Systolic murmurs
#NAME?
Diastolic murmurs
#NAME?
Malar facial flush
Symptom in mitral stenosis
Austin Flint Murmur
Middle to late diastolic rumble caused by vibration of anterior mitral valve leaflet when struck by regurgitant jet in Aortic Regurgitation
Treatment of Tricuspid Stenosis
Bioprosthesis
Carcinoid Heart Disease
primary carcinoid tumors with metastatic spread to liver
- neuroendocrine malignancy
- secretion of vasoactive substance (serotonin, histamine)
- Occurs in pulmonic stenosis
Treatment of Pulmonic Stenosis
Balloon valvuloplasty (carcinoid cause has poor response to valvuloplasty)
Treatment of Tricuspid Regurgitation
Annuloplasty
Graham Steell Murmur
high pitched, blowing decrescendo diastolic murmur immediately after P2 with pulmonary systolic arterial pressure > 70mmHg in pulmonary regurgitation
Symptoms of Aortic Stenosis
Exertional chest pain
Syncope
Shortness of breath
CHF
Angina
Diagnosis of Aortic Stenosis
Cath = GOLD STANDARD
Predominant Cause of Mitral Stenosis
Rheumatic Heart Disease
Treatment of Mitral Regurgitation
ACEi = Hallmark (afterload reduction to reduce regurgitation)
4 Distinct Features of Tetrology of Fallot
1. Right ventricular outflow tract obstruction
2. Ventricular septal defect (nonrestrictive)
3. Aortic override of the ventricular septum
4. Right ventricular hypertrophy
Patent Ductus Arteriosus
- CHF most common cause of death
- HARSH, CONTINUOUS MURMUR (machinery-like), envelops second heart sound
Chest X-ray Coarctation of Aorta
Rib notching
FIGURE OF 3 SIGN
enlarged intercostal collaterals
Eisenmenger Physiology
Left ventricle has higher pressure than the right ventricle, so it shunts left to right; eventually reverses
- Seen with Ventricular Septal Defect
Patent Foramen Ovale
Clinical importance = HIGH risk of stroke
- Bubble study to test
Percentage of Aneurysms that involve the abdominal aorta
75%
Still's Murmur
- "Innocent" murmur
- Systolic murmur
- Vibratory/musical quality
- Differential = small ventricular septal defect, subaortic stenosis
Jones Criteria
- Evaluate for Rheumatic Fever
- previous upper airway infection with GAS detected with either 2 major manifestations or 1 major and 2 minor
- Major = carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules
- Minor = fever, arthralgia, elevated erythrocyte sedimentation rate, elevated C reactive protein, prolonged PR interval
Hallmark of Rheumatic Carditis
Mitral insufficiency
Most Common Manifestation of Rheumatic Fever
Arthritis
Sydenham's Chorea
purposeless and involuntary movements of face and limbs, muscular hypotonia, emotional liability
- Diagnostic of Rheumatic Fever
Drug of Choice for Rheumatic Fever
Penicillin
5 H's of Hypotension
Hypoxia
Hypovolemia
Hypo/hyperkalemia
Hypo/hyperthermia
Hydrogen ions (acidosis)
5 T's of Hypotension
Tension pneumothorax
Tamponade
Thrombosis (MI)
Thromboembolism (PE)
Toxins or tablets (drug overdose)
Most common primary diagnosis in US
Hypertension
HTN emergency
Acute and rapidly evolving end-organ damage
SBP > 220, DBP > 120
Treatment - inpatient with IV meds
HTN urgency
NO evolving end organ damage
SBP > 220, DBP > 120
Treatment - outpatient with oral meds
Non-black treatment of HTN
Start with thiazide diuretic, CCB, ACEi, or ArB
Black treatment of HTN
Start with thiazide diuretic or CCB
Kidney disease + HTN treatment
initial or add-on an ACEi or ARB
When to refer for HTN
After 3 agents used
HCTZ Caution
Avoid in patients with sulfa allergy
Can cause electrolyte issues
ACEi Caution
Pregnancy category D
- caution in renal disease - hyperkalemia
- allergic reaction = dry cough
Treatment for Tamponade
Pericardiocentesis
JVD- Kussmaul's sign
Rise in JVD with inspiration (Tamponade)
Symptoms of Restrictive Cardiomyopathy
SEVERELY ENLARGED ATRIA
- elevated JVD
Pericardial Effusion d/t CHF
Transudative effusion
Pericardial Effusion d/t Infection/Inflammation
Exudative effusion
Acute Pericarditis
T = trauma/tumor
U = uremia
M = MI
O = other infection (VIRAL, bacterial, fungal)
R = Rheumatoid, radiation
- ST elevation across all leads
Treatment for Acute Pericarditis
Colchicine*
Supportive care - NSAIDs, Aspirin
Tend to avoid corticosteroids (viral shedding)
Dressler Syndrome
#NAME?
Treatment of Constrictive Pericarditis
Pericardial Stripping
Amyloidosis
#NAME?
Leading cause of sudden cardiac death in competitive athletes
Hypertrophic Cardiomyopathy
Venturi effect
#NAME?
Brockenbrough response
#NAME?
Testing for Dilated Cardiomyopathy
Cath
Most Common Cause of Myocarditis
Coxsackievirus
Lyme Carditis
#NAME?
Acute Bacterial Endocarditis
Staph Aureus, IV drug user, Tricuspid valve, right side of heart
Subacute Bacterial Endocarditis
Strep Viridans, aortic valve, left side of heart, dental procedure prophylaxis
Janeway Lesions
Nonpainful
Erythematous
Nodular lesions on palms and soles
Associated with Bacterial Endocarditis
Osler Nodes
Painful
Red lesions on hands and feet
Associated with Bacterial Endocarditis
Roth Spots
Retinal hemorrhage with pale center
Associated with Bacterial Endocarditis
Duke Criteria
Diagnosis of Bacterial Endocarditis
- 2 major, 1 major and 3 minor, or 5 minor
- Major = 2 separate positive blood cultures (staph aureus, strep viridans, enterococcus)
- Minor = Fever, immunologic phenomena (roth spots, osler nodes, rheumatoid factors...), predisposition (IV drug use), Microbiologic evidence (positive blood culture not meeting major criteria), and vascular phenomena (arterial embolism, janeway lesions, etc)
HUTT
Head upright table tilt test
- Test for syncope
Most feared consequence of AFib
Thromboembolism --> CVA
Most common arrhythmia requiring treatment
Atrial Fibrillation
Brugada Syndrome
#NAME?
First-line treatment PVC
Beta Blockers
Causes of Junctional Rhythm
Athletes = high vagal tone
Medication = BB, CCB, antiarrhythmics, digoxin toxicity
Sick sinus syndrome = sinus node disease of "block" between SA node and AV node
Wolff-Parkinson White
- Second most common form of Supraventricular tachycardia
- Narrow to slightly widened QRS tachycardia
- Rate = 160-240 bpm
- Short PR < 0.12 msec
- Delta wave
- Treatment = Catheter based intervention preferred (avoid Cardizem)
Most Common Indication for Pacemaker
Sick Sinus Syndrome
Prinzmetal's Angina
#NAME?
Syndrome X
#NAME?
Cocaine Ischemia
AVOID BETA BLOCKERS
Treatment = Benzodiazepines, nitrates, CCB
Vulnerable plaque
#NAME?
Spontaneous Coronary Dissection
- Women > men
- 70% under age 50
- Hormonal changes, pregnancy, etc...
- Sudden split or tear between layers of coronary arteries
- Presents as ACS (acute MI), sudden cardiac death, diagnosed post mortem
Sustained Ventricular Tachycardia Treatment
Amiodarone
Framingham Point Scores
- Coronary Artery Disease
- High score = higher 10 year risk of MI
- Older, high cholesterol, smoker, low HDL, High systolic BP
Characteristics of CHF
Dyspnea and fatigue
Most common cause of Right heart failure
Left heart failure