CARDIO Chap 420-445 Flashcards
1
Q
Mature equivalent of
Bulbus cordis
A
Right ventricle
2
Q
Mature equivalent of
Truncus arteriosus
A
Aorta & pulmonary artery
3
Q
Mature equivalent of
Sinus venosus
A
Atria
4
Q
Radial-Femoral delay (radial pulse felt prior to femoral pulse)
A
Coarctation of the aorta
5
Q
Mid systolic click
A
Mitral valve prolapse
6
Q
Pulmonary ejection clicks
A
Pulmonary stenosis
7
Q
ECG: Positive T wave in V4R and V1, Tall R wave and deep S wave in V6 in an infant
A
RVH
*Normal infants has inverted T waves in V4R, V1 and V3R until 2 years
8
Q
Tall (>2.5mm), narrow, spiked P waves
A
Right Atrial enlargement (PS, Ebstein anomaly, Tricuspid Atresia)
9
Q
Broad, bifid, biphasic P waves
A
Left Atrial enlargement (large left to right shunts)
*Remember B
10
Q
Flat P wave
A
Hyperkalemia
11
Q
Mutation in dystrophin gene (chromosome Xp21)
A
Dilated Cardiomyopathy
12
Q
MC form of ASD
A
Ostium secundum defect
13
Q
7yo, Patient came in due to exercise intolerance
No symptoms prior
Pe: left precordial bulge, palpable right ventricular systolic lift at left sternal border, noted FIXED WIDELY SPLIT 2ND heart sound in ALL PHASES of respiration, and SYSTOLIC EJECTION murmur heard at left middle and upper sternal border
CXR: Enlarged pulmonary artery, increased pulmonary vascularity
A
Atrial Septal defect
14
Q
Scimitar syndrome
- cresenteric shadow of vascular density along the right border of cardiac silhouette seen in CXR
A
Partial Anomalous Pulmonary Venous Return (PAPVR)
15
Q
Down syndrome with wide fixed splitting of S2 and apical holosystolic murmur that radiates to the left axilla
A
Atrioventricular Septal defect
16
Q
MC cardiac malformation
A
VSD
17
Q
MC type of VSD
A
Membranous type
18
Q
VSD associated with Aortic Regurgitation
More common in Asian & males
A
Supracristal VSD
19
Q
Continuous systolic machinery-like murmur best heard at the 2nd left intercostal space that radiates to the left clavicle
A
Patent Ductus Arteriosus (PDA)
20
Q
Pulmonary stenosis secondary to valve dysplasia
MC cardiac anomaly in?
A
Noonan syndrome
21
Q
MC right ventricular outflow obstruction
A
Isolated Pulmonary Stenosis
22
Q
Initial treatment of choice for pulmonary stenosis
A
Balloon Valvuloplasty
23
Q
T/F: Clinical manifestations of Acyanotic heart disease with obstructive lesions (VALVULAR STENOSIS) depends on the degree of obstruction
A
True
24
Q
Endocardial fibroelastosis (endocardial fibrous scarring associated with which type of obstructive heart lesion)
A
Aortic Stenosis
25
Risk of sudden death during or immediately after exercise if unoperated
Severe Aortic Stenosis
26
MC origin of coarctation of the aorta
Juxtaductal coarctation (below the origin of the left subclavian artery at the origin of the ductus)
27
Hypertension in upper extremities but low blood pressure in lower extremities
Bounding pulses on the upper extremities with weak pulse lower extremities
CXR: notching of inferior border of the ribs
Coarctation of the aorta
| *notching of inferior border of the ribs - due to pressure of collateral vessels
28
SHONE complex
Mitral stenosis
Subvalvar Aortic Stenosis
Coarctation of the aorta
29
High-pitched, apical holosystolic murmur
CXR: Left atrial and ventricular enlargement
ECG: Bifid p waves
Mitral insufficiency
*Bifid p waves (LA enlargement)
30
Late systolic apical murmur preceded by a click
| Associated with Marfan syndrome & Ehler-Danlos syndrome
Mitral valve prolapse
| -billowing of one or both mitral leaflets especially posterior cusp at the end of systole
31
Test to distinguish cyanotic congenital heart disease from pulmonary disease
Hyperoxia test
32
Cyanotic congenital heart disease with primary defect is an anterior deviation of the infundibular septum
Tetralogy of Fallot (TOF)
33
Complete obstruction of the right outflow tract
Pulmonary atresia
34
Cyanotic child, hyperpneic and restless, gasping
Pe: dusky skin, clubbing of fingers, with left anterior hemithorax bulge
Diagnosis?
Management?
Paroxysmal hypercyanotic attack (Tet spell) in TOF
Knee to chest position
Morphine (0.2mg/kg)
Propanolol (0.1mg/kg)
If severe, correct acidosis with Sodium bicarbonate
*loud systolic murmur of TOF usually disappears in Tet spells
35
Boot shaped heart in CXR (coeur en sabot)
Tetralogy of Fallot
36
TOF is commonly associated with what syndrome
Di George Syndrome (CATCH 22)
```
Cardiac anomalies
Abnormal facies
Thymic hypoplasia
Cleft palate
Hypocalcemia
Deletion in chomosome 22q11.2
```
37
Medication to maintain patency of ductus arteriosus especially in ductal dependent heart disease
Prostaglandin E1 (0.01-0.2umg/kg/min)
38
Medication ised to decrease frequency and severity of hypercyanotic spells
Oral Propanolol (0.5-1mg/kg every 6 hours)
39
Palliative systemic-to-pulmonary artery shunt in TOF
Blalock-Taussig shunt
40
Cyanosis with left axis deviation and LVH in ECG
Tricuspid Atresia
41
Downward displacementnof an abnormal tricuspid valve into the right ventricle
Ebstein Anomaly
42
CXR: Boxed shaped heart
Ebstein anomaly
43
CXR: Egg on a string
Transposition of Great Arteries (TGA)
44
Neonate presents with dyspnea & cyanosis in the first hour of life. Unresponsive to hyperoxia test. O2 sat is 75%
(+) Maternal DM
CXR: Egg on a string
Transposition of Great Arteries
45
Treatment of choice for d-TGA
Arterial switch (Jatene) procedure
46
T/F: Obstructive TAPVR is a pediatric cardiac emergrny
True. Because prostaglandin is ineffective
47
T/F: Obstructive TAPVR is a pediatric cardiac emergrny
True. Because prostaglandin is ineffective
48
CXR: Snowman sign or Figure of 8
*perihilar pattern of pulmonary edema
Total Anomalous Pulmonary Venous Return
49
Single arterial trunk arises from the heart
| VSD always present
Truncus Arteriosus
50
Pulmonary vascular obstructive disease and right-sided heart failure
Pulmonary Hypertension
51
MC cause of Pulmonary Hypertension
Idiopathic or Familial
52
Development of pulmonary vascular disease in congenital heart disease due to unrestricted pulmonary blood flow
Eisenmenger Syndrome
53
Development of pulmonary vascular disease in congenital heart disease due to unrestricted pulmonary blood flow that is minimally responsive to pulmonary vasodilators
Eisenmenger Syndrome (obstructive pathologic changes in the pulmonary vessels)
54
Factors that increase the risk of developing Eisenmenger syndrome
Increased pulmonary arterial pressure
Increased pulmonary blood flow
Hypoxia or hypercapnia
55
Normal physiologic variation if rhythm related to respiration
Phasic sinus arrythmia
56
Intermittent shift in the pacemaker of the heart from sinus node to another part of the atrium
Wandering atrial pacemaker
*normal variant
57
Premature P wave preceding QRS
Reset sinus node pacemaker leading to incomplete compensatory pause
Premature Atrial Contractions (PAC)
58
Premature, widened, bizarre QRS complexes not preceded by a premature P wave
Premature Ventricular Contraction (PVC)
59
First line of therapy for PVC
Lidocaine (1mg/kg q5mins x2 doses, then 20-50ug/k/min drip)
60
Treatment for refractory PVC
Amiodarone
61
Narrow QRS complex
>230 beats/min in neonates
Abnormal P wave axis
Supraventricular Tachycardia (SVT)
62
Short P-R interval
| Slow upstroke of QRS (Delta wave)
Wolf-Parkinson-White Syndrome
63
Treatment of choice for stable patients with SVT
Adenosine (rapid IV push)
64
Treatment of SVT with symptoms of heart failure
Synchronized cardioversion (0.5-2J/kg)
65
Maintenance therapy for SVT with antegrade accessory pathway (non-WPW)
Beta-Blockers
66
Arrythmia most often recognized in early postoperative period after cardiac surgery
It is an automatic arrythmia in which junctional rate exceeds that of the sinus node
Tx?
Accelerated Junctional Ectopic Tachycardia
Tx: Amiodarone
67
ECG: Saw tooth waves
Dx & Tx?
Atrial flutter
| Tx: Synchronized Cardioversion
68
Irregularly irregular rhythm, absent p waves, irregular R-R interval
Atrial fibrillation
69
Treatment of choice in hemodynamically UNSTABLE patients with Atrial flutter and Ventricular tachycardia
Cardioversion
70
Presence of at least 3 PVCs at >120 beats/min
Ventricular tachycardia
71
Treatment of choice during cardiac arrest with ventricular tachycardia
Amiodarone (2.5-5mg/kg over 30 to 60mins)
72
Long QT syndrome associated with congenital sensorineural deafness
Jervell-Lange-Nielsen syndrome
73
Long QT syndrome associated during sleep
LQT3
Highly lethal
74
Sudden pause in heat beat due to failure of impulse formation within thesinus node
Sinus arrest
75
Sudden pause in heat beat due to a block between the sinus pacemaker complex and the surrounding atrium
Sinoatrial block
76
ECG: Prolonged PR interval but all atrial impulses conducted to ventricles
1st degree AV block
77
ECG: PR interval increases progressively then drop beat (P wave not conducted), afterwards normal rhythm
2nd degree AV block (Mobitz Type 1, Wenckebach type)
78
ECG: Normal PR interval the drop beat
2nd degree AV block (Mobitz Type II)
79
ECG: multiple P waves but rare QRS (escape rhythm)
No impulse from the atria reach the ventricles
3rd degree AV block (complete heart block)
80
ECG: P wave and QRS have no constant relationship
Mother has autoimmune disease (SLE, Sjogren)
Congenital complete AV block
81
MC cause of death in competitive athletes
Hypertrophic Heart Disease
82
Coronary artery anomaly associated with sudden death
Origin of the LEFT coronary artert from the Right sinus of Valsalva (traverses the aorta and pulmonary artery, during exercise, increase aortic & pulmonary pressure leading to compression of left coronary artery resulting to ischemoa)
83
Pathology: transmural fatty replacement of right ventricular myocardium with patchy areas of fibrosis
Associated with sudden death
Arrythmogenic right ventricular dysplasia
84
T/F: Digoxin & Verapamil are contraindicated in Wolf-Parkinson-White (WPW) Syndrome
True (because they can augment conduction down accessory pathways)
85
Corrected QTc interval of >0.47sec
Long QT syndrome
86
Mechanism of sudden death in long QT syndrome
Torsades de pointes (polymorphic ventricular tachycardia)
87
ECG: coved ST segment elevation in V1-V3
Autosomal dominant
Mutation in SCN5A gene
Associated with fever, nighttime electrolyte disorders, or occur after a large meal
Brugada syndrome
88
Universally fatal condition following blunt nonpenetrating trauma
Associated with ventricular fibrillation unresponsive to resuscitative efforts
Commotio cordis
89
Therapy of choice for survivors of arrythmic sudden death
Implantable cardioverter defibrillator
90
Leading cause of endocarditis in pediatric patients
Group A Hemolytic Streptococcus & Staphylococcus aureus
91
Tender, pea sized intrademal nodules in the pads of fingers & toes in Infective Endocarditis
Osler nodes
92
Painless, small erythematous hemorrhagic lesions on yhe plam & soles in Infective Endocarditis
Janeway lesions
93
Linear lesions beneath the nails in in Infective Endocarditis
Splinter hemorrhages
94
MC organism causing Infective Endocarditis in intravenous drug users
Pseudomonas aeruginosa
| Serratia marcenses
95
MC organism causing Infective Endocarditis in patients with indwelling catheters
Coagulase negative Staphylococci
96
T/F: absence of vegetations DOES NOT EXCLUDE Endocarditis
True (some vegetations are often not visualized in the early phase of disease)
97
Duke Major criterias for Infective Endocarditis
Positive blood cultures (2 separate cultures)
| Evidence of Endocarditis in 2d echo
98
Duke Minor criterias for Infective Endocarditis
Predisposing conditions
Fever
Embolic vascular signs
Immune complex phenomena (GN, arthritis, osler nodes, roth spoths)
Presence of newly diagnosed clubbing, splenomegaly, splinter hemorrhages, & petechiae
High ESR
High CRP
Presence of indwelling lines
Microscopic hematuria
Single, positive blood culture
Echocardiographic signs not meeting criteria
99
Empirical therapy for IE patients without prosthetic valve at high risk for S. Aureus, enterococcus or Strep viridians
Vancomycin (40mkday in 2-3 doses) plus
| Gentamicin (3mkday in 3 doses) for 4 to 6 weeks
100
T/F: Surgery is indicated for patient with IE with SEVERE aortic, mitral or prosthetic involvement with INTRACTABLE heart failure
True
101
MC affected valve in Acute Rheumatic Fever
Mitral valve
102
Previous history of Rheumatic fever
With holosystolic murmur best heard at apex radiating to the axilla
ECG: bifid P waves, LVH
2D echo: thickened mitral valve
Rheumatic Heart Disease (Mitral Insufficiency)
103
Prophylaxis for bacterial endocarditis
Oral Amoxicillin 50mkdose
| Oral Cephalexin, Clarithromycin, Azithromycin or Clindamycin (if penicillin allergic)
104
Wide pulse pressure with bounding peripheral pulses
Left ventricular apical heave
High pitched, blowing murmur beginning at the 2nd heart sound up to late diastole heard best at the upper and midleft sternal border radiating to the apex and upper right sternal border
Aortic insufficiency
105
MC form of Cardiomyopathy
| Common indication for cardiac transplanntation
Dilated Cardiomyopathy
106
Increased left ventricular wall thickness in the absence of structural heart disease
Hypertrophic Cardiomyopathy
107
Normal ventricular chamber dimensions and myocardial wall thickness, preserved systolic function but with diastolic dysfunction
2D echo: markedly dilated atria
Restrictive Cardiomyopathy
Tx of choice: Cardiac Transplantation
108
Distinctive trabeculated or spongy-appearing left ventricle
Left ventricular noncompaction
109
Stroke vokume x Heart rate
Cardiac output
110
Most commonly used parameter in assessing ventricular fubctionnin 2d echo
Fractional shortening (difference between End systolic and end diastolic diameter divided by end-diastolic diameter)
Normal: 28-42%
111
MC used diuretic in pediatric heart failure
Furosemide
112
May present with THIOCYANATE POISONING (fatigue, nausea, disorientation, acidosis, muscular spasm) when given in high doses for several days
Nitroprusside (peripheral arterial vasodilation & after load reduction)
113
T/F: Hypokalemia, hypomagnesemia, and hypercalcemia potentiates digitalis toxicity
True
114
Given innpatients with low cardiac oitput refractory to standard therapy
Milrinone (phosphodiesterase inhibitor)
115
Low cardiac output and hypotension leading to inadequate tissue perfusion
Cardiogenic shock
116
SBP and/or DBP >/=95th percentile
Hypertension
117
SBP and/or DBP >/=90th but <95th percentile
Prehypertension
118
SBP and/or DBP >/=95th percentile in medical setting but normal BP outside
White coat hypertension
119
Cause of heart failure associated with MUMPS virus
Endocardial fibroelastosis
120
Sharp, stabbing chest pain, worse with insporation, relieved by sitting upright
Pe: perocardial friction rub, tachycardia, narrow pulse pressure, muffled or distant heart sounds, (+) jugular venous distention
Acute Pericarditis
121
Fall of systolic BP >10mmHg with inspiration associated with sharp stabbing chest pain, muffled heart sounds, jugular venous distention
2d echo: compression and collapse of right atrium
Cardiac tamponade
122
CXR: Erlenmeyer flask or Watter bottle appearance
Pericarditis
123
7th day Post cardiac surgery patient presented with fever, irritability, lethargy, anorexia, chest discomfort
Dx & Tx?
Postpericardiotomy syndrome
-appears usually 7-14 days post op
Tx: aspirin and NSAIDs
124
Pericardial scarring leading to impaired distensibility and filling
Pe: jugular venous distention, peripheral edema, hepatomegaly, ascites, distant heart sounds
Labs: abnormal liver function tests, hypoalbuminemia, hypoproteinemia, lymphopenia
Constrictive pericarditis
Tx: anti-inflammatory agents, pericardiectomy
125
MC pediatric cardiac tumor
Rhabdomyoma
Associate dwith Tuberous sclerosis
Multiple lesions arising from the myocardium extending into cardiac chambers
126
Second most common pediatric cardiac tumor
Solitary, intramyocardial
May cause heart failire, cyanosis or rhythm disturbances
Fibromas
127
MC causes of secondary (metastasis) tumors in the heart
Wilm's
| Lymphoma/Leukemia
