Flashcards in BRS- Cardio Deck (91):
Compensatory mechanisms seen in cardiac failure
Congenital lesions causing increased pulmonary blood flow
Endgame for congenital heart lesions (^pulm flow or obstructive etc)
What acquired diseases may lead to CHF? (8)
fluid changes: anemia/ overload
Three general symptoms assc with CHF
Two vital sign changes assc with CHF
How does digoxin improve cardiac fxn?
increases efficiency of contractions, relieves tachycardia
How do PDEi improve cardiac fxn?
reduce afterload to enhance contractility
Four drug classes used in CHF for kiddos:
List the three "innocent" murmurs of childhood
Which of the three innocent murmurs are systolic? continuous?
stills + pulmonic systolic= systolic murmurs
venous hum= continuous
Which of the three innocent murmurs are loudest when supine? standing?
supine + exercise= stills, pulmonic systolic
standing= venous hum
List the most prominent location of the three innocent murmurs:
Neck: venous hum
upper left: pulmonic systolic
lower left: stills
Which of the three innocent murmurs changes with jugular venous compression
Systolic ejection murmur at left sternal border with split S2 is characteristic of what lesion?
Holosystolic murmur at the left lower sternal border is characteristic of what lesion?
Constant machine like murmur at upper left sternal border is characteristic of what lesion?
What congenital lesion may present with a murmur similar to aortic stenosis (systolic, upper right sternal border)?
To where does the murmur of aortic stenosis radiate?
Systolic ejection murmur at upper left sternal border with a click is characteristic of what lesion?
Innocent heart murmurs: ages
-venous: school age
-pulmonic systolic: any age
-stills: ages 2-7
Of the acyanotic congenital heart diseases, which present with RAD on ECG
ASD, pulmonic stenosis
Of the cyanotic heart lesions which may be normal on ECG or have LVH?
coarctation, aortic stenosis
Of the acyanotic lesions, which present with LVH until PHTN occurs, then RVH?
What are the three types of ASD?
sinus venosus (high)
Which of the three types of ASD is most common? Assc with Downs?
primum- downs (primum= one= trisomy twenty ONE)
secundum- most common
Where do pulmonary veins drain in sinus venosus type ASD?
What are the three types of VSD?
When must VSD be emergently operated on?
When causing PHTN, PHTN is irreversible if left over time.
Symptoms of VSD
PHTN develops: CHF disappears
Of the six acyanotic congenital heart lesions, which may have a diastolic rumble at the apex?
ASD, VSD, PDA
Symptoms of PDA
-widened pulse pressure
-CHF if severe
Direction of blood flow in case of PDA
aorta --> PA
MC location of aortic coarctation
just below LSCA, proximal to ductus
Drugs that may be used to treat coarctation before surgery
Signs & symptoms of coarc
-elevated BP in RUE
-bruit at left upper back
-rip notching on CXR
-CHF at time of PDA closure
Pathophys of aortic stenosis
Symptoms of coarctation when CHF develops
poor pulses all four extremities
What are the five cyanotic heart lesions?
3) tricuspid atresia
Test for diagnosing Cardiac related causes of CHF
100% O2 challenge
Noncardiac causes cyanosis
-NM disease = chest wall dysfxn
Murmur of tet is predominately caused by _____
systolic murmur at ULSB with click
What causes a "tet" spell and how is it reversed?
decreased SVR = cyanosis
valsalva, squatting, HTN= increased SVR= relieved cyanotic spell
When does cyanosis occur in tet?
CXR finding in tet
boot shaped heart
What are the four features of tet?
interventricular septal defect
hypertrophy of the right ventricle
Transposition of the great arteries causes _____circulation
parallel instead of series
CXR finding in transposition
egg on a string
What is usually present in Tricuspid atresia?
How is tricuspid atresia repaired?
connect IVC to PA (Fontan)
Finding in tricuspid atresia that distinguishes it from other cyanotic lesions?
only cyanotic lesion to cause LVH
Common murmur to transposition and tricuspid atresia?
no murmur/ single S2
Truncus arteriosus murmur
diastolic murmur at mitral valve
Murmur of TAPVC
pulmonary ejection murmur at LSB
Repair of TAPVC
anastomose PV to LA
CXR appearance of TAPVC
snowman appearance (enlarged heart)
ECG findings in TAPVC
#1 acquired heart disease in US? worldwide?
#1 and #2 most common predisposing factors
80% have structural disease and 50% are post op
List some classic symptoms of endocarditis
janeway and olsers nodes (oslers = ouch)
roth spots= white retinal lesions
What are vegetations made of in endocarditis?
Two most common bacteria seen in endocarditis?
Most important step in diagnosing endocarditis?
#1 blood cultures
also... transesophageal echo for vegetations
When are abx needed to px against endocarditis during procedures?
6 months post op after a cardiac procedure
lifelong if any residual lesion following cardiac surgery
How long are IV abx given after dx of endocarditis?
Signs and symptoms of pericarditis?
-pain when supine
-distant heart sounds
Severe outcome of pericarditis?
#1 cause pericarditis?
(CX, echo, adeno, flu, para, EBV)
Three non infectious causes pericarditis
post pericardotomy (1/3 cases)
2 bacterial causes of endocarditis
ECG changes assc with pericarditis
low voltage QRS
alterations in ST
most serious outcome
causes 20% of SCD in atheletes
Infectious Etiologies for myocarditis
coryne, strep pyo, staph a, TB
Autoimmune/ inflammatory causes of myocarditis
What does echo show in case of myocarditis?
global ventricular dysfunction
Causes of dilated cardiomyopathy + which is most common?
MCC SCD in athletes?
Describe murmur assc with HCM
harsh systolic murmur worsened with valsalva
(caused by LVOT obstruction by anterior mitral leaflet)
Causes of restrictive CM
MC peds dysrhythmia
Causes of SVT
AVRT with delta wave (long PR, upsloping QRS)
Treatment of SVT
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
Treatment of heart block
Causes of heart block
SLE in mother
Long QT syndrome risk
torsades --> death
Treatment long QT syndrome
Two hereditary syndromes causing Long QT
AR, Jervell Lange Nielson = long QT + deaf
AD, Romano Ward= long QT only
Most common cardiac related cause of chest pain