Cards Flashcards
What is the leading cause of mitral valve stenosis and valve replacement in adults in the US
Acute Rheumatic fever
What protein is most important virulence factor for group A streptococcal infections
M protein
what is the jones criteria
cardial manifestions for rheumatic fever
Major: Carditis, chorea, erytehma marginatum, polyarthritis, subcutaneous nodule
Minor: arthralgia, elevated ERS or CRP, fever, prolonged PR interval, leukocytosis
what is the treatment of acute rheumatic fever
PCN and ASA
what is a noncyanotic heart condition when the foramen ovale fails to close.
ASD
what murmur is heard with an ASD
Wide fixed, split S2.
Systeolic ejection murmurat the second left intercostal space with an early to mid-systolic rumble
what is the treatment for ASD
symptomatic: Diuretics, ACEi, digoxin
Definitive: surgical closure
what is a noncyanotic heart condition that causes high blood pressure in UE, and low BP in LE
coarctation of the aorta
what murmur is heard with coarctation of the aorta
ejection murmur heard at the aortic area and LSB that radiates into the left axilla and left back
how is coarctation of the aorta diagnosed
definitive dx with echo or CT/MR angiography
EKG - LVH
CXR: notcing of ribs, “figure of 3 sign”
what is the treatment for coarctation of the aorta
balloon angioplasty with stent placement of surgical correction
when is surgery done for coarctation of the aorta
between ages of 2-4yo
what should be administered to neonates with aortic coarctation
Prostaglandin E1 to keep ductus arteriosus open
what occurs with Coarctationo of the aorta is left untreated
adults die by age of 50yo due to arotic rupture, CVA or aortic dissection
what is the most common cause of sudden death in young athletes
Hypertrophic cardiomyopathy
What murmur is heard with Hypertrophic cardiomyopathy (HOCM)
systolic murmur at LSB/ loud S4
increases with standing and valsalva, decreases with squatting
How is HOCM diagnosed
ECHo and MRI
what is the treatment for HOCM
BB + Disopyramide
CCB
what medication class should be avoided with HOCM
Diuretics
what is Kawasaki disease
vasculitis mostly affecting children where the immune system attacks arteries, damaging endotherlial cells of Blood vessels
what is the pneumonic for Kawaskaki disease
CRASH and burn
- conjunctival injection (spares limbus)
- Rash (all body parts; flakes)
- Adenopathy (enlarged cervical lymph nodes)
- Hand and Foot rash
- Fever (5 or more days that doesnt resolve with antipyretics)
what is the presentation of Kawasaki disease
5 days or more of high fever
bilat non-purulent conjunctival injection
erytheamtous morbiliform rash
oral mucositis
asymmetric cervical adenopathy
how is kawasaki disease diagnosed
4 of 5 CRASH symtpoms + high fever lasting 5 days
Increase CRP, ESR
Increased platelet count
increase WBCs with left shift
Increase liver transaminases
Echo
what is the treatment for Kawasaki disease
IVIG and ASA
self-limited and resolved in 6-8 weeks with or without tx but 25% risk of heart complications if left untreated
What is a PDA
ductus arteriosus is a normal fetal structure - if it remains open, its called a PDA
what is the presentation of a PDA
3-6 week infants can present with tachypnea, diaphoresis, inability or difficulty with feeding and no weight gain
what is the murmur heard with a PDA
rough “machinery” murmur late in systole at the time of S2 making it loud
best heard at the pulmonic area, 2nd ICS LSB
how is a PDA diagnosed
ECHO
what is the treament for PDA
indomethacin
what are red flags of syncope
syncope during exertion
multiple recurrences in short time
heart murmur/structal heart disease
old age
significant injury during syncope
fhx unexpected death/exertional/unexplained recurrent syncope
what are the types of syncope (5)
- vasovagal
- cardiac
- orthostatic hypotension
- cerebral vascular disease
- orther non-cardiogenic causes
how is syncope diagnosed
ECG
glucose
pulse ox
echo
tilt table
CNS imaging (rare)
What is a cyanotic heart condition
Tetralogy of fallot
what is the presentation of tetralogy of fallot
difficult feeding, FTT
“tet spells”
Four features: PROVe
what are the four features of tetraology of fallot
PROVe
- pulmonary stenosis
- RVH
- overriding aorta
- VSD
what murmur is heard with tetralogy of fallot
crescendo-decrescendo, holosystolic at LSB radiating to back
what is seen on CXR with tetralogy of fallot
Boot shaped heart
what is the most common pathologic murmur in childhood
Ventricular septal defect
what murmur is heard with VSD
Loud, harsh, holosystolic murmur, left to right
best heard at the LLSB
How is VSD diagnosed
ECHO
what is the treatment for VSD
most close by age 6, surgery if large
