Cardiology Flashcards
In utero, this structure allows 50% of umbilical venous blood to go directly to the IVC, bypassing the liver
Ductus venosus
Pulmonary vascular obstructive disease usually seen in VSDs that may cause pulmonary hypertension
Eisenmenger’s syndrome
In fetal transitional circulation, after birth, the interruption of blood supply of umbilical cord results in:
1) increase in SVR (due to removal of placenta)
2) closure of ductus venosus (due to cut blood supply from placenta)
In fetal circulation, less oxygenated blood from the pulmonary artery flows through this structure that opens directly to the descending aorta and then to the placenta for oxygenation
Ductus arteriosus
Acyanotic infant with systolic ejection murmur at 2nd left ICS with widely split S2; on PE, right-sided enlargement; leads to CHF and Pulmonary hypertension if left untreated
Atrial septal defect (Ostium Secundum type most common)
In fetuses, around 1/3 of blood from fetal Inferior Vena Cava is directed to the left atrium directly via this structure:
Foramen Ovale (other 2/3 enters right ventricle then pulmonary artery)
Acyanotic infant with systolic regurgitant murmur at the left lower sternal border with loud S2 heard (unsplit); left-sided enlargement with biventricular hypertrophy if with Eisenmenger’s Syndrome (pulmonary vascular obstructive disease); this defect may usually present with recurrent pulmonary infections and delayed growth and development
Ventricular Septal Defect (most common congenital heart disease)
Acyanotic infant with a continuous “machinery-like” murmur heard at the 2nd left infraclavicular area; on PE, patient has hyperactive precordium, bounding pulses with wide pulse pressure.
Patent Ductus Arteriosus (patency between left pulmonary artery and descending aorta)
Most common cause of cyanotic congenital heart disease in newborns; patient has single, loud S2 with hypoxemia unresponsive to oxygen inhalation; on CXR, an egg-shaped cardiac silhouette with a narrow, superior mediastinum.
Transposition of the Great Arteries (aorta arises from right ventricle, pulmonary artery arises from left ventricle)
Cyanotic condition in infant with pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect and the aorta overriding this defect; patient may present with a systolic ejection murmur at 2nd upper left sternal border. On CXR, boot-shaped heart seen.
Hypoxic spells (paroxysm of hyperpnea, irritability, prolonged crying, increasing cyanosis, decreasing intensity of murmur after crying, feeding or defecation)
Tetralogy of Fallot
Palliative surgical management of Tranposition of Great Arteries wherein the objective is to create an interatrial communication to avoid progressive hypoxemia
Balloon atrial septostomy (Rashkind procedure) and surgical atrial septostomy (Blalock-Hanlon procedure)
Definitive surgical repair for TGA wherein objective is to switch right and left-sided blood
1) Atrial level repair (Senning or Mustard)
2) Ventricular level repair (Rastelli)
3) Great Artery level repair (Jatene)
General management of hypoxic spells in TOF:
1) Knee-chest position (decrease systemic venous return from legs)
2) Morphine sulfate (suppress respiratory center)
3) NaHCO3
4) Oxygen (improve arterial oxygenation)
5) Phenylephrine (raise SVR)
6) Propranolol (stabilize vascular reactivity of systemic arteries to prevent drops in SVR)
7) Ketamine (raise SVR)
Surgical management options for Tetralogy of Fallot:
Bloalock-Taussig (for >3 months old) and Gore-Tex Shunt (for
What are the components of Tricuspid Atresia?
1) Atretic tricuspid valve (missing valve)
2) Hypoplastic Right Ventricle
3) Ventricular Septal Defect
4) Atrial Septal Defect
5) Pulmonary Stenosis
Management of patient with Tricuspid Atresia with severe cyanosis?
Blalock-Taussig Procedure
Management of 4-8month old patient with Tricuspid Atresia?
Bidirectional Glenn shunt (anastomosis of SVC and pulmonary arteries to reduce volume load of LV)
Management of 1.5-3 year old patient with Tricuspid Atresia?
Modified Fontan Operation
Cyanotic condition where in the pulmonary arteries arise from the aorta with the presence of a stenotic quadracuspid truncal valve and the presence of a large ventral septal defect
Truncus Arteriosus
All four pulmonary veins connect to the superior vena cava thus increased volume is drained back to the right atrium causing right ventricle overload. On CXR, snowman sign is seen.
Total anomalous pulmonary venous return
A 5 year old child came in with weak femoral pulses. On BP taking of extremities, measurements were higher on the upper extremities than the lower ones. On CXR, rib notching was seen.
Coarctation of the Aorta
What specific part of the aorta is usually affected in Coarctation of Aorta?
Descending aorta, distal to the origin of the left subclavian artery
An obstructive condition wherein it is asymptomatic unless severe and on auscultation, a systolic ejection murmur is heard at the left upper sternal border with radiation to the back
Pulmonary Stenosis
PE findings of a harsh systolic ejection murmur at the right upper sternal border with occasional systolic thrill at the suprasternal notch. This condition is usually implicated in syncope and sudden death occuring during exertional activity (ex. Exercise)
Aortic stenosis
What chromosomal abnormality is typically associated with Coarctation of Aorta?
Turner’s Syndrome (45, XO)
Aschoff bodies in the myocardium are seen in?
Rheumatic Fever
Valvular damage in RHD usually affects these following valves (in order of incidence):
Mitral valve > aortic valve > tricuspid valve > pulmonary valve
The major manifestations in Jones Criteria include:
Mnemonic: JONES
1) Joint inflammation (Arthritis)
2) “Oh, my heart” (Carditis)
3) Nodules (Subcutaneous)
4) Erythema Marginatum
5) Sydenham’s Chorea
Diagnostic used in Rheumatic Fever to increase probability of diagnosis on top of the usage of Jones Criteria:
Antistreptolysin Titer (ASO)
Remember the 2-4-6-8 ASO rule:
Elevated after 2 weeks (post-infection)
Peaks after 4-6 weeks
Declines after 8 weeks
Choice of antibiotics to eradicate Streptococcus:
Penicillin
Benzathine
Eryhtromycin
Anti-inflammatory agent used in treating Rheumatic fever with MILD carditis:
Aspirin
Anti-inflammatory agent used in treating Rheumatic fever with SEVERE carditis:
Prednisone
Most common valvular involvement in adults with valvular heart diseae
Mitral stenosis
Most common valvular involvement in children with Valvular heart disease and Rheumatic Heart Disease
Mitral Regurgitation
Most common valvular heart disease regardless of age and gender. Usually associated with connective tissue disorders such as Marfan’s syndrome and Ehler-Danlos syndrome.
Mitral Valve Prolapse
