HEART Flashcards
VALVE AREA > 1.5CM2 AND < 25 mmHg is defined as (mild/moderate/severe) grade aortic stenosis
mild- no restriction Suggest annual physical and echo
VALVE AREA 1.0CM2-1.5CM2 AND aoritc pressure 25-40 mmHg is defined as (mild/moderate/severe) grade aortic stenosis
moderate- low intesnity sports as long as does no abnormal heart rhythms, BP, ST changes.
VALVE AREA < 1cm2 >40mmHg is defined as (low/moderate/severe) grade aortic stenosis
severe- cannot play * Moderate with symtpoms also cannot play
In what circumstanes would athlete with MVP be resticted from sport?
Moderate to severe Regurg Famly History of MVP death history of cardiac syncope ventricular arrythmias
ARVD athletes recomendations for sport
Cannot compete in endurance or competitive sport. Can participate in low intensity recreational sport.
Most common form of SCD > 35 yrs
CAD
Coronary arty risk score >___ should have LV function. assessed
100
EF < ___% with exercse is considered substantial risk factor for athletes with CAD
50%
Anybody with MI should refrain from vigorous physical activity for at least __ week
4
How can one try to differeiante Athletic heart vs HCM
Athletic heart- Increased wall thickness and increased cardiac chamber volume HCM- increased wall thickness and decreased cardiac chamber volume
When should you screen someone for LV function ?
asymptomatic patient with diabetes starting a vigorous exercise program. or men >45 and woman >55 previously sedimentary starting rigours exercise program
Athlete with 145/90 during screening physical allowed to play?
Stage 1 or 2 htn, no restriction as long as no end organ damage. May not participate until BP well controlled if has end organ damage
What is the recomended study for pediatric athletes with HTN
renal ultrasound
What is recomended for children >95% or 90-94% with DM or renal disease?
echocardiogram
BP meds recomended for athletes?
ARBS, ACE, and CCB
Most common arrhythmia in athletes
A-fib
Can athletes with a-fib play competative sport?
as long as no structural heart disease
How doese exercise relate to A-fib
vigorous exercise proportional to prevalence
One lab to order with AFib?
TSH
Medication managment for athletes with A-fib?
Beta blocker Avoid collision sports if starting on Blood thinners
RTP after A-fib ablation
4-6 weeks
After diagnosis of Myocarditis should refrain from strenuous activity for _____
6 months
Commotio Cordis as result of what kind of irregular heart rhyth
v-Fib , right before T wave
Presentation of Anomalous CA
SCD, exertional CP, syncope, and pre syncope
Workup for Anomalous CA
Coronary artery angiography
Anomalous CA can RTP how long after correct surgery?
None until 3 months after surgery
What are EKG signs for ARVD
T wave inversion V1-V3 followed by flat or downsloping ST segement
ARVD pathology
mutations in desmosomal proteins that replace muscle fibers with fibrofatty replacement usually in RV
Harsh crescendo-decrescendo systolic murmur R 2nd intercostal
Aortic Stenosis ( Squatting - increases preload) and will make it louder
decrescendo blowing diastolic murmur heard best at the left lower sternal border.
Aortic Regurgitation
Diastolic is the leafy valve letting blood back in the left ventricle
An innocent murmur can be any murmur excluding (diastolic/systolic)
diasystolic
Diastolic murmur lower left sternal border
Tricuspid stenosis
Systolic murmur upper left sternal border
Pulmonary stenosis
Diastolic murmur heard at apex w/ opening stap
Mitral stenosis
Snap is heard as LV trying to fill. after systole
Systolic injection murmur in a football physical. What could you do exacerbate the murmur if you are concerned for HCM?
Valsalva - decrease venous return/increases arterial resistance
Sitting to standing- decrease venous return
What is the name of this wave and what heart condition is it specific for?
epsilon wave
ARVD
Genetic link for HCM
Auto Dominent
Describe EKG findings in HCM
Inferiolateral Leads
V4-V6, 1, 2, AVF, AVL
Deep T wave inversion
Dagger like Q WAVES
V5, V6, II, AVF
EKG OF 16 YR OLD AAMALE BASEKTBALL PLAYER
NORMAL IF ASYMPTOMATIC
ST ELEVATION DOME V1-V4
MARFAN’S SYNDROME has a defect in the ___ gene.
Fibrillin
Name one eye abnormality and 2 heart conditions of Marfans
- Lens Dislocation
- Aortic dissection
- Mitral and Aortic valve incompitancy
Marfan’s is passed down how?
Auto dominent
Marfans’
Ho often are follow up echos needed for Marfans?
<45 mm- 12 months
>45 mm -6 months
What size aortic root in Marfans would require surgery?
>50 mm
What heart condition is this seen in ?
Delta wave
WPW
The other signs would be long QRS AND SHORTENED PR INTERVAL
Patient with suspected WPW put on treadmill for further assessment and was identified as risk as inconclusive? What is the next step?
EP study
What is this abnormality and what is it associatied with?
Ebstein’s abnormality
Tricuspid valve mutation Dilated RV
Seen in what cardiac condition
Brugada.
Right Bundle branch block and ST elevation in V1-V3
Which heart condition involves mutated sacromeres proteins.
HCM
Mutation in the ryanodine,calsequestrin, or ankyrin B proteins
Catecholaminergic Polymorphic Ventrical Tachycardia
Resting ECG of qtc > ____ is diagnostic Prolonged QT syndrome
500
Recommended exercise stress test
Characterized by prominent trabeculae and deep interrebecular recesses
LV Non Compaction
ST CONVEX ELEVATION FOLLOWED BY INVERSE T WAVE IS NORMAL IN WHAT LEADS?
V1-V4 AA ATHLETE
WHAT IS THE DIFFERENCE IN THE MURMUR OF AORTIC STENOSIS VS HCM?
HCM DOES NOT RADIATE TO THE CAROTIDS.
