Term
| Hear a diastolic murmur, next step and why |
|
Definition
| echo is ordered b/c most diastolic murmurs are pathologic |
|
|
Term
| Hear a continuous murmur, next step and why |
|
Definition
| Echo is ordered, b/c most continuous murmurs are pathologic |
|
|
Term
| Phase most murmurs are found in |
|
Definition
|
|
Term
Parasternal heave
Palpable thrill
Pt leans forward, holds breath after exhalation, diastolic murmur
Pt on L side exhales --> diastolic murmur
Pt on L side--> sysotolic murmur |
|
Definition
RVH
Aortic Stenosis
Aortic regurg--->L3rd ICS
Mitral stenosis--> L5th ICS
Mitral Regurg --> axilla |
|
|
Term
When you hear a murmur tells
Where you hear a murmur tells
What you hear with a murmur tells |
|
Definition
Systolic/diastolic
location
regurg/stenosis |
|
|
Term
Murmur is loud/ changing:
tells us
what next |
|
Definition
| body is compensating, relieve the stress the body is compensating for |
|
|
Term
Causes of:
An obstruction
Increaesed normal blood flow
Regurgitant flow across an incompetent valve
Abnormal shunting of blood |
|
Definition
AS
Aortic murmur w/ high output state/anemia
Mitral valve prolapse
VSD |
|
|
Term
Valve open + murmur =
During Systole valve position
During Diastole valve position
If suppposed to be open think,
If suppose to be closed think, |
|
Definition
AS
AV closed/ SL open
AV open/ SL closed
stenosis
regurge/ prolapse |
|
|
Term
Sysolic murmur by positon:
RUSB =
LUSB =
Erb's =
LLSB =
APEX = |
|
Definition
AS
PS, PDA
HCM
TR, VSD
MR, MVP |
|
|
Term
| systolic Crescendo- decreschendo, increases and decreases w/ |
|
Definition
| valsalva/standing, squatting |
|
|
Term
Diastolic murmur location
LUSB=
Erb's=
LLSB =
Apex =
Erb's point, exhale/hold breath while leaning forward
Continuous murmur location:
LUSB =
LUSB/RUSB/back/ clavicals = |
|
Definition
pulmonic regurg/ split S2
Aortic regurg
TS
MS
AI/AR
PDA
Venous Hum |
|
|
Term
| 1. Machine like Benign sound, turbulent sound in 2. Jugular veins, children, over clavicals, Loud diastole |
|
Definition
|
|
Term
| Early to mid systolic, soft (I-II/VI), breathing variant, normal exam & w/u, no family Hx |
|
Definition
|
|
Term
| All diastolic murmurs (besides...), all pan-systolic murmurs, late systolic murmurs, LOUD murmurs, Continuous murmurs |
|
Definition
| Pathologic murmurs besides Venous Hum |
|
|
Term
| non-suppurative sequelae occuring 2-3 weeks post pharyngeal infection w/ GAS, 5-15 y/o, Rampant in underdeveloped countries....Philipines |
|
Definition
|
|
Term
| Previously MCC of valvular heart dz, decreased due to PCN, school aged children |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Important ARF presentation patient Hx question |
|
Definition
| Hx of Strep throat in family |
|
|
Term
| morbid condition following/occuring as a consequence of another condition |
|
Definition
|
|
Term
| Arthritis affects numerous joints- presents one joint at a time, abnormal heart beat, CP, red patches on skin, small painless lumps beneath skin, rapid involuntary extremity/facial movements |
|
Definition
| GAS Specific Sx, 5-15 y/o |
|
|
Term
| areas of focal necrosis surrounded by inflammatory cells, plasma cells, macrophages--form fibrous scar tissue |
|
Definition
|
|
Term
Major JONES criteria
Rubor, calor, dolor, <4 wk duration, migratory
New MS/AI; cardiomegaly, CHF, Aschoff bodies
Firm, painless nodules, wrist/elbows/knees/achilles tendon- erupt with murmur formation
Milk maid's sign-->explain
Patches, not painful/itchy, on trunk no migration to face, hot shower provokes
Minor JONES Cirteria
How many of each |
|
Definition
Joints(polyarteritis), carditis, nodules(SQ), erythema marginatum, syndeham chorea
Milkmaid grip->grip increase then decrease, males, neurlogic d/o
Arthralgias, Fever, elevated ESR/CRP, heart block, Prior Hx of RF
2 Major/ 1 Major; 2 Minor |
|
|
Term
1st sign of ARF
Last sign of ARF |
|
Definition
Polyartertitis
Chorea/ SQ nodules |
|
|
Term
| ASO/Anti-DNase B/ ASTZ- if 1+ is (+) what's next |
|
Definition
| Apply Jones Criteria and see if strep is found |
|
|
Term
1. GAS + Jones Citeria =
2. Presumptive Dx can be made with which follow circumstances
3.CXR with patients with RF |
|
Definition
ARF
Strep + 2 major/ Strep + 1 major and 2 minor
2. Chorea is the only manifestation
Indolent carditis- pt doesn't get medical care early
Recurrent RF- considered if any RF manifestations arise
3. Cardiomegaly/Heart Failure |
|
|
Term
1.Common ECG finding in carditis
2.Progression of this arrhythmia |
|
Definition
1. Heart Block
2. 1st - 2nd(I-Wienkebach, II-Mobitz) - 3rd (KNOW THESE BLOCKS |
|
|
Term
1.Tx of ARF
2.% of recurrent infections...
3.Why hospitalize |
|
Definition
1.Acute Sx relief
Bed Rest
Sx relief until all Sx/ESR,CRP are normal
GAS eradication= ABX
GAS prophylaxis=
Hospitalization
2. 50%
3.MC age 5-15y/o, heart is affected, potentially high HB occurance-bad |
|
|
Term
Tx of ARF specific Sx:
Acute Sx relief
Carditis
ABX Eradication
ABX prophylaxis |
|
Definition
pericardial inflammation= (ASA-100mg/kg)/(Predinsone: 1-2mg/kg for 4-12wks, taper)
HB/HF= conventional Tx/valve repair
Rash=antihistamine
ABX Eradication:
Penicillin VK: Child-250mg, >12 500mg both BID
PCN all= Macrolide
(+/-) pharyngitis, household contact TC- Tx (+)
Prevention:
RF + carditis + valvular dz=10yr/40y/o
RF + carditis - valvular dz=10yr/21y/o
RF - carditis = 5 yrs/ 21y/o |
|
|
Term
Most severe sequelea of ARF
Occurs.... years after the original dz
MC affected valves |
|
Definition
Rheumatic heart dz
10-20 yrs
Mitral (MS), but also Aortic |
|
|
Term
Most common cardiac valve lesion in US
In North America dz is due to
Most common valve lesion in the world |
|
Definition
AS
degenerative calcific diseased valve wear and tear
Rheumatic valve dz, mitral valve involvement |
|
|
Term
| Dyspnea on exertion/ decreased exercise tolerance, exertion dizziness, exertion angina- related to valve d/o |
|
Definition
|
|
Term
Pulsus parvus et tardus, best heard in
S4 related to |
|
Definition
AS, carotid artery
A stiff wall |
|
|
Term
| Cardinal Sx of advance/end stage dz and average survival after onset of AS |
|
Definition
Angina - 5 yr
Exertional Syncope - 3yr
CHF 2 yr
Dyspnea 2 yr
A fib 6mo- precipitates overt HF and can increase mortality rates |
|
|
Term
Why does AS cause:
Syncope
CHF |
|
Definition
1. LV cannot push out enough blood to feed the brain due to vasodilation and reduced orifice opening
2.Pressure built up in LV causes LA to fill with blood resulting in an increase in lung fluid causing congestion |
|
|
Term
Systolic, harsh, best heard at RUSB, radiates to carotids
selective radiation of high frequency AS to apex is known as... |
|
Definition
1. AS
2. Galverdian phenomenon - may be confused for MR |
|
|
Term
Diagnosis and Evaluation of AS
Echocardiogram if:
2 things we look at
Exercise Testing |
|
Definition
done every 6-12 mo Vmax >=4m/s (stage C/severe)
ANY CHANGE in Sx
Jet velocity and valve area3-4cm, normal is 3.5
ASX severe AS to confirm absence of Sx |
|
|
Term
AS: Tx additional informatio-
1. How beneficial is medical Tx of AS?
2.Who should be approached with extreme caution and Tx with this concomittance?
3.Which Rx should be avoided in all AS pt?
4. Definitive Tx = ?
5. Definitive Tx for young adults with congenital AS? |
|
Definition
| 1.no proven delay in progression 2.extreme caution with anti-HTN, start and titrate slow with close monitoring 3.Diuretics should be avoided- could lead to further decrease in CO 4.Aortic valve replacement 5. balloon aortic valvuloplasty- effective in young adults with congenital AS |
|
|
Term
MC etiology in developed countries is due to abnormalities of valve leaflets/dilation of aortic root?
Most common etiology in underdeveloped countries is rheumatic heart dz? |
|
Definition
|
|
Term
| 1. Cause of aortic root dilation in Aortic regurgitation |
|
Definition
|
|
Term
| MC acute native valve medical emergency related to Aortic Insufficiency? |
|
Definition
Endocarditis
Aortic dissection |
|
|
Term
Result of:
Acute AR
Chronic AR |
|
Definition
1. rapid decompensation-->inability to compensate increased EDP, backs up into the LA-->Lungs
2. Ventricular dilation-->CHF-->widened pulse pressure to push out extra blood |
|
|
Term
"water hammer" pulse
Prolonged asymptomatic period
DOE/orthopnea, PND |
|
Definition
1.Aortic Insufficiency
2.CHF |
|
|
Term
Clinical features:
Head bobbing with systole-forceful extra stroke volume
Water-hammer -
Capillary pulsations in the nail beds-
Pistol shot sounds over radial/femoral artery -
To-and-from femoral murmur |
|
Definition
DeMusset's sign
Corrigan's Pulse
Quincke's pulse
Traube's sign
Duroziez's sign |
|
|
Term
| Blowing diastolic murmur, accentuated with sitting up, leaning forward, exhaling, Erb's, Heard best RSB and apex, Austin Flint Murmur |
|
Definition
|
|
Term
Aortic Insufficiency
CXR- acute-
Chronic- |
|
Definition
pulmonary edema
LVH, enlarged cardiac silhouette |
|
|
Term
Aortic Insufficiency: Echocardiogram
Echocardiogram |
|
Definition
Confirm the presence and severity of acute
Determine the cause of chronic AR
Determine LV function, detect LV changes: hypertrophy, dimension/volume, and systolic function
For enlarge aortic root assess regurgitation and the severity of aortic dilation
Periodic re-evaluation-severe AR |
|
|
Term
| Frequency of monitoring Aortic Insufficiency |
|
Definition
3-5 yrs mild-Stage B
1-2 yrs moderate-Stage B
6-12 mo
re-evaluate mild/moderate/severe AR with new/changing Sx |
|
|
Term
| Aortic Regurgitation and SX |
|
Definition
| Most are not candidates, they generally not Sx at mild/moderate |
|
|
Term
| Dx testing for Aortic Regurgitation |
|
Definition
Radionucleotide angiography/MRI- initial/serial-->suboptimal echo
Cardiac Cath: when noninvasive tests are inconclusive
Exercise stress testing: for chronic AR |
|
|
Term
| Medical Tx Aortic Regurgitation |
|
Definition
Pharmacologic Tx- no Tx required in asymptomatic patients
Vasodilators- for severe AR, patients w/ Sx or reduced LV who are not SX candidates
Surgical Tx- Aortic valve replacement is only effective for severe AR |
|
|
Term
Aortic Insufficiency Prognosis
Without SX death occurs: |
|
Definition
Chronic progression over 10 yrs
>4 yrs after angina
>2 yrs after HF symptoms |
|
|
Term
MS worsens with:
Pulmonary hypertension Passive v. Reactive |
|
Definition
1.A-fib, tachycardia, Pregnancy (increase preload)
2. passive = pressure increase from backward flow of blood from LA
Reactive = pulmonary arterial/arteriolar vasoconstriction, PA hypertrophy |
|
|
Term
Increased LA pressure --> pathophysiology end result and Sx
Why does this worsen with A fib?
Why does this worsen with tachycardia?
Why does it worsen with pregnancy? |
|
Definition
1. back up of blood -- > transudates in the lungs --> dyspnea
2. lack of atrial kick --> less blood into LV --> decreased CO
3. Shorter emptying time--> increased volume left in atrium
4. increased volume of blood (preload) for mom and baby--> pathology of MS is the same but now increased volume leads to increased volume left in the LA |
|
|
Term
Diastolic murmur, OS, best heard at the apex while in the LLDP
Severity is dependent on... |
|
Definition
1.MS
2. duration of the murmur |
|
|
Term
| Orthopnea, RHF, Dysphonia |
|
Definition
| MS- Pillows needed to sleep, caused by LHF, Dilated LA impinges the recurrent larygeal nerve |
|
|
Term
ECG: p-mitrale
CXR: LAE/ CHF signs
Echo: Fish mouth/ Left atrial thrombus |
|
Definition
|
|
Term
Normal v. Severe MS
Mean gradient
valve area
PA systolic pressure |
|
Definition
Normal: Severe:
0 >10
4-6 <1
<30 >50 |
|
|
Term
Diagnostic testing of MS:
Imaging of choice and Use/Frequency |
|
Definition
1. Echocardiogram
2. Assessment of severity based on MVA, mean gradient, PA pressure; Known MS re-evaluation with changing S/s; evaluate progression of ASX, stable patients via serial images
3. MVA:
>1.5cm = 3-5yr
1-1.5cm = 1-2yr
<1cm = annually |
|
|
Term
|
Definition
| presence/absence of LA thrombus; pre-op for percutaneous mitral balloon valvotomy |
|
|
Term
| Management basics of MS if pulmonary artery pressure >50mmHg |
|
Definition
|
|
Term
| Management basics of MS if pulmonary artery pressure <50mmHg |
|
Definition
|
|
Term
| Poor exercise tolerance / PASP >60 mmHg / PA wedge pressure =>25mmHg |
|
Definition
|
|
Term
|
Definition
|
|
Term
What to do next:
Class II
MVA >1.5cm
Exercise stress test PASP > 60mmHg, PAWP =>25mmHg, MVG >15mmHg and class IIb MS |
|
Definition
|
|
Term
What to do next:
Class II
MVA=<1.5cm
not favorable of PMBV
Sere PH; PAP >60-80mmHg |
|
Definition
| Commissurotomy/ MVR (replacement) |
|
|
Term
What to do next:
Class III/IV
MVA =< 1.5cm
not favorable of PMBV
and not a high risk SX pt |
|
Definition
| MVR / Mitral valve repair |
|
|
Term
What to do next:
Class III/ IV
MVA =< 1.5cm
not a high risk SX pt |
|
Definition
|
|
Term
When is pharmacologic Tx appropriate for MS
What Rx are used for MS
What is the use of these individual Rx |
|
Definition
Stabilization prior to intervention
1.Tx decompensation due to intercurrent illness
Post intervention Sx
2. Dignoxin-3. help slow ventricular rate/improve diastolic LV filling (not DOC)
BB/CCB (verapamil/diltiazam)- slow heart rate down- prevent angina
Limit exercise - decrease oxygen demand to prevent angina
Statins: slow progression of Rheumatic MS |
|
|
Term
| Preferred SX Tx of MS (definitive) |
|
Definition
| Valvotomy/Valve replacement (PMBV) |
|
|
Term
|
Definition
Primary -MVP- degenerative MR
Secondary - Ischemic heart dz- CAD/major MR etiology |
|
|
Term
Epidemiology of MR:
Transient MR think: |
|
Definition
1. Female>male; Posterior leaflet MC
2. transient ischemia/papillary muscle involvement |
|
|
Term
|
Definition
Acute- normal LA size/compliance, high LA pressure, low CO, high pulmonary venous pressure, pulmonary congestion, body compensates - venous constriction/ increase HR- increase MR problems
Chronic- increased LA size/compliance, more normal LA and pulmonary venous pressure, LV hypertrophies and dilates, stretches MR annulus, MR worsens low CO, HF |
|
|
Term
Severity of MR is based on 5 things:
1 question from here |
|
Definition
1. size of the regurgitation opening
2. Systolic gradient b/t the LA and LV
3. Afterload
4. LA compliance
5. Regurg durationq |
|
|
Term
| Loud, holosystolic, at paex and radiates to the axilla, best heart at the apex/LLSB, intensifies with hand grip |
|
Definition
|
|
Term
EKG - LAE, LVH
CXR: LAE/LVH
Echo: LAE/LVH |
|
Definition
|
|
Term
| Functions of the pericardium |
|
Definition
| Limits the motion to within the mediasteinum, restricts sudden dilation of the heart, barrier to prevent infection from the lungs, Generally ASX if absent |
|
|
Term
| 3 major dz of the pericardium |
|
Definition
| Acute pericarditis, effusion/tamponade, constrictive pericarditis |
|
|
Term
Pt with: pleuritic CP increased with cough/position, distinctive EKG changes- diffuse ST elevation, pericardial friction rub on ausculatation
MCC Infectious
MCC Non-Infectious |
|
Definition
Acute Pericarditis- acute inflammation of the pericardium
2. Idiopathic/vira (coxsackie A/B, CMV,
HSV, HIV)
3. transmural MI- inflammation extending from the epicardial surface to the pericardium-Dressler's Syndrome
Another cause- Neoplasm- Hodgkins Lymphoma, breast/lung CA can mestatsize to the heart leading to tamponade |
|
|
Term
Pathophysiology of pericardium
Highest mortality is from what type of pericarditis? |
|
Definition
cause, local vasodilation, increased vascular permeability, infiltration of pericardium with leukocyte exudation- inflammation, fibrin deposition, inflammation, rub and pain rom decreased space
2. Purulent pericarditis |
|
|
Term
Variations correlate to likely etiology:
PMN, histocytes, thin exudate
MC yellow exudate, rough/shaggy, scarring of pericardiium- restriction of diastolic filling- cause, pathophysiology
Intense inflammatory response-cause, pathophysioloy
Grossly Bloody, serosanguinous-cause, pathophysiology |
|
Definition
1. Serous
2. Serofibrinous (Bread and Butter)- direct cellular damage by virus, viral infected cell damage by sensitized T cells, ADCC
3. Suppurative- toxin and enzyme production by bacteria, myocardial damage, rapid tamponade onset
4. Hemorrhagic (TB/cancer) |
|
|
Term
| Pt with: Anterior CP, fairly sudden, provoked by inspiration/coughing, made better by sitting up/leaning forward, sharp pain that radiates to the shoulders/ neck (trapezius ridge); PE: pericardial rub, scratchy/squeak sound BEST HEARD with diaphragm over LSB |
|
Definition
|
|
Term
| High risk acute pericarditis requiring immediate hospitalization? |
|
Definition
| Fever >100.4 and leukocytosis, large pericardial effusion, evidence of tamponade, immunocompromised, Hx of warfarin use, acute trauma, failure to improve with 7 days of NSAID Tx, elevated cardiac cTn-->myopericarditis |
|
|
Term
| Obtained in all cases of Pericarditis and findings |
|
Definition
EKG -Concave up; diffuse ST elevation
CXR - Water bottle heart; pulmonary infiltrates
Echo - fluid in pericardial sac |
|
|
Term
Labs should be drawn for pt with pericarditis (CBC/ESR/CRP/cTn) what other labs should be drawn in:
fever >100.4
TB screen is outdated
Permiscuous behavior
RA suspected |
|
Definition
|
|
Term
most helpful in immunocompromised or (+) HIV AND in regions endemic with this dz?
Why not routinely obtain viral studies in a pt with pericarditis?
Test performed in pt used for Dx of malignant/ bacterial etiology/ refractory to medical Tx of pericarditis? |
|
Definition
PPD
low yield/management not changed by results
Pericardiocentesis |
|
|
Term
| Tx for viral/idiopathic pericarditis |
|
Definition
Rest
Rx: colchicine (3 mo) + NSAID(2wk) (unless CI (ie. MI/PUD)- ASA)
Steroids: ONLY is refractory to NSAID/colchicine/ASA |
|
|
Term
Rx Tx: Dose/Duration/Tapering
Ibeprofen
Indomethocin
Colchicine
ASA
Prednisone |
|
Definition
1. 600-800mg TID/ 1-2wk/ decrease weekly
2. 50mg TID/ 1-2wk/ decrease weekly
3. 0.5-0.6mg BID/ 3mo/ not done
4.650-1000mg TID/ 1-2wk/decrease weekly
5. 0.25-0.5mg daily/ 3mo/ 21 day |
|
|
Term
| definition of pericardial effusion |
|
Definition
fluid in pericardial space exceeds the physiologic heart expansion capability leading to decreased EDV-->decreased CO-->tachycardia
(>250mL) |
|
|
Term
| Pericadial effusion/Tamponade severity is dependent on... |
|
Definition
Volume of effusion
Rate of development (acute/chronic; no compensation/compensation)
Compliance characteristics of the pericardium |
|
|
Term
Transudative etiologies of pericarditis
Exudative etiologies of pericarditis |
|
Definition
CHF/hypoalbuniemia/hypoprotienemia/hypothyroidism
Trauma/post MI free wall rupture/AD |
|
|
Term
| pt with: dyspnea, dysphagia, hoarsness, hiccups, JVP increased with dominant "X" descent, decreased pulse pressure, rub, atypical CP(dull/ache/constant left sided CP) |
|
Definition
|
|
Term
| Pt with: JVD, hypotension, muffled heart sounds, atypical CP, "small quiet heart", tachycardia, loss of "y" descent on JVP, Pulsus paradoxus |
|
Definition
|
|
Term
| Condition caused by SBP >10mmHg decrease during inspiration |
|
Definition
|
|
Term
Pericadial effusion/tamponade:
ECG |
|
Definition
Effusion: Flat T waves, low voltage
Tamponade: Electrical alternans- pathognomonic, low voltage |
|
|
Term
Pt with: CP, friction rub, fever, diffuse ST segment elevation + :
Inflammatory signs:
Large effusion with NO inflammatory signs/tamponade
Tamponade WITHOUT inflammatory signs |
|
Definition
1. acute idiopathic pericarditis
2. chronic idiopathic pericardial effusion
3. Malignant effusion |
|
|
Term
Further tests for
pericardial effusion:
tamponade: |
|
Definition
1. pericardiocentesis
2. pericardiocentesis + cardiac cath
Dx and Tx; measure intracardiac/intrapericardial pressure |
|
|
Term
| Additional lab tests for exudates to narrow DDx: |
|
Definition
| Gram stain, C & S, neoplastic workup |
|
|
Term
| Effusion etiology of pericardial effusion |
|
Definition
Malignacy/infectious/parainfections/ postpericardiotomy syndrome/ collagen vascular dz
high S.G., protien, Protien & LDH ratio, low glucose
(transudates is everything else; opposite lab values) |
|
|
Term
Tx for:
Pericardial Effusion
Pericardial Tamponade |
|
Definition
1 & 2- Tx underlying cause
1. Mild (ASX)-observe, serial echo
Mod-severe (Sx):Pericardiocentesis/catheter drainage/pericardiectomy- last resort
2. Aggressive fluid management, Pericariotomy (pericadial window)- recurrent |
|
|
Term
| Pt presents with: RHF, insidous onset, fimpairment of diasolic filling without impairment of systolic filling, abnormalities ONLY during diastole |
|
Definition
Constrictive pericarditis
increase in RV pressure->increase fluid into PA->decrease in LV pressure->decrease CO->backs up into pulmonary tree->pulmonary edema |
|
|
Term
Pt with: cachexia, precordial knock, RHF Sx, increased JVP (Kussmaul's Sign)
What is it?
Imaging of Choice?
What can r/o this dz?
Test that confirms this dz? |
|
Definition
1. Constrictive pericarditis;
2. TTE; precordial knock(early diastolic heart sound before S3)
3. CT scan; additional info for pre-op
4. Cathe- distinguish b/t constrictive pericarditis v. restrictive cardiomyopathy |
|
|
Term
| Tx for Constrictive pericarditis |
|
Definition
|
|
Term
Regurgitant volume/ orifice area in:
Mild:
Moderate:
Severe |
|
Definition
1. <30 mL/beat; <0.2cm
2. 30-59mL/beat; 0.2-0.39cm
3. >=60mL/beat; >=0.40cm |
|
|
Term
|
Definition
baseline evaluation
annual/semiannual surveillance
function after a change in S/s |
|
|
Term
| Exercise Doppler echo use in MR? |
|
Definition
1.reasonable to assess exercise tolerand and the affects of exercise on pulmonary after pressure
2.MR severity |
|
|
Term
|
Definition
Acute setting: decrease the preload(diuretics/ vasodilators)
Chronic: no benefit from Rx; SX repair before deterioration occurs |
|
|
Term
| What SX is performed in MR? |
|
Definition
1. MV repair(preferred)- optimal,mortality lower than for...
2. MV replacement |
|
|
Term
MCC of organic regurgitation in US
Associated with these types of d/o? |
|
Definition
MVP
Connective tissue d/o:
Marfans's/Ehlers-Danlos Syndrome/ OI |
|
|
Term
| MC Sx is ASX or non-anginal CP |
|
Definition
|
|
Term
| Mid systolic click, late systole murmur, increased by squatting, decreased by standing |
|
Definition
|
|
Term
Imaging of choice for MVP?
When to use / not use? |
|
Definition
1. Echo (TEE?);
2. Use:risk stratification in ASX patients w/ physical signs or Dx MVP
Not Use: exclude MVP in ASX pt, Routine repition ASX w/ MVP and w/wo MR and S/s |
|
|
Term
| MC congenital d/o in newborns |
|
Definition
|
|
Term
| When does the heart begin to form in fetal development? |
|
Definition
|
|
Term
L - R problems are typically caused by which type?
def of cyanosis? |
|
Definition
1. Acyanotic lesions
2. Blue-purple discoloration of skin/mucous membranes--> increase de02 Hgb--> >=4g/dL-->80-85% SPO2 |
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Term
| Development of pulmonary vascular dz due to chronic large L-R heart shunt-->R-L shunt increasing the amount of deoxygenated blood to the system-->cyanosis |
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Definition
|
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Term
Fixed Split
Machine like murmur
Not a true ASD |
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Definition
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Term
An ASD:
allows what?
Pathway of this? |
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Definition
| Communication of the atria-->LA-RA-->oxygenated blood is sent back to the lungs-->less blood to LV-->decreased CO |
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Term
When does ASD develop?
What three structures are involved in ASD?
MC type of ASD? |
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Definition
1. 5th week of gestation
2. septum primum/septum secundum/ AV canal septum
3. Ostium Secundum |
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Term
| Infants with a large ASD have what concomittant d/o? |
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Definition
| HF/recurrent respiratory infections/ FTT |
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Term
ASD related questions:
Why no Sx until age 30?
Why fatigue and DOE?
Why fixed split of S2?
Why palpitations?
Why increased atrial arrhythmia? |
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Definition
1. not enough HR
2. Blood backed up into the lungs--> pressure results in fluid build up
3. Can hear seperate valves close b/c of pressure differential
4.Atrial enlargement leads to atrial tachycardia
5. Irritation of tissues + tachycardia --> arrhythmias |
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Term
|
Definition
|
|
Term
ASD:
Imaging of choice?
Management:
<6mm?
>8mm?
CI? |
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Definition
1.Echo
2. Spontaneous closure MC by age 2-5 y/o
3. Spontaneous is unlikely; SX is needed involving:
Large = Cardiopulmonary bypass-->pericardial/ Dacron patch
Small = suturing
4. Scuba diving |
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Term
|
Definition
|
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Term
MC CHD defect in infants and children?
Resolution of defect occurs by what age?
MC subtype of this defect? |
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Definition
1. VSD
2. 2y/o
3. Membranous VSD |
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Term
ASX, palpable thrill (4/6) along LSB, low pitched harsh holosystolic, best heard at the L mid- lower sternal border
Tx? |
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Definition
Small VSD
2. Followed by cardiology, echo, most close spontaneously |
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Term
Pt with: signs of HF at 3-4 w.o., tachypnea, FTT, hepatomegaly, grunting, retractions, RV heave, prominant and displaced apical impulse, reversal of shunt and a new diastolic murmur progresses
Tx? |
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Definition
Moderate-large VSD
2. Tx HF: Diuretics/ACE-I/Digoxin
FTT: Dietary interventions
SX |
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Term
Any VSD repaired posthetically w/wo residual effects should have prophylaxis for what procedures?
Time frame? |
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Definition
1. Dental/respiratory procedures
2. Repaired= first 6 mo
repaired w/ residual = lifetime |
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Term
PDA:
MC found in...
Why is the incidence rate increaseing?
What is the pressure in the Aorta? |
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Definition
1. Premature births/ 1st trimester maternal rubella infections
2. Increased survival rate of premature infants
3. Sys: 140-100, Dys: 90-60 |
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Term
| What usually happens with the Ductus arteriosus during birth? |
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Definition
| Exposure to O2 causes contriction of tissue and gradual closure |
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Term
| Pt with: Eisenmenger's Syndrome, Lower extremity cyanosis, UE remain acyanotic |
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Definition
|
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Term
Pt with: Continuous machine-like murmur, best heard over the infra-clavicular area
Complications:
ECG/CXR changes:
Steps taken after Tx: |
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Definition
1. PDA
2. IE/ HF/ Pulmonary HTN
3. LAE/LVH
4. Prophylactic ABX for 6mo post PDA closure |
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Term
| 4 things that make up ToF? |
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Definition
| VSD; Overriding Aorta; RVH; PA stenosis |
|
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Term
| MC cyanotic heart defect requiring intervention during the first year of life? |
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Definition
|
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Term
| Pt with: DOE (why?), cyanosis, hyperventilation, squat after exercise/ when Sx are present (how does this help?), FTT, erythrocytosis, clubbing |
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Definition
| 1. ToF- tet spells 2. sending deoxygentated through system-->decreased O2 for cell use-->signals sent to medullary rhymicity center to increase respirations( doesn't make sense?) 3. kinks the femoral arteries-->increases systemic pressure-->decreased R-L shunt-->more blood flow into the lungs |
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Term
CXR: Boot shaped heart?
what is the definitive Dx of this d/o?
Tx? |
|
Definition
ToF
2. Echo-->RVOFT
3. O2/genupectoral position/Bolus-->fails-->Morphine--> fails--> Propranolol/esmolol-->fails-->emergent SX |
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Term
MCC of death following SX repair of ToF?
Post op care of ToF? |
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Definition
1. arrhythmia/ HF
2. Prophylactic ABX for IE |
|
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Term
"Blue Baby", severity is dependent on concomittent ASD/VSD
Dx?
Tx? |
|
Definition
Transposition of Great Vessals
2. Echo confirms
3. Emergent SX, PGE, balloon septoplasty |
|
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Term
| Egg on a String shaped heart? |
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Definition
| Transposition of Great Vessals |
|
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Term
| Reversal of shunt leads to hypoxemia--> reduced Hgb--> increased RBC production-->Erythrocytosis-->Hyperviscosity--> HA/Fatigue/Stroke |
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Definition
|
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Term
| Situations that increase the risk of Eisenmenger Syndrome? |
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Definition
| Pregnancy, volume depletion, isometric exercise, high altitude, endocardial pacing, air emboli, SX |
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Term
| MCC of Ebstein's Anomaly? |
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Definition
|
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Term
| 1st trimester bipolar mothers should be switched to a second line Manic/depressive controlling agent. Why? |
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Definition
| Li can result in Ebstein's anomaly |
|
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Term
Endocarditis prophylaxis should-
used in:
NOT be used in: |
|
Definition
1. Cyanotic patiens, prosthetic cardiac valves/repair,
2. Acyanotic pt w/ Ebstien's anomaly w/o Hx of valve replacement/endocarditis |
|
|
Term
| 2 ways of classifying Duke's Citeria |
|
Definition
|
|
Term
Bugs that cause IE?
Native
IVDU
Prosthetic valve-recent SX <1yr
Prosthetic valve-Remote SX >1yr |
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Definition
1. Strep/ S. Aureus
2. Strep/ S. aureus
3. S. epidermidis/ S aureus/ Enterococcous
4. Strep/ S. epidermidis/ S. aureus/ Enterococcus |
|
|
Term
Average age of onset and valve MC affected:
Community acquired
IVDU |
|
Definition
|
|
Term
|
Definition
>60y/o
Male
Structural Heart Dz
Prosthetic HeartValve
Congenital Heart Dz
Indwelling catheter/ Intravascular procedure
IVDU
Hx of IE
Poor dentition/ Dental infection
HIV |
|
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Term
|
Definition
| endocardial surface injury-->thrombus formation-->bacteremia attach-->multiply-->stimulates further thrombus formation and creation of vegetation-->local destruction/immune injury-->hematogenous seeding-->emoblization(septic) |
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Term
|
Definition
|
|
Term
Minimum citeria needed for:
Definite IE
Possible IE |
|
Definition
1.Pathologic Criteria:
Microorganisms found in: culture/tissue/seeding of embolus/intracardiac abcess
Pathologic: vegetation/intracardiac abcess based on histology
Clinical Criteria:
2 major/1 major + 3 minor/ 5 minor
2. 1 major + 1 minor/ 3 minor |
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Term
|
Definition
1. (+) BC:
2 seperate blood cultures
Persistantly (+) = (+)BC 12h apart OR All of 3 or a majority of >=4 with the 1st and last drawn >1h apart
Single (+) BC for Coxiella / Antiphase 1 IgG AB titer >1:800
2. Evidence of endocardial involvement:
(+) echo for IE-->TEE for prosthetic heart valves/ TTE for everyone else
New valvular regurgitation- increase in/change in pre-existing does not count |
|
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Term
|
Definition
Predisposing factors-Heart condition/IVDU
Fever
Vascular phenomena
Immunologic phenomena
Microbiologic evidence
Echo |
|
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Term
Minor Criteria-->definition:
Predisposing factors
Fever
Vascular phenomena
Immunologic phenomena
Microbiologic evidence
Echo |
|
Definition
1. heart conditions/ IVDU
2. >100.4
3. major arterial emboli/ septic pulomnary infarcts/ mycotic aneurysm/ intracranial hemorrhage/ conjunctival hemorrhages/ Janeway lesions
4. GN/Osler's nodes/ Roth Spots/ RA factor
5. (+) BC- not meeting major criterion
OR
Serologic evidence of IE organisms |
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|
Term
major criteria:
When should BC be taken
Echocardiogram background |
|
Definition
1.before ABX
minimum of 3 from different sites
2. NEW regurgitation
TTE- initial test of choice- detects large vegetations, quantifies valvular dysfunction, non-invasive easy
TEE- More sensitive, useful evaluation for prosthetic valves |
|
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Term
| Over what time frame should BC be obtained in acutely ill pt |
|
Definition
|
|
Term
IE Dx:
Labs taken and results |
|
Definition
BC- microorganisms
Urnialysis- Proteinuria
CBC- Normocytic, nomochromic anemia, elevated WBC-->mostly PMN
Acute phase reactants- CRP/ESR elevated
(+) RF |
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Term
| Initial Tx decisions of IE: |
|
Definition
| empiric ABX Tx OR ABX based on C&S |
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Term
How to Tx IE pt:
stable pt, not acutely ill:
unstable acutely ill strong suspicion of IE: |
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Definition
1. admit, wait on BC results (1-3d)--> accurate Dx is key
2. admit-->emipiric ABX Tx (vancomycin) after BC collection (drawn: 2+ sites, 20-30 min b/t) |
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Term
IE Tx with BC results of:
Strep
Staph oxacillin susceptible
Staph oxacillin resistant
Staph oxacillin resistant PCN allergy
PCN allergy
Fungi, Brucella spp, P. aeruginosa |
|
Definition
1. PCN G
2. IV nafcillin + gentamicin
IV Cefazolin + gentamicin
3. Vancomycin
4. Ceftriaxone / Ceftriaxone+gentamicin
Vancomycin
5. cephalexin/macrolides/clindamycin
6. SX |
|
|
Term
After ABX initiation when do pt become:
afebrile
better
done with Tx |
|
Definition
1. 7 days
2. 2wks
3. 4-6wks |
|
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Term
| Highest risk pt requiring IE prophylaxis: |
|
Definition
Prosthetic cardiac valve
Previous IE
Congenital heart dz
cardiac transplantation->valvulopathy |
|
|
Term
Which phase and definition of:
Plateau phase
Repolarization |
|
Definition
1. phase 2; prolonged cardiac action potential-->sustained/increased contraction
2. Phase 3; Ca++ channels close-->continuous K efflux-->neuron mV drops |
|
|
Term
| Which cells have less "coupled" intercalated discs? |
|
Definition
| Pacemaker cells (SA node especially) as compared to non-pacemaker cells |
|
|
Term
Arrhythmias classification:
2 types of classes and Arrhythmias found in that class |
|
Definition
1. Altered impulse formation-->
Altered normal automaticity (SNS/PNS)
Abnormal automacticity-> secondary pacemakers taking over (AV node, etc.)
Triggered activity->often by drugs
2. Altered Impulse Conduction->
HB/ transient (MI/electrolyte imbalance) v. permanent/ unidirection v. bidirectional/ AVRT/ AVNRT- Bundle of Kent- WPW; James bypass tract- LGL/ |
|
|
Term
Arrhythmias:
Cause of early depolarization?
Rx condition commonly causing a delay after depolarization? |
|
Definition
1. Torsades
2. Dig toxicity |
|
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Term
| Pt: ABC's are taken care of, monitor shows a tachycardia rhythm, pulse is felt, hypotensive and shows signs of shock. Next step? |
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Definition
| Synchronized cardioversion- narrow complex consider adenosine (6/12/12) |
|
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Term
| Pt: ABC's are taken care of, monitor shows tachycardia showing >0.12 QRS complexes, pulse is felt. Next step? |
|
Definition
IV access
12 lead EKG
Adenosine (6/12/12)- monomorphic
MgSO4
Antiarrhythmics
Expert consultation |
|
|
Term
Antiarrhythmics: name
Bradycardia Rx: name
Cardiac arrest Rx: name |
|
Definition
1. Procainamide
Amiodarone
Sotalol- not for prolonged QT
2. Atropine, Dopamine, Epinepherine
3. Epinepherine/ vasopressin/ amiodarone |
|
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Term
| Pt: ABC's are taken care of, monitor shows a tachycardia rhythm, pulse is felt, stable, not widened. Next step? |
|
Definition
IV access
12 lead EKG
Adenosine - if regular
B-blockers/CCB
Expert consultation |
|
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Term
| Pt: ABC's are taken care of 12 lead is establihed and shows bradycardia, pulse is felt, AMS with ischemic chest discomfort. Next Step? |
|
Definition
| Atropine-->Pace/Dopamine infusion/Epinepherine-->expert consultation |
|
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Term
| Pt: ABC's are taken care of, monitor shows bradycardia with a palpable pulse, stable. Next Step? |
|
Definition
|
|
Term
| Pt: ABC's established, monitor shows VT, no pulse felt. Next step? |
|
Definition
Clear!!
CPR - IV access
Rhythm Check
Shock again
CPR- epinepherine, advanced airway placement
Rhythm Check
Shock
CPR- Amiodarone (300/150)/ consider H/T's
Repeat |
|
|
Term
Coexising d/o influencing heart rhythm/rate:
Cardiac d/o related
Non-cardiac d/o related
Labs to order:
Studies to order if arrhythmia is: very infrequent but concerning
Frequent- 1d study
Frequent- <4wk study |
|
Definition
1. CAD/CHF/Cardiac Risk Factors
2. Hyper/hypothyroidism/Anemia/COPD/Chronic hypoxia
3. CBC/TSH/Electrolytes (Ca/Mg)
4. Implantable loop recorder
Holter monitor
Event monitor |
|
|
Term
Tilt Table testing:
Indications
CI |
|
Definition
1. Syncope; no structural causes w/ everything else r/o
2. Syncope with known structural cause |
|
|
Term
Most frequent cause of compensatory pause
Tx for SVT:
Sx and ASX |
|
Definition
1.PAC
2. Sx-> avoid triggers(EtOH/B blocker/Catheter ablation->Sx/APB->AF |
|
|
Term
| Typically occurs in pt with pre-existing heart dz |
|
Definition
Atrial Flutter
Can occur after initiation antiarrhythmis drug supressing-->flecainide |
|
|
Term
| Atrial flutter has an increased likelyhood of? |
|
Definition
| Thromboembolic events->stroke/DVT |
|
|
Term
Atrial flutter->management
Rate control:
Rhythm control/conversion:
Stable: |
|
Definition
1. Atrial flutter rate is difficult to control (most stay 2:1)->non-DHP CCB/BB/Dig
2. Synchronized cardioversion-> unstable/stable->cardioversion: ibutilide-DOC
3. Anti-coagulation-> CHA2DS2VASC:
CHF, HTN, Age(>75), DM, Stroke 2 Vascular dz, Age 65-74, Sex category |
|
|
Term
| Etiologies of Atrial fibrillation: |
|
Definition
PIRATES:
Pulmonary embolism
Iatrogenic(cardiac SX)
Rheumatic heart dz (MR/MS)
Acute coronary syndrome/Coronary heart dz
Thyroid (hyperthyroidsm)
EtOH- holiday heart
Sleep-> OSA/Sick heart HF |
|
|
Term
| MC arrhythmia requiring Tx |
|
Definition
|
|
Term
1. Self-terminating/intermittent; <7d
2. AF fails to self-terminate <7d;pharmacologic/elecrical cardioversion
3. AF lasting >12mo
4. Persistant AF and a joint decision by the patient AND clinician to d/c further rhythm control strategy |
|
Definition
1. Paroxysmal AF
2. Persistent AF
3. Long-standing persisent AF
4. Permanent AF |
|
|
Term
|
Definition
| "a" waves are the atrial kick, no atrial kick, no S4 heart sound |
|
|
Term
|
Definition
| A fib= no P waves, irregularly irregular |
|
|
Term
A fib-> HOTN/ischemia/ severe HF/cerebrovascular-> what to do next?
A fib-> H&P/ Dx (ECG/TTE/TEE)-> what to do next? |
|
Definition
1. Cardioversion
2. Determine underlying etiology and Tx |
|
|
Term
A fib->preferred control approach for:
Younger pt
Older pt |
|
Definition
1. <60; rhythm control->cardioversion + antiarrythmics
2. >60; rate control->Rx->slow AV node |
|
|
Term
| A fib->management-> who is at risk for thrombotic formation? |
|
Definition
1. New onset AF- related to rapids ventricular response
2.Extremely high risk->A fib w/ valvular heart dz |
|
|
Term
| AF <48h duration w/ HF/DM/CHA2DS2VASC score >=2-> Tx |
|
Definition
| Heparin/LMWH/Dabigatran/Apixaban ASAP prior to cardioversion |
|
|
Term
| AF >48h/unknown duration->management: |
|
Definition
1. Min. of 3wk->Warfarin(DOC) w/ INR 2-3->prior to cardioversion
2. TEE->after target INR/2d of dabigatran/apixaban |
|
|
Term
|
Definition
|
|
Term
| A fib->management->rate control->Pharmacologic Tx with what Rx |
|
Definition
| BB/non-DHP CCB/Dig(HF related)->use in AF and Preexcitation syndrome WPW->CAUTION-->AV nodal blockers->paradoxical ventricular response-> prevent->Urgent, stable=IV procainamide/Ibutilide OR Unstable=DC cardioversion |
|
|
Term
| A fib->management->rate control->electrically? |
|
Definition
Anti-coagulation Tx prior to cardioversion
If unstable->IV heperin(do not delay cardioversion) |
|
|
Term
| A fib->managment->rhythm control for symptomatic paraoxysmal AF->TOC, alternative if TOC is CI/failed |
|
Definition
1. AAD= flecainide/amiodarone/sotalol/dronedarone
2. catheter ablation recommended for:
Sympotmatic paroxysmal AF->young pt/AAD complications/ failed AAD
Symptomatic persistent/longstanding persistent AF->AAD CI/failed |
|
|
Term
| How does amiodarone work? |
|
Definition
| Blocks K channel blockade->slows repolarization->prolongs AP and refractiveness of myocardium |
|
|
Term
| Advantages and disadvantages of Direct thrombin and factor Xa inhibitors? |
|
Definition
Adv: no IRN monitoring/less diet or drug interactions
Dis: BID/ $$$/ no reversal |
|
|
Term
Problem with Warfarin?
Risk of INR at:
<1.8
>3.5 |
|
Definition
1.Narrow therapeutic range/food interactions (spinich)
2. doubles stroke risk
3. increases risk of bleeding |
|
|
Term
| Refractory AF->management: |
|
Definition
Tx directed towards ostial portion of Pulmonary veins->MC site
EP intervention
RFA-radiofrequency ablation->circumfrential/focal
MAZE procedure
Obliteration of L atrial appendage |
|
|
Term
PSVT? 3 types->MC type
MCC of narrow QRS complex tachycardia? |
|
Definition
AVNRT (MC)/AVRT/ Atrial tachycardia
Re-entry |
|
|
Term
|
Definition
same thing, but MAT >100bpm v. WAP <100bpm
intermittent episodes of PSVT->Lung dz->usually permanent arrhythmia (p-MAT) |
|
|
Term
|
Definition
1. Antidromic; more dangerous->AV node cannot slow conduction
2. Orhodromic: less dangerous b/c still has to pass through AV node normally and can be contolled/paused slightly |
|
|
Term
| PSVT->management-> AVNRT->basis of Tx |
|
Definition
Stable v. Unstable->ACLS algorhythm
Rate v. Rhythm control-> decison based on:
Frequency/Sx severity/Rx tolerance/pt preference |
|
|
Term
PSVT->Managment->AVRT->Antidromic/Orthodromic
Which rhythms to cardiovert? |
|
Definition
1.antidromic: IV procainamide
Orthodromic: vagal, IV adenosine, IV verapamil
2. WPW and unstable rhythm |
|
|
Term
PSVT->managment:
WPW
AT(FAT/MAT) |
|
Definition
1. catheter ablation
2. Rx->rate control-> BB(unless CI=CCB)
Ablation->Rx CI/failure |
|
|
Term
|
Definition
1. Narrow; slowing/termination with vagal
2. wide; AV dissociation/other non1:1 AV relationship; Fusion beats, capture beats |
|
|
Term
PVC:
Worst outcome with which patients?
With exercise? |
|
Definition
1. Post MI patients
2. if they stop with exercise cessation=benign |
|
|
Term
Sustained VT
v.
Nonsustained VT |
|
Definition
1. BAD, underlying structural dz, >30s
2. series of at least 3 consecutive ventricular beats->duration of <30s/do not require emergency intervention |
|
|
Term
How to distinguish Ashman's Phenomenon from PVC's?
If unable to distinguish SVT v. VT what to do? |
|
Definition
1. Fixed R-R with Ashman's phenomenon
2. Tx as VT |
|
|
Term
VT->management:
ASX and non sustained
Acute sustained->monomorphic v. polymorphic
Acute sustained-> Stable
Acute sustained->unstable |
|
Definition
1.Tx underlying cause
2. Have structural heart dz determines Tx
3. ACLS->cardiovert(pulse)/DFIB(pulseless/TdP)
4. cardioversion->procainamide/amiodarone/IV mag sulfate(TdP) |
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