Cardiovascular Flashcards
Systolic ejection crescendo-decrescendo best heard at pulmonic area. Widely fixed, split S2
Atrial septal defect
Usually asymptomatic until > 30 y/o
Atrial septal defect
Diagnosis of atrial septal defect
CXR: cardiomegaly
ECG: incomplete RBBB
Echo: gold standard
Management of atrial septal defect
Spontaneous closure likely in first year so may observe if small
Surgical correction if symptomatic
Bilateral lower extremity claudication
Coarctation of the aorta
Systolic blood pressure in upper extremities > lower extremities, delayed or weak femoral pulses
Coarctation of the aorta
Systolic murmur that radiates to the back/scapula/chest
Coarctation of the aorta
Diagnosis of coarctation of the aorta
- CXR: rib notching - “3” sign
- ECG: LVH
- Angiogram: gold standard, CT scan
Management of coarctation of the aorta
Surgical correction
Balloon angioplasty, prostaglandin E preoperatively
Continuous machinery murmur loudest at pulmonic area
Patent ductus arteriosus
Bounding pulses, wide pulse pressure
Patent ductus arteriosus
Pulmonary hypertension - left to right shunt switches and become right to left shunt (cyanotic). Normal hands with cyanotic lower extremities (clubbed, blue toes)
Eisenmenger’s Syndrome
Patent Ductus Arteriosus
Ventricular Septal Defect
Tetralogy of Fallot
Diagnosis of patent ductus arteriosus
- CXR: normal or cardiomegaly
- ECG: LVH, left atrial enlargement
- Echo: gold standard
Management of patent ductus arteriosus
IV indomethacin - closes
Surgical correction if fails
Most common cyanotic heart disease overall
Tetralogy of Fallot
Tet spells - period of episodes of cyanosis relieved with squatting or putting an infant’s knees to its chest
Tetralogy of Fallot
4 components of tetralogy of fallot
- RV outflow obstruction - pulmonary artery stenosis
- RV hypertrophy
- VSD
- Overriding aorta
Harsh holosystolic murmur at left upper sternal border, right ventricular heave
Tetralogy of fallot
Diagnosis of tetralogy of fallot
- CXR: boot shaped heart
- ECG: right ventricular hypertrophy
- Echo - gold standard
Management of tetralogy of fallot
Surgical repair performed in first 4-12 months of life
Most common type of congenital heart disease
Ventricular septal defect
Most common type of ventricular septal defect
Perimembranous
Loud high-pitched harsh, holosystolic murmur at the lower left sternal border
Ventricular septal defect
Diagnosis of ventricular septal defect
- CXR: RV hypertrophy
- Echo: preferred over cath
- ECG: OVH, RAE/LAE
- MRI: only if echo nondiagnostic
- Cardiac cath - if other tests fail
Management of ventricular septal defect
Most will close spontaneously within 10 years
Restrictive VSD (left > right pressure) associated with good prognosis
Surgery - patch closure
Acute autoimmune inflammatory multi-systemic illness mainly affecting children 5-15 y/o
Acute rheumatic fever
Complications of rheumatic fever
Cardiac
Rheumatic valvular disease - mitral MC, then aortic
Diagnosis of rheumatic fever
Jones criteria
Signs/symptoms of rheumatic fever
- Polyarthritis
- Active carditis
- Erythema marginatum (rash)
Management of rheumatic fever
- Aspirin
- Penicillin G
+/- corticosteroids if severe and with carditis
Warm + CREAM
Kawasaki Disease
Fever + 4 of the following:
Conjunctivitis
Rash
Extremity changes: edema, erythema of palms and soles
Adenopathy
Mucous membranes: pharyngeal erythema, lip swelling and fissures, strawberry tongue
Diagnosis of Kawasaki Disease
ESR/CRP elevated Leukocytosis Increased platelets Normochromic normocytic anemia Echo and angiography needed if heart involvement
Management of Kawasaki Disease
IV immunoglobulin
High dose aspirin
Most common initial complaint of hypertrophic cardiomyopathy
Dyspnea
Harsh systolic crescendo-decrescendo murmur at lower left sternal border
Hypertrophic cardiomyopathy
HCM will have decreased murmur intensity with:
Squatting, supine, handgrip
HCM with have increased murmur intensity with:
Valsalva and standing, exertion
Diagnosis of HCM
Echo
ECG: LVH
Management of HCM
Avoid exertion, implantable defibrillator
Beta blockers
Surgical: myomectomy, EtOH ablation
