Cardiovascular Flashcards
Coarctation of Aorta
Presentation
- acyanotic, CV collapse (neonate), CHF (infant), arterial HTN/murmur (child)
- delayed, weak femoral pulses
PP:
- inc LV afterload w/SNS activity and RAAS activation leading to HTN, LVH, CHF
- 70% also have bicuspid aortic valve
Difference in pulses and/or blood pressure in upper vs. lower extremity
Imaging:
- rib notching
- figure 3
Infants: FTT, poor feeding, shock
Systolic murmur radiating to back/scapula
Mgmt:
- surgical repair
- balloon angioplasty +/- stent
- Prostaglandin E1 reduces symptoms and improves lower extremity blood flow
Tetralogy of Fallot
MC congenital
R to L shunt = Cyanosis **
- VSD
- RV outflow obstruction (pulmonary stenosis)
- Overriding aorta
- RV hypertrophy
Sxs:
- hypoxic spells, tachypnea
- systolic ejection murmur mid/upper LSB and DOE
CXR: boot shaped heart, decreased pulmonary vascular markings
Mgmt:
- treat hypoxic spells w/squatting (increase SVR) or Morphine
- surgical repair between 3-24mo
Aortic aneurysm
RF:
- atherosclerosis (MC)
- smoking, hyperlipidemia, Marfan’s, syphilis
PP: proteolytic degeneration of aortic wall, connective tissue and inflammation/immune response
Sxs:
- asx until rupture
- rupture: severe back/abdominal pain, syncope or hypotension, with tender pulsatile mass
- a/w unilateral groin/hip pain
Dx:
- Abd U/S*
- CT - choice for thoracic aneursym
- Gold: angiography, often used before surgical intervention
Mgmt:
- > 5.5cm or 0.5cm expansion in 6 mo = immediate surgical repair
- > 4.5cm = vascular surgeon refer
- 4-4.5cm = US q 6mo
- 3-4cm = US q year
BB - reduce shearing force, decrease expansion and rupture risk
Aortic dissection classification
Stanford:
- A: ascending; ascending + descending
- B: descending
Debakey
- Type 1: ascending, descending
- Type 2: ascending
- Type 3: descending
Aortic dissection
RF: HTN, Marfan, Ehler Danlos, 50-60yo
PP: tear in aortic intima d/t cystic medial necrosis
- blood under high systemic pressure flows into the media at the point of tear causing false lumen
Sxs:
- chest pain: tearing, ripping, knife
- dec peripheral pulses; differences between R/L
Ascending: acute new-onset aortic regurgitation
Descending: back pain, HTN
Dx:
- CT w/contrast
- Gold: MRI angio (if hemodynamically stable)
- TEE
- CXR: widening mediastinum
Mgmt:
- acute proximal = surgical
- descending = med (esmolol, labetalol)
Peripheral arterial disease
Sxs:
- intermittent claudication
- resting leg pain: advanced disease
Dx:
ABI
- normal: 1-1.2
- <0.9 diagnostic
Gold: arteriography
Mgmt:
- cilostazol*
- other plt inhibitors: aspirin, clopidogrel
- revascularization: percutaneous transluminal angioplasty; bypass grafts; endarterectomy
Cardiac tamponade
- muffled heart tones
- distended neck veins
- hypotension
ECG: diffuse ST elevation
Echo: RV collapse during diastole
Mgmt: pericardiocentesis
Pericardial effusion
Low grade fever
Pleuritic sharp chest pain relieved with leaning forward; aggravating lying supine
Friction rub
PP: inflammation of heart lining
- idiopathic
- viral
- bacteria
ECG: low voltage QRS, electrical alternans
Echo: fluid in pericardial space seen in front of RV
Mgmt:
- NSAIDs
- activity restriction
Large: pericardiocentesis
