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Dana's Exam Learning. > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Characteristics of a VSD on examination?

A

Loud, harsh, blowing pansystolic/holosystolic murmur, best heard at LLLE with thrill (should be L–>R shunt)

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2
Q

What is Eisenmenger syndrome?

A

Reversal of shunt through a defect to R–> L due to pulmonary hypertension - Cyanosis - murmur may disappear - accentuated S2 - cubbing

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3
Q

Normal foetal cardiac physiology x 4

A

1) Right –> Left shunting at the atrium through patent foramen ovale and from the arterial level thorugh the ductus arteriosis 2) High pulmonary vascular resistance 3) Low pulmonary blood flow 4) Ventricles work in parallel

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4
Q

What is this?

A

Ebsteins anomaly, cardiomegally, lung hypoplasia

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5
Q

TAPVD = total anomalous pulmonary venous drainage

A

Most commonly infra-cardiac and below the diaphragm

If also an obstruction to flow into LA = BAD, needs urgent surgery

Pulmonary blood flow goes into RA so RA saturations will be high

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6
Q

Causes of murmurs in first 24 hours of life?

A

Semi-lunar valve stenosis AV / tricuspid valve regurtiation Usually NOT ASD/VSD

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7
Q

Causes of cyanosis in the first 24 hours of life

A

Transposition of the great arteries single ventricle physiology

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8
Q

When do duct dependent lesions appear?

A

24 hrs –> 2 weeks of life

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9
Q

Cardiac lesions dependent on blood flow to lungs?

A

Present with cyanosis when duct closes eg) Critical pulmonary stenosis, pulmonary atresia, single ventricle with PS/PA

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10
Q

Cardiac lesions dependent on blood flow to body?

A

Present with low cardiac output (shocked) when duct closes eg) critical aortic stenosis, critical coarctation of the aorta, hypoplastic left heart syndrome

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11
Q

What is the hyperoxia test?

A

Place child in high oxygen environment - if sats / pO2 >150mmHg, likely lung pathology - If low sats / poor pO2, likely to be a cardiac issue with mixing of oxygenated and deoxygenated blood

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12
Q

Transposition of the Great Arteries (describe)

A

CXR - narrow upper/anterior mediastinum as aorta and pulmonary vessels are on top of each other, heart not huge, Present with cyanosis, M>F Mx - prostaglandin (keep duct open), septostomy (open ASD larger to mix blood, may need atrial switch procedure

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13
Q

Cyanotic neonate, what does this ECG show?

A

Small RV/TV large R waves

= ECG of pulmonary atresia

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14
Q

Management of pulmonary atresia

A

Mx: prostaglandin to keep duct open, If septum intact, associated with fistula to coronary artieries which when corrected, drop in pressure can cause myocardial ischaemia

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15
Q

Describe Truncus arteriosis

A

Large VSD

Single large outflow tract

CXR - pulmonary plethora

Well until pulmonary vascular resistance drops

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16
Q

Tetraology of fallot + pulmonary atresia

A

Large VSD

No pulmonary outflow tract (atresia) - maintain bronchial arteries from aorta

ADD INFO

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17
Q

Main signs and symptoms of heart failure in infants

A

*** Poor feeding

tachypnoea

tachycardia

**** poor growth

diaphoresis

hepatomegally

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18
Q

What percentage of children will have a systolic heart murmur?

+ most common

A

Up to 50%

15% will have a >2/6 murmur

Most do not have CHD and dont need any other investigation

  • Most commonly “functional” murmur, ASD, small VSD, AS/PS, rarely PDA or coart if child is well
  • minor lesions can wait until >3yrs
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19
Q

Older childen - common causes of heart murmurs?

A

1) innocent murmur
2) ASD - lound second heart sound, hyperdynamic praecordium, ,systolic flow murmur

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20
Q

Characteristics of coarctation of aorta?

A

Murmur heard best posteriorly (b/w scapular)

Hypertension

Difficult to palpate femoral pulses

associated with bicuspid aortic valve

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21
Q

Characteristics of an innocent murmuer in older kids? (x 5)

A

Healthy child, no exercise intolerance

No signs of heart failure / cyanosis

Normal praecordium

Murmur intensity varies with posture and fever

Normal second heart sound

* Pathological murmurs are almost never intermittent *

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22
Q

What is still’s murmur?

A

Vibratory murmur

A twanging sound, like that made by a piece of string

= aortic leave vibration

Almost always resolves when sitting

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23
Q

What is a venous hum and how can you elicit it?

A

Benign phenomenon

Heard loudest above the right clavicle

Continous, if loud, often confused with PDA

Assess my occluding ipsilateral internla juglar vein (if is disapears = venous hum)

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24
Q

Rheumatic heart disease

A

Mitral / aortic regurg

Valve thickening and deformity

pancarditis (pericardium, myocardium, epicardium)

Follow guildelines

* Can present in complete heart block *

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25
Causes of Cardiomyopathy in a structurally normal heart (x 6)
Myocarditis Familial dilated cardiomyopathy Tachycardia induced Mitochondrial Myopathies Metabolic
26
Heart failure management
Diuretics ACE inhibitors Spironolactone betablockers \* may need inotropes eg) dobutamine, milrinone
27
What is the bernouli equation?
Change in pressure = 4 x (distal velocity2 - proximal velocity2) Assume promimal velocity is low (except in coart) therefore: Change in pressure = 4 x (distal velocity2) mmHg
28
What is the noral expected fractional shortening?
30% = diameter of ventricle in diastole minus diameter of ventricle in systole divided by VDD
29
What is the expected ejection fraction
60%
30
$4yo M, well, 2/6 ESM LLSE, normal BP, RV lift ECG (see below) CXR - pulmonary plethora, prominent pulmonary artery, cardiomegally
ECG = borderline RAD, incompelte RBBB (narrow QRS) = ASD Should also have flixed spltting of S2
31
4 yo M, well, normal puses and BP 2/6 vibratory ESM ECG (see below) Murmur goes away with head tilted back
iRBBB (RSR V1), high voltages, narrow QRS, normal rate and sinus rhythm TWI V1-V3 (normal in age 4) = Still's murmur (aortic leaflet vibration)
32
4 yo M, well, 4/6 pansystolc murmumr LLSE
ECG: Sinus rhythm, (upright p wave L I and aVf) HR 120, normal axis (+60),normal pwave, PR 140ms, High voltage R waves V6, , seep S V2 ? LVH Dx: VSD (generous LV voltages)
33
4 yo child, slim, recurrent chest infections BP 95/60, normal pulses, overactive praecordium 2/6 low pitched pansystolic murmur lower LSE 2/4 diastolic murmur at apex CXR - cardiomegally, pulmonary plethora, hyperexpanded lungs
Tall, dominant R wave V1-2 (RVH) V5 - very high voltage (R-S) Deep s-wave V6 (LVH) = biventricular hypertrophy = _Large VSD_ If AVSD --\> superior axis
34
2 yo M, cyanotic (88%), loud systolic murmur
Sinus rhythm normal rate 160, QRS axis - right deviation +160 R wave dominant V1-2, S wave dominant V5-6, Upright t-wave V1 (usually inverted) V4R - large R waves, no S waves) = Right ventricular hypertrophy = Tetralogy of Fallot
35
Normal neonatal heart _Right heart T-wave_
At birth, RVH is normal, upright t-wave in V1 because right ventricle is dominat As soon as pulmonary vascular resistance falls, left ventricle dominates, RV regresses **_Day 4 - 4 years, Normal to have TWI V1_**
36
Sinus, rate 150, RWD Half voltage sign at start!! Very high voltages, biventricular hypertrophy
37
8 month old
Tall p waves = right atrial dilataton Pumonary atresia with small RV, large RA On rhythm strip, first huge wave is the P wave
38
Tall p wave V1,2 RVH (tall R wave V1, deep S V6, upright T V1 right axis) = Total anomalous pulmonary venous connection (late diagnosis)
39
Bifid P-waves, Too long V1, deep wave LA enlargement
40
Bifid P-waves (tall) + causes
RA enlargement \> 3mm tall Causes - large ASD, tricuspid anomalies
41
Bifit p-waves (long) + causes
Left atrial enlargement \> 2.5mm long Causes : mitral stenosis, mitral regurg, large VSD, large duct, cardiomyopathies
42
43
Murmur in a small but well 4 year old, modest murmur, Harrisons sulci, CXR pulmonary plethora
Rate - normal, ? sinus (can have more than one atrial foci) Left axis deviation - 60 Upright T in V1, very large T in V4-6, iRBBB = AVSD -or primum ASD
44
Causes of leftward axis on ECG?
LVH (especially in large LVD with volume overload) LBBB (broad QRS) Left anterior hemiblock "superior axis", narrow QRS - (Tricuspid atresia, AV canal defect, congenitally corrected TGA)
45
Are Q waves in inferior leads in infants normal or worrying?
Usually normal in inferior and lateral leads (V5-6) Key feature - thin (even if short) Pathological in V1 (unless neonate) **_Deep, wide Q-waves (esp post op) = BAD = infarction_**
46
Which leads should you measure QTc? and what is the formula?
Meausre in lead 2 or V5 Normal is less than 450ms QTc = QT(ms)/Squareroot R-R(ms)
47
What are normal ST segment parameters?
Elevation up to 1mm normal in limb leads Up to 2mm in V2-V4 Often early repolarisation (teenagers) DDx: cardiomyopathies, myocarditis,
48
Diagram of normal heart axis
49
Haemodynamics in cardiac catheterisation
How does blood go round\> - pressure/ pressure gradients - wave forms - saturations -
50
Angiography in cardiac catheterisation
" shaddow puppet" of the structure you are injecting the dyeinto - not cross sectinal like CT - Dynamic - nearly 4D Great for vascular information - high spatial resolution \<1mm (coronaries / tight stenosis - Absent or disconnected vessels --\> POOR for intracardiac info (atrial septim / inlet valves)
51
Intervention in cardiac catheterisation
Evolved as an alternative to surgery / to defer surgery - narrow things are ballooned / stented - Holes / vessels get blocekd Stent / valve impantation
52
Who needs cardaic cath?
When you need precice info of pulmonary vascular resistace / shunt quantification --\> usually L--\>R shunt (large VSD) - Eg - Eisenmengers Complex lesions prior to single ventricle palliation When you need precise / additional info on vessel anatomy Increasing MRIs
53
What pressure clasifies as pulmonary hypertension?
\>25mmHg - Mild \>35mmHg - Moderate \>45 mmHg - severe
54
Left --\> Right shunt
Pink patient with extra pulmonary blood flow Breathless, congested lungs, good saturations Often present as pump failure but pump is working overtime
55
RIght --\> Left Shunt
Reduced pulmonary blood flow Blue patient Normal cardiac output to the circulation Not breathlessness, normal ventilation but poor oxygenation EG) tetralogy of fallots
56
= ASD normal pressures - no stenosis LPA 30 = mild pulmonary HTN
57
Step up at ventricular level LPA 46mmHg - severe RV pressure high LPA (65mmHg)vs RV (85mmHg) - pessure gradient 20 mmHg between RV and LPA = Large VSD, L--\>R shunt + pulmonary hypertension + RV outflow tract obstruction (pulmonary stenosis)
58
Very high pressure gradient between RV --\> PA = PV outlow tract obstruction Very high right ventricular pressure Systemic sats are low (R --\> L shunt) = Tetralogy of fallot
59
What is cardiac output (L/min)
Stroke volume x HR = Q (Flow rate) Mearure with MRI Fick principle - calcualte cardiac output based on known input (O2) and uptake/use (VO2) and carrer (Hb) Assume 120ml/metre squared
60
Things that vary VO2
Activity, sedation, anaethetic (Ga reduced by 30%) Muscle relaxants Growth (Foetus VO2 30% higher) Anabolic vs catabolic states Sepsis Surgery
61
Equation for oxygen content
O2 sats x Hb x 1.36 + dissolved O2 eg (0.98 x 120 x 1.36) Differnece in oxygenation between PV - PA
62
Qp:Qs ratio
In normal person = 1:1 R--\> L Shunt 0.5:1 L --\> R shunt = 4:1
63
Aortic stenosis
64
What is resistance?
Resistance is a measure of how much pressure gradient is required ot generate a certain flow rate = mmHg / Lirtre per minute = Woods units 1-2 = normal PVR 2-4 WU/m squared = mild elevation \>7.9 WU/m square = severe elevation
65
When would you use ECMO?
Patients with BIventricular dysfunction OR pulmonary hypertension --\> assists oxygenation Not a great choice in overwhelming sepsis but used when back against the wall
66
When and why do you use a Ventriculaar assist device?
Assists the ventricles Does NOT assist in oxygenation --\> commonly used in ventricular dysfunction due to acute and reversible process (EG - myocarditis) or as a bridge to transplant or if cann not be separated from bypass following cardiacsurgery Increased risk of blood stream infection
67
What does this ECG show?
Wolff Parkinson white syndrome (during palpitation) - broad complex tachycardia ~280bpm - accessory pathway for initiation and maintenance of tachycardia
68
What does this ECG at rest show?
Wolff Parkinson white - Short PR interval Delta waves (Lead II, III, avF and V4) = congenital cardiac pre-excitation syndrome with abnormal conduction through an accessory pathway
69
What are the characteristiscs of an antidromic AVNRT?
ANTI = wrong direction of conduction but repeatable = WIDE QRS
70
What are the characteristics of an orthodromic AVNRT?
WPW, short PR, delta wave Ortho = same direction as normal conduction = narrow
71
When do you measure serum calcium in a congenital cardiac defect?
DiGeorge (22.2 deletion) - ELEVATED calcium William's syndreom - LOW calcium

Dana's Exam Learning. (17 decks)

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