Cardiovascular Flashcards
Viral Myocarditis
- -viral prodrome, then s/s of heart failure
- -dyspnea, syncope, tachycardia, n/v, hepatomegaly
Two most common etiologies?
Tx: inotropes and ?
Viral Myocarditis
–Coxsackie B, adenovirus
direct viral injury, autoimmune inflammation –> myocyte necrosis –> impaired systolic/diastolic fxn
respiratory distress due to left HF
hepatomegaly due to right HF
Tx: diuretics, inotropes
Ventricular Septal Defect (VSD)
- -left to right shunt
- -dyspnea, feeding difficulties, poor growth
Harsh holosytolic murmur heard where?
Diastolic rumble heard across what valve?
Which type is more likely to close (muscular or membranous)?
What parameter is the main determinant of shunt severity?
Ventricular Septal Defect
- -left to right shunt
- -dyspnea, feeding difficulties, poor growth, sweating, pulmonary infection, heart failure
- -harsh holosytolic murmur heard at left lower sternal border
- -diastolic rumble across mitral valve heard at apex
- -muscular VSD more likely to close than membranous VSD (more common)
Shunt severity
- -shunt increases as PVR decreases during first few weeks of life
- -increased PVR –> Eisenmenger Syndrome
Atrial Septal Defect
- -ostium secundum defect
- -exercise intolerance
- -widely split and fixed S2
- -ECG: RAD, RVH
- -often asymptomatic until 3rd decade
Systolic ejection murmur heard where?
Atrial Septal Defect
- -ostium secundum defect
- -exercise intolerance
- -systolic ejection murmur at left upper sternal border
- -widely split and fixed S2
- -ECG: RAD and RVH
Tetralogy of Fallot
Four components?
Where can the systolic ejection murmur be heard?
Rx to prevent closure of ductus arteriosus?
Tetraology of Fallot
- -pulmonary stenosis
- -RVH
- -VSD
- -overriding aorta
Systolic ejection murmur at left upper sternal border
*single S2
Pathophys Principles
- pulmonary stenosis, VSD –> R2L shunt
- hypercyanotic ‘tet’ spell: agitation, exertion –> increase PVR –> increase R2L shunt
- squatting –> increase SVR –> decrease R2L shunt
Diagnostic Features
- CXR: boot-shaped heart
- single S2
Tx
- lateral knee-chest position to increase SVR
- PGE-1 to prevent ductal closure
Dx?
- -most common cause of secondary HTN in children
- -causes renal HTN
- -usually affects right renal artery
- -“string of beads” appearance
- -hum or bruit heard at costovertebral angle
Fibromuscular Dysplasia
Hypertrophic Obstructive Cardiomyopathy
Mode of inheritance?
LVH –> LVOT obstruction
- How does squatting affect preload/afterload?
- How does Valsalva affect preload/afterload?
Tx
–what two classes of drugs?
Hypertrophic Obstructive Cardiomyopathy
MoI: AD
–African Americans
Pathophys Principles
1. LVH –> LVOT obstruction
- Maneuvers to increase preload or afterload –> increase LV cavity size –> decrease LVOT obstruction –> decrease murmur
- -squatting, hand grip, leg raise, supine
* squatting –> increase preload and afterload - Maneuvers to decrease preload –> decrease LV cavity size –> increase LVOT obstruction –> increase murmur
- -Valsalva, abrupt standing, nitroglycerin
Features
–palpitations, dizziness, syncope, risk of sudden death
Tx
- -beta blockers (propranolol)
- -Ca chnl blockers (verapamil)
Most common cyanotic heart disease in immediate newborn period (usually first few hours of life)?
Most common cyanotic heart disease after neonatal period?
Most common overall congenital heart lesion?
Congenital lesion associated with maternal rubella infxn?
Regurgitant lesion seen in Marfan, Ehlers-Danlos?
Transposition of the great arteries (TGA)
–most common cyanotic HD in immediate newborn period
Tetralogy of Fallot
–most common cyanotic HD after neonatal period
VSD
–most common congenital heart lesion
PDA
–associated with maternal rubella infxn
MVP
–Marfan, Ehlers-Danlos
Transposition of the great arteries (TGA)
What is the main defect?
Initial tx?
NB: more common in infant with diabetic mother
Transposition of the great arteries (TGA)
Pathophys Principles
- -aorta arises from RV; pulmonary artery from LV
- -2 parallel circuits; need foramen ovale and PDA for mixture of blood
Features
–severe cyanosis and tachypnea with PDA closure
CXR
–“egg on a string” heart (narrow mediastinum)
Tx
–PGE-1 to keep open PDA
Dx?
- -severe newborn cyanosis
- -CXR: decreased pulmonary blood flow
- -ECG: LAD, LVH
Tricuspid Atresia
Pathophys: no outlet from RA to RV
–systemic venous return enters LA thru PFO or ASD
Triad
- -severe newborn cyanosis
- -CXR: decreased pulmonary blood flow
- -ECG: LAD, LVH
- *LAD is specific to Tricuspid Atresia!
Tx
–PGE-1 to keep open PFO
Dx?
Association?
- -HTN in the upper body; hypoperfusion in the lower body
- -“differential cyanosis”
- -leg muscle fatigue
- -rib notching
Coarctation of the Aorta
(Infantile form)
*association with Turner Syndrome
*often involves bicuspid aortic valve
Pathophys
- narrowing is distal to aortic arch; proximal to PDA
- RV blood flows ax PDA to supply aorta
- collaterals develop between hypertensive and hypoperfused vessels
Presentation
- -differential cyanosis: upper body is pink; lower body is cyanotic
- -HTN in upper extremities
- -leg muscle fatigue
- -collaterals –> rib notching; continuous murmur heard all over chest well
Tx
- -PGE-1 ti keep open PDA
- -surgery
- -hearing loss
- -syncope, long QT
- -normal vitals and exam
- -family hx of sudden death
Dx?
MoI?
Tx (class)?
Jervell and Lange-Nielsen Syndrome
–form of congenital long QT syndrome
–AR
Tx: beta blockers
ECG
- -delta wave
- -shortened PR interval
- -widened QRS
Dx?
Wolff-Parkinson-White Syndrome
–accessory AV conduction pathway
Features
- -supraventricular tachycardia
- -otherwise healthy adolescent
- -chest pain, palpitations, syncope, cardiac arrest
ECG Triad
- -delta wave (sloped initial portion of QRS)
- -shortened PR interval
- -widened QRS
Three clues for an innocent murmur
- -asymptomatic (normal activity, eating, growth)
- -no family hx
- -what type of maneuvers will decrease murmur intensity?
Three clues for an innocent murmur
- -asymptomatic (normal activity, eating, growth)
- -no family hx
- -maneuvers that decrease venous return –> decrease murmur intensity
Breath-Holding Spell
–brief period of apnea and skin color change associated with an emotional trigger (crying, anger)
Association?
Breath-Holding Spell
- -brief period of apnea and skin color change associated with an emotional trigger
- -assoc w Fe-deficiency anemia
Endocardial Cushion Defect
Association?
Main pathology re: septal defect?
Endocardial Cushion Defect
*assoc w Down Syndrome
Pathophysiology
- -contiguous ASD and VSD
- -AV valve insufficiency
Features
- -heart failure in early infancy
- -hyperdynamic precordium (precordial bulge and lift)
- -diaphoresis and dyspnea with feeds
