Cardio Flashcards
S3
“Kentucky”
Rapid ventricular filling - MR, CHF
Normal in kids and preggers
S4
“Tennessee/atrial kick”
High atrial pressure d/t VH
Normal S2 splitting
Inspiration –> Pulmonic closes after aortic
Wide S2 splitting
Pulmonic stenosis & RBBB –> Delay in RV emptying
Fixed S2 splitting
ASD –> L-R shunt delays pulmonic closure
- secundum = #1
- primum = DOWN SYNDROME
- paradoxical emboli
Paradoxical S2 splitting
Aortic stenosis & LBBB —> delays LV emptying
Hand grip
Inc MR, VSD
Valsalva
Most DEC
Inc MVP, hypertrophic
Squatting
Dec MVP, hypertrophic
Mitral/Tricuspid regurg
Holosystolic, high pitched “blowing”
Rheumatic fever
Radiates to axilla
MR
- Complication of MVP, LV dilation, endocarditis, Rheumatic, papillary muscle rupture
Ejection click –> Crescendo-decrescendo
Aortic stenosis - Radiates to carotids - Pulsus et tardus - weak pulses - Wear and tear, bicuspid valve, or chronic RF -
Angine, syncope w/ exercise, radiates to carotids
Aortic stenosis
- “Fish mouth” commisure
- -> LVH, anemia
Weak pulses compared to heart sounds
Pulsus et tardus - Aortic stenosis
Holosystolic, harsh murmur at left sternal border
VSD
- Most common
- FETAL ALCOHOL
Mid-systolic click with late systolic crescendo
MVP
- Can predispose to endocarditis
- Caused by RF, chordae rupture, Marfan, ED syndrome
High-pitched, blowing diastolic murmur
AR
- Widened pulse pressure, bounding pulses, head bobbing
- Heard over LEFT sternal border (pulmonic area)
- INC when leaning forward w/ held expiration
Widened pulse pressure, bounding pulses, head bobbing, pistol shot bruit over femoral pulsating uvula
AR
- aortic root dilation - syphiltic aneurysm, dissection, endocarditis
- LV dilation w/ ECCENTRIC hypertrophy
Opening snap with diastolic rumble in LLD position
Mitral stenosis (same as tricuspid)
- D/T RF…endocarditis, SLE, amyloid, carcinoid
- -> LA dilation –> pul congestion/HTN –> RHF
- -> A-fib –> mural thrombi
Continuous machine-like murmur
PDA
- RUBELLA
- Prematurity
- LE cyanosis
- Tx = indomethacin
Pressure formula
P = flow x resistance
Resistance formula
R = 8(viscosity) x length / pi(radius)^4
Inc viscosity –> inc TPR –> inc work
MAP
MAP = 2/3 DBP x 1/3SBP
High-pitched, blowing, holosystolic murmur at the apex
MR
Rupture of papillary muscle –> flash pulmonary edema
Day 1-4 post-MI complication
Fatal arrhythmia, pericardial friction rub
Day 5-10 or 4-7 post-MI complication
Rupture of papillary muscle, IV septum, Ventricular free wall
Months to years post-MI complication
Ventricular aneurysm
Peaked T-waves
HyperK –> Torsades –> asystole
Tx = calcium gluconate
Causes of hyperK
Burns, tumor lysis, rhabdo BBs, ACEs, ARBs, Digitalis, K+ sparing Renal failure Acidosis Low insulin
U-waves
HypOK+
Opening snap with high-pitched diastolic rumble, inc with inspiration
Tricuspid stenosis
Mitral is the same but inc w/ Expiration
4-24 hours post-MI
Hypereosinophilia
No nuclei
1-3d post-MI
Lots of neutrophils –> coagulative necrosis
Pericardial friction rub
New murmur 1 week post-MI
IV septum rupture
ST elevation in V1-6, I, aVL
Left Main coronary artery
ST elevation in V1-2
Proximal LAD - septal
ST elevation in V3-4
LAD - anterior
ST elevation in V5-6
LAD - Apical
ST elevation in V1-4
LAD - anteroseptal
ST elevation in I, aVL
Left circumflex
ST elevation in II, III, aVF
RCA/PD - inferior
- supplies LV papillary muscle
Pericardial friction rub with ST elevation in all 12 leads
- Acute pericarditis*
- SLE, Scleroderma, Post-MI Dressler syndrome
- Diffuse ST elevation & PR depression
Viral pericarditis
Coxsackie B
Chest pain relieved by sitting forward
Pericarditis
ST depressions in II, III, aVF + cardiac enzymes
Inferior wall NSTEMI = SUBendocardium
unstable angina can have ST depression but no enzymes
Causes of 3rd degree AV block
Lyme, Chagas, endocarditis, Syphilis, Auto-immune
Silent MIs
Diabetics and Women - looks for Q waves
Q-waves
> 25% of R wave or wide
Indicates an OLD MI
High TAGs assoc w/?
Pancreatitis
QRS >3 boxes, rSR in V1, 2, slurred S waves in I and V6
RBBB
HA, lower extremity claudication, UE/LE BP differences
Coarctation of Aorta
- Turner syndrome
- Rib notching, bicuspid aortic valve
- Distal to L subclavian
- –> LVH
Infantile form = assoc w/ PDA –> cyanosis
Elastic lamina fragmentation
Giant cell arteritis
- Giant cells w/ intimal fibrosis
- ESR >100
Middle ages Asian female w/ weak pulses in extremities
Takayasu
- Granulomatous aortic arch
Young adult w/ HTN, melena, (+) serum HBsAg, segmental fibrinoid necrosis
Polyarteritis nodosa
- “String of pearls”
Asian 4 y/o w/ fever, conjunctivitis, rash on palms and soles
Kawasaki’s
- Early MI***
- Tx = aspirin***
30 y/o male smoker w/ claudication and Raynaud’s
Buerger Disease
- necrotizing vasculitis of digits –> gangrene, AUTO-AMPUTATION
Middle aged male w/ sinusitis, hemoptysis, hematuria
Wegener’s
- c-ANCA, GRANULOMAS
- Tx = cyclophosphamide
Microscopic polyangitis is similar but NO granulomas
Middle aged male w/ asthma, peripheral eosinophilia
Churg-Strauss
Causes of hyaline arteriolosclerosis/non-enzymatic glycosylation
HTN
Diabetes
Hyperplastic arteriolosclerosis
Hyperplasia of smooth muscles –> onion skinning
D/T Malignant HTN —> fibrinoid necrosis w/ ‘flea-bitten’ appearance
Calcification in linear streaks on mammography
Monckeberg Medial Calcific Sclerosis
‘Tree bark’ aorta thoracic aneurysm
Tertiary syphilis –> aortic valve insufficiency
65 y/o male smoker w/ pulsatile abdominal mass
AAA - BELOW renal arteries
- atherosclerosis
- rupture >5cm
Chest pain <20min, ST depression d/t subendocardial ischemia
Stable angina
- Nitro dilates veins
Chest pain at rest, ST depression d/t subendocardial ischemia
Unstable angina
- rupture of plaque
- nitro dilates veins
Prinzmetals agina
Coronary vasospasm
- ST ELEVATION
- Tx = CCBs
1-3 wks post-MI
RED border - granulation tissue
1 month post-MI
Scar/fibrosis
Intralveolar hemosiderin-laden MO
Left sided HF
Tx = ACE
Nutmeg liver
Right sided HF –> cirrhosis, pitting edema
Boot shaped heart
Tetralogy of Fallot
- Stenosis of RV outflow
- RVH
- VSD
- Overriding aorta
- -> cyanotic spells –> SQUATTING helps
Early cyanosis assoc w/ MATERNAL DIABETES
Transposition
- Tx = PGE to maintain PDA
Acute RF Jones Criteria
J - joint arthritis O - MR, aschoff bodies, friction rub N - Nodules E - erythema marginatum S - Syndeham chorea
M-protein MOLECULAR MIMICRY
Most common cause of death in acute RF
Myocarditis
Characteristic cells of myocarditis
Anitschkow cell - caterpillar nuclei
Chronic RF
Stenosis –> “fish mouth” valves
Mitral –> thickened chordae
Aortic –> fusion
Bug infecting prosthetic valves
S. epi
Fever, erythema on palms and soles, painful lesions on finger and toes, splinter hemorrhages in nails
Endocarditis
- anemia of chronic disease = INC FERRITIN
NBTE
Sterile vegetations d/t hypercoagulable state or ADENOCARCINOMA
–> MR
Libman-Sacks endocarditis
Sterile vegetations on BOTH sides of valve = SLE
–> MR
Causes of dilated cardiomyopathy
Genetic Myocarditis - Coxsackie Alcohol Doxorubicin, Cocaine Pregnancy
Mutation in HOCM
SARCOMERE PROTEINS
Haphazard myofibers
HOCM
- sudden death in athletes
- syncope w/ exercise
Causes of restrictive cardiomyopathy
Amyloid Sarcoid Hemochromatosis Fibroelastosis = KIDS*** Loeffler - fibrosis + eosinophils
Low voltage EKG
Restrictive cardiomyopathy
Most common primary cardiac tumor in kids
Rhabdomyoma
- Assoc w/ tuberous sclerosis*
- ventricle
Metastatic tumors to heart
More common than primary
- breast, lung, melanoma, lymphoma
- pericardium –> pericardial effusion
