Cardiac 3

Question 0

Aortic regurgitation

Answer 0

Left sided and systolic. Can –> LVH and dilation

Ausc: High pitched decrescendo diastolic murmur. Loudest at 3-4th interspace. Best w pt leaning forward, holding breath

Dx: his and PE. Doppler echo

Question 1

Aortic regurg pt picture

Answer 1

Dt: RF, myxoma, endocarditis, congenital bicuspid valve, syphilis, CT disorder

Ssxs: asx or DOE, fatigue, syncope, chest pain…–>arrhythmia, CHF, cardiogenic shock

Question 2

Aortic stenosis

Answer 2

Auscultation: loud, rough crescendo-decrescendo murmur at upper L sternal border
Dx: his and PE. Doppler echo

Question 3

Aortic stenosis pt picture

Answer 3

Congenital bicuspid valve (RF, aging)

Ssxs: syncope, angina, DOE, arrhythmias

Question 4

Mitral valve prolapse

Answer 4

Ausc: late sys murmur and midsystolic click

Dx: Echo

Question 5

MVP pt picture

Answer 5

Pregnant, severely dehydrated, Marfans (myxomatosis degeneration)

Ssxs: usu asx, sxs w high adrenergic tone. Chest pain, palpitations, arrhythmias, dyspnea

Question 6

Infective endocarditis pt picture

Answer 6

IV drug user, deep dental work, high fever with no obvious source, new onset murmur

Question 7

Infective endocarditis

Answer 7

Etiology: if non IV: strep viridans. If IV: staph aureus

Need 2 things: blood borne pathogen AND cardiac lesion
(Dental surgery, catheterization, hemodialysis + congenital defect, rheumatic valve dz, bicuspid aortic valve, MVP)

Lab: 3 blood cultures over an hour

Question 7

Infective endocarditis sxs

Answer 7

FROM JANE
Fever, Roth spots, Osler nodes, murmur, janeway lesions, anemia, nail bed, emboli

Cough, chest pain, hemoptysis w septic PE, tricuspid murmur

Question 7

Infective endocarditis imaging

Answer 7

Transthoracic echocardiogram to look at vegetation

ECG: maybe new AV block

Question 10

Dx criteria acute pericarditis

Answer 10

Must have 2/4...
Chest pain
Pericardial friction rub
ECG changes
New/worsening pericardial effusion

Question 11

Cardiac tamponade vs pericarditis

Answer 11

Tamponade: electrical alternans on ECG. Squeezing, can’t get blood out.. dec CO and thus BP falls. Tachypnea/dyspnea.

Pericarditis: chest pain, sometimes with dyspnea. Fever, chills, weakness.

Question 12

Pericarditis etiology

Answer 12

Idiopathic. Viral infxn, MI, trauma, CT disorder (lupus loves pleura)

Question 13

Pericarditis ssxs

Answer 13

Acute onset chest pain, sharp pleuritic pain.

Worse with motion, cough, breathing deeply
Better with sitting up, leaning forward

Pericardial effusion–> muffled, friction rub

Question 14

Pericarditis sequelae

Answer 14

Cardiac tamponade. Drop in CO, BP…tachycardia/tachypnea, pulsus paradoxus. Muffled heart sound. Emergency.

Dx: ECG: electrical alternans. Pericardiocentesis

Question 15

Abdominal Aortic Aneurysms pt picture

Answer 15

Men. Atherosclerosis, smoking, HTN, older age, FHx, Caucasian

Usu asx. May be deep back/abdominal pain

Dx: ultrasound

Question 16

Thoracic aneurysm

Answer 16

Sxs: More symptomatic than AAA. Chest/back pain, cough, dyspnea, dysphagia, hemoptysis, thromboembolism

Dx: his and PE, CXR

Question 17

Aortic dissection pt picture

Answer 17

Risk factors: for atherosclerosis–coke, smoke, HTN, dyslipidemia); CT disorder, iatrogenic

African American men, eldery, HTN pts
Sxs: sudden severe pain, syncope, cardiac tamponade, BP uneven bilaterally

CXR: mediastinal shadow

Question 18

Peripheral arterial dz

Answer 18

Risk factors of atherosclerosis

Sxs: pain on exertion, IC, numbness, tingling, ulcers

Question 19

Peripheral arterial dz dx

Answer 19

PE: chcek peripheral pulses, ROM exam

1) Doppler ultrasound. 2) angiography. 3). MRA/CTA

Question 20

Primary Raynauds dz.

Answer 20

ischemia

3-5% women affected

Question 21

Myxomatous

Answer 21

Pathological condition of weakening CT. Eg Marfans