CARDIOLOGY Flashcards
The most common type of ASD
ostium secundum (50-70%)
- Systolic ejection murmur at RUSB
- Balloon valvuloplasty
- Ross procedure (valve translocation)
Aortic stenosis
- nonpruritic serpiginous or annular erythematous evanescent rashes most prominent on the trunk and inner proximal portions of the extremities;
- never on the face (disappear on exposure to cold and reappear after a hot shower or if covered with a blanket)
Erythema marginatum
Patency of the ductus arteriosus is dependent on ______
low O2and high prostaglandins
3 sign
Coarctation of the Aorta
Fontan operation: RA to PA; RV is bypassed to oxygenate the blood
Tricuspid Valve Atresia (TVA)
bounding peripheral pulses and widened pulse pressure, continuous “machinery” murmur
PDA
- Pulmonary arteries arise from aorta
- Truncal valve, occasionally quadracuspid, stenotic and/or insufficient overrides the ventricular septal defect
- Ventricular septal defect, large
TRUNCUS ARTERIOSUS
one method of distinguishing cyanotic congenital heart disease from pulmonary disease?
Hyperoxia test
- Norwood Procedure
- Glenn anastomosis
Hypoplastic Left Heart Syndrome
hallmark finding is a systolic regurgitant murmurs at the apex with radiation to the left anterior axillary line
MITRAL REGURGITATION
Wide pulse pressure Bounding peripheral arterial pulses Continuous murmur
PDA
Palliative systemic-to-pulmonary artery shunt performed to augment pulmonary artery blood flow. For repair of TOF
BLALOCK-TAUSSIG SHUNT
All ____ murmurs are pathologic.
diastolic
MC causative agents of INFECTIVE ENDOCARDITIS
viridans Streptococci and Staphylococcus aureus
- Systolic ejection murmur at 2 nd LICS
- widely split S2
- Right sided enlargement
ASD
• Rashkind Atrial Septostomy
• Jantene Arterial Switch
• Senning and Mustard
TGA
A 13 y/o female patient presents to the clinic with fever and joint pains. It started 3 days ago when she had fever of 38.8°C with right knee swelling, which was warm, and very painful. At present, her right knee pain and swelling has resolved but now her right ankle and left knee is swollen and painful. PE revealed BP 90/60, HR 125, RR 24, T 38.7°C, (+) high pitched apical holosystolic murmur radiating to the axilla. What is the most likely dx in this case?
Rheumatic Fever
* This case mentioned the following main features of rheumatic fever: fever, arthralgia, migratory polyarthritis, systolic regurgitant murmur radiating to the axilla signifying mitral valve regurgitation. A common differential diagnosis is juvenile idiopathic arthritis as both conditions usually present with fever and joint swelling, but the presence of a systolic murmur indicates RF instead.
What is the main pathophysiologic mechanism behind the hypercyanotic spells or Tet spells in TOF?
due to decreased pulmonary blood flow
ANTIBIOTIC THERAPY for ARF
Once the diagnosis of acute RF has been made and regardless of the throat culture results, the patient should receive 10 days of oral Penicillin or Erythromycin or a single IM injection of benzathine Penicillin to eradicate GAS from the upper respiratory tract.
- Rib notching
- Result of increased blood flow through the interthoracic and intercostal vessels which serve as collateral circulation
COARCTATION OF THE AORTA
hallmark PE finding is a high-pitched diastolic murmur loudest at 3 rd -4 th LICS more audible when sitting and leaning forward
• other findings: diastolic thrill at 3rd LICS; hyperdynamic precordium, bounding water hammer pulse or Corrigan pulse, wide pulse pressure
AORTIC REGURGITATION
Inverted E
Coarctation of the Aorta
Fontan Procedure
Tricuspid Atresia
EVIDENCE OF ANTECEDENT GROUP A STREPTOCOCCAL INFECTION: Antistreptolysin O (ASO) Titers usually become elevated ______after strep infection, peaks at ______, and decreases after another ______
*a 4-fold rise in titer in 2 samples taken 10 days apart
2 weeks
4-6 weeks
2 weeks
4 anomalies in Tetralogy of Fallot
- VSD
- Pulmonary Stenosis (Right ventricular outflow tract obstruction)
- RVH
- Overriding aorta
Functional closure of the DA occurs by constriction of the medial, smooth muscle in the ductus within_______ after birth.
10-15 hours
most of the SVC blood goes to the RV; about ____ of IVC blood is directed to the LA through the FO whereas the ____ enters the RV and PA
1/3
2/3
less oxygenated blood in the PA flows through the ____ to the descending aorta and then to the placenta for oxygenation
widely open DA
associated with the presence of an endocardial cushion defect / Atrioventricular septal defect
Down syndrome
What is the strongest stimulus for constriction of the ductal smooth muscle which leads to closure of the ductus.
A postnatal increase in 02 saturation of the systemic circulation
“fish mouth buttonhole deformity”
MITRAL VALVE STENOSIS
- Systolic ejection murmur at LUSB with radiation to the upper back
- Balloon valvuloplasty
- valvotomy (Brock procedure)
Pulmonic stenosis
Cyanosis manifesting within few hours at birth or within few days of life
Transposition of great Arteries
Eisenmenger syndrome is associated with?
VSD
*Exposure of pulmonary artery system to high pressure and increased flow → irreversible changes occur in the pulmonary arterioles → progressive increase in PVR → when PVR exceeds SVR, ductal shunting reverses and becomes R->L → pulmonary vascular obstructive disease (Eisenmenger’s syndrome) → PA is prominent with RVH and pulmonary hypertension → bidirectional shunt causes cyanosis
the most consistent feature of ARF.
Valvulitis
3/6 systolic murmur described as “blowing” on the upper left 2 nd ICS and a widely split S2.
RVH and RAH
atrial septal defect
- Atretic (missing) tricuspid valve
- Hypoplastic right ventricle
- Ventricular septal defect
- Atrial septal defect
- Pulmonary stenosis
TRICUSPID ATRESIA
- occurs more often in prepubertal girls
- choreic movements (spontaneous purposeless movements followed by motor weakness), hypotonia, emotional lability, hyperactivity, obsessions & compulsions
Sydenham chorea
Cyanosis manifesting after the first year of life, usually in an infant or a toddler
Tetralogy of Fallot
“Snowman sign” or “figure of 8”
TOTAL ANOMALOUS PULMONARY VENOUS RETURN
Disparity in pulsation & BP in the arms & legs Weak popliteal, posterior tibial, and dorsalis pedis pulses
CoA
usually heard in young infants and children, systolic in timing, varies with position, associated with normal diagnostic results (CXR, ECG, 2D echo).
Functional or innocent murmurs
CHANGES IN CIRCULATION AFTER BIRTH
- The primary change after birth is a shift of blood flow for gas exchange from the placenta to the lungs.
-
Interruption of the umbilical cord results in the following:
- An increase in systemic vascular resistance due to removal of the low-resistance placenta
- Closure of the ductus venosus as a result of lack of blood return from the placenta
-
Lung expansion results in the ff:
- Reduction of the PVR → an increase in pulmonary blood flow → a fall in PA pressure
- Functional closure of the FO occurs due to increased pressure in the LA
- Closure of PDA as a result of increased arterial O 2 saturation
Systolic ejection or blowing murmur – heard best on the _______; blood flows through stenotic structures thus producing a “blowing” sound
base or at the 2nd ICS
- All 4 pulmonary veins drain to the RA
- > RV volume overload: right heart enlargement
- inc pulmonary vascular markings
TOTAL ANOMALOUS PULMONARY VENOUS RETURN
- The aorta arises from the RV carrying desaturated blood to the body; the PA arises posteriorly from the LV carrying oxygenated blood to the lungs
- Result: complete separation of pulmonary & systemic circulations → hypoxemic blood circulating throughout the body & hyperoxemic blood circulating in the pulmonary circuit
TRANSPOSITION OF THE GREAT VESSELS
S2 widely split and fixed in all phases of respiration
ASD
Late systolic murmur with an opening click
MVP
DISCUSS THE FETAL CIRCULATION
- Oxygenated blood from placenta → 50% of umbilical venous blood enters hepatic circulation → rest bypasses liver & joins IVC via DV → RA → FO → LA →LV → ascending aorta (fetal upper body and brain)
- Fetal SVC blood → RA → TV → RV → PA (only 10% of RV outflow enters the lungs) → major portion bypasses the lungs and flows through ductus arteriosus → descending aorta → lower part of fetal body → placenta via the 2 umbilical arteries
Systolic regurgitant murmur – heard best on the _____________; blood backflows from one chamber / valve to another because of incompetent structures
apex or at the left lower sternal border
Loud, harsh, blowing holosystolic murmur
VSD
DUKE CRITERIA
INFECTIVE ENDOCARDITIS
MAJOR
1. Blood culture – viridans Strep or Strep bovis, HACEK (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella), Staphylococcus, Enterococcus o 2 separate sites 12 hours apart o 3 or more 1 hour apart
2. Echocardiographic findings – oscillating mass vegetations, regurgitant flow near a prosthesis, abscess, partial dehiscence of prosthetic valves, new wave regurgitant flow
MINOR
- Fever
- Predisposing condition
- Vascular – emboli, pulmonary infarct, aneurysm, Janeway lesions
- Immunologic – GN, Osler nodes, Roth Spots, RF
- Microbiological evidence
- Echocardiographic findings
Maternal condition with related fetak heart defect
most common cyanotic heart disease in newborns
Transposition of Great Arteries
- Most are asymptomatic but can have CHF if severe
- Weak, delayed, or absent femoral pulses
• Blood pressure higher in the arms > legs
• LVH may be seen in CXR or ECG
COARCTATION OF THE AORTA
How does squatting relieve the tet spell in TOF?
- Continuous “machinery-like” murmur at the 2 nd left infraclavicular area
- Bounding pulses;
- wide pulse pressure;
- left-sided enlargement,
- enlarged aorta
PDA
- Systolic regurgitant murmur at LLSB
- loud and single S2
- Left sided enlargement;
- biventricular hypertrophy if with Eisenmenger syndrome
VSD
TRANSPOSITION OF THE GREAT VESSELS
- all of the structures on the left side of the heart are severely underdeveloped.
- The right ventricle must then do a “double duty” of pumping blood both to the lungs (via the pulmonary artery) and out to the body via a patent ductus arteriosus.
HYPOPLASTIC LEFT HEART SYNDROME
most common cyanotic congenital heart disease in infants and young children.
Tetralogy of Fallot
refers exclusively to the circumstance in which classic auscultatory findings of valvar dysfunction either are not present or are not recognized by the clinician but 2d echo reveal mitral or aortic valvulitis.
Subclinical carditis
Duration of prophylaxis for people who have had acute rheumatic fever
o Only a single arterial trunk with a truncal valve arised from the heart and supplies to the pulmonary, systemic and coronary circulation
o A large VSD below the truncal valve
o PAs arise from the single arterial trunk
TRUNCUS ARTERIOSUS
• Blalock-Taussig Shunt with GoreTex conduit
• Aortopulmonary window shunt
• Waterson Cooley
• Pott shunt
TOF
Between______ of age, there is a slower fall in the PVR and PA pressure.
6-8 weeks
Anatomic closure is completed by _____ of age by permanent changes in the endothelium and subintimal layers of the ductus.
2-3 weeks
Duke’s Criteria definite diagnosis for Infective endocarditis
Definite endocarditis:
- 2 major criteria, or;
- One major and 3 minor, or;
- 5 minor criteria
JONES CRITERIA for rheumatic fever
- 2 MAJOR or 1 MAJOR + 2 MINOR
- Large joints are affected (knees, ankles, wrists, elbows)
- Arthritis in major should have tenderness, swelling and other signs of inflam. If there are no signs of inflam, it’s just arthralgia which is a minor criteria.
