Cardiology Flashcards
Elevated BP in Kids less than 13
- 90th percentile to less than 95th percentile
Elevated BP in Kids more than 13
120-129/80
Stage 1 HTN in Kids less than 13
- 95th percentile to 95 + 12 mmHg
Stage 1 HTN in Kids more than 13
130/80 to 139/89
Stage 2 HTN in Kids less than 13
- 95th percentile + 12 or more
Stage 2 HTN in Kids more than 13
more than 140/90
ASDs- murmur
mid-systolic murmur in pulmonary area (similar to pulm stenosis)
fixed split S2 (delayed closure of pulm valve)
diastolic murmur at LLSB (tricuspid valve)
ASDs and typical age for closure
3-4
ASD closure in adults
Right sided heart dilation
symptoms of dyspnea
Qp:Qs >1.5:1
ASD differential
isolated anomalous pulmonary venous connection (looks identical on TTE)
Worrisome about ASD In adults??
paradoxical embolism
Risk of ASD, including when closed…
atrial fibrillation
VSD murmur
pansystolic over LLSB
can have mid diastolic rumble at apex (across mitral valve)
VSD size
related to AV area
small is 1/3, moderate 1/3 to 2/3, large is >2/3
Pulmonary Stenosis Murmur
SEM
Click (mild or moderate stenosis) at LLSB or LUSB, louder with exhalation
Diagnosis of Pericarditis (MKSAP)
2 of the following
- typical chest pain
- pericardial friction rub
- EKG findings
- pericardial effusion
Coarctation of Aorta - classic findings
HTN in upper extremities
radial to femoral artery delay
rib notching on x-ray
Tetralogy of Fallot
VSD
Overriding aortic arch
RV outflow obstruction (pulmonary stenosis)
RVH
Pulm HTN Group 1
pulmonary arterial HTN
Pulm HTN Group 2
Left heart disease
Pulm HTN Group 3
Lung disease and/or hypoxia
Pulm HTN Group 4
Chronic thromboemobolic pulm HTN
Pulm HTN Group 5
Multifactorial
Aortic Stenosis related bleeding diathesis
acquired von Willebrand syndrome
Further evaluation for patients with WPW
stress test
normalization of QRS indicates low risk for SCD
AE ticagrelor
dyspnea
P2Y12 Blockers in STEMI
PCI- ticagrelor (brilinta) or prasugrel (effient)
Fibrinolytics- clopidogrel
No intervention- ticagrelor
normal capillary wedge pressure
8-12 mmHg
Elevated JVP
3-4 cm above sternal angle
or 7-8 above RA
Hypoplastic Left Heart Syndrome - Features
underdeveloped left ventricle
underdeveloped aorta
PDA dependent
ASD
Hypoplastic Left Heart Syndrome - Procedures
Norwood –> Glenn –> Fontan
Norwood Procedure
1st procedure
Neoaorta from main pulmonary artery tissue
RV to PA conduit
Glenn Procedure
2nd procedure
anastomose SVC to pulm arterial system
take down conduit
Fontan Procedure
3rd procedure
connect IVC to pulm arterial system
Two continuous murmurs in pediatrics
PDA
venous hum
WPW- What are the TWO consequences
1) SVT
2) Sudden Cardiac Death
DAPT
6 months after drug-eluting stent
12 months after CABG
1 year after ACS
Normal Axis
Positive, upright in I and AvF
0-90
LAD
Positive in I, negative AvF
RAD
Negative in I, positive in AvF
Extreme RAD
Negative in I and Avf
Small and Large Blocks on EKG
.04 sec and .2 sec
Sinus rhythm
upright P wave in I, II and inverted in aVr
Positive QRS in I, II, AvF
TOF Repair
VSD Repair
Transannular patch to relieve pulmonary stenosis
TOF Murmur
harsh SEM over pulm area 2/2 pulmonary stenosis
Tet Spell- Physiology
increased pulmonary vascular resistance and increased HR
decrease ventricular filling and pulmonary flow
Tet Spell - Treatment
Increase SVR (knees to chest) oxygen IV bolus IV BB phenylephrine
Pulmonary Stenosis Murmur
SEM
Click (mild or moderate stenosis) at LLSB or LUSB, louder with exhalation
PDA Murmur
loud systolic (continuous machinery) at left precordium
Eisenmenger Syndrome
severe pulmonary HTN from reversal of shunt (now R to left)
LBBB
large S wave (rS) in V1
R in V6 (short bunny ears)
Mitral Regurgitation Murmur
- holosystolic at apex
- can be preceded by clicks (think MVP)
CHD associated with DiGeorge Syndrome
Truncus Arteriosus
precordial catch syndrome
short stabbing pains in chest
often with inspiration
possibly due to irritation of an intercostal nerve
Hypertrophic Cardiomyopathy- features/pathology
Left ventricular hypertrophy (with normal or small ventricle size)
Diastolic Dysfunction
Can Have
- LV outflow obstruction
- Systolic anterior motion of mitral valve
Hypertrophic Cardiomyopathy Murmur
systolic ejection murmur at LLSB or apex (think similar to aortic stenosis since its LVOT)
increase with Valsalva or standing
decrease with squat, hand grip, leg elevation
HCM First Line Treatment
Beta Blockers
Aortic Stenosis Murmur
SEM Click (mild or moderate stenosis) at apex and RUSB, no change with respirations
CoA/IAA Murmur
Harsh systolic murmur, loudest over the back/infraclavicular region
Adult Aortic Coarc Murmurs
1) systolic, continuous murmur in left infraclavicular region or over back
2) murmurs from intercostal vessels over chest wall
Figure 3 Signs in Coarcs
dilation of area below and above coarct
Rib Notching in Coarcs
dilation of intercostal collateral arteries
High Intensity Statin
atorva 40-80
rosuva 20-40
Indications of low cardiac output in shock
narrow pulse pressure
cool extremities
delayed cap refill
Indications of high cardiac output in shock
wide pulse pressure +/- low diastolic pressure
warm extremities
bounding pulses
Pericarditis –> CAUSES
viral or post viral (entero, adeno, parvo)
TB
Lyme
Immune (JIA, KD)
Pericarditis Treatment
NSAIDS
sometimes colchicine
Myocarditis –> CAUSES
enterovirus (coxsackie) is classic
Lyme dz
Chagas/trypanosma cruzi in developed world
Duchene Muscular Dystrophy
Myocarditis Treatment
Supportive + HF therapy
can sometimes consider IVIG, immunosuppression
Myocarditis Complication/Progression
chronic dilated cardiomyopathy (CDM)
Vessels of the Aortic Arch
brachiocephalic, left common carotid, left subclavian
How to Discern Left vs Right Sided Aortic Arch
trachea on the left versus the right
