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88 Cards in this Set
- Front
- Back
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Continuous machine-like murmur, loudest at S2:
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PDA
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Most common valve lesion:
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Mitral valve PROLAPSE
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When will you hear a mitral valve prolapse? As what?
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LATE systolic murmur with a midsystolic CLICK
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Holosystolic murmur:
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VSD
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Ejection click, then crescendo-decrescendo systolic ejection murmur:
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Aortic stenosis
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What is wrong with pressure gradients in aortic stenosis?
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LV pressure is much much higher than aortic pressure during systole.
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When is aortic pressure highest normally?
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Just after RAPID ejection during systole - at the start of reduced ejection
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Where does the ejection murmur of Aortic stenosis radiate?
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To the carotids and apex of the heart
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What is Pulsus parvus et tardus?
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The finding of WEAK pulses compared to the heart sounds.
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And what is pulsus parvus et tardus see in?
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Aortic stenosis
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Holosystolic high-pitched blowing murmur:
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Mitral regurgitation
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Where is mitral regurg heard loudest?
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Apex
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Immediate high-pitched blowing diastolic murmur at the start of systole:
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Aortic regurg
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What does Aortic regurg cause?
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Wide pulse pressure
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Left atrial pressure >> Left ventricular pressure during diastole:
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Mitral stenosis
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When in diastole is mitral stenosis heard?
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LATE - it's delayed and follows an opening snap.
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How does Mitral stenosis differ from Tricuspid?
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Tricuspid gets louder with inspiration
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Why do patients with CHF have dyspnea on exertion?
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Because the LV output fails to increase with exercise - it can't!
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Why do patients with CHF have dilated hearts?
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Because of the frank starling mechanism - increased EDV to increase CO
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Why do CHF patients have Pulmonary edema?
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Because the LV failure causes pulmonary VEIN pressure to increase and filtration pressure increases causing lung edema!
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What do patients with CHF get at night?
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Paroxysmal nocturnal dyspnea
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What are Heart failure cells?
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Hemosiderin-laden macrophages in ALVEOLI
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What is Orthopnea?
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Shortness of breath when supine
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Why do CHF patients have orthopnea?
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Because when they lie down it increases VR which exacerbates the pulmonary vascular congestion
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What is Nutmeg liver?
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The hepatomegaly and gross change seen in the liver of patients with CHF
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What causes the nutmeg liver and hepatomegaly?
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"Backup" in portal flow due to increased central venous pressure
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What can the hepatomegaly and venous backup lead to, though rare?
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Cardiac 'cirrhosis'!
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Why do CHF patients get ankle and sacral edema?
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Because the RV fails causing increased venous pressure and fluid transudation.
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What finding is indicative of the RV failure and increased venous pressure?
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Increased JVP - jugular venous DISTENTION
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What are 6 types of THROMBI that can develop in the heart?
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FAT BAT
-Fat -Air -Thrombus -Bacteria -Amniotic fluid -Tumor |
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Where do the MAJORITY of pulmonary emboli develop?
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In the deep leg veins (dvt)
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What 2 things are FAT emboli associated with?
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-Liposuction
-Long bone fractures |
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What can amniotic fluid emboli lead to?
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DIC
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3 signs of Pulmonary embolus:
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-Chest pain
-Tachypnea -Dyspnea |
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What predisposes patients to DVT?
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Virchow's triad
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What is Virchow's triad?
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1. Stasis
2. Hypercoagulability 3. Endothelial damage |
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What is Cardiac tamponade?
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Compression of the heart by fluid in the pericardial sac leading to decreased CO
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What does Cardiac tamponade do to the heart chambers?
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Equilizes all their pressures!
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What will your exam findings be in Cardiac tamponade?
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-Hypotension
-Elevated JVP -Decreased/muffled heart sounds -Weak pulses, pulsus paradoxus -Rapid heartrate |
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What does the ECG show in Cardiac tamponade?
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Electrical alternans - beat to beat alterations in the QRS complex height.
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What heartvalve is most frequently involved in Bacterial endocarditis?
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Mitral valve!
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If it's the tricuspid valve, think:
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IV drug abuse
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What are 4 complications of Bacterial endocarditis?
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CEGS
-Chordae rupture -Embolism -Glomerulonephritis -Suppurative Pericarditis |
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What are 8 findings in Bacterial endocarditis? (acronym)
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FROM JANE
-Fever -Roth's spots -Osler's nodes -Murmur -Janeway lesions -Anemia -Nail0bed hemorrhage -Emboli |
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What are osler's nodes?
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Tender raised lesions on the fingers and toe pads
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What are roth's spots?
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Retinal hemorrhages
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What is significant about the murmur that you'll hear in bacterial endocarditis?
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It is NEW
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What are Janeway lesions?
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Little red dots on the palms and soles
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Why does the new murmur often develop in bacterial endocarditis?
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Because of valve damage
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What is necessary for diagnosis of bacterial endocarditis?
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Multiple blood cultures
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What is the most common causative organism in ACUTE bacterial endocarditis?
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Staph aureus
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What kind of valves will S. aureus infect?
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Previously normal ones
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What agents cause Subacute bacterial endocarditis?
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Viridans streptococci
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What size vegetations are seen in Staph vs Strep endocarditis?
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Staph = large
Strep = small |
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What kind of valves does Strep viridans infect?
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PReviously damaged ones
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What is Libman-Sack's endocarditis?
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Vegetations on BOTH SIDES of the valve
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What does the presence of vegetations on both sides of valves cause?
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Stenosis
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What disease is Libman-sack's endocarditis seen in?
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Systemic lupus
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SLE causes
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LSE
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LSE is seen in
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SLE
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What does Rheumatic heart disease follow?
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PHARYNGEAL infections with Group A strep
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What does rheumatic heart disease cause?
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Early death due to myocarditis
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What is the order of freq in which heart valves are affected in rheumatic heart disease?
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1. Mitral
2. Aortic 3. Tricuspid |
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What are 2 funny histologic findings seen in Rheumatic heart disease?
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-Aschoff bodies
-Anitschkow's cells |
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Aschoff bodies:
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Granulomas with giant cells
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Anitschkow's cells:
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Activated histiocytes
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How do you remember the complications of Rheumatic heart disease?
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FEVERSS
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What is FEVERSS?
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-Fever
-Erythema marginatum -Valve damage -ESR elevated (sedrate) -REd hot joints - polyarthritis -Sucutaneous nodules -St. vitus' dance |
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What is ST. vitus' dance?
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chorea
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3 types of pericarditis that you can see:
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-Serous
-Fibrinous -Hemorrhagic |
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When do you see Serous pericarditis? (4 conditions)
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-SLE
-Rheumatoid arthritis -Infection -Uremia |
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What are 3 conditinos in which you can see Fibrinous pericarditis?
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RUM
-Rheumatic FEVER -Uremia -Myocardial infarct |
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What is it called when a myocardial infarct results in fibrinous pericarditis? Timeframe?
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DRESSLER'S SYNDROME
-few weeks later |
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What are 2 things that cause HEMORRHAGIC pericarditis?
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-TB
-Malignancy |
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What ECG change will be seen in pericarditis?
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ST ELEVATIONS IN ALL LEADS!
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What is a common symptom of pericarditis?
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Pericardial PAIN
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What does Syphilitic heart disease affect?
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The AORTA
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At what stage of syphilis is syphilitic heart disease seen?
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Tertiary
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What does syphilis do to the aortic valve? How?
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-Dilates the aorta and valve ring
-By disrupting the vasa vasora |
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What is a common finding as a result of the disruption of the aorta?
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CALCIFICATION
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What complication can result from the disruption/dilation caused by syphilitic heart disease?
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Aneurysm and rupture of the aorta
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What is the most common primary cardiac tumor in adults?
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MYXOMA
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What part of the heart do 90% of myxomas develop?
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Atrium - mostly left
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What are Myxomas?
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Ball-valve obstructions
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What is the most common primary heart tumor in CHILDREN? Associated with what syndrome?
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Rhabdomyomas - assoc with Tuberous sclerosis
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What is the most common heart tumor in general?
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Metastases
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What is a sign of metastatic tumors in the heart?
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Kussmaul's sign
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Kussmaul's sign:
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Increased systemic venous pressure on inspiration
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