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Cardiology-Notes Flashcards

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1
Q

What might a normal newborn EKG show?

A

physiologic R axis deviation

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2
Q

What is acrocyanosis? When is it normal?

A

peripheral cyanosis
from peripheral vasoconstriction
can be normal in newborns, but should resolve
if it persists–think about central cause-heart defect.

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3
Q

Cyanosis w/o respiratory distress–what should you think of?

A

congenital heart defect

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4
Q

How do congenital cyanotic heart disease patients react to 100% oxygen?

A

no improvement

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5
Q

How might polycythemia in a patient with congenital heart dx contribute to acrocyanosis?

A

increased RBCs (as a reaction to cyanosis) can cause sluggish blood flow & prompt peripheral cyanosis

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6
Q

What are some symptoms associated with a pathologic murmur in an infant?

A

diaphoresis
tiring with feeds
poor weight gain

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7
Q

What are some symptoms associated with a pathologic murmur in children?

A 
chest pain
dizziness
syncope
SOB
fatigue
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8
Q

What are some concerning physical exam findings of a murmur?

A 
holosystolic
diastolic
>=3/6
INCREASES with standing or Valsalva (decreased blood return)
Loud, fixed split, or single S2
decreased or absent femoral pulses
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9
Q

What is the work up for a concerning murmur in a child?

A

CXR (cardiomegaly)
EKG (hypertrophY)
ECHO
cardio referral

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10
Q

Holosystolic harsh @ LLSB. Do you need an ECHO?

A

Yes, possibly a VSD.

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11
Q

What are the heart defects of R–>L shunts? Blue babies?

A

1-5

  1. Truncus Arteriosus (1 vessel)
  2. Transposition of the Great Vessels (2 vessels)
  3. Tricuspid Atresia (tri-3)
  4. Tetrology of Fallot (4-tetra)
  5. TAPVR (5 letters)
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12
Q

What are the heart defects of L–>R shunts? Blue kids?

A

1-3
1 VSD
2. ASD
3. PDA

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13
Q

Which congenital heart defects are associated with Digeorge 22q11?

A

the Ts
Truncus Arteriosus
Tetrology of Fallot

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14
Q

Which heart defect is associated with congenital rubella?

A

PDA

Ruby is the color of love. public displays of affection.

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15
Q

Which heart defects are associated with Turner’s syndrome?

A

coarctation of the aorta

bicuspid aortic valve

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16
Q

Which cardiac conditions are associated with marfan’s? & ehlers danlos?

A

aortic root dilation aka ascending thoracic aortic aneurysm
increased risk for aortic dissection
MVP
aortic insufficiency (regurg)

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17
Q

Diabetic moms have increased risk of children with what?

A

transposition of the great vessels.

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18
Q

Friedrich’s ataxia is associated with what?

A

hypertrophic cardiomyopathy

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19
Q

What are the features that are shared by Marfan syndrome and homocystinuria?

A 
pectus deformity
tall stature with high arm/height ratio
larger lower segment than upper segment
arachnodactyly
joint hyperlaxity
skin hyperelasticity
scoliosis
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20
Q

What are the features of Marfan syndrome that distinguish it from homocystinuria?

A

autosomal dominant
normal intellect
lens dislocation
aortic root dilation

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21
Q

What are the features of homocystinuria that distinguish it from Marfan’s syndrome?

A 
autosomal recessive
intellectual disability
thrombosis
megaloblastic anemia
fair complexion
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22
Q

When can PDA be beneficial? What is it associated with? What does the murmur sound like?

A

beneficial in R–>L shunts blue babies
associated w/ congenital rubella
sounds like a continuous machine like murmur

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23
Q

What is the presentation of PDA?

A 
may be asymptomatic
accentuated increased pulses
if large-can get CHF
tachypnea, tachycardia, poor feeding, FTT
can lead to Eisenmenger
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24
Q

WHat is the workup and treatment of a PDA?

A

dx: via ECHO
treatment: usu closes in a few weeks
can ligate surgically if it doesn’t close or use indomethacin
keep it if they have R–>L shunt.

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25
what is an ASD? Which types are most common? associations?
endocardial cushion defect ostium secundum is most common-90% ostium primum is second most common-seen in down syndrome
26
What is the murmur and presentation of ASD?
split S2-delayed closure of the pulmonary valve b/c of increased blood in the R heart fixed splitting of S2 presentation-fixed split S2, paradoxical emboli
27
What is the most common congenital heart defect and what is it associated with?
VSD | associated with FAS, vascular rings
28
What can improve vascular rings stridor?
extension of the neck and racemic epi
29
What is the VSD murmur?
2/6 harsh, holosystolic LLSB (T) | diastolic rumble over cardiac apex
30
What is the presentation of VSD?
``` asymptomatic at birth pulmonary resistance drops... can get CHF tachypnea, tachycardia, poor feeding, FTT Eisenmenger Need ECHO may need repair surgically ```
31
What is Still's murmur?
benign murmur that is 2/6 low frequency midsystolic murmur at LLSB just reassure if harsher, holosystolic, 3/6 then think VSD.
32
What are the features of Tetrology of Fallot?
Overriding aorta Pulmonic stenosis RVH VSD
33
Which conditions is tetrology of fallot associated with ?
``` 22q11 down syndrome alagille syndrome (aut dom) ```
34
What is the murmur and presentation of tetrology of fallot?
VSD murmur T spot 3/6 harsh holosytolic murmur Pulmonic stenosis murmur: harsh systolic ejection murmur at LUSB (P) boot shaped heart on CXR kids squat during a cyanotic spell
35
What is the appropriate treatment for tetrology of fallot?
surgery before 6 months
36
Who gets transposition of the great vessels? Murmur?
maternal diabetes 22q11 Murmur: Single S2, VSD murmur
37
Presentation and treatment of transposition of the great vessels?
cyanosis with RVH egg on a string Xray PGE2 then surgical correction-make a VSD or ASD. Mix the blood.
38
What's the deal with tricuspid atresia?
need both an ASD and VSD to survive hypoplastic RV, tricuspid valve fails to develop, L axis deviation decreased pulmonary artery development--see fewer markings on CXR PGE2 until surgery
39
What's the deal with TAPVR?
all 4 pulmonary veins return to the right atrium get RA and RV enlargement-->RVH and R axis deviation CXR: cardiomegaly, increased pulmonary markings diastolic and systolic murmur--b/c increased flow across tricuspid and pulmonary valves.
40
What is the presentation of coarctation of the aorta?
lower extremity hypoperfusion (cyanosis) and acidosis won't have equal palpable femoral pulses adults-rib notching HTN in upper extremities get RAAS activation HTN b/c of decreased renal perfusion keep ductus arteriosus open with PGE2.
41
Central cyanosis w/o murmur?
hypoplastic left heart
42
benign condition that presents with soft systolic murmur heard best at LUSB (P) w/ radiation to both axilla?
peripheral pulmonary stenosis | due to acute angle of R & L pulmonary arteries.
43
What is the murmur of a bicuspid aortic valve? what can it lead to?
S2 click | aortic stenosis, aortic regurg, aortic root dilation
44
What is Ebstein's anomalY?
due to maternal lithium usage malformed tricuspid valve is in the RV get tricuspid regurg and RA enlargement
45
What would an EKG of ebstein's anomaly show?
R axis deviation | tall p waves from RA enlargement
46
What is the murmur of MVP? Which conditions may cause this?
``` mid systolic click. More severe with earlier click. Marfarns, Ehlers Danlos, OI ADPKD ```
47
What is the treatment for MVP?
beta blockers if there is chest pain | but really nothing helps.
48
Which conditions are associated with mitral regurg?
infective endocarditis acute rheumatic heart dx tuberous sclerosis
49
What is the presentation, complications, and treatment of mitral regurgitation?
holosystolic blowing murmur this increases with squatting and expiration (like most murmurs) can get volume overload and L-sided heart failure need valve replacement
50
Which condition can cause a rhabdomyoma in children?
benign hamartoma of cardiac muscle | associated with tuberous sclerosis
51
What are the features of tuberous sclerosis?
HAMARTOMAS ash leaf spots (white leaf patches over body) renal angiomyolipoma mitral regurgitation rhabdomyoma seizures subependymal astrocytoma angiofibromas in butterfly pattern on face shagreen patches-orange dimply leathery spots on the face. AUTOSOMAL DOMINANT
52
Where can HOCM murmurs be heard?
apex | LLSB
53
What does valsalva do to preload? Which murmur increases with it?
increases intrathoracic pressure decreases preload increases HOCM murmur
54
Which murmurs increase with inspiration? expiration?
increases with inspiration-R sided murmur | increases with expiration--L sided murmur
55
ASD V. VSD?
ASD-fixed split S2.
56
Other disorders that can cause tetrology of fallot and transposition of the great vessels?
cru di chat | trisomy 13/18
57
bounding peripheral pulses?
truncus arteriosus, pda
58
What are some arrhythmias associated with ebstein's anomaly?
SVT | WPW
59
Causes of aortic stenosis?
1. calcific 2. congenital 3. rheumatic fever 4. infective endocarditis 5 tertiary syphilis
60
pulvus parvus et tardus?
weak pulses with delayed peak | aortic stenosis
61
Wide pulse pressure | water hammer pulse
``` aortic regurgitation water hammer (corrigan's) Austin flint: low pitched diastolic rumble ```
62
Causes of mitral regurgitation?
``` endocarditis (s. aureus) papillary muscle rupture ischemia chordae tendinae rupture myxomatous degeneration rheumatic fever marfan's cardiomyopathy tuberous sclerosis ```

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