Chapter 8: High Yield Cardiac Flashcards
Chest pain <20 min. With exertion. EKG shows ST-segment depression
Stable angina.
Episodic chest pain unrelated to exertion - due to coronary artery vasospasm. EKG shows ST-segment ELEVATION due to transmural ischemia.
Prinzmetal angina
Occlusion of the left anterior descending artery (LAD) leads to infarction of the _____ [2].
Anterior wall and anterior septum of the LV. Most commonly involved artery in MI (45%).
Occlusion of right coronary artery (RCA) leads to infarction of the ______[3].
Posterior wall, posterior septum, papillary muscles of the LV.
Occlusion of the left circumflex artery leads to infarction of the ____[1].
lateral wall of the LV.
Gold standard laboratory test for MI
Troponin I. Levels rise 2-4 hrs after infarction, peak at 24 hrs, return to nml in 7-10 days. CK-MB is useful for detecting reinfarction (rise 4-6 hrs after infarction, peak at 24, return to nml in 72 hrs).
Left-sided heart failure tx
ACE inhibitor
‘Nutmeg’ liver, JVD, Dependent pitting edema.
Right sided heart failure
Hemosiderin-laden macrophages in the alveoli, dyspnea, paroxysmal nocturnal dyspnea, orthopnea
Left-sided heart failure
Eisenmenger syndrome
A left-to-right shunt reverses. Increased flow through the pulmonary circulation results in hypertrophy of pulmonary vessels and pulmonary htn. leads to late cyanosis with right ventricular hypertrophy, polycythemia, and clubbing.
A congenital left-to-right shunt. most common congenital heart defect. associated with fetal alcohol syndrome. Large defects can lead to Eisenmenger syndrome.
Ventricular Septal Defect. tx = surgical closure
Left-to-right shunt and split S2 on auscultation. Gives paradoxical emboli
Atrial Septal Defect (ASD). most common type is OSTIUM SECUNDUM. OSTIUM PRIMUM type is associated with DOWN SYNDROME
Holosystolic “MACHINE-LIKE” murmur.
PDA. Associated with CONGENITAL RUBELLA. Left-right shunt between aorta and pulmonary artery. Can lead to Eisenmenger syndrome, resulting in lower extremity cyanosis.
Treatment of a PDA
Indomethacin - decreases PGE.
Right-to-left shunt
Stenosis of the right ventricular outflow tract; right ventricular hypertrophy; VSD; and an aorta that overrides the VSD. “Boot-shaped” heart on x-ray
Tetralogy of Fallot. Pt learns to squat in response to a cyanotic spell; increases arterial resistance –> decreases shunting and allows more blood to reach the lungs
What disease is associated with Transposition of the Great Vessels
Maternal Diabetes
Single, large vessel arising from both venticles.
Truncus arteriosus
Location of coarctation of the aorta in the infantile form. _____ Disorder association?
Coarction lies after the aortic arch, but BEFORE the PDA. Associated with a PDA, and TURNER SYNDROME. Presents as lower extremity cyanosis in infants at birth
HTN in the upper extremities, hypotension with weak pulses in the lower extremities. Notching on the ribs. Associated with?
Adult form of coarctation of the aorta. Lies after the aortic arch. Get collateral circulation across intercostal arteries. ASSOCIATED WITH BICUSPID AORTIC VALVE
Jones Criteria
For dx of Acute Rheumatic Fever:
1. Evidence of prior group A beta-hemolytic strept infection (elevated ASO or anti-DNase B titers).
2. Minor criteria: fever and elevated ESR.
3. Major:
J: Joint - Migratory polyarthritis.
O: Heart. Endocarditis [mitral valve - small vegetations leading to regurgitation. Myocarditis with ASCHOFF BODIES (ANITSCHKOW CELLS) Pericarditis - leading to friction rub and chest pain
N: Nodels [Subcutaneous nodules
E: Erythema marginatum [annular, nonpruritic involving trunk and limbs]
S: Sydenham chorea [rapid, involuntary muscle movements]
Systemic complication of pharyngitis due to group A Beta-hemolytic strep. Children 2-3 weeks after strep pharyngitis. Caused by molecular mimicry –> BACTERIAL M PROTEIN.
Acute Rheumatic Fever
Stenosis with “FISH-MOUTH” appearance. Usually mitral valve - thickening of chordae tendineae and cusps. Occasionally aortic valve leading to fusion of the commisures.
Chronic Rheumatic Heart Disease. Complication = infectious endocarditis
Systolic ejection click followed by a crescendo-decrescendo murmur.
Aortic stenosis May lead to CONCENTRIC left ventricular hypertrophy, angina and syncope with exercise, and Microangiopathic hemolytic anemia [schistocytes]
Early, blowing diastolic murmur. Hyperdynamic circulation due to increased pulse pressure. Presents with bounding pulse [WATER-HAMMER PULSE], Pulsating nail bed [QUINCKE PULSE], and head bobbing.
Aortic Regurgitation. Results in LV dilation and ECCENTRIC hypertrophy
Mid-systolic click followed by a regurgitation murmur. Louder with squatting.
Mitral Valve prolapse. Due to myxoid degeneration of the valve.
Holosystolic “blowing” murmur. Louder with squatting and expiration.
Mitral Regurgitation. Results in volume overload and left-sided heart failure. Usually arises as a complication of mitral valve prolapse, LV dilation, ect
Opening snap followed by diastolic rumble
Mitral stenosis [usually due to chronic rheumatic valve diseae] Volume overload leads to dilation of the left atrium; Right-sided heart failure; A-fib
Most common cause of endocarditis. Results in small vegetations (subacute endocarditis)
Streptococcus viridans. infects previously damaged valves.
Most common cause of endocarditis among IV drug users. Targets tricuspid resulting in large vegetations that destroy the valve (acute endocarditis)
Staph. aureus
What is Staph epidermidis associated with
endocarditis of prosthetic valves
If the patient has endocarditis and underlying colorectal carcinoma, what bug do they have
Steptococcus bovis
Endocarditis with negative blood cultures
HACEK organisms (difficult to grow) Haemophilus, Actinobacillus, Cardibacterium, Eikenella, Kingella
Janeway lesions
Erythematous non-tender lesions on palms and soles –> Bacterial endocarditis
Osler nodes
Tender lesions on fingers or toes –> bacterial endocarditis
Splinter hemorrhages in nail bed
Due to embolization of septic vegetations in endocarditis
Sterile vegetations that arise in association with a hypercoagulable state or underlying adenocarcinoma. Arise on mitral valve along lines of closure and result in mitral regurgitation
Nonbacterial Thrombotic Endocarditis
Sterile vegetations that arise in association with SLE. Vegetations are present on the surface and undersurface of the mitral valve and result in mitral regurgitation.
Libman-Sacks endocarditis
Pt presents with CHF. Find low-voltage EKG with diminished QRS amplitude
Restrictive Cardiomyopathy
Benign mesenchymal tumor with gelatinous appearance and abundant ground substance on histo. Forms a pedunculated mass in the L atrium that causes syncope due to obstruction of the mitral valve
Myxoma
Benign hamartoma of Cardiac muscle. Associated with tuberous sclerosis. Usually in ventricle.
Rhabdomyoma.
“Holosystolic, high-pitched blowing murmur”
Mitral/tricuspid regurgitation
Crescendo-decrescendo systolic ejection murmur following ejection click
Aortic stensosis
Holosystolic, harsh-sounding murmur. located at tricuspid area.
VSD
Late systolic crescendo murmur with midsystolic click. best heard over apex. Loudest at S2.
MVP
Immediate high-pitched “blowing” diastolic murmur with a wide pulse pressure.
aortic regurg. can get bounding pulses and head bob
Follows opening snap. Delayed rumbling late diastolic murmur.
Mitral stenosis
Continuous machine-like murmur
PDA. loudest at S2
PCWP > LV diastolic pressure
Mitral stenosis
Infant of a diabetic bother
Transposition of great vessels
V1-V4
anterior wall - LAD
V1, V2
anterior septal - LAD
V4-V6
Anterolateral - LCX
I, aVL
Lateral wall - LCX
II, III, aVF
Inferior wall - RCA
