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79 Cards in this Set
- Front
- Back
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What causes blue babies?
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Right to left shunts - early cyanosis
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What do left to right shunts cause?
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Blue kids - later
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What are the 3 T's? What type of cyanosis/shunt? Which is most common?
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-TOF - most common
-TGV -Truncus arteriosus Right to left shunts Early cyanosis bc mixing unoxygenated blood w/ systemic |
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What may children with a right-to-left shunt do to compensate?
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Squat
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Why squat?
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Increase venous return
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What are the 3 causes of a Left-to-Right shunt? In what order of freq?
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-VSD most common
-ASD med -PDA - least common |
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Why do Left-to-Right shunts result in cyanosis later?
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It takes time for the pulmonary vessels to hypertrophy in response to the increased perfusion by mixing LV blood with RV; then pulm hypertension
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What is it called when a L-R shunt turns into a R-L shunt?
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Eisenmenger's syndrome
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What is the most common congenital cardiac anomaly?
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VSD - ventricular septal defect
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What is the sign of an ASD?
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Wide fixed splitting of S2 (aortic/pulm) and a LOUD S1 (mitral/tricusp)
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What closes a PDA?
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Indomethacin
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What is Eisenmenger's syndrome?
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When an untreated VSD/ASD/PDA leads to progressive pulm htn and reverses to a R-L shunt
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What are the 3 signs of Eisenmenger's syndrome?
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-Late cyanosis
-Clubbing -Polycythemia |
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Where does the hole for the R-L shunt come from?
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The same one as in the L-R shunt, just the flow reverses
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What are the 4 things in TOF?
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PROV
-Pulm stenosis -Right ventric hypertrophy -Overriding aorta (over the VSD) -VSD |
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Why do babies with TOF have early cyanosis?
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Because though its a VSD, the shunt is right-to-left from the ventricular hypertrophy and pulmonary stenosis
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What is the X-ray finding in kids with TOF?
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Boot-shaped heart due to RVH
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What is Tetralogy of Fallot CAUSED by?
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Anterior-superior displacement of the infundibular septum!
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What do babies with TOF do?
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Squat
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And what does squatting do?
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Increases femoral artery pressure to help the R-L shunt and reduce the pulmonary hypertension
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What is TGV?
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When the aorta comes off the RV and the pulmonic trunk comes off the LEFT v
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What is Transposition of the great vessels CAUSED by?
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Failure of the aorticopulmonary septum to SPIRAL during devo
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What is required for babies with TGV to live?
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A SHUNT and then Surgical correction!
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What are 3 shunts that a patient with TGV could have?
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VSD, PDA, Patent foramen ovale
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What cardiac anomaly is associated with Turner's syndrome?
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Coarctition of the aorta
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What are 2 types of COA?
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-Infantile
-Adult |
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What is the problem with coarctition of the aorta in
-Infants -Adults |
Infants: aortic stenosis in close to the aorta - before DA
Adults: AFTER the ductus |
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In what sex is COA more common?
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M3:F1
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What is the tipoff to COA?
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Strong pulses in upper limbs
Weak pulses in lower limbs |
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What direction does blood flow thru the ductus arteriosus in fetal life?
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RIGHT to LEFT; from pulmonic to aortic
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What happens when the Ductus remains open after birth?
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Now the shunt flow reverses and becomes Lft-Right causing pulm hypertension, RV hypertrophy, and failure.
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What is the treatment to close a PDA?
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Indomethacin
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What would you use to keep a PDA open and for what purpose?
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Prostaglandin E
For transposition of great vessels |
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What congenital cardiac defects are associated with 22q11 syndromes?
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-Truncus arteriosus
-Tetralogy of fallot (digeorge) |
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What syndrome is associated with ASDs/VSDs?
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Downs
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What syndrome is associated with septal defects and a PDA?
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Congenital RUBELLA
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What syndrome is associated with Coarctition of the aorta?
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Turner's
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What syndrome is associated with Aortic insufficiency and dissection?
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Marfan's
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What syndrome is associated with TGV?
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Offspring of diabetic mothers
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Monckeberg
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Calcification of arteries - radial and ulnar - arteriosclerosis
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What does Monckeberg show on histology?
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Pipestem arteries
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Onion skinning of hyperplastic areries:
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Arteriolosclerosis in essential hypertension
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Fibrous plaques and atheromas in the intima of arteries:
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Atherosclerosis
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Hyaline thickening of small arteries:
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Arteriolosclerosis
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What size vessels involved in ATHEROsclerosis:
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-Elastic arteries
-Large musc arteries -Med musc arteries |
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3 steps in the progression of Atherosclerosis:
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1. Fatty streaks
2. Proliferative plaques 3. Complex atheromas |
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Symptoms of Atherosclerosis:
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Angina
Claudication May be asymptomatic |
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When will ischemic heart disease cause Angina?
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When CAD occlusion is >75%
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What is the most common cause of stable angina (only during exercise)?
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Atherosclerosis
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Most common cause of MI:
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Acute thrombosis due to CAD - atherosclerosis
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Most common cause of ACUTE cardiac death (w/in 1 hr of symptom onset):
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Lethal arrythmia
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Chronic ischemic heart disease:
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Progressive onset of congestive heart failure due to chronic ischemic heart damage
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Where will infarcts be RED:
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Loose tissues w/ collateral supply - lungs/intestine
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When would an infarct in the heart be red?
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Following REPERFUSION
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Where will infarcts be PALE?
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Solid tissues with single supply
brain heart kidney spleen |
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So most common cause of an MI:
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Coronary artery occlusion
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Top 3 places for a CA occlusion - decreasing order:
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-LAD
-RCA -Left circumflex |
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Gold standard for MI diagnosis in first 6 hours:
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ECG
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ST elevation:
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transmural infarct
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ST depression:
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subendocardial infarct
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pathologic Q waves:
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transmural infarct
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Most common cause of death after MI in first few hours/days:
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ARRYTHMIA
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Complication of LARGE infarcts:
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Cardiogenic shock
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Cause of death in 4-10 days after MI:
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Cardiac tamponade - rupture of free wall/muscle/iv septum
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What do you think if you hear a friction rub 3-5 days post MI?
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Fibrinous pericarditis
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What autoimmune phenomenon can cause fibrinous pericarditis after MI? How long after?
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Dressler's syndrome - WEEKS later
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3 types of cardiomyopathy:
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-Dilated
-Hypertrophic -Restrictive |
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Most common cardiomyopathy:
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Dilated
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6 causes of dilated cardiomyopathy:
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Alcohol
Beriberi Coxsackie B Cocaine Chagas disease Doxorubicin toxicity |
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How do you id dilated cardiomyopathy?
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Balloon heart on xray
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What kind of dysfunction does dilated cardiomyopathy cause?
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Systolic
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What causes Diastolic dysfnction?
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Hypertrophic cardiomyopathy
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How do you id Hypertrophic cardiomyopathy?
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Banana outflow - normal heart size
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What is Hypertrophic cardiomyopathy the most common cause of?
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Sudden death in young athletes
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What are 50% of cases of Hypertrophic cardiomyopathy?
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Familial and Auto Dominant
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Treatment for Hypertrophic cardiomyopathy:
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B-blocker
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3 cardiac exam findings in hypertrophic cardiomyopathy:
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-LOUD S4
-Impulse palpable -Systolic murmur (outflow) |
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Major causes of Restrictive cardiomyopathy:
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SAPHEE
-Sarcoid -Amyloid -Post-radiation -HEmochromatosis -Endomyocardial fibrosis |
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Loffler's:
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Endomyocardial fibrosis
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