FM/IMC Flashcards
? is the MC type of cardiomyopathy
What PE heart sound is associated w/ this MC
What causes this to occur
Dilated
S3 (fluid overload) w/ low EF
Damaged myocardium weakens, causes all chambers to dilate
Dilated cardiomyopathy is characterized by ?
What two factors increase these Pts risk for sudden cardiac death
What is the best way to Dx this condition
Dec contraction and systolic dysfunction
Ventricular enlargement, Progressive HF
Echo showing LV dilation w/ EF <50%
What is seen on CXR of dilated myopathy
What is seen on PE
How is Dilated Cardiomyopathy Tx and cardiac out put increased
Balloon-heart w/ megaly/pulm congestion
Displaced apical impulse
Inc JVP
Large liver
Edema
Loop+ACEI+BB; Inc CO w/ Digitalis;
Transplant/LVAD
What duo is characteristic for HOCM
How does this present on PE
How is this murmur changes
Septal hypertrophy >1.5cm w/ ventricular outflow obstruction mimicking AS; diastolic dysfunction d/t autosomal dominant mutation of sarcomeres
Bifid pulse
Medium pitched, cres-decrescendo
Prominent A-wave- atria contracting against closed valve
S4 gallop w/ apical lift
Inc w/ dec volume: valsalva, standing, tachycardia
Dec w/: squat, grips
How is HOCM Tx
What drugs are avoided in HOCM and what drug is c/i
Define Restrictive Cardiomyopathy
Metoprolol/Verapamil- dec contractility/HR
ICD if syncope/sudden arrest
Surgical/Alcohol ablation of septal hypertrophy
Dec preload: Nitrate ARB Diuretic ACEI;
Digoxin- inc contractility will inc obstruction
Right HF d/t non-compliant ventricals w/ dec diastolic filling
What is heard on PE of restrictive myopathy
Half of these cases are caused by ?
How is restrictive cardiomyopathy Dx
P-HTN; S4 d/t stiff/thick ventricle
Idiopathic
Echo w/ cardiac cath- high atrial pressure
Uncertain= MRI to eval texture
What is seen on EKG of restrictive myopathy
What is seen on Echo
How is restrictive cardiomyopathy Tx
Non-specific, abnormal ST/T wave w/ low voltage
Dilated atria, Hypertrophy
Diuretics if edema/congestion
Define ASD
ASDs are the ? MC congenital heart Dz and place Pts at risk for ?
ASD Sxs are dependent on size and Sxs don’t present until ? age
Interatrial septal hole- diastolic L to R shunt w/ volume overload of R side (atrial contracted= RV vol overload)
2nd (VSD is 1st); paradoxical emboli
ASx <30
>30: dyspnea, angina
>50: Afib, RVF
What is heard on PE for ASDs
What may be seen on EKG if shunt is significant enough
What will be seen on CXR if ASD is present
Wide, fixed S2 (lub dub-dub) w/ systolic murmur at P-area
P-HTN- pulmonic ejection murmur
RAD, RVH, RBBB- rSR pattern in V1
Megaly w/ R side dilation
Prominent pulm artery w/ inc vasculature
Most ASDs will spontaneously close if ? size or by ? age
When is surgical closure indicated
Pts w/ ASDs are c/i from ? hobby
<3mm; 3-8mm- by 3y/o
RV overload on Echo at 2-6y/o
Diving
Define PDA
What do these sound like
What can be the reporting c/c of PDAs
PD- normal fetal structure connecting PA w/ aorta to bypass lungs causing L to R shunt
Systolic, machinery murmur w/ thrill at P-area w/ wide pulse pressure and low DBP; accentuates in late systole
LE cyanosis, FTT, Tachy/Tachy
What is seen on PE or PDAs
How are these Tx
? is the MC pathologic murmur of childhood
Wide pulse pressure w/ low DBP
Premature: Indomethacin w/ fluid restriction
Surgical/Catheter closure
VSD (ASD- 2nd MC)
Define VSD
What do these sound like
How are these Tx
L-R ventricular shunt overloading pulm artery (P-HTN)
Holosystolic murmur on L sternal border
Watch- refer to Peds Cards for serial echos
Infants w/ large VSDs can develop ? issues and are Tx w/
If the above fails, when is surgical closure performed
? is the classic clinical presentation of Aortic Coarctations
CHF, growth retardation; Tx- Digoxin w/ diuretics
First 6mon
Arm BP > leg BP- Bounding arm pulses
Where do the majority of aortic coarctations occur
Half of the Pts will have ? valve defect that puts them at risk for ?
How are these Tx w/ surgical interventions and what are the indications for emergent closure
Below origin of L sublcavian artery
Bicuspid AV- leads to Berry aneurysm formation
Balloon angioplasty 2-4y/o;
Emergent- HTN Megaly CHF Shock
Neonates born w/ aortic coarctation need to have ductus arteriosus kept open w/ ?
What happens if these Pts live untreated
What is the only cyanotic, congenital heart Dz of blueprint
Prostaglandin E1
Death by 50y/o d/t Rupture, Dissection, CVA
Tetrology d/t R-L shunt through VSD
Why do Tetrology Pts need annual EKGs until Tx
Post-surgical survival is >80% but the MCC of death are ?
What complications can still exist after surgery
QRS lengthening d/t risk for sudden death
Sudden death, HF
HF, Arrhythmias, Residual obstruction, Pulm regurgitation
Define Primary HTN
Ranges for Normal, Elevated, Stage 1 and Stage 2 HTN
ACC/AHA and JNC 8 BP targets
SBP ≥130/DBP ≥80 on two readings on two visits
N: <120/80 and <80
E: 120-129 and <80
1: 130-39 or 80-89
2: ≥140 or ≥90
ACC/AHA: <130/80
JNC: <140/90 for all <60y/o;
<150/90 for all ≥60
How is Normal, Elevated, Stage 1 and 2 HTN Tx
N: lifestyle w/ f/u q12mon
E: lifestyle and f/u q3-6mon
Stage 1, <10%: lifestyle and f/u q3-6mon
Stage 1, >10%/CVD/DM/CKD: lifestyle w/ 1 med, f/u in 30d
Met- f/u q3-6mon
Not- f/u q30d until met
Stage 2: life style w/ 2 meds, f/u in 30d:
Met- f/u q3-6mon
Not- f/u q30d until met
What meds are used for HTN Tx in Non-Black or Diabetic Pts
What is used for black Pts
What is their BP target
ACE/ARB, Amlodipine, Thiazide-like/Indapamide
Stage 2= two meds from different classes
Thzd-type and/or CCBs
<130/80
S/e of CCBs for HTN Tx and specifically used for ?
S/e of ACE/ARB for HTN Tx and specifically used for ? and c/i during ?
S/e of using Spironolactone for HTN Tx
S/e: Edema; Angina pectoris
Proteinuria;
S/e: HyperK Angioedema Cough (c/i pregnancy)
HyperK
S/e of using BB for HTN Tx and are c/i during ?
Two s/e of using hydralazine for HTN Tx
When does USPSTF suggest HTN screenings to begin
Cause: Impotence; C/i: asthma
Lupus-like syndrome, Pericarditis
18y/o;
3y/o if conditions associated w/ HTN
Adults w/ RFs need to be screened for HTN ? often or ? previous measurement
How is BP taken and ? reading indicates need for more evaluation and work up
What PE finding can suggest HTN is present
q6mon; SBP 120-129
Pt rests x 5min
Cuff covers 2/3 of bicep
>15mmHg between both arms
AV nicking w/ fundoscopy- arteriole crosses venule causing compression and venous bulging
When does ACC/AHA suggest starting Rx management for HTN
What life style modifications are recommended to Pts
Define Secondary HTN and when is this Dx considered?
All Stage 2
Stage 1 w/: DMT2 CKDz ASCVDz/Risk ≥10%
DASH diet <2.3g Na/day M: two drink/day W: one drink/day PT 30min/day x 5d/wk
SBP ≥130/DBP ≥80 w/ an identifiable cause:
HTN refractory to meds