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Flashcards in BRS- Cardio Deck (91):
1

Compensatory mechanisms seen in cardiac failure

-Na/H2O retention
-Catecholamine release
-^HR, CX

2

Congenital lesions causing increased pulmonary blood flow

TGA
TAPVC
Large VSD/PDA

3

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

CHF

4

What acquired diseases may lead to CHF? (8)

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

5

Three general symptoms assc with CHF

FTT
poor feeds
exercise intolerance

6

Two vital sign changes assc with CHF

tachypnea, tachycardia

7

How does digoxin improve cardiac fxn?

increases efficiency of contractions, relieves tachycardia

8

How do PDEi improve cardiac fxn?

reduce afterload to enhance contractility

9

Four drug classes used in CHF for kiddos:

-Dig
-Diuretics
-Ionotropics
-PDEi

10

List the three "innocent" murmurs of childhood

-Stills
-Pulmonic Systolic
-Venous Hum

11

Which of the three innocent murmurs are systolic? continuous?

stills + pulmonic systolic= systolic murmurs
venous hum= continuous

12

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

supine + exercise= stills, pulmonic systolic
standing= venous hum

13

List the most prominent location of the three innocent murmurs:

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

14

Which of the three innocent murmurs changes with jugular venous compression

venous hum

15

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

ASD

16

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

VSD

17

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

PDA

18

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

Coarctation

19

To where does the murmur of aortic stenosis radiate?

carotids

20

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

Pulmonic stenosis

21

Innocent heart murmurs: ages

-venous: school age
-pulmonic systolic: any age
-stills: ages 2-7

22

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

ASD, pulmonic stenosis

23

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

coarctation, aortic stenosis

24

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

VSD, PDA

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