Cardiology Buzz Words

DOE, PND, edema. Echo w/ LVH or RVH, hypokinesis
CHF

S3
CHF, dilated cardiomyopathy

Pregnancy, thyrotoxicosis, anemia, beriberi, paget’s disease
High output heart failure

Ischemic heart disease, HTN, dilated CM, valve disease, arrhythmia
Low output heart failure

Heart failure after URI
Myocarditis

Young athlete with syncope during athletic event or practice. No physical exam abnormalities
Hypertrophic CM (or fatal arrhythmia. Get EKG or Echo)

Alcoholic with DOE, heart failure
Dilated CM

holiday heart, Alcoholic with palpitations
Atrial fibrillation

Irregularly irregular
Atrial fibrillation; (if > 48 or chronic – anticoagulate)

Hx angina but no acute sx. EKG no acute changes. What next?
Exercise stress test

Crushing CP, dyspnea, palpitations, radiation to neck or left arm
Angina (if lasts < 30 minutes), AMI if lasts > 30 minutes

Constant, sharp CP worse lying down, better sitting up and leaning forward
Pericarditis

pulsus paradoxus
Pericardial effusion/tamponade, pericarditis

Electrical alternans, narrow pulse pressure, pulsus paradoxus
Pericardial effusion/tamponade

JVD, Hypotension, muffled heart sounds
Pericardial effusion/tamponade

Pericarditis post open heart surgery
Dressler’s syndrome (Tx w/ ASA #1, Indomethacin or other NSAID OK)

Sudden onset ripping, tearing chest pain, diminished pulses
Aortic dissection

Flank pain, hypotension, pulsatile abdominal mass
AAA

EKG changes, N, V, yellow-green visual disturbances
Digoxin toxicity (Hypokalemia will make worse)

HTN Tx w/ meds, cough or angioedema are SE
ACEI

DM & HTN, what is first line choice for tx?
ACEI

Heart failure, LVH, what is first line choice?
ACEI (improves survival, prevents development of heart failure Sx)

Post MI, what is first line choice?
Beta-blockers

Tx of HTN w/ alpha-blocker, what is biggest SE?
postural Hypotension

HTN not responsive to basic meds
Renal artery stenosis (Think secondary HTN)

Mechanical valve or prosthesis & Dental, GU, GI, or ortho procedure prophylaxis
Bacterial endocarditis (strep. Viridians) prevention

Elderly w/ systolic murmur
Aortic stenosis [(due to calcifications – age related or bicuspid valve – congenital)]

Diamond shaped (crescendo-decrescendo), blowing systolic murmur, radiates to carotids. May have angina, syncope, CHF
Aortic stenosis

Lateral displaced PMI, Canon “a” waves, Quincke’s pulse, Corrigan’s pulse, Austin flint murmur, deMusset’s sign, water
Aortic Regurgitation/Insufficiency [Quincke’s pulse (subungual capillar pulsation), Corrigan (rapid rise and fall), Austin filnt (low pitch middiastolic murmur at apex)]

Diastolic murmur with opening snap best heart at apex without radiation
Mitral stenosis

Systolic ejection murmur heard best at base with radiation to left clavicle
Pulmonary stenosis

Female or Post MI, systolic murmur best @ apex preceded by mid-systolic click without radiation
Mitral valve prolapse

Systolic murmur heard best at apex with radiation to left axilla (apical systolic), opening snap
Mitral regurgitation

New murmur after MI (esp. if apical systolic)
Mitral regurgitation (caused by papillary muscle rupture)

Murmur & Hx rheumatic heart disease
Mitral stenosis (#1, Tricuspid Stenosis #2)

Continuous harsh, machine-like murmur
PDA

Cyanotic infant with systolic thrill @ LSB, systolic ejection murmur +/- click
Tetralogy of falot

Holosystolic murmur @ LSB, may have ventricular hypertrophy
VSD

Infant w/ dyspnea, difficulty feeding. Holosystolic murmur @ LSB, 3rd ICS. LVH & RVH
VSD

Peds w/ leg pain after physical activity, abnormal heart sounds, unequal UE & LE pulses, rib notching
Coarctation of aorta

Short PR, wide QRS, Delta wave
Wolf-parkinson-white (avoid Digoxin)

Young (<30yo), palpitations, long arms & fingers, pectus excavatum, ectopic lentis, flexible joints
Marfan’s Syndrome

no hair, brittle nails, pallor on elevation, calf or LE pain esp. with walking short distances relieved with rest or at PM;Claudication with rest pain, (ABI < 0.4)
Arterial insufficiency/PAD, Intermittent claudication [(ABI best choice, ateriogram gold standard); Tx is arterial bypass]

LE pain after long periods of standing. Dilated, tortuous, veins
Varicose veins (Tx w/ compression stockings)

Trendelenberg test of extremities
Tests for veinous insufficiency.

Blue extremities worse w/ cold exposure, improves w/ warming
Acrocyanosis

Kerly B lines
CHF

apical ballooning, brokenheart syndrome, octopus heart
Takotsubo cardiomyopathy

friction rub
acute pericarditis

Osler nodes, Janeway lesions, Roth’s spots
infective endocarditis

pain, pallor, pulselessness, paresthesia, paralysis
peripheral vascular disease

virchow’s triad
stasis, vascular injury, hypercoagulability

paradoxical splittling of s2
LBBB

splitting of 2nd heart sound
atrial septal defect

Beck’s triad
JVD, Hypotension, muffled heart sounds

Which heart sound could sound like “Ten-nes-see” and is also known as the atrial gallop? 4th Heart Sound or S4 Which heart sound could sound like “Ken-tuc-ky” and is also known as the ventricular gallop? 3rd Heart Sound or S3 …

Critical Aortic Stenosis 3-6% of all cases of CHD Males 4x>females Aortic valve obstruction bicuspid or unicuspid aortic valve Interrupted Aortic Arch 1% CHD ^ assoc. with 22q11 complete discontinuity of proximal and distal portions of aortic arch R->L shunt …

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