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