Cardiovascular Flashcards
Benign murmur
History:
- asymptomatic
- no family history
- normal growth
Murmur:
- early or midsystolic
- musical or vibratory
- grade 1-2 intensity
- decreases or disappears with standing & valsalva maneuver
Others:
- normal vital signs
- normal S1 & S2
- symmetric pulses
Management:
- reassurance
Pathologic murmur
History:
- infants: poor weight gain, respiratory distress, difficulty feeding
- older children: exertional fatigue, chest pain, syncope
- family history of sudden cardiac death or congenital heart defect
Murmur:
- holosystolic or diastolic murmur
- harsh
- grade = or > 3 intensity
- intensity persist with standing & valsalva maneuver
Others:
- central cyanosis
- loud, fixed, or single S2
- weak femoral pulse
- hepatomegaly
Management:
- ECG & Echo
Common benign (innocent) murmur
- Still murmur:
- systolic, vibratory, best heard over LLSB, increase intensity when supine (best heard)
- common in young children
- resolve by adolescence
- due to turbulent LV outflow
- decrease intensity with decrease preload (valsalva/standing/squatting) - Pulmonic flow murmur:
- systolic ejection, best heard over LUSB, may radiate to axilla - Venous hum:
- continuous, best heard over the supra- or infraclavicular area, decrease intensity with neck rotation
- LLSB: left lower sternal border
- LUSB: left upper sternal border
Aortic coarctation
- continuous murmur
- best heard over the back
- result from flow through compensatory collateral vasculature
- lower extremity pressure is decreased compared to upper extremity pressure measurement.
- weak femoral pulses & upper extremity HTN
Aortic stenosis
Pulmonic stenosis
Etiology:
- congenital
- rarely acquired (carcinoid)
Clinical:
1. Severe: right-sided heart failure in childhood
2. Mild: symptoms(dyspnea) in early adulthood
3. Crescendo-decrescendo murmur ( increase on inspiration)
4. Systolic ejection click & widened split of S2
Diagnosis
- echo
Treatment:
- balloon valvulotomy
- surgical repair
Tricuspid atresia
Combination of:
1. Absent tricuspid valve
2. Atrial septal defect (ASD)
3. Ventricle septal defect (VSD)
Sign:
1. Tall P wave ( right atrial enlargement)
2. Left-axis deviation ( left-sided volume overload)
3. Decrease pulmonary markings on chest x-ray ( hypoplasia of right ventricle & pulmonary outflow tract)
Turner syndrome (45, X)
(short stature, webbed neck, broad chest with widely spaced nipples)
- should undergo cardiac evaluation ( echo, 4-extremity blood pressure)
associated with:
- Bicuspid aortic valve (BAV)
- coarctation of aorta
- Aortic dissection
- Horseshoe kidney
- Streak ovaries (amenorrhea, infertility )
Tetralogy of Fallot
- cyanotic congenital heart disorder
- due to RV hypertrophy, RV outflow obstruction, VSD, overriding aorta
- Associated with: DiGeorge syndrome ( chromosome 22q11.2 deletion), which present with cleft palate & craniofacial abnormalities (low-set ears, bulbous nose)
Mitral valve prolapse (MVP)
- Prevalent in patient with:
connective tissue disorder (Marfan syndrome, Ehler’s-Danlos syndrome) —> have tall stature.
Atrioventricular canal defect (AVCD)
-Due to abnormal endocardial cushion development
- anomalies in atrioventricular valve + atria septal defect + ventricular septal defect
- commonly seen with Down syndrome
Classification of stable angina
Classic:
1. Typical location (substernal), quality & duration
2. Provoked by exercise or emotional stress
3. Relieved by rest or nitroglycerin
Atypical:
- only 2 out of the 3 characteristics of classic angina
- example: an epigastric burning provoked by exertion (heavy lifting) & relieved over several minutes by rest
Non-anginal:
- only 1 of the 3 characteristic of classic angina
Diagnosis:
- INITIAL: exercise stress ECG
- FOLLOWED BY: coronary angiography
- or exercise stress echo (to diagnose ischemic heart disease)
Screening: abdominal aortic aneurysm
- men (age 65-75) ± smoking history ± no smoke, but have family history (first degree with AAA rupture)
- one time abdominal duplex ultrasound
- surgical repair of AAA (> 5.5 cm)
Cardiovascular risk of non-cardiac surgery
( preoperative cardiovascular risk assessment)
6-risk predictors:
1. High-risk surgery (vascular,intra-thoracic)
2. Ischemic heart disease
3. History of congestive heart failure
4. History of stroke of TIA
5. Diabetes treated with insulin
6. Preoperative creatinine > 2
Risk for cardiac death, nonfatal cardiac arrest, nonfatal MI:
- if 0-1 factors: low risk
- if > 2 factors: high risk
can go to surgery without further testing
1. Low risk patient
2. Increased risk patient with adequate functional capacity > 4 metabolic equivalents (METs)
Coronary angiography
Indicated for:
1. Unstable angina
2. Acute MI
3. Abnormal stress testing (for stable angina)
