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Cardiovascular U World > Cardiovascular 1 > Flashcards

Cardiovascular 1 Flashcards

1
Q

All patients with turner syndrome require screening for cardiac diseases with a 4 extremity blood pressure, ECG and ECHO. The most serious life threatening cardiovascular complications in turner syndrome is?

A

Aortic dissection or rupture

(increased risk of bicuspid aortic valve and coarctation of the aorta)

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2
Q

signs of heart failure like poor perfusions, gallop and rales in the setting of upper respiratory symptoms are concerning for?

A

myocarditis

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3
Q

workup of viral myocarditis

A

ECG
Cardiac Enzymes
Chest X-Ray: cardiomegaly and pulmonary edema (bilateral hazy opacities)
ECHO: decreased ejection fraction with hypokinesis

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4
Q

diagnosis of myocarditis

A

Endomyocardial biopsy OR cardiac MRI

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5
Q

treatment of myocarditis

A

diuretics, ACE inhibitors, ionotropes, IVIG (all supportive measures)

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6
Q

rapid deceleration can exert what 3 forces on the aorta leading to blunt thoracic aortic injury

A

shearing, torsional, and stretching forces

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7
Q

what is the most common site of blunt thoracic aortic injury

A

aortic isthmus which is the transition between the ascending and descending aorta

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8
Q

complete aortic rupture is a tear of the

A

intima, media and adventitia that leads to rapid death

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9
Q

incomplete aortic rupture leads to

A

(tear through intima and media)

  1. creating a false lumen
    2 . obstructive intimal flap or hematoma that stops blood flow with proximal hypertension and distal hypotension
  2. compression and stretching of surrounding structures like the left recurrent laryngeal nerve causing a hoarse voice
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10
Q

diagnosis of aortic injury (blunt trauma, dissection) is with?

A

CT angiography of the chest

with emergent surgical evaluation

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11
Q

prosthetic heat valves are at high risk for?

A

infective endocarditis

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12
Q

risk of infective endocarditis is increased following which invasive procedures with a prosthetic heart valve?

A

dental work that penetrates the apical tooth like a dental cleaning

respiratory procedures

skin/soft tissue procedures in active infection

GI/GU procedures

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13
Q

how do you combat infective endocarditis in prosthetic heart valve following dental work

A

prophylactic antibiotics administered 30-60 minutes

oral amoxicillin (One 2 gram dose) in dental and respiratory procedures

IV vancomycin in skin/soft tissue infections

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14
Q

what is an innocent murmur

A

a murmur most commonly in children that is turbulent blood flow through a structurally normal heart

features
1. grade 1-2
2. Mid or early systolic in nature
3. vibratory of musical quality
4. splitting of 32

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15
Q

what are the 3 most common innocent murmurs

A
  1. still murmur
  2. pulmonic flow murmur
  3. Venous hum
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16
Q

what is still murmur

A

an innocent murmur that is systolic, vibratory murmur best heard over the left lower sternal border with increased intensity when supine (laying on back)

most common innocent murmur caused by turbulent left ventricular outflow

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17
Q

what is pulmonic flow murmur

A

an innocent murmur that is a systolic ejection of the left upper sternal border that can radiate to the axilla

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18
Q

what is a venous hum murmur

A

an innocent murmur that is continuous in nature best heard over the clavicular area with decreased intensity with neck radiation

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19
Q

laying supine, valsalva and standing do what to the heart

A

decrease venous blood return to the heart

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20
Q

treatment of an innocent murmur?

A

reassurance because they typically resolve by adolescence

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21
Q

treatment of infected gangrene with signs of systemic infection

A

amputation of the foot promptly to prevent overwhelming sepsis

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22
Q

indications for leg amputation

A

nonrevascularizable limb ischemia
unsalvageable soft tissue damage
life threatening infection (infected gangrene)

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23
Q

what is a left ventricular aneurysm

A

a late complication of a transmural MI (if there is a delay in coronary repurfusion it increases the risk of left ventricular aneurysm of occuring)

necrosed myocardium is replaced by scar tissue and causes much of the left ventricular wall to become convex and dyskinetic

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24
Q

clinical symptoms of a left ventricular aneurysn

A

months after an MI will present with

heart failure (JVD, pulmonary edema)
+/- angina , ventricular arrhythmia, stroke

25
Q

ECG findings in left ventricular aneurysm

A

persistent ST elevation and deep Q waves in leads corresponding to the previous MI

26
Q

how is a left ventricular aneurysm diagnosed

A

ECHO: thinned and dyskinetic myocardial wall

27
Q

what are the signs of a right ventricular infarction

A

hypotension
JVD
clear lung fields
ST elevation in the inferior leads (II, III, AVF)

28
Q

cough, progressive dyspnea, and orthopnea are consistent with ?

A

pulmonary edema

29
Q

cough, progressive dyspnea, and orthopnea with new Atrial Fibrillation and rapid ventricular response is consistent with

A

pulmonary edema with rapid decompensation

30
Q

what is Rheumatic mitral stenosis

A

a slow progressive disease that can present during pregnancy - stenosis of the mitral valve following group A strep infection

symptoms of pregnancy can be seen before symptoms of rheumatic mitral stenosis

31
Q

diagnosis and treatment of mitral valve stenosis (mostly caused by rheumatic fever)

A

diagnosis: echo
treatment: loop diuretics and rate control , anticoagulants

32
Q

constrictive pericarditis can be caused by radiation therapy - what is constrictive pericarditis

A

scarring and loss of normal elasticity of the heart (inelastic pericardium) will constrict venous return to the right side of the heart and cause right sided heart failure (JVD, dyspnea on exertion, fatigue)

33
Q

symptoms of constrictive pericarditis

A

fatigue, dyspnea on exertion, cirrohosis, JVD, heptajugular reflux, kussmaul sign (increase in JVP on inspiration) pericardial knock, peripheral edema,

34
Q

imaging for constrictive pericarditis

A

CXR: pericardial calcifications
ECHO: confirms diagnosis and shows increased pericardial thickness, abnormal septal motion, biatrial enlargement

35
Q

treatment of constricitve pericarditis

A

temportary: diuretics
longterm: pericardiectomy

36
Q

a patient with sudden onset chest pain that radiates to the back with associated syncope is concerning for?

A

acute aortic dissection

37
Q

hypotension, JVD and muffled heart sounds are?

A

Becks triad suggestive of cardiac tamponade

38
Q

what is the most common cause of death in type A aortic dissection

A

dissection into the pericardium that results in blood in the pericardium and cardiac tamponade

39
Q

if tamponade occurs in the setting of aortic dissection what operation can make it worse

A

pericardiocentesis because it can worsen bleeding and extension of the dissection

40
Q

how do we treat aortic dissection with cardiac tamponade?

A

preform a transesophageal echocardiography (TEE) rapidly to confirm the plane of the aortic dissection and surgically repair

41
Q

Persistent pulmonary hypertension of the newborn

A

a persistent opening of the ductus arteriosus known as PDA causes a right to left shunt. At birth typically pulmonary vacular resistance will decrease but in persistent pulmonary hypertension of the newborn PVR remains elevated and causes deoxygentaed blood from the pulmonary artery to mix with oxygenated blood in the aorta causing a lower post ductal (foot) saturation and strong pulses.

42
Q

findings in persistent pulmonary hypertension of the newborn

A

decreased postductal relative to preductal saturation

prominent s2

can have cyanosis and respiratory distress

43
Q

what are some risk factors for persistent pulmonary hypertension of the newborn

A

pulmonary hyperplasia, infection, meconium aspiration

44
Q

treatment of persistent pulmonary hypertension of the newborn

A

oxygen and ventilation

inhaled nitric oxide to vasodilate pulmonary vasculature

45
Q

in a patient with shock a central venous catheter is placed to measure central venous pressure with measures what?

A

it measures the pressure in the SVC which approximated right atrial pressure aka preload

46
Q

a low CVP (low preload) is reflective of what kinds of shock

A

hypovoluemic or distributive shock

46
Q

an elevated CVP (high preload) is reflective of what type of shocl

A

cardiogenic or obstructive

46
Q

blunt cardiac injury can cause what kind of shock

A

cardiogenic (elevated CVP and refractory hypotension)

47
Q

can aortic dissection cause ST elevation on ECG?- abrupt onset chest pain

A

yes, this would mean the dissection extended proximally to include the right coronary artery and cause a heart attack (type A dissection)

right ventricle MI (JVD and hypotension with clear lungs)

*can occur in pregnancy due to hormonal changes that alter aortic wall structure

48
Q

patient with exertional dyspnea, pounding heart sensation (can feel heart pounding) and widended pulse pressure most likely have ?

A

chronic aortic regurgitation

48
Q

what is the pathogenesis of chronic aortic regurgitation?

A

blood from LV leaks back into LA which causes an increase in end diastolic volume, myocardial hypertrophy and chamber enlargement. The increase in LV size brings the apex of the heart closer to the chest wall which makes you feel your heart beeting

49
Q

cause of chronic aortic regurgitation

A

aortic root dilation, congenital bicuspid valve, rheumatic heart disease

50
Q

the widened pulse pressure in aortic regurgitation causes what?

A

a water hammer or corrigan pulse which is a rapid upstroke followed by a rapid collapse of a peripheral pulse

51
Q

describe the murmur of Aortic regurgitation

A

early diastolic high pitched decrescendo murmur

52
Q

patients with periperative myocardial infarction may lack?

A

chest pain and can develpo cardiogenic shock

52
Q

pulmonary capillary wedge pressure estimates what

A

left atrial pressure (preload)

53
Q

if a patient has High blood pressure and is on OCPs what do you do first

A

stop OCPS

54
Q

what is the most common peripheral artery aneurysm ?

A

politeal artery

55
Q

when people have a popliteal artery aneurysm you should screen what

A

other arteries with ultrasound like abdominal aorta. iliac and femoral vessels

Cardiovascular U World (1 decks)

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