Cardiac Stuff Flashcards
(28 cards)
Complate atrioventricular septal defect murmur?
- Loud S2 (Pulm HTN)
- hyperdynamic precordium
- systolic ejection murmur at Left Upper sternal Border (hearing the turbulence over the pulmonary valve where there is a BUNCH of blood flowing due to the L –> R Shunt)
ASD Murmur?
- fixed, split S2
- systolic ejection murmur at Left upper sternal border (turbulence over tons of blood over the pulm valve)
(remember S2 split comes because the Pulm valve will stay open a tad bit longer because you have a rush of venous return and the valve stays open longer, but with an ASD, there’s still tons of extra R heart return from the L–> shunt)
PDA
continuous machineline murmur @ ALL OVER left sternal border
Tetralogy of Fallot Classic murmur? Findings on X-ray
- Single second heart sound (S2)
- harsh, crescendo-decrescendo murmur (due to RVOT obstruction) @ LUSB
X-ray = “boot-shaped” heart due to RVH
Murmur of VSD
harsh, holosystolic murmur @ the Left LOWER sternal border
diabstolic rumble over the apex (increased flow across the mitral valve)
how to treat a tet spell? What are the 4
- Overriding aortic arch
- RVOT (Pulmonary Valve stenosis or even atresia!)
- Ventral Septal Defect
- Right Ventricular hypertrophy
tx:
- Knee-chest position to increase Systemic vascular resistance and decrease the amount of R==> L shunting.
- oxygen to stimulate pulmonary vasodilation
- morphine to relax patient and depress HR
- Fluids to improve R ventricular filling
Mitral Valve prolapse murmur
- midsystolic click
2. late systolic murmur
What are the 5 CYANOTIC heart defects? Most common? What type of shunts are these?
- Truncus arteriosus
- Transposition of the great vessels
- Tricuspid atresia
- Tetralogy of Fallot
- total anomalous Pulmonary venous return
Most common is transposition of the great vessels
These are Left-to-right shunts which make them totally cyanotic
What is the X-ray finding on transposition of the great vessels?
“Egg-on-a-string” heart (narrow medistinum)
How does total anomalous pulmonary venous return present? X-ray?
Severe cyanosis, respiratory distress
X-ray -
enlarge supracardiac veins & SVC (“snowman” sign)
pulmonary edema
VSD Presentation?
failure to thrive, easy fatiguability, heart failure
What is the characteristic findings of tricuspid valve atresia? What is the pathology
- Left axis deviation in the neonate
- small or absent R waves in the precordial leads
Basically, the fact that there is no valve means that there is no communication and the right ventricle becomes hypoplastic as well as the pulmonary valve
Presentation of laryngomalacia and vascular rings and pathology? How to tell the difference?
Laryngomalacia
- 4-8 months
- laxity of the supraglottic structures during inspiratory phase –> inspiratory stridor
- WORSENS IN SUPINE AND GETS BETTER IN THE PRONE OR WITH SITTING UP
vascular rings
- before 1 years
- abnormal development of the aortic arch leading to tracheal, bronchial, and esophageal compression
- IMPROVES WITH NECK EXTENSION (throwing your head back)
- 50% HAVE CARDIAC ABNORMALITIES
- does not improve with epi or bronchodilators
Presentation of viral myocarditis? X-ray and echo? dx? Bugs?
Presentation:
- viral prodrome
- heart failure: dyspnea, syncope, tachycardia
- nausea and vomiting
- hepatomegaly
X-ray
- cardiomegaly
- pulmonary edema
Echo:
- diffuse hypokinesis
- decreased EF
dx: endomyocardial biopsy
bugs:
- Coxsackie B
- adenovirus
What is found after rheumatic fever? What the murmur? what is the tx?
after rheumatic fever you get persistent mitral valve disease.
Murmur:
- LOUD S1
- mid-systolic rumble
tx: Anyone with a history of rheumatic fever gets continuous antibioic prophylaxis to prevent Group A. Strep and persistent damage. so Penicillin
Murmur of Hypertrophic Cardiomyopathy? What makes it louder?
systolic
- ejection murmur at the left sternal border.
- pulse has a dual upstroke, strong apical pulse
Louder is anything that decreases preload (thus making the left ventricle cavity smaller and thus increases the murmur)
- valsalva
- abrupt standing
- nitro
Softer is anything that increases afterload
- squatting
- hand grip
What do you see on EKG with WPW? What is the presentation? pathology
- widened QRS
- with a delta wave
- shortened PR interval
Presentation: Most asymptomatic, some will present with chest pain, palpitations, syncope, or cardiac arrest.
Path: there is an accessory pathway that conducts antegrade from the atria to the ventricles faster than conduction through AV node
What are features of Jervell and Lange-Nielsen Syndrome? What is the inheritance pattern?
- sudden death in family
- QT interval greater than 600 ms
- CONGENITAL SENSORINEURAL DEAFNESS
inheritance - autosomal recessive
What is dx of long Qt syndrome? What is risk? What is presentation?
What is tx?
QT longer than 440 ms in males and 460 in femals.
Risk: torsade de pointes (ventricular arrythmia leading to death)
presentation of long Qt: fainting, lightheadedness, palpitations
tx; propranolol and long-term pacemaker placement
Cardiac condition associated with
Down’s Syndrome
Complete endocardial cushion defect (ASD and VSD)
then VSD
Then ASD
Cardiac condition associated with
congenital rubella
PDA
Cardiac condition associated with
Turner’s Syndrome
coarctation of the aorta
biscupid aortic valve
Cardiac condition associated with
Kawasaki Disease
Coronary artery aneurysms
Cardiac condition associated with
Neonatal Lupus
congenital heart block
