Cardiology Flashcards by Jamaira Belmes

Heard best on the BASE or at the 2nd ICS

Blood flows through a stenotic structure – BLOWING sound

Systolic ejection or Blowing murmur

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Heard best on the APEX or at the LEFT LOWER STERNAL BORDER

Blood backflows from the one chamber/valve to another because of incompetent structures

Systolic regurgitant murmur

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ACYANOTIC HEART DISEASE (left to right shunt

VSD
ASD
PDA
COA
ECD

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CYANOTIC HEART DISEASE (right to left shunt

DECREASED PULMONARY BLOOD FLOW
Pulmonary Atresia
Pulmonary Stenosis
TOF
Tricuspid Atresia
Ebstein Anomaly

INCREASED PULMONARY BLOOD FLOW
Transposition of the Great Arteries (TGA)
Total Anomalous Pulmonary Venous Return (TAPVR)
Truncus Arteriosus

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Systolic ejection murmur at 2nd LICS

widely split S2

enlargement of the R sided chambers of the heart - RA, RV and PA

ATRIAL SEPTAL DEFECT

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MC form of ASD

Ostium Secundum Defect

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Systolic regurgitant murmur at LLSB

Loud and single S2

enlargement of the LA, LV and main PA

VENTRICULAR SEPTAL DEFECT

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MC form of VSD

Membranous

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Surgical intervention in ASD in NOT need if the point of defect is

< 3 mm

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Blood shunts left to right through the ductus arteriosus d.t. higher aortic pressure

enlarged LA, LV, main PA, aorta

continuous “machinery like” murmur at the 2nd left infraclavicular area

PATENT DUCTUS ARTERIOSUS

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Atrioventricular Septal Defect (Endocardial Cushion Defect)

Ventricular Septal Defect

Trisomy 21 (Down Syndrome)

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Aortic Root Dilation

MVP

Marfan Syndrome

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Pulmonic stenosis

LVH

Noonan syndrome

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Cyanosis manifesting within few hrs at birth or w/n few hrs of life

Transposition of Great Arteries (TGA)

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Cyanosis manifesting after the 1st year of life usually in INFANT or TODDLER

Tetralogy of Fallot (TOF)

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MC cyanotic heart defect BEYOND infancy

Systolic ejection murmur at 2nd LUSB

Loud and single S2

Tetralogy of Fallot

couer en sabot or boot shaped heart

Blalock-Taussig procedure

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4 components of TOF

obstruction if RV outflow tract (Pulmonic stenosis)

VSD

overriding aorta

right ventricular hypertrophy

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What is the main pathophysiologic mechanism behind the hypercyanotic or Tet spells in TOF

d.t. decreased pulmonary blood flow

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Atretic (missing) tricuspid valve
Hypoplastic R ventricle
VSD
ASD
Pulmonary stenosis

Systolic regurgitant murmur at LLSB

Tricuspid Atresia

Glenn shunt
Fontan Procedure

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Aorta arises from the RV
PA arises posteriorly from the LV

complete separation of pulmonary and systemic circulation – hypoxemic blood circulating throughout the body and hyperoxemic blood circulating in pulmonary circuit

Defects the permit mixing of 2 circulations – ASD, VSD, PDA – needed for survival

Transposition of the Great Vessels

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MCC of cyanotic CHD in NEWBORN

single and loud S2

no murmur if with intact ventricular septum

Transposition of the Great Vessels

Egg shaped
Egg on string

Rashkind, Senning, Mustard or Jatene Procedure

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PA arises from aorta

Truncus arteriosus fails to divide into pulmonary trunk and aorta d.t. failure of aorticopulmonary septum formation

VSD is always present

single S2
systolic ejection
murmur at LSB

minimal cyanosis in neonates

Truncus Arteriosus

Rastelli procedure

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All 4 pulmonary veins drain to RA

RV volume overload

Total mixing of systemic venous and pulmonary venous blood flow within the heart

Systolic murmur at LSB in mild cases

Total Anomalous Pulmonary Venous Return (TAPVR)

Snowman sign or Figure of 8 sign

Van Praagh Procedure

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Lesion is in the DESCENDING AORTA, DISTAL to the origin of the LEFT SUBCLAVIAN ARTERY

pressure build up in the proximal aorta and LV – HPN in the UPPER EXTREMITY

weak, delayed or (-) femoral pulses

BP HIGHER IN THE ARMS

(+) RIB NOTCHING

systolic murmur at 3rd to 4th LICS with radiation to L infrascapular area

Coarctation of the Aorta

Primary re-anastomosis or parch aortoplasty

Jones Criteria -- Rheumatic Fever

Required evidence of recent strep infection -- ASO, strep antibodies, Strep A culture, anti-DNAse B, anti hyaluronidase MAJOR CRITERIA MINOR CRITERIA

Major Criteria (Rheumatic Fever)

``` Joints (migratory polyarthritis) - 70% Carditis - 50% Nodules, Subcutaneous Erythema marginatum - < 15 % Sydenham chorea - 15% ```

Minor Criteria (Rheumatic Fever)

FRAPE ``` Fever -- > 38.5 C and > 38 C Risk Factor (Previous RH or RHD) Arthralgia Prolonged PR interval Elevated acute phase reactants -- ESR, CRP, leukocytosis ```

Any 1 of the ff can serve as evidence of preceding infection (Jones criteria)

Increased or rising ASO titer or other strep antibodies (anti-DNAse B) (+) Throat culture for GABHS (+) rapid group A streptococcal carbohydrate antigen test

Diagnosis of Initial ARF

``` 2 MAJOR OR 1 MAJOR + 2 MINOR OR 3 MINOR ```

Should be performed in ALL cases of confirmed and suspected ARF

Echocardiography with Doppler

Antibiotics to eradicate Streptococcus

``` Penicillin VK (oral) 200-500 mg QID x 10 days OR Benzathine PCN (IM) 0.6 -1.2 MU IM OR Erythromycin 250 mg TID x 10 days ```

Anti-inflammatory agents - 6-8 weeks

ASA - 100 mg/kg/day (arthritis and mild carditis) Prednisone - 2 mg/kg/day (carditis and cardiomegaly)

Primary Prophylaxis

Prevents 1st episode of RF | Treat streptococcal throat infection

Duration of Prophylaxis Rheumatic Fever without carditis

5 years until 21 years of age whichever is longer

Duration of Prophylaxis Rheumatic Fever with carditis but (-) RHD

10 years until 21 years of age whichever is longer

Duration of Prophylaxis Rheumatic Fever with carditis and with residual heart disease (persistent valvular disease)

10 years or until 42 years of age whichever is longer sometimes lifelong prophylaxis

Systolic Ejection Murmurs

ASD - 2nd LICS with WIDELY SPLIT S2 PS - 2nd LICS w/ radiation to the back AS - 2 RICS w/ radiation to the back Coarctation of the Aorta - 3rd - 4th LICS with radiation to the interscapular area

Systolic Regurgitant Murmurs

VSD - LLSB Mitral regurgitation - LLSB w/ radiation to the AXILLA

Thickening of leaflets and fusion of commissures -- calcification and immobility of the valves FISH MOUTH BUTTONHOLE DEFORMITY

Mitral Valve Stenosis

Heart defect most commonly associated with DOWN SYNDROME

Endocardial Cushion Defect

Murmur grade associated with THRILL

Grade IV

Murmur that is ALWAYS pathologic

Diastolic Murmur

Bedside test to differentiate pulmonary from cardiovascular cause of cyanosis

Hyperoxia test

Management of Hypoxic Spells in TOF

``` Knee chest position Morphine sulfate NaHCO3 IV Oxygen Phenylephrine Propranolol Ketamine ```

Heart defect most commonly associated with RUBELLA

PDA

Heart defect most commonly associated with MATERNAL DM

TGA

Heart defect most commonly associated with MATERNAL LUPUS

Complete Heart Block

Heart defect most commonly associated with MATERNAL INTAKE OF ASPIRIN

PPHN

Heart defect most commonly associated with MATERNAL INTAKE OF ALCOHOL

VSD | PS

Heart defect most commonly associated with MATERNAL INTAKE OF LITHIUM

Ebstein Anomaly

Tachycardia in rheumatic fever is significant when notes during

SLEEPING

MC manifestation of RF

Arthritis

Most CONSISTENT feature of ARF

Carditis

Most likely cause of IE in patients with UNDERLYING HEART DISEASE and AFTER DENTAL PROCEDURE

viridans Streptococci

Most likely cause of IE in patients after GUT or lower bowel manipulation

Group D Streptococcus

Most likely cause of IE in patients after open heart procedure

Fungal

Most likely cause of IE in IV drug abusers

Staphylococcus | Pseudomonas

Most likely cause of IE in patients with CVP or prosthetic valves

Coagulase negative Staph

Recommended treatment duration for IE

4-6 weeks