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PANCE > Cardiology - Congenital & Valve > Flashcards

Cardiology - Congenital & Valve Flashcards

1
Q

What is the sound S1?

A

combined sound of mitral and tricuspid valve closing

M1 = mitral valve
T1 = tricuspid valve
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2
Q

What is the sound S2?

A

combined sound of aortic and pulmonic valves closing

A2 = aortic
P2 = pulmonic
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3
Q

What is the sound S3?

A

rapid return of blood

think systolic CHF

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4
Q

What is the sound S4?

A

stiff ventricle

think diastolic CHF or ischemia

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5
Q

What should you think of when you hear “rubs”?

A

pericarditis

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6
Q

What are gallops?

A

S1+S2 plus S3 or S4 or both

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7
Q

What should you think of with S1+S2 plus S3?

A

systolic CHF

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8
Q

What should you think of with S1+S2 plus S4

A

diastolic CHF or ischemia (MI)

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9
Q

How does inspiration affect the heart sounds?

A

inspiration causes pulmonic and tricuspid murmus to get louder (increases venous return)

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10
Q

How does exhalation affect the heart sounds?

A

exhalation causes Aortic and Mitral murmurs to get louder

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11
Q

What are the two classifications of congenital heart anomalies?

A

cyanotic

noncyanotic

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12
Q

What type of shunts are cyanotic?

A

right to left

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13
Q

What are 4 examples of cyanotic heart?

A
  • tetralogy of Fallot
  • pulmonary atresia
  • hypoplastic left heart syndrome
  • transposition of the great vessels
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14
Q

Classify tetralogy of Fallot?

A
  • VSD
  • pulmonary valve stenosis (RV outflow is obstructed)
  • overriding aorta
  • RV hypertrophy
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15
Q

What are 5 examples of non cyanotic congenital heart?

A
  • ASD
  • VSD
  • AV septal defect
  • PDA
  • Coarctation of the aorta
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16
Q

What congenital heart is common in down syndrome?

A

AV septal defect

noncyanotic

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17
Q
  • left parasternal lift
  • pulmonic ejection murmur
  • fixed splitting of S2
A

ASD

noncyanotic

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18
Q

Describe a chest xray for ASD?

A

dilated pulmonary arteries and increased pulmonary vascularity

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19
Q

If ASD is not repaired what can happen?

A

can lead to pulmonary HTN

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20
Q

Blood pressure is high, but equal in both arms. Lower BP in legs

  • claudication with activity
  • rib notching
A

coarctation of the aorta (non cyanotic)

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21
Q

What congenital heart is common with Turner syndrome?

A

coarctation of the aorta (non cyanotic)

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22
Q

continuous machinery murmur

A

PDA

noncyanotic

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23
Q

What congenital heart is common with congenital rubella? FTT?

A

PDA

noncyanotic

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24
Q

Treatment for PDA?

A
  • indomethacin (inhibit prostaglandins)

- surgery

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25
Q

What is the most common type of ASD?

A

ostium secundum (there are 4 types)

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26
Q

What happens in PDA?

A

PDA does not close - there is a channel bypassing the lungs, which allows placental gas exchange during fetal state

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27
Q

Most common congenial defect?

A

VSD (noncyanotic)

down syndrome

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28
Q

pansystolic (holosystolic) murmur

-hear mid sternal border

A

VSD

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29
Q

Which way does blood shunt with Eisenmenger?

A

right to left (cyanotic)

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30
Q

Which congenital heart is “boot-shaped heart”

-squatting child

A

tetralogy of Fallot (cyanotic = right to left)

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31
Q

What are 3 disease associated with tetralogy of Fallot?

A

Down syndrome
Digeorge syndrome
congenital rubella

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32
Q

patient presents with dizzy spells, often squats, crescendo-decrescendo holosystolic at LSB which radiates to the back?

A

tetralogy of Fallot (cyanotic)

33
Q

What is a TET spell?

A

hyper cyanotic spell = extreme cyanosis, hyperpnea, agitation

34
Q

Treatment for tetralogy of Fallot?

A

phlebotomy

35
Q

Which congenital heart defect is common in child born to diabetic mothers?

A

transposition of great vessels (cyanotic)

36
Q

What occurs in transposition of great vessels?

A
  • aorta and pulmonary artery are switched
  • LV pumps to lung
  • RV pumps to body
37
Q

What has to occur for a child to survive with transposition of great vessels?

A
  • PDA
  • ASD
  • VSD
38
Q

What is the most common sign in a new born for transposition of the great vessels?

A
  • cyanosis

- tachypnea without resp. distress

39
Q

What is Eisenmenger Syndrome?

A

right heart failure caused by pulmonary HTN (cor pulmonale)

40
Q

What is the treatment for most congenital heart anomalies?

A

surgery

-can give prostaglandin prior to surgery

41
Q

What are 5 examples of systolic murmurs?

A
  • aortic stenosis
  • pulmonary stenosis
  • mitral regurgitation
  • tricuspid regurgitation
  • mitral valve prolapse
42
Q

What are 4 diastolic murmurs?

A
  • aortic regurg
  • pulm regurg
  • mitral stenosis
  • tricuspid stenosis
43
Q

What is MRTAPS?

A

mnemonic for systolic murmur
M=mitral
R=regurg
T=tricuspid

A=aortic
P=pulmonic
S=stenosis

44
Q

What is a functional murmur?

A

-physiologic murmur
=due to conditions outside the heart, no valve defects
=benign
=innocent

45
Q

murmur is audible on listening carefully for some time

A

grade 1

46
Q

murmur is faint but audible

A

grade 2

47
Q

loud murmur readily audible but with no palpable thrill

A

grade 3

48
Q

loud murmur with palpable thrill

A

grade 4

49
Q

loud murmur with palpable thrill. audible barely touching the chest with scope

A

grade 5

50
Q

loud murmur with palpable thrill, audible to ear

A

grade 6

51
Q

how does sound radiate in a murmur?

A

sound radiates in the direction of the blood flow

52
Q

Symptoms: angina, syncope (with effort), heart failure

Exam: narrow pulse pressure, apical lift, S4 slow carotid upstroke

A

Aortic Stenosis
(systolic mumur)

ASH
angina syncope heart (failure)

53
Q

What does LVH do?

A

LVH = makes LV stiff

stiff ventricle = diastolic HF = s4 + dyspnea

54
Q

midsystolic murmur radiates to neck. hear better if pt sits and leans forward.

A

aortic stenosis

55
Q

Cause of Aortic Regurgitation?

A
  • rheumatic fever
  • enodocarditis (destroy leaflets)
  • CT disorder
56
Q

diastolic decrescendo. hear better if patient sits, leans forward with full exhalation. wide pulse pressures

A

aortic regurgitation (radiates down)

57
Q

Treatment for aortic regurgitation?

A

ACEI, loop diuretic, BB

(mainstay for compensated systolic failure)

-ABX = if endocarditis or rheumatic fever

58
Q

1 of this valve disorder is rheumatic fever!

A

mitral stensis

59
Q

mitral stenosis can have what type of arrhythmia?

A

atrial fibrillation

60
Q

symptoms: palpations (afib), heart failure (CHF), dyspnea with exertion

A

mitral stenosis

mnemonic PHD (palpitation, heart failure, dyspnea)

61
Q

middiastolic, opening snap, best heard at apex (pt in lateral position)

A

mitral stenosis

62
Q

Treatment for mitral stenosis?

A

medical = BB or CCB to slow heart rate

surgery = definitive

63
Q

holosystolic murmur, apex, radiate to axilla

A

mitral regurgitaiton

64
Q

causes of mitral regurgitation?

A
  • chordae tendonae rupture
  • valve degeneration
  • endocarditis
  • dilatation
65
Q

What should you think of with Austin Flint murmur?

A

aortic regurg

66
Q

young female, thin
sharp, jabbing chest pain
palpitations, No EKG changes, dyspnea

mid-systolic click and late apical systolic murmur

A

mitral valve prolapse

TX: reassurance, BB

67
Q

mid diastolic murmur best heard over the left sternal border with rumbling

A

tricuspid stenosis

often from rheumatic fever

68
Q

If the tricuspid valve is involved…

A

so are the aortic and mitral valves!!

rheumatic fever affects mitral = then aortic = then tricuspid valves

69
Q

pansystolic murmur, best heard at LLSB, increases with inspiration, JVP

A

tricuspid regurg

70
Q

What is Carvallo’s sign?

A

murmur of tricuspid regurgitation increases in intensity during held, deep inspiration

=tricuspid regurg

71
Q

Symptoms of tricuspid regard are similar to what?

A

Right heart failure

  • ascites
  • hepatomegaly
  • edema
  • Jugular venous distention
72
Q

common cause of pulmonary regurgitation?

A

pulmonary HTN

73
Q

What is Noonan Syndrome? (KIDS)

A

pulmonary stenosis

  • ASD
  • HOCM
  • short stature
  • learning problem
  • pectus excavatum
  • webbed neck
  • flat nose bridge
74
Q

murmur is systolic crescendo-decrescendo ejection in left upper sternal border

A

pulmonary stenosis

75
Q

symptoms of this heart murmur = SOB, JVD, Right heart failure

A

pulmonary stenosis

76
Q

What are the different types of valve replacement?

A
  • mechanical
  • biologic
  • closure device (for ASD)
77
Q

mechanical valves

A

metallic valves that require anticoagulation with warfarin

= if no warfarin leads to clot

=INR 2.5-3.5

+click is normal

78
Q

Do you hear a click with biologic valves?

A

no

PANCE (16 decks)

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