Cardiology Flashcards
Fixed Split S2
ASD
Loud Single S2
Pulmonary HTN
TGA
Ejection Click
- constant = aortic valve
- intermittent = pulmonary valve
- mid-systolic = mitral valve prolapse
Ejection murmur radiating to the neck
AS radiating through carotids
Ejection murmur radiating to the back
pulmonary stenosis
Findings in Coarctation
- Harsh murmur louder in back (due to collaterals)
- sBP arm > leg by 20mmHg
- rib-notching on CXR
- lower extremity saturation < upper extremity saturation (supplied by PDA)
- R arm HTN compared to 4 limbs
Regurgitant murmur at the apex
Mitral regurgitation»_space; VSD
Regurgitant murmur at LLSB
VSD»_space;> tricuspid regurgitation
Continuous murmurs
- PDA (most common)
- coronary artery fistula
- venous hum (goes away when supine)
Louder murmur when upright
hypertrophic cardiomyopathy
Quieter murmur when upright
Still’s murmur
(most murmurs follow this)
Louder murmur with squatting
MR with MVP
Easier to hear murmur when leading forward
aortic insufficiency
Pulsus paradoxus
- > 10mmHg fall in SPB with inspiration
- due to tamponade
Left parasternal heave
RV dilation
Apex beat with inferior or lateral displacement
LV dilation
Indications for ECG in Syncope
- history not diagnostic of vasovagal (no prodrome, mid-exertional)
- family history of SUCD or heart disease in young individuals
- abnormal cardiac exam
- new medication with cardiac effects
Innocent murmurs of childhood
Sinus arrhythmia
- irregular, variations with inspiration
- asymptomatic, no treatment
Third degree heart block
- congenital, structural
- asymptomatic, fatigue or syncope
- treat if reversible, pacemaker if symptomatic
WPW
- palpitations during tachycardia
- can have syncope and sudden death
- acute - vasovagal, adenosine, cardioversion
- chronic - beta blocker, ablation
Long QT Syndrome
- 1: exertion, swimming
- 2: auditory triggers and post-partum
- 3: sleep trigger
- Treatment with beta blocker, ICD if indicated, exercise restrictions changing
- leads to VT or torsades de pointes
Management of SVT
- vagal maneuvers (expire against closed glottis)
- ice to face (human dive reflex)
- adenosine 0.1mg/kg then 0.2mg/kg
- synchronized cardioversion (first line if unstable)
Premature Atrial Contractions
- need a P before every QRS
- normal width QRS
- no treatment unless reversible cause
Premature ventricular contractions
- wide QRS
- no p wave before the QRS
- only treat reversible causes
Bundle Branch Block on ECG
- RBBB: rabbit ears in V1
- LBBB: rabbit ears in V6
ECG changes in ventricular hypertrophy
- LVH: Tall R wave in V6, seep S in V1
- RVH: tall R in V1, Deep S in V6, Q wave in V1 and abnormal T in V1
Features of Marfan syndrome
3 points:
- thumb sign
- wrist sign
2 points:
- pectus
- hindfoot valgus
- protrusion of acetabulum
- pneumothorax
- dural ectasia
3 points:
- arm span : height > 1.05
- myopia
- facial features
- MV prolapse
- striae
- scoliosis/kyphosis
- reduced elbow extension
Cardiac finding in T21
AVSD
Cardiac finding in Turner Syndrome
CoA, bicuspid aortic valve, AS, HLHS
Cardiac Finding in 22q11.2
TOF, TA, aortic arch anomalies
Cardiac Finding in William’s Syndrome
Supravavlular aortic stenosis
Cardiac finding in Noonan Syndrome
Pulmonary stenosis, Hypertrophic cardiomyopathy
Cardiac finding in Alagile Syndrome
Peripheral pulmonary stenosis
What causes aortic dilation?
- Marfan
- Ehlers Danlos
- Loeys-Dietz
Cardiac Finding in VATER/VACTERL
VSD, TOF, TGA
Cardiac Finding in CHARGE
VSD, ASD, TOF, DORV
What syndromes are associated with cardiomyopathies?
- Frederich/s Ataxia
- Noonans
- Pompe
- DMD
What cardiac finding is associated with NF1
CoA
What is the cardiac finding in TS?
rhabdomyomas
What are the cardiac findings associated with Kabuki syndrome?
CoA, ASD, AS, MS, HLHS
Cardiac finding in FASD
VSD
Cardiac finding in T13
PDA, septal defects, aortic stenosis
Cardiac findings in T18
VSD, polyvalvular disease
Cardiac findings in Holt-Oram syndrome (limb defects)
ASD
Cardiac findings in Ellis-Van Creveld (polydactyly)
ASD
Cardiac finding in infant of a diabetic mother (IDM)
Hypertrophic cariomypathy, transient septal hypertrophy
CHD with increased pulmonary flow
- ASD
- VSD
- AVSD
- PDA
- AV malformation
- TAPVR
- TA
- TGA
CHD with decreased pulmonary vascularity
- TOF
- TA
- Ebstein’s
- Pul HTN
- TGA with PS
CHD with normal pulmonary vascularity
- AS
- CoA
- Congenital MS
- PV stenosis
What is Eisenmenger physiology?
Increased pulmonary blood flow (ASD, VSD) leads to pulmonary HTN, and increased PVR causes reversal of shunting from R to L leading to cyanosis
What is the most common congenital heart lesion?
VSD
Indications for prostaglandins?
- critical PS
- critical CoA
- TGA (improves mixing, can make worse if blood flow closes the PFO)
- HLHS
- Ebstein’s anomaly
How do you treat a tet spell?
- remove stressors
- knee chest/squat position (increased afterload and decrease R to L shunt)
- oxygen (drop PVR)
- fluid (increased preload)
- morphine (treat hyperpnea and decrease systemic catecholamines)
- phenylephrine (increased SVR)
- propranolol (lessen RV outflow obstruction)
Complications of the Fontan Procedure
Arrythmias
- sinus node dysfunction
- atrial flutter/SVT
Cyanosis
- collaterals
- pulmonary AVMs
PLE
Plastic bronchitis
Thromboembolism
CHD with a normal CXR
- AS
- CoA
- HLHS
- TA
- PS
- TGA (CAN have a normal CXR sometimes)
Features of pathologic murmurs
- diastolic
- continuous
- holosystolic
- late systolic
ECG changes of rheumatic fever
- prolonged PR interval
- LA enlargement
Jones Criteria for Acute Rheumatic Fever
MAJOR
- carditis (valve involvement - MR > AR > MS > AS)
- migratory polyarthritis
- chorea
- erythema marginatum
- subcutaneous nodules
MINOR
- fever > 38.5
- arthralgia
- history of previous ARF
- elevated ESR > 60 /CRP > 30
- prolonged PR on ECG
Criteria: evidence of recent strep infection and 2 major or 1 major and 2 minor
Treatment of ARF
- Penicillin x 10 days to eradicate GAS
- Bed rest - 1-2 weeks for arthritis, 4 weeks for carditis
- High dose ASA for carditis (prednisone if severe)
- ASA or naproxen for arthritis (uniquely sensitive to ASA)
- Pen V BID for prevention
How long do you continue secondary prevention in ARF?
- no carditis: 5 years or until 21
- carditis: lifelong
*whatever is longer
ECG changes in cardiomyopathy?
- Dilated: wide ST changes
- Hypertrophic: big voltages
- Restrictive: HUGE bilateral atrial voltages
Cardiac clinical features of Pompe Disease
- cardiomegaly
- increased wall thickness
- can lead to SVT
- ECG has short PR interval, extremely tall WRS voltages
ECG Change in brudaga syndrome?
- coved ST segment in right precordial leads and RBB
- sudden unexplained nocturnal death syndrome with malignant ventricular arrythmias
Medications causing long QT
- Antiarrhythmic
- antihistamines (diphenhydramine)
- antibiotics and antifungals (macrolides, septra, clinda, azoles)
- psychotropic drugs (TCAs, carbamazepine, risperidone, haldol)
- others
Duke Criteria for Endocarditis
2 major OR 1 major + 3 minor OR 5 minor
MAJOR
- positive culture (typical bug x 2) or ECHO evidence (vegetation, abscess)
MINOR
- fever > 38
- vascular phenomena (emboli, conjunctival hemorrhage, janeway lesions)
- immune (glomerulonephritis, Osler nodes, roth spots, RF)
- +ve cultures not meeting major criteria
- high risk (IVDU or known cardiac risk factor)
Indications for endocarditis prophylaxis?
WHO
- prosthetic heart valves
- Cyanotic (single ventricle, TOF)
- completely repaired with prosthetic material or device for 1st 6 months post repair
- history of endocarditis
- repaired CHD with residual defects (leak, abnormal flow near patch or device)
WHEN
- dental - when gums will be injured, tooth extraction, dental abscess, bleeding anticipated, oral suture removal, oral biopsy, placement of orthodontic bands, fillings
- Resp - T&A, biopsy during bronchoscopy
- surgery through an infected area (skin, GI/GU
NOT
- dental - injury to lips/gums, loss of baby teeth, injection of anesthetic, placement of removable appliances
- resp - intubation, ear tubes, nosebleeds
- Skin - skin suturing, circumcision
- GI/GU - scopes, catheter insertions, strictura dilations, biopsies
- C?S, deliveries
Physical exam findings in pulmonary hypertension
- precordial bulge, RV heave
- loud single S2
- TR and PR murmurs
- pulsatile liver, hepatomegaly
- edema
