Cardio Flashcards
Acute Pericarditis Presentation, Dx, and Tx
Pleuritic chest pain, +/- fever, Pericardial rub on auscultation.
Diffuse ST segment changes on EKG
Echo shows effusion
Tx: NSAIDS + Colchicine, Steroids for contraindications or refractory dz
Mitral Stenosis
Opening snap then rumbling mid diastolic murmur
Mitral Regurgitation
Holosystolic with Mid-systolic click, apex to axilla, dyspnea, fatigue, heart failure.
Pulsus parvus et tardus
“Weak and late pulse” caused by severe aortic stenosis
VSD
Harsh holosystolic murmur usually 3/6 or greater, requires echo to evaluate. Most will close spontaneously.
Transposition of the Great Vessels
Single loud S2, +/- VSD, egg on a string heart
ToF
Harsh pulmonic stenosis murmur, VSD murmur, boot-shaped heart (right hypertrophy)
Tricuspid atresia
Single S2, VSD murmur, Minimal pulmonary blood flow
Truncus Arteriosis
Single S2, systolic ejection murmur, increased pulmonary blood flow and edema.
Total anomalous pulmonary venous return with obstruction
severe cyanosis and resp distress. Pulmonary edema, snowman sign (englarge supracardiac veins & SVC)
Constrictive pericarditis
Causes
Presentation
idiopathic, post viral, post radiation, post hodgkins lymphoma, tuberculosis (most common in 3rd world).
Acites, elevated JVP, edema, pericardial knock, pulsus paridoxus, Kussmaul’s sign.
May see pericardial calcifications on xray
RV heave
Sign of RV hypertrophy, commonly due to pulmonary arterial hypertension (as seen in SS)
papillary muscle rupture
2-7 days post MI, severe MR, RCA associated MI
ventricular wall aneurysm
5 days to 3 months, functional MR, mural thrombus, LAD
Cardiac effects of thyroid hormone
Increased contractility, increased CO, decreased SVR, increased myocardial O2 demand.
Multifocal Atrial Tachycardia
Exacerbation of pulmonary disease, hypokalemia, catecholamine surge (sepsis). 3 or more P-wave forms with an atrial rate greater than 100. Correct underlying disturbance, Verapamil if refractory.
Physiology of HCM
Autosomal Dominant, more common in AA Anything that increases the volume of the left ventricle will decrease the murmur by improving the obstruction. -Increasing Afterload or Preload: Handgrip (Preload), Squatting (Preload and afterload), passive leg raise (preload).
Intraventricular Septum Rupture
3-5 days post-MI, LAD, chest pain, shock, new holosystolic murmur.
PVCs in patients with heart history
BB or CCB
Causes of Acute Pericarditis
post Viral, autoimmune (Lupus), Uremia, Postmyocardial infarction (Dressler’s Syndrome)
Severe Aortic Stenosis
Aortic Jet velocity >4 m/s
Mean transvalvular pressure gradient >40mmHg
Valve area is usually less than 1cm
Indication for AS intervention
Severe stenosis plus one of the following
Symptomatic
LVEF <50%
Undergoing other cardiac surgery
Indications for Mitral Valve Repair
LVEF <60% regardless of symptoms
Electrical alternans
Changes in QRS complex amplitude from beat to beat
Seen in pericardial effusions
Mobitz I
Progressively longer PR interval until a beat is dropped
Mobitz II
PR interval constant, random dropped beats.
Severe AS
Late peaking systolic murmur
Soft single S2
pulsus parvus et tardus
Most common heart defect in down syndrome
complete atrioventricular septal defect
Thready pulses that disappear with inspiration
Pulsus paradoxus
think cardiac tamponade
Young person with heart failure after viral illness
Myocarditis –> Dilated Cardiomyopathy
Coxsackie B
Infective Endocarditis vs Cardiac tumor
IE: Vegitations + regurg
Tumor: Mass + Stenosis
S4
Normal older adult
Ventricular Hypertrophy
Acute MI
S3
Children, young adults, pregnancy
Heart Failure, Restrictive CM, High output state
Suspected Aortic dissection/aneurysm with elevated Cr
TEE
Afib after sternotomy
Relatively common, most will go away in less than 24 hours. Rate control.
If it persists then you can consider cardioversion and anticoagulation.
Mediastinitis
5% of sternotomies
Fever, tachycardia, chest pain, leukocytosis
Widened mediastinum on xray
draining woud
Tx: Surgical debridement and abx
Old guy, CP, syncope, recent viral illness, markedly enlarged heart
HAVE to consider aortic dissection, even without differences in UE BP.
Palpable thrill with harsh, holosystolic murmur
Left 4th intercostal space
VSD
