Tulane (High Yield) Flashcards
What can echocardiography determine?
Chamber size, wall thickness, wall motion, valves, pericardium, intracardiac tumors, thrombi, and vegetations
Heart murmur that increases with valsalva and decreases with squatting…
Hypertrophic cardiomyopathy
What defines a cardiac myxoma?
Attachment to intertribal septum
Timing/presentation of Chronic Rheumatic Heart Disease
Years to decades after Acute Rheumatic Carditis
What differentiates Monckeberg medial calcific sclerosis from other types of atherosclerosis
Monckeberg medial calcific sclerosis is non-inflammatory (occurs in the elderly); also it occurs in the media as opposed to the intima
What are the 2 most common heart murmurs
Aortic stenosis and mitral regurgitation (both systolic)
When can the pulse (carotid upstroke) be felt?
During S1 (beginning of systole)
What murmur(s) radiate to the carortids
Aortic stenosis
What murmur(s) radiate to the axilla
Mitral regurgitation
What does an S4 indicate?
Hypertensive heart disease (stiff, thickened ventricle)
“Weak and delayed pulse” is a hallmark of what heart abnormality
Aortic stenosis
What is the most common cause of R-sided heart failure?
L-sided heart failure
What type of murmurs increase with inspiration
R-sided murmurs
What pressure differential defines aortic stenosis?
More than 40 mmHg across the valve
2 important causes of pulmonic stenosis
Early weight loss products (phentermine, fenfluramine) and cardiac carcinoid
Blood supply of the posterolateral papillary muscle? Why is this important?
Right coronary artery; if occluded can cause papillary necrosis or acute mitral regurgitation (highly fatal)
What does prolonged PR interval in the setting of endocarditis indicate?
Aortic regurgitation
Diastolic murmur preceded by “opening snap” is usually what?
Mitral stenosis
Definition of functional mitral regurgitation
Valve structure is the same, but heart structure has changed (making leaflets unable to coapt properly)
Presentation of cardiac carcinoid
Flushing and weakness (remember association with pulm stenosis and tricuspid regurgitation)
“Tombstone” appearance of ST elevation…
STEMI
Pathology behind majority of deaths from MI
Arrhythmias (often V tach or V fib) caused by acute underperfusion
Hallmark of plaque rupture on EKG?
ST segment elevation
Components of vulnerable plaque
Thin fibrous cap, rich lipid core with foam cells, active metalloprotease activity
ST elevation in leads II, III, and aVF
RCA occlusion (reciprocal depression seen in other leads)
Diastolic murmurs can be one of 4 things
Aortic regurgitation
Pulmonic regurgitation
Mitral stenosis
Tricuspid stenosis
Process by which aortic stenosis can cause angina
Aortic stenosis causes LV hypertrophy, which can impede elasticity of coronary arteries, slighting their ability to fill in diastole (even though AS affects systole)
What type of murmur is caused by aortic regurgitation, and why?
Early diastolic “decrescendo” murmur; ventricular filling during diastole opposes magnitude of regurgitation through aorta
Indications of hyperkalemia/hypokalemia on an EKG
Peaked T waves (+ wide QRS) = hyperkalemia; flat “u waves” = hypokalemia (in severe cases also diffuse ST depression)
Implication of an inverted T wave
Ischemia
Sarcoidosis predisposes what EKG change/arrhythmia?
AV block (1st degree)
BBBs on auscultation, broadly?
Splitting (“changes the 2nd heart sound”)
1st Degree AV block causes
Ischemia, Drugs (Verapamine, diltiazem, digoxin, beta blockers), Aging (fibrosis), Inflammation (e.g. sarcoidosis)
What do large (amplitude) QRS complexes (at least in v3) indicate?
LVH
RAA indication on EKG, implication on echo, clinical feature
Peaked P waves; tricuspid regurgitation; tripod posture (to allow intercostals to augment expiratory phase)
Leads representing LCA
I and aVL
Diffuse, concave ST elevation (with PR segment depression)
Acute pericarditis (remember: leather saddle)
Define Kussmaul’s sign and associated pathologies
Neck veins fail to collapse with inspiration; constrictive pericarditis and restrictive cardiomyopathy
2 important causes of constrictive pericarditis and clinical feature
Radiation (e.g. for lung ca), previous TB; pericardial knock (in early diastole, “lub dub BOOM” d/t calcification of pericardium)
Pericardial tamponade clinical presentation
High yield: Beck’s triad (low BP, muffled/distant heart sounds, incr. JVP), pulsus paradoxus (not unique, but on inspiration BP falls b/c CO falls d/t LA compression)
Less yield: dyspnea, orthopnea, electrical alternans (QRS complexes have different heights), RV collapse on echo (apparently RV is thin walled)
Normal ABI
> 1 (pressures should be higher in lower extremities than upper)
Where do AAA most often arise and why?
Distal to renal arteries; no vasa vasorum in arterial wall = most susceptible area
CVD pathology associated with syphilis
[Thoracic] aortic aneurysm
Differentiate between ACS and Aortic dissection
In dissection pain radiates from chest to back (also look for “tennis ball sign” on CT)
Wide, fixed splitting of S2 on ausculatation
ASDs
Most common site of ASD
Foramen ovale (osmium secundum defect)
3 predisposing factors for PDA
High altitude, prematurity, Rubella
Consequence of PDA reversing
Cyanosis of feet (PDA is distal to great arteries)
Demographics of coarctation of the aorta
Males:females 4:1
Genetic abnormality associated with coarctation of the aorta
Turner syndrome (monosomy X)
Genetic abnormality associated with pulmonic stenosis
Noonan syndrome (wide set eyes, ocular problems, ptosis, shield chest, webbing, hypo plastic jaw, receding hairline, kyphoscoliosis)
What is the most common neonatal cyanotic heart defect? How does it need to be treated?
Transposition of great vessels; emergent surgery
Clinical features of Eisenmenger syndrome
Prominent neck veins, “a wave,” clubbing of all fingers and toes, loud P2
S3 classic finding of what type of heart failure
Systolic (HFrEF)
S4 classic finding of what type of heart failure
Diastolic (HFpEF)
What is De Musset’s sign and what does it indicate?
“Head bobbing” with each heart contraction; aortic regurgitation
Sarcoidosis usual clinical presentation
Usually women with photophobia, rash, hypercalcemia, Hilar adenopathy, can have V tach but death is usually caused by AV block
What type of HF is associated with infiltrative disorders and why?
HFpEF (diastolic HF), because myocytes get stiff (e.g. in amyloidosis, sarcoidosis, metastatic cancer)
Subendocardial infarct on EKG
ST segment depression (NSTEMI)
Transmural infarct on EKG
ST segment elevation (STEMI)
What are cannon “A” waves and what do they represent?
Atria contracting against closed AV valve (atria and ventricles beating asynchronously); diagnostic of complete (3rd degree) AV block
What arterial occlusion can affect the sinus and AV nodes (in most individuals)
RCA
What does a Q wave represent on an EKG
Myocardial cell death
For what reasons would you withhold NTG for a patient with chest pain?
Hypotension or PDE5 inhibitors
RCA occlusion has the potential to affect what (4) structures
Posterior ventricular wall + septum, posteromedial papillary muscle (remember mitral regurgitation connection), SA node and AV node
What indicates Left Axis Deviation, and what does Left Axis Deviation indicate?
Upright QRS in lead 1, flipped in aVF (vice cersa for RA deviation); direction of depolarization of the myocytes is not normal (strongly associated with CAD)
Anyone who develops new LBBB years after an MI is considered to have a…
STEMI (remember the case, “chest pain and new LBBB is considered a STEMI”)
Why does PR prolongation cause a soft S1?
Delay in ventricular activation causes AV valves to be able to “float” back into position instead of “snapping” back d/t ventricular contraction
Kawasaki Disease Symptoms
CRASH & burn: Conjunctivitis, Rash, Adenopathy, Strawberry Tongue, Hand & Feet Erythema, Fever (“burn”)
Etiology of Granulomatosis with Polyangiitis
T cell mediated HSR
Differences between true aneurysm, false aneurysm and dissection
In true aneurysm no layers are torn; in false aneurysm intima and media are torn; in dissection only intima is torn
“Speckled” appearance of heart on echo
Amyloidosis (causes refraction)
CVD pathology commonly arising from multiple myeloma
Secondary amyloidosis (can cause restrictive cardiomyopathy)
“Myocardium stains green with Congo Red…”
Amyloidosis
Defining cause of “hypertrophic cardiomyopathy”
Mutation in encoding sarcomere proteins causes myofiber “disarray”
Describe systolic anterior motion (SAM) of the mitral valve (at least in the setting of HCM)
Narrow orifice caused by VS hypertrophy impedes outflow, which increases velocity, “sucking” one of the MV leaflets in which exacerbates the outflow obstruction
Maneuvers that lower LV EDV
VENDS: Valsalva, Exercise, Nitrates, Diuretics/Dehydration, Standing (from recumbent position)
Maneuvers that increase LV EDV
“Higher Loads Be Softer” - Handgrip, Lying down, Beta blockers, Squatting
Only two maneuvers increase aortic stenosis murmurs. What are they?
Squatting & Lying Down
Leading causes of sudden cardiac death
HCM (1), anomalous coronary artery (2), Congenital Long-QT Syndrome and Brugada Syndrome
Important maneuvers for MVP
Handgrip (murmur later and softer, happens with squatting too) & Valsalva (murmur earlier and louder)
Causes of low voltage (on EKG) to consider
Infiltrative disorders (e.g. amyloidosis, sarcoidosis), pericardial tamponade, emphysema, hypothyroidism
