Cardio Flashcards
Tetralogy of fallot
Prov
Pulmonary stenosis, ventricular septal defect, overriding aorta, right ventricular hypertrophy
Dressler’s syndrome
Inflammatory response characterized by low grade fever, chest pain, pericardial effusion. Typically occurs 1 to 6 weeks status post MI . can cause constrictive pericarditis or cardiac Tamponade
Ebsteins anomaly
Congenital. Downward displacement of septal and posterior leaflets of the tricuspid valve into right ventricle below the AV junction
Infective endocarditis affects what valves first?
Prosthetic valves and typically on the left side of the heart for example a prosthetic mitral valve.
Preload
End diastolic volume. Increased right ventricular preload from CHF inspiration or exercise. Decreased right ventricular preload by decreasing left ventricular output, exhalation
Pulse pressure
The difference between systolic and diastolic blood pressure
Jones Criteria
Must be 2 Major or 1 Major + 2 Minor
MAJOR: PACES: PolyArthritis, Chorea, Erythema Marginatum, Subcutaneous nodules
MINOR: Fever, Arthralgia, Labs (elevated ESR), Prolonged PRI (FALPP)
1 cause of Mitral Stenosis
Rheumatic Fever. Will cause atrial irritation and A. Fib
Tx Myocarditis
Lasix + ACEI/ARB
Sx Myocarditis
Antecedent viral syndrome (Coxsackie) DOE Palpitations \+/- fever Tachycardia out of proportion to fever JVD, crackles, edema Can cause dilated cardiomyopathy
SBE: Subacute bacterial endocarditis: ETIO
Typically strep viridian’s (usually occurs in pts with established VHD)
Triad Sx of Endocarditis
Fever, murmur, + blood cultures
ETIO Acute bacterial Endocarditis
Staph aureus
ETIO Pulmonic Stenosis
typically congenital disease of the young
TX Infective Endocarditis
PCN and Ceftriaxone
ETio: IVDU: Tricuspid valve, staph aureus
Non IVDU: Mitral valve: strep viridans
3 drugs associated with Myocarditis
Cocaine, Lithium, AZT
ETIO: Mitral Regurg
AMI–> papillary muscle dysfunction or rupture of the chordae tendineae
Pulsus Paradoxus
Drop in systolic pressure > 10mmHg with INSPIRATION. = pericardial tamponade
ETIO: Pericarditis
VIRAL: Coxsackie
If it is bacterial, typically Strep Pneumoniae
Pain is relieved by leaning forward
CKMB Vs Troponin
Both rise in appx 4 hours (trop faster?)
CKMB normal in 2-3d
Troponin normal in 7 days
Goal Digoxin level in HF pt
Between 0.5 and 0.8ng/dl
Good in pts with A. Fib
AHA/ACC HF Staging
Focused on prevention
Stage A: at RISK but no sx or structural changes of HF
Stage B: Structural changes but no sx HF
Stage C: Structural change with prior or current sx
Stage D: Refractory HF requiring specialized interventions
NYHA Classification
Class I: Cardiac disease without limitation. No sx with normal activity
Class II: Slight limitation. Ok at rest but sx with normal activity
Class III: Marked limitation. Ok at rest but sx with less than normal activity
Class IV: Sx at rest. Unable to do any physical activity
EF in Diastolic HF?
Normal or “Preserved”
L sided HF vs R sided
L sided: pulmonary congestion
R sided: venous congestion (liver and periphery)
Hypertrophic vs Dilated Cardiomyopathy cause what kind of heart failure
Hypertrophic–> Diastolic
Dilated–> Systolic
Pts with what type of VHD have a higher incidence of nitroglycerin induced syncope?
Aortic Stenosis
Water hammer pulse
(variable pulse) seen with aortic regurg
Mitral Stenosis: where best heard? What sound?
Associated with what other heart problem ?
Diastolic opening snap
New onset A. Fib in 80% of pts
Most common valvular disorder caused by rheumatic fever
Sx best heard at apex
Mitral Regurg etiology
Spontaneous chordae tendineae rupture s/p MI typically LAD.
MVP most common cause
Patent Ductus Arteriosus: location and type of sound?
Continous machinery murmur
Heard best at L middle and L upper sternal border with radiation to back
TX A. Fib
Hemodynamically stable: 1st line Cardizem. 2nd line B blockers (becomes 1st line if pt has A. Fib from Graves Disease) 3rd line= Cardioversion 100-200 Joules. Only if less than 6 hours
Use PO Digoxin to control the ventricular rate
V Tach treatment
If Hemodynamically unstable 1st step is cardioversion
If Hemodynamically stable: 1st line Lidocaine 2nd line Amiodarone
V Fib tx
CPR Defib 200J or 360J CPR Defib 200J or 360 J CPR Epi 1mg IV Defib Amiodarone 300mg once or Lidocaine 1 to 1.5mg/kg Defib Repeat Amiodarone 150mg once or lidocaine 0.5 to 0.75mg max of three doses
PSVT TX
1st line: Adenosine
2nd line: Diltiazem
3rd line: Electrical cardioversion
Group A Strep: how soon does it cause post strep glomerulonephritis vs Rheumatic heart disease
Post Strep Glomerulonephritis: 2-4 weeks after infection
Rheumatic Heart Disease: years after infection
Avoid CCBs in what heart problem ?
CHF
HTN tx for pregnant women?
Methlydopa 1st line
Hydralazine 2nd line
Most common cardiac malformation
VSD
Suspect what pediatric CV abnormality if patient squats after exercising?
Tetralogy of Fallot
Where does Mitral Regurg radiate?
Axilla
Hoarseness is a sx of what valvular disorder?
Mitral Stenosis: RA enlargement pushes on L recurrent laryngeal nerve
How can the sound of A. Regurg be accentuated?
Sit up, lean forward and hold breath, or after deep inspiration or squatting
Where does A. Stenosis radiate?
Carotids
PDA is associated with what disease during the 1st trimester?
Rubella
PDA: what vessel?
Persistence of the vessel joining pulmonary artery and aorta
Tetralogy of Fallot vs ASD: shunting/cyanosis?
ASD: Acyanotic, L to R shunt
Tetralogy of Fallot: cyanotic, R to L in VSD
ASD: which way is the shunting? ASD is associated with increase in the pressure of the _______
L to R shunt. (typically high to low flow from L to R side of the heart during diastole). Associated with increased pressure in the pulmonary arteries causing Pulmonary HTN.
Coarctation of the Aorta
narrowing of the aorta, typically found just after the vessels are given off to the left arm
Response of the kidneys in Coarctation of the Aorta
Kidneys release more renin in attempt to increase pressure and flow to the kidneys which was decreased because of narrowing of the aorta. This causes HTN, especially in the arms, with LOW BP in the legs. pulses in the legs may be decreased in intensity or delayed compared with the arms.
Coarctation of the Aorta occasionally co-exists with what other congenital heart disease?
Aortic valve abnormality
Ductus Arteriosus
A normal fetal structure that allows blood to bypass circulation to the lungs (shunts blood from the L pulmonary artery to the aorta)
What causes the ductus arteriosus to close after birth?
High levels of oxygen (in a normal baby- typically closes in 24 hours)
What type of intervention required with PDA?
Typically corrects itself within several months of birth but may require infusion of chemicals, placement of “plugs” via catheters or surgical closure. Also may be treated with high flow O2 and Indomethacin.
What EKG findings associated with pericarditis?
ST elevation in all leads
IVDU with infective endocarditis what bacteria and what valve?
Staph aureus, Tricuspid
Non IVDU with endocarditis what bacteria and what valve
Strep viridans, mitral
In 80% of these patients (new onset) they have A. Fib and typical diastolic opening snap accentuated S1
Mitral stenosis
What valve most commonly affected by rheumatic fever?
Mitral
Most common heart abnormality in children?
VSD
What class of drugs is contraindicated in pts with 1st degree AV block?
CCBs
Which coronary artery is associated with a LATERAL MI?
L circumflex
Which coronary artery is associated with an ANTERIOR Mi?
LAD
Which coronary artery is associated with INFERIOR MI
RCA
Why do ACEI not work well in the black male population?
Tend to have lower levels of Renin. Can use ARBs instead.
What antihypertensives work well in pts with osteoporosis?
Thiazides (low dose, may prevent fractures)
Lipid lowering agent of choice in pts with liver disease
Bile acid sequestrants
Pt with Von Willebrands will affect the PT or PTT?
PTT (will have normal PT, normal platelets and abnormal PTT)
Heparin will affect the PT or PTT?
PTT
ASA will affect PT or PTT?
PT
1st and 2nd line treatment of pericarditis?
Typically viral:
1st: Indomethacin
2nd: Steroids (unless it is bacterial in which case treat with antibiotics)
Rheumatic heart disease commonly affects what 3 valves (in order)
Mitral
Aortic
Tricuspid
General rule regarding where murmurs are heard?
Sound radiates in the direction of blood flow
Murmur of Aortic Stenosis vs Hypertrophic cardiomyopathy relationship to squatting
AS Murmur increases with squatting, improves standing
Hypertrophic Cardiomyopathy increases standing and decreases with squatting
Why is the murmur of AS better heard when pt sits up and exhales?
It decreases the after load and the murmur can blow without resistance
You give adenosine to a pt suspected to have PSVT and they get worse: V fib or V tach, what is the dx?
WPW
New L BBB concerned about what?
AMI
Tx stable angina vs Prinzmetal’s angina?
BBblocker stable angina
CCB Prinzmetal’s (coronary vasospasm)
Difference between unstable angina and NSTEMI/STEMI
Enzymes elevated in NSTEM/STEMI
AAA tx
5.5 repair
Aortic Dissection tx
Type A= ascending aorta= surgery
Type B= descending aorta= B blockers. If complete rupture or end organ damage–> surgery
RX for hypertrophic cardiomyopathy
Verapamil
Physical exam finding of LVH
S4 gallops, apical lift or heave. LVH is compensatory response to systemic HTN or aortic valve stenosis and can cause diastolic heart failure as the L ventricle becomes stiff.f
Diastolic heart failure associated with what changes in the heart?
LVH
What is anginal equivalent
Is dyspnea without anginal discomfort caused by ischemia.
What medication should be avoided in cocaine induced HTN?
B blockers. Instead use CCBs and alpha blockers or combined alpha beta like labetolol.
Xray shows rib notching and 3 sign?
Coarctation of the aorta
Fixed wide splitting S2
ASD
