Cardiology - Congenital & Valve Flashcards
What is the sound S1?
combined sound of mitral and tricuspid valve closing
M1 = mitral valve T1 = tricuspid valve
What is the sound S2?
combined sound of aortic and pulmonic valves closing
A2 = aortic P2 = pulmonic
What is the sound S3?
rapid return of blood
think systolic CHF
What is the sound S4?
stiff ventricle
think diastolic CHF or ischemia
What should you think of when you hear “rubs”?
pericarditis
What are gallops?
S1+S2 plus S3 or S4 or both
What should you think of with S1+S2 plus S3?
systolic CHF
What should you think of with S1+S2 plus S4
diastolic CHF or ischemia (MI)
How does inspiration affect the heart sounds?
inspiration causes pulmonic and tricuspid murmus to get louder (increases venous return)
How does exhalation affect the heart sounds?
exhalation causes Aortic and Mitral murmurs to get louder
What are the two classifications of congenital heart anomalies?
cyanotic
noncyanotic
What type of shunts are cyanotic?
right to left
What are 4 examples of cyanotic heart?
- tetralogy of Fallot
- pulmonary atresia
- hypoplastic left heart syndrome
- transposition of the great vessels
Classify tetralogy of Fallot?
- VSD
- pulmonary valve stenosis (RV outflow is obstructed)
- overriding aorta
- RV hypertrophy
What are 5 examples of non cyanotic congenital heart?
- ASD
- VSD
- AV septal defect
- PDA
- Coarctation of the aorta
What congenital heart is common in down syndrome?
AV septal defect
noncyanotic
- left parasternal lift
- pulmonic ejection murmur
- fixed splitting of S2
ASD
noncyanotic
Describe a chest xray for ASD?
dilated pulmonary arteries and increased pulmonary vascularity
If ASD is not repaired what can happen?
can lead to pulmonary HTN
Blood pressure is high, but equal in both arms. Lower BP in legs
- claudication with activity
- rib notching
coarctation of the aorta (non cyanotic)
What congenital heart is common with Turner syndrome?
coarctation of the aorta (non cyanotic)
continuous machinery murmur
PDA
noncyanotic
What congenital heart is common with congenital rubella? FTT?
PDA
noncyanotic
Treatment for PDA?
- indomethacin (inhibit prostaglandins)
- surgery
What is the most common type of ASD?
ostium secundum (there are 4 types)
What happens in PDA?
PDA does not close - there is a channel bypassing the lungs, which allows placental gas exchange during fetal state
Most common congenial defect?
VSD (noncyanotic)
down syndrome
pansystolic (holosystolic) murmur
-hear mid sternal border
VSD
Which way does blood shunt with Eisenmenger?
right to left (cyanotic)
Which congenital heart is “boot-shaped heart”
-squatting child
tetralogy of Fallot (cyanotic = right to left)
What are 3 disease associated with tetralogy of Fallot?
Down syndrome
Digeorge syndrome
congenital rubella
patient presents with dizzy spells, often squats, crescendo-decrescendo holosystolic at LSB which radiates to the back?
tetralogy of Fallot (cyanotic)
What is a TET spell?
hyper cyanotic spell = extreme cyanosis, hyperpnea, agitation
Treatment for tetralogy of Fallot?
phlebotomy
Which congenital heart defect is common in child born to diabetic mothers?
transposition of great vessels (cyanotic)
What occurs in transposition of great vessels?
- aorta and pulmonary artery are switched
- LV pumps to lung
- RV pumps to body
What has to occur for a child to survive with transposition of great vessels?
- PDA
- ASD
- VSD
What is the most common sign in a new born for transposition of the great vessels?
- cyanosis
- tachypnea without resp. distress
What is Eisenmenger Syndrome?
right heart failure caused by pulmonary HTN (cor pulmonale)
What is the treatment for most congenital heart anomalies?
surgery
-can give prostaglandin prior to surgery
What are 5 examples of systolic murmurs?
- aortic stenosis
- pulmonary stenosis
- mitral regurgitation
- tricuspid regurgitation
- mitral valve prolapse
What are 4 diastolic murmurs?
- aortic regurg
- pulm regurg
- mitral stenosis
- tricuspid stenosis
What is MRTAPS?
mnemonic for systolic murmur
M=mitral
R=regurg
T=tricuspid
A=aortic
P=pulmonic
S=stenosis
What is a functional murmur?
-physiologic murmur
=due to conditions outside the heart, no valve defects
=benign
=innocent
murmur is audible on listening carefully for some time
grade 1
murmur is faint but audible
grade 2
loud murmur readily audible but with no palpable thrill
grade 3
loud murmur with palpable thrill
grade 4
loud murmur with palpable thrill. audible barely touching the chest with scope
grade 5
loud murmur with palpable thrill, audible to ear
grade 6
how does sound radiate in a murmur?
sound radiates in the direction of the blood flow
Symptoms: angina, syncope (with effort), heart failure
Exam: narrow pulse pressure, apical lift, S4 slow carotid upstroke
Aortic Stenosis
(systolic mumur)
ASH
angina syncope heart (failure)
What does LVH do?
LVH = makes LV stiff
stiff ventricle = diastolic HF = s4 + dyspnea
midsystolic murmur radiates to neck. hear better if pt sits and leans forward.
aortic stenosis
Cause of Aortic Regurgitation?
- rheumatic fever
- enodocarditis (destroy leaflets)
- CT disorder
diastolic decrescendo. hear better if patient sits, leans forward with full exhalation. wide pulse pressures
aortic regurgitation (radiates down)
Treatment for aortic regurgitation?
ACEI, loop diuretic, BB
(mainstay for compensated systolic failure)
-ABX = if endocarditis or rheumatic fever
1 of this valve disorder is rheumatic fever!
mitral stensis
mitral stenosis can have what type of arrhythmia?
atrial fibrillation
symptoms: palpations (afib), heart failure (CHF), dyspnea with exertion
mitral stenosis
mnemonic PHD (palpitation, heart failure, dyspnea)
middiastolic, opening snap, best heard at apex (pt in lateral position)
mitral stenosis
Treatment for mitral stenosis?
medical = BB or CCB to slow heart rate
surgery = definitive
holosystolic murmur, apex, radiate to axilla
mitral regurgitaiton
causes of mitral regurgitation?
- chordae tendonae rupture
- valve degeneration
- endocarditis
- dilatation
What should you think of with Austin Flint murmur?
aortic regurg
young female, thin
sharp, jabbing chest pain
palpitations, No EKG changes, dyspnea
mid-systolic click and late apical systolic murmur
mitral valve prolapse
TX: reassurance, BB
mid diastolic murmur best heard over the left sternal border with rumbling
tricuspid stenosis
often from rheumatic fever
If the tricuspid valve is involved…
so are the aortic and mitral valves!!
rheumatic fever affects mitral = then aortic = then tricuspid valves
pansystolic murmur, best heard at LLSB, increases with inspiration, JVP
tricuspid regurg
What is Carvallo’s sign?
murmur of tricuspid regurgitation increases in intensity during held, deep inspiration
=tricuspid regurg
Symptoms of tricuspid regard are similar to what?
Right heart failure
- ascites
- hepatomegaly
- edema
- Jugular venous distention
common cause of pulmonary regurgitation?
pulmonary HTN
What is Noonan Syndrome? (KIDS)
pulmonary stenosis
- ASD
- HOCM
- short stature
- learning problem
- pectus excavatum
- webbed neck
- flat nose bridge
murmur is systolic crescendo-decrescendo ejection in left upper sternal border
pulmonary stenosis
symptoms of this heart murmur = SOB, JVD, Right heart failure
pulmonary stenosis
What are the different types of valve replacement?
- mechanical
- biologic
- closure device (for ASD)
mechanical valves
metallic valves that require anticoagulation with warfarin
= if no warfarin leads to clot
=INR 2.5-3.5
+click is normal
Do you hear a click with biologic valves?
no
