Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
64 Cards in this Set
- Front
- Back
Murmur: Mitral/tricuspid regurgitation
|
Holosystolic, high ptched "blowing murmur
|
|
When is a Mitral regurgitation murmur loudest/ enhanced?
|
Loudest: at apex and radiates towards axilla
Enhanced by maneuvers that increase total preripheral resistance (squatting, hand grip) |
|
In what diseases would you commonly hear a Mitral regurgitation?
|
Ischemic heart disease, mitral valve prolapse and Left ventricular dilation
|
|
When is a Tricuspid regurgitation murmur loudest/ enhanced?
|
-loudest at tricuspid area and radiates to right sternal border
-enhanced by inspiration (increases RA return) |
|
What does an aortic stenosis sound like?
|
-Crescendo-descrescendo systeolic ejection murmur following an ejection click
|
|
Clinical findings of Aortic stenosis other than sound?
|
-Radiates to carotids/apex
-"pulsus parvus et tardus"--pulses weak compared to heart sounds -can lead to syncope -Age related calcific aortic stenosis or bicuspid aortic valve |
|
MCC of degenerative (senile) calcification of the valve leaflets
|
Aortic stenosis
|
|
Sound of VSD murmur? Where is it loudest?
|
Holistic harsh sounding murmur. Loudest at tricuspid area.
|
|
Sound of mitral prolapse? Loudest?
|
-Late crescendo murmur with midsystolic click (MC; sue to sudden tensing of chordae tendinae)
-Loudest at S2 |
|
Mitral polapse:
-What can it predipose you to? -What can cause it? |
-Usually benign
-Can predispose to infective endocarditis -Can be caused by myxomatous degeneration (excess dermatin sulfate in valve), rheumatic fever, chordae rupture |
|
Most frequent valvular lesion?
|
Mitral prolapse
|
|
What would make a mitral prolapse murmur closer to S1 than S2?
|
Standing = less preload so click is closer to S1
When laying down: Increase preload so click is closer to S2 Anxiety: decreased preload so closer to S1 |
|
What does a Aoritc regurgitation murmur sound like?
|
Immediate high-pitched "blowing" diastolic murmur.
|
|
Chronic aortic regurgitation?
|
-Wide pulse pressure
-can present with bounding pulses and head bobbing |
|
What is aortic regurgitation due to?
|
aortic root dilation, bicuspid aortic valve or rheumatic fever
|
|
What does mitral stenosis sound like?
|
Follows an opening snap (due to tensing of chordae tendinae). Delayed rumbling late diastolic murmur
|
|
When does mitral stenosis occur?
|
-rheumatic fever
|
|
How is mitral stenosis enhanced?
|
-expiration (increases LA return)
|
|
What does a PDA murmur sound like?
|
Continuous machine-like murmur. Loudest at S2
|
|
Cardiac defect a/w 22q11 syndrome?
|
Truncus arteriosus, tetralogy of fallot
|
|
Congenital Cardiac defect a/w down's syndrome
|
ASD, VSD, AV septal defect (endocardial cushion defect)
|
|
Cardiac defect a/w congenital rubella?
|
Septal defects, PDA, pulmonary artery stenosis
|
|
Congenital Cardiac defect a/w Turner's syndrome
|
coarctation of the aorta
|
|
Congenital Cardiac defect a/w Marfan's syndrome?
|
Aortic insufficiency
|
|
Congenital Cardiac defect a/w infant diabetic mother?
|
Transposition of the great vessels
|
|
MCC of death in primary HTN?
|
MI
|
|
2nd MCC of death in primary HTN?
3rd? |
2nd = stroke
3rd = renal failure |
|
Monckeberg Arteriosclerosis
|
Calcification in the media of the arteries, especially radial or ulnar. Usually benign; "pipestem arteries. Does not obstruct blood flow; intima not involved.
|
|
3 types of angina in ischemic heart disease
|
Stable, prinzmetal's variant, Unstable/crescendo
|
|
Stable Angina
|
-Mostly seondary to atherosclerosis
-ST depression -restrosternal chest pain with exertion |
|
Prinzmetal's variant angina
|
-occurs at rest secondary to coronary artery spasms (transmural ischemia)
-ST elevation |
|
Unstable/crescendo angina
|
-thrombis but no necrosis
-ST depression -worsening chest pain at rest or with minimal exertion |
|
Postinfarction fibrinous pericarditis
|
-Friction rub (3-5 days post MI)
-Chest pain is relieved by leaning forward and worse when leaning back |
|
Dressler's syndrome
|
-autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post MI)
-tx: non-steroidals |
|
Etiologies of Dilated (congestive cardiomyopathy)
|
-Alchoholic use
-wet Beriberi -Coxasackie B virus myocarditis, chronic Cocaine use, Chagas' dz -Doxorubicin toxicity -hemochromatosis and peripartum cardiomyopathy |
|
Would it be better to stand up or lay down if a pt had hypertrophic cardiomyopathy?
|
-lay down (if you increase preload to decrease the obstruction)
|
|
Causes of restrictive/obliterative cardiomyopathy
|
-sarcoidosis
-amyloidosis -postradiation fibrosis -endocardidial fibroelastosis -Loffler's syndrome (endomyocardial fibrosis with a prominent eosinophilic infiltrate) -hemochromatosis (dilated cardiomyopathy can also occur) |
|
MC reason for a child to get a heart transplant?
|
endomyocardial fibrosis
|
|
Best treatment for CHF?
|
ACE and sprinolactone
|
|
s/s of bacterial endocarditis
|
FROM JANE
-Fever -Roth spots (red w/ white center) -Osler's nodes (ouch) -Murmur -Janeway lesions (small erythematous lesions on palm or sole -Anemia -Splinter hemorrhages on nail bed -Emboli |
|
Pt presents with colon cancer/ ulcerative colitis and endocarditis. Whats the organism?
|
Strep Bovis
|
|
Pt has prosthetic valves and presents with endocarditis. Organism?
|
S. epidermis
|
|
Libman-Sacks endocarditis
|
-Verrucous (wartlike), sterile vergitations occur on both sides of the valve.
-Usually benign -a/w mitral regurg and less commonly mitral stenosis -MC heart manifestation of SLE (SLE causes LSE) |
|
What is the most common heart manifestation of SLE?
|
Libman-Sacks enodocarditis
|
|
s/s of Rheumatic fever
|
FEVERSS
-Fever -Erthema marginatum -Valvular damage (vegitation and fibrosis) -increased ESR -Red-hot-joints (migratory polyarteritis) -Subcutaneous nodules (Aschoff bodies) -St. Vitus' dance (chorea) |
|
pulsus paradoxus (Kussmaul's pulse)
|
-Seen in Cardiac tamponade
-exaggerated decrease in amplitude of pulse during inspiration. Seen in severe cardiac tamponade, asthma, sleep apnea, pericarditis and croup |
|
What causes serous pericarditis?
|
SLE, rheumatoid arthritis, viral infection, uremia
|
|
What causes fibrinous pericarditis?
|
Uremia, MI (Dressler's syndrome), rheumatic fever
|
|
What causes hemorrhagic pericarditis?
|
TB, malignancy (melanoma)
|
|
Findings in pericarditis?
|
pericardial pain, friction rub, pulsus paradoxus, distant heart sounds, ST elevation
|
|
pericardial knock?
|
constrictive pericarditis
|
|
MC overall cause of Pericarditis?
|
-coxasackievirus
|
|
MCC for constrictive pericarditis?
|
TB
|
|
MC primary cardiac tumor in adults?
|
myxoma,
|
|
myxoma?
|
-produces VEGF vascular endothelial growth factor
-occur in the atria (usually left atrium) -ball valve obstruction -a/w syncopal episodes |
|
Wegner's granulomatosis
|
1) necrotizing vasculitis
2) necrotizing granulomas in the lungs and upper airway 3) necrotizing glomerulonephritis -Hemoptysis, hematura, perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea c-ANA and treated with Cyclophosphamide and Corticosteroids Wegner was a small grandma horse, who wore a saddle. She worked very hard, breathing heavy and having dyspnea. The horse couldn't hear (otitis media), so one day a Cycler hit her, she bled out and necrotized. |
|
Sturge-Weber dz
|
-Effects capillary sized blood vessels, port wine stain, leptomeningeal angiomatosis (AV malformations), seizures and early onset glaucoma
Sturgey weber was small and retarded and liked to drink wine. One day he drank so much he gave himself a seizure and he went blind |
|
Buerger's dz
|
-a/w smoking
-aka thromboagniitis obliterans -intermiitent claudication (Ryanauds) -Can lead to gangrene -tx: smoking cessation |
|
Kawasaki dz
|
-necrotizing vasculitis in infants/children
-Asians -Fever, conjunctivitis, changes in lips/oral mucosa, strawberry tongue, lymphadentitis, desquamative skin rash. May develop coronary aneurysms Tx: IV immunoglobin, aspirin |
|
Polyarteritis nodosa
|
-fever, weightloss, malaise, abdominal pain, melena, headahce, myalgia, HTN, neurologic dysfunction, cutaneous eruptions
-Hep B -Tx: corticosteroid and cyclophamide -P-ANCA -Renal and visceral vessels NOT pulmonary arteries |
|
Takayasu's arteritis symptoms
|
-Fever, Arthritis, Night sweats, Myalgia SKIN nodules, Ocular disturbaces, Weak pulses in upper extremities
FAN MY SKIN ON Wednesday |
|
essential hypertension therapy?
|
Diuretics, ACE inhibitors, angiotension II receptor blockers (ARBs), calcium channel blockers
|
|
CHF therapy?
|
-Diuretics, ACE inhibitors/ARBs
-Beta blockers (compensated CHF, C/I in decompensated CHF) -K-sparing diuretics |
|
Diabetes antihyptension therapy?
|
-Ace inhibitors/ARBs
-calcium channel blockers -diuretics -B-blockers -alpha blockers |