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62 Cards in this Set

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Right-to-left shunts (early cyanosis)
Teratology
Transposition
Truncus

Children may squat to Increase Venous Return
Left-to-right shunts (late cyanosis)
1. VSD
2. ASD
3. PDA

VSD > ASD > PDA

Progressive Pulmonary HTN --> R->L Shunt (Eisenmenger's)
Eisenmenger's syndrome
Uncorrected VSD, ASD or PDA leads to progressive pulmonary hypertension. As pulm. resistance increases, shunt changes from L->R to R->L
Teratology of Fallot
PROVe:
Pulmonary stenosis
RVH
Overriding aorta
VSD

"boot-shaped" heart
Transposition of great vessels
Aorta leaves RV & pulmonary trunk leaves LV

Not compatible with life unless shunt allows adequate mixing (VSD, PDA or patent foramen ovale)
Coarctation of aorta
Preductal vs Postductal

Preductal (Infantile) close to heart

Postductal (Adult) distal to ductus arteriosus. Notching of ribs, HTN in upper extremities, weak pulses in lower extremities
Patent Ductus Arteriosus
"machine-like" murmur
use Indomethacin to close
use PGE to keep open (ie in transposition of great vessels)
Hypertension Risk Factors
++age, obesity, diabetes, smoking, genetics, black > white > asian
Hypertension predisposes to
Atherosclerosis
stroke
CHF
renal failure
retinopathy
aortic dissection
Types of Angina
Stable: @exertion. secondary to atherosclerosis
Prinzmetal: @rest. secondary to coronary artery spasm
Unstable: Thrombosis w/o necrosis. worsening chest pain
ECG of MI
ST elevation - transmural
ST depression - subendocardial
Q waves - transmural/old
Biomarkers of MI
Troponin: 4hrs - 10days
CK-MB: 24hrs
LDH: 2-7days
AST: nonspecific
Complications of MI
Cardiac arrhythmia
LV failure & pulm. HTN
Cardiogenic shock
Rupture of free wall/septum/papillary muscle 4-10days -> tamponade
Thromboembolism - mural thrombus
Fibrinous pericarditis - frisction rub (3-5days)
Dressler's syndrome - autoimmune -> fibrinous pericarditis (weeks)
Dilated Cardiomyopathy
Most common.
Systolic dysfxn
"Balloon" on CXR
Hypertrophic cardiomyopathy
Assymetric hypertrophy involving septum
Diastolic dsfxn
"Banana" on ECG
Sudden death in young athletes
"Baloon" shaped heart on CXR
Dilated Cardiomyopathy
"Banana" shaped LV on Echo.
Hypertrophic Cardiomyopathy
Sudden death in young athlete
Hypertrophic Cardiomyopathy
Holosystolic high-pitched blow. Loudest at apex.
Mitral Regurgitation.
Crescendo-descrescendo systolic murmur following click. Radiates to carotids.
Aortic stenosis
Pulsus parvus et tardus
Aortic stenosis
Holosystolic murmur.
VSD
Late systolic murmur with midsystolic click.
Mitral prolapse. Common.
"Diastolic high-pitched blow"
Aortic regurgitation
Widened pulse pressure
Aortic regurgitation
"Opening snap with delayed diastolic rumble"
Mitral stenosis
"Continuous machine-like murmur
PDA
Most common primary tumor in adults
Myxoma
"ball-valve" obstruction
myxoma
Most frequent primary cardiac tumor in children
rhabdomyoma
most common heart tumor
metastatic
pulsus paradoxus
Seen in Cardiac Tamponade
-Note pulsations via auscultation that is not felt in radial pulse-
electrical alternans
Seen in cardiac tamponade
-beat-to-beat alterations of QRS complex height-
"Round white spots on retina surrounded by hemorrhage"
Roth's Spots.
Seen in bacterial endocarditis
"small erythematous lesions on palm or sole"
Janeway Lesions.
Seen in bacterial endocarditis
"Tender raised lesions on finger or toe pads"
Osler's nodes
Seen in bacterial endocarditis
Splinter hemorrhages on nail bed
Bacterial endocarditis
"Rapid onset of large vegetations on previously normal valves"
Acute Bacterial Endocarditis.
S. Aureus likely organism
"Insidious onset of small vegetations on abnormal or diseased valves."
Subacute Bacterial Endocarditis
Endocarditis associated with IV drug use.
Tricuspid valve endocarditis
Fever
Erythema marginatum
Valvular damage
ESR elevation
Polyarthritis
Subcutaneous nodules
Chorea
Rheumatic Fever
Diffuse ST elevation in all ECG leads
pericarditis
Causes of Serous Pericarditis
SLE
Rheumatoid arthritis
Infection
Uremia
Causes of Fibrinous pericarditis
uremia
MI
rheumatic fever
Causes of hemorrhagic pericarditis
TB
malignancy
"Young asian female with fever, arthritis, night sweats, myalgia, skin nodules, ocular disturbances, weak pulses in upper extremities"
Takayasu's arteritis
=Thickening of aortic arch and/or proximal great vessels
"Elderly female with unilateral headache, jaw claudication, impaired vision"
Giant Cell Arteritis
aka Temporal Arteritis
=vasculitis of medium & small arteries >> branches of carotid.
Direct general agonist (a1, a2, b1, b2)
Epinephrine (inscreased systolic & decreased diastolic)
alpha1, alpha2 & beta1 agonist
Norepinephrine (elevated systolic & diastolic)
beta1 & beta2 agonist
Isoproterenol (lowers systolic & diastolic)
Beta1 agonist
Dobutamine (shock, CHF)
Alpha1 agonist
Phenylephrine (vasoconstrictor)
Beta-blockers
Propranolol, metropolol
Lowers CO, HR & Contractility
Lowers O2 demand
Use after MI
Toxicity: asthma, bradychardia, impotence
Calcium Channel Blockers
Nifedipine, verapamil, ditiazem
Use for: HTN, Angina, Arrythmia (not nifedipine)
ACE Inhibitors
Prevents inactivation of vasodilator.
Use for: HTN, CHF, diabetic renal disease
Nitrates
Use for: Angina
lower EDV / BP
increase contractility / HR
lowers O2 demand
Cardiac drug working on Na/K ATPase pump
Digoxin
Cardiac drug working on voltage-gated calcium channel
Calcium channel blocker
Beta agonist
Class I antiarrhythmics
Na channel blockers
1A: Quinidine
1B: Lidocaine
1C: Flecainide, Encainide
Class II antiarrhythmics
Beta Blockers
Propranolol
Esmolol
Metoprolol
Atenolol
Timolol
Class III Antiarrhythmics
K channel blockers
Sotalol, amiodarone
Used when other antiarrhythmics fail
Class IV Antiarrhythmics
Ca channel blockers
Verapamil, diltiazem