Cardiovascular

Question 1

How do you treat hypertrophic cardiomyopathy?

Answer 1

1st line: beta-blockers
2nd line: d/c BB and start CCB (verapamil)

IF medical therapy fails:
- Surgical removal of hypertrophic tissue
Pacing and
- implanted defibrillator (ICD) may be necessary

Question 2

What is the typical patient presentation of hypertrophic myopathy?

Answer 2

Sudden cardiac death in young athletes!

Question 3

What are the S/SXS of hypertrophic cardiomyopathy?

Answer 3

Physical exam:

• Sustained apical impulse (lasts longer than systole)
• Prominent “a” wave (abnormal jugular venous pulse caused by the right atrium contracting against resistance)
• Bisferiens carotid pulse (a double peak per cardiac cycle)
• Loud S4 Systolic murmur that decreases with squatting

Question 4

What are the Ix/results for hypertrophic cardiomyopathy?

Answer 4

Chest x-ray
– typically negative

ECG:

• LV hypertrophy
• Exaggerated septal Q waves

Echo:

• Will confirm diagnosis
• LVH
• Small LV

Question 5

Kawasaki disease: clinical presentation

Answer 5

Fever +:

• Bilateral, nonexudative conjunctivitis
• Oral mucous membrane changes: Erythema of pharynx, erythema/fissured (cracked) lips, Strawberry tongue
• Peripheral extremities: erythema of palms/soles, edema of hand/feet (acute phase), perlungual (pealing skin at finger/toes nails)
• Polymorphous Rash
• Cervical lymphadenopathy (>1 node >1.5cm diameter)

Question 6

Kawasaki disease: Ix/Dx

Answer 6

Dx is Clx:

fever >5 days + 4/5 other clinical features

Question 7

Kawasaki disease: Tx/Mx

Answer 7

• IVIG 2g/kg, over 8-12 hrs w/in first 10 days of illness; or more if vasculitis/systemic inflammation persists (ex. fever)
• HD ASA in acute phase (80-100 mg/kg/day) OR lower dose of 30-5-mg/kg/day, up to 4g/day; decreased to 3-5 mg/kg/day 48hrs after fever resolution

Question 8

Dx of mitral regurgitation

Answer 8

Dx:

LVH & left axis deviation on ECG

Question 9

Atrial septal defect - Clinical Hx

Answer 9

• often asymptomatic in childhood

Question 10

Atrial septal defect - Physical Exam

Answer 10

2-3/6 pulmonic outflow murmur, widely split and fixed S2

o If large ASD –can have signs of HF (tachypnea, FTT, hepatomegaly, pulmonary rales/retractions)

Question 11

Atrial septal defect - Ix

Answer 11

ECG:
- RAD, mild RAH, RBBB
CXR:
- increased pulmonary vasculature, cardiac enlargement
Echo:
- test of choice*

Question 12

Atrial septal defect - Mx

Answer 12

elective surgical or catheter closure b/t 2-5 yrs of age

Question 13

Description of innocent/functional murmurs

Answer 13

• Hx/PE: asymptomatic
• systolic ejection murmur
• <3/6, soft/vibratory
• N S2 (no splitting)
• no extra sounds
• murmur varies w/ change of position