Cardiac path

Question 1

physical exam shows “wide fized splitting on S2”. What is most likely Dx?

Answer 1

Atrial septal defect

Question 2

machine like murmur

Answer 2

patent ductus arteriousis

Question 3

what are signs of a left to right shunt?

Answer 3

late cyanosis that occurs secondary to shunt reversal (Eisenmenger syndrome) - blue kids, NOT blue babies

Question 4

what are the 3 types of left to right shunts in order of frequency?

Answer 4

ventricular septal defect
atrial septal defect
patent ductus arteriosus

VSD>ASD>PDA

Question 5

what are the signs of a right to left shunt

Answer 5

early cyanosis - blue babies - usually require urgent surgery

Question 6

baby has bootshapped heart on x-ray with cyanosis. Squating improves cyanosis. What do they have?

Answer 6

tetrology of fallot - RIGHT to LEFT shunt - squating increases systemic vascular resistance and decreases the RL shunt

Question 7

what is the cause of a tetrology of fallot?

Answer 7

anteriorsuperior displacement of infundibular septum - most common cause of early childhood cyanosis

Question 8

what are the 4 features of tetrology of fallot?

Answer 8

pulmonary stenosis
right ventricular hypertrophy
overriding aorta
VSD

Question 9

What results from an uncorrected left to right shunt?

Answer 9

right to left shunt

left to right shunting => pulmonary hypertension => compensatory right ventricular hypertrophy => right to left shunting=> cyanosis

Question 10

what congenital heart defect is associated with turner syndrome?

Answer 10

coarction of the aorta (brachial>femoral pulses)

bicuspid aortic valve (higher infectious endocarditis risk)

Question 11

what congenital heart defect is associated with 22q11 (DeGeorge) syndrome?

Answer 11

Truncus arteriosus (fused aorta/pulmonary artery + VSD)
Tetrology of fallot (PROV)

Question 12

what congenital heart defect is associated with down syndrome?

Answer 12

endocardial cushion defect

Question 13

what congenital heart defect is associated with congenital rubella?

Answer 13

PDA

Pulmonary artery stenosis

Question 14

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?

Answer 14

worsened - more venous return to the left atrium from the lungs so increase stroke volume, more regurg

Question 15

what heart sounds are produced from a mitral valve prolapse?

Answer 15

mid-systolic click and mid to late systolic murmur

Question 16

What produces an S4 heart sound?

Answer 16

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.

Question 17

what is the most likely cause of sterile platelet-rich thrombi attached to the mitral valve leaflets found in autopsy

Answer 17

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

Question 18

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

Answer 18

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 (

Question 19

32 year old african american collapses while playinng baseball. What is the likely cause?

Answer 19

hypertrophic cardiomyopathy

Question 20

what causes hypertrohphic cardiomyopathy?

Answer 20

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)

Question 21

what murmur is caused by hypertrohphic cardiomyopathy?

Answer 21

crescendo-decresendo murmor heard best between the apex and left sternal bboarder radiating to the suprasternal notch (result of LV outflow obstruction)

Question 22

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?

Answer 22

pericardial effusion - typicallly occurs in the setting of pericarditis