CARDIOLOGY Flashcards by Sharmaine Lozano

The most common type of ASD

ostium secundum (50-70%)

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Systolic ejection murmur at RUSB
Balloon valvuloplasty
Ross procedure (valve translocation)

Aortic stenosis

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nonpruritic serpiginous or annular erythematous evanescent rashes most prominent on the trunk and inner proximal portions of the extremities;
never on the face (disappear on exposure to cold and reappear after a hot shower or if covered with a blanket)

Erythema marginatum

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Patency of the ductus arteriosus is dependent on ______

low O2and high prostaglandins

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3 sign

Coarctation of the Aorta

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Fontan operation: RA to PA; RV is bypassed to oxygenate the blood

Tricuspid Valve Atresia (TVA)

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bounding peripheral pulses and widened pulse pressure, continuous “machinery” murmur

PDA

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Pulmonary arteries arise from aorta
Truncal valve, occasionally quadracuspid, stenotic and/or insufficient overrides the ventricular septal defect
Ventricular septal defect, large

TRUNCUS ARTERIOSUS

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one method of distinguishing cyanotic congenital heart disease from pulmonary disease?

Hyperoxia test

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Norwood Procedure
Glenn anastomosis

Hypoplastic Left Heart Syndrome

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hallmark finding is a systolic regurgitant murmurs at the apex with radiation to the left anterior axillary line

MITRAL REGURGITATION

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Wide pulse pressure Bounding peripheral arterial pulses Continuous murmur

PDA

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Palliative systemic-to-pulmonary artery shunt performed to augment pulmonary artery blood flow. For repair of TOF

BLALOCK-TAUSSIG SHUNT

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All ____ murmurs are pathologic.

diastolic

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MC causative agents of INFECTIVE ENDOCARDITIS

viridans Streptococci and Staphylococcus aureus

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Systolic ejection murmur at 2 nd LICS
widely split S2
Right sided enlargement

ASD

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• Rashkind Atrial Septostomy

• Jantene Arterial Switch

• Senning and Mustard

TGA

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A 13 y/o female patient presents to the clinic with fever and joint pains. It started 3 days ago when she had fever of 38.8°C with right knee swelling, which was warm, and very painful. At present, her right knee pain and swelling has resolved but now her right ankle and left knee is swollen and painful. PE revealed BP 90/60, HR 125, RR 24, T 38.7°C, (+) high pitched apical holosystolic murmur radiating to the axilla. What is the most likely dx in this case?

Rheumatic Fever

* This case mentioned the following main features of rheumatic fever: fever, arthralgia, migratory polyarthritis, systolic regurgitant murmur radiating to the axilla signifying mitral valve regurgitation. A common differential diagnosis is juvenile idiopathic arthritis as both conditions usually present with fever and joint swelling, but the presence of a systolic murmur indicates RF instead.

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What is the main pathophysiologic mechanism behind the hypercyanotic spells or Tet spells in TOF?

due to decreased pulmonary blood flow

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ANTIBIOTIC THERAPY for ARF

Once the diagnosis of acute RF has been made and regardless of the throat culture results, the patient should receive 10 days of oral Penicillin or Erythromycin or a single IM injection of benzathine Penicillin to eradicate GAS from the upper respiratory tract.

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Rib notching
Result of increased blood flow through the interthoracic and intercostal vessels which serve as collateral circulation

COARCTATION OF THE AORTA

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hallmark PE finding is a high-pitched diastolic murmur loudest at 3 rd -4 th LICS more audible when sitting and leaning forward

• other findings: diastolic thrill at 3rd LICS; hyperdynamic precordium, bounding water hammer pulse or Corrigan pulse, wide pulse pressure

AORTIC REGURGITATION

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Inverted E

Coarctation of the Aorta

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Fontan Procedure

Tricuspid Atresia

EVIDENCE OF ANTECEDENT GROUP A STREPTOCOCCAL INFECTION: Antistreptolysin O (ASO) Titers usually become elevated \_\_\_\_\_\_after strep infection, peaks at \_\_\_\_\_\_, and decreases after another \_\_\_\_\_\_ \*a 4-fold rise in titer in 2 samples taken 10 days apart

2 weeks 4-6 weeks 2 weeks

4 anomalies in Tetralogy of Fallot

* VSD * Pulmonary Stenosis (Right ventricular outflow tract obstruction) * RVH * Overriding aorta

**Functional** closure of the DA occurs by constriction of the medial, smooth muscle in the ductus within\_\_\_\_\_\_\_ after birth.

10-15 hours

most of the SVC blood goes to the RV; about ____ of IVC blood is directed to the LA through the FO whereas the ____ enters the RV and PA

1/3 2/3

less oxygenated blood in the PA flows through the ____ to the descending aorta and then to the placenta for oxygenation

widely open DA

associated with the presence of an endocardial cushion defect / Atrioventricular septal defect

Down syndrome

What is the strongest stimulus for constriction of the ductal smooth muscle which leads to closure of the ductus.

**A postnatal increase in 02 saturation of the systemic circulation**

“fish mouth buttonhole deformity”

MITRAL VALVE STENOSIS

* Systolic ejection murmur at LUSB with radiation to the upper back * Balloon valvuloplasty * valvotomy (Brock procedure)

Pulmonic stenosis

Cyanosis manifesting within few hours at birth or within few days of life

Transposition of great Arteries

Eisenmenger syndrome is associated with?

**VSD** \*Exposure of pulmonary artery system to high pressure and increased flow → irreversible changes occur in the pulmonary arterioles → progressive increase in PVR → when PVR exceeds SVR, ductal shunting reverses and becomes R-\>L → pulmonary vascular obstructive disease **(Eisenmenger's syndrome)** → PA is prominent with RVH and pulmonary hypertension → bidirectional shunt causes cyanosis

the most consistent feature of ARF.

Valvulitis

3/6 systolic murmur described as “blowing” on the upper left 2 nd ICS and a widely split S2. RVH and RAH

atrial septal defect

* Atretic (missing) tricuspid valve * Hypoplastic right ventricle * Ventricular septal defect * Atrial septal defect * Pulmonary stenosis

TRICUSPID ATRESIA

* occurs more often in **prepubertal girls** * choreic movements **(spontaneous purposeless movements followed by motor weakness),** hypotonia, emotional lability, hyperactivity, obsessions & compulsions

Sydenham chorea

Cyanosis manifesting after the first year of life, usually in an infant or a toddler

Tetralogy of Fallot

"Snowman sign" or "figure of 8"

TOTAL ANOMALOUS PULMONARY VENOUS RETURN

Disparity in pulsation & BP in the arms & legs Weak popliteal, posterior tibial, and dorsalis pedis pulses

CoA

usually heard in young infants and children, systolic in timing, varies with position, associated with normal diagnostic results (CXR, ECG, 2D echo).

Functional or innocent murmurs

CHANGES IN CIRCULATION AFTER BIRTH

* **The primary change after birth is a shift of blood flow for gas exchange from the placenta to the lungs.** * **Interruption of the umbilical cord results in the following:** * An increase in systemic vascular resistance due to removal of the low-resistance placenta * Closure of the ductus venosus as a result of lack of blood return from the placenta * **Lung expansion results in the ff:** * Reduction of the PVR → an increase in pulmonary blood flow → a fall in PA pressure * Functional closure of the FO occurs due to increased pressure in the LA * Closure of PDA as a result of increased arterial O 2 saturation

**Systolic ejection or blowing murmur** – heard best on the \_\_\_\_\_\_\_; blood flows through stenotic structures thus producing a “blowing” sound

base or at the 2nd ICS

* All 4 pulmonary veins drain to the RA * \> RV volume overload: right heart enlargement * inc pulmonary vascular markings

TOTAL ANOMALOUS PULMONARY VENOUS RETURN

* The aorta arises from the RV carrying desaturated blood to the body; the PA arises posteriorly from the LV carrying oxygenated blood to the lungs * Result: complete separation of pulmonary & systemic circulations → hypoxemic blood circulating throughout the body & hyperoxemic blood circulating in the pulmonary circuit

TRANSPOSITION OF THE GREAT VESSELS

**S2 widely split** and **fixed** in all phases of respiration

ASD

Late systolic murmur with an **opening click**

MVP

DISCUSS THE FETAL CIRCULATION

* **Oxygenated blood from placenta** → 50% of umbilical venous blood enters hepatic circulation → rest bypasses liver & joins IVC via DV → RA → FO → LA →LV → ascending aorta (fetal upper body and brain) * **Fetal SVC blood** → RA → TV → RV → PA (only 10% of RV outflow enters the lungs) → major portion bypasses the lungs and flows through ductus arteriosus → descending aorta → lower part of fetal body → placenta via the 2 umbilical arteries

**Systolic regurgitant murmur** – heard best on the \_\_\_\_\_\_\_\_\_\_\_\_\_; blood backflows from one chamber / valve to another because of incompetent structures

apex or at the left lower sternal border

Loud, harsh, blowing holosystolic murmur

VSD

DUKE CRITERIA

INFECTIVE ENDOCARDITIS ## Footnote **MAJOR** **1. Blood culture** – viridans Strep or Strep bovis, HACEK (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella), Staphylococcus, Enterococcus o 2 separate sites 12 hours apart o 3 or more 1 hour apart **2. Echocardiographic findings** – oscillating mass vegetations, regurgitant flow near a prosthesis, abscess, partial dehiscence of prosthetic valves, new wave regurgitant flow **MINOR** * Fever * Predisposing condition * Vascular – emboli, pulmonary infarct, aneurysm, Janeway lesions * Immunologic – GN, Osler nodes, Roth Spots, RF * Microbiological evidence * Echocardiographic findings

Maternal condition with related fetak heart defect

most common cyanotic heart disease in newborns

Transposition of Great Arteries

* Most are asymptomatic but can have CHF if severe * Weak, delayed, or absent femoral pulses **• Blood pressure higher in the arms \> legs** • LVH may be seen in CXR or ECG

COARCTATION OF THE AORTA

How does squatting relieve the tet spell in TOF?

* Continuous “machinery-like” murmur at the 2 nd left infraclavicular area * Bounding pulses; * wide pulse pressure; * left-sided enlargement, * enlarged aorta

PDA

* Systolic regurgitant murmur at LLSB * loud and single S2 * Left sided enlargement; * biventricular hypertrophy if with Eisenmenger syndrome

VSD

TRANSPOSITION OF THE GREAT VESSELS

* all of the structures on the left side of the heart are severely underdeveloped. * The right ventricle must then do a "double duty" of pumping blood both to the lungs (via the pulmonary artery) and out to the body via a patent ductus arteriosus.

HYPOPLASTIC LEFT HEART SYNDROME

most common cyanotic congenital heart disease in infants and young children.

Tetralogy of Fallot

refers exclusively to the circumstance in which classic auscultatory findings of valvar dysfunction either are not present or are not recognized by the clinician but 2d echo reveal mitral or aortic valvulitis.

Subclinical carditis

Duration of prophylaxis for people who have had acute rheumatic fever

**o Only a single arterial trunk with a truncal valve** arised from the heart and supplies to the pulmonary, systemic and coronary circulation o A large VSD below the truncal valve o **PAs arise from the single arterial trunk**

TRUNCUS ARTERIOSUS

**• Blalock-Taussig Shunt with GoreTex conduit** **• Aortopulmonary window shunt** **• Waterson Cooley** **• Pott shunt**

TOF

Between\_\_\_\_\_\_ of age, there is a slower fall in the PVR and PA pressure.

6-8 weeks

**Anatomic** closure is completed by _____ of age by permanent changes in the endothelium and subintimal layers of the ductus.

2-3 weeks

Duke's Criteria definite diagnosis for Infective endocarditis

Definite endocarditis: 1. 2 major criteria, or; 2. One major and 3 minor, or; 3. 5 minor criteria

JONES CRITERIA for rheumatic fever

* 2 MAJOR or 1 MAJOR + 2 MINOR * Large joints are affected (knees, ankles, wrists, elbows) * Arthritis in major should have tenderness, swelling and other signs of inflam. If there are no signs of inflam, it's just arthralgia which is a minor criteria.

CARDIOLOGY Flashcards

(71 cards)