Crescendo decrescendo systolic murmur, radiates to carotids - Old patient - syncope, angina, dyspnea - calcified valve - bicuspid aortic valve - pulsus parvus et tardus (late, weak pulse)

Opening snap - hx rheumatic fever - diastolic

holosystolic HARSH murmur - down syndrome, cru di chat, edward syndrome, patau syndrome, TORCH infections

high pitched, blowing early diastolic decrescendo murmur - acute= infective endocarditis - Chronic= bicuspid aortic valve - Valvular AR best heard along left sternal border - AR due to aortic root dilation can be heard on left and right sternal borders

Opening snap with delayed diastolic rumbling murmur - SLE, RA, rheumatic fever - mimckers= left atrial myxoma, bacterial endocarditis

- continuous machine like murmur (both systole/diastole) - congenital rubella, premature infants (FAS, fetal hydantoin syndrome- phenytoin use) Keep open with prostaglandins Close with indomethacin

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Presentation of sick sinus syndrome and ECG findings

Impaired SA node automaticity (degeneration/fibrosis of SA node)

fatigue, lightheadedness, syncope, presyncope, palpitations
ECG: alternating bradycardia and tachyarrhythmias (tachycardia-bradycardia syndrome); sinus pauses/arrest, SA exit block

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Side effects of ACE inhibitors

Cough, drug-induced angioedema

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Lab work up of new hypertension

Renal: Electrolytes, Cr, UA (hematuria/proteinuria), Ur albumin/Cr ratio

Endocrine: fasting glucose, a1c, lipid profile, TSH

Cardiac: ECG (LVH or previous MI), echo (optional)

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Which bacteria cause endocartitis after dental manipulation or respiratory tract incision/biopsy?

Viridians streptococci (sanguinis, mutans, mitis, milleri)

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Tx of torsades de pointe in hemodynamically unstable vs. stable patients

Unstable- defibrillation

Stable- IV Magnesium sulfate

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Presentation of Pericarditis

substernal, pleuritic chest pain- better when leaning forward

inflammatory, infectious, or malignant etiology
Widespresad ST elevations and PR depressions on ECG

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Presentation of endocarditis

**staph aureus= acute, viridans= subacute

valve dysfunction or vegetations on echo

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When do murmurs get louder/softer?

Right sided murmurs louder with inspiratoin

RINSpiration

Left sided murmurs louder with expiration

LEXPiration

Increased preload- more flow over murmur (squatting, leg raise)= LOUDER murmurs

Except: HOCM/MVP

*more blood flow over septum pushes hypertrophied septum back into normal positioning and decreases murmur sound

Decreased preload (less blood across heart)- valsalva= SOFTER murmurs

Except: HOCM/MVP

**less blood= septum not back in position= louder murmur

Increased afterload (more back-pressure on heart)= louder regurgitant murmurs, softer HOCM/MVP

Decreased afterload= louder HOCM/MVP

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Aortic Stenosis

Crescendo decrescendo systolic murmur, radiates to carotids

Old patient - syncope, angina, dyspnea
calcified valve
bicuspid aortic valve
pulsus parvus et tardus (late, weak pulse)

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Mitral regurgitation

Tricuspid regurgitation

Holostystolic murmur

rheumatic fever
radiates to axilla

Tricuspid- holosystolic, IVDA

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Mitral stenosis

Opening snap

hx rheumatic fever
diastolic

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VSD

holosystolic HARSH murmur

down syndrome, cru di chat, edward syndrome, patau syndrome, TORCH infections

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Aortic regurgitation

high pitched, blowing early diastolic decrescendo murmur

acute= infective endocarditis
Chronic= bicuspid aortic valve
Valvular AR best heard along left sternal border
AR due to aortic root dilation can be heard on left and right sternal borders

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Miral stenosis

Opening snap with delayed diastolic rumbling murmur

SLE, RA, rheumatic fever
mimckers= left atrial myxoma, bacterial endocarditis

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PDA

continuous machine like murmur (both systole/diastole)
congenital rubella, premature infants (FAS, fetal hydantoin syndrome- phenytoin use)

Keep open with prostaglandins

Close with indomethacin

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Constrictuve pericarditis presents with:

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kussmaul sign- increase in JVP with inspiration
can also be seen in tamponade

Pulsus paradoxus

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Fall in systolic BP >10 with inspiration

Cardiac tamponade or constrictive pericarditis

Treatment of:

SVT (narrow complex)

Ventricular tachcardia (wide complex)

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SVT: adenosine

VT: amiodarone

Who should recieve antibiotic prophy for infective endocarditis?

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Just people with prosthetic heart valves or previous IE

Atrial septal defect

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Left to right shunting

Wide and fixed splitting of S2
mid-systolic or ejection murmur over LUSB
mid-diastolic rumble

First line tx for patients with septic shock who do not respond to fluid repletion

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Norepinephrine

First line tx for patients with cardiogenic shock

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Dobutamine

Treatment in acute myocardial ischemia

What treatment decreases the chest pain in acute MI?

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Morphine, oxygen, nitrates (venous dilatation), aspirin, beta blockers, LMWH, possibly statins

Venous dilation (via nitrates)- decreases LV preload and therefore reduces stress on ventricle- decreased myocardial oxygen demand

Tx of hyperkalemic emergency (usually >6.5)

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IV calcium gluconate or and/or insulin+dextrose

can result in heart block

Tx of unstable patient with complete heart block

1st atropine even if unstable transcutaneous pacing follows if still unstable If still refractory, dopamine or dobutamine

Presentation of Ruptured Abdominal Aortic Aneurysm

- Sudden onset severe abdominal/back/flank pain (referred pain) - hypotension - pulsatile abdominal mass

Clinical suspicion for blunt thoracic aortic injury-- workup for stable vs. unstable patient

Stable: CT angiography Unstable: straight to surgery +/- TEE in operating room

Predisposing factors for Torsades de Pointe Tx of Torsades

antiarrhythmics, structural heart diseaes, hypokalemia, hypomagnesima Tx: magnesium sulfate

High Output Heart failure 2/2 Thyroid Storm

Decreased SVR--\> increased cardiac index (output)--\>hyperdynamic circulation--\> increased venous return to heart--\> LV overwhelmed, fluid back up into lungs--\> Increased PCWP Decreased SVR, increased cardiac index, increased PCWP

Viral myocarditis in young person can lead to?

Dilated cardiomyopathy

Preferred imaging modality for fibromuscular dysplasia? (cause of secondary hyperaldosteronism)

computed tomography angiography of abdomen

Leriche syndrome (aortoiliac occlusion-- bifurcation of aorta)

- claudication of butt, thighs, hip bilaterally - absent or diminished femoral pulses - impotence

Anatomic origin of Afib

Pulmonary Veins

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