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Written exam > Cardio cram > Flashcards

Cardio cram Flashcards

1
Q

Syndromes associated with ASD

A

Holt Oram
Fetal alcohol syndrome

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2
Q

Widely split fixed S2
ESM left upper sternal border
Mid-diastolic rumble
Mild RVH or RBBB

A

= ASD
- ESM (relative PS) and mid-diastolic rumble (relative TS)
Primum ASD = superior axis
Secundum ASD = RAD

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3
Q

Syndromes associated with VSD

A

T21
DiGeorge
Turner

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4
Q

Holosystolic murmur LLSB +/- thrill
Apical mid-diastolic murmur
Early decrescendo murmur
LVH or LAH

A

= VSD
- Early decrescendo murmur (AR with infundibular VSD)
- outlet associated with aortic insufficiency/LVOT
LVH -> LAH -> RVH
BVH if large shunt

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5
Q

Syndromes associated with AVSD

A

T21

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6
Q

Apical holosystolic murmur
Superior axis
RVH or RBBB
Prolonged PR interval

A

= AVSD

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7
Q

Syndromes associated with PDA?

A

Maternal rubella
Prematurity

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8
Q

Bounding pulses, wide pulse pressure, hyperactive praecordium
Continuous machinery murmur
LVH or LAH

A

= PDA

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9
Q

Systolic murmur LUSB, mid-diastolic rumble, RVH or RBBB (or normal ECG)

A

= PAPVR

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10
Q

Syndromes associated with pulmonary stenosis

A

Rubella = PS and PPS
Alagille = PPS
Williams = PPS
Noonan = dysplastic PV

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11
Q

ESM LUSB radiating to back
A2 and P2 widely split
Prominent a wave
RAD, RAH and RVH strain

A

Pulmonary stenosis

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12
Q

Syndromes associated with aortic stenosis

A

Supravalvular - Williams, familial hyperchol
Valvular - Turner (bicuspid AV)

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13
Q

Harsh ESM RUSB
Early decrescendo LLSB
S2 splits normally or narrowly
LVH with strain

A

Aortic stenosis

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14
Q

Syndromes associated with coarctation

A

Turner
Kabuki
PHACES

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15
Q

Single S2, S3 gallop, reduced femoral pulses
Nonspecific ejection systolic
Low post ductal sats
Normal or RAD
RVH and RBBB, progresses to LVH by 2 years

A

= coarctation of the aorta

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16
Q

Inter AA

A

Extreme form of CoA in which the aortic arch is atretic or a segment of the arch is absent

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17
Q

Load S1 at apex, narrow split S2, low frequency mid-diastolic rumble
LAH, RVH +/- LAD

A

= MS
May have opening snap (rheumatic)
LAD associated with pulmonary hypertension

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18
Q

Syndrome associated with MR

A

MPS (Hurler) - most common cardiac lesion
Most common murmur in KD and ARF

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19
Q

S1 normal/reduced, loud S3, pansystolic murmur at apex
LVH +/- LAH, ECG can also be normal

A

= MR
Loud S3 due to increased blood flow across MV
May have apical mid-diastolic murmur of relative TS

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20
Q

Syndromes associated with mitral valve prolapse?

A

Marfan
EDS
OI
Stickler
PCKD (adults)
Klinefelter

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21
Q

Mid-systolic click +/- late systolic murmur
Enhanced by expiration
May have 1st degree AV block

A

= mitral valve prolapse

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22
Q

Syndromes associated with aortic regurgitation?

A

Overall rare, but associated with dilated aortic root (Marfan, EDS)
MPS (Hurler)

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23
Q

High pitched diastolic decrescendo murmur at LLSB, hyperdynamic praecordium, bounding pulse, wide pulse pressure
LVH if severe

A

Aortic regurgitation

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24
Q

Conditions associated with TOF?

A

22q11
T21
Alagille

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25
Q

Harsh ESM, systolic thrill, continuous murmur, single S2
RAD, RAH, RVH

A

= TOF
ESM - right ventricle outlet obstruction
Continuous murmur - PDA
Single S2 - pulmonary component not audible

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26
Q

Variations of TOF

A

TOF + PA: usually no murmur, S1 ejection click, S2 loud and single
TOF + absent PV: PS and PR ‘to and fro’ murmur

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27
Q

Conditions associated with tricuspid atresia

A

Pulmonary stenosis
TGA - common!!!
Coarctation

28
Q

Cyanosis, single S2, LV impulse, holosystolic murmur LLSB
Superior axis, RAH +/- LAH, LVH

A

= TA
VSD causing holosystolic murmur LLSB is most common

29
Q

Conditions associated with Ebstein anomaly

A

Maternal lithium use
Cardiac associations - PS, PA, TOF, VSD

30
Q

Mild to severe cyanosis, quadruple rhythm (split S1, S3 and S4), holosystolic or early systolic murmur of TR at LLSB, hepatomegaly
Superior axis, RBBB, RAH, 1st degree AV block, WPW

A

= Ebstein anomaly
May also have SVT/other atrial tachycardias

31
Q

Cyanosis, single and loud S2, usually no murmur (but can be present)
Upright T wave in V1

A

= dTGA
Can have VSD holosystolic murmur or outflow tract murmur
May have BVH, RAH or LAH on ECG

32
Q

L-TGA associated with what conditions?

A

VSD = 80%
PS = 50%
TR = 40%
Dextrocardia in 50%

33
Q

Absence of q waves in V5/6, presence of Q waves in V1, upright T waves across praecordium, varying AV block, atrial arrhythmia +/- WPW

A

= L-TGA

34
Q

Hyperactive RV impulse, widely split S2, systolic murmur LUSB, mid-diastolic murmur LLSB
RV overload (rsR’ in V1) and RVH

A

= TAPVR (without obstruction)

35
Q

Cyanosis, marked tachypnoea, single S2, gallop rhythm, no murmur, pulmonary crackles, hepatomegaly
RAD, RVH

A

= TAPVR (with obstruction)

36
Q

Associations with truncus arteriosus

A

22q11 (30%)
VSD always present, with complete mixing
May also have coronary artery abnormality or interrupted aortic arch/right aortic arch

37
Q

Varying cyanosis, hyperactive praecordium, single S2, ejection systolic click LUSB, systolic murmur
BVH in majority +/- LAH

A

= truncus arteriosus
Can have varying signs of CHF
Systolic murmur due to VSD

38
Q

Associations with double inlet left ventricle

A

TGA 85%
PS/PA 50%

39
Q

Associations with hypoplastic left heart?

A

Turner
T18, T13
Jacobson’s syndrome
22q11
Cardiac - ASD/PFO, VSD, coarctation (75%)
CNS abnormalities in 30%

40
Q

Shock and acidosis, pulses weak/absent, loud and single S2, no murmur, grey colour
RVH

A

= hypoplastic left heart

41
Q

5 most common cyanotic lesions

A
  1. Truncus arteriosus
  2. TGA
  3. Tricuspid atresia
  4. TOF (most common)
  5. TAPVR
42
Q

DDx for cyanosis and respiratory distress

A

= increased pulmonary blood flow: TGA, truncus arteriosus, obstructed TAPVR

43
Q

DDx for cyanosis without respiratory distress

A

= reduced pulmonary blood flow: TA, Ebstein, PA, PS, TOF

44
Q

Lesions presenting with shock

A

Hypoplastic left heart
Critical AS
Critical CoA
Interrupted aortic arch

45
Q

Lesions presenting with very early cyanosis?

A

TGA
Pulmonary atresia
Ebstein malformation

46
Q

Lesions associated with respiratory distress

A

At birth - truncus arteriosus, TAPVR, PDA in preterm infants
At 6 weeks - VSD, PDA

47
Q

Causes of single S2 related to abnormal valve position

A

Truncus arteriosus
TOF
Tricuspid atresia
HLH
TGA
L-TGA

48
Q

Causes of single S2 related to abnormal valve

A

Severe AS/PS/aortic atresia
PA
Eisenmenger
Large VSD

49
Q

Other causes of single S2

A

Pulmonary hypertension

50
Q

Characteristics of TOF

A
  1. Large VSD
  2. RVOT/PS (subvalvular)
  3. Overriding aorta
  4. RVH
51
Q

Characteristics of TA

A

Tricuspid valve absent - no connection between RA and RV, hypoplastic RV
Requires inter-atrial communication, systemic blood flow to cross to LA via ASD or PFO

52
Q

Characteristics of PA and intact ventricular septum

A

Absent PV - majority have a diaphragm like membrane PV
Inter-atrial communication required for systemic blood flow

53
Q

Characteristics of Ebstein anomaly

A

Downward displacement of TV into RV cavity - atrialised RV, hypoplasia of RV
Inter-atrial communication always present (PFO, ASD)

54
Q

Characteristics of D-TGA?

A

Aorta is located anterior and to the right of the PA (dextro = ‘d’)
Requires mixing lesion

55
Q

Characteristics of L-TGA?

A

Congenitally adjusted TGA:
RA -> LV -> PA
LA -> RV -> aorta
(i.e. wrong ventricles but blood moving the direction it should)

56
Q

Characteristics of TAPVR

A

No direct communication between PV and LA
PV drain to alternative sites:
supra cardiac 50%
infra cardiac 20%
cardiac 20%
mixed 10%
ASD/PFO required for survival

57
Q

Characteristics of truncus arteriosus?

A

Common PA and aorta (single arterial trunk)
VSD always present
Complete mixing of ventricles

58
Q

Characteristics of double inlet left ventricle (single ventricle)

A

Both AV valves connected to a main, single chamber
Main chamber connected to a rudimentary chamber via the BVF
One great artery arises from each chamber

59
Q

Characteristics of hypoplastic left heart syndrome

A
  1. Hypoplasia of LV - completely non-functional
  2. Atresia or critical stenosis of AV/MV
  3. Hypoplasia of ascending aorta and aortic arch
60
Q

Indications for Fontan procedure

A

Dominant RV - HLHS
Dominant LV - DILV, PA and intact VSD, tricuspid atresia
Other - unbalanced AVSD, complicated DORV

60
Q

Indications for Fontan procedure

A

Dominant RV - HLHS
Dominant LV - DILV, PA and intact VSD, tricuspid atresia
Other - unbalanced AVSD, complicated DORV

61
Q

Phase 0 of cardiac action potential

A

Contractile cells are depolarised to threshold potential by the influx of Na and K through gap junctions.
When threshold potential is reached (-70mV) sodium channels open to allow rapid depolarisation through influx of sodium into cell

62
Q

Phase 1 of cardiac action potential

A

Sodium channels begin to close, therefore reduced influx of sodium
Rapid open and closure of potassium channels, allows efflux of potassium
Combined effect = brief depolarisation of the cell

63
Q

Phase 2 of cardiac action potential

A

Potassium channels open again allowing efflux of potassium from the cell
L-type calcium channels (activated by Na in phase 0) allow influx of calcium ions
Depolarising potassium is electrically balanced by depolarising calcium and tapering sodium currents, results in a plateau (distinguishes cardiac AP from nerve and skeletal muscle)
Influx of calcium triggers calcium release from sarcoplasmic reticulum, the intracellular calcium is responsible for cardiac myocyte contraction

64
Q

Phase 3 of cardiac action potential

A

Rapid depolarisation occurs through closure of L-type calcium channels whilst potassium channels remain open, allowing more potassium to leave the cell and resulting in a net negative current
Potassium channels close when membrane potential is restored to -85-90mV.
Ionic pumps restore concentrations to levels from prior to AP

65
Q

Phase 4 of cardiac action potential

A

Resting membrane potential of -90mV maintained through ionic pumps until stimulated to threshold potential.

Written exam (21 decks)

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