Cardio Flashcards
(87 cards)
1
Q
S3
A
“Kentucky”
Rapid ventricular filling - MR, CHF
Normal in kids and preggers
2
Q
S4
A
“Tennessee/atrial kick”
High atrial pressure d/t VH
3
Q
Normal S2 splitting
A
Inspiration –> Pulmonic closes after aortic
4
Q
Wide S2 splitting
A
Pulmonic stenosis & RBBB –> Delay in RV emptying
5
Q
Fixed S2 splitting
A
ASD –> L-R shunt delays pulmonic closure
- secundum = #1
- primum = DOWN SYNDROME
- paradoxical emboli
6
Q
Paradoxical S2 splitting
A
Aortic stenosis & LBBB —> delays LV emptying
7
Q
Hand grip
A
Inc MR, VSD
8
Q
Valsalva
A
Most DEC
Inc MVP, hypertrophic
9
Q
Squatting
A
Dec MVP, hypertrophic
10
Q
Mitral/Tricuspid regurg
A
Holosystolic, high pitched “blowing”
Rheumatic fever
11
Q
Radiates to axilla
A
MR
- Complication of MVP, LV dilation, endocarditis, Rheumatic, papillary muscle rupture
12
Q
Ejection click –> Crescendo-decrescendo
A
Aortic stenosis - Radiates to carotids - Pulsus et tardus - weak pulses - Wear and tear, bicuspid valve, or chronic RF -
13
Q
Angine, syncope w/ exercise, radiates to carotids
A
Aortic stenosis
- “Fish mouth” commisure
- -> LVH, anemia
14
Q
Weak pulses compared to heart sounds
A
Pulsus et tardus - Aortic stenosis
15
Q
Holosystolic, harsh murmur at left sternal border
A
VSD
- Most common
- FETAL ALCOHOL
16
Q
Mid-systolic click with late systolic crescendo
A
MVP
- Can predispose to endocarditis
- Caused by RF, chordae rupture, Marfan, ED syndrome
17
Q
High-pitched, blowing diastolic murmur
A
AR
- Widened pulse pressure, bounding pulses, head bobbing
- Heard over LEFT sternal border (pulmonic area)
- INC when leaning forward w/ held expiration
18
Q
Widened pulse pressure, bounding pulses, head bobbing, pistol shot bruit over femoral pulsating uvula
A
AR
- aortic root dilation - syphiltic aneurysm, dissection, endocarditis
- LV dilation w/ ECCENTRIC hypertrophy
19
Q
Opening snap with diastolic rumble in LLD position
A
Mitral stenosis (same as tricuspid)
- D/T RF…endocarditis, SLE, amyloid, carcinoid
- -> LA dilation –> pul congestion/HTN –> RHF
- -> A-fib –> mural thrombi
20
Q
Continuous machine-like murmur
A
PDA
- RUBELLA
- Prematurity
- LE cyanosis
- Tx = indomethacin
21
Q
Pressure formula
A
P = flow x resistance
22
Q
Resistance formula
A
R = 8(viscosity) x length / pi(radius)^4
Inc viscosity –> inc TPR –> inc work
23
Q
MAP
A
MAP = 2/3 DBP x 1/3SBP
24
Q
High-pitched, blowing, holosystolic murmur at the apex
A
MR
Rupture of papillary muscle –> flash pulmonary edema
25
Day 1-4 post-MI complication
Fatal arrhythmia, pericardial friction rub
26
Day 5-10 or 4-7 post-MI complication
Rupture of papillary muscle, IV septum, Ventricular free wall
27
Months to years post-MI complication
Ventricular aneurysm
28
Peaked T-waves
HyperK --> Torsades --> asystole
Tx = calcium gluconate
29
Causes of hyperK
```
Burns, tumor lysis, rhabdo
BBs, ACEs, ARBs, Digitalis, K+ sparing
Renal failure
Acidosis
Low insulin
```
30
U-waves
HypOK+
31
Opening snap with high-pitched diastolic rumble, inc with inspiration
Tricuspid stenosis
Mitral is the same but inc w/ Expiration
32
4-24 hours post-MI
Hypereosinophilia
| No nuclei
33
1-3d post-MI
Lots of neutrophils --> coagulative necrosis
| Pericardial friction rub
34
New murmur 1 week post-MI
IV septum rupture
35
ST elevation in V1-6, I, aVL
Left Main coronary artery
36
ST elevation in V1-2
Proximal LAD - septal
37
ST elevation in V3-4
LAD - anterior
38
ST elevation in V5-6
LAD - Apical
39
ST elevation in V1-4
LAD - anteroseptal
40
ST elevation in I, aVL
Left circumflex
41
ST elevation in II, III, aVF
RCA/PD - inferior
| - supplies LV papillary muscle
42
Pericardial friction rub with ST elevation in all 12 leads
* **Acute pericarditis***
- SLE, Scleroderma, Post-MI Dressler syndrome
- Diffuse ST elevation & PR depression
43
Viral pericarditis
Coxsackie B
44
Chest pain relieved by sitting forward
Pericarditis
45
ST depressions in II, III, aVF + cardiac enzymes
Inferior wall NSTEMI = SUBendocardium
| unstable angina can have ST depression but no enzymes
46
Causes of 3rd degree AV block
Lyme, Chagas, endocarditis, Syphilis, Auto-immune
47
Silent MIs
Diabetics and Women - looks for Q waves
48
Q-waves
>25% of R wave or wide
| Indicates an OLD MI
49
High TAGs assoc w/?
Pancreatitis
50
QRS >3 boxes, rSR in V1, 2, slurred S waves in I and V6
RBBB
51
HA, lower extremity claudication, UE/LE BP differences
Coarctation of Aorta
- Turner syndrome
- Rib notching, bicuspid aortic valve
- Distal to L subclavian
- --> LVH
Infantile form = assoc w/ PDA --> cyanosis
52
Elastic lamina fragmentation
Giant cell arteritis
- Giant cells w/ intimal fibrosis
- ESR >100
53
Middle ages Asian female w/ weak pulses in extremities
Takayasu
| - Granulomatous aortic arch
54
Young adult w/ HTN, melena, (+) serum HBsAg, segmental fibrinoid necrosis
Polyarteritis nodosa
| - "String of pearls"
55
Asian 4 y/o w/ fever, conjunctivitis, rash on palms and soles
Kawasaki's
- Early MI***
- Tx = aspirin***
56
30 y/o male smoker w/ claudication and Raynaud's
Buerger Disease
| - necrotizing vasculitis of digits --> gangrene, AUTO-AMPUTATION
57
Middle aged male w/ sinusitis, hemoptysis, hematuria
Wegener's
- c-ANCA, GRANULOMAS
- Tx = cyclophosphamide
Microscopic polyangitis is similar but NO granulomas
58
Middle aged male w/ asthma, peripheral eosinophilia
Churg-Strauss
59
Causes of hyaline arteriolosclerosis/non-enzymatic glycosylation
HTN
| Diabetes
60
Hyperplastic arteriolosclerosis
Hyperplasia of smooth muscles --> onion skinning
| D/T Malignant HTN ---> fibrinoid necrosis w/ 'flea-bitten' appearance
61
Calcification in linear streaks on mammography
Monckeberg Medial Calcific Sclerosis
62
'Tree bark' aorta thoracic aneurysm
Tertiary syphilis --> aortic valve insufficiency
63
65 y/o male smoker w/ pulsatile abdominal mass
AAA - BELOW renal arteries
- atherosclerosis
- rupture >5cm
64
Chest pain <20min, ST depression d/t subendocardial ischemia
Stable angina
| - Nitro dilates veins
65
Chest pain at rest, ST depression d/t subendocardial ischemia
Unstable angina
- rupture of plaque
- nitro dilates veins
66
Prinzmetals agina
Coronary vasospasm
- ST ELEVATION
- Tx = CCBs
67
1-3 wks post-MI
RED border - granulation tissue
68
1 month post-MI
Scar/fibrosis
69
Intralveolar hemosiderin-laden MO
Left sided HF
| Tx = ACE
70
Nutmeg liver
Right sided HF --> cirrhosis, pitting edema
71
Boot shaped heart
Tetralogy of Fallot
- Stenosis of RV outflow
- RVH
- VSD
- Overriding aorta
- -> cyanotic spells --> SQUATTING helps
72
Early cyanosis assoc w/ MATERNAL DIABETES
Transposition
| - Tx = PGE to maintain PDA
73
Acute RF Jones Criteria
```
J - joint arthritis
O - MR, aschoff bodies, friction rub
N - Nodules
E - erythema marginatum
S - Syndeham chorea
```
***M-protein MOLECULAR MIMICRY***
74
Most common cause of death in acute RF
Myocarditis
75
Characteristic cells of myocarditis
Anitschkow cell - caterpillar nuclei
76
Chronic RF
Stenosis --> "fish mouth" valves
Mitral --> thickened chordae
Aortic --> fusion
77
Bug infecting prosthetic valves
S. epi
78
Fever, erythema on palms and soles, painful lesions on finger and toes, splinter hemorrhages in nails
Endocarditis
| - anemia of chronic disease = INC FERRITIN
79
NBTE
Sterile vegetations d/t hypercoagulable state or ADENOCARCINOMA
--> MR
80
Libman-Sacks endocarditis
Sterile vegetations on BOTH sides of valve = SLE
--> MR
81
Causes of dilated cardiomyopathy
```
Genetic
Myocarditis - Coxsackie
Alcohol
Doxorubicin, Cocaine
Pregnancy
```
82
Mutation in HOCM
SARCOMERE PROTEINS
83
Haphazard myofibers
HOCM
- sudden death in athletes
- syncope w/ exercise
84
Causes of restrictive cardiomyopathy
```
Amyloid
Sarcoid
Hemochromatosis
Fibroelastosis = KIDS***
Loeffler - fibrosis + eosinophils
```
85
Low voltage EKG
Restrictive cardiomyopathy
86
Most common primary cardiac tumor in kids
Rhabdomyoma
* **Assoc w/ tuberous sclerosis***
- ventricle
87
Metastatic tumors to heart
More common than primary
- breast, lung, melanoma, lymphoma
- pericardium --> pericardial effusion
