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Cardio Quiz 2d

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eem8u's version from 2016-12-17 17:00

Congenital Heart Defects

Question Answer
causes of cyanotic heart dxtetralogy of Fallot, transposition of great arteries
cause of acyanotic heart dxASD, VSD, PDA, coarctation of aorta
***fixed splitting of S2ASD
****harsh holosystolic murmurVSD
****drug to close PDAindomethacin
drug to keep PDA patentprostaglandin E2 (vasodilator)
****infant squatting seen withTetralogy of Fallot (during Tet spell, to increase SVR)
most common cause of cyanotic heart dx in infancytetralogy of fallot
most common congenital heart defectVSD
define eisenmenger’s syndromecompensatory pulmonary vascular hypertrophy > pulmonary HTN and RV hypertrophy in longterm L> shunt **in increased pulmVR shunt reverses R>>L**
eisenmenger’s syndrome seen withASD, VSD, PDA
assc w/ fetal alcohol syndromeVSD
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Normal Embryology
Question Answer
***role of foramen ovaleRA > LA shunt to supply directly to head and heart
RV suppliessystemic via DUCTUS ARTERIOSUS (shunt from PA > aorta) and to lung (but only 12%)
aorticopulmonary septum develops from*migrating neural crest cells*
******how does PDA usually close after birth prostaglandin levels fall > smooth muscle constriction of PDA > closed by one day > intimal proliferation > ligamentum arteriosum forms by 3 weeks
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Atrial Septal Defect
Question Answer
direction of shunt (uncomplicated)LA to RA
auscultation (2)1-fixed splitting of S2 (due to delayed pulmonic valve closure w/ increased pressure) & 2- systolic murmur due to increased flow across pulmonic valve
primary sx**asymptomatic **
most common location of defectostium secundum (**not foramen ovale**)
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Ventricular Septal Defect
Question Answer
primary sx in infantstachypnea, poor feeding (HF develops
___% of infants have large defects10%
auscultationharsh HOLOsystolic murmur (louder with smaller defect)
direction of shuntLeft to Right
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Patent Ductus Arteriosus
Question Answer
prenatal risk factormaternal rubella infection
direction of shuntaorta > pulmonary (L to R)
open PDA causes volume or pressure overloadVOLUME
auscultationcontinuous, MACHINE-like murmur (b/c blood is flowing through during systole and diastole)
txcan be treated with indomethacin (NSAID, prostaglandin synthesis inhibitor)
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Coarctation of aorta
Question Answer
defineddiscrete narrowing of aortic lumen
cause pressure or volume overloadPRESSURE
CXRnotched from development of collaterals to bypass aorta
exam findings (2)elevated BP upper body (b/c coarctation after aortic arch) and weak femoral pulses
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Tetralogy of Fallot
Question Answer
4 components pulmonary a. stenosis > RV hypertrophy / VSD w/ overriding aorta
CXRboot shaped heart (from)
describe pathophys of “tet spell”large degree of pulm a stenosis > high P in RV > R to L shunt > cyanosis
describe role of squattingincreases SVR (kinking femoral arteries) > reduce R>L shunt (or temporarily reverse shunt to L>R)
????tx - short termmaintain anatomic communication b/t aorta and pulmonary artery
tx - longtermclosure of VSD & enlarge sub pulmonary infundibulum (which is usually stenotic)
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Transposition of Great Arteries
Question Answer
etiologygreat vessels arise from the opposite ventricle > two parallel circuits
tx- short-term (2)**absolute need for mixing of blood** 1- maintain potency of PDA (via prostaglandins) 2- Rashkind procedure (enlarge a foramen ovale, patent foramen ovale (PFO), or atrial septal defect (ASD))
tx- definitive(surgical) *arterial switch
prepartum associationmaternal diabetes
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Pericardial Disease

Question Answer
fx of pericardium (3)1- protect heart from deformation 2- lubrication for heart surface 3- barrier to infection!
most anterior portion of heart isRIGHT ventricle!
pulsus parados indicatescardiac Tamponade
kussmaul sign indicatesconstrictive pericarditis
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Acute Pericarditis
Question Answer
primary sxPOSITIONAL chest pain (worsens when supine, improves when leaning forward)
auscultationFRICTION RUB (of 2 layers rubbing a/g e/o)
EKG - day 1 (2)1- ST elevation - CONCAVE and DIFFUSE 2- PR depression (see 28.8)
Tx (approach and progression)underlying cause > NSAIDS (first line) > colchicine > steroids (Avoid b/c can cause recurrent)
NSAIDs- contraindicationacute period after MI (b/c can cause heart muscle rupture
EKG - day 2**Low voltage EKG > b/c fluid accumulation around surface of heart (see 28.12)k
EKG - pericardial effusionELECTRICAL ALTERNANS = alternating short and tall QRS b/c heart is swinging w/in fluid (see 28.13)
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Cardiac Tamponade
Question Answer
pulsus paradoxes - defineddrop in systolic blood pressure of > 10 mm of Hg during INSPIRATION (less than 10 is still within normal range)
pulsus paradoxes - causefluid accumulation around RV > septal shift > LV cavity reduction > decreased LV filling and CO / occurs during inspiration b/c more blood enters R side with negative intrathoracic P’s
treatmentemergent periocardiocentesis
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Constrictive Pericarditis
Question Answer
Auscultationknocking sound (b/c of fibrosis)
systemic sx (2) LE edema, dyspnea on exertion, enlarged liver,
kussmaul sign - defineelevated JVP with inspiration (usually depresses as intrathoracic P decreases)
kussmaul sign - causeelevation of JVP caused by constriction
txsurgical stripping of pericardium
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Systemic Hypertension

Question Answer
high BP, definedelevated long-term FORCE of blood a/g arterial walls
2 factors determining BPamount of BP heart pumps *CO* AND amount of RESISTANCE to flow in arteries
high BP - damage to kidneyglomerular damage/renal failure
high BP - BV damageoxidative stress /endothelial dysfunction > fibrosis > decreases elasticity
high BP - heartcardiac hypertrophy > systolic & diastolic dysfx
incidence of HTN among AA In US43-46%
incidence of HTN among white people in US26-27%
global burden of HTN is at least ____ worldwide30% (d/n discriminate based on income)
residual lifetime risk of HTN at age 55>90%
how do SBP/DBP change with ageSBP increase (as heart becomes stiffer), DBP increase
HTN doubles risk for ____ (2)HF and ischemic stroke
HTN increases (less than double) risk for ___renal failure and CAD
describe variance of HTN in african diasporamore prevalence in US (33%) than in west africa (16%)
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Treatment of systemic HTN
Question Answer
medical mgmt of HTN reduces stroke risk by ___ %30-40 %
long-term medical tx for HTN reduces HF by ___ %50%
***tx goal for SBP/DBPlower than 140/90 mmHGg
conditions to initiate drug therapy with TWO drugswhen BP is ≥160/100, are refractory to mono therapy or Comorbidities
first line choice for black ptsCC blocker and diuretic
first line choice for NON-black itsACE-i’s and Blocker
conditions for mono therapyBp lower than 160 and no comorbidities
dash diet can reduce HTN by 6 mmHg
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Medication Side Effects
Question Answer
ACEI’s (2)cough, lightheadedness
ARB’slightheadedness
Aldosterone Antagonist (3)(K+ sparing) hyperkalemia, gynecomastia, increased urination
BB’s(2) fatigue, lightheaded
diuretics (2)hypovolemia, hypokalemia
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