Cardiovascular wrong questiong review items Flashcards
Which murmurs get louder with squatting or handgrip and why?
Squatting increases venous return and increases reverse flow. Regurgitation murmurs such as AR, MR, and VSD get louder.
Which murmurs get softer with squatting?
HCOM and MVP
Most common ectopic foci causing Atrial Fibrillation
Pulmonary Veins.
Common location of cardiac myxomas
Left atrium, tend to present as mitral valve disease with dyspena, orthopnea, cough, pulmonary edema, hemptosys. Can be a nadir for clots and causes strokes.
Effect of atropine and vagal maneuvers on Mobitz I
Atropine blocks parasympathetic input, speeds up the heart and improves type I AV block. Vagal maneuvers increase parasympathetic tone and worsen type I AV block.
How do Nitrates improve angina?
They act as both venodilators and coronary artery vasodilators. It is the increase in capacitace vessels that decreases preload LVED volume. This inturn, lowers the myocardial oxygen demand by lowering wall stress.
Failure of hypotension to resolve after bolus or elevated CVP/PCWP
Consider myocardial contusion. Get cardiac markers and ECG to check for new LBBB or dysrhythmia.
Hx of URI followed by sudden onset of CHF
Viral myocarditis, most likely from Coxsackievirus B infection. On echo will show dilated ventricles and diffuse hypokinesia with systolic dysfunction.
Persistent localized ST elevation
Aneurysms.
Predictors of abdominal aneurysm rupture
Size, rate of expansion, and smoking.
Causes of viral myocarditis in peds
Coxsackie B virus and Adenovirus.
Tricuspid valve atresia
Presents as central cyanosis with Left axis deviation on ECG and decreased pulmonary markings.
Presentation of Digoxin toxicity
Nausea, vomiting, decreased appetite, confusion, and weakness. Can also present with visual symptoms such as scotoma, blurry vision, changes in color or blindness. Look for inciting event such as viral illness or excessive diuretic use.
Clinical presentation of Infective Endocarditis
Intermittent fever, fatigue, new holosystolic murmur, and positive blood cultures.
Empiric coverage for Infective Endocarditis
Vancomycin to cover MSSA/MRSA, streptococci, and enterococcus. If cultures come back positive for Viridans Streptococci, switch to either Penicillin G IV or IV Cextriaxone.
