4th Year Cardiology Flashcards
what is a heave?
force pushes flat hand off the chest
what is a thrill?
palpable murmur
what is acrocyanosis?
hands and feet are blue
characteristics of murmurs
timing= pulse, systolic/ diastolic/ continuous location= intensity= graded 1-6 radiation quality= soft, harsh, blowing positional change
innocent murmur features
physiological soft <3/6 short systolic asymptomatic
what is an atrial septal defect (ASD)?
hole in the septum between the right and left atria
which way does blood shunt in an ASD?
left to right as pressure is higher on the left
what does an ASD cause to the right side of the heart?
enlarges atria, pulmonary artery and right ventricle
classification of ASD
secundum= middle of the wall primum= lower part of the septum
presentation of ASD
recurrent resp infections
fatigue post-feed
failure to thrive
SOB on exertion/ feeding
murmur in ASD
mid-systolic, crescendo-decrescendo murmur at the upper left sternal border with a fixed split of the 2nd HS
diagnosis of ASD
echocardiogram
management of ASD
surgery
pulmonary vasodilators to avoid Eisenmenger’s syndrome
VSD
blood flows from the left ventricle to the right
what does a VSD cause?
both ventricle enlargement, pulmonary artery and exposes pulmonary system to high pressure
presentation of small VSD
tends to be asymptomatic
medium/large VSD presentation
4-6 weeks with increased sweating during feeding
failure to thrive
fatigue post-feed
frequent resp infections
management of VSD
if large surgery, small tend to close without intervention
murmur in VSD
pansystolic left lower sternal border
what is an AVSD
lack of AV septum
classification of AVSD
- complete defect= common valve
2. partial defect
presentation of AVSD
blue
breathless
poor feeding
failure to thrive
diagnosis of ASVD
LV angiogram- goose neck
echo
what is AVSD associated with?
Down’s
heterotaxy syndrome
Kartagner’s
presentation of coarctation of the aorta
poor feeding
weak femoral pulses
cyanosis
diagnosis of coarctation of the aorta
BP difference in arm/leg
echo
CXR
complications of coarctation of the aorta
berry aneurysms
IE
dissection
under development of arm and leg
murmur in coarctation of the aorta
systolic?
management of coarctation
surgical repair= end-end resection or subclavian flap artoplasty
balloon septostomy
open heart surgery- cardiopulmonary bypass
four findings in tetralogy of Fallot
overriding aorta
VSD
RV outflow hypertrophy
pulmonary valve stenosis
genetic associations with tetralogy of Fallot
T21
T18
T13
DiGeorge (22q11)
presentation of tetralogy of Fallot
cyanosis poor feeding failure to thrive SOB tets spell
shunt in tetralogy of Fallot
right > left causing cyanosis
RF for tetralogy of Fallot
rubella
maternal age >40
alcohol during pregnancy
diabetes
CXR finding in tetralogy of Fallot
boot shaped heart
what is a tets spell?
intermittent symptomatic periods of right to left becomes temporary worse causing a cyanotic episode
happens when pulmonary vascular resistance increases or systemic vascular resistance decreases due to CO2 (vasodilator)
precipitants of tets spell
walking
exertion
crying
presentation of tets spell
irritable
cyanotic
SOB
LOC
management of tets spell
squat/ bend knees to chest to increase SVR
oxygen
beta blockers to relax RV
morphine decreases respiratory drive
fluids
sodium bicarbonate can buffer metabolic acidosis
phenylephrine infusion increases SVR
what does the PDA become?
fossa ovalis
pansystolic murmur causes
mitral regurgitation
tricuspid regurgitation
VSD
MR murmur
pansystolic in 5th ICS MCL
tricuspid regurg murmur
pansystolic in 5th ICS left sternal border
ejection systolic murmur causes
aortic stenosis
pulmonary stenosis
HOCM
aortic stenosis murmur
ejection systolic 2nd ICS right sternal border
pulmonary stenosis murmur
ejection systolic 2nd ICS left sternal border
HOCM murmur
ejection systolic 4th ICS left sternal border
PDA murmur
continuous crescendo-decrescendo machinery murmur that makes the 2nd HS hard to hear
what does the murmur in tetralogy of Fallot come from?
pulmonary stenosis (ejection systolic in 2nd ICS left sternal border)
when does cyanosis occur?
when deoxygenated blood enters the systemic circulation as it bypasses the pulmonary circulation
heart defects that have cyanosis (right to left shunt)
VSD, ASD, PDA if develops Eisenmenger’s
transposition of the great arteries
complications of ASDs
stroke AF atrial flutter pulmonary hypertension right-sided heart failure Eisenmenger's
management of ASD
transvenous catheter closure
open heart surgery
anticoagulation
which heart defect has increased risk of IE?
VSD
three conditions that can result in Eisenmenger’s
ASD
VSD
PDA
what can make Eisenmenger’s develop quicker?
pregnancy
management of eisenmeng’ers
impossible to reverse heart lung transplant sildenafil for pulmonary hypertension anticagoulation antibiotics
surgical options for aortic stenosis
percutaneous balloon aortic valvoplasty
surgical aortic valvotomy
valve replacement
management of pulmonary valve stenosis
balloon valvuloplasty via venous catheter
what is Ebstein’s anomaly?
congenital heart condition where tricuspid valve is set lower in the right side of the heart causing a bigger RA and small RV leading to poor flow to pulmonary vessels
what is Ebstein’s associated with?
ASD and WPW
presentation of Ebstein’s
HF gallop rhythm cyanosis SOB poor feeding
management of Ebstein’s
surgery
transposition of the great arteries
no connection between systemic and pulmonary circulation
