Cases

Front 1

Arteriovenous fistula (shunt)

Back 1

Fatigue and palpitations with exercise. High output cardiac failure. Tachycardia, increased CVP and venous return. Continuous murmur at location. Congenital, surgical or acquired through trauma (often in legs).

Front 2

Vitamin B1 (thiamine) deficiency (Beriberi)

Back 2

Often occurs in alcoholics that are malnourished, pts with gastric disorders or babies nursed by a mother with beriberi. Thiamine deficiency means pyruvate dehydrogenase doesn't work (decreased acetylcholine from acetyl-CoA and high lactic acid) as well as a-ketogluterate dehydrogenase (low ATP, hypoxia-like... vasodilation) and transketolase. Three sets of symptoms: Wet beriberi: High cardiac output failure, edema, dyspnea (crackles in lower lung), cardiomegaly, S3 heart sound, midsystolic murmur, jugular venous distension; dry beriberi: peripheral neoropathy, foot drop, hyporeflexia, hepatomegaly; Wernicke-Korsakoff syndrome: confabulation, retrograde amnesia, nystagmus, ataxia ptosis, brain hemorrhages, necrosis of the thalamus, hypothalamus (mammilary bodies) and paraventricular regions

Front 3

Causes of High-output heart failure

Back 3

AV fistula, hyperthyroidism, wet beriberi, and anemia (decrease viscosity and may lead t tissue hypoxia). All decrease peripheral resistance.

Front 4

Atrial Septal Defects

Back 4

90% involve the ostium secundum and 5 % each involve the ostium primum (usually associated with endocardial cushion defects, AV valve insufficiency and sometimes VSDs) and sinus venosus (associated with a frameshift mutation in a transcription factor). These are the most common heart defects diagnosed in adults and symptoms include left-right shunt (acyanotic), right sided heart hypertrophy, wide fixed splitting of S2, pulmonic valve systolic outflow murmur, which may lead to increased pulmonary resistance, pulmonary hypertension (10% of cases) and eisenmenger's syndrome. Also seen: paradoxical septal movement, dyspnea, palpitations, cardiomegaly, small aorta compared to pulmonary outflow tracts, and potential for paradoxic emboli and infective endocarditis.

Front 5

Cardiac Tamponade

Back 5

Can be due to a chest wound or a hemorrhaged MI, etc. Clinically, Hypotension that does not respond to fluid resuscitation, pulsus paradoxus, Kussmaul sign, distant heart sounds and diminished apical impulse, cyanosis, pericardial fluid. With chest wounds and MI blood fills the pericardial sac (btwn epicardium (visceral pericardium) and parietal/fibrous pericardium. Requires immediate pericardiocentesis, and possibly thoracotomy when hemopericardium present.