Structural Cardiac Disorders and CM Flashcards
What is the MC type of congenital heart disease?
VSD
What are the 4 types of VSD? Which is MC?
- Perimembranous (MC): hole in LV outflow near tricuspid valve
- Muscular: multiple holes in “swiss cheese” pattern
- Inlet: posterior to tricuspid valve
- Supracristal: Beneath pulmonic valve
What are the s/s of small (restrictive) VSD?
Asx or mild
Found incidentally due to murmur
Restrictive = normal pressure btwn ventricles maintained
What are s/s of moderate VSD?
Excessive sweating or fatigue, esp. during feeds
What are s/s of Eisenmenger’s syndrome?
Right to left shunt
Asx at rest, but +/- cyanosis*, dyspnea, CP, & syncope
What does VSD look like on PE?
Loud high-pitched holosystolic murmur at lower left sternal border
Mod VSD: +/- thrill, diastolic rumble at mitral area
Large VSD: signs of CHF
How do you dx VSD?
CXR: LA enlargement, RV hypertrophy Echo: preferred over cath ECG: LVH/RVH MRI Cath
How do you treat VSD?
Most close spontaneously within 10 years
Patch closure if sx
Larger shunts are repaired by age 2 to prevent pulmonary HTN
What are characteristics of coarctation of the aorta?
Increased LV afterload –> HTN, LVH, CHF
70% also have bicuspid aortic valve
What are s/s of coarctation of the aorta?
Secondary HTN*
Bilateral claudication*, dyspnea, syncope
What does coarctation of the aorta look like on PE?
Systolic murmur that radiates to back/scapula/chest
Increased BP upper > LE
Delayed/weak femoral pulses
How do you dx coarctation of the aorta? What is gold standard?
CXR: Rib notching, “3 sign”
ECG: LVH
Angiogram = GOLD
How do you treat coarctation of the aorta?
Surgical repair
Balloon angioplasty +/- stent
PGE1
What is the MC cyanotic congenital heart disease?
Tetralogy of fallot (right to left shunt)
What are causes of tetralogy of fallot?
- RV outflow obstruction (pulmonary artery stenosis)
- RV hypertrophy
- VSD (large unrestrictive)
- Overriding aorta
What are s/s of tetralogy of fallot?
Blue baby syndrome (cyanosis)
“Tet-spells”: older children relieve spells by squatting
Eisenmenger’s syndrome (seen w/ VSD, PDA, & TOF)
What does tetralogy of fallot look like on PE?
Harsh holosystolic murmur @ left upper sternal border
Right ventricular heave
How do you dx TOF? What is GOLD?
CXR: boot shaped heart
ECG: RVH, RAE
Echo: GOLD
How do you treat TOF?
Surgical repair performed in 1st 4-12 mos of life
PGE1 infusion (prevents ductal closure)
What is patent ductus arteriosus?
Communication btwn descending thoracic aorta & pulmonary artery
Left to right shunt
What causes PDA?
Prematurity
Perinatal distress & hypoxia
Rubella inf in 1st trimester
Continued PGE2
What are s/s of PDA?
Most asx
Poor feeding, wt loss
Eisenmenger’s syndrome: left to right shunt switches & becomes right to left shunt
What does PDA look like on PE?
Continuous machinery murmur loudest @ pulmonic area
Wide pulse pressure: bounding peripheral pulses
How do you dx PDA? What is gold standard?
CXR: normal or cardiomegaly
ECG: LVH, LA enlargement
Echo = GOLD
How do you treat PDA?
IV indomethacin 1st line (closes PDA)
Surgical correction if indomethacin fails. Best to be performed before 1-3yo
What are characteristics of dilated CM?
Systolic dysfunction –> ventricular dilation –> dilated weak heart
MC in men, 20-60yo
What causes dilated CM?
- Idiopathic MC
- Viral myocarditis (enteroviruses MC, PB19, Chagas)
- Toxic: Etoh, cocaine, anthracyclines (doxorubicin)
- Pregnancy
What are s/s of dilated CM?
Systolic HF sx: Both L & R sided
+ S3
Viral myocarditis: viral prodrome a few wks –> signs of HF or CP, + cardiac enzymes
What does dilated CM look like on PE?
L sided HF: pulmonary congestion
R HF: peripheral edema, increased JVP, hepatic congestion
How do you dx dilated CM?
Echo:
- LV dilation: thin walls
- Decreased EF
- Regional or global LV hypokinesis
CXR: Cardiomegaly
How do you treat dilated CM?
Standard systolic HF tx:
ACEI, diuretics, etc.
Implantable defibrillator if EF < 35%
What are characteristics of restrictive CM?
Diastolic dysfunction
Ventricular rigidity impedes ventricular filling (decreased ventricular compliance)
What causes restrictive CM?
Infiltrative diseases:
- Amyloidosis MC
- Sarcoidosis
What are s/s of restrictive CM?
R sided HF MC than L sided
tachyarrhythmias
What does restrictive CM look like on PE?
Kussmaul sign (increased JVP w/ inspiration)
R-sided HF: peripheral edema, increased JVP, hepatic congestion
How do you dx restrictive CM?
Echo:
- marked dilation of both atria
- diastolic dysfunction
How do you treat restrictive CM?
No specific tx
Treat underlying cause
What are characteristics of hypertrophic CM?
Diastolic dysfunction (due to impaired ventricular relaxation/filling)
Subaortic outflow obstruction: hypertrophied septum + systolic anterior motion of mitral valve increased w/ increased contractility & decreased LV volume
What causes hypertrophic CM?
Inherited genetic d/o of L &/or R ventricular hypertrophy
What are s/s of hypertrophic CM?
Often asx dyspnea 90%. MC initial complaint Angina, syncope Arrhythmias Sudden cardiac death (esp. exertion) due to VF
What does hypertrophic CM look like on PE?
Harsh systolic cres-decresc murmur @LLSB (sounds like aortic stenosis)
- decreased murmur intensity: increased VR (squatting, supine); handgrip
- increased murmur: decreased VR (valsalva & standing) & exertion, amyl nitrate
Usually no carotid radiation. Loud S4
How do you dx hypertrophic CM?
Echo: asymmetric wall thickness (esp. septal)
ECG: LVH
How do you treat hypertrophic CM?
BBs, verapamil, ICD placement
Cautious use of digoxin, nitrates & diuretics
Septal myomectomy, Etoh ablation
Avoid dehydration & extreme exertion/exercise
