Cardiovascular 1 Flashcards
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?
Aortic dissection or rupture
(increased risk of bicuspid aortic valve and coarctation of the aorta)
signs of heart failure like poor perfusions, gallop and rales in the setting of upper respiratory symptoms are concerning for?
myocarditis
workup of viral myocarditis
ECG
Cardiac Enzymes
Chest X-Ray: cardiomegaly and pulmonary edema (bilateral hazy opacities)
ECHO: decreased ejection fraction with hypokinesis
diagnosis of myocarditis
Endomyocardial biopsy OR cardiac MRI
treatment of myocarditis
diuretics, ACE inhibitors, ionotropes, IVIG (all supportive measures)
rapid deceleration can exert what 3 forces on the aorta leading to blunt thoracic aortic injury
shearing, torsional, and stretching forces
what is the most common site of blunt thoracic aortic injury
aortic isthmus which is the transition between the ascending and descending aorta
complete aortic rupture is a tear of the
intima, media and adventitia that leads to rapid death
incomplete aortic rupture leads to
(tear through intima and media)
- creating a false lumen
2 . obstructive intimal flap or hematoma that stops blood flow with proximal hypertension and distal hypotension - compression and stretching of surrounding structures like the left recurrent laryngeal nerve causing a hoarse voice
diagnosis of aortic injury (blunt trauma, dissection) is with?
CT angiography of the chest
with emergent surgical evaluation
prosthetic heat valves are at high risk for?
infective endocarditis
risk of infective endocarditis is increased following which invasive procedures with a prosthetic heart valve?
dental work that penetrates the apical tooth like a dental cleaning
respiratory procedures
skin/soft tissue procedures in active infection
GI/GU procedures
how do you combat infective endocarditis in prosthetic heart valve following dental work
prophylactic antibiotics administered 30-60 minutes
oral amoxicillin (One 2 gram dose) in dental and respiratory procedures
IV vancomycin in skin/soft tissue infections
what is an innocent murmur
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
what are the 3 most common innocent murmurs
- still murmur
- pulmonic flow murmur
- Venous hum
what is still murmur
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
what is pulmonic flow murmur
an innocent murmur that is a systolic ejection of the left upper sternal border that can radiate to the axilla
what is a venous hum murmur
an innocent murmur that is continuous in nature best heard over the clavicular area with decreased intensity with neck radiation
laying supine, valsalva and standing do what to the heart
decrease venous blood return to the heart
treatment of an innocent murmur?
reassurance because they typically resolve by adolescence
treatment of infected gangrene with signs of systemic infection
amputation of the foot promptly to prevent overwhelming sepsis
indications for leg amputation
nonrevascularizable limb ischemia
unsalvageable soft tissue damage
life threatening infection (infected gangrene)
what is a left ventricular aneurysm
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
clinical symptoms of a left ventricular aneurysn
months after an MI will present with
heart failure (JVD, pulmonary edema)
+/- angina , ventricular arrhythmia, stroke
ECG findings in left ventricular aneurysm
persistent ST elevation and deep Q waves in leads corresponding to the previous MI
how is a left ventricular aneurysm diagnosed
ECHO: thinned and dyskinetic myocardial wall
what are the signs of a right ventricular infarction
hypotension
JVD
clear lung fields
ST elevation in the inferior leads (II, III, AVF)
cough, progressive dyspnea, and orthopnea are consistent with ?
pulmonary edema
cough, progressive dyspnea, and orthopnea with new Atrial Fibrillation and rapid ventricular response is consistent with
pulmonary edema with rapid decompensation
what is Rheumatic mitral stenosis
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
diagnosis and treatment of mitral valve stenosis (mostly caused by rheumatic fever)
diagnosis: echo
treatment: loop diuretics and rate control , anticoagulants
constrictive pericarditis can be caused by radiation therapy - what is constrictive pericarditis
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)
symptoms of constrictive pericarditis
fatigue, dyspnea on exertion, cirrohosis, JVD, heptajugular reflux, kussmaul sign (increase in JVP on inspiration) pericardial knock, peripheral edema,
imaging for constrictive pericarditis
CXR: pericardial calcifications
ECHO: confirms diagnosis and shows increased pericardial thickness, abnormal septal motion, biatrial enlargement
treatment of constricitve pericarditis
temportary: diuretics
longterm: pericardiectomy
a patient with sudden onset chest pain that radiates to the back with associated syncope is concerning for?
acute aortic dissection
hypotension, JVD and muffled heart sounds are?
Becks triad suggestive of cardiac tamponade
what is the most common cause of death in type A aortic dissection
dissection into the pericardium that results in blood in the pericardium and cardiac tamponade
if tamponade occurs in the setting of aortic dissection what operation can make it worse
pericardiocentesis because it can worsen bleeding and extension of the dissection
how do we treat aortic dissection with cardiac tamponade?
preform a transesophageal echocardiography (TEE) rapidly to confirm the plane of the aortic dissection and surgically repair
Persistent pulmonary hypertension of the newborn
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.
findings in persistent pulmonary hypertension of the newborn
decreased postductal relative to preductal saturation
prominent s2
can have cyanosis and respiratory distress
what are some risk factors for persistent pulmonary hypertension of the newborn
pulmonary hyperplasia, infection, meconium aspiration
treatment of persistent pulmonary hypertension of the newborn
oxygen and ventilation
inhaled nitric oxide to vasodilate pulmonary vasculature
in a patient with shock a central venous catheter is placed to measure central venous pressure with measures what?
it measures the pressure in the SVC which approximated right atrial pressure aka preload
a low CVP (low preload) is reflective of what kinds of shock
hypovoluemic or distributive shock
an elevated CVP (high preload) is reflective of what type of shocl
cardiogenic or obstructive
blunt cardiac injury can cause what kind of shock
cardiogenic (elevated CVP and refractory hypotension)
can aortic dissection cause ST elevation on ECG?- abrupt onset chest pain
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
patient with exertional dyspnea, pounding heart sensation (can feel heart pounding) and widended pulse pressure most likely have ?
chronic aortic regurgitation
what is the pathogenesis of chronic aortic regurgitation?
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
cause of chronic aortic regurgitation
aortic root dilation, congenital bicuspid valve, rheumatic heart disease
the widened pulse pressure in aortic regurgitation causes what?
a water hammer or corrigan pulse which is a rapid upstroke followed by a rapid collapse of a peripheral pulse
describe the murmur of Aortic regurgitation
early diastolic high pitched decrescendo murmur
patients with periperative myocardial infarction may lack?
chest pain and can develpo cardiogenic shock
pulmonary capillary wedge pressure estimates what
left atrial pressure (preload)
if a patient has High blood pressure and is on OCPs what do you do first
stop OCPS
what is the most common peripheral artery aneurysm ?
politeal artery
when people have a popliteal artery aneurysm you should screen what
other arteries with ultrasound like abdominal aorta. iliac and femoral vessels
