Mehl. Cardio: tricuspid reg/sten; pulm reg/sten 04-02 (2) Flashcards
M. “Ball-in-valve” murmur. Assoc. with what?
Associated with cardiac tumors (i.e., myxoma in adult, or rhabdomyoma in kids for tuberous sclerosis).
M. “Ball-in-valve” murmur. described as?
Described as a diastolic rumbling murmur that abates when the patient is re-positioned unconventionally (e.g., onto his or her right side.
M. Venous hum. what murmur?
On 2CK Peds form; described as a murmur in the neck that abates when the kid is laid supine + the neck rotated.
M. Venous hum. what murmur? Tx?
Benign + don’t treat.
M. Functional (flow) murmur. in what setting? What causes it?
Systolic murmur seen in the setting of higher heart rate caused by infection, anemia, or pregnancy. Caused by increased flow across the pulmonic and/or aortic valves.
M. Functional (flow) murmur.
Known as a functional murmur because this means it goes away once the heart rate comes back down.
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M. Functional (flow) murmur.
Seen all over 2CK Peds forms, where they try to trick you into thinking the kid has a valvular pathology of some kind, but there isn’t; there will merely be an infection or simple viral infection.
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M. Functional (flow) murmur.
Can be seen sometimes with what pathology?
Can be seen sometimes with ASD, where the patient will have fixed splitting of S2 “plus a systolic murmur” -> merely higher right-sided volume, so more flow across the pulmonic valve.
M. PDA. Ductus arteriosus is special vessel in fetal circulation that connects what?
Connects the proximal pulmonary trunk to the descending arch of the aorta
M. PDA. the connection allows for blood to bypass the high-resistance lungs in utero. After birth, this vessel should close, resulting in a remnant called the ligamentum arteriosum, but sometimes it does not close -> PDA.
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M. PDA. If a PDA occurs, blood moves in the neonate from what to what?
L -> R (i.e., opposite of in utero) from the descending arch of the aorta to the pulmonary trunk.
M. PDA. yra diagrama su deguonim sirdies kamerose.
You can see in the above diagram, somehow the blood become more oxygenated from the RV to the pulmonary artery, which is ordinarily impossible. The only way this could have occurred is if oxygenated blood came L->R from the aorta to the pulmonary artery via a PDA.
Buvo Right heart 73 proc. -> in pulm. artery tampa 85 proc. –> pulm vein 99 proc., –> tada kairioj sirdy nukrenta iki 96 proc.
M. PDA. Murmur described three ways on USMLE.
M. PDA. murmur. 1?
continuous, machinery-like murmur;
LUSB or left infraclavicular area
M. PDA. murmur 2?
2) pan-systolic pan-diastolic murmur (meaning it’s continuous throughout both systolic and diastole)
M. PDA. murmur 3?
3) to-and-fro. The latter shows up on 2CK offline NBME 6.
M. PDA. Classically associated with ???? HY
congenital rubella
M. PDA. congenital rubella. What symptoms manifest in mother while pregnant?
They’ll give a kid born with a PDA and then ask what the mom experienced while pregnant; answer = arthritis and/or rash (rubella often presents as arthritis in adults).
M. PDA. Tx?
Indomethacin (NSAID) will close the PDA.
M. PDA. Prostaglandin E1 is used to keep a PDA open (if a kid with congenital heart malformations is born cyanotic and we need to buy time until surgery).
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M. PDA. An open PDA can mask cyanosis in a newborn in a variety of conditions (i.e.,., hypoplastic left heart syndrome or pre-ductal coarctation). If they tell you a kid is born with normal APGAR scores but a week later becomes cyanotic and they ask why, the answer is “closure of ductus arteriosus.”
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M. Pulmonic stenosis. seen in what?
tetralogy of Fallot.
M. Pulmonic stenosis. described how? murmur
Described as mid-systolic murmur, or just regular “systolic” murmur, that increases with inspiration, at the left sternal border, 2nd intercostal space.
This is the theoretical location, whereas AS is the 2nd intercostal space on the right, not left. But the USMLE often isn’t strict about murmur locations this way.
M. Pulmonic regurgitation. Same as with tricuspid stenosis, this is a nonexistent murmur on USMLE. I’ve never seen it assessed.
In theory it would be the same as aortic regurg but on the right (i.e., holo- diastolic murmur), but increases with inspiration.
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M. Tricuspid stenosis. in theory what sound?
In theory, would be a rumbling diastolic murmur similar to mitral stenosis, but would increase with inspiration since it’s on the right side of the heart.
M. Tricuspid stenosis.
Nonexistent murmur on USMLE. I don’t think I’ve ever seen this assessed once on any NBME exam for Steps 1 and 2 combined.
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M. Tricuspid regurgitation. will be described as? incr. when?
Will be described on USMLE as a holosystolic murmur that increases with inspiration.
M. Tricuspid regurgitation. right sided murmur gets worse with?
Inspiration -> diaphragm moves down -> decreased intra-thoracic pressure -> increased right-heart filling.
M. Tricuspid regurgitation. what finding in liver?
Can cause pulsatile liver
M. Tricuspid regurgitation. HY about it, cause?
Highest yield cause of TR on USMLE is pulmonary hypertension / cor pulmonale. I see this all over the NBME exams.
For whatever reason, these conditions do not cause pulmonic regurg; they cause tricuspid regurg. In other words, if you see tricuspid regurg in a Q, your first thought should be pulmonary hypertension or cor pulmonale (right heart failure due to a pulmonary cause).
M. Tricuspid regurgitation. Adult cause? 2
IV drug user endocarditis is obvious risk factors for TR.
Carcinoid syndrome in theory can cause, but low yield.
