Heart Flashcards
What quality and regularity of pulses are observed in aortic stenosis
Pulsus parvus et tardus (pulses are weak and late)
= narrow pulse pressure
What are signs and symptoms of heart disease (7)
Dyspnea, peripheral edema, chest pain, palpitations, hemoptysis, syncope, fatigue
Which valve problem has a wide pulse pressure
Aortic insufficiency
“Water-hammer pulse”
What does the apical impulse feel like in LVH
Increased and displaced laterally
What may be palpated in RVH
A parasternal heave
Studies used in detection of heart disease
CXR, ECG, echocardiography, cardiac catheterization
Which two drugs are used for cardiotonic effects in cardiac arrest
Epinephrine, calcium
Which drug reverses bradycardia from cardiac arrest
Atropine
How can the myocardium be protected from ischemia in cardiopulmonary bypass
Hypothermia and cardioplegia
When is surgery indicated for aortic stenosis
Presence of symptoms
Angina, syncope, dyspnea
Myxomatous degeneration, aortic dissection, bacterial endocarditis, rheumatic fever, or aortic root aneurysm may cause what
Aortic insufficiency
What signifies the severity of aortic insufficiency
The duration of murmur during diastole
Symptomatic aortic insufficiency with LVEF <50% and LV dilation requires what intervention
Aortic valve replacement surgery
Triad of apical diastolic rumble, opening snap and loud S1 indicates what
Mitral valve stenosis
Tx of mitral stenosis in less severe cases
More severe cases?
Less: commissurotomy (open or balloon mitral valvuloplasty)
More: mitral valve replacement
Leaflet thickening (proteoglycans) and chordae elongation is called what, and where is it commonly seen
Myxomatous degeneration
Commonly in mitral insufficiency
Dyspnea on exertion, fatigue, palpitations with holosystolic blowing murmur that radiates to axilla
Mitral valve insufficiency
Most important diagnostic test for mitral insufficiency
Echocardiography
Most accurate diagnostic test for tricuspid stenosis and insufficiency
Cardiac catheterization
What syndrome can produce pulmonic stenosis
Carcinoid syndrome
What causes multiple valvular disease
Rheumatic fever
TR and TS rare without mitral involvement
What ECG changes may be seen in CAD
ST segment changes, T wave changes
Which test evaluates induction of angina
Exercise stress test
Which test delineates ischemic and infarcted areas of myocardium
Radio thallium scan
Which two studies provide the most accurate info on the extent of CAD
Cardiac catheterization
Coronary angiography
When is coronary obstruction physiologically significant on angiography
50% narrowed diameter
Surgical Tx for CAD
Balloon angioplasty with stenting (single vessel disease)
Coronary artery bypass grafting (triple vessel)
When is CABG preferred to catheter-based interventions
Anatomic considerations like chronic total occlusions, left main stenosis, extensive lesions
What is the conduit of choice for CABG
Internal mammary artery
Which MI complications warrant surgery
Ventricular aneurysm, ruptured ventricle, ruptured interventricular septum, mitral valve papillary rupture
Which type of heart tumor is most common
Metastatic tumor
Where do most metastatic heart tumors arise
Melanoma, lymphoma and leukemia
Tx of cardiac tumors
Surgical excision if possible
Signs of pericardial tamponade
Distended neck veins, hypotension, pulsus paradoxus, distant heart sounds
Workup for blunt trauma to the sternum
ECG, cardiac enzymes, echocardiogram, cardiac catheterization (if new murmur).
What may new murmurs indicate in blunt trauma and what is the tx
Valve rupture requiring surgical repair or replacement
Tx for pericardial effusion
Pericardiocentesis or pericardiostomy
How are chronic pericardial effusions managed
Pericardiotomy via thoracotomy or sternotomy
Possible causes of pericarditis
Bacterial, viral infections, uremia, trauma, malignant disease, connective tissue disorders
Tx for chronic constrictive pericarditis
Pericardiectomy
Which first trimester infection may cause congenital heart disease
Rubella (togavirus) can cause patent ductus arteriosus
What are the signs of congenital heart disease
Easy fatigability, poor feeding and weight gain, pulmonary infections, cyanosis
What is the best study for congenital heart disease
Echocardiography
Tx for PDA and indications
Ligation of the ductus
in premature infants with pulmonary dysfunction, CHF in first year of life, persistence until age 2-3
Headaches, epistaxis, lower extremity weakness, dizziness
Symptoms of coarctation
Which procedure is used to define the location of coarctation
Cardiac catheterization
Possible surgical tx of coarctation includes
End to end anastomosis
Prosthetic patch graft
Subclavian flap procedure
What can occur secondary to uncorrected ASD
Pulmonary vascular obstructive disease
Systolic murmur in L 2nd intercostal space
Fixed split S2
ASD
Diagnosis of ASD from cardiac catheterization comes from what observation
Step-up in oxygen saturation between VC and right atrium
Tx of ASD
Surgical closure before school age
Percutaneous closure possible in cath lab
What is Eisenmenger’s syndrome
Irreversible pulmonary vascular obstructive disease leading to reversal of flow across VSD
When is closure of a septal defect necessary
When pulmonary blood flow is 1.5-2x greater than systemic blood flow
What are the major causes of death in TOF
Cerebrovascular accidents and brain sepsis
What tx can be performed in TOF before definitive correction
A systemic to pulmonary shunt
What tx can be performed in TGA before definitive correction
Balloon atrial septostomy
To increase mixing of blood
Tx of mitral valve regurgitation
Annuloplasty
Preferred to valve replacement
