S2 week 4

MSSA in case of penicillin allergy

1st generation cephalosporin like cefazolin used as sub for nafcillin/oxacillin

risk factors for AAA

>65, male, smoking, family history of AAA

positive-sense single strand RNA virus, enterovirus genus

COX b

sub-sternal chest pain for several weeks burn pain after large meals made worse by lying down alleviated by tums

GERD

what microbes move higher on ddx when blood culture results are negative?

HACEK/cox

bibasilar crackles

LVHF

treatment of pericarditis

NSAIDS if not sufficient, colchicine has anti-inflammatory effect mediated by inhibition of neutrophils mobility, prevents formation of microtubules by binding to tubulin

ECG of brugada syndrome pts shows what

ST elevation and pseudo-RBBB most prominent in V1 and V2

most common presentation brugada syndrome:

V tach

MRSA

Vancomycin

cardiac tamponade

acute compression of the heart caused by fluid accumulation in the pericardial cavity

pt sharp retrosternal pain, worse with inspiration, friction rub ECG: ST segment elevation, PR depression Echo: + fluid

acute pericarditis

AS typically characterized by

angina, syncope, symptoms of HF shortness of breath during exertion

primary imaging techniques used for diagnosing CAD

angiograms

hypertensive emergency may be characterized by organ damage like:

aortic dissection

tearing chest pain radiating to back

aortic dissection

loud systolic ejection murmur best heard at upper right sternal border

aortic sclerosis

brugada syndrome is more common in what race

asian population

Strep gallolyticus

associated with colon cancer and can cause subacute endocarditis

myocarditis known to result from exposure to venom from what

black widow spiders

pt severe hypotension, neck veins distended, distant heart sounds (all 3 becks triad), increase HR, decrease CO ECG: low-voltage QRS complex

cardiac tamponade

common secondary cause of achalasia due to infection by trypanosoma cruzi

chaga disease

2nd gen immigrant from SA, widely split S2, elevated levels troponin, CK

chagas disease which causes myocarditis

what can mitral stenosis cause

chronic pulmonary HT, leads to increased right-sided pressure and both RVH and RAE

mitral stenosis causes what noise

classic soft rumbling mid-diastolic murmur heard loudest at the apex

what is mitral valve prolapse

congenital abnormality thats inherited in autosomal dominant fashion presents as late systolic murmur heard best at the apex and with mid-systolic click

tenderness palpation over 3-5th costochondral junctions, no swelling, chest pain

costochondritis

tietze syndrome

costochondritis + palpable edema localized, inflammatory, chest pain

most common causes of culture negative endocarditis are:

cox b, bartonella, and HACEK

tricuspid valve atresia

cyanotic at birth decreased pulmonary flow

total anomalous pulmonary venous return

cyanotic heart disease newborn all 4 pulmonary veins drain into right side of heart instead of left snowman sign fixed splitting of second heart sound and hepatomegaly

pathology associated with thoracic aortic aneurysm

cystic medial degeneration

cardiac tamponade leads to what

decrease in cardiac output, then hypotension, then OBSTRUCTIVE SHOCK, HR increases to compensate

most common heart condition in chagas disease

dilated cardiomyopathy

myocarditis caused by cox b virus most commonly results in what

dilated cardiomyopathy

pulsus paradoxus

drop in systolic > 10mmhg classic sign of cardiac tamponade also happens with asthma, OSA, croup, pericarditis

treatment for cardiac tamponade

emergency pericardiocentesis

best explains new onset diastolic heart murmur at upper right sternal border in pt w classic sx of aortic dissection

extension of dissection to aortic root

to perform coronary angiography, a catheter is usually inserted into which vessel

femoral a

fecal-oral in cox b

fluid fields flies fingers

hypotension

fluid in pericardial sac prevents end-diastolic filling, leading to decreased CO and hypotension

A-16

hand foot and mouth disease

myocarditis resulting from lyme disease most commonly presents as what

heart block

muffled heart sound

heart surrounded by fluid and further away from surface of thorax making more difficult to hear crisp heart sounds

A-25

hemorrhagic conjunctivitis

risk factors for thoracic aortic aneurysms

hypertension, bicuspid aortic valve, CT disease like marfans

constrictive pericarditis

impaired filling of heart due to thickening of pericardium. pts present with signs of right side heart failure, fatigue, edema, hepatomegaly, dyspnea on imaging, calcifications and thickening of pericardium

pts w brugada syndrome who survive potentially fatal ventricular arrythmias should have what to prevent further attacks

intracardiac defibrillator implantation

signs of severe AS:

late-peaking murmur paradoxically split S2/inaudible AS, small and delayed carotid pulsus (parvus et tardus), LV heave, audible S4

pt with rheumatic heart disease has mitral stenosis this means:

left atrial pressure: increased end diastolic volume: decreased end systolic volume: decreased SV: decreased

VSD results in what

left to right shunt pts develop fatigue, shortness of breath, exercise tolerance, failure to thrive acyanotic

obstructive shock is characterized by what

low CO increased preload increase SVR

best initial drug to administer in the management of torsade de pointes

magnesium sulfate

chest x-ray shows what in aortic dissection

medistinal widening

vegetations in libman sacks endocarditis may result in what

mitral regurgitation

most common site of infection in subacute endocarditis

mitral valve

recent dental affects what valve

mitral valve

Group A Coxsackie

most commonly affects children under 5 infect skin & mucous membranes

ECG: mild ST segment elevations in inferior and lateral leads. troponin mildly elevated chest discomfort, dyspnea, following flu like illness

myocarditis

MSSA penicillinase-resistant penicillin:

nafcillin or oxacillin

antiprotozoal drugs of choice to treat chagas

nifurtimox or benznidazole

janeway lesions

nonpainful erythematous macules on palms of hands and soles of feet

cardiac tamponade can lead to what

obstructive shock if left untreated

osler ndoes

painful, erythematous nodules on tips of fingers and toes

most common presentation of wolff parkinson white syndrome thats sympotomatic

palpitation with syncope

mitral valve prolapse is associated w what

panic attacks

treatment for constrictive pericarditis

pericardectomy

myocarditis may present as chest pain due to involvement of what

pericardium

A-7

permanent paralysis (rare)

pain radiation pattern in acute pericarditis

phrenic nerve afferent innervation

low levels of what could lead to torsades de pointes

potassium and magnesium

jugular venous distention

prevention of end-diastolic filling of heart leads to blood being backed up

A newborn is evaluated shortly after birth by the neonatologist because of persistent cyanosis. A loud machinery-like systolic and diastolic murmur is present. Which of the following should be given to the baby immediately?

prostaglanding E1

vegetative lesions due to infectious endocarditis can break off resulting in what and lead to cough and hemoptysis

pulmonary emboli

naloxone

rapidly reverses opioid overdose opioid antagonist

vector by which chagas disease is transmitted

reduviid bug feces

roth spot

retinal hemorrhages with pale centers

unilateral preorbital swelling seen in pts with acute chagas disease

romana sign

tertiary syphilis

small vessel vasculitis in vasa vasorum of thoracic aorta (obliterative endarteritis) which leads to aneurysms

janeway lesions

small, painless erythmatous lesions on palm/sole and are sign of infective endocarditis

causes of cardiac tamponade

stab wound blunt trauma after MI aortic dissection

ASD presents with

systolic murmur, fixed splitting of S2 heart sound leads to paradoxical embolus

heart rhythm in myocarditis is typically sinus:

tachycardia

osler nodes

tender, raised lesions on fingers or toe pads and are sign of infective endocarditis

A 2-month-old infant is brought to the pediatrician because of respiratory distress and cyanotic episodes. Physical examination reveals a right ventricular heave and a loud systolic ejection murmur. Chest radiograph shows a "boot-shaped" cardiac silhouette. Which of the following is the likely diagnosis?

tetralogy of fallot

class 1A and class 3 antiarrythmics can lead to what

torsades de pointes

development of afib on top of wolf parkinson white syndrome will result in

torsades de pointes

infective endocarditis can cause

tricuspid regurgitation, which can lead to right-sided heart failure, and can generate emboli that go into pulmonary vasculature causing shortness of breath and pleuritic chest pain

most common valve affected by staph a

tricuspid valve

most common protozoal cause of myocarditis

trypanosoma cruzi

flagellated parasites dilated large bowels

trypansosma cruzi

treatment of choice if pt has new prosthetic valve (less than 12 months)

vanco + genta + rifampin

if penicillin allergy what is typical treatment

vancomycin + gentamicin

fatal end result of torsades de pointes

ventricular fibrillation

subacute bacterial endocarditis is characterized by smaller vegetations on abnormal valves and is primarily caused by

viridans streptococci

chagas disease

visceral protozoal infection that presents with dilated cardiomyopathy, megacolon, megaesophagus

when has an aortic dissection occurred:

when longitudinal tear of the tunica intima creates a false lumen bw layers of aorta

patent foramen ovale occurs

when septum primum and septum secundum fail to fuse do not cause fixed-splitting of S2 can lead to paradoxical embolus

ECG changes in pericarditis

widespread concave ST segment elevation and PR depression