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cardiac > cardiac > Flashcards

cardiac Flashcards

1
Q

High arched palate

A

Marfans

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2
Q

Orange tonsils

A

Tangiers disease

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3
Q

Loeys Dietz

A 
arterial tortuosity ,
hypertelorism
 wide or split uvula
aneurysms at the aortic root
cleft palate 
club foot
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4
Q

bifid uvula

A

Loeys Dietz

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5
Q

blue sclera

A

osteogenesis imperfecta

marfans

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6
Q

why should you do a fundoscopic exam in infective endocarditis

A

friable vegetation on valve- embolism- retinal occlusion

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7
Q

Hollenhurst plaque

A

BRAO, due to lipid plaque emboli, occurs thru internal carotid artery. seen in atherosclerosis

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8
Q

Wegners granulomatosis

A

Saddle nose, acute necrotizing granuloma of the upper and lower respiratory tract.

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9
Q

c

A 
Small-vessel vasculitis
Necrotizing granulomatous vasculitis (NGV)
Microscopic polyangiitis (MPA)
Churg-Strauss syndrome (CSS)
Medium-vessel vasculitis
Polyarteritis nodosa
Kawasaki disease
Large-vessel vasculitis
Takayasu arteritis
Giant cell arteritis
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10
Q

Immune-complex mediated vasculitis

A 
Goodpasture's syndrome
Henoch-Schönlein purpura
Behçet's disease
Essential cryoglobulinemia
IgA nephropathy
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11
Q

Secondary vasculitis

A 
SLE 
Rheumatoid arthritis
Antiphospholipid antibody syndrome
Infection
Drug-inducedInflammatory bowel disease
Hypocomplementemic urticarial vasculitis
Paraneoplastic
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12
Q

Superior vena cava syndrome

A

most commonly bronchogenic carcinoma
Shortness of breath is the most common symptom, followed by face or arm swelling
Difficulty breathing
Headache
Facial swelling
Venous distention in the neck and distended veins in the upper chest and arms
Upper limb edema
Light headedness
Cough
Edema of the neck, called the collar of Stokes
Pemberton’s sign

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13
Q

Pemberton’s sign

A

Presence of latent pressure in the thoracic inlet.
The maneuver is achieved by having the patient elevate both arms until they touch the sides of the face.
A positive Pemberton’s sign is marked by the presence of facial congestion and cyanosis, as well as respiratory distress after approximately one minute

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14
Q

Straight Back Syndrome

A

Thoracic deformity characterized by loss of the normal upper thoracic spinal kyphosis

Reduced antero-posterior diameter of the chest causing a compression or “pancaking” of the heart and great vessels so as to appear enlarged.
This is accompanied by a leftward displacement of the heart, resulting in cardiac murmurs, chest pain and tracheal compression
Mitral valve prolapse (MVP) has been reported in 64% of patients

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15
Q

Eruptive xanthomas

A

Lipena retinalis

sever triglycerigides

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16
Q

palmar crease xanthoma

A

type 3 hyperlipidemia

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17
Q

Carneys syndrome

A

lupus pernio
multiple atrial myxomas
erythema nodosum

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18
Q

Holt oram

A

Absence of radial bone
1st degree heartblock
ASD
fixed thumb

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19
Q

osler Weber rendu

A

Hemorrhagic hereditary telengectasia

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20
Q

malar telengectasia

A

mitral stenosis, scleroderma

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21
Q

Jaundice

A

RHF, congestive hepatomegaly (cardiac cirrhosis)

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22
Q

janeway lesions

A

non tender, raised slightly hemorrhages on the pals and soles
infective endocarditis

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23
Q

oslers nodes

A

painful nodes on hands/ feet. See in in IE

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24
Q

Homan sign

A

posteriror calf pain on active dorsiflexion of the foot against resistance

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25
Q

Mitral regurgitation

A

holosystolic, high-pitched “blowing murmur.” Loudest at apex and radiates toward axilla. Enhanced by maneuvers that increase total peripheral resistance or expiration.

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26
Q

Tricuspid regurgitation

A

Tricuspid regurgitation
Holosystolic, high-pitched “blowing murmur.” Loudest at tricuspid area and radiates to right sternal border, Enhanced by maneuvers that increases total peripheral resistance and with with inspiration.

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27
Q

Aortic stenosis

A

Crescendo-decrescendo systolic ejection murmur following ejection click. Radiates to carotids/apex. Pulses are weak compared to heart sounds.

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28
Q

Ventricular septal defect

A

Holosystolic, harsh-sounding murmur worse with inspiration. Loudest at tricuspid area. Newborns

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29
Q

Mitral prolapse

A

Late systolic crescendo murmur with midsystolic click loudest at S2. Enhanced by standing or valsalva.

30
Q

Aortic regurgitation

A

Immediate high-pitched diastolic murmur. Wide pulse pressure when chronic; can present with bounding pulses and head bobbing

31
Q

Mitral stenosis

A

Follows opening snap. Delayed rumbling late diastolic murmur.

32
Q

Patent ductus arteriosis

A

Continuous machine-like murmur loudest at S2.

33
Q

Mnemonic for systolic murmur

A

MR (mitral regurg)
-Peyton Manning (physiologic murmur)
AS (aortic stenosis)
MVP (mitral valve prolapse)

34
Q

Pnemonic for diastolic murmur

A

ARMS (aortic regurg and mitral stenosis)

35
Q

Five considerations in deciding what type of murmur it is

A

What part of the cardiac cycle it occurs in (sys, dias)

  • Location best heard
  • Associated sxs (chest pain, shortness of breath, cyanosis, exercise intolerance, palpitations)
  • Blood pressure measurements and whether there are thrills
  • Changes in the murmur with respirations, position change
36
Q

Etiology of aortic stenosis

A

age 15-65

  • usually congenital (eg bicuspid valve)
  • 2nd most commonly, rheumatic fever
37
Q

Usual course of aortic stenosis

A
  • asymptomatic until 5th or 6th decade

- rapid deterioration at onset of cardiac symptoms

38
Q

Complications of aortic stenosis

A

(mnemonic ASC= aortic stenosis complications)

  • Angina (in 2/3, half also have CAD)
  • Syncope (usually exertional, often preceded by dizziness)
  • Congestive heart failiure (dyspnea, rapid deterioration)
39
Q

Physical findings in aortic stenosis

A
  • Systolic murmur loudest upper sternal border and carotids or apex
  • Usually S4
  • Forceful apical impulse (LV dilatation)
  • apical impulse diffuse and lateral
  • narrow pulse pressure
  • Cardiomegaly (late sign)
  • Normal ECG
40
Q

AS preventive consideration

A

subactueEnocarditis prophylaxis (in high risk)

41
Q

Aortic regurgitation etiology

A
  • Rheumatic heart disease
  • Congenital anomaly
  • Aortic root abnormalitis
  • Syphilis
42
Q

Usual course of aortic regurgitation

A
  • Prolonged asymptomatic period (even with exerise)
  • Development of exercise intolerance (late stages)
  • CHF (very late stages)
43
Q

Symptoms of aortic regurgitation

A
  • CHF
  • Angina
  • Dizziness
  • Pounding heartbeat
  • atypical chest pain (caused by mechanical interaction between the heart and the chest wall)
  • Palpitations due to tachycardia or premature beats
44
Q

Signs of aortic regurgitation

A
  • Very wide pulse pressure
  • Arterial pulses are wide and quick (waterhammer pulse)
  • PMI displaced downward and left
  • Very enlarge LV (late sign)
  • LVH on ECG
45
Q

Aortic regurgitation preventive consideration

A
  • SBE prophylaxis (in high risk)
46
Q

Stages of mitral valve stenosis (4)

A
  • Stage 1: long asymptomatic period (20y) then gradual reduction in exercise tolerance (3-5y)
  • Stage 2: onset of pulmonary congestion
  • Stage 3: development of pulmonary HTN
  • Stage 4: Severely low cardiac output
47
Q

Signs and Symptoms of mitral stenosis (7 items)

A
  • dyspnea (most common)
  • hemoptysis
  • Afib
  • RVH
  • loud S1
  • apical diastolic murmur radiating to axilla
  • left atrial enlargement
48
Q

Preventive consideration in mitral stenosis

A
  • needs SBE prophylaxis (in high risk
49
Q

Mitral Regurgitation etiology

A

Congenital

  • Rheumatic heart disease
  • Acute endocarditia
  • MVP
  • Calcified anulus
50
Q

Course of mitral regurgitation

A
  • prolonged asymptomtic period
  • onset of CHF (4th-6th decade)
  • downhill course over a 10yr period
  • left ventricular failiure
51
Q

Signs and symptoms of mitral regurgitation (7 items)

A
  • slowly preogressive CHF
  • fatiguelic apical murmur
  • bacterial endocarditis
  • PMI diffuse and displaced laterally
  • holosystolic (usually grade II) apical murmur with radiation to axilla and sternum
  • LA and LV enlargement
  • Afib
52
Q

Preventive consideration in mitral regurgitation

A

SBE prophylaxis (in high risk)

53
Q

Mitral valve prolapse etiology (2 items)

A

redundancy of MV leaflets with degeneration of MV tissue

- common in women 14-30 yrs

54
Q

Mitral valve prolapse symptoms (7)

A
  • most are asymptomatic
  • palpitations (PACs, PVCs esp with exercise)
  • PSVT
  • chest pain (common)
  • dyspnea
  • dizziness
  • numbness
55
Q

Mitral valve prolapse signs

A
  • midsystolic click at apex and LSB
  • (late in disease) late systolic click accentuated with standin, quieter with squatting
  • Afib
56
Q

Preventive consideration in mitral valve prolapse

A
  • SBE prophylaxis (in high risk)
57
Q

Capillary pulse of Quincke

A
  • pt with increased systolic output: in aortic stenosis, thyrotoxicosis, anemia
  • press acral end of pt’s fingernail, observe border btwn pink & pale tissue
  • if pt has decreased peripheral vascular resistance & increased systolic output, the issue under the nail pulsates in the rhythm of the heart beat
58
Q

Pulsus paradoxus

A
  • sbp fluctuates according to breathing
  • quiet insp: intra thoracic p drops, sbp also drops
  • exp: intra thoracic p increases, so does sbp
  • in healthy: the difference btwn highest & lowest sbp is max 10mmHg
  • if higher: cardiac failure, emphysema, exudative/constructive pericarditis due to increased systemic venous p

Pulsus paradoxus: wide span sbp during insp & exp

59
Q

Pulsus alternans

A

alternating strong & weak beats
-in chronic L ventricular dysfunction

  • in healthy pt with sinus rhythm:
    1. Sbp fluctuates only with breathing
    2. With shallow breathing/ after short apnea, the successive peak of bp is identical
  • in pt with pulsus alternans:
    1. with slow p release from cuff, the sbp is heard every 2nd beat
    2. by further cuff p release, by 5-30mmHg all pulses are heard
60
Q

Increased jugular/venous p:

A
  • congestive heart failure
  • constrictive pericarditis
  • severe tricuspid regurgitation (palpable)
61
Q

MR. ASS - Systolic Murmurs

A

These murmurs are also described as occurring during S1, or as holosystolic, pansystolic, early systolic, or midsystolic murmurs. Compared with diastolic murmurs, these murmurs are louder and can radiate to the neck or axillae.
MR (Mitral Regurgitation) AS (Aortic Stenosis

62
Q

MR

A

A pansystolic (or holosystolic) murmur:
Heard best at the apex of the heart or the apical area.
Radiates to axilla.
Loud blowing and high-pitched murmur (use diaphragm of the stethoscope)

63
Q

AS

A

A midsystolic ejection murmur:
Best heard at the second ICS at the right side of the sternum.
Radiates to the neck.
A harsh and noisy murmur (use diaphragm of the stethoscope)
Patients with aortic stenosis should avoid physical overexertion, as there is increased risk of sudden death.
Heard best with the patient sitting and leaning forward.
Monitored by serial cardiac sonograms with Doppler flow studies. Surgical valve replacement if worsens.

64
Q

MS. ARD - Diastolic Murmurs

A

Diastole is also known as the S2 heart sound, early diastole, late diastole, or middiastole. Diastolic murmurs are always indicative of heart disease (unlike systolic murmurs)

65
Q

MS (Mitral Stenosis)

A

a low pitched diastolic rumbling murmur:
Heard best at the apex of the heart or the apical area.
Also called an “opening snap” (use bell of the stethoscope)

66
Q

AR (Aortic Regurgitation)

A

A high pitched diastolic murmur:
Best heard at the second ICS at the right side of the sternum.
High-pitched blowing murmur (use diaphragm of the stethoscope).

67
Q

Diastolic murmurs

A

usually indicate valvular heart disease. Types: aortic regurgitation, mitral stenosis

68
Q

Systolic murmurs

A

may indicate valvular disease but often occur when the heart valves are normal.

69
Q

Other useful characteristics of murmurs

A

variation with respiration, with the position of the patient, or with other special maneuvers.

Murmurs originating in the right side of the heart tend to vary with respiration more than left-sided murmurs.

70
Q

Functional murmurs

A

are short, early, midsystolic murmurs that decrease in intensity with maneuvers that reduce left ventricular volume, such as standing, sitting up, and straining during the Valsalva maneuver. These murmurs are often heard in healthy patients and are not pathologic.

71
Q

Radiation or Transmission From the Point of Maximal Intensity

A

This reflects not only the site of origin but also the intensity of the murmur, the direction of blood flow, and bone conduction in the thorax. Explore the area around a murmur and determine where else you can hear it.

A loud murmur of aortic stenosis often radiates into the neck in the direction of arterial flow, especially on the right side. In mitral regurgitation, the murmur often radiates to the axilla, suggesting the role of bone conduction.

cardiac (4 decks)

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