cardiology

Question 1

CHF

Answer 1

Causes: increased pulmonary blood flow (VSD, PDA, TGA), obstructive lesions (stenosis or coarctation), AVM, viral myocarditis, severe anemia (high output failure)
Sx: tachypnea, cough, wheezing, rales, tachycardia, sweating, pale skin, HSM, peripheral edema, FTT, poor feeding, cyanosis and shock
Tx: dig, furosemide, dobutamine, amrinone/milrinone
- cath
- surgery

Question 2

ostium primum ASD

Answer 2

common congenital defect in down syndrome

Question 3

ostium secundum ASD

Answer 3

most common type

Question 4

ASD sx/tx

Answer 4

Sx: increased right ventr impulse, systolic ejection murmur, fixed split second heart sound
Tx: closure by open heart surgery

Question 5

VSD

Answer 5

small VSDs –> holosystolic murmur which decreases as size of VSD increases
large VSDs –> CHF, less turbulence, mitral filling fumble may be heard
- Pulm vascular resistance may become elevated and may lead to pulm HTN

Question 6

PDA

Answer 6

Sx: can lead to CHF if large
- machine like mumur left upper sternal border, widened pulse pressures, brisk pulses
- risk of pulm HTN
Tx: indomethacin to close PDA
- prostaglandin E keeeps open PDA

Question 7

Most common cause of central cyanosis

Answer 7

5 Ts

Tetralogy of fallot (most common central cyanosis beyond newborn)
transposition of great arteries
tricuspid atresia
truncus arteriosus
total anomalous pulm venous connection

Question 8

tetralogy of fallow

Answer 8

VSD, overriding aorta, pulm stenosis, RVH
Tx: surgical repair
- acutely - knee-chest position, iv fluids, oxygen, morphine, propranolol, sodium bicarb, transfusion

Question 9

tricuspid atresia

Answer 9

always present with ASD or PFO
Sx: LAD and LVH with cyanosis
Tx: get flow from IVC to pulmonary arteries

Question 10

most common cause of acquired heart disease

• worldwide
• US

Answer 10

• acute rheumatic fever

- kawasaki disease

Question 11

pericarditis

Answer 11

Cause: infection - coxsackie, echo, adeno, flu, para, EBV
purulent - staph, strep
post surgery
Sx: fever, dyspnea, malaise, CP worse lying down, friction rub and distant heart sounds

Question 12

myocarditis

Answer 12

Cause:
- viral - enterovirus, coxsackie
- bacteria - diph, strep pyogenes, staph, m tuberc
- fungi - candida and cryptococcus
- protozoa - t cruzi
- autoimmune - SLE, rheumatic fever, sarcoid
- kawasaki
Sx: dyspnea, malaise, flu illness, tachy, muffled heart sounds, tachypnea
Dx: ESR, CKMB, CRP, EKG, echo