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BRS- Cardio Flashcards

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1
Q

Compensatory mechanisms seen in cardiac failure

A
  • Na/H2O retention
  • Catecholamine release
  • ^HR, CX
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2
Q

Congenital lesions causing increased pulmonary blood flow

A

TGA
TAPVC
Large VSD/PDA

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3
Q

Endgame for congenital heart lesions (^pulm flow or obstructive etc)

A

CHF

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4
Q

What acquired diseases may lead to CHF? (8)

A 
viral myocarditis 
fluid changes: anemia/ overload 
chronic hypoxia 
hyperthyroid 
doxo 
cardiomyopathy 
ischemic disease
dysrhythmias
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5
Q

Three general symptoms assc with CHF

A

FTT
poor feeds
exercise intolerance

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6
Q

Two vital sign changes assc with CHF

A

tachypnea, tachycardia

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7
Q

How does digoxin improve cardiac fxn?

A

increases efficiency of contractions, relieves tachycardia

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8
Q

How do PDEi improve cardiac fxn?

A

reduce afterload to enhance contractility

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9
Q

Four drug classes used in CHF for kiddos:

A
  • Dig
  • Diuretics
  • Ionotropics
  • PDEi
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10
Q

List the three “innocent” murmurs of childhood

A
  • Stills
  • Pulmonic Systolic
  • Venous Hum
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11
Q

Which of the three innocent murmurs are systolic? continuous?

A

stills + pulmonic systolic= systolic murmurs

venous hum= continuous

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12
Q

Which of the three innocent murmurs are loudest when supine? standing?

A

supine + exercise= stills, pulmonic systolic

standing= venous hum

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13
Q

List the most prominent location of the three innocent murmurs:

A

Neck: venous hum
upper left: pulmonic systolic
lower left: stills

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14
Q

Which of the three innocent murmurs changes with jugular venous compression

A

venous hum

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15
Q

Systolic ejection murmur at left sternal border with split S2 is characteristic of what lesion?

A

ASD

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16
Q

Holosystolic murmur at the left lower sternal border is characteristic of what lesion?

A

VSD

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17
Q

Constant machine like murmur at upper left sternal border is characteristic of what lesion?

A

PDA

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18
Q

What congenital lesion may present with a murmur similar to aortic stenosis (systolic, upper right sternal border)?

A

Coarctation

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19
Q

To where does the murmur of aortic stenosis radiate?

A

carotids

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20
Q

Systolic ejection murmur at upper left sternal border with a click is characteristic of what lesion?

A

Pulmonic stenosis

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21
Q

Innocent heart murmurs: ages

A
  • venous: school age
  • pulmonic systolic: any age
  • stills: ages 2-7
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22
Q

Of the acyanotic congenital heart diseases, which present with RAD on ECG

A

ASD, pulmonic stenosis

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23
Q

Of the cyanotic heart lesions which may be normal on ECG or have LVH?

A

coarctation, aortic stenosis

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24
Q

Of the acyanotic lesions, which present with LVH until PHTN occurs, then RVH?

A

VSD, PDA

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25
What are the three types of ASD?
primum (low) secundum (mid) sinus venosus (high)
26
Which of the three types of ASD is most common? Assc with Downs?
primum- downs (primum= one= trisomy twenty ONE) | secundum- most common
27
Where do pulmonary veins drain in sinus venosus type ASD?
RA, SVC
28
What are the three types of VSD?
inlet outlet, supracristal trabecular, muscular
29
When must VSD be emergently operated on?
When causing PHTN, PHTN is irreversible if left over time.
30
Symptoms of VSD
small: none mod-large: CHF PHTN develops: CHF disappears
31
Of the six acyanotic congenital heart lesions, which may have a diastolic rumble at the apex?
ASD, VSD, PDA
32
Symptoms of PDA
- brisk pulses - widened pulse pressure - CHF if severe
33
Direction of blood flow in case of PDA
aorta --> PA
34
MC location of aortic coarctation
just below LSCA, proximal to ductus
35
Drugs that may be used to treat coarctation before surgery
IV PGE | ionotropes
36
Signs & symptoms of coarc
- elevated BP in RUE - bruit at left upper back - rip notching on CXR - CHF at time of PDA closure
37
Pathophys of aortic stenosis
commissural fusion
38
Symptoms of coarctation when CHF develops
no murmur | poor pulses all four extremities
39
What are the five cyanotic heart lesions?
1) tet 2) truncus 3) tricuspid atresia 4) transposition 5) TAPVC
40
Test for diagnosing Cardiac related causes of CHF
100% O2 challenge
41
Noncardiac causes cyanosis
- pulm dz - sepsis - hypoglycemia - polycythemia - NM disease = chest wall dysfxn
42
Murmur of tet is predominately caused by _____
pulm stenosis | systolic murmur at ULSB with click
43
What causes a "tet" spell and how is it reversed?
decreased SVR = cyanosis | valsalva, squatting, HTN= increased SVR= relieved cyanotic spell
44
When does cyanosis occur in tet?
PDA closure
45
CXR finding in tet
boot shaped heart
46
What are the four features of tet?
``` IHOP interventricular septal defect hypertrophy of the right ventricle overriding aorta pulmonic stenosis ```
47
Transposition of the great arteries causes _____circulation
parallel instead of series
48
CXR finding in transposition
egg on a string
49
What is usually present in Tricuspid atresia?
ASD, VSD
50
How is tricuspid atresia repaired?
connect IVC to PA (Fontan)
51
Finding in tricuspid atresia that distinguishes it from other cyanotic lesions?
only cyanotic lesion to cause LVH
52
Common murmur to transposition and tricuspid atresia?
no murmur/ single S2
53
Truncus arteriosus murmur
single S2 systolic ejection diastolic murmur at mitral valve
54
Murmur of TAPVC
pulmonary ejection murmur at LSB
55
Repair of TAPVC
anastomose PV to LA
56
CXR appearance of TAPVC
snowman appearance (enlarged heart)
57
ECG findings in TAPVC
RVH
58
#1 acquired heart disease in US? worldwide?
US: Kawasakii World: ARF
59
``` Infective Endocarditis #1 and #2 most common predisposing factors ```
80% have structural disease and 50% are post op
60
List some classic symptoms of endocarditis
``` janeway and olsers nodes (oslers = ouch) roth spots= white retinal lesions nailbed hemorrhages murmur hematuria spenlomegaly ```
61
What are vegetations made of in endocarditis?
platelets, fibrin
62
Two most common bacteria seen in endocarditis?
strep viridans | staph aureus
63
Most important step in diagnosing endocarditis?
``` #1 blood cultures also... transesophageal echo for vegetations ```
64
When are abx needed to px against endocarditis during procedures?
structural lesions 6 months post op after a cardiac procedure lifelong if any residual lesion following cardiac surgery
65
How long are IV abx given after dx of endocarditis?
4-6 weeks
66
Signs and symptoms of pericarditis?
- friction rub - pain when supine - distant heart sounds - pulsus paradoxus
67
Severe outcome of pericarditis?
tamponade
68
#1 cause pericarditis?
viral | CX, echo, adeno, flu, para, EBV
69
Three non infectious causes pericarditis
lupus uremis post pericardotomy (1/3 cases)
70
2 bacterial causes of endocarditis
staph aureus | strep pnuemo
71
ECG changes assc with pericarditis
low voltage QRS | alterations in ST
72
Myocarditis: | most serious outcome
causes 20% of SCD in atheletes
73
Infectious Etiologies for myocarditis
coxsackie cadida, crypto trypanosoma cruzi coryne, strep pyo, staph a, TB
74
Autoimmune/ inflammatory causes of myocarditis
- SLE - RF - Sarcoid - Kawasaki
75
What does echo show in case of myocarditis?
global ventricular dysfunction
76
Causes of dilated cardiomyopathy + which is most common?
``` #1 idiopathic also: beriberi mitochondrial abnormality carnitine def viral myocarditis ....etc ```
77
MCC SCD in athletes?
AD HCM
78
Describe murmur assc with HCM
harsh systolic murmur worsened with valsalva | caused by LVOT obstruction by anterior mitral leaflet
79
Causes of restrictive CM
amyloidosis gauchers fabrys hemochromatosis/ hemosiderinosis
80
MC peds dysrhythmia
SVT
81
Causes of SVT
AVRT/AVNRT
82
Describe WPW
AVRT with delta wave (long PR, upsloping QRS)
83
Treatment of SVT
vagal maneuvers adenosine SCD
84
Describe the types of heart block
type 1: long PR type 2-I: progressively longer PR --> dropped beat type 2-II: dropped beat type 3: no conduction from A --> V *type 2-I= wenke
85
Treatment of heart block
pacing
86
Causes of heart block
post surgical SLE in mother endocarditis
87
Long QT syndrome risk
torsades --> death
88
Treatment long QT syndrome
BBers/ pacing
89
Two hereditary syndromes causing Long QT
AR, Jervell Lange Nielson = long QT + deaf | AD, Romano Ward= long QT only
90
Most common cardiac related cause of chest pain
pericarditis
91
Cause chest pain in marfans
aortic dissection

Pediatrics (12 decks)

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