cardiology Flashcards
a 9-year old girl is brought to the clinic by her mother on account of fever. She has red skin lesions on the trunk and proximal extremities, and also small, non-tender lumps located over the joints. On further enquiry, she reports a history of sore throat which occurred about 4 weeks ago.
What is your suspected diagnoses? what can you order to help support the diagnoses?
Rheumatic fever and you can order an antistreptolysin O titer.
What is the leading cause of mitral valve stenosis and replacement in adults?
Rheumatic fever
What is the order in which the heart valves are affected. as in which valve first and so on?
Mitral 1st, aortic 2nd, tricuspid 3rd
What bacterial infection usually comes before a child develops rheumatic fever?
Strep pharyngitis
The presence of what protein is the most important virulence factor group A streptococcal infection in humans
M protein
what are the “major” aspects of jones criteria?
carditis chorea erythema marginatum polyarthritis subcutaneous nodules
What are the minor criteria for rheumatic fever?
Arthralgia elevated ESR or CRP fever prolonged PR interval leukocytosis
Pt with rheumatic fever can develop what kind of heart rythm?
A fib
what is the tx for rheumatic fever?
penicillin and asa
a healthy 7-year-old girl who has reached all developmental milestones. On examination, the precordium is hyperdynamic with a prominent right ventricular heave. A grade III/VI systolic ejection murmur is present in the 2nd left intercostal space (pulmonic position) with an early to mid-systolic rumble and fixed splitting of the second heart sound (s2) during inspiration and expiration.
What heart issue does the Pt have?
ASD
How would you describe the murmur for ASD
Wide fixed, split second heart sound. Systolic ejection murmur best heard at the second left intercostal space with an early to mid systolic rumble
How is ASD best diagnosed?
Catherization
If pt is symptomatic what meds can you use to treat ASD?
Diuretics, ACEI, digoxin
Definitive Tx of ASD would be?
surgical closure
an 8-year-old boy who is seen for the first time in your office. His parents report that he tires easily and often complains of weakness in his legs. Physical exam shows a healthy boy with a blood pressure of 141/91 mmHg. You notice that his lower extremities are slightly atrophic with a mottling appearance. Upon further examination, he is found to have very weak and delayed femoral pulses with a blood pressure of 96/60 in the lower extremities
What is the most likely Dx?
Coarctation of the Aorta
What kind of murmur would you hear with Coarctation of aorta?
late systolic Ejection murmur heard at the aortic area and left sternal border that radiates into the left axilla and left back
What sign on CXR would you see with COA?
the 3 sign
What are the key finding of a Pt with COA?
elevated BP in the arms with low BP in the legs
The chance of having what kind of aneurysm is increased if you have COA?
cerebral berry aneurysm
What is the workup for COA?
1- echocardiogram
2- ECG showing LVH
3. CXr- showing the 3 sign aka rib notching
What is the Tx for COA
prostaglandins E1
a 15-year-old woman presents the ER after a syncopal episode. She had a loss of consciousness 3 times over the past 12 months. Each event occurred during or just after physical exercise. On PE: BP 110/70 mm Hg, HR 75/min, normal S1/S2, and an III/VI systolic ejection murmur is heard best at the left sternal border that decreases with squatting. The EKG shows a normal sinus rhythm with diffuse increased QRS voltage
What are you thinking Dx is?
hypertrophic cardiomyopathy
What syndrome is HOCM associated with?
Marfans syndrome
True or False: HOCM is autosomal dominant?
True
What are some signs and symptoms of HOCM?
SOD, Chest pain, syncopal episode after exertion
If someone has HOCM and they perform a maneuver that decreases preload, will the murmur increase or decrease?
it will increase, so if they increase preload with an action like squatting it will decrease
What is the first thing youd order to help diagnose HOCM if you suspect it?
an Echo
Can also do an MRI
Tx for HOCM?
Beta-Blockers + Disopyramide
CCB’s
True or false: diuretics are also part of the management for HOCM?
False do not use in Pts with HOCM
a 5-year-old boy presents to the emergency room with 5 days of fevers, ranging from 102-104°F (38.9-40°C). His mother reports that he also has a bad rash that developed on day 3. On physical exam, he has bilateral conjunctivitis, an extensive morbilliform rash on his trunk with desquamation, a bright red tongue, and swollen hands and feet. Labs are remarkable for elevated C-reactive protein, white blood cell count, and erythrocyte sedimentation rate
What is the likely Dx?
Kawasaki disease
What should you give immediately if you suspect kawasaki disease?
IVIG and aspirin
in kawasaki disease is the immune system attacking the veins or arteries?
The arteries
What is the mnemonic used to help remember the symptoms of kawasaki disease?
CRASH AND BURN (FEVER)
What does CRASH stand for in kawasaki?
C- conjunctival injection (spares limbus)
R- rash all body parts (flakes)
A- Adenopathy (enlarged cervical lymph nodes)
S- strawberry tongue
H- hand and foot rash
Fever- last for 5 days and does not resolve with medications
What are some cardiac sequela from kawasaki disease?
coronary artery aneurysm
myocarditis
MI
How many of the CRASH symptoms do you need to have to diagnose KD
4 or 5 plus lasting fever
What is one test all Pts with KD should get?
An echo to rule out cardiac abnormalities
When would you repeat an echo for someone who had KD?
2 weeks after diagnoses and then 6-8 weeks
What labs are elevated in KD.
Pretty much all inflammatory markers
ESR CRP Platlets WBC with left shit Liver transaminase
a 2-week-old infant with a history of prematurity presents with a pink torso and upper extremity and blue lower extremities. On cardiac auscultation, you notice a rough, continuous “machinery murmur” heard over the left sternal border at the 2nd intercostal space
What is the likely Dx? What study would you order first to confirm?
PDA an ECHO
How can an infant present if they have a PDA?
tachypnea, difficulty feeding, no weight gain, diaphoresis
Which NSAID has been used to close a PDA?
indomethacin
What should be included in the workup for syncope?
ECG, glucose, echo, pulse Ox, tilt table
CNS imaging but thats rare
a 2-week-old newborn brought to the ER by his mom who reports a sudden loss of consciousness during feeding and with crying. She also has noticed that the infant’s lips have turned blue on three occasions during feeding
What is the most likely Dx?
tetralogy of fallot
If you ordered an X-ray on an infant with tetralogy of fallot what would it show?
a small boot shaped heart
What kind of murmur would be heard with tetralogy of fallot?
A grade 3/6 harsh systolic ejection murmur is heard at the left upper sternal border.
Crescendo-decrescendo, holosystolic at LSB radiating to the back
The four features of tetralogy of fallot are?
PROV
Pulmonary stenosis
Right ventricular hypertrophy
overriding aorta
Ventricular septal defect
a 4-year-old boy who is brought to your office by his parents because he gets tired very easily and cannot keep up with the other children. On exam, you hear a loud, harsh, holosystolic murmur at the left lower sternal border without radiation to the axillae
What is the likely Dx?
VSD
VSD can lead to what?
Pulmonary hypertension
Most VSDs close by which age?
age 6
