Cardiac exam Flashcards

Question

Venous hum

Answer 1

**prevalence:** ages 2-6yrs **timing:** diastolic component loudest **location:** supraclavicular fossa on the right and may radiate **quality:** associated thrill **position:** disappears when flat

Answer 2

**inspection:** no cyanosis/clubbing **clinical:** - pansystolic mumur maximal at left sternal edge - loud S2 - active praecordium - thrill at left sternal edge - no radiation but heard all over chest wall - diastolic rumble at apex **haemodynamically significant if:** - symptoms including tachypnoea - mumur may be softer - hyperactive praecordium - loud S2 - displaced apex - diastolic mumur - growth decreased **treatment:** **- medical:** diuretics, ACEi **- surgical (age 4yrs or shunt\>2:1):** pulmonary artery banding 1st if complication, VSD repair

Answer 3

**haemodynamic:** RV overload during diastole with an increased pulmonary blood flow secondary to shunt **complications:** atrial arrhythmias, pulmonary HTN, heart failure **clinical:** - parasternal heave - ejection systolic mumur left sternal edge - S2 widely split - diastolic mumur due to flow across tricuspid valve **ECG:** - ostium secundum: RAD, partial RBBB - ostium primum: LAD, partial RBBB **treatment:** surgical closure 4th/5th decade

Answer 4

**pathophysiology:** left to right shunt through ASD/VSD **clinical:** hyperdynamic apex beat, RV heave, palpable thrill LLSE - loud pansystolic mumur LLSE, MR at apex **complications:** atrial dilation, arrhythmias, volume loaded ventricles, pulmonary HTN **ECG:** superior axis (-40 to -150), RVH **CXR:** cardiomegaly, pulmonary plethora **Treatment:** repair 4 to 6 months, diuretics - delaying treatment increases the risk of pulmonary hypertension

Answer 5

**congenital:** Ehlers-Danlos, Marfan syndrome, Turner syndrome **acquired:** rheumatic fever, post operative, infective endocarditis **pathophysiology:** LV overload, pulmonary oedema **clinical:** - collapsing pulse - decrescendo diastolic mumur LSE - increased sitting forward in expiration - associated thrill **ECG:** LVH **CXR:** cardiomegaly

Answer 6

associated syndromes: Noonan's, Williams **pathophysiology:** RV overload **clinical:** - thrill over pulmonary area - RV heave - ejection systolic mumur LUSE - radiation to back - widely split S2 **ECG:** RVH, tall p waves **CXR:** normal **treatment:** surgery depending on pressure gradient p**ost repair:** residual systolic and diastolic mumur

Answer 7

**associations:** Turner syndrone, Williams (supravalvular), coarctation **pathophysiology:** LV overload **symptoms:** syncope, pain on exertion **clinical:** - collapsing pulse - suprasternal/carotid thrill - apex displaced - ejection click LLSE - ejection systolic mumur at LLSE radiating into the neck **ECG:** LVH (tall R waves V5/V6, inverted T in 1, aVL, V5-6) **CXR:** prominent LV **treatment:** valve replacement if gradient \>60mmHg **post repair:** mumur of aortic stenosis and regurgitation

Answer 8

**associations:** Turner's, biscuspid valve (70%) **clinical:** - high BP arms, low in legs (20mmHg difference) - radiofemoral delay - systolic mumur loudest at left interscapular area - ejection click LUSE if biscuspid aortic valve **ECG:** LVH **CXR:** cardiac enlargement, rib notching **treatment:** end-end anastomoses via left thoracotomy **complications:** residual HTN, recoarctation

Answer 9

**decreased pulmonary blood flow:** * tetralogy of fallot * pulmonary atresia * Ebstein's * tricuspid atresia **poor mixing:** * transposition great arteries **common mixing:** * truncus arteriosus * DORV * TAPVD * univentricular heart

Answer 10

**Tetrad:** 1. RVOT obstruction 2. VSD 3. Overiding aorta 4. RVH **Variations:** 25% Right sided AA **clinical:** * FTT, clubbing, cyanosis * RV impulse * systolic thrill ULSE * systolic ejection mumur ULSE **CXR:** prominent RV, small pulmonary arteries, oligaemia **ECG:** RAD, RVH, tall p wave **treatment:** - modified BT Shunt - corrective survery 4-12 months **complications:** - exertional dyspnoea - cerebral thrombosis/brain abscess - infective endocarditis - arrhythmias **tx tet spells:** morphine, beta blockers, vasoconstrictors

Answer 11

**familial:** AD 60% **HOCM:** associated with septal hypertrophy or abnormal MV movement causing LVOTO **symptoms:** angina, syncome, arrhythmias, sudden death **clinical:** * systolic ejection mumur from LVS hypertrophy or mitral regurgitation **treatment:** beta blockers, endocarditis prophylaxis, myectomy

Answer 12

most common cardiomyopathy **cause:** usually idiopathic, toxic insult **pathophysiology:** dilation 4 chambers **clinical:** * displaced apex * MR or TR mumur * 3rd heart sound * left and right sided cardiac failure **symptoms:** weakness, pulmonary oedema **treatment:** medical, transplantation

Answer 13

* VSD * ASD * TOF: BT shunt then definitive procedure at 1 year * TGA: arterial switch

Answer 14

**Can be temporary or permanent** * BT shunt * Pulmonary banding * Atrial septostomy

Answer 15

**1st week:** * duct dependent * severe obstructive lesion **First month:** * severe pulmonary pressure: PA banding or BT shunt * obstructive lesions eg. TAPVD **Infants:** * left to right shunt to prevent pulmonary HTN * RVOTO **Children:** * staged procedures * asymptomatic lesions **Adolescence:** * surgery for acquired diseases * stent procedure eg. non duct dependent CoA * repeat procedures

Answer 16

* diaphragmatic palsy * arrhythmias * vocal cord palsy * protein losing enteropathy (post Fontan) * developmental problems

Cardiac exam Flashcards

(54 cards)