AV node)
Amiodarone (prolongs refractory period)
Digitalis (do NOT perform stress test on pt taking digitalis due to decreased ST segment)
· Bile Sequestrates
Loop Diuretics (Furasemide - Lasix)
Post MI (Discharge Meds) DOC
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