Chapter 8: High Yield Cardiac Flashcards
Chest pain <20 min. With exertion. EKG shows ST-segment depression
Stable angina.
Episodic chest pain unrelated to exertion - due to coronary artery vasospasm. EKG shows ST-segment ELEVATION due to transmural ischemia.
Prinzmetal angina
Occlusion of the left anterior descending artery (LAD) leads to infarction of the _____ [2].
Anterior wall and anterior septum of the LV. Most commonly involved artery in MI (45%).
Occlusion of right coronary artery (RCA) leads to infarction of the ______[3].
Posterior wall, posterior septum, papillary muscles of the LV.
Occlusion of the left circumflex artery leads to infarction of the ____[1].
lateral wall of the LV.
Gold standard laboratory test for MI
Troponin I. Levels rise 2-4 hrs after infarction, peak at 24 hrs, return to nml in 7-10 days. CK-MB is useful for detecting reinfarction (rise 4-6 hrs after infarction, peak at 24, return to nml in 72 hrs).
Left-sided heart failure tx
ACE inhibitor
‘Nutmeg’ liver, JVD, Dependent pitting edema.
Right sided heart failure
Hemosiderin-laden macrophages in the alveoli, dyspnea, paroxysmal nocturnal dyspnea, orthopnea
Left-sided heart failure
Eisenmenger syndrome
A left-to-right shunt reverses. Increased flow through the pulmonary circulation results in hypertrophy of pulmonary vessels and pulmonary htn. leads to late cyanosis with right ventricular hypertrophy, polycythemia, and clubbing.
A congenital left-to-right shunt. most common congenital heart defect. associated with fetal alcohol syndrome. Large defects can lead to Eisenmenger syndrome.
Ventricular Septal Defect. tx = surgical closure
Left-to-right shunt and split S2 on auscultation. Gives paradoxical emboli
Atrial Septal Defect (ASD). most common type is OSTIUM SECUNDUM. OSTIUM PRIMUM type is associated with DOWN SYNDROME
Holosystolic “MACHINE-LIKE” murmur.
PDA. Associated with CONGENITAL RUBELLA. Left-right shunt between aorta and pulmonary artery. Can lead to Eisenmenger syndrome, resulting in lower extremity cyanosis.
Treatment of a PDA
Indomethacin - decreases PGE.
Right-to-left shunt
Stenosis of the right ventricular outflow tract; right ventricular hypertrophy; VSD; and an aorta that overrides the VSD. “Boot-shaped” heart on x-ray
Tetralogy of Fallot. Pt learns to squat in response to a cyanotic spell; increases arterial resistance –> decreases shunting and allows more blood to reach the lungs
What disease is associated with Transposition of the Great Vessels
Maternal Diabetes
Single, large vessel arising from both venticles.
Truncus arteriosus
Location of coarctation of the aorta in the infantile form. _____ Disorder association?
Coarction lies after the aortic arch, but BEFORE the PDA. Associated with a PDA, and TURNER SYNDROME. Presents as lower extremity cyanosis in infants at birth
HTN in the upper extremities, hypotension with weak pulses in the lower extremities. Notching on the ribs. Associated with?
Adult form of coarctation of the aorta. Lies after the aortic arch. Get collateral circulation across intercostal arteries. ASSOCIATED WITH BICUSPID AORTIC VALVE
Jones Criteria
For dx of Acute Rheumatic Fever:
1. Evidence of prior group A beta-hemolytic strept infection (elevated ASO or anti-DNase B titers).
2. Minor criteria: fever and elevated ESR.
3. Major:
J: Joint - Migratory polyarthritis.
O: Heart. Endocarditis [mitral valve - small vegetations leading to regurgitation. Myocarditis with ASCHOFF BODIES (ANITSCHKOW CELLS) Pericarditis - leading to friction rub and chest pain
N: Nodels [Subcutaneous nodules
E: Erythema marginatum [annular, nonpruritic involving trunk and limbs]
S: Sydenham chorea [rapid, involuntary muscle movements]
Systemic complication of pharyngitis due to group A Beta-hemolytic strep. Children 2-3 weeks after strep pharyngitis. Caused by molecular mimicry –> BACTERIAL M PROTEIN.
Acute Rheumatic Fever
Stenosis with “FISH-MOUTH” appearance. Usually mitral valve - thickening of chordae tendineae and cusps. Occasionally aortic valve leading to fusion of the commisures.
Chronic Rheumatic Heart Disease. Complication = infectious endocarditis
Systolic ejection click followed by a crescendo-decrescendo murmur.
Aortic stenosis May lead to CONCENTRIC left ventricular hypertrophy, angina and syncope with exercise, and Microangiopathic hemolytic anemia [schistocytes]
Early, blowing diastolic murmur. Hyperdynamic circulation due to increased pulse pressure. Presents with bounding pulse [WATER-HAMMER PULSE], Pulsating nail bed [QUINCKE PULSE], and head bobbing.
Aortic Regurgitation. Results in LV dilation and ECCENTRIC hypertrophy
