Term
what is the most comon birth defect in cards |
|
Definition
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|
Term
what is the most common heart disease |
|
Definition
|
|
Term
what is the cause of congenital heart disease |
|
Definition
enivornment and genetics 90% unknown |
|
|
Term
with what types of heart problems are mothers advised not to reproduce 4 |
|
Definition
aortic diseases: marfans, coarctation cyanotic heart disease pulmonary HTN |
|
|
Term
how is the severity of a left to right shunt determine |
|
Definition
the bigger the shunt the more blood moves through into the pulmonary circut |
|
|
Term
what are the 3 left to right shunts |
|
Definition
|
|
Term
explain what eisnmenger's syndrome is and the complications of it |
|
Definition
In left to right shunt blood from the systemic circuit is forced into the lower pressure pulmonary circuit. Evuntally the pulmonary circuit will form HTN and it will be lower pressure for it to shunt back into the systemic circuit This will cause deoxygenated blood to enter the systemic circuit prematurely and this late cyanosis |
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|
Term
what are 7 signs of esienmenger's syndrme |
|
Definition
pulmonary vascular disease pulmonary HTN exercise syncope arrhythmia hemoptysis stroke secondary polycythemia |
|
|
Term
|
Definition
cyanosis activates erythropoetin which increases RBC and blood viscosity |
|
|
Term
what is the tx for eisnmenger's syndrome |
|
Definition
avoid more viscosity: no oral contraceptives theraputic phlebotomy |
|
|
Term
whan is theraputic phlebotomy done, what do you do |
|
Definition
Hb>20 or HCT>65 then you can do it muscle replace Fe and volume to prevent syncope |
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|
Term
what is the most common congenital heart defect in adilts |
|
Definition
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|
Term
|
Definition
open septum between atria allows high pressure blood from the LA into the RA which increases delivery of blood to the lungs |
|
|
Term
ASD: locations, their prevelance |
|
Definition
sinus venosus: near the SVC ostium secondum: midlline, fossa ovalia, most common ostium primum: near AV valves |
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|
Term
what location of ASD is associated with another birth defect disorder, what disorder is it |
|
Definition
ASD ostium primum down syndrome |
|
|
Term
what are the two complications of ASD, explain why each happen |
|
Definition
paradoxical emboli: DVT normally lodges in lungs, but because there is an opening between the atria it could go RA to LA then to systemic circulation and lodge in brain
eismenger's syndrome: the shunt is delivering lots of blood to the lungs, after a while the lungs will develop HTN and become higher pressure than the systemic circut causing reversal of the shunt and deoxygenated RA blood to be allowed into the circulation causing LATE CYANOSIS |
|
|
Term
what are the heart sounds associated with a , explain why you heart them 6 |
|
Definition
wide fixed S2 split: there is more blood in the RA making it hard for the pulmonary valve to close on time
systolic ejection murmur: the increase RV blood is forced through the pulmonary valve
diastolic rumble: increased blood volume moving across the trucuspid in filling
RV heave: the RV has more blood to push out
ostium primum: mitral regurgitation
ostium secondum: Afib in 50s |
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|
Term
other than the heart sounds, what exam finding would there be, why |
|
Definition
prominent jugular venous pressure: traffic jam, extra blood in RA |
|
|
Term
|
Definition
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|
Term
|
Definition
pulmonary HTN RV hypertrophy LV hypertrpohy in primum ASD |
|
|
Term
|
Definition
RA and RV dilation paradoxical septal movement |
|
|
Term
what is the most frequent congenital heart disease |
|
Definition
|
|
Term
what congenital heart diseas is associated with fetal alcohol syndrom |
|
Definition
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|
Term
|
Definition
opening in muscular septum allows blood from high pressure LV into lower pressure RV which shunts more blood into the pulmonary circut |
|
|
Term
|
Definition
pressure and volume hypertrophy
eismenger's syndrome: more blood in pulmonary circut forms HTN and the systemic circut becomes less pressure so shunt reverses and deoxygenated blood from the RV moves to LV causing LATE CYANOSIS, secondary polycythemia, and CLUBBING |
|
|
Term
how can you tell if a VSD is small or big |
|
Definition
small: LOUD systolic murmur, thrill, palpable, found early
big: soft diastolic mitral outflow rumble |
|
|
Term
|
Definition
surgical closure of shunt (small may close on its own) |
|
|
Term
|
Definition
girls > boys associated with MATERANL RUBELLA |
|
|
Term
|
Definition
normal ductus arteriosis closes by 3mo due to oxygen induced release of PGE
blood shunts from high pressure aorta to low pressure pulmonary artery which delivers more blood to the lungs and less to the systemic circut |
|
|
Term
what is a complication of PDA |
|
Definition
eismenger's syndrome: more blood is being delivered to the pulmonary circut so it develops HTN and the aorta becomes less pressure so the shunt reverses and deoxygenated blood moves from pulmonary artery to aorta AFTER THE BRANCHES WHICH CAUSES LE CYANOSIS |
|
|
Term
|
Definition
machinery murmur cyanosis of the LE after reversal |
|
|
Term
|
Definition
small defect could calcify and close as adult surgery is curative antibotic prophylaxis, NSAIDS prior to shunt development, removal of PGE |
|
|
Term
what are the 4 right to left shunts |
|
Definition
hypoplastic left heart syndrome tricuspid atresia tertaolgy of fallot truncus arteriosis transposition of the great vessels |
|
|
Term
what are two conditions we are worried about in all conditions with a right to left shunt |
|
Definition
cyanotic congenital heart disease: right to left shunts present in infancy (blue baby) as clubbing, cyanosis, dyspnea
emboli from peropherial veins can enter the circulation by bypassing the lungs |
|
|
Term
what is the most common right to left shunt |
|
Definition
|
|
Term
what is the cause of tertaology of fallot, how is the severity determined |
|
Definition
VSD displacement of aorta over VSD subpulmonic stenosis: smaller opening more shunting and more cyanosis thickening of ventricle wall |
|
|
Term
5 exam findings in tertaolgy of fallot |
|
Definition
bluish skin squatting: increases TPR and pressure on right side forcing blood through the stenosis and to the lungs crying poor feeding CXR: boot shaped heart |
|
|
Term
explain the flow of blood in a tertolgy of fallot |
|
Definition
blood enters RV and the pulmonary valve is hard to get through due to stenosis so instead it goes through VSD and into the aorta that is right next to it and out to the peripherial circulation before it is oxygenated causing EARLY CYANOSIS |
|
|
Term
what is the cause of truncus artriosis |
|
Definition
maternal diabetes developmental failure in seperation of truncus into aorta and pulmonary artery |
|
|
Term
explain the flow of blood in truncus arteriosis |
|
Definition
common aorta/pulmonary artery allows mixing of oxygenated and deoxygenated blood which causes early cyanosis |
|
|
Term
what conditions is truncus arteriosis associated with 2 |
|
Definition
|
|
Term
transposition of the great vessels: flow of blood, complications |
|
Definition
aorta comes from RV and pulmonary artery from LV
this creates two seperate pulmonary and systemic circuts and oxygenated blood cannot reach the systemic circut causing EARLY CYANOSIS
the baby is alive because some oxygenated blood goes from the pulmonary artery to the aorta through the PDA |
|
|
Term
tx transposition of the great vessels |
|
Definition
PDA MUST remain open for the baby to stay alive surgical corrections |
|
|
Term
6 obsturction of outflow conditions |
|
Definition
spuravalvular aortic stenosis coarctation of the aorta valvular aortic stenosis aortic regurgitation mitral stenosis mitral regurgitation |
|
|
Term
what condition is supravalvular stenosis associated with, what are other signs 3 |
|
Definition
WILLIAMS SYNDROME (elvin facies, MR, hypercalcemia) |
|
|
Term
cause of supravalvular stenosis |
|
Definition
diaphragmatic (hour glass) stenosis ABOVE the aortic valve PROXIMAL to the coronary artery lesses blood delivery to the ENTIRE systemic circulation |
|
|
Term
exam findings in supravalvular stenosis |
|
Definition
systolic murmur in suprasternal notch |
|
|
Term
what 2 other conditions is coarctation of the aorta associated with |
|
Definition
TURNER SYNDROME bicuspid aorta |
|
|
Term
who gets coardctaiton of the aorta |
|
Definition
males > females 7% of cardiac birth defects |
|
|
Term
what is wrong in coarctation of aorta |
|
Definition
narrowing of aortic arch distal to left subclavian but proximal to PDA |
|
|
Term
explain the flow of blood in infantile coarctation of the aorta |
|
Definition
blood from the RV enters the PDA to the aorta because it is lower pressure after the stenosis causing CYANOSIS TO THE LE |
|
|
Term
explain the flow of blood in adult coarctation of the aorta |
|
Definition
blood from the LV has a difficult time passing through the stenosis so more goes out the aortic branches causing UE HTN AND LE HYPOTENSION |
|
|
Term
3 complications of coarctation of aorta and why |
|
Definition
heart failure: excess work of LV pushin against stenosis anrueysm in circle of willis: due to UE HTN aortic dissection/rupture: due to pressure on stenotic area |
|
|
Term
exam findings in coarctation of aorta 6 |
|
Definition
HTN in UE hypotension in LE reduced pulses in LE radiofemoral delay 3 sign rib notching due to formation of collateral circulation |
|
|
Term
treatment and prognosis of coarctation of aorta 3 |
|
Definition
death in middle age if not corrected with surgery of percutaneous balloon dilation contaol HTH (may rise after surgery) often die of CAD, stroke, rupture, CHF |
|
|
Term
what is the most common obstructive congenital heart disease |
|
Definition
|
|
Term
what are the 3 causes of valvular aortic stenosis, explain each, and what age they come about |
|
Definition
congenital bicuspid: <55yo, increased risk of Ca build up due to wear/tear
degenerative aortic stenosis: >55yo, dystrophic Ca build up due to wear/tear makes it so cusps dont line up
CHRONIC rheumatic fever (40-50yo, 15y after infection): always occurs with mitral stenosis, aortic effect uncommon. due to chronic rheumatic fever causing scaring and FUSING of the valve (fish mouth) |
|
|
Term
aortic valve stenosis effects on the heart |
|
Definition
obstruction of LV out flow causes hypoplastic left heart and LV hypertrophy |
|
|
Term
5 exam findings in aortic stenosis and why |
|
Definition
often asympatomatic until adult due to compensation mechanicms
ejection click and diastolic murmur: pressure behidn stenosis blows open valve (click) and high pressure blood rushes through (crescendo) and then slows (decrescendo)
syncope and angina with exercise: limited blood to brain and heart
pulse parvus (volume): radial pulse weak
pulse tarvus (timine): radial pulse not felt in time with heart |
|
|
Term
how can the severity of an aortic stenosis be determined |
|
Definition
SOUND OF MURMUR INCREASES WITH SEVERITY |
|
|
Term
2 EKG signs of aortia stenosis |
|
Definition
|
|
Term
|
Definition
if severe (<0.75cm2 or >50mmHG) needs surgery |
|
|
Term
causes of aortic regurgitation 8 |
|
Definition
congenital bicuspid degeneration: <55yo degeneration: >55yo rheumatic fever: uncommon endocarditis: cauces valve damage and incomplete closure seronegative arthritis ankylosing spondylitis RA margans: aortic root dilation pulls edges of valve away from eachother |
|
|
Term
when should a marfans patient get surgery for the aortic regurgitation |
|
Definition
|
|
Term
2 exam findings in aortic regurgitation |
|
Definition
short duration murmur: blood quickly goes back through the valve in diastole to equalize pressures (worse severity) making decrescendo murmur
hyperdyanmic circulation signs |
|
|
Term
explain hyperdynamic circulation and the outcomes |
|
Definition
when blood regurgitates into the LV next cycle will push more blood out (inc SV and systolic pressure) but some will come back in (dec diastolic pressure) widening pulse pressure
bounding pulses, pulsating nail beds, nead nodding |
|
|
Term
ECHO/EEG signs in aortic regurgitation |
|
Definition
|
|
Term
how is severity of aortic regurgitation determined |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
chronic rheumatic fever causing scaring the FUSION of the cusps |
|
|
Term
heart sounds in mitral stenosis and why |
|
Definition
1st is loud: when LA pushes open stenotic valve in diastole it causes snap followed by murmur when blood is pushed through |
|
|
Term
how is severity of mitral stenosis detchermined |
|
Definition
longer rumble after 1st heart sound, more severe |
|
|
Term
what is a complication of mitral stenosis, why |
|
Definition
AFib: dilation in LA causes changes in conduction leading to stasis and mural thrombi |
|
|
Term
CXR, EKG, ECHO signs of mitral stenosis |
|
Definition
CXR: straightening of right heart border, kearly B lines (straight line son CXR in severe stenosis)
EKG: RV hypertrophy
ECHO: shows severity, diagnosis, gradient |
|
|
Term
when is a mitral stenosis considered severe |
|
Definition
|
|
Term
|
Definition
surgery if severe AFib: pacemaker or meds balloon valvuloplasty if valve is pliable and not too crusty and stenosed |
|
|
Term
cause of mitral regurgitation 4 |
|
Definition
acute rheumatic fever due to endocarditis vegetations mitral valve prolapse endocarditis papillary muscle ischemia: Post MI papillary mucle dies and it cant keep valve closed |
|
|
Term
where is the most common location of a papillary muscle ischemia and why |
|
Definition
posteriomedial papillary muscle due to flow of blood |
|
|
Term
5 exam findings in mitral regurgitation and why |
|
Definition
holocystolic murmur: LV contracts and some goes back in oblideration of 1st heart sound wide split 2nd heart sound low pitch early diastolic rumble dyspnea due to LV pressure increase |
|
|
Term
how can you make a mitral regurgitation louder 3, why |
|
Definition
squat: increased resistance on atria forces blood into LA
expiration: increased blood in LA increases blood in LV causing more regurgitation |
|
|
Term
what kind of cancer is most likley in the heart |
|
Definition
secondary tumors, primary are very rare |
|
|
Term
how often in metastis to the heart |
|
Definition
occurs in 5% of dying cancer patients |
|
|
Term
what percent of primary cardiac tumors are malignant |
|
Definition
|
|
Term
what are the 6 primary tumors of the heart |
|
Definition
myoxmas lipomas rhabdomyomas angiosarcomas papillary fibroblastoma fibroma |
|
|
Term
myoxma: gender, age, metastic?, location, prevelance |
|
Definition
female 50s MOST COMMON PRIMARY CARDIAC TUMOR 40% benign 90% aorta (usually by fossa ovalis) 75% in LA |
|
|
Term
|
Definition
mesenchyme proliferation causes gelatenous ground substance |
|
|
Term
|
Definition
mitral heart disease (ball value effect) murmurs in heart systemic emboli large peduncukared |
|
|
Term
what is the effect of myexoma on the mitral valve |
|
Definition
tumor is on wall of LA causing blockage to the mirtal valve and decreased systemic blood and syncope when less reaches the brain |
|
|
Term
|
Definition
subendocardium subepicardium myocardium (poorly localized in encapsulated masses) |
|
|
Term
rhabdomyoma: associated disease, prevelance |
|
Definition
most common primary cardiac tumor in infants and kids (40% of tumors in that age group)
associated with tuberous sclerosis |
|
|
Term
cause of rhabdomyomas, location, size |
|
Definition
fetal harmatomas large 90% ventricular myocardium |
|
|
Term
what is the most common primary malignant tumor of the heart |
|
Definition
|
|
Term
what is the most frequent cardiac tumor, what is the most frequent complication |
|
Definition
metastasis from another cancer to the parenchyma causes effusion |
|
|
Term
what are 4 common malignancies that metastasize to the heart |
|
Definition
lung, breast, melanoma, lymphoma |
|
|
Term
what are 5 manuvers that can help with diagnosis of valve disease |
|
Definition
inspiration valsalva hangrip squatting change from supine to upright |
|
|
Term
what does inspiration do the the CV |
|
Definition
increased venous return increased right sided murmur |
|
|
Term
what does valsalve to to the CV |
|
Definition
increases intrathoracic pressure decreases venous return to heart most sound decreased due to decreased LV filling and decreased CO (EXCEPT HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY (SUBVALVULAR AORTIC STENOSIS) AND MITRAL STENOSIS) |
|
|
Term
what does handgrip do to the CV |
|
Definition
increases CO and systemic vascular resistance |
|
|
Term
what does squatting do the to CV |
|
Definition
increases peripherial vascular resistance increases venous return |
|
|
Term
what does changing from supine to upright do to the CV |
|
Definition
decreases venous return and SV increases HR and systemic vascular resistance |
|
|
Term
mitral valve prolapse: prevelance, ages, gender |
|
Definition
3-5% of the population 20-30yo women > men |
|
|
Term
causes of mitral valve prolapse 7 |
|
Definition
degeneration of mitral valve due to marfans elhers danlos ruptured papillary m or chordae tendinae endocarditis arrhythmia thombi |
|
|
Term
what condition is mitral valve prolapse often combined with |
|
Definition
mitral valve regurgitation |
|
|
Term
explain what happens to the valve in mitral valve prolapse |
|
Definition
balooning of the valve into LA in systole due to degenerating loppy valve |
|
|
Term
symptoms of mitral valve prolapse |
|
Definition
|
|
Term
complications of mitral valve prolapse 5 |
|
Definition
severe mitral regurgitation infective endocarditis arrhythmia thrombi |
|
|
Term
what are te six infections of the heart |
|
Definition
rheumatic heart disease non-bacterial thrombotic endocarditis libman sacs endocarditis infective endocarditis myocarditis pericarditis |
|
|
Term
rheumatic heart disease: locations, prevelance, most common dysfunction |
|
Definition
3% of GAS will cause rheumatic heart failure mitral valve > women aortic valve > men (overall more rare) stenosis > regurgitation |
|
|
Term
cause of rheumatic heart disease |
|
Definition
slight familial predisposition
pt gets pharyngitis via GAS pyogenes which has M proteins that resemble human tissue the body makes antigens to the M proteins and they attack the GAS and the body (molecular mimicry) |
|
|
Term
what are the 3 changes in the heart tissue with acute rheumatic heart disease |
|
Definition
pancarditis: inflammatory infiltrate of all three layers
endocarditis: vegitations on mv causes regurgitation
myocarditis: most common cause of death in acute phase
pericarditis: causes friction rub |
|
|
Term
what are two signs of rheumatic myocarditis |
|
Definition
aschoff bodies: chronic inflammation, giant cells, fibrnoid
anichkow cells: histocytes with catipillar nuclei in bodies |
|
|
Term
what changes in the heart with chronic rheumatic heart disease |
|
Definition
scarring and fibrnoid necrosis of the valves causes fusion and thickening leaving valve stenosed with "fish mouth" appearance |
|
|
Term
explain how rheumatic fever is diagnosed |
|
Definition
1. evidence of strep infection (ASO, anti-DNAase) 2. 2 major or 1 major + 2 minor |
|
|
Term
what are the 5 major criteria for rheumatic fever |
|
Definition
Joint- migratory polyarthritis O - pancarditis Nodules in SC Erythema migrinatum: rash on trunk with red borders Syndehams chorea: rapid involuntary movement |
|
|
Term
non-thrombotic bacterial endocarditis, define, aka, location |
|
Definition
marantic endocarditis 50% mitral sterile deposition of fibrin, platelets, blood components on line of closure vegetations |
|
|
Term
non-thrombotic bacterial endocarditis causes 2 |
|
Definition
hyperviscosity: elevated platelets, adenocarcinomas subtle endothelial abnormalities |
|
|
Term
non-thrombotic bacterial endocarditis complication |
|
Definition
|
|
Term
libman-sacs endocarditis: cause, common presentations |
|
Definition
SLE attacks tricuspid, mitral, cords, endocardium causing fibrnoid necrosis on BOTH sides of valves |
|
|
Term
libman-sacs endocarditis tx and prognosis |
|
Definition
decrease incidence with steroid therapy embolic event sin valve fibrosis common |
|
|
Term
4 microbes causing infective endocarditis, their virulence, most common pt, type of endocarditis |
|
Definition
S. viridans: low virulence, small vegetations, don't destory valve (subacute)
S. aureus: high virulence common in iv drug user, large vegetations destory valve (acute)
S. epidermiditis: common on presthetic valves
S. bovis: common with colorectal cancer |
|
|
Term
what predisposes someone for endocarditis |
|
Definition
heart lesion, IV drug use, any exposed collagen on valve allows for thrombotic vegitations on heart valve that can trap bacteria |
|
|
Term
what valves are most often infected in infective endocarditis |
|
Definition
mostly aortic and mitral tricuspid in S aureus IV drug user because it is very virulent and tricuspid is the first valve it hits |
|
|
Term
signs of acute endocarditis |
|
Definition
rapid onset, fever, chills, weakness |
|
|
Term
signs of subacute endocarditis |
|
Definition
|
|
Term
signs of a septic emboli from endocarditis 3 |
|
Definition
janeway lesions: red lesions on palms and soles osler lesions: painful lesions on finger splinter hemorrhages: on nail beds |
|
|
Term
treatment of infectious endocarditis |
|
Definition
get positive blood cultyre (major criteria) 6 mo antibiotics |
|
|
Term
viral causes of myocarditis 5 |
|
Definition
most common cosackie, echo, influenza, HIV, CMV |
|
|
Term
bacterial causes of myocarditis 5 |
|
Definition
chalmydia (C. psittaci) rickettsia (R. typhi) corynebacterium dyptheriae N. meningitidis B. burdgferi |
|
|
Term
fungal, protzoa, worm causes of myocarditis 4 |
|
Definition
canditia T. cruzi, toxoplasmosis helminths |
|
|
Term
autoimmune causes of myocarditis 5 |
|
Definition
post viral (post-strep) SLE drug hypersensitivity: methylopa, sulfa transplant rejection sarcoidosis giant cell arteritis |
|
|
Term
signs of myocarditis non-acute 5 |
|
Definition
asymptomatic fever fatigue CP palpitations |
|
|
Term
signs of myocarditis acutte 3 |
|
Definition
arrythmia dilated cardiomyopathy mitral regurgitation |
|
|
Term
what is the normal cause of pericarditis |
|
Definition
|
|
Term
signs of acute pericarditis |
|
Definition
fibrnous exudate resolves or professes to chronic |
|
|
Term
signs of chronic pericarditis |
|
Definition
delicate fibrous adhesions or fibrous scaring (causes constrictive pericarditis) |
|
|
Term
what are the 3 types of pericardial effusions and their cause |
|
Definition
serous: decreased protein (cirrhosis) or increased pressure
serosangiunous: decreased protein with blood (trauma, cancer)
chyloys: lymph obstruction (cancer)
sanguinous: trauma or acute events (dissection/rupture) |
|
|
Term
|
Definition
primary mycardial abnormalities (intrinsic disease) myocarditis that causes cardiac dysfunction |
|
|
Term
what are the 3 types of cardiomyopathy, which is most common |
|
Definition
dilated 90% flabby hypertrophic restrictive |
|
|
Term
dilated cardiomyopathy: changes in heart and effects |
|
Definition
atria and ventricles dilated decreasing contraction and thus emptying which causes biventricular eccentric hypertrophy and heart failure
dilation stretches the tissue changing conduction causing AFib
dilation stretches the mitral and tricuspid valve causing regurgitation |
|
|
Term
5 causes of dilated cardiomyopathy |
|
Definition
myocarditis: cosackie late complication pregnancy: 3rd trimester, after birth alcohol drugs (cocaine) inherited muscular dystrophy |
|
|
Term
cause of hypertrophic cardiomyopathy |
|
Definition
genetic mutation in sarcomere proteins causes wall to have much more muscle so it cant contract decreasing CO |
|
|
Term
complications of hypertrophic cardiomyopathy |
|
Definition
changes in contraction causes VFib and sudden death
syncope with exercise: increased muscle causes stenosis within the LV decreasing blood to the brain and heart
septal hypertrophy
intermittent ourflow obstruction |
|
|
Term
how is hypertrophyc cardiomyopathy diagnosed |
|
Definition
biopsy: myocytes disorganized (dissarray) |
|
|
Term
define restrictive cardiomyopathy |
|
Definition
idiopathic fibrosis thickens ventricles and decreases their heart wall causing fibrosis |
|
|
Term
causes of restrictive cardiomyopathy |
|
Definition
loffler's syndrome: eosinophils and inflammation in heart wall cause fibrosis
endocardial fibroelastosis: fibrin and elastin replace epicardium decreasing stretch |
|
|
Term
complications of restrictive cardiomyopathy |
|
Definition
CHF: blood cant leave the heart causing failure |
|
|