Cardiology Flashcards
What is the likely diagnosis for pt presenting with chest pain that radiates to left shoulder and back, worsens with lying flat and improves with leaning forward, blood pressure that varies with inspiration (decreases by more than 10; pulsus paradoxus), muffled heart sound and EKG showing low voltage QRS complexes and diffuse ST elevations?
Pericarditis (with pericardial effusion)
What is the most likely diagnosis for pt presenting with murmur and EKG showing right ventricular hypertrophy (rsR’ in V1, tall R and no S in V3 and V4) and exercise intolerance that starts in the 2nd decade of life?
ASD (atrial septal defect)
What is the most likely diagnosis for pt presenting with nausea, vomiting, abdominal pain, scotomas, altered color vision, confusion, premature ventricular contractions and EKG showing flattened/ inverted T wave, shortened QT, and ST depression after ingestion of family members medication?
Digoxin
tx: Digoxin- specific Fab antibodies
A patient presenting with deterioration in handwriting, chorea (jerking movements of arms), subcutaneous nodules, erythema marginatum (red, serpiginous macular lesions with pale centers), arthritis and carditis after strep pharyngitis most likely suffers from …
Acute rheumatic fever
Jones criteria
(sydenham chorea)
What is the most likely diagnosis for pt presenting with holosystolic murmur hear best at the left midsternal border?
VSD (ventricular septal defect)
tx fluid overload with lasix
What is the most common congenital heart defect associated with fetal alcohol syndrome (microcephaly, miface hypoplasia, thin upper lip, long smooth philtrum, bilateral ptosis, short palpebral fissures)?
VSD (ventricular septal defect)
What is the most likely diagnosis for pt presenting with a continuous murmur heard over the anterior portion of the upper check thruout systole and diastole that varies in intensity as the head is moved?
Venous hum
What is the most likely diagnosis for pt presenting with a systolic ejection murmur heard best over the 1st and 2nd left intercostal spaces and associated with widely split and fixed 2nd heart sound?
Atrial septal defect
ASD
What is the most likely diagnosis for pt presenting with conjunctivitis (sparing limbus), erythematous mouth/ pharnyx, strawberry tongue, red cracked lips, generalized rash, induration of hands and feet with red palms and soles, and unilateral cervical lymphadenopathy?
Kawasaki disease
complication: coronary aneurysm
(tx: IVIG and aspirin)
What is the best treatment for patient presenting with recurrent syncope and EKG showing bizarre T waves and prolonged QT?
beta blocker (propanolol)
What is the most likely diagnosis for pt presenting with sudden chest pain, shortness of breath and fatigue 1-6 weeks after cardiac surgery?
Pericarditis
due to immune mediated reaction to trauma to pericardium
what is the most likely diagnosis for newborn presenting with severe cyanosis, low PaO2, and CXR showing diminished vascularity in lungs? And what is the best initial step in management?
Pulmonary atresia
Prostaglandins (to keep PDA open)
The … on EKG symbolizes the time from the atrial depolarization to conduction thru the AVD node and His bundle to the onset of ventricular systole.
PR interval
What is the most likely diagnosis for pt presenting with EKG showing wide QRS tachycardia with frequent variations of the QRS axis and morphology?
Long QT syndrome
EKG finding is torsades de pointes
For what patient is a Rs pattern (QRS with tall R wave and smaller s wave) in the right precordium normal?
infants a few months old
What procedures is subacute bacterial endocarditis prophylaxis? (4)
- dental procedures with manipulation of gingival tissue/ perforation of oral mucosa
- tonsillectomy
- adenoidectomy
- bronchoscopy with biopsy
What is the most likely diagnosis for pt presenting with harsh cresendo-descrendo systolic murmur heard best at the left midsternal border radiating to right upper sternal border, increases with standing/ valsalva and decreases with squatting/sitting?
Hypertrophic Cardiomyopathy
What are the 4 components of Tetralogy of Fallot?
- large VSD
- right ventriculur outflow tract obstruction
- overriding aorta
- right ventricular hypertrophy
What is the most likely diagnosis for pt presenting with unilateral chest pain that is reproducible with palpation and has associated visible swelling, erythema and warmth?
Tietze syndrome
(inflammation of the 2nd costochondral cartilage)
(tx: NSAIDs and rest)
What is the most likely diagnosis for a pt presenting with cyanosis, CXR showing marked cardiomegaly (wall to wall heart), a holosystolic murmur at the left sternal border that radiates to the right lower sternal border, and an ECHo showing tricuspid valve displaced inferiorly into the right ventricle in the setting of maternal lithium use?
Ebstein anomaly
What diagnosis is associated with an egg on a string appearance on CXR?
transposition of the great vessels
What is the most likely diagnosis for pt presenting with holosystolic murmur heard best at the left lower sternal border that radiates to right lower sternal border and increases with inspiration, jugular venous distension, hepatomegaly and lower extremity edema in the setting of IV drug use?
Tricuspid regurgitation
usually accompanied by S. aureus infection and septic pulmonary emboli
What is the most likely diagnosis for pt presenting with midsystolic clinic followed by midsystolic murmur head best at the apex?
Mitral valve prolapse
associated with Marfans
What is the most likely diagnosis for pt presenting with a snowman sign (rounded figure of eight sign) of the cardiac contour on CXR?
supracardiac anomalous pulmonary venous return
due to abnormal development of the pulmonary veins
What is the most likely congenital cardiac defect associated with William syndrome?
Supraclavicular aortic stenosis
What maneuvers enhance the midsystolic click of mitral prolapse?
decreasing left ventricular volume by:
- sitting
- standing
What is the best initial treatment for pt with critical coarctation of the aorta?
Proostagladin (PGE 1)
to keep PDA open
What congenital heart defect can be significantly improved by a balloon atrial septostomy (tear hole in atrial septm)?
transposition of great vessels
allows 2 separate circulations to mix
What manifestation of rheumatic fever is the latest to develop?
Syndeham chorea
What electrolyte abnormality results in a shortened QTc and an abrupt upstroke in the initial portion of the T wave?
hypercalcemia
What is the most likely diagnosis for pt presenting with syncope (or sudden death) with EKG showing right bundle-branch block and ST elevation in leads V1-V3?
Brugada syndrome
defect in myocardial Na channels
What is the most likely diagnosis for pt presenting with EKG findings of shortened PR interval, widened QRS complex, and slow upstroke of the QRS complex?
Wolff-Parkison White syndrome
results in surpaventricular tachycardia
What age range is inverted T waves normal?
ages 1 week to 12 years old
upright as newborn and in late adolescence
For what circumstances is subacute bacterial endocarditis prophylaxis indicated? (4)
- prosthetic heart valve
- unrepaired cyanotic congenital heart defect
- repaired congenital heart defect with residual defect near prosthetic device
- transplanted heart with residual cardiac valve leafleft pathology and regurgitation
What is a GI complication associated with Kawasaki disease that occurs in the first 2 weeks of illness and is self-limited?
Acute distention of gallbladder
What is the most common cyanotic heart defect manifesting in the first days of life?
transposition of great vessels
What is the most likely diagnosis for newborn with continuous harsh machine like murmur associated with bounding pulses and thrill at the left 2nd intercostal space?
Patent ductus arteriosus
associated with maternal rubella infection
What is the most likely diagnosis for pt presenting with sudden onset severe chest pain radiating to neck/ back/ shoulders, difficulty swallowing, crepitus, and a harsh crunchlike systolic sound over the precordium?
Pneumomediastinum
Hamman sign is the sound
What is the recommended antibiotic regimen for SBE (subacute bacterial endocarditis)?
single dose of amoxicillin (50 mg/kg or 2g) 30-60 minutes before
(alternatives cephalexin 2g, azithromycin 500 mg, clindamycin 600mg)
What is the most likely diagnosis for sudden death after being punched or hit (with fist/ baseball/ lacrosse stick/ hockey puck) in the chest?
Commotio cordis
die due to ventricular fibrillation
What is the most likely diagnosis for pt presenting with stridor, chronic wheezing, respiratory distress, apnea, swallowing dysfunction with vomiting and barium contrast esophagogram shows anterior filling defect (indentation) in the esophagus on lateral projection?
Pulmonary sling
left pulmonary artery courses between trachea and esophagus
What genetic syndrome is associated with rhabdomyomas (nodules embedded in ventricular wall)?
Tuberous sclerosis
What congenital cyanotic heart defect results in diffuse reticular pattern in lung fields consistent with pulmonary edema in first few days of life?
Total anomalous pulmonary venous return (with obstruction of pulmonary venous return)
What is the most likely diagnosis for pt presenting with syncope and sensorineural deafness?
Jervell and Lange-Nielsen syndrome
What is the most likely diagnosis for pt presenting with medium pitched systolic ejection murmur heard best at the left upper sternal border that radiates to the right upper sternal border, to posterior lung fields and to axilla?
Functional peripheral pulmonary artery stenosis
resolves by 6 months of age
What is the most common cardiac defect in pt with Noonan syndrome?
Pulmonary valve stenosis
crescendo-decrescendo systolic murmur with palpable thrill at 2nd left intercostal space
What is the most likely diagnosis for newborn with cyanosis, systolic murmur heard best at the left lower sternal border, EKG showing left ventricular hypertrophy and CXR showing decreased pulmonary vasculature?
Tricuspid atresia
What is a serious complication of unrepaired tetralogy of Fallot?
brain abscesses and cerebral thrombosis
What is the most common congenital defect in patients with trisomy 21 (Down syndrome)?
Atrioventricular septal defect
What is the treatment for supraventricular tachycardia?
- vagal maneuvers (bags of ice on baby, blow pinwheel)
2. Adenosine
What is a potential life threatening side effect of adenosine? (2)
- Asystole
2. bronchospasm
What is the most common cardiac defect associated with anorexia nervosa?
mitral valve prolapse
apical systolic murmur associated with midsystolic apical click
what are the 2 most common medications that cause drug induced systemic lupus erythematous?
- procainamide
2. Hydralazine
what is the most likely diagnosis of pt presenting with an uplifted cardiac apex suggesting RVH with associated concavity of the upper left heart border (boot shape)?
Tetralogy of Fallot
What is the most likely diagnosis for patient found ot have rib notching?
Coarctation of aorta
What is the treatment for a PDA (patent ductus arteriosus)?
Ibuprofen or Tylenol
What is the etiology of an S3 heart sound (ken TUCK y)?
large volume of blood filling a dilated left ventricle
what is a possible complication associated with a pt taking aspirin for Kawasaki disease if they develop Varicella or Influenza infection?
Reye syndrome
encephalopathy associated with hepatic dysfunction
What is the treatment for patients presenting with cardiac arrhythmia secondary to hyperkalemia (no P wave, widened QRS)?
Calcium gluconate (stabilize cardiac membrane)
followed by glucose and insulin to push K into cells
What is the most common etiology of supraventricular tachycardia (SVT) in chidlren?
AV re-entry
What is the best initial treatment for a patient with isolated low HDL and high triglycerides?
diet with low saturated fats and exercise
What mechanism increased venous return to the heart?
Squatting or sitting
What mechanisms decreased venous return to the heart?
valsalva or standing
What is the action of increased venous return on hypertrophic cardiomyopathy murmurs?
decreased murmur (more separation between obstruction)
What is the most likely diagnosis for patient presenting with severe and sudden onset knife like chest pain over the left precordium lasting 30 seconds to 1 minute , can’t catch breath during episode as it results is worsening of chest pain with a normal cardiac examination?
Precordial catch syndrome
tx: reassurance
What does an S4 gallop suggestive of?
dilated ventricle with decreased compliance
harder to fill
What are the type cardiac abnormalities common in patients with Marfan syndrome?
- Mitral valve prolapse
2. aortic root dilation
What is the best initial treatment for dilated cardiomyopathy?
diuretics and ACE inhibitors
When should children have routine screening for high cholesterol even if completely healthy?
At ages 9-11 years old and again at 17-21 years old
What is the best initial treatment for patient with hypertrophic cardiomyopathy (HCM)?
beta blocker and restrict physical activity (competitive sports)
(beta blockers slow heart rate to allow ventricles to fill better)
What is the best screening plan for a patient who has family history of hypertrophic cardiomyopathy?
genetic testing of patient and family members
autosomal dominant genetic defects in myosin or troponin
