Cardio Flashcards
ASD Path: Pt: Dx: Tx:
Path: Patent foramen ovale -> blood shunting between atria
Ostium secundum MC
Pt: Most asx
Dx:
- Systolic ejection crescendo-decrescendo murmur @ pulmonic area (think pulmonic stenosis)
- Fixed splitting of S2-does not vary with inspiration
- TTE
Tx: Spontaneous vs surgical closure
CoArc Path: Pt: Dx: Tx:
Path: Congenital narrowing of descending thoracic aorta
Pt: Secondary HTN Bilateral claudication Infantile: pre-ductal Adultas: post-ductal
Dx: Systolic murmur that radiates to the back/scapula/chest Inc BP upper > lower extremities Delayed/weak femoral pulses CXR: rib notching; “3 sign”
Tx: Balloon angioplasty +/- stent
PDA Path: Pt: Dx: Tx:
Path: PDA fails to close
Pt: Dyspnea, FTT, tachy, hypoxia
Dx:
Continuous machinery murmur
Loudest at pulmonic area
Wide pulse pressure; bounding peripheral pulses
Tx: Close PDA -IV indomethacin -Surgery Keep PDA open: Prostaglandin E (PGE)
TET Path: Pt: Dx: Tx:
Path:
- RV outflow obstruction (PA stenosis)
- RV hypertrophy
- VSD (large unrestrictive)
- Overriding aorta
Pt: Cyanotic; Tet spells: relieved by squatting
Dx:
Harsh holosystolic murmur at left upper sternal border
RV heave
CXR: boot-shaped heart
Tx: Surgery
VSD Path: Pt: Dx: Tx:
Path:
Hole in ventricular septum
MC congenital heart dz
Perimembranous MC type
Pt: Larger the VSD, more severe the symptoms
Dx: Loud high-pitched harsh, holosystolic murmurs at left sternal border
Tx: Spontaneous closure vs surgery
Continuous machinery murmur
PDA
Systolic ejection crescendo-decrescendo murmur @ pulmonic area
Fixed splitting of S2
ASD
Inc BP upper > lower extremities
Delayed/weak femoral pulses
CoArc
Harsh holosystolic murmur at left upper sternal border
TET
Wide pulse pressure; bounding peripheral pulses
PDA
CXR: rib notching; “3 sign”
CoArc
CXR: boot-shaped heart
TET
Loud high-pitched harsh, holosystolic murmur at left sternal border
VSD
Absolute CI to TPA
Hx cerebrovascular hemorrhage
CVA in past year
HTN: SBP >180; DBP >110
Prinzmetal angina Path: Pt: Dx: Tx:
Path: Coronary spasm -> transient ST elevations usually without an MI
Pt: CP (MC non-exertional)
Dx:
EKG-> ST elevations
Sx and ST elevations resolve with CCB and nitroglycerin
Tx:
CCB (nondihydropyridine)!!!: verapamil, diltiazem
Nitrates prn
Hypertensive emergency:
Path:
Pt:
Tx:
Path: Inc BP with acute end organ damage
Pt: Neuro: -encephalopathy: nicardipine, labetalol -stroke: nicardipine, labetalol (ischemic stroke only if BP >185/110 and getting TPA) -seizure
Cardiac:
- Aortic direction: esmolol, labetalol
- ACS: nitroglycerin, BB
- Acute HF: nitroglycerin, furosemide
Renal: AKI, proteinuria, hematuria (glomerulonephritis)
-Tx: fenoldopam
Retinal: malignant HTN/Grade IV retinopathy (papilledema) blurred vision
Hypertensive urgency
Path:
Tx:
Path: BP >180/110 w/o sx
Tx: Reduce BP within 1 hr
Clonidine (alpha-2): rebound hypertension if d/c abruptly
Captopril (ace): angioedema, AKI
Furosemide: electrolyte abnormalities, alkalosis
Labetalol (alpha-1; beta-1&2): CI asthma, COPD, AV heart block, CHF
Nicardipine (DPP CCB): reflex tachycardia, HA, NA, flushing
Cardiogenic shock
Path:
Tx:
Path:
Myocardial dysfunction-> inadequate tissue perfusion -> dec CO with inc SVR
MI, myocarditis, valve dysfunction, congenital heart dz, cardiomyopathy, arrhythmias
Tx:
Oxygen + limited fluid resuscitation (isotonic)- only shock where fluids are limited
Inotropic support: dobutamine, epi, intraaortic balloon pump
Tx underlying cause
Dilated cardiomyopathy Path: Pt: Dx: Tx:
Path:
- Idiopathic MC cause: autoimmune
- Systolic dysfunction: Ventricular dilation -> dilated weak heart; MC present 20-60yr; MC in men
- Viral myocarditis; ex. Enteroviruses
- Toxic: ETOH, Cocaine, Pregnancy, Radiation, Doxorubicin, Daunorubicin
Pt:
Systolic heart failure sx (both R and L)
Embolic phenomena, arrhythmias
Viral Myocarditis: viral prodrome a few weeks-> signs of HF or chest pain, + cardiac enzymes, nonstop ST-T changes
Dx: BNP *>500 w/ acute dyspnea suggestive of heart failure *<100 heart failure is unlikely *Levels do not correlate w/ HR severity Echo -LV dilation: thin walls -Dec EF -Regional or global LV hypokinesis CXR: cardiomegaly, pulmonary edema, pleural effusion
Tx:
Standard systolic HF tx
ACEi, BB, Diuretics, Na+ restriction, Digoxin
Implantable defibrillator if EF <35%
Hypertrophic cardiomyopathy Path: Pt: Dx: Tx:
Path:
- Diastolic dysfunction due to impaired ventricular relaxation/filling
- Subaortic outflow obstruction-> hypertrophic septum
- Inherited genetic disorder of inappropriate left and/or RV hypertrophy
Pt: Often asx
Dyspnea-> MC initial complaint
Angina pectoris, syncope
Arrhythmias: AF; VT/VF (palpitations, syncope)
Sudden cardiac death: esp in adolescent/preadolescent Childrens (especially exertion) due to v-fib
Harsh systolic cres-decrescendo murmur @LLSB-> sounds like AS
-Dec murmur intensity: inc venous return-> squatting, supine); handgrip (inc. afterload)
-Inc murmur: dec. venous return (valsalva & standing) and exertion-> b/c dec LV volume & inc. contractility will dec CO
-Usually no carotid radiation
-Normal pulse
-Loud S4 +/- mitral regurgitation
Dx: Echo: -asymmetric wall thickness (esp septal) -Systolic anterior motion mitral valve EKG: LV hypertrophy
Tx:
Avoid exertion, implantable defibrillator to prevent VF
Medical: BB, verapamil, disopyramide
Cautious use of digoxin, nitrate and diuretics
Digoxin inc contractility
Nitrates and diuretics dx volume
Surgical: myomectomy, ETOH ablation
Restrictive cardiomyopathy Path: Pt: Dx: Tx:
Path:
- Diastolic dysfunction w/ relatively preserved contractility
- Ventricular rigidity impedes ventricular filling (dec. ventricular compliance)
- Infiltrative diseases: Amyloidosis (MC), Sarcoidosis, hemochromatosis, Scleroderma, metastatic dz; idiopathic
Pt:
R sided failure sx MC than L sided sx
Poorly tolerated tachyarrhythmias
Kussmaul’s sign: Inc JVP w/ inspiration
Dx:
Echo
-ventricle non-dilated w/ normal wall thickness
-MARKED DILATION OF BOTH ATRIA
-Diastolic dysfunction w/ normal/near normal systolic fn
Tx: Tx underlying cause
Aortic aneurysm Path: Pt: Dx: Tx:
Path: Focal dilation of aortic diameter at least 1-1.5x measured at renal arteries
>3cm, MC infrarenally
Risk factors-> atherosclerosis, age>60, smoking, males, HLD, connective tissue disorder (marfan’s), syphilis, HTN
Pt:
Most Asx-> Screening: Abd U/S in males aged 65-75 who have ever smoked
>60yr old male, severe back/abdominal pain, syncope, hypotension
Tender, pulsatile abdominal mass
+/- flank ecchymosis
Dx: Abdominal U/S CT scan-> test of choice Angiography-> gold standard MRI/MRA Abdominal radiograph
Tx: BB Surgical repair-> endovascular stent graft or open repair Asx repair AAA grows >/= 5.5cm Grows > 0.6-0.8 cm in 6m
Rheumatic fever
Path:
Dx:
Tx:
Path:
Acute autoimmune inflammatory multi-systemic illness; MC affect 5-15yr
Infection with GABHS (Strep pyogenes) stimulated antibody production to host tissues and damages organs directly; Infection usually precedes rheumatic fever by 2-6w
Dx: Jones Criteria 2 major OR 1 major + 2 minor AND evidence of recent GAS infection
Major
- Joint-> migratory polyarthritis; 2+ joints affected or migratory (lower to upper)
- Oh my heart-> active carditis
- Nodules-> subcutaneous
- Erythema marginatum: macular, erythematous, non-pruritic annular rash w/ rounded, sharply demarcated
- Sydenham’s chorea: Sudden involuntary jerky, non-rhythmic, purposeless movements especially involving head/arms
Minor Clinical -Fever >101.3/38.5 -Arthralgia -Laboratory: Inc. ESR, CRP, Leukocytosis ECG: prolonged PR interval
Evidence of recent group A streptococcal infection
- throat cultures
- Rapid antigen detection tests
- elevated/increasing streptococcal antibody titers (ASO)
Tx:
Penicillin G (Erythromycin if PCN allergy)
Anti-inflammatory: ASA 2-6w taper
+/- corticosteroids in severe cases and carditis
