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Cardiovascular Flashcards

1
Q

What is the leading cause of mitral valve stenosis and valve replacement in adults in the US?

A

acute rheumatic fever

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2
Q

What are the valves that get replaced with acute rheumatic fever?

A

1st mitral valve, 2nd aortic valve, 3rd tricuspid alve

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3
Q

When does rheumatic fever develop?

A

in children and adolescents following pharyngitis with group A beta-hemolytic streptococcus

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4
Q

The presence of what protein is seen with acute rheumatic fever?

A

the presence of the M protein is the most important virulence factor for group A streptococcal infection in humans and anti-M antibodies against the streptococcal infection may cross-react with heart tissue

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5
Q

When is the peak incidence of acute rheumatic fever?

A

ages 5-15 years

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6
Q

What is the jones criteria (major)?

A 
carditis
chorea
erythema marginatum 
polyarthritis 
subcutaneous nodules
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7
Q

What is the jones criteria (minor)?

A 
arthralgia 
elevated ESR or C-reactive protein 
fever
prolonged PR interval (on ECG)
leukocytosis
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8
Q

What is cardiac rhythm may patients with rheumatic heart develop?

A

atrial fibrillation

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9
Q

What is the tx of acute rheumatic fever?

A

pcn and asa

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10
Q

What is an atrial septal defect?

A

noncyantoic foramen ovale fails to close

Ostium secundum is most common

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11
Q

What are the physical exam findings of an atrial septal defect?

A
  • wide fixed, split, second heart sound (S2)
  • systolic ejection murmur at second left inutersotals space with an early to mid-systolic rumble
  • failure to thrive
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12
Q

How is an atrial septal defect dx?

A

best diagnosed by passing a catheter through defect

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13
Q

What is the tx for an atrial septal defect?

A

symptomatic: diuretics, ACE inhibitors, digoxin
definitive: surgical closure

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14
Q

When is a coarctation of the aorta found?

A

noncyantoic - typically found just after the vessels are given off to the left arm

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15
Q

What does coarctation of the aorta cause?

A

high blood pressure, as the kidney do not “see” as high of blood pressure as they would like

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16
Q

What does coarctation of the aorta lead to?

A

release substances to raise the pressure/renine

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17
Q

How old is a person with coarctation of the aorta?

A

in their teens, twenties need to r/o in a young adult with HTN

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18
Q

What are the key findings of coarctation of the aorta?

A

elevated blood pressure in the arms with a low blood pressure in the legs
-pulses in the leg may be decreased in intensity or delayed compared with their occurrence in the arm

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19
Q

What is heard on physical exam with coarctation of the aorta?

A

ejection murmur is heard at the aortic area and the left sternal border that radiated into the left axilla and left back

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20
Q

What is seen in 50% of cases with coarctation of the aorta?

A

a bicuspid valve - also increase incidence of cerebral berry aneurysm

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21
Q

How is coarctation of the aorta dx?

A
  • 1st echocardiogram
  • EKG = LVH
  • CXR = rib notching “figure of 3 sign”
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22
Q

What is the tx of coarctation of the aorta?

A
  • prostaglandins E1

- generally, require surgical repair with dilating the segment with balloons

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23
Q

What is hypertrophic cardiomyopathy?

A
  • genetic condition autosomal dominant
  • the most common cause of sudden death in young athletes
  • 2.8 times more common in young athletes vs non-athletes
  • Marfan’s syndrom
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24
Q

What is seen on EKG with hypertrophic cardiomyopathy?

A

12 lead EKG practice test

-LVH on EKG

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25
What occurs in the heart in a person who has hypertrophic cardiomyopathy?
LV myocardium becomes hypertrophied leading to outflow obstruction sxs
26
What are the symptoms of hypertrophic cardiomyopathy?
SOB, chest pain, syncopal episode after exertion
27
What is are the physical exam findings of a hypertrophic cardiomyopathy?
systolic murmur left sternal border/loud S4 (outflow obstruction) - the cardiac murmur will sound similar to the murmur of aortic stenosis - however, a murmur due to HCM will increase in intensity with any maneuver that decreased the volume of blood in the left ventricle - increase with standing increase with Valsalva - decreased with squatting - in contrast, standing up results in decreased venous return and thus decreased preload - with less preload there is less blood to separate the anterior leaflet from the hypertrophied septum, resulting in more obstruction and hence increased intensity of the murmur
28
How is hypertrophic cardiomyopathy dx?
echocardiogram, MRI
29
What is the tx of hypertrophic cardiomyopathy?
- beta-blockers + disopyramide (nor pace) - calcium channel blockers - diuretics should be avoided
30
What is Kawasaki disease?
a vasculitis mostly affecting children where the immune system attacks arteries, taming endothelial cells of blood vessels
31
What is the first sign of Kawasaki disease?
lasting fever
32
Who does Kawasaki disease most often affect?
kids younger than 5 years old and boys
33
What is Kawasaki disease characterized by?
CRASH and burn (fever) - Conjunctival injection (spares limbus) - Rash (all body parts, flakes) - Adenopathy (enlarged lymph nodes, cervical) - Strawberry tongue - Hand and foot rash - fever (5 or more days that doesn't resolve with antipyretics) 25% of patients have cardiac sequelae - coronary artery aneurysm in 25% of patients and may lead to death - myocarditis - myocardial infarction
34
What is the presentation of Kawasaki disease?
- 5 days or more of high fever, arthritis may be reported - bilateral non-purulent conjunctival injection - erythematous morbilliform rash with desquamation on the trunk that may spread - may also be urticarial or erythema multiform-like - non-vesicular - erythema and swelling of the hands and feet with desquamation - oral mucositis - red cracked lips - strawberry tongue - asymmetric cervical adenopathy - firm, unilateral, and nontender
35
What is the dx of Kawasaki disease?
diagnostic criteria = four of five CRASH symptoms + high fever lasting five days - vasculitis in coronary arteries is a definitive sign - it is possible to have cases that do not meet all clinical diagnostic requirements
36
What are the lab findings of Kawasaki disease?
- increased inflammatory markers - increased C-reactive protein - increased erythrocyte sedimentation rate - increased platelet count (often at weeks 2-3) - increased white blood cells with a shift to left - increased liver transaminases - echocardiography for all patients with Kawasaki disease to assess for cardiac abnormalities - obtained at time of diagnosis and again at 2 and 6-8 weeks after diagnosis
37
What is the tx of Kawasaki disease?
include both intravenous immunoglobulin (IVIG) and aspirin | -self limited and resolves in 6-8 weeks or without treatment but 25% risk of heart complications if left untreated
38
What is a patent ductus arteriosus?
ductus arteriosus is a normal fetal structure | -if it remains open it's called a patent ductus arteriosus
39
How do patients with a patent ductus arteriosus present?
3-6 week infants can present with tachypnea, diaphoresis, inability or difficulty with feeding, and no weight gain -low birth weight premature infant adults with PDA may present with signs and symptoms of heart failure
40
What is heard on physical exam in a person with patent ductus arteriosus?
rough "machinery" murmur late in systole at the time of S2 making it loud -murmur is best heard at the pulmonic area 2nd ICS left sternal border and inferior to the clavicle bounding pulses and a widened pulse pressure
41
What will close a patent ductus arteriosus?
because prostaglandin E-2 is responsible for keeping the ductus patent - inhibitors of prostaglandin will close it -this is why NSAIDS are the treatment and are contraindicated in pregnancy
42
How is a patent ductus arteriosus diagnosed?
echocardiogram
43
What is the tx of patent ductus arteriosus?
indomethacin has been used to help close a PDA?
44
What is syncope refer to?
a transient loss of consciousness/postural tone secondary to an acute decrease in cerebral blood flow
45
What is syncope characterized by?
a rapid recovery of consciousness without restriction
46
What is the most common cause of syncope?
vasovagal, idiopathic
47
What are the red flags of syncope?
syncope during exertion, multiple recurrences in short time, heart murmur/structural heart disease, old age, significant injury during syncope, family hx of unexpected death/extertional/unexplained recurrent syncope
48
What is syncope usually from?
insufficient cerebral blood flow/from benign causes
49
What is the less common cause of syncope?
cardiac arrhythmia
50
What is vasovagal syncope?
(neurocardiogenic) most common cause
51
What is cardiac syncope?
arrhythmias (AV block, sick sinus syndrome), obstruction of blood flow (aortic stenosis, hypertrophic cardiomyopathy), massive MI
52
What is orthostatic hypertension?
defect in vasomotor reflexes, common in elderly, diabetics, patients taking certain medications (diuretics, vasodilators)
53
What is a rare cause of syncope?
cerebral vascular disease
54
What are some other noncardiogenic causes of syncope?
metabolic causes (hypoglycemia, hyperventilation), hypovolemia (hemorrhage), hypersensitivity (syncope precipitated by wearing a tight collar or turning the head), mechanical reduction of venous return (valsalva maneuver, postmicturition), and various medications (Beta-blockers, nitrates, antiarrhythmic agents)
55
How is syncope dx?
ECG, glucose, pulse ox, echo, tilt table, CNS imaging = rare
56
What is the tx for syncope?
fix the underlying cause
57
What is the presentation of tetralogy of fallot?
difficult feeding, failure to thrive, "tet spells" = a baby with cyanosis and loss of consciousness with crying
58
What are the features of tetralogy of fallot?
PROVe - pulmonary stenosis - right ventricular hypertrophy - overriding aorta - ventricular septal defect
59
What are the physical exam findings of tetralogy of fallot?
crescendo-decrescendo, holosystolic at LSB radiating to the back
60
What is chest radiography of tetralogy of fallot?
boot shaped heart
61
What is the most common pathologic murmur in childhood?
ventricular septal defect
62
Where is the hole or "defect" in the heart muscle with a ventral septal defect?
between the ventricles (the intraventricular "septum")
63
What can be a complication of ventral septal defect?
the heart can dilate, the muscle can become weak, and the pressures in the pulmonary arteries can increase (pulmonary hypertension) due to the increase in blood flow
64
What are the physical exam findings of ventral septal defect?
loud, harsh, holosysoltic murmur, left to right - heard best at the lower left sternal border
65
What are some characteristics of ventral septal defect?
- like ASD's, the size and therefore the clinical course of these defects is quite variable - some remain large, while others become smaller over time - it is not unusual for small-to-medium-sized VSD's to eventually close spontaneously
66
How are ventral septal defects dx?
echocardiogram
67
What is the treatment of ventral septal defects?
most close by age 6, surgery if large

Peds EOR (12 decks)

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