Other - Heart
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- In what conditions would you hear a systolic ejection murmur?
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valvular aortic stenosis
idiopathic hypertrophic subaortic stenosis
pulmonic stenosis
ASD - When would you hear a flow murmur?
- fever, anemia, exercise, pregnancy, large stroke volume (bradycardia, complete heart block, aortic regurgitation)
- When would you hear a pansystolic murmur?
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mitral regurgitation
tricuspid regurgitation
VSD - Diastolic murmurs?
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aortic regurgitation (blowing, decrescendo, high-pitched, pandiastolic)
mitral stenosis (opening snap?) - When do you hear a wide split of S2?
- ASD, pulmonic stenosis, RBBB, RV overload (pulmonary embolus)
- When do you hear a paradoxical split of S2?
- LBBB
- What is pulsus alternans and when do you hear it?
- variations in blood pressure associated with alternating weak and strong LV contractions; in severe LV dysfunction (CHF)
- What is a positive Kussmaul sign and when do you see it?
- JVP increases with inspiration; CHF
- What are the ST changes in stable angina, Prinzmetal's variant, and MI?
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stable angina - ST depression
Prinzmetal - ST elevation
MI - ST elevation & T-wave inversion with Q-wave development - transmural
OR ST depression without Q-wave development - How long after an MI would the patient experience a rupture?
- 1-7 days
- What is Dressler syndrome?
- postinfarction pericarditis.. it's autoimmune and occurs 2-10 wks after MI
- What are the five major criteria for the diagnosis of acute rheumatic fever?
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migratory polyarthritis
Sydenham's chorea
erythema marginatum
carditis
subcutaneous nodules - What is marantic endocarditis?
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a paraneoplastic syndrome
sterile vegetations on the mitral valve associated with mucin-producing tumors of the colon and pancreas
also associated with DIC - Discuss the stages of compensation in shock.
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compensated stage - reflex tachycardia and peripheral vasoconstriction (cold, clammy, pale extremities)
decompensated stage - initial compensation isn't enough CO; decreased BP, increased tachycardia, metabolic acidosis, respiratory distress, decreased renal output
irreversible - coma and death - Which valve abnormality presents with bounding pulses and a wide pulse pressure?
- aortic regurgitation
- What is Fiedler's myocarditis? Rheinhard's?
- idiopathic myocarditis with eosinophilic infiltrate with giant cell and granuloma formation; rheinhard's - extensive eosinophilic infiltration
- What causes myocardial pseudocysts?
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Chagas' disease* (T. cruzi) and toxoplasmosis
*Romana sign - unilateral swelling of the eyelid - Describe dilated cardiomyopathy. What are the clinical features? Complications? Etiologies?
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decreased contractility, stasis, mural thrombi
progressive CHF, thromboembolism, arrhythmia
pregnancy-induced nutritional, hypertensive, volume, or metabolic abnormalities; alcohol tox, genetic, postviral infection (*there's a GAPP in my heart so it's DILATED) - Describe hypertrophic cardiomyopathy. What are the clinical features? Complications? Etiologies?
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asymmetrical hypertrophy of the ventricular septum, causing obstruction of the LV outflow tract, LV>RV, dilated atria
dyspnea, angina, a-fib, syncope, sudden death, mural thrombi, CHF
genetic, catecholamine hypersensitivity, ischemia, primary collagen disorder
(my HYPER CAT IS GENETICally COLored) - What are the causes of restrictive cardiomyopathy?
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cardiac amyloidosis, sarcoidosis
*rheumatoid arthritis! AA - What is the most common location of a myxoma?
- left atrium
- What is the most common primary cardiac tumor in kids and what systemic disease is the tumor associated with?
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rhabdomyoma
tuberous sclerosis - What neoplasms are most likely to metastasize to the heart? Which layer of the heart is usually involved?
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bronchogenic carcinoma, lymphoma from regional nodes
pericardium - Emboli from venous circulation vs. emboli from arterial circulation.
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venous - involve pulmonary circulation **may involve systemic circulation via a cardiac shunt (ASD)
arterial - 75% from mural thrombi due to MI; usually affect legs, then brain, other viscera, and arms