Cardio Flashcards
wide pulse pressure seen in
pda truncus arteriosus avm aortic insufficiency anemia sepsis
narrow pulse pressure seen in
pericardial tamponade
aortic stenosis
heart failure
cardiac in hunter hurler
valvular insufficiency, heart failure, hypertension
cardiac in duchenne dystrophy
cardiomyopathy, heart failure
cardiac in pompe
short PR interval
cardiomegaly
heart failure
arrhythmia
cardiac in kawasaki
coronary artery aneurysm
thrombosis
myocardial infarction
myocarditis
cardiac in marfan
aortic and mitral insufficiency
dissecting aortic aneurysm
cardiac in juvenile rheumatoid arthritis
pericarditis
cardiac in sle
pericarditis
libman sacks endocarditis
congenital AV block
cardiac in lyme
arrhythmias
myocarditis
heart failure
cardiac in graves
tachycardia
arrhythmias
heart failure
cardiac in tuberous sclerosis
cardiac rhabdomyoma
cardiac in neurofibromatosis
pulmonic stenosis
coA
cardiac in trisomy 21
endocardial cushion defect
vsd
asd
pda
cardiac in trisomy 18
vsd
asd
pda
ps
cardiac in trisomy 13
vsd
asd
pda
dextrocardia
cardiac turner
coA
aortic stenosis
cardiac in CHARGE (coloboma, heart, atresia choanae, retardation, genital and ear abnormalities)
tof
aortic arch and conotruncal anomalies
cardiac in digeorge
aortic arch anomalies
conotruncal anomalies
cardiac in vacterl
vas
cardiac in william syndrome
supravalvular aortic stenosis
peripheral pulmonary stenosis
cardiac of infant of diabetic mother
hypertrophic cardiomyopathy
vsd
conotruncal anomalies
cardiac of asplenia syndrome
complex cyanotic heart anomalous pulmonary venous return dextrocardia single ventricle single AV valve
cardiac in polysplenia syndrome
azygos continuation of inferior vena cava
pulmonary atresia
dextrocardia
single ventricle
cardiac in fetal alcohol syndrome
vsd
asd
cardiac in fetal hydantoin syndrome
exposure to teratogenic effects of phenytoin or carbamazepine
tga
vsd
tof
s1 associated with closing of
mitral and tricuspid valves
s2 associated with closing of
aortic and pulmonic valves
s2 should normally split in
inhalation
s4 indicates
diastolic failure
lvh
s3 indicates
cardiomyopathy
failure
pulmonary ejection murmur radiates to
back and axilla
aortic ejection murmur radiates to
neck
class I antiarrhythmic drug
Depression of phase of depolarization (velocity of upstroke of action potential); sodium channel blockade
class Ia antiarrhythmic drug
Prolongation of QRS complex and QT interval
class Ia antiarrhythmic drug ex.
Quinidine, procainamide, disopyramide
class Ib antiarrhythmic drug
Significant effect on abnormal conduction
class Ib antiarrhythmic drug ex.
Lidocaine, mexiletine, phenytoin, tocainide
class Ic antiarrhythmic drug
Prolongation of QRS complex and PR interval
class Ic antiarrhythmic drug ex.
Flecainide, propafenone, moricizine?
class II antiarrhythmic drug
β blockade; slowing of sinus rate; prolongation of PR interval
class II antiarrhythmic drug ex.
Propranolol, atenolol, acebutolol
class III antiarrhythmic drug
Prolongation of action potential; prolongation of PR, QT intervals, QRS complex; sodium and calcium channel blockade
class III antiarrhythmic drug ex.
Bretylium, amiodarone, sotalol
class IV antiarrhythmic drug
Calcium channel blockade; reduction in sinus and AV node pacemaker activity and conduction; prolongation of PR interval
class IV antiarrhythmic drug ex.
Verapamil and other calcium channel blocking agents
physio and anatomic problem:
Cyanosis with respiratory distress
Increased pulmonary blood flow
Transposition
physio and anatomic problem:
Cyanosis without respiratory distress
Decreased pulmonary blood flow
Right heart obstruction
physio and anatomic problem:
hypoperfusion
EITHER:
Poor cardiac output
Left heart obstruction
OR
Poor cardiac function
Normal anatomy
physio and anatomic problem:
Respiratory distress with desaturation (not visible cyanosis)
Bidirectional shunting
Complete mixing
physio and anatomic problem:
Respiratory distress with normal saturation
Left-to-right shunting
Simple intracardiac shunt
surgery for tricuspid atresia
Surgery is staged with an initial subclavian artery-to-pulmonary shunt (BlalockTaussig procedure) typically followed by
a two-stage procedure: bidirectional cavopulmonary shunt (bidirectional Glenn) and Fontan procedure
surgery for hypoplastic left heart
surgical repair is staged with the first surgery (Norwood procedure) done in the newborn period.
Subsequent procedures create a systemic source for the pulmonary circulation (bidirectional Glenn and Fontan procedures), leaving the right ventricle to supply systemic circulation
factors affecting PRELOAD
Total blood volume Venous tone (sympathetic tone) Body position Intrathoracic and intrapericardial pressure Atrial contraction Pumping action of skeletal muscle
factors affecting AFTERLOAD
Peripheral vascular resistance
Left ventricular volume (preload, wall tension)
Physical characteristics of the arterial tree (elasticity of vessels or presence of outflow obstruction)
factors affecting contractility
Sympathetic nerve impulses* Circulating catecholamines* Digitalis, calcium, other inotropic agents* Increased heart rate or postextrasystolic augmentation* Anoxia, acidosis† Pharmacologic depression† Loss of myocardium† Intrinsic depression†
etiology in dilated cardiomyopathy
Infectious
Metabolic
Toxic
Idiopathic
hemodynamics in dilated cardiomyopathy
Decreased systolic function
tx in in dilated cardiomyopathy
Positive inotropes Diuretics Afterload reduction β-Blockers Antiarrhythmics Anticoagulants Cardiac transplantation
etiology in hypertrophic cardiomyopathy
Sporadic Inherited (autosomal dominant)
hemodynamics in hypertrophic cardiomyopathy
Diastolic dysfunction (impaired ventricular filling)
tx in in hypertrophic cardiomyopathy
β-Blockers
Calcium channel blockers
etiology in restrictive cardiomyopathy
Infiltrative (amyloidosis, sarcoidosis) Noninfilltrative (idiopathic, familial) Storage disease (hemochromatosis, Fabry disease) Endomyocardial disease
hemodynamics in restrictive cardiomyopathy
Diastolic dysfunction (impaired ventricular filling)
tx in in restrictive cardiomyopathy
Diuretics
Anticoagulants
Cardiac transplantation
signs nonconstrictive pericarditis
Fever
Tachycardia
Friction rub (accentuated by inspiration, body position)
Enlarged heart by percussion and x-ray examination
Distant heart sounds
signs in tamponade
Distended neck veins Hepatomegaly Pulsus paradoxus (>10 mm Hg with inspiration) Narrow pulse pressure Weak pulse, poor peripheral perfusion
signs in constrictive pericarditis
Distended neck veins Kussmaul sign (inspiratory increase in jugular venous pressure) Distant heart sounds Pericardial knock Hepatomegaly Ascites Edema Tachycardia
Wide splitting is noted in
atrial septal defect, pulmonary stenosis, Ebstein anomaly, total anomalous pulmonary venous return, and right bundle branch block
A single 2nd sound occurs in
pulmonary or aortic atresia or severe stenosis, truncus arteriosus, transposition of the great arteries.
midsystolic click
mvp
total fetal cardiac output—the combined output of both the left and right ventricles—is
≈450 mL/kg/min
in transition of fetus to neonate, the LV will need to do 200% increase cardiac output of
≈350 mL/kg/min
normal adult cardiac output of approximately
75 mL/kg/min
foramen ovale is usually functionally closed by the
3rd mo of life
Functional closure of the ductus arteriosus is usually complete by
10-15 hr
When the Po2 of the blood passing through the ductus reaches about __ mm Hg, the ductal wall begins to constrict
50 mm Hg
Cyanosis, the visible sign of this shunt, occurs when approximately ___ of reduced hemoglobin is present in systemic blood
5 g/100 mL
balloon atrial septostomy
rashkind procedure
___ remains leading cause of death in kids with anomalies
congenital heart disease
qp:qs 2:1 implies
twice the normal pulmo blod flow
hypoplastic or absent radii
1st degree AV block
ASD
autosomal dominant
holt oram syndrome
VSD pressure is restrictive meaningn
RV pressure is normal
indications for surgical correction vsd
any age large defects with symptoms that can’t be controlled medically
infant 6-12mo old with large defects assoc with pulmo hypertension even if controlled
patient >24mo with qp:qs > 2:1
supracristal VSD of any size
pulmonary stenosis is a common finding in
noonan and alagille
suprevalvular aortic stenosis with pulmonary branch stenosis idiopathic hypercalcemia of infancy elfin facies mental retardation deletion in chrosome 7 (maternal)
williams
subvalvar aortic stenosis
mitral stenosis
coarctation of aorta
shone syndrome
most coarctation of the aorta occur
just below origin of the left subclavian artery at the origin of the ductus arteriosus
juxtaductal coarctation
posterior brain fossa abnormalities facial hemangiomas arterial anomalies cardiac anomalies like coarctation of aorta eye anomalies
PHACE syndrome
interrupted aortic arch type b associated wtih
digeorge 22q11
stenosis of common pulmonary vein
cor triatriatum
mitral valve prolapse
Marfan syndrome, straight back syndrome, pectus excavatum, scoliosis, Ehlers-Danlos syndrome, osteogenesis imperfecta, and pseudoxanthoma elasticum.
prolapse is defined as
> 2mm movement from long axis
valve thickening >5mm is “classic”
tx for taussig bing malformation
rastelli
normally the aorta is. ___ to the pulmonary artery
posterior and right
position d tga
aorta is anterior and to the right of pulmonary artery
d tga more common in
males of diabetic moms
successful rashkind procedure for TGA will cause paO2 to rise
35-50mmhg
surgical treatment of choice TGA
arterial switch (Jatene) procedure performed in 2wks
atrial switch
mustard or senning operation
disadvantage of atrial switch TGA
right ventricle as systemic pumping chamber
L TGA
ventricular inversion
t or f
prostaglandin effective for TAPVR
false
cxray finding of TAPVR in neonate
perihilar pulmonary edema with small heart
hypoplastic left heart associated with
turner syndrome
trisomy 13 and 18
holt oram syndrome
rubinstein taybi syndrome
tx for hypoplastic left heart
norwood
sano
anomalous venous return from lung
scimitar syndrome
blood flow from the left coronary artery is reversed (empties to pulmonary artery) in ALCAPA
myocardial steal
angiomas of nasal and buccal mucus membrane, GI tract, liver
mutation in endoglin gene
communication between pulmonary artery and vein thus bypassing lungs
no cardiomegaly
osler weber rendu syndrome
hereditary hemorrhagic telangiectasia type I
ectopia cordis midline supraumbilical ab defect anterior diaphragm deficiency defect in lower sternum intracardiac defect (VSD, TOF, or diverticulum of the left ventricle)
pentalogy of cantrell
heath edwards classification of patho changes in eisenmengerization
Grade I changes involve medial hypertrophy alone
grade II consists of medial hypertrophy and intimal hyperplasia
grade III involves near obliteration of the vessel lumen
grade IV includes arterial dilation
grades V and VI include plexiform lesions, angiomatoid formation, and fibbrinoid necrosis
which grades indicate irreversible pulmo vascular obstructive disease
grade IV to VI
eisenmenger physio defined as pulmo arterial resistance to greater than
12 wood units or
ratio of pulmo to systemic resistance of > or = to 1
endocarditis prophylaxis needed for
patients with previous endocarditis
unrepaired cyanotic CHD
completely repaired congenital heart defects with prosthetic material or device during the 1st 6 mo after the procedure
repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
seen wolff parkinson white syndrome
atrial -> ventricle conduction bundle of kent
normal qrs
orthodromic conduction
seen wolff parkinson white syndrome
ventricle -> atrial conduction retrograde reentry
wide qrs
antidromic conduction
treatment of choice for AVNRT AV nodal re entrant tachycardia
adenosine
in WPW what drugs are contraindicated
digoxin and ca channel blockers
non WPW DOC for arrhythmia control
b blockers
or digoxin
DOC for WPW
b blockers
DOC for junctional ectopic tachycardia JET
amiodaron
sotalol
tx for atrial flutter
synchronized DC cardioversion
tx for atrial fibrillation
ca channel blockers
DOC for stable vtach
amiodarone
lidocaine
procainamide
LQT1 events are
stress induced
LQT3 events
occur during sleep
drugs assoc with prolonged QT
erythromycin clarithromycin azithromycin cotrimoxazole cipro fluconazole amitriptylline haloperidol risperidone
tx for long QT syndrome
b blockers
abnormality in conduction pathway esp after surgery
sometimes with tachy-brady syndrome
sick sinus syndrome
maternally derived antibodies that cause congenital heart block
anti SSA/Ro
anti SSB/La
fainting spell due to heart block
stoke adams attacks
likelihood that heart block post open heart surgery is low if it persists more than __days
10-14 days
vfib after blunt nonpenetrating trauma to chest
commotio cordis
leading causes of endocarditis in kids
viridans type streptococci (alpha hemolytic strep)
staph aureaus
pathogen in endocarditis
more common in patients with heart disease
staph
pathogen in endocarditis
common after dental procedures
viridans group strep
pathogen in endocarditis
after lower bowel or genitourinary manipulation
group D enterococci
pathogen in endocarditis
seen in IV drug users
pseudomonas
serratia marcescens
pathogen in endocarditis
seen after open heart surgery
fungal
pathogen in endocarditis
in presence of indwelling central venous catheter
coagulase negative staph
childen at highest risk for endocarditis
prosthetic cardiac valves or other prosthetic material used for cardiac valve repair
unrepaired cyanotic congenital heart disease (including those palliated with shunts and conduits)
completely repaired defects with prosthetic material or device during the 1st 6 mo after repair
repaired congenital heart disease with residual defects at or adjacent to the site of a prosthetic patch or device
valve stenosis or insuffciency occurring after heart transplantation
permanent valve disease from rheumatic fever (mitral stenosis, aortic regurgitation)
previous infective endocarditis
greatest risk of embolization in endocarditis if
> 1cm mass
fungating
diagnosis of endocarditis
Duke criteria
Major criteria include
(1) positive blood cultures (2 separate cultures for a usual pathogen, 2 or more for less-typical pathogens)
(2) evidence of endocarditis on echocardiography (intracardiac mass on a valve or other site, regurgitant flow near a prosthesis, abscess, partial dehis- cence of prosthetic valves, or new valve regurgitant flow)
Minor criteria include
predisposing conditions,
fever,
embolic-vascular signs, i
mmune complex phenomena (glomerulonephritis, arthritis, rheuma- toid factor, Osler nodes, Roth spots),
a single, positive blood culture or serologic evidence of infection,
echocardiographic signs not meeting the major criteria.
Two major criteria, 1 major and 3 minor, or 5 minor criteria
empiric therapy before pathogen identified in endocarditis
vancomycin
gentamicin
apical presystolic murmur similar to mitral stenosis in RHD heard as result of regurgitant aortic flow preventing mitral valve to open fully
austin flint murmur
aortic insufficiency
murmur in RHD simmilar to aortic insufficiency but without bounding pulses
graham steell murmur
most common form of cardiomyopathy
dilated cardiomyopathy
dilated cardiomyopathy
left ventricular dilatation
systolic dysfxn
hypertrophic cardiomyopathy
diastolic dysfxn
increased ventricular wall thickness
restrictive cardiomyopathy
nearly normal wall and chamber size
preserved systolic fxn
diastolic dysfxn
associated with dilated cardiomyopathy
duchenne emery dreifuss fatty acid oxidation disorders carnitine abnormalities organic acidemias mitochondrial (kearns sayre syndrome) alstrom syndrome barth syndrome
associated with hypertrophic cardiomyopathy
mitochondiral (friedreich ataxia)
stoarge disorders (pompe, fabry, mucopolysaccharidoses, hemochromatosis, danon disease)
noonan syndrome
associated with restrictive cardiomyopathy
myofibrillar myopathies
storage disorders
familial restrictive cardiomyopathy
autosomal recessive
chronic progressive external ophthalmoplegia
cerebellar ataxia, proximal muscle weakness, deafness, diabetes mellitus, growth hormone deficiency, hypoparathyroidism
dilated cardiomyopathy
Kearns–Sayre syndrome
x linked disorder dilated (or sometime hypertrophic) cardiomyopathy neutropenia growth delay cardiolipin abnormalities phospholipid disorder
barth syndrome
autosomal recessive
childhood obesity, blindness due to congenital retinal dystrophy, and sensorineural hearing loss
hyperinsulinemia, early-onset type 2 diabetes, and hypertriglyceridemia
dilated cardiomyopathy
Alström syndrome
autosomal recessive
progressive damage to the nervous system
hypertrophic cardiomyopathy
reeduced expression of mitochondiral protein FRATAXIN
friedreich ataxia
autosomal receessive glycogen storage disease typeII deficiency lysosomal acid alpha-glucosidase enzyme progressive muscle weakness (myopathy) hypertrophic cardiomyopathy
pompe disease
x linked lysosomal storage disease kidney failure pain hypertrophic cardiomyopathy angiokeratomas neuropathy
fabry disease
glycogen storage type IIB
X-linked lysosomal and glycogen storage disorder
hypertrophic cardiomyopathy
skeletal muscle weakness, and intellectual disability
danon disease
post cardiac surgery 7-14 days ago fever lethargy anorexia irritability chest/ab discomfort
postpericardieotomy syndrome
DOC for hypertensive diabetics with proteinuria
ACE inhibitors or ARBs
DOC for hypertensive with headache or migraine
b blocker
ca channel blocker
in hypertensive emergency, reduction of BP should be
10% in first hour
15% more in next 3-12 hours
