what is the function of platelet for forming atheromarelease platelet-derived growth factor(PDGF), activating macrophages and endothelial cells, and this triggers smooth muscle cell(SMC) recruitment from the media and proliferation in the intima cardiologyUWorld May 24, 2020, 3:54 AM HirotoShishido
Korotkoff can be heard thrughout the respiratory circle → normal
Korotkoff can be heard only during expiration at 120mmHg, but can be heard throughout the respiratory circle at 100mmHg→ puslsus pardoxus cardiologyUWorld May 22, 2020, 2:40 AM HirotoShishido
administration of nitrateAround-the-clock nitrate administration (in any form) rapidly results in ☆development of tolerance to nitrates.
This is why a ☆nitrate-free interval must be provided every day in patients that are using daily long acting nitrates.
Usually the nitrate-free period is timed to occur during the night when the patient is sleeping and cardiac work is the least. cardiologypharmacologyUWorld May 20, 2020, 9:37 PM HirotoShishido
why does the patient with heart failure(HF) often have hyperkalemia despite adequete aldosterone formationpatients with HF have low effective arterial volume(EAV) due to third-spacing of retained fluid into the interstium(eg pulmonary, extermity edema)
→low EAV will cause ☆reduced sodium and water delivery to the collecting duct, which impairs sodium/potassium exchange by thn Na-K-ATPase, resulting in hyperkalemia renalcardiologyUWorld May 18, 2020, 9:56 PM HirotoShishido
common complication of transcatheter aortic valve implantation(TAVI)paraventricular leak (improper sealing of the prosthetic valve to the native valve annulus)→ ☆aortic regurgitation cardiologyUWorld May 13, 2020, 1:52 AM HirotoShishido
when is the portion of the myocardium affected by ischemia stop contractingthe depletion of ATP in critical cellular areas and the accumulation of toxins results in loss of contractility within ☆about 60 seconds of total myocardial ischemia
watershed infarctInfarct due to severe hypoperfusion(¥more prevalent in patients following cardiac surgery) proximal upper and lower extremity weakness (“man- in-the-barrel syndrome”), ¥higher order visual dysfunction (if posterior cerebral/middle cerebral cortical border zone stroke).
pitting
・transudate(accelular, protein poor fluid)
・prulent exudate(increased capillary permeability→ neutrophilic, protein rich fluid)
・lipodermatosclerosis(venous insufficiency→ hydrostatic→ lymphocytic, hemosiderin rich fluid)
+protein deficiency cardiologyAmboss level4 May 7, 2020, 3:41 AM HirotoShishido
septation of the chambersseptum primum→ ostium primum, ostium secundtm
septum secundum→ foramen ovale
ASD→ aplasia of the septum (primum or) septum secundum
→ostium(foramen) secundum defects is the most common cardiologyUWorld May 6, 2020, 11:24 PM HirotoShishido
coronary steal syndromevasodilator-induced alteration of coronary blood flow in patients with coronary atherosclerosis resulting in myocardial ischemia
target of radiofrequent ablation for the patient with atrial fluttercavotricuspid isthmus
(between the crista terminalis(ridge that runs along the vena cava) and the tricuspid annulus cardiologyUWorld May 4, 2020, 4:28 AM HirotoShishido
biventricular pacemakera device that requires 2 or 3 leads
If 3 leads are used, the first 2 are placed in the right atrium and right ventricle. The third lead is used to pace the left ventricle.
The preferred transvenous approach involves passing the left ventricular
pacing lead from the right atrium into the coronary sinus, which resides in the ☆atrioventricular groove on the posterior aspect of the heart. cardiologyUWorld May 3, 2020, 7:14 AM HirotoShishido
common location of intimal tear of Stanford type B dissectioncommonly close to the origin of the left subclavian artery cardiologyUWorld May 2, 2020, 10:02 AM HirotoShishido
effects of verapamil administration(the action potential of cardiac pacemaker cells)
phase 4 Na, Ca(T type) transient
phase 0 Ca(☆L type) long← class Ⅳ blocks
phase 3 K
class Ⅳ→ slowing of phase ☆4 spontaneous depolarization, phase 0 upstroke cardiologyUWorld Apr 30, 2020, 7:50 AM HirotoShishido
high intraplaque activity of which makes the plaque unstableThin-cap fibroatheromas are characterized by a large necrotic core covered by a thin fibrous cap. Activated macrophages infiltrating the atheroma contribute to the breakdown of extracellular matrix
proteins (eg, collagen) ☆by secreting metalloprotinases.
lysyl oxidase strengthens extracellular collagen fibers by cross link, contributing to stabilization of fibrous cap
(Beta-aminopropionitrile (a chemical found in certain kinds of ☆sweet peas) causes inhibition of lysyl oxidase) cardiologyUWorld Apr 25, 2020, 10:36 PM HirotoShishido
Pictureseptic pulmonary emboli
intravenous drug use are at increased risk of developing ☆tricuspid valve endocarditis
caused by ☆☆★S aureus, pseudomonas, candida
(*S bovis(gallolyticus) is present in colon cancer, S epidermidis on prosthetic valves)
the majority of patients with tricuspid valve endocarditis experience embolization of tricuspid valve vegetation fragments; these fragments lodge in distal portions of the pulmonary arterial tree and cause septic pulmonary infarcts. cardiologyinfectious diseaseUWorld step2CK Apr 24, 2020, 5:19 AM HirotoShishido
class Ⅰc antiarrythmics
adverse effects☆Flecainide, ProPAFEnone
Fries and PAFE Can
block the inward sodium current→ ☆prolong the QRS duration especially at higher rates("use-dependence")
common complication of adult-type coacrctation of the aortahypertension associated complications including left ventricular failure, ruptured dissecting aortic aneurysm, and ☆intracranial hemorrhage(congenital berry aneurysms of the Circle of Willis) cardiologyneurologyUWorld Apr 22, 2020, 9:29 AM HirotoShishido
