Cardiac path Flashcards
physical exam shows “wide fized splitting on S2”. What is most likely Dx?
Atrial septal defect
machine like murmur
patent ductus arteriousis
what are signs of a left to right shunt?
late cyanosis that occurs secondary to shunt reversal (Eisenmenger syndrome) - blue kids, NOT blue babies
what are the 3 types of left to right shunts in order of frequency?
ventricular septal defect
atrial septal defect
patent ductus arteriosus
VSD>ASD>PDA
what are the signs of a right to left shunt
early cyanosis - blue babies - usually require urgent surgery
baby has bootshapped heart on x-ray with cyanosis. Squating improves cyanosis. What do they have?
tetrology of fallot - RIGHT to LEFT shunt - squating increases systemic vascular resistance and decreases the RL shunt
what is the cause of a tetrology of fallot?
anteriorsuperior displacement of infundibular septum - most common cause of early childhood cyanosis
what are the 4 features of tetrology of fallot?
pulmonary stenosis
right ventricular hypertrophy
overriding aorta
VSD
What results from an uncorrected left to right shunt?
right to left shunt
left to right shunting => pulmonary hypertension => compensatory right ventricular hypertrophy => right to left shunting=> cyanosis
what congenital heart defect is associated with turner syndrome?
coarction of the aorta (brachial>femoral pulses)
bicuspid aortic valve (higher infectious endocarditis risk)
what congenital heart defect is associated with 22q11 (DeGeorge) syndrome?
Truncus arteriosus (fused aorta/pulmonary artery + VSD) Tetrology of fallot (PROV)
what congenital heart defect is associated with down syndrome?
endocardial cushion defect
what congenital heart defect is associated with congenital rubella?
PDA
Pulmonary artery stenosis
mitral regurgitation is a blowing holosystolic murmur best heart at the cardiac apex that radiates to the axilla. Would MR be improved or worsened expiration?
worsened - more venous return to the left atrium from the lungs so increase stroke volume, more regurg
what heart sounds are produced from a mitral valve prolapse?
mid-systolic click and mid to late systolic murmur
What produces an S4 heart sound?
S4 represents an ultra-low frequency heart sound at the end of diastole just before S1 that is best heart at the CARDIAC APEX. It’s caused by blood striking a stiff left ventical and is usually a sign of LEFT VENTRICULAR HYPERTROPHY. Unlike S3, S4 is always pathologic even in a young person.
what is the most likely cause of sterile platelet-rich thrombi attached to the mitral valve leaflets found in autopsy
non-bacterial thrombotic endocarditis associated with ADVANCED MALIGNANCY
also possible:
anti-phospholipid syndrome (hypercoadulable auto-immune state associated with pregnancy complications and thrombosis - findins: anti-cardiolipin antibody + lupis anti-coagulant; treatment: heparin, not warfarin/cumadin b/c crosses placenta)
- increased risk for water-house freedman syndrome from adrenal infarct
SLE - Libman-Sacks endocarditis
what would be the effect on the following due to isolated diastolic heart failure?
left ventricular end-diastolic pressure
left ventricular end-diastolic volume
left ventricular ejection fraction
diastolic heart failure is due to increased intrinsic ventricular wall thickness or due to impaired myocardial relation – think concentric hypertrophy (thick ventrical)
increased
normal
normal
in general diastolic heart failure has normal or near normal left ventricular ejection fraction (>50%) and normal end diastolic volume with increased LV filling pressure (shift is upward on pressure volume loop)
systolic heart failure has increased filling pressure, increased end diastolic volume and decreased ejection fraction (
32 year old african american collapses while playinng baseball. What is the likely cause?
hypertrophic cardiomyopathy
what causes hypertrohphic cardiomyopathy?
autosomal dominant disorder associated with mutations in beta-myosin heavy chain
innapropriate left ventrical hypertrophy with disordered arrangement of cardiac myfibrils => diastolic dysfunction (rigit LV wall and decreased volume)
what murmur is caused by hypertrohphic cardiomyopathy?
crescendo-decresendo murmor heard best between the apex and left sternal bboarder radiating to the suprasternal notch (result of LV outflow obstruction)
pt presents with pulsus paradoxus (abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration), pericardial friection rub and widened pulse pressure with dyspnea, cough and chest pain. What is the most likely Dx?
pericardial effusion - typicallly occurs in the setting of pericarditis
