Cardiology Flashcards
Dressler’s syndrom
post-MI syndrome (1-2wks)
pericarditis, fever, leukocytosis, and pericardial/pleural effusion
Cardiac markers in MI
Myoglobin: rises 1-4h peaks 6-7h normal 24h
Troponin-I: rises 3-12h peaks 24h normal 5-10d
Troponin T: rises 3-12h peaks12-48 norm5-14d
Total CK: rises 3-5h peaks 24h normal 48-72h
CK-MB: rises 3-12h peaks 24h normal 48-72h
LDH: rises 10h peaks 24-48h normal 10-14d
Drawing of cardiac markers in MI
Myoglobin 1-2h after onset
troponin - 12h after onset
Ck-MB three times; 12h apart
LDH once 24h + after onset
Congenital heart anomalies are classified as
cyanotic and non-cyanotic
Cyanotic congenital heart defects
Tetralogy of Fallot
Pulmonary atresia
Hypoplastic left heart syndrome
transposition of the great vessels
Non-cyanotic heart defects
ASD VSD AV septal defect/canal PDA Coarctation of the aorta
Tetralogy of Fallot
subaortic septal defect, RV outflow obstruction, overriding aorta, RVH
cres-decres holosytolic murmur at LSB rad to back
cyanosis, clubbing, inc RV impulse at LLSB, loud S2
polycythemia present
TET spells (cyanosis, hyperpnea, agitation)
Pulmonary Atresia
Most often with an intact ventricular septum
Pulmonary valve closed; ASD and PDA present
May have TR
cyanosis/tachypnea at birth; single s1/s2; hyperdynamic apical impulse
Hypoplastic left heart syndrome
group of defects with a small L ventricle and normally placed great vessels
presentation varies
M>F; 1/4 of cardiac deaths before age 7
Transposition of the great vessels
complete transposition of the aorta and pulmonary arteries
systolic murmur if VSD; sys ejec mur if pul stenos
cyanosis in newborn MC
may have CHF symp, poor feeding, absent LE pulses
ASD- MC type
ostium secundum is the MC
Systolic ej murmur 2nd L ICS; early-mid sys rumble
FTT; fatigue; RV heave; wide FIXED SPLIT S2
VSD types
muscular, perimembranous, or outlet openings btw the ventricles
systolic murmur at LLSV
asymptomatic to signs of CHF
AV septal defect
Due to incomplete fusion between the endocardal cushions
*common in Downs syndrome (15-20% DS pts)
First dx may occur in adulthood
constellation of defects
Coarctation fo the aorta
narrowing in the proximal thoracic aortasystolic LUSB and left intersapular murmur; may be cont
Infants present w CHF
pathognomonic differences btw arterial pulses and BP in UE vs LE
PDA
failure to close or a delay in closure of the channel bypasing lungs 12-15% cong dx; MC in premature infants CONTINUOUS MACHINERY MURMUR Wide pulse pressure hyperdynamic apical pulse
Machinery murmur
PDA
Holosystolic murmurs
MR
TR
VSD
Differences in UE and LE BP and arterial pulses is pathognomonic for
Coarctation
Widened pulse pressures
aortic regurg/insuff
midsystolic murmur heard 2nd R ICS rad to neck and LSB. Loud and hash in quality. Inc with pt siting and leaning forward
AS
Blowing, high-pitched diastolic decrescendo murmur. 2nd-4th L ICS rad to apex and RSB. Inc with pt sitting and leaning forward on full exhalation. May have soft systolic component. Pulses are large and bounding
AR
Low-pitch, mid-dyastolic murmur heard at apex. No radiation. Heard best with patient in L lateral on full exhalation. S1 accentuated with opening snap following S2
MS
Medium-high blowing holosystolic murmur heard best at apex; radiates to L axilla. S2 decreased with apical impulse prolonged
MR
Holosystolic, blowing murmur heard best at LLSB with radiation to R sternum and xiphoid area. JVP elevated
TR
Systolic, harsh murmur heard best at 2-3 L ICS. Midsystolic cres-decres with radiation to left should/neck.
PS
ejection click
high pitched, early systolic sound associated with the opening of an abnormal valve, sometimes followed by a murmur
Aortic Stenosis - 2nd R ICS @ the SB
Pulmonic Stenosis- 2nd L ICS @ the SB
Wide spliting
delay of the pulmonic valve closure -
Pulmonic Stenosis
Right Bundle Branch Block
Fixed splitting
early closure of the aortic valve
Mitral Regurgitation
Atrial Septal Defect
Paradoxical splitting
delay in the closure of the aortic valve
Left Bundle Branch Block-
S2 is usually a single sound in inspiration with LBBB
Opening Snap
high-pitched diastolic sound associated with the opening of an abnormal valve, sometimes followed by a murmur
Tricuspid valve - @ the LLSB
Mitral valve - @ the apex
S3
an early diastolic sound (blood passively entering the ventricle) associated with Heart Failure
heard at the LLSB or Apex with Left Heart Failure
heard over the lower sternum/ epigastric area with Right Heart Failure
may be normal in children
S4
late diastolic sound associated with the active ejection of blood from the atria into the ventricles when the atria contract.
S4 may be normal with an enlarged healthy heart in an athletic, or abnormal with ventricular hypertrophy.
Which cardiomyopathy? Sustained PMI or triple apical impulse, loud S4, variable sys murmur, bisferiens carotid pulse, JVP w prominent a wave
hypertrophic
bisferiens carotid pulse
AR
AR + AS
hypertrophic cardiomyopathy
Becks triad
cardiac tamponade
Hypotension, JVD, muffled heart sounds
electrial alternans
pericardial effusion
new murmur and fever
endocarditis
painless dark lesions on palms/soles assoc w endocarditis
janeway lesions
painful violaceous, raised lesions on fingers, toes, feet assoc w endocarditis
osler nodes
exudative, flame-shaped hemorrhages seen on the retina in endocarditis
roth spots
MCC of acute endocarditis
staph aureus
MCC subacute endocarditis
strep viridens
appropriate empiric tx for endocarditis
vanc and ceftriaxone
kussmaul’s sign
JVD on inspiration (constrictive pericarditis, tamponade, restric cardiomyopathy)
tx hypertrophic cardiomyopathy
β blockers and CCBs Giving these for their NEGATIVE INOTROPY ↓ myocardial O2 demand ↓ ectopy ↓ outflow obstruction by ↑ LV filling
drug of choice for endocarditis prophy
amoxicillin
