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32 Cards in this Set
- Front
- Back
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Loeffler Endocarditis
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Loeffler endocarditis is a form of restrictive cardiomyopathy which affects the endocardium and occurs with white blood cell proliferation, specifically of eosinophils
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-Massive dilation of aortic root and aortic arch w/o atherosclerosis
-distinctive wrinkling on the inside surface of aorta -obliterative endarteritis of the vasa vasorum What is the diagnosis? |
Tertiary syphillis
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Muffled heart sounds a few days after an MI, what has happened?
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The heart muscle has become necrotic and then ruptured, leaking blood into the pericardial space.
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Pt w/ hx of colorectal cancer presents w/ fatigue, wt loss and raised temp. He has punctate hemorrhages under fingernails. What is the causative agent?
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Streptococcus Bovis is often associated with colon cancer and can cause an endocarditis. (If a pt has S. Bovis, you should check out their colon for cancer)
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Draw the right coronary artery, posterior descending, left coronary artery, left anterior descending, and circumflex arteries. What portion of the heart do these supply?
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Right coronary arter gives off the posterior descending which will give you posterior/inferior infarcts
The left cronary artery gives the left anterior descending (the major cause of MI because of the branching angle), it will give an anterior MI, and the circumflex artery will give you a lateral infarct |
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What is cardiac output if arterial O2 is 5, venous O2 is 2 and rate of total O2 use is 6?
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Answer: 2
CO = Rate of O2 use/ (arterial O2 content - venous O2 content) (Called Fick principle) |
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Calculate MAP if BP is 120/90
Calculate MAP if CO is 5 and total peripheral resistance is 5 |
40 + 60 = 100
- MAP is 1/3 systolic + 2/3 diastolic 25 - MAP is CO X total peripheral resistance |
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OK, seriously, tell me which is the mitral valve and which is the tricuspid.
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Mitral (bicuspid) is between left atrium and ventricle
Tricuspid is between right atrium and ventricle. Think "tRIGHTcuspid" |
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1- Mitral valve opens
2- Mitral valve closes 3- Isovolumetric contraction 4- Aortic valve opens 5- Systole ejection 6- Aortic valve closes 7- Isovolumetric relaxation Sounds (Starting at mitral valve opening and going counter-clockwise) S3 - right after mitral valve opens (early diastole), heard with increased filling pressures (CHF). THE MOST RELIABLE MARKER OF CHF (QBANK) S4 - late diastole ("atrial kick"). High atrial pressure, associated with venticular hypertrophy where left atrium has to push against a stiff LV wall S1 - the closing of the mitral valve S2- the closing of the aortic valve |
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What are the three possibilities when you hear a holosystolic murmer (that doesn't crescendo)
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If it is high pitched "blowing murmur", it can be a mitral regurge if heard at mitral area, tricuspid regurge if heard at tricuspid area
If its more harsh-sounding at the tricuspid area (or anywhere, really) it would be a ventral septal defect |
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Crescendo-decrescend systolic murmur after an ejection click
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Aortic stenosis
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Midsystolic click with a murmur afterwards
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Mitral valve prolapse (click is d/t sudden tensing of chordae tendineae)
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A blowing, high picthed continuous diastolic murmur
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Aortic regurge.
Can have high pulse pressure, bounding pulses, and head bobbing |
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Diastolic murmur following an opening snap
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Mitral stenosis
Often follows rheumatic fever |
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Continuous machine-like murmur heard throughout systole and diastole
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Patent ductus arteriosis
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Baby is blue at birth, what are the possible causes?
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Right-to-left shunts: 4 T's:
-Tetralogy (most common) -Transposition of great vessels (usually fatal) -Truncus arteriosis (failure to develop a divide between aorta and pulmonary artery, resulting in common trunk. SEEN IN DIGEORGE Tricuspid atresia |
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KID is blue (not a neonate)
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LEFT TO RIGHT shunts:
VSD (most common congenital cardiac anomaly) ASD (loudS1, wide S2) PDA (close with indomethacin) Since these or left to right shunts, the pulmonary circulation eventually undergoes enough hypertrophy to give you pulmonary htn, leading to a RIGHT TO LEFT shunt (called Eisenmenger's syndrome). That's why they turn blue as kids! |
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1- Baby blue?
2- Baby half blue? 3- Kid blue? 4- Kid half blue? 5- 25 year old blue? |
1- The 4 T's (tetrology, transposition of great vessels, truncus arteriosis, tricuspid atresia)
2- Preductal aortic coarctation 3- VSD 4- PDA 5- ASD - |
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Kid presents with SOB, digital clubbing and squats down to catch his breath.
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tetRoLogy of fallot (R to L shunt)
PROVe you know this! Pulmonary stenosis Right ventricular hypertrophy (boot shaped heart) Overriding aorta VSD Caused by anterosuperior displacement of infundibular septum The polycythemia is beacuase the kidneys release erythropoeitin ***Most asked and the most common cause of cyanosis |
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Transposition of the great vessels
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Left ventricle supplies the lungs and the right ventricle has to fill the aorta. This is d/t failure of the aorticopulmonary system to spiral, a NEURAL CREST PROBLEM
You will see blue baby with boot shaped heart d/t RVH Kid's mom will likely have DIABETES To survive the baby must be able to mix blood via a VSD, ASD, or PDA, so give the kiddo alPROSTadil to keep it open. Fatal without surgery |
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Infant presents with CHF, and weak pulses/cyanosis in the lower extremeties. A machine-like murmer throughout systole and diastole.
What genetic condition is this associated with? What will heart look like on XRAY? What med do they need? |
This is a coarctation of the aorta INfantile type is IN close to the heart (proximal to a patent ductus arteriosis)
Associated with Turners XRAY shows RVH (boot shaped) Give them alprostadil to keep the ductus open until surgery |
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An adult presents with high BP in arms and low BP in legs, what will you see on XRAY?
What will this pt die from? |
This is coarctation of the aorta AAAdult type AAAway from heart (distal to ductus arteriosis).
Collateral circulation is through internal thoracic to the intercostals and you get notching of the ribs. Death from left CHF, dissecting aorta, or stroke (high BP in brain) |
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What drug do you give to keep ductus arteriosis open? What drug would close it?
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INDomethacin closes it, and alPROSTadil keeps it open.
INDian girls close their legs and PROSTitutes keep them open. |
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Pt comes in with fever, small erythematous lesions on palm or sole, and splinter hemorrhages in nail beds.
Likely cause? If IV drug user, what is now the likely cause? Complications? |
This is bacterial endocarditis, mitral valve is most commonly effected, unless its an IV drug user then it is tricuspid ("don't TRI DRUGS")
If it is acute than it is s. aureus. If it is sub-acute it is s. viridans. Could also be s. bovis in colon cancers or s. epidermidis on prosthetic valves. In IV drug users it will be s. aureus (MOST COMMON), psuedomonas or candida. Symptoms include: -Fever, -roth spots (round white spots on reitina Rrrroth - Rrrretina), -Osler's nodes (painful lesions on finger/toe pads -Murmur -Janeway lesions (red lesions on palms and soles -Anemia -Nail bed hemorrages (splinter hemorrhage) - Emboli Complications are emboli, chordae rupture, glomerulonephritis, suppurative pericarditis. |
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Cardiac Myxoma
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This is the ball-valve tumor and is the #1 cardiac tumor in adults.
Look for scattered mesenchymal cells in a myxoid background. Multiple syncopal episodes |
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Rhabdomyomas
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Most frequent cardiac tumor in kiddos, associated with tuberous sclerosis (so look for tubers)
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What is Kussmaul's sign and what does it indicate?
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Increased jugular venous pressure on inspiration and indicates a cardiac tumor.
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What are some of the complications of an MI?
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1- Cardiac arrhythmias, usually the cause of death before you get to the hospital
2- LV failure --> pulmonary edema 3- Ventricular free wall rupture --> cardiac tamponade and papillary muscle rupture --> severe mitral regurgitation and intreventricular septal rupture --> VSD 4- Formation of an aneurysm 5- Postinfarction fibrinous pericarditis- friction rub (3-5 days post-MI) 6- Dressler's syndrome - autoimmune phenomenon resulting in fibrinous pericarditis (several weeks post MI). This will present as chest pain and fever (QBANK) |
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Kawasaki DZ
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ASIAN KIDS under 4
Fever, lymphadenitis, conjunctivitis, desquamation and rash on hands, feet, and mouth. Watch for CORONARY ANEURYSMS! |
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What are the Beta-1 seleactive blockers?
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Atenolol, Acebutelol, betoxolol, bisoprolol, esmolol, metoprolol
Remember that these can be used to treat asthmatics but can cause AV blocks. |
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Rheumatic Heart DZ
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Caused by strep pyogenes, can cause chorea in kids, and causes of mitral valve problems (QBANK)
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What complication should you watch for 5-10 days after an MI? How about after a few weeks when a scar is formed?
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In 5-10 days there is a bunch of macrophages so look for weakened wall and rupture. The thin scar formed a few weeks after an MI is weak but won't break so you'll see ventricular aneurysms.
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