Cardiology-Notes Flashcards
What might a normal newborn EKG show?
physiologic R axis deviation
What is acrocyanosis? When is it normal?
peripheral cyanosis
from peripheral vasoconstriction
can be normal in newborns, but should resolve
if it persists–think about central cause-heart defect.
Cyanosis w/o respiratory distress–what should you think of?
congenital heart defect
How do congenital cyanotic heart disease patients react to 100% oxygen?
no improvement
How might polycythemia in a patient with congenital heart dx contribute to acrocyanosis?
increased RBCs (as a reaction to cyanosis) can cause sluggish blood flow & prompt peripheral cyanosis
What are some symptoms associated with a pathologic murmur in an infant?
diaphoresis
tiring with feeds
poor weight gain
What are some symptoms associated with a pathologic murmur in children?
chest pain dizziness syncope SOB fatigue
What are some concerning physical exam findings of a murmur?
holosystolic diastolic >=3/6 INCREASES with standing or Valsalva (decreased blood return) Loud, fixed split, or single S2 decreased or absent femoral pulses
What is the work up for a concerning murmur in a child?
CXR (cardiomegaly)
EKG (hypertrophY)
ECHO
cardio referral
Holosystolic harsh @ LLSB. Do you need an ECHO?
Yes, possibly a VSD.
What are the heart defects of R–>L shunts? Blue babies?
1-5
- Truncus Arteriosus (1 vessel)
- Transposition of the Great Vessels (2 vessels)
- Tricuspid Atresia (tri-3)
- Tetrology of Fallot (4-tetra)
- TAPVR (5 letters)
What are the heart defects of L–>R shunts? Blue kids?
1-3
1 VSD
2. ASD
3. PDA
Which congenital heart defects are associated with Digeorge 22q11?
the Ts
Truncus Arteriosus
Tetrology of Fallot
Which heart defect is associated with congenital rubella?
PDA
Ruby is the color of love. public displays of affection.
Which heart defects are associated with Turner’s syndrome?
coarctation of the aorta
bicuspid aortic valve
Which cardiac conditions are associated with marfan’s? & ehlers danlos?
aortic root dilation aka ascending thoracic aortic aneurysm
increased risk for aortic dissection
MVP
aortic insufficiency (regurg)
Diabetic moms have increased risk of children with what?
transposition of the great vessels.
Friedrich’s ataxia is associated with what?
hypertrophic cardiomyopathy
What are the features that are shared by Marfan syndrome and homocystinuria?
pectus deformity tall stature with high arm/height ratio larger lower segment than upper segment arachnodactyly joint hyperlaxity skin hyperelasticity scoliosis
What are the features of Marfan syndrome that distinguish it from homocystinuria?
autosomal dominant
normal intellect
lens dislocation
aortic root dilation
What are the features of homocystinuria that distinguish it from Marfan’s syndrome?
autosomal recessive intellectual disability thrombosis megaloblastic anemia fair complexion
When can PDA be beneficial? What is it associated with? What does the murmur sound like?
beneficial in R–>L shunts blue babies
associated w/ congenital rubella
sounds like a continuous machine like murmur
What is the presentation of PDA?
may be asymptomatic accentuated increased pulses if large-can get CHF tachypnea, tachycardia, poor feeding, FTT can lead to Eisenmenger
WHat is the workup and treatment of a PDA?
dx: via ECHO
treatment: usu closes in a few weeks
can ligate surgically if it doesn’t close or use indomethacin
keep it if they have R–>L shunt.
what is an ASD? Which types are most common? associations?
endocardial cushion defect
ostium secundum is most common-90%
ostium primum is second most common-seen in down syndrome
What is the murmur and presentation of ASD?
split S2-delayed closure of the pulmonary valve b/c of increased blood in the R heart
fixed splitting of S2
presentation-fixed split S2, paradoxical emboli
What is the most common congenital heart defect and what is it associated with?
VSD
associated with FAS, vascular rings
What can improve vascular rings stridor?
extension of the neck and racemic epi
What is the VSD murmur?
2/6 harsh, holosystolic LLSB (T)
diastolic rumble over cardiac apex
What is the presentation of VSD?
asymptomatic at birth pulmonary resistance drops... can get CHF tachypnea, tachycardia, poor feeding, FTT Eisenmenger Need ECHO may need repair surgically
What is Still’s murmur?
benign murmur that is 2/6 low frequency midsystolic murmur at LLSB
just reassure
if harsher, holosystolic, 3/6 then think VSD.
What are the features of Tetrology of Fallot?
Overriding aorta
Pulmonic stenosis
RVH
VSD
Which conditions is tetrology of fallot associated with ?
22q11 down syndrome alagille syndrome (aut dom)
What is the murmur and presentation of tetrology of fallot?
VSD murmur T spot 3/6 harsh holosytolic murmur
Pulmonic stenosis murmur: harsh systolic ejection murmur at LUSB (P)
boot shaped heart on CXR
kids squat during a cyanotic spell
What is the appropriate treatment for tetrology of fallot?
surgery before 6 months
Who gets transposition of the great vessels? Murmur?
maternal diabetes
22q11
Murmur: Single S2, VSD murmur
Presentation and treatment of transposition of the great vessels?
cyanosis with RVH
egg on a string Xray
PGE2
then surgical correction-make a VSD or ASD. Mix the blood.
What’s the deal with tricuspid atresia?
need both an ASD and VSD to survive
hypoplastic RV, tricuspid valve fails to develop, L axis deviation
decreased pulmonary artery development–see fewer markings on CXR
PGE2 until surgery
What’s the deal with TAPVR?
all 4 pulmonary veins return to the right atrium
get RA and RV enlargement–>RVH and R axis deviation
CXR: cardiomegaly, increased pulmonary markings
diastolic and systolic murmur–b/c increased flow across tricuspid and pulmonary valves.
What is the presentation of coarctation of the aorta?
lower extremity hypoperfusion (cyanosis) and acidosis
won’t have equal palpable femoral pulses
adults-rib notching HTN in upper extremities
get RAAS activation HTN b/c of decreased renal perfusion
keep ductus arteriosus open with PGE2.
Central cyanosis w/o murmur?
hypoplastic left heart
benign condition that presents with soft systolic murmur heard best at LUSB (P) w/ radiation to both axilla?
peripheral pulmonary stenosis
due to acute angle of R & L pulmonary arteries.
What is the murmur of a bicuspid aortic valve? what can it lead to?
S2 click
aortic stenosis, aortic regurg, aortic root dilation
What is Ebstein’s anomalY?
due to maternal lithium usage
malformed tricuspid valve is in the RV
get tricuspid regurg and RA enlargement
What would an EKG of ebstein’s anomaly show?
R axis deviation
tall p waves from RA enlargement
What is the murmur of MVP? Which conditions may cause this?
mid systolic click. More severe with earlier click. Marfarns, Ehlers Danlos, OI ADPKD
What is the treatment for MVP?
beta blockers if there is chest pain
but really nothing helps.
Which conditions are associated with mitral regurg?
infective endocarditis
acute rheumatic heart dx
tuberous sclerosis
What is the presentation, complications, and treatment of mitral regurgitation?
holosystolic blowing murmur
this increases with squatting and expiration (like most murmurs)
can get volume overload and L-sided heart failure
need valve replacement
Which condition can cause a rhabdomyoma in children?
benign hamartoma of cardiac muscle
associated with tuberous sclerosis
What are the features of tuberous sclerosis?
HAMARTOMAS
ash leaf spots (white leaf patches over body)
renal angiomyolipoma
mitral regurgitation
rhabdomyoma
seizures
subependymal astrocytoma
angiofibromas in butterfly pattern on face
shagreen patches-orange dimply leathery spots on the face.
AUTOSOMAL DOMINANT
Where can HOCM murmurs be heard?
apex
LLSB
What does valsalva do to preload? Which murmur increases with it?
increases intrathoracic pressure
decreases preload
increases HOCM murmur
Which murmurs increase with inspiration? expiration?
increases with inspiration-R sided murmur
increases with expiration–L sided murmur
ASD V. VSD?
ASD-fixed split S2.
Other disorders that can cause tetrology of fallot and transposition of the great vessels?
cru di chat
trisomy 13/18
bounding peripheral pulses?
truncus arteriosus, pda
What are some arrhythmias associated with ebstein’s anomaly?
SVT
WPW
Causes of aortic stenosis?
- calcific
- congenital
- rheumatic fever
- infective endocarditis
5 tertiary syphilis
pulvus parvus et tardus?
weak pulses with delayed peak
aortic stenosis
Wide pulse pressure
water hammer pulse
aortic regurgitation water hammer (corrigan's) Austin flint: low pitched diastolic rumble
Causes of mitral regurgitation?
endocarditis (s. aureus) papillary muscle rupture ischemia chordae tendinae rupture myxomatous degeneration rheumatic fever marfan's cardiomyopathy tuberous sclerosis
