Cardio Flashcards
cardio defect seen in turners
coarctation of the aorta
signs of coarctation of aorta
weakness lower extremities (from BP discrepency)
rib notching (congestion)
mild continuous murmur all over ( collaterals between HTN and hypoperfused vessels)
what causes the narrowing of aorta in coarctation
thickening of tunica media
systolic ejection murmur at left inerscapular area
coarctation
causes of amyloidosis
inflammatory arthritis chronic infections IBD malignancy vasculitis
CHF Sx with proteinuria and easy bruising
amyloid
signs of amyloid
waxy skin, macroglossia, hepatomegaly and periperhal or autonomic neuropathy
how to confirm amyloidosis causing cardiomyopathy
tissue biopsy from fat pad, bone marrow, rectum kidney or endomyocardium
continuous flow murmur in child
PDA
management vfib
defibrillation
ischemica reperfusion syndrome
form of compartment syndrome. confied tissue space with edema
need fasciotomy
suspect renovascular HTN when
elecation serum Cr after ACEI or ARB severe HTN with recurrent flash pulm edema severe HTN with idffuse atherosclerosis severe HTN after age 65 abdominal bruit resistent HTN to 3 combined medications
risk facotr for aoartic aneurysm
atherosclerosis
S4 heard when
acute phase of myocardial infarction from ischemia causing dysfunction and stiffening of left ventricular myocardium
acute Tx AF in patients with WPW
unstable- elctrocardioversion
stable- ibutilite or procainamide
complication AMI hours-1 week
ventricular septal rupture
complication after AMI up to 2 weeks
free wall rupture
complication hours to a month post AMI
postinfarction angina
When can papillary muscle rupture occur post MI
2 days-1 week
when does pericaritis post MI happen
1 day to 3 months
when do left ventricular aneurysms occur post mi
5 days to 3 months
Signs of ventricular aneurysm psot MI
persistent ST elecation after recent MI with deep Q eaves in same leads
sigsn cardiac tamponade
hypotension, tachycardia, distended neck veins and pulsus paradoxus
what causes cardiac tamponade
fluid in pericardial sack
AS in young adult, cause of chest pain?
increased myocardial oxygen demand
innocent murmurs in kids decrease with what maneuever
ones that decrease Venous return like standing up
preload increases in what shock
cardiogenic
pulmonary capillary wedges pressure increases in what shock
cardiogenic
cardiac index increases in what type of schok
septic
systemic vascular resistance increases in what shock
hypovolemic and cardiogenic
mixed venous oxygen saturation increases in what shock
septic
detect VSD in child, next step
echo
Afib post CABG patient with low BP, next step?
cardioversion
next step for SVT arryhthmia
adenosine to identify origin of arrhythmia
when to give statin in new diagnosed DM
if above 40 years old with diabetes, give statin
findings on peripheral blood smear in systemic scleroderma
shicstocytes
signs primary hyperPTH
hyperCa (polyuria and polydispia)
kidney stones
confusion, depression, psychosis
first line antiHTN in pregnancy
methyldopa
labetolol
hydralazine
CCB
MVA accident. if PCWP increases after saline IV but BP does not change much
myocardial contusion because there is left ventricular dysfunction
patient was having AMI and medically managed, now has pale cold limb. next step?
anticoagulation, vasc surgery consult and a Transthoracic echo to look for left ventricular thrombus
dyspnea dry cough and holosystolic murmur
mitral regurg
recommended Tx for afib secondary to hyperthyroid
beta blockers
cyanotic 1 week old with decreased pulmonary vascular markings and normal size heart.
tricuspid valve atresia
EKG findings on tricuspid atresia
left axis deviation
small R waves and tall peaked P waves
normal heart deviation in newborn
RAD because right atrium is larger due to PDA
explain the murmur in tricuspid atresia
loud holosystolic at Left lower sternal border because there is usually a VSD associated with the defect
common heart anomoly with downs
complete AV canal defect. large ventricles
what is ebsteins anomaly
displacement of malformed tricuspid valve into right ventricle. causes tricuspid regurg. and Right atrial enlargement. cardiomegaly
boot shaped heart
tetralogy of fallot
what is total anomalous pulmonary venous return
all 4 pulmonary veins fail to connect to left atrium and go to right. (some go to proper place) results in pulmonary overcirculation
hemoptysis raises suspicion for what valvular disease
mitral stenosis likely from rheumatic in most cases
increase risk for what with mitral stenosis or regurg
afib. increased risk for stroke etc. cardiac emboli
5 common side effects of amoidarone
pulmonary fibrosis thyroid dysfunction (hypo>hyper) hepatotoxicity (stop if LFT more that 2x high) corneal deposits skin changes (blue grey discoloration)
risk factor contributing to aortic dissection
systemic HTN longstanding
decrescendo diastolic murmur
aortic regurg.
risk factor associate with aortic aneurysms
atherosclerosis
inspiratory stridor in a child 6 months
6 months most common is croup- laryngotracheobronchitis. barky cough
persistent stridor that worsens in supine and improves in prone
laryngomalacia
persistent stridor that improves with neck extension
vascular ring
Dx of vascular ring causing stridor in infant
barium contrast esophagogram, bronchoscopy or CT or MRIangiogram
diagnosis of aortic dissection
stat TEE
if hemodynamically stable and no TEE around then CT or MRI
what type of aortic dissection causes pericardial effusion
Acute Type A
prinzmental angina is similar to what pathology in extremities
raynauds, vasospasms
what cardiac medication cna limit ventricular remodeling post MI
ACEI
start within 24 hours of MI
What happens with large AVF
shunting blood decreases SVR and increases cardiac preload and cardiac output
signs of large AVF
widened pulse pressure, strong peripheral arterial pulsation and a systolic flow murmur
causes of high output cardiac failure
AVF anemia thyrotoxicosis paget disease anemia thiamine deficiency
change in murmur from hypertrophic cardiomyopathy with valsalva.
increases
vascular signs of infective endocarditis
janesway lesions- macular erythematous nodular lesions on palms and soles
mycotic aneurysm
systemic emboli
immunologic signs if infective endocarditis
osler nodes- painful violaceous nodules on fingertips and toes
roth spots- edematous, hemorrhagic lesions of the retina
what is adults stills disease
inflammatory disorder with recurrent high fevers, rash, and arthritis
rash is maculopapular and nonpruritic, only affecting trunk and extremities
what causes hypotension, hyperpigmentation and hyponatremia
adrenal insufficiency
most appropriate Tx for a patient with aortic dissection
labetolol- type B (descending) can be managed medically
signs of dig toxicity
nausea, vomiting, decreased appetite, confusion and weakness
can also have scotomata, blurry vision with changes in color
what other cardiac drug increases risk of dig toxicity
loop diuretics
what arrythmia is caused by dig toxicity
Atrial tachy with AV block
slower atrial rate (150-250) with p waves but p waves may look different.
most common pathogens for viral myocarditis
coxsackie B and adeno
kawasaki
fever x 5 days cervical lymph node >1.5 cm rash bilateral nonexudative conjunctivitis mucositis swelling or erythema of palms and soles
Indications for urgent dialysis
Acidosis
Electrolyte abnormalities like hyperkalemia
Ingestion ot toxins, lithium, valproate
Overload of volume
Uremia (encephalopathy, pericarditis, bleeding)
diagnosis vasovagal syncope
tilt table testing
appropriate management of kawasaki
aspirin and IV Ig
inability to palpate the point of maximal impulse
large pericardial effusion
what causes the outflow obstruction in HCM
hypetrophied interventricular septum and the abnormal motion of the mitral valve leaflets–> “systolic anterior motion”
electrical alterans
pericardial effusion
what is BUN/Cr in hypovolemic patient
increased ratio like 20:1
stable wide complex tachycardia with fusion/capture beats, next step
IV amiodarone
what to do for unstable v tach
synchronized cardioversion
where do the ectopic foci for AF originate
pulmonary veins
most common cause of secondary HTN in children
fibromuscular dysplasia
what electrolyte is a good indication of severe heart failure
hyponatremia
from release of renin and ADH. water reabsorption leading to dilutional hyponatremia
how does cold water immersion affect PSVT
decreases conduction through the AV node
managemetnt third degree heart block
temporary pacing
which murmur maneuvers decrease preload
valsalva
abrupt standing
nitroglycerin
which murmur maneuvers increase afterload
hand grip
squatting
which mrumur maneuver increase preload
passive leg raise and squatting
if patient has chronic rhinitis and nasal polyps and just put on beta blocker
watch for dyspnea and bronchoconstriction
signs of edwards
micrognathia, microcephaly, rocker bottom feet, overlapping fingers and absent palmar creases
common heart defect in edwards
VSD
basic workup for HTN
UA, chem panel, lipid profile, baseline EKG
kid with congenital QT syndrome
propanolol and pacemaker
what electrlyte abnormalities can cause long QT
hypoK
hypoCa
hypoMg
what drugs increase warfarin’s effect (CYP450 inhibitors)
acetominophen, NSAIDs antibiotics/antifungals amiodarone cimetidine cranberry juice, binko, vit E omeprazole thyroid hormone SSRIs
what drugs decrease warfarin’s effect (CYP450 inducers)
carbamazepine ginseng green vegetables (spinach) (Vitamin K) oral contraceptives phenobarbital rifampin St johns wort
after arterial puncture, within 12 hours become hypotensive
suspect retroperitoneal hemorrhage and order CT non contrast
how does knee to chest help with tetralogy
increase sysmteic resistance
4 parts of tetralogy
right ventricular outflow tract obstruction from pulm stenosis or atresia)
right ventricular hypertrophy
overriding aorta
VSD
when to definitely anticoagulate for Afib
CHAD score 2-6
CHADS2 score
CHF HTN Age >75 DM Stroke or TIA
murmur with acute aortic dissection in marfanoid patient
early diastolic murmur
pulsus parvus et tardus
aortic stenosis
clopidogrel is what R blocker
P2y12
Malignant HTN criteria
severe HTN with retinal hemorrhages, exudates or papilledema
systemic arterial P that falls >10mmHg with inspiration
asthma- pulsus paradoxus
Mitral valve prolapse occurs due to what
myxomatous degeneration of leaflets
murmurs with complete AV septal defect
loud S2 due to pulmonary HTN
systolic ejection murmur
hososystolic murmur of VSD
bradycardia, AV block, hypotension and diffuse wheezing. OD on what drug
beta blocker
management of beta blocker OD
secure ariway and give isotonic fluid and IV atropine
glucagon IV
common side effect of CCB in women
peripheral edema from dilation of precapillary vessels
combine what drug with CCB to decrease edema
ACEI
at what degree stenosis do you do surgery for carotid stenosis
60-99% if asymptomatic
>50% is sypmtomatic
women >70% surgery!
strongest predictor for stent thrombosis within 12 months of placement
is medical noncompliance
what murmur is best heard during expiration
aortic regurg
PAD patients are greatest risk to suffer what in 5 years
MI
initial Tx of chronic venous disease
leg elevation, exercise and compression stockings
murmur in tetralogy
harsh systolic ejection murmur in left upper sternal border and a single S2 from poor pulmonary blood flow
constrictive pericarditis causes
idiopathic or viral
cardiac surgery or radiation
TB pericardiitis (endemic areas)
Tx for prinzmetals angina
diltiazem
what happens to preload in cardiac tamponade
decreases
treatment and management for acute arterial occlusion
IV heparin
complication of nitroprusside for HTN emergency
can cause cyanide toxicitiy which can cause lactic acidosis and seizures
PCI for STEMI patients in what time
12 hours since onset
90minutes with contact personnel
most likely impact on high BP non pharmacologic
weight loss then dietary modification to DASH
what happens to RAAS system with CHF
RAAS is activated and causes vasoconstriction of the efferent renal arterioles increasing intraglomerular pressure to maintain GFR
presentation late aortic coarctation
chest pain, claudication, HA, epistaxis, heart failure and aortic dissection
exam for aortic coarctation
brachio femoral delay
check BP in upper and lower extremities
what happens to ribs in longstanding coarctation of aorta
notching ribs 3-8 from enlarged intercosals
aortic stenosis murmur
mid late peaking systolic murmur with soft and single second heart sound
smoking cessation or weight loss for HTN
weight loss
furosemid causes what abnormalities for electrolytes
hypoMg and kypoK
mild persistent HTN in young woman on OCP
switch to different birth control
vasodilation is what type related reaction
prostaglandin related reaction
heart defect with turners
bicuspid aortic valve
bloody diarrhea and fever after surgery correcting infrarenal AAA
bowel ischemia
fatigue, cough dyspnea with hemoptysis and early diastolic sound
myxoma tumor
do a TEE or TTE
DiGeorge
Catch 22 cotruncal cardiac defects abnormal facies thymic aplasia cleft palate hypocalemia
eisenmenger syndrome
cyanosis and dyspnea from right to left shunting through large VSD
management of cocaine overdose
IV benzos for BP and anxiety
aspiring
nitro and CCB for pain
NO NO beta blockers
situational syncope
autonomic dysregulation
narrow complex tachycardia causing hypotension
next step
synchronized cardioversion
CHA2DS2VASc
CHF HTN Age>75 2 pts DM Stroke/TIA/DVT 2 pts Vascular disease Age 65-74 Sex (female)
maximum 9
S4 heart sound
corresponds with left ventricular hypertrophy most likely secondary to long standing HTN
Water hammer pulse
aortic regurg
Pulseless electrical activity management
CPR and vasopressor therapy
reversible causes of pulseless electrical activity
Hypovolemia Hypoxia Hydrogen ions (acidosis) hypo or hyperK hypothermia Tension pneumo tamponade toxins thrombosis trauma
type 1 HIT vs type 2
type 1 is in first 2 days
type 2 is from Ab to platelet factor 4 and presents 5-10 days after initiation heparin
what is the effect of dipyridamole and adenosine in cardiac stress testing
cause coronary steal
the obstructed coronary aa are already maximally dilated
Tx for hypertrophic cardiomyopathy
Beta blockers
what murmurs get louder with squatting
AR MR and VSD
what murmurs get softer with squatting
MVP and HCM
what murmurs get louder with standing
HCM and MVP
what murmurs get louder with valsalva
HCM and MVP
what murmurs get louder wtih handgrip
AR MR and VSD
what murmrs get softer with handgrip
HCM and AS
rhemuatic fever is from what infection
GAS
management of rheumatic fever in child with recurrent pharyngitis
IM penicillin q4 weeks
pericalcular abscess indications
aortic valve endocarditis causing AR and a AV conduction block with syncope
tricuspid regurg murmur
holosystolic that is accentuated with inspiration
features of cholesterol emboli
levedo reticularis, ulcers, gangrene, blue toe syndrome renal injury CNS like stroke and amaurosis fugax ocular involvement GI like ischemia and pancreatitis
lab studies in cholesterol emboli
eosinophilia, hypocomplementemia
abnormal Ankle brachial index
ABI of >1.30
calcified uncompressible vessels
Tx for sinus bradycardia
IV atropine 0.5 mg bolus every 3-5 minutes for up to 3.0 mg
Tx for hemochromatosis
phlebotomy
early onset HTN with bilateral upper abdominal masses
PKD auto dominant so do abdominal US
secondary effects of fibromuscular dysplasia
decrease perfusion kidneys causing increased renin and aldosterone
the ratio is
inheritance of HCM
auto dominant
common anatomical cause of aortic stenosis
bicuspid valve
what is kussmaul
increase JVD with inspiration
Tx for endocarditis susceptible to penicillin
IV penicillin G or IV ceftriaxone
mid diastolic sound and signs of R side CHF
constrictive pericarditis because there is mid diastolic sound
rupture of left ventricular wall results in what
pericardial tamponade
ventricular septal rupture results in what murmur
pansystolicand is best heard at left sternal border with a thrill and does not radiate
papillary muscle wall rupture murmur
mitral regurug
and has pansystolic murmur loudest at apex and radiates to axilla
