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83 Cards in this Set
- Front
- Back
What are three structures inside the Carotid Sheath?
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Internal Jugular Vein (lateral)
Common Carotid Artery (Medial) Vagus Nerve (Posterior) |
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Occlusion of this coronary artery will cause atypical chest pain, epigastric pain similar to GERD.
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Right Coronary Artery
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In 80% of cases, the SA node and AV node are supplied by which blood vessel?
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Right Coronary Artery
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Which coronary artery most commonly occluded? And this vessel supplies what portion of the heart?
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LAD; supplying the anterior ventricular septum.
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Left atrial enlargement can cause dysphagia and hoarsness. Explain.
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Compression of esophageal nerve (dysphagia) and compression of the recurrent laryngeal nerve, a branch of the vagus (hoarseness)
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Make 2 equations for Mean Arterial Pressure using the following: 1) Cardiac Output, TPR
2) Systolic pressure, Diastolic pressure |
1) MAP = CO x TPR
2) MAP = 2/3 Diastolic pressure + 1/3 Systolic pressure |
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In a healthy individual, ___ is an index of arteriolar resistance
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TPR
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How do catecholamines increase Contractility and Stroke Volume?
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Increases activity of Ca++ pump in the sarcoplasmic reticulum.
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How does a low extracellular Na+ cause increased contractility and Stroke volume?
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Decreased activity of the Na+/Ca++ exchanger
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What is preload?
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ventricular end diastolic volume
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What is Afterload?
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Mean arterial pressure (proportional to peripheral resistance);
It is essentially the force needed to eject blood from the left ventricle into the aorta |
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Patient complaining of retrosternal chest pain on exertion. Nitrogylcerin is given. What is the MOA of this drug.
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Nitroglycerin (NO release) causes increase cGMP and smooth mucle relaxation -- VENODILATOR --> Decreases preload.
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Frank-Starling Mechanism
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Force of contraction if proportional to initial length of the cardiac muscle fiber (preload)
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____ is an index of ventricular contractility.
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Ejection fraction.
EF= SV/EDV |
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RESISTANCE, PRESSURE, FLOW:
Flow (Q) is INDEPENDANT when vessels are __________; affecting flow in one vessel does not effect other vessels |
Total resistance of vessels in PARALLEL;
therefore Q is dependent when the total resistance is in series. |
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Which phase of the cardiac cycle has the most Oxygen consumption?
a) Isovolumetric Contraction phase b) Systolic Ejection phase c) Isovolumetric relaxation phase d) Rapid filling phase e) Reduced filling phase |
Isovolumetic contraction phase
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What phase of the cardiac cycle marks the period just after the mitral valve opens?
a) Isovolumetric Contraction phase b) Systolic Ejection phase c) Isovolumetric relaxation phase d) Rapid filling phase e) Reduced filling phase |
Rapid filling period
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What phase of the cardiac cycle marks the period between the mitral valve closure and aortic valve opening?
a) Isovolumetric Contraction phase b) Systolic Ejection phase c) Isovolumetric relaxation phase d) Rapid filling phase e) Reduced filling phase |
Isovolumetric contraction phase
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What heart sound? Mitral and tricuspid closure.
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S1
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Heart sound associated with an increased filling pressure and more commonly in dilated ventricles. Found in early diastole.
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S3
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how does INCREASED Contractility effect the following:
1) SV 2) EF 3) ESV |
1) ↑ stoke volume
2) ↑ ejection fraction 3) ↓ end systolic volume |
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How does INCREASED afterload affect the following
1) Aortic Pressure 2) SV 3) ESV |
1) ↑ Aortic pressure
2) ↓ Stroke volume 3) ↑ End systolic volume |
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S4 heart sounds are heard when and what causes them?
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S4 is heard in late diastole. S4 is associated with ventricular hypertrophy.
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In JVP, the "a" wave represents what?
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atrial contraction
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In normal healthy individual, what phase of respiration causes splitting of S2 and why?
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INSPIRATION → leads to drop in intrathoracic pressure increasing the capacity of pulmonary circulation → pulmonic valve closes later
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Delayed RV empyting seen in conditions such as pulmonic stenosis and right bundle branch block.
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Wide Splitting of S2
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Fixed Splitting of S2
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ASD
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Pulmonic valve closes before Aortic valve in ____________. What phase of respiration eliminates the S2 Split?
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Paradoxical Splitting.
Inspiration |
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Pandiatolic murmur, heard best at the Left Sternal Border?
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Aortic/Pulmonic Regurgitation
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Description of heart murmurs that are associated with "Regurgitation"?
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They will be either Holosystolic or Holodiastolic, high-pitched "blowing" murmur.
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What are the most common causes of Aortic Stenosis?
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Aortic Stenosis, due to age-related calcified valves or bicuspid aortic valve.
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Holosystolic "Harsh" sounding murmur heard best at the Tricupsid Area
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VSD
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Describe Aortic Stenosis
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Late Systolic, Crescendo-Decresendo Murmur preceded by an Ejection Click
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Late-systolic crescendo murmur with a Mid-Systolic Click
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Mitral Valve Prolapse
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continuous machinery murmur
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PDA
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What causes the "Plateau" of Phase 2 of the cardiac muscle action potential?
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Ca++ Influx
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What causes cardiac nodal cells' spontaneous depolarization resulting in automaticity
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I"f" Channels, Slow Na+ Influx
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Cardiac myocytes are electronically coupled to eachother by?
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Gap Junctions
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How are Skeletal Muscle and Ventricular Muscle Action Potentials SIMILAR? (2)
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1) Na+ Voltage-gated Channels are closed at rest
2) K+ Ungated Channels are always open |
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How are Skeletal Muscle and Ventricular Muscle Action Potentials DIFFERENT? (2)
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1) Ca+ Channels play a role cardiac myocyte action potentials
2) In the heart, voltage-gated K+ channels are CLOSED at Rest; In skeletal muscle, voltage-gated K+ channels are OPEN at Rest. |
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P wave on ECG
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Atrial depolarization
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What are some causes of U wave on ECG?
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hypoKalemia and Bradycardia
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QT Interval
Shorten < 0.35 - 0.44 sec < Prolonged What are examples of conditions assocaiated with SHORTENED QT Interval |
HyperCalcemia
Digitalis |
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QT Interval
Shorten < 0.35 - 0.44 sec < Prolonged What are examples of conditions assocaiated with Prolonged QT Interval |
HypoCalcemia
Quinidine Procanamide Disopyramide |
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Slow rising onset of the QRS complex on ECG. "Delta wave"
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Wolff-Parkinson-White Syndrome
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Pacemaker potentials have only what phases?
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0, 3, 4
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PR interval is prolonegd
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1st degree AV Block
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1st degree heart block, pr interval is ( > ____ msec)
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> 200 msec
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"sawtooth" appearance on ECG, due to rapid succession of identical, back-to-back atrial depolarization waves
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Atrial Flutter
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"dropped beat" with progressive lengthening of PR interval
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2nd Degree AV Block, Mobitz type 1
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How can you distinguish Mobitz type I from Mobitz type II heart block?
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Both are 2nd Degree AV block both type I and II have "dropped beats" but Mobitz type II is not associated with gradual lengthening of PR prior to a dropped beat.
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Completely erratic rhythm with no identifiable waves. Fatal arrhythmia without immediate CPR and defibrillation.
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Ventricular fibrillation
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Atria and ventricles are beating independently of each other. Both P waves and QRS complexes are present.
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3rd Degree (Complete) AV Block
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What Chemoreceptors monitor changes in arterial pH and PCO2?
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Central Chemoreceptors
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Peripheral chemoreceptors (2) respond to what changes in the blood (3).
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carotid and aortic bodies respond to ↓ PO2, ↑ PCO2, and ↓ pH
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Starling forces: Edema in Nephrotic syndrome, Liver failure
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↓ plasma protein; ↓ plasma colloid osmotic pressure - pulls fluid into capillary
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Starling forces: Edema in Heart Failure
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↑ capillary pressure; ↑ capillary pressure - pushes fluid out of the capillary
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Starling forces: Edema in lymphatic blockage
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↑ interstitial fluid colloid osmotic pressure - pulls fluid out of capillary
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Starling forces: Edema seen in burn patients
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↑ capillary permeability = ↑ Kf (filtration constant)
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Right-to-Left Shunts "blue babies"
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1. TOF
2. TOGV 3. TA 4. Tricuspid Atrisia 5. TAPVR |
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Left-to-Right Shunts, "blue kids"
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1. VSD
2. ASD 3, PDA |
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reversal of a L→R shunt to R→L shunt; presents with late cyanosis (clubbing and polycythemia)
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Eisenmenger's Syndrome
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Describe TOF
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1. Pulmonary Stenosis
2.RVH 3.Overriding of the Aorita 4. VSD |
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What is the cause of truncus arteriousis?
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failure in the formation of the aorticopulmonary septum to divide the truncus arteriosum into the aorta and pulmonary trunks.
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Child Chest X-ray reveals boot-shaped heart (RVH) with history of cyanotic spells.
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TOF
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Hypertension in upper extremities, and weak pulses in the lower extremities
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Coarctation of the Aorta
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ASD, VSD, AV septal defects (endocardial cushion defect) are associated with what congenital disorder?
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Trisomy 21 (Down Syndrome)
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Septal defects, PDA, and pulmonary artery stenosis are associated with what congenital disorder?
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enveloped, linear ss-RNA virus (Toga Virus)
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Aortic insufficiency is associated with what congenital disorder?
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defect in fibrillin (Marfans)
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Ischemic Heart disease associated with coronary artery spasm
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Printzmetal Variant Angina
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What closes PDA?
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Indomethacin
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What will keep the PDA patent?
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PGE and low O2 tension
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MC cardiac arrhythmia
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atrial fibriliation
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MC primary tumor of the heart
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Atrial myxoma (usually Left)
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MC of MI in YOUNG women with SLE
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Premature coronary atherosclerosis
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MC cause of acute infective endocarditis
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gram-positive, grape-like clusters, catalase positive, coagulase positive, β-hemolysis (Staph Aureus)
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MC cause of subacute infective endocarditis
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gram-positive streptococci, α-hemolysis (green hemolysis), catalase negative, optichin resistent (Strep Viridans)
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Infective endocarditis associated with large vegetations on previously normal valves, what microbe?
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Staph Aureus
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Infective endocarditis associated with small vegetation on previously diseased/congenitally abnormal valves, what microbe?
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Strep Viridans
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MNEUMONIC "FROM JANE" is for what disease?
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Bacterial Endocarditis:
Fever Roth's spots Osler's nodes Murmur (Mitral valve MC affected) Janeway lesions Anemia Nail-bed hemorrhage Emboli |
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Causative agent of Rheumatic Heart Disease
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Group A β-hemolytic Strep (strep pyogenes)
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What are the manifestation of Rheumatic Heart Dease?
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Mneumonic: FEVERS
1. Fever 2. Erythema marginatum 3. Valvular damage (mitral>aortic>>tricuspid valve) 4. ↑ ESR 5. Red-hot joints (Migratory polyarthritis) 6. St. Vitus's Dance (Chorea) / Van Sydenham's Chorea |
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What is the pathophysiology of RHD?
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Type III Hypersensitivity Reaction, Antibodies to M Protein
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