Blonder Flashcards
ASD
opening in intra-atrial septum
most common - secundum
closure - catheter device
patent foramen ovale
foramen covered by septum primum not sealed shut in 20% of normal subjects
bubble study on echo
over time ASD
resistance - stiff and non-compliant
then pressure increases
pressure follows resistance
myxomatous mitral valve
mitral valve prolapse syndrome
most common septal defect
bicuspid AV
ASD is second**
ASD
usually asymptomatic until adult - surgery by age 40
atrial arrhythmia, paradoxical emboli, cerebral abscess, right heart failure, pulmonary HTN > eisenmanger syndrome
ASD at bottom of septum
primum
-worse
sinus venosus ASD
least common
-cannot be closed percutaneously
two types
-superior (SVC) and inferior (IVC)
scimitar syndrome
partial anomalous venous return
hypoplasia of lobe of right lung
thoracic aorta > pulmonary artery collaterals
lesions <8mm without symptoms
larger lesions enlarge with age
pulmonary HTN and eisenmenger syndrome
require >2.5:1 shunt
wide fixed split S2
ASD - splitting stays equal
increased P2
pulmonary HTN
S1 split
tricuspid component
upper left sternal border murmur
systolic ejection murmur
most common congenital heart disease at birth
VSD
spontaneous closure
infundibular VSD
below aortic and pulmonic valves
leading to progressive aortic regurgitation, the hallmark
membranous VSD
conoventricular
deficiency of membranous septum
inlet defect VSD
AV canal
down’s
muscular VSD
in trabecular system
small/restrictive VSD
orifice diameter < or = 25% aortic annulus diameter
no LV volume overload
no pulmonary HTN
moderate size VSD
orifice 25-75% diameter
mild-moderate volume overload
large VSD
orifice 75% diameter
moderate L>R shunts with LV volume overload
pulmonary HTN
> eisenmenger
tetralogy of fallot
VSD
aorta overrides
concentric RV hypertrophy
RVOT obstruction
causes of AV block
-vagal tone increase
-fibrosis of conduction system (50%)
-IHD
-cardiomyopathy and myocarditis
-congenital heart disease
familial AV block (auto dom)
latrogenic
Dr. caused AV block
-digitalis, non-DHP CCBs, beta blockers, amiodarone, adenosine
cardiac surgery
catheter
alcohol septal ablation
first degree AV block
PR interval >0.2
decreased CO
progressive PR interval prolongation
mobitz type I second degree AV block
PR interval unchanged, but get P wave that doesn’t conduct
mobitz type II second degree AV block
P and QRS dissociation
third degree AV block
usually need a pacemaker
rheumatic heart disease
mitral valve stenosis
indication for pacing
wide QRS
most common arrhythmia
atrial fib
more in men, increases with age
reduced CO - decreased diastolic filling time
risk factors for A fib
hypertensive heart disease
CHD
RF
AF that terminates spotaneously or within 7 days, may recur
paroxysmal AF
AF that fails to terminate within 7 days
persistent
require pharm or cardioversion
AF longer than 12 months
long standing persistant
patients with persistant AF where joint decision is made to no longer control rhythm
permanent AF
palpitations, syncope, dyspnea, fatigue
AF
rate control for AF
patient anti-coag
-rate controlled by AV blockers
rhythm control for AF
anticoag and restore NSR by meds
-or electrical cardioversion
TEE used to rule out LA thrombus prior to cardioversion
CHA2DS2 - Vasc
CHF HTN Age 65-74 1 point >75 2 points DIabetes Stroke 2 points
Vasc disease Hx +1
Female +1
all 9 15% per year for A-fib stroke risk
PVCs
with syncope = serious**
very common complaint
- not really that big of a deal
- unless with acute coronary syndromes or MI
reassurance is mainstay of treatment
beat after pause - very forceful
