Cardio Flashcards
1
Q
wide pulse pressure seen in
A
pda truncus arteriosus avm aortic insufficiency anemia sepsis
2
Q
narrow pulse pressure seen in
A
pericardial tamponade
aortic stenosis
heart failure
3
Q
cardiac in hunter hurler
A
valvular insufficiency, heart failure, hypertension
4
Q
cardiac in duchenne dystrophy
A
cardiomyopathy, heart failure
5
Q
cardiac in pompe
A
short PR interval
cardiomegaly
heart failure
arrhythmia
6
Q
cardiac in kawasaki
A
coronary artery aneurysm
thrombosis
myocardial infarction
myocarditis
7
Q
cardiac in marfan
A
aortic and mitral insufficiency
dissecting aortic aneurysm
8
Q
cardiac in juvenile rheumatoid arthritis
A
pericarditis
9
Q
cardiac in sle
A
pericarditis
libman sacks endocarditis
congenital AV block
10
Q
cardiac in lyme
A
arrhythmias
myocarditis
heart failure
11
Q
cardiac in graves
A
tachycardia
arrhythmias
heart failure
12
Q
cardiac in tuberous sclerosis
A
cardiac rhabdomyoma
13
Q
cardiac in neurofibromatosis
A
pulmonic stenosis
coA
14
Q
cardiac in trisomy 21
A
endocardial cushion defect
vsd
asd
pda
15
Q
cardiac in trisomy 18
A
vsd
asd
pda
ps
16
Q
cardiac in trisomy 13
A
vsd
asd
pda
dextrocardia
17
Q
cardiac turner
A
coA
aortic stenosis
18
Q
cardiac in CHARGE (coloboma, heart, atresia choanae, retardation, genital and ear abnormalities)
A
tof
aortic arch and conotruncal anomalies
19
Q
cardiac in digeorge
A
aortic arch anomalies
conotruncal anomalies
20
Q
cardiac in vacterl
A
vas
21
Q
cardiac in william syndrome
A
supravalvular aortic stenosis
peripheral pulmonary stenosis
22
Q
cardiac of infant of diabetic mother
A
hypertrophic cardiomyopathy
vsd
conotruncal anomalies
23
Q
cardiac of asplenia syndrome
A
complex cyanotic heart anomalous pulmonary venous return dextrocardia single ventricle single AV valve
24
Q
cardiac in polysplenia syndrome
A
azygos continuation of inferior vena cava
pulmonary atresia
dextrocardia
single ventricle
25
cardiac in fetal alcohol syndrome
vsd
| asd
26
cardiac in fetal hydantoin syndrome
| exposure to teratogenic effects of phenytoin or carbamazepine
tga
vsd
tof
27
s1 associated with closing of
mitral and tricuspid valves
28
s2 associated with closing of
aortic and pulmonic valves
29
s2 should normally split in
inhalation
30
s4 indicates
diastolic failure
| lvh
31
s3 indicates
cardiomyopathy
| failure
32
pulmonary ejection murmur radiates to
back and axilla
33
aortic ejection murmur radiates to
neck
34
class I antiarrhythmic drug
Depression of phase of depolarization (velocity of upstroke of action potential); sodium channel blockade
35
class Ia antiarrhythmic drug
Prolongation of QRS complex and QT interval
36
class Ia antiarrhythmic drug ex.
Quinidine, procainamide, disopyramide
37
class Ib antiarrhythmic drug
Significant effect on abnormal conduction
38
class Ib antiarrhythmic drug ex.
Lidocaine, mexiletine, phenytoin, tocainide
39
class Ic antiarrhythmic drug
Prolongation of QRS complex and PR interval
40
class Ic antiarrhythmic drug ex.
Flecainide, propafenone, moricizine?
41
class II antiarrhythmic drug
β blockade; slowing of sinus rate; prolongation of PR interval
42
class II antiarrhythmic drug ex.
Propranolol, atenolol, acebutolol
43
class III antiarrhythmic drug
Prolongation of action potential; prolongation of PR, QT intervals, QRS complex; sodium and calcium channel blockade
44
class III antiarrhythmic drug ex.
Bretylium, amiodarone, sotalol
45
class IV antiarrhythmic drug
Calcium channel blockade; reduction in sinus and AV node pacemaker activity and conduction; prolongation of PR interval
46
class IV antiarrhythmic drug ex.
Verapamil and other calcium channel blocking agents
47
physio and anatomic problem:
| Cyanosis with respiratory distress
Increased pulmonary blood flow
| Transposition
48
physio and anatomic problem:
| Cyanosis without respiratory distress
Decreased pulmonary blood flow
| Right heart obstruction
49
physio and anatomic problem:
| hypoperfusion
EITHER:
Poor cardiac output
Left heart obstruction
OR
Poor cardiac function
Normal anatomy
50
physio and anatomic problem:
| Respiratory distress with desaturation (not visible cyanosis)
Bidirectional shunting
| Complete mixing
51
physio and anatomic problem:
| Respiratory distress with normal saturation
Left-to-right shunting
| Simple intracardiac shunt
52
surgery for tricuspid atresia
Surgery is staged with an initial subclavian artery-to-pulmonary shunt (BlalockTaussig procedure) typically followed by
a two-stage procedure: bidirectional cavopulmonary shunt (bidirectional Glenn) and Fontan procedure
53
surgery for hypoplastic left heart
surgical repair is staged with the first surgery (Norwood procedure) done in the newborn period.
Subsequent procedures create a systemic source for the pulmonary circulation (bidirectional Glenn and Fontan procedures), leaving the right ventricle to supply systemic circulation
54
factors affecting PRELOAD
```
Total blood volume
Venous tone (sympathetic tone)
Body position
Intrathoracic and intrapericardial pressure
Atrial contraction
Pumping action of skeletal muscle
```
55
factors affecting AFTERLOAD
Peripheral vascular resistance
Left ventricular volume (preload, wall tension)
Physical characteristics of the arterial tree (elasticity of vessels or presence of outflow obstruction)
56
factors affecting contractility
```
Sympathetic nerve impulses*
Circulating catecholamines*
Digitalis, calcium, other inotropic agents*
Increased heart rate or postextrasystolic augmentation*
Anoxia, acidosis†
Pharmacologic depression†
Loss of myocardium†
Intrinsic depression†
```
57
etiology in dilated cardiomyopathy
Infectious
Metabolic
Toxic
Idiopathic
58
hemodynamics in dilated cardiomyopathy
Decreased systolic function
59
tx in in dilated cardiomyopathy
```
Positive inotropes
Diuretics
Afterload reduction
β-Blockers
Antiarrhythmics
Anticoagulants
Cardiac transplantation
```
60
etiology in hypertrophic cardiomyopathy
```
Sporadic
Inherited (autosomal dominant)
```
61
hemodynamics in hypertrophic cardiomyopathy
Diastolic dysfunction (impaired ventricular filling)
62
tx in in hypertrophic cardiomyopathy
β-Blockers
| Calcium channel blockers
63
etiology in restrictive cardiomyopathy
```
Infiltrative (amyloidosis, sarcoidosis)
Noninfilltrative (idiopathic, familial)
Storage disease (hemochromatosis, Fabry disease)
Endomyocardial disease
```
64
hemodynamics in restrictive cardiomyopathy
Diastolic dysfunction (impaired ventricular filling)
65
tx in in restrictive cardiomyopathy
Diuretics
Anticoagulants
Cardiac transplantation
66
signs nonconstrictive pericarditis
Fever
Tachycardia
Friction rub (accentuated by inspiration, body position)
Enlarged heart by percussion and x-ray examination
Distant heart sounds
67
signs in tamponade
```
Distended neck veins
Hepatomegaly
Pulsus paradoxus (>10 mm Hg with inspiration)
Narrow pulse pressure
Weak pulse, poor peripheral perfusion
```
68
signs in constrictive pericarditis
```
Distended neck veins
Kussmaul sign (inspiratory increase in jugular venous pressure)
Distant heart sounds
Pericardial knock
Hepatomegaly
Ascites
Edema
Tachycardia
```
69
Wide splitting is noted in
atrial septal defect, pulmonary stenosis, Ebstein anomaly, total anomalous pulmonary venous return, and right bundle branch block
70
A single 2nd sound occurs in
pulmonary or aortic atresia or severe stenosis, truncus arteriosus, transposition of the great arteries.
71
midsystolic click
mvp
72
total fetal cardiac output—the combined output of both the left and right ventricles—is
≈450 mL/kg/min
73
in transition of fetus to neonate, the LV will need to do 200% increase cardiac output of
≈350 mL/kg/min
74
normal adult cardiac output of approximately
75 mL/kg/min
75
foramen ovale is usually functionally closed by the
3rd mo of life
76
Functional closure of the ductus arteriosus is usually complete by
10-15 hr
77
When the Po2 of the blood passing through the ductus reaches about __ mm Hg, the ductal wall begins to constrict
50 mm Hg
78
Cyanosis, the visible sign of this shunt, occurs when approximately ___ of reduced hemoglobin is present in systemic blood
5 g/100 mL
79
balloon atrial septostomy
rashkind procedure
80
___ remains leading cause of death in kids with anomalies
congenital heart disease
81
qp:qs 2:1 implies
twice the normal pulmo blod flow
82
hypoplastic or absent radii
1st degree AV block
ASD
autosomal dominant
holt oram syndrome
83
VSD pressure is restrictive meaningn
RV pressure is normal
84
indications for surgical correction vsd
any age large defects with symptoms that can't be controlled medically
infant 6-12mo old with large defects assoc with pulmo hypertension even if controlled
patient >24mo with qp:qs > 2:1
supracristal VSD of any size
85
pulmonary stenosis is a common finding in
noonan and alagille
86
```
suprevalvular aortic stenosis with pulmonary branch stenosis
idiopathic hypercalcemia of infancy
elfin facies
mental retardation
deletion in chrosome 7 (maternal)
```
williams
87
subvalvar aortic stenosis
mitral stenosis
coarctation of aorta
shone syndrome
88
most coarctation of the aorta occur
just below origin of the left subclavian artery at the origin of the ductus arteriosus
juxtaductal coarctation
89
```
posterior brain fossa abnormalities
facial hemangiomas
arterial anomalies
cardiac anomalies like coarctation of aorta
eye anomalies
```
PHACE syndrome
90
interrupted aortic arch type b associated wtih
digeorge 22q11
91
stenosis of common pulmonary vein
cor triatriatum
92
mitral valve prolapse
Marfan syndrome, straight back syndrome, pectus excavatum, scoliosis, Ehlers-Danlos syndrome, osteogenesis imperfecta, and pseudoxanthoma elasticum.
93
prolapse is defined as
>2mm movement from long axis
| valve thickening >5mm is "classic"
94
tx for taussig bing malformation
rastelli
95
normally the aorta is. ___ to the pulmonary artery
posterior and right
96
position d tga
aorta is anterior and to the right of pulmonary artery
97
d tga more common in
males of diabetic moms
98
successful rashkind procedure for TGA will cause paO2 to rise
35-50mmhg
99
surgical treatment of choice TGA
```
arterial switch (Jatene) procedure
performed in 2wks
```
100
atrial switch
mustard or senning operation
101
disadvantage of atrial switch TGA
right ventricle as systemic pumping chamber
102
L TGA
ventricular inversion
103
t or f
| prostaglandin effective for TAPVR
false
104
cxray finding of TAPVR in neonate
perihilar pulmonary edema with small heart
105
hypoplastic left heart associated with
turner syndrome
trisomy 13 and 18
holt oram syndrome
rubinstein taybi syndrome
106
tx for hypoplastic left heart
norwood
| sano
107
anomalous venous return from lung
scimitar syndrome
108
blood flow from the left coronary artery is reversed (empties to pulmonary artery) in ALCAPA
myocardial steal
109
angiomas of nasal and buccal mucus membrane, GI tract, liver
mutation in endoglin gene
communication between pulmonary artery and vein thus bypassing lungs
no cardiomegaly
osler weber rendu syndrome
| hereditary hemorrhagic telangiectasia type I
110
```
ectopia cordis
midline supraumbilical ab defect
anterior diaphragm deficiency
defect in lower sternum
intracardiac defect (VSD, TOF, or diverticulum of the left ventricle)
```
pentalogy of cantrell
111
heath edwards classification of patho changes in eisenmengerization
Grade I changes involve medial hypertrophy alone
grade II consists of medial hypertrophy and intimal hyperplasia
grade III involves near obliteration of the vessel lumen
grade IV includes arterial dilation
grades V and VI include plexiform lesions, angiomatoid formation, and fibbrinoid necrosis
112
which grades indicate irreversible pulmo vascular obstructive disease
grade IV to VI
113
eisenmenger physio defined as pulmo arterial resistance to greater than
12 wood units or
| ratio of pulmo to systemic resistance of > or = to 1
114
endocarditis prophylaxis needed for
patients with previous endocarditis
unrepaired cyanotic CHD
completely repaired congenital heart defects with prosthetic material or device during the 1st 6 mo after the procedure
repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)
115
seen wolff parkinson white syndrome
atrial -> ventricle conduction bundle of kent
normal qrs
orthodromic conduction
116
seen wolff parkinson white syndrome
ventricle -> atrial conduction retrograde reentry
wide qrs
antidromic conduction
117
treatment of choice for AVNRT AV nodal re entrant tachycardia
adenosine
118
in WPW what drugs are contraindicated
digoxin and ca channel blockers
119
non WPW DOC for arrhythmia control
b blockers
| or digoxin
120
DOC for WPW
b blockers
121
DOC for junctional ectopic tachycardia JET
amiodaron
| sotalol
122
tx for atrial flutter
synchronized DC cardioversion
123
tx for atrial fibrillation
ca channel blockers
124
DOC for stable vtach
amiodarone
lidocaine
procainamide
125
LQT1 events are
stress induced
126
LQT3 events
occur during sleep
127
drugs assoc with prolonged QT
```
erythromycin
clarithromycin
azithromycin
cotrimoxazole
cipro
fluconazole
amitriptylline
haloperidol
risperidone
```
128
tx for long QT syndrome
b blockers
129
abnormality in conduction pathway esp after surgery
| sometimes with tachy-brady syndrome
sick sinus syndrome
130
maternally derived antibodies that cause congenital heart block
anti SSA/Ro
| anti SSB/La
131
fainting spell due to heart block
stoke adams attacks
132
likelihood that heart block post open heart surgery is low if it persists more than __days
10-14 days
133
vfib after blunt nonpenetrating trauma to chest
commotio cordis
134
leading causes of endocarditis in kids
viridans type streptococci (alpha hemolytic strep)
| staph aureaus
135
pathogen in endocarditis
| more common in patients with heart disease
staph
136
pathogen in endocarditis
| common after dental procedures
viridans group strep
137
pathogen in endocarditis
| after lower bowel or genitourinary manipulation
group D enterococci
138
pathogen in endocarditis
| seen in IV drug users
pseudomonas
| serratia marcescens
139
pathogen in endocarditis
| seen after open heart surgery
fungal
140
pathogen in endocarditis
| in presence of indwelling central venous catheter
coagulase negative staph
141
childen at highest risk for endocarditis
prosthetic cardiac valves or other prosthetic material used for cardiac valve repair
unrepaired cyanotic congenital heart disease (including those palliated with shunts and conduits)
completely repaired defects with prosthetic material or device during the 1st 6 mo after repair
repaired congenital heart disease with residual defects at or adjacent to the site of a prosthetic patch or device
valve stenosis or insuffciency occurring after heart transplantation
permanent valve disease from rheumatic fever (mitral stenosis, aortic regurgitation)
previous infective endocarditis
142
greatest risk of embolization in endocarditis if
>1cm mass
| fungating
143
diagnosis of endocarditis
| Duke criteria
Major criteria include
(1) positive blood cultures (2 separate cultures for a usual pathogen, 2 or more for less-typical pathogens)
(2) evidence of endocarditis on echocardiography (intracardiac mass on a valve or other site, regurgitant flow near a prosthesis, abscess, partial dehis- cence of prosthetic valves, or new valve regurgitant flow)
Minor criteria include
predisposing conditions,
fever,
embolic-vascular signs, i
mmune complex phenomena (glomerulonephritis, arthritis, rheuma- toid factor, Osler nodes, Roth spots),
a single, positive blood culture or serologic evidence of infection,
echocardiographic signs not meeting the major criteria.
Two major criteria, 1 major and 3 minor, or 5 minor criteria
144
empiric therapy before pathogen identified in endocarditis
vancomycin
| gentamicin
145
apical presystolic murmur similar to mitral stenosis in RHD heard as result of regurgitant aortic flow preventing mitral valve to open fully
austin flint murmur
| aortic insufficiency
146
murmur in RHD simmilar to aortic insufficiency but without bounding pulses
graham steell murmur
147
most common form of cardiomyopathy
dilated cardiomyopathy
148
dilated cardiomyopathy
left ventricular dilatation
| systolic dysfxn
149
hypertrophic cardiomyopathy
diastolic dysfxn
| increased ventricular wall thickness
150
restrictive cardiomyopathy
nearly normal wall and chamber size
preserved systolic fxn
diastolic dysfxn
151
associated with dilated cardiomyopathy
```
duchenne
emery dreifuss
fatty acid oxidation disorders
carnitine abnormalities
organic acidemias
mitochondrial (kearns sayre syndrome)
alstrom syndrome
barth syndrome
```
152
associated with hypertrophic cardiomyopathy
mitochondiral (friedreich ataxia)
stoarge disorders (pompe, fabry, mucopolysaccharidoses, hemochromatosis, danon disease)
noonan syndrome
153
associated with restrictive cardiomyopathy
myofibrillar myopathies
storage disorders
familial restrictive cardiomyopathy
154
autosomal recessive
chronic progressive external ophthalmoplegia
cerebellar ataxia, proximal muscle weakness, deafness, diabetes mellitus, growth hormone deficiency, hypoparathyroidism
dilated cardiomyopathy
Kearns–Sayre syndrome
155
```
x linked disorder
dilated (or sometime hypertrophic) cardiomyopathy
neutropenia
growth delay
cardiolipin abnormalities
phospholipid disorder
```
barth syndrome
156
autosomal recessive
childhood obesity, blindness due to congenital retinal dystrophy, and sensorineural hearing loss
hyperinsulinemia, early-onset type 2 diabetes, and hypertriglyceridemia
dilated cardiomyopathy
Alström syndrome
157
autosomal recessive
progressive damage to the nervous system
hypertrophic cardiomyopathy
reeduced expression of mitochondiral protein FRATAXIN
friedreich ataxia
158
```
autosomal receessive
glycogen storage disease typeII
deficiency lysosomal acid alpha-glucosidase enzyme
progressive muscle weakness (myopathy)
hypertrophic cardiomyopathy
```
pompe disease
159
```
x linked
lysosomal storage disease
kidney failure
pain
hypertrophic cardiomyopathy
angiokeratomas
neuropathy
```
fabry disease
160
glycogen storage type IIB
X-linked lysosomal and glycogen storage disorder
hypertrophic cardiomyopathy
skeletal muscle weakness, and intellectual disability
danon disease
161
```
post cardiac surgery 7-14 days ago
fever
lethargy
anorexia
irritability
chest/ab discomfort
```
postpericardieotomy syndrome
162
DOC for hypertensive diabetics with proteinuria
ACE inhibitors or ARBs
163
DOC for hypertensive with headache or migraine
b blocker
| ca channel blocker
164
in hypertensive emergency, reduction of BP should be
10% in first hour
| 15% more in next 3-12 hours
