Lecture 5: Cardiology Flashcards

Question

ventricular septal defect

Answer 1

* **Small** VSD * 80-85% of VSDs * asymptomatic * generally close on their own without surgery * **Moderate** VSD * serially monitored by cardiologists * **Large** VSD with normal pulmonary vascular resistance * left-to-right shunting as pulmonary vascular resistance naturally decreases (2-8 weeks of life) * infant develops congestive heart failure * failure to thrive * difficulty feeding * labored breathing/pulmonary edema

Answer 2

* an untreated large VSD will cause pulmonary overcirculation * overcirculation of pulmonary system causes pulmonary hypertension * normal left-to-right shunt reverses to right-to-left shunt as pulmonary system pressures surpass systemic pressures * prolonged cyanosis * causes organ and vascular damage * platelet dysfunction * treatable only with heart transplant

Answer 3

* main artery to body stenotic or interrupted * causes upper extremity hypertension and reduced flow to abdominal organs and lower extremities (SBP different by 20 should raise concern) * **all newborns screened for femoral pulses and saturations** * mild cases may have long-term growth problems, * often have aortic valve abnormalities audible on exam * may have chronic leg discomfort or lower extremity wasting * in severe cases with pre ductal coarctation the PDA needs to be kept open to ensure survival * if PDA closes, shock and acidosis ensue rapidly

Answer 4

* five most common cyanotic CHD * truncus arteriosus * transposition of the great arteries * tricuspid atresia * tetralogy of Fallot * total anomalous pulmonary venous return

Answer 5

* ~10% of all congenital heart disease * four components to defect * ventricular septal defect * pulmonary stenosis * right ventricular hypertrophy * overriding aorta * The patient may be ‘pink’ (not cyanotic) if pulmonic stenosis mild and VSD shunts left to right * “Tet spells” where patient grows cyanotic, progressively worse with age * infants become agitated, tachypneic and have difficulty feeding * toddlers may squat to resolve Tet spell * long systolic ejection murmur (from PS) * classic CXR appearance - boot-shaped heart * surgically repaired in infancy * Tet spells are medical emergencies: SOB, cyanosis, loss of consciousness * Squatting helps to fix these

Answer 6

* follows a previous infection with ***Strep*** *pyogenes* (GAβHS) – rate in untreated is approx. 3% * typically between ages 5 and 15 years * mortality of 2-5% * pathophysiology * sensitization of B lymphocytes * formation of anti-streptococcal antibodies * formation of Immune complexes * myocardial & valvular inflammatory response * major criteria JONES criteria (mnemonic J\<3NES) – * 2 major criteria make the diagnosis * joints – migratory polyarthritis * carditis * as myocarditis, pericarditis or valvular disease * nodules (subcutaneous) * extensor surfaces of extremities * erythema marginatum * pink-red macules grow, then coalesce into serpiginious long patches * Sydenham’s chorea – uncontrolled movements * with or without psychiatric disease * may define disease as a single criterion * 1 major + 2 minor can also signify disease * Minor criteria * polyarthralgia * fever * elevated ESR, CRP * prolonged PR interval * Previous rheumatic fever * Supportive serology of previous infection * anti-streptolysin O is the best test * anti-DNAse B & streptozyme also used

Answer 7

* antibiotics * short-term to treat indolent infection * long-term to prevent recurrence * often every 3-4 weeks for life * aspirin for anti-inflammatory effects * sometimes requires corticosteroids * supportive * cardiac meds (digoxin, diuretics) * endocarditis prophylaxis for procedures

Answer 8

* greatest risk is to those with preexisting heart disease or cardiac foreign material * may be acute or subacute * viridans streptococci * *S. aureus* * less common * enterococci * HACEK organisms (fastidious Gram-negative rods) * fever * chest pain * symptoms of heart failure * fatigue, tachypnea, dyspnea on exertion * changing murmur * petechiae & embolic phenomena * splenomegaly +/- hepatomegaly * arthritis * weight loss (subacute or chronic illness) * Bacteremia with positive blood cultures * hematuria * markedly elevated inflammatory markers

Answer 9

* treatment * long-term antibiotics * directed therapy (based on cultures) * surgical excision or valve repair sometimes warranted * supportive care for sequelae * congestive heart failure * use transthoracic echos first and blood cultures, etc. * Has to be treated for a very long time

Answer 10

* cardiac risk factors that are often indications for prophylaxis * prior history of infective endocarditis * any valvulopathy * prosthetic heart valves * unrepaired cyanotic CHD * repaired CHD with prosthetic material, device or venous pacer wires * risk of procedure also important to determine need * dental/oral or upper respiratory tract * amoxicillin * GU/GI procedures * amoxicillin for enterococcal coverage * aminoglycoside - for gram-negative coverage * procedures that involved infected tissues * clindamycin or vancomycin to cover MRSA

Answer 11

* Pain is in the center of the chest over the past 3 days. * No history of chest pain * Pain is worse with deep breathing * No fever * He has been coughing * No history of pain with activity, some increase in symptoms while active * No history of fainting * No family history of cardiac disease