Cardiovascular Flashcards
Congenital heart defects
Etiology Differentials Defining characteristics Diagnostic criteria Management
Murmurs
Etiology Differentials Defining characteristics Diagnostic criteria Management
Hypertension
Etiology: Primary does not have a disease cause (but may be d/t weight, FH, etc.) SBP more indicative of primary HTN Secondary HTN causes: renal disease, scarring from previous pyelo, coarctation of aorta, endocrine d/o, genetic d/o (Williams synd., neurofibromatosis, tuberous sclerosis, CNS tumors); DBP more indic. of secondary Differentials Defining characteristics: <13yo Elevated BP is 90-95th%tiles Hypertension is between 95-99th%tiles for age, gender, height Stage 2 HTN 99th% + 5hmmHg 13yo+ (120-129/80 is elevated)(>130/80 is HTN stage I)(>140/90 stage II) Diagnostic criteria: High BPs on three separate occasions Management: Stage I- repeat manually, repeat in 1-2 weeks and av. readings Stage II- repeat manually, refer or reeval in 1 week Diagnostics to r/o secondary causes (ex: renal), comorbidities, end organ damage. If <10yo, refer to cardiologist May be bruits in abd. or flank areas
Rheumatic fever
Etiology: presents usually in ages 5-15yo 2 weeks after s. pyogenes (GBA) infection Differentials: congenital heart disease, isolated valve changes, infective endocarditits, annular dilation with L heart dilation, cardiomyopathy Defining characteristics: Recent strep infection Diagnostic criteria: major: carditis, arthritis, chorea, erythema marginatum, subQ nodules; minor: oligoarthraliga, fever, sedimentation rate >60 and/or C-reactive protein >3, prolonged PR interval Management: Antibiotics (PCN, then erythro, then azithro preferred in order); NSAIDs for joint sx; corticosteroids for severe carditis; chest xray, echo, EKG Complications: CHF from valvular changes
Rate and rhythm changes
Etiology Differentials Defining characteristics Diagnostic criteria Management
Myocarditis
Etiology Differentials Defining characteristics Diagnostic criteria Management
Hypercholesterolemia
Etiology Differentials Defining characteristics Diagnostic criteria Management
Kawasaki disease
Etiology:
Differentials: viral or bacterial infections, toxin-mediated diseases, hypersensitivity reactions
Defining characteristics: acute, generalized systemic small and medium vessel vasculitis; macrophages and neutrophils infiltrate vasculature and necrosis of vessel layers ensues. Luminal myofibroblastic proliferation involving cytotoxic T lymphocytes.
Diagnostic criteria persistent fever for 5 days AND four of the following: bilateral conjunctival inj., lips/oral cavity changes, cervical lymphadenopathy, polymorphous exanthema (rash), edema hands/feet. LABS: albumin <3, urine >10 WBC, platelets <450k after 7d of fever, anemia, WBC <15, elevated ALT. SUBACUTE phase: desquamation of skin over fingertips, thrombocytosis, cardiac disease, arthralgias
Management
Coarctation of the aorta
May be diminished or absent femoral pulses and impulse lag if radial is assessed simultaneously SBP in RIGHT upper extr. may be 20mmHg greater than lower extr.
Heart sounds
S1: Mitral and tricuspid valves closing. Loudest at the apex; synchronous with apical and carotid pulses S2: Aortic and pulmonic valves closing. Can split with inspiration in kids. Loudest at Upper LEFT sternal border. Wide split S2s may indicate inc. pulmonary flow S3: Rapid ventr. filling, “gallop,” heard at apex with diaphragm, loudest in L lateral (Sounds like Kentucky combined with S1 and S2) S4: always pathologic; inc. atrial force and ventr. distention. “Gallop” sounds like Tennessee. Heard just before S1. Low pitched, heard at apex with bell Clicks are high frequency. Pulmonic ejection clicks may sound like split S1, disappear with inspiration. Aortic ej. clicks heard at Erb point between S1 and S2. Nonejection clicks are heard at apex with leaning/standing, disappear with inspiration and d/t mitral valve prolapse.
Rheumatic fever can cause:
Heart damage, major joints pain, chorea (Chorea is a movement disorder that causes involuntary, irregular, unpredictable muscle movements. or look restless or fidgety), erythema marginatum (pink blanching papules or macules, nonpruritic), subQ nodules
Heart sound locations
All People Enjoy Time Magazine Aortic (L sternal) Pulmonic (R sternal border) Erbs point (L 3rd space) Tricuspid (R 4th sternal border) Mitral (5th medial to midclavicular)
