BRS- Cardio Flashcards
Compensatory mechanisms seen in cardiac failure
- Na/H2O retention
- Catecholamine release
- ^HR, CX
Congenital lesions causing increased pulmonary blood flow
TGA
TAPVC
Large VSD/PDA
Endgame for congenital heart lesions (^pulm flow or obstructive etc)
CHF
What acquired diseases may lead to CHF? (8)
viral myocarditis fluid changes: anemia/ overload chronic hypoxia hyperthyroid doxo cardiomyopathy ischemic disease dysrhythmias
Three general symptoms assc with CHF
FTT
poor feeds
exercise intolerance
Two vital sign changes assc with CHF
tachypnea, tachycardia
How does digoxin improve cardiac fxn?
increases efficiency of contractions, relieves tachycardia
How do PDEi improve cardiac fxn?
reduce afterload to enhance contractility
Four drug classes used in CHF for kiddos:
- Dig
- Diuretics
- Ionotropics
- PDEi
List the three “innocent” murmurs of childhood
- Stills
- Pulmonic Systolic
- Venous Hum
Which of the three innocent murmurs are systolic? continuous?
stills + pulmonic systolic= systolic murmurs
venous hum= continuous
Which of the three innocent murmurs are loudest when supine? standing?
supine + exercise= stills, pulmonic systolic
standing= venous hum
List the most prominent location of the three innocent murmurs:
Neck: venous hum
upper left: pulmonic systolic
lower left: stills
Which of the three innocent murmurs changes with jugular venous compression
venous hum
Systolic ejection murmur at left sternal border with split S2 is characteristic of what lesion?
ASD
Holosystolic murmur at the left lower sternal border is characteristic of what lesion?
VSD
Constant machine like murmur at upper left sternal border is characteristic of what lesion?
PDA
What congenital lesion may present with a murmur similar to aortic stenosis (systolic, upper right sternal border)?
Coarctation
To where does the murmur of aortic stenosis radiate?
carotids
Systolic ejection murmur at upper left sternal border with a click is characteristic of what lesion?
Pulmonic stenosis
Innocent heart murmurs: ages
- venous: school age
- pulmonic systolic: any age
- stills: ages 2-7
Of the acyanotic congenital heart diseases, which present with RAD on ECG
ASD, pulmonic stenosis
Of the cyanotic heart lesions which may be normal on ECG or have LVH?
coarctation, aortic stenosis
Of the acyanotic lesions, which present with LVH until PHTN occurs, then RVH?
VSD, PDA
What are the three types of ASD?
primum (low)
secundum (mid)
sinus venosus (high)
Which of the three types of ASD is most common? Assc with Downs?
primum- downs (primum= one= trisomy twenty ONE)
secundum- most common
Where do pulmonary veins drain in sinus venosus type ASD?
RA, SVC
What are the three types of VSD?
inlet
outlet, supracristal
trabecular, muscular
When must VSD be emergently operated on?
When causing PHTN, PHTN is irreversible if left over time.
Symptoms of VSD
small: none
mod-large: CHF
PHTN develops: CHF disappears
Of the six acyanotic congenital heart lesions, which may have a diastolic rumble at the apex?
ASD, VSD, PDA
Symptoms of PDA
- brisk pulses
- widened pulse pressure
- CHF if severe
Direction of blood flow in case of PDA
aorta –> PA
MC location of aortic coarctation
just below LSCA, proximal to ductus
Drugs that may be used to treat coarctation before surgery
IV PGE
ionotropes
Signs & symptoms of coarc
- elevated BP in RUE
- bruit at left upper back
- rip notching on CXR
- CHF at time of PDA closure
Pathophys of aortic stenosis
commissural fusion
Symptoms of coarctation when CHF develops
no murmur
poor pulses all four extremities
What are the five cyanotic heart lesions?
1) tet
2) truncus
3) tricuspid atresia
4) transposition
5) TAPVC
Test for diagnosing Cardiac related causes of CHF
100% O2 challenge
Noncardiac causes cyanosis
- pulm dz
- sepsis
- hypoglycemia
- polycythemia
- NM disease = chest wall dysfxn
Murmur of tet is predominately caused by _____
pulm stenosis
systolic murmur at ULSB with click
What causes a “tet” spell and how is it reversed?
decreased SVR = cyanosis
valsalva, squatting, HTN= increased SVR= relieved cyanotic spell
When does cyanosis occur in tet?
PDA closure
CXR finding in tet
boot shaped heart
What are the four features of tet?
IHOP interventricular septal defect hypertrophy of the right ventricle overriding aorta pulmonic stenosis
Transposition of the great arteries causes _____circulation
parallel instead of series
CXR finding in transposition
egg on a string
What is usually present in Tricuspid atresia?
ASD, VSD
How is tricuspid atresia repaired?
connect IVC to PA (Fontan)
Finding in tricuspid atresia that distinguishes it from other cyanotic lesions?
only cyanotic lesion to cause LVH
Common murmur to transposition and tricuspid atresia?
no murmur/ single S2
Truncus arteriosus murmur
single S2
systolic ejection
diastolic murmur at mitral valve
Murmur of TAPVC
pulmonary ejection murmur at LSB
Repair of TAPVC
anastomose PV to LA
CXR appearance of TAPVC
snowman appearance (enlarged heart)
ECG findings in TAPVC
RVH
1 acquired heart disease in US? worldwide?
US: Kawasakii
World: ARF
Infective Endocarditis #1 and #2 most common predisposing factors
80% have structural disease and 50% are post op
List some classic symptoms of endocarditis
janeway and olsers nodes (oslers = ouch) roth spots= white retinal lesions nailbed hemorrhages murmur hematuria spenlomegaly
What are vegetations made of in endocarditis?
platelets, fibrin
Two most common bacteria seen in endocarditis?
strep viridans
staph aureus
Most important step in diagnosing endocarditis?
#1 blood cultures also... transesophageal echo for vegetations
When are abx needed to px against endocarditis during procedures?
structural lesions
6 months post op after a cardiac procedure
lifelong if any residual lesion following cardiac surgery
How long are IV abx given after dx of endocarditis?
4-6 weeks
Signs and symptoms of pericarditis?
- friction rub
- pain when supine
- distant heart sounds
- pulsus paradoxus
Severe outcome of pericarditis?
tamponade
1 cause pericarditis?
viral
CX, echo, adeno, flu, para, EBV
Three non infectious causes pericarditis
lupus
uremis
post pericardotomy (1/3 cases)
2 bacterial causes of endocarditis
staph aureus
strep pnuemo
ECG changes assc with pericarditis
low voltage QRS
alterations in ST
Myocarditis:
most serious outcome
causes 20% of SCD in atheletes
Infectious Etiologies for myocarditis
coxsackie
cadida, crypto
trypanosoma cruzi
coryne, strep pyo, staph a, TB
Autoimmune/ inflammatory causes of myocarditis
- SLE
- RF
- Sarcoid
- Kawasaki
What does echo show in case of myocarditis?
global ventricular dysfunction
Causes of dilated cardiomyopathy + which is most common?
#1 idiopathic also: beriberi mitochondrial abnormality carnitine def viral myocarditis ....etc
MCC SCD in athletes?
AD HCM
Describe murmur assc with HCM
harsh systolic murmur worsened with valsalva
caused by LVOT obstruction by anterior mitral leaflet
Causes of restrictive CM
amyloidosis
gauchers
fabrys
hemochromatosis/ hemosiderinosis
MC peds dysrhythmia
SVT
Causes of SVT
AVRT/AVNRT
Describe WPW
AVRT with delta wave (long PR, upsloping QRS)
Treatment of SVT
vagal maneuvers
adenosine
SCD
Describe the types of heart block
type 1: long PR
type 2-I: progressively longer PR –> dropped beat
type 2-II: dropped beat
type 3: no conduction from A –> V
*type 2-I= wenke
Treatment of heart block
pacing
Causes of heart block
post surgical
SLE in mother
endocarditis
Long QT syndrome risk
torsades –> death
Treatment long QT syndrome
BBers/ pacing
Two hereditary syndromes causing Long QT
AR, Jervell Lange Nielson = long QT + deaf
AD, Romano Ward= long QT only
Most common cardiac related cause of chest pain
pericarditis
Cause chest pain in marfans
aortic dissection
