Cardiovascular Flashcards
1
Q
Cyanotic congenital heart defects
A
-All start with “T”
2
Q
Atrial Septal Defect
A
- Any defect in the atrial septum that allows flow
- Fetal physio: patency of foramen ovale allows R-L flow to bypass lungs.
- In adults, L pressure is greater than R pressure allowing flow to go from left to right. R pressures will start to rise and reverse the shunt, causing deoxygenated blood to flow to the body
- Sx: Fixed S2 split, midsystolic ejection murmur, enlarged RA and RV on CXR
- Tx: surgical closure
3
Q
Coarctation of the Aorta
A
- Narrowing of the aorta distal to take off of the left subclavian artery
- RFs: turner’s syndrome, males
- Workup: CXR (aortic knob, coarctation, dilated poststenotic aorta), echo, cardia cath
- Dx: disparity of BP between upper and lower extremities
- Sx: diminished femoral pulses, severe HTN, HA, epistaxis, claudication, continuous systolic murmur
- Tx: Surgery=resection with end to end anstomosis, subclavian artery flap, patch graft, interposition graft, percutaneous repair option
- Post op complications: parplegia, HTN, horner’s syndrome, injury to recurrent laryngeal nerve
4
Q
Ventricular Septal Defect
A
- Most common congenital heart defect
- High rate of spontaneous closure (if small)
- L to R shunt–> increased pulmonary blood flow
- Sx: LVH on EKG, enlarged LV on CXR
- Tx: intracardiac closure is TOC, transcatheter can also be used
5
Q
Patent Ductus Arteriosus
A
- Physiologic R to L shunt in fetal circulation connected the pulmonary artery to the aorta bypassing the lungs-Normally closes shortly after birth
- Prostaglandins maintain patency
- Will become L to R shunt after birth
- Sx: continuous “machinery” murmur, poor feeding, respiratory distress, CHF
- Dx: PE, echo, catheter
- Tx: indomethacin or other NSAIDs(inhibit prostaglandins), surgical ligation, percutaneous closure
6
Q
Tetralogy of Fallot
A
- Most common cyanotic congenital heart disorder
- Etiology: Misalignment of the infundibular septum in early development
- Tetrad:
- Pulmonary stenosis/obstruction of the R ventricular outflow
- Overriding aorta
- RVH
- Large VSD
- Sx: hypoxic spells, cyanosis, clubbing, murmur
- Dx: CXR, echo
- Tx: Intracardiac repair with closure of VSD and relief of pulmonic stenosis. May need re-op. In non-surgical candidates: subclavian artery to pulmonary artery shunt to get blood flow to the lungs.
7
Q
Pacemaker/AICD
A
- Pacemaker: Maintain HR when natural pacemaker is not fast enough or there is a block in the heart’s electrical conduction system
- AICD(automatic implantable cardioverter defibrillator): small battery powered electrical impulse generator implanted in pts who are at risk of SCD due to V fib and Vtach. It detects cardiac arrhythmia and corrects it by delivering jolt of electricity
- Procedure: anesthesia and possible IV abx. Large needle in a vein usually near the shoulder opposite dominant hand. Thread needle through vin to the correct place in the heart. X ray is used to guide. Incision is made in the chest or abdomen. Metal box goes in incision under the skin and connects to the wires.
8
Q
Coronary Artery Disease
A
- Atherosclerotic occlusive lesions of the coronary arteries
- Number 1 killer of men and women in the US
- 3 vessels most often affected: LAD, circumflex, and RCA
- RFs: HTN, smoking, high cholesterol/lipids, obesity, DM, FH, age (>45 for men, >55 for women), elevated CRP, metabolic syndrome, oral contraceptive use, estrogen deficiency
- Sx: CP, crushing pain, substernal SOB, nausea, upper abdominal pain, sudden death, fatigue, arm/shoulder/neck/back/jaw pain, dyspnea on exertion
- Labs: lipid panel, CMP, CBC, TSH, troponin/CKMB, EKG(ST depression indicates anginal episode, Q waves indicate previous MI)
- Dx tests: exercise stress test(horizontal or downsloping ST depression 1mm or greater is a positive test), echo(can show wall motion abnormalities) , ejection fraction, cardiac catheterization with coronary angiography
- Tx: B-blockers(first line therapy to reduce anginal episodes and improve exercise tolerance because they decrease heart rate and contractility), ASA, nitrates(vasodilators so decrease myocardial demand), HTN meds, statins (for regression of atherosclerosis), angioplasty(PTCA/balloon), PCI(stents; used on stenotic lesions of 70% or greater), CABG
- CABG= coronary artery bypass grafting
- Indications: left main disease, 2 or more affected vessels, unstable or disabling angina, postinfarct angina, coronary artery rupture/dissection/thrombosis after PTCA.
- Internal mammary pedicle graft and saphenous vein free graft are used most often
- Complications: hemorrhage, tamponade, MI, dysrhythmias, infection, graft thrombosis, sternal dehiscence, stroke
- Give ASA and B-blockers after operation
9
Q
Catheterization
A
- Gold standard dx test for CAD
- catheter is inserted in the femoral or radial artery and threaded up to the coronary arteries
- injection of contrast dye into the coronary arteries allows for visualization and quantification of stenotic lesions
- Risks: substantial radiation exposure and risk or contrast-induced nephropathy
10
Q
Aortic Stenosis
A
- Destruction and calcification of valve leaflets resulting in obstruction of left ventricular outflow–>pressure overload on the LV–>LVH
- Etiology: calcification, rheumatic fever, degenerative
- Sx: angina, dyspnea, exertional syncope, CHF, crescendo decrescendo systolic ejection murmur, S4, paradoxical splitting of S2, left ventricular heave or lift
- Workup: CXR, EKG, echo, cardiac cath
- Surgical Tx: valve replacement with tissue or mechanical prosthesis. Indicated if pt is symptomatic or valve cross sectional area is 50mmHg.
- Mechanical valves are more durable but require lifetime coagulation.
- If not a good surgical candidate: balloon aortic valvuloplasty.
11
Q
Aortic Insufficiency
A
- Incompetency of the aortic valve(regurgitant flow)
- Etiology: bacterial endocarditis, rheumatic fever, annular ectasia
- RFs: bicuspid aortic valve, connective tissue disease
- Sx: palpitations, dyspnea, orthopnea, fatigue, angina, increase in diastolic BP, decrescendo high pitch diastolic murmur, austin flint murmur, increased pulse pressure
- Dx: CXR, echo, catheterization
- Tx: aortic valve replacement. Vasodilators(nifedipine, ACEIs)-will delay the need for surgery
- Indications for surgery: symptomatic pt, LV dilatation, decreasing LV function, decreasing EF(less than 55%), acute onset
12
Q
Mitral Stenosis
A
- Calcific degeneration and narrowing of the mitral valve
- RFs: rheumatic fever
- Sx: dyspnea, SOB at night, pulmonary edema, increased left atrial pressure, hemoptysis, hoarseness, palpations, crescendo diastolic rumble murmur, opening snap heard after S2, irregular pulse, stroke
- Dx tests: echo, cath
- Indications for intervention: symptomatic, pulmonary HTN, mitral valve area <1cm/m squared, recurrent thromboembolism
- Tx: open heart surgery, balloon valvuloplasty, valve replacement
- Medical tx: diuretics
13
Q
Mitral Insufficiency(regurgitation)
A
- Incompetence of the mitral valve–>blood regurgitated into the LA during systole–>volume overload on LA, LV
- Etiology: mitral valve prolapse, rheumatic fever, post MI due to papillary muscle dysfunction/rupture, ruptured chordae
- Sx: often insidious; dyspnea, palpitations, fatigue, holosystolic murmur, S3
- Dx: echo, EKG
- Indications for treatment: symptomatic, LV>45mm
- Medical tx: afterload reduction with ACEIs/ARBs
- Tx: valve replacement, annuloplasty(suture prosthetic ring to the dilated valve annulus)
14
Q
Tricuspid Stenosis
A
- Narrowing of tricuspid valve(RA->RV)
- Etiology: occurs with mitral valve stenosis
- RFs: valve repair, carcinoid syndrome, female
- Sx: hepatomegaly, jaundice, JVD
- Dx: PE, EKG shows RAE, echo
- Tx: salt restriction and diuretics to diminish hepatic congestion, valve replacement
- May be progressive causing Right heart failure
15
Q
Tricuspid Insufficiency
A
- Inability of tricuspid valve to stay closed during systole–>blood reenters RA
- Etiology: rheumatic fever, pulmonary HTN
- Sx: fatigue, peripheral swelling, weakness, decreased urine output
- Dx: holosystolic murmur that is intensified during inspiration
- Tx: diuretics, tricuspid annuloplasty or valve replacement
