uWORLD Cardio Pathophysiology QuestionBank, 100% proven pass rate.

uWORLD Cardio Pathophysiology QuestionBank, 100% proven pass rate. uWORLD: A 67 yo man comes to the ED due to progressive SOB and chest tightness. he has no lightheadedness or syncope. The patient takes lisinopril for ...

uWORLD Cardio Pathophysiology QuestionBank, 100% proven pass rate. uWORLD: A 67 yo man comes to the ED due to progressive SOB and chest tightness. he has no lightheadedness or syncope. The patient takes lisinopril for HTN and metformin for Type 2 DM. He has smoked a pack of cigarettes daily of the last 40 years. The blood pressure cuff is inflated to 140 mmHg and the pressure is released very slowly. At 120 mmHg, intermittent Korotkoff sounds are head only during expiration. At 100mmHg, Korotkoff sounds are heard throughout the respiratory cycle The physical examination finding can be seen in the following? - ☑☑Pericardial disease > Pulsus paradoxus is defined by a decrease in systolic blood pressure of > 10 mmHg with *inspiration*. It is most commonly seen in patients with cardiac tamponade but can also occur in severe asthma, chronic obstructive pulmonary disease, and constrictive pericarditis > Inspiration causes an increase in systemic venous return, resulting in increased right heart volumes. Under normal conditions, this results in expansion of the right ventricle into the pericardial space with little impact on the left side of the heart. However, in conditions that impair expansion into the pericardial space )eg, acute cardiac tamponade), the increased right ventricular volume occurring with inspiration leads to *bowing of the inter ventricular septum* toward the left ventricle. This leads to a decrease in left ventricular (LV) end-diastolic volume and stroke volume, with a resultant decrease in systolic pressure during inspiration. A patient has pulses paradoxus. The patient is tachypeneic and unable to speak in full sentences. Examination revels prolonged expiration and prominent bilateral wheezing. Heart sounds are nonroman. Chest imaging shows a normal-sized heart and hyper inflated lungs with a flattened diaphragm. Beside ECG revels no intrapericardial fluid accumulation or pericardial thickening. Which of the following physiologic changes is most likely to provide immediate relief in this patient? - ☑☑cAMP accumulation in smooth muscle cells > Asthma and chronic obstructive pulmonary disease (COPD) exacerbation are the most frequent causes of pulses paradoxus in the absence of significant pericardial disease. Beta-adrengeric agonists controlacute asthma and COPD exacerbations by causing bronchial smooth muscle relaxation via increase intracellular cAMP. uWORLD: A 35 yo man is evaluated for progressive fatigue and SOB. Recently, he has noticed bilateral leg swelling and abdominal distention despite overall weight loss. He does not use tobacco, alcohol, or illicit drugs. Despite treatment, the patient dies several weeks later. Autospy revels significant endocardial thickening with dense fibrous deposits around the tricuspid and pulmonary valves as well as moderate pulmonary valve stenos. The left-sided cardiac chambers and valves are normal. Measuring the levels of which substances would have helped in diagnosing this patient? - ☑☑Urinary 5- hydroxyindolearcretic acid > Carcinoid syndrome typically presents with episodic flushing, secretary diarrhea and wheezing. It can lead to pathognomonic plaque-like deposits of fibrous tissue on the right-sided endocardium, causing tricuspid regurgitation and right-sided heart filature. Elevated 24 hour urnary 5-hydroxyindoleacetic acid can confirm the diagnosis. > The autospy findings - endocardial thickening and fibrosis of tricuspid and pulmonary valves - are chracerstic of *carcinoid heart disease.*. Carcinoids are well-differentiated neuroendocrine turbos found most commonly in the distill small intestine and proximal colon, with a strong propensity for metastasis to the liver. These tumors secrete seers products (including histamine, serotonin, and vasoactive intestinal peptide) that are metabolized in the liver. In patients with liver metastasis, these hormones are relased directly into the systemic circulation, leading to carcinoid syndrome. > Carcinoid heart diseases is caused by excessive secretion of *serotonin*, which stimulates fibroblast growth and fibrognesis. Pathognomic plaque-like *deposits of fibrous tissue* occur most commonly on the *endocardium*, leading to *tricuspid regurgitation*, pulmonic valvulpathy, and right-sided heart failure )eg ascites, peripheral edema). Endocardial fibrosis and thickening are generally limited to the right heart as vasoactive products and inactivated distally by pulmonary vascular endothelial monoamine oxidase. FYI - Measuring of plasma cortisol: Used for diagnosing adrenal insufficiency and Crushing syndrome- Measuring of homocysteine: elevation may contribute to arterial and venous thrombosis and to the development of atherosclerosis. - Measuring of plasma phenylalanine: May be elevated in patients with phenylalanine hydroxylase deficiency, resulting in central nervous system damage/intellectual disability : - Measuring of porphobilinogen: May be elevated in the porphyria, which are caused by deficiencies of the heme synthesis enzymes. The porphyries may produce cutaneous lesions, skin photosensitivity, or attacks of abdominal pain and neurological disturbances (acute intermittent porphyria) - Measuring of vanillymandelic acid: by product of norepinephrine and epinephrine, and can be used to detect *neuroblastoma* and other tumors of neural crest origin uWorld: A 62 yo woman comes to the hospital with intermittent but progressive substernal chest pain over the last 36 hours. Medical history includes HTN and hyperlipidemia, but the patient has been poorly compliant with her medication regimen and outpatient follow-up. She previously smoked a pack daily for 30 years but quit last year. Her blood pressure is 130/75 mmHg and pulse is 73/min. ECG on admission shows normal sinus rhythm with a 2-mm ST segment elevation in leads V2-V5. The patient is treated with medical management. However, on the fifth day of hospitalization she dies suddenly, despite adequate resuscitation. Which is the most likely cause of death in the patient? - ☑☑Profound hypotension