Cardiac Emergencies - Kantner

Question 1

Cardiomyopathy

Answer 1

there is a lot of overlap between CM and myocarditis

Question 2

Pulm over circulation syndrome

Answer 2

unrepaired VSD,
unrepaired AV Canal
unrepaired PDA
Large Av malformation

Question 3

Pump failure -

Answer 3

Myocarditis
CM
Incessant arrhythmia
ALCAPA

Question 4

Obstructive L H lesions

Answer 4

Critical CoA
Critical aortic valve stenosis
Hypoplastic L heart syndrome

Question 5

LH failure symtpoms

Answer 5

abdominal pain, cramping, vomiting ( impaired git perfusion )
Fussiness, Poor feeding FTT
Decreased energy
Resp symptoms is later finding

Question 6

LH failure physical findings -

Answer 6

Tachycardia, 
poor perfusion 
pulm congestion, rales, rhonchi 
gallop rhythm 
hypotension

Question 7

CXR when to be concerned about heart size

Answer 7

Heard border > 1/2 thorax

AP portable film will tend to oversize heart size

Question 8

Compensatory mechanisms for dilation/ decreased contractility

Answer 8

Increased HR - will compensate for SV loss

In an infant - the most stress they get is during feeding

Question 9

Dopamine used more compared to epinephrine because

Answer 9

less chromotropic effects

Question 10

Lucotropic effects

Answer 10

reduced heart stifness ( seen with milrinone)

Question 11

How to support cardiac patients

Answer 11

HF to support pulm edema

Avoid sedation because they are catecholamine depleted

Question 12

Acute myocarditis - most common viral cause

Answer 12

Coxsackie B

Question 13

ALCAPA

Answer 13

anomalous, L Ca off the PA

Question 14

ALCAPA presentatiion

Answer 14

85% present in first 1-2 months 
fussiness with feeds 
pallor
general irritability  - when Mom picks up before and after feeding - child is irritable 
Tachycardia

Question 15

Later symptoms of ALCAPA

Answer 15

CHF - tachycardia diaphoresis, poor feeding , FTT

Mortality in 1st year

Question 16

ALCAPA EKG

Answer 16

Deep Q waves in 1 and AVL - this is what you need to look for
ST changes in lateral leads

Question 17

ALCAPA pathophys

Answer 17

At birth - they have high PVR - PA pressures high - so adequate perfusion pressure along cap bed
As PVR and PA pressure falls in first few weeks - progressive ischemia ensures
Surgical repair is curative ( arterial switch operation0

L coronay flow is poor and also going backwards

Question 18

Arrhythmias

Answer 18

Very fast - SVT , At flutter( 1:1 conduction) - dimnished vent filling
Fast - EAT, JET A flutter with 2:1 rate at about 150 - gradually develop CHF symptoms
Slow - Congenital CHB / Lupus

Question 19

Ectopic atrial tachycardia

Answer 19

Look for unusual P-wave morphology, consistent rate at 150 regardless of rest - no physiological variation

Question 20

What is EAT

Answer 20

just another focus in atrium that is beating fast

Question 21

Atrial flutter

Answer 21

Generrally will have 2 or 3 q waves for every qrs - will have a regular occurence

Question 22

Adenosine dose and how to give

Answer 22

50-100mcg
Use your stop cock 
 rapid push 
adenosine - needs to be flushed 
12 lead before and after with continuous monitoring 
or let the 12 lead run the whole time