Cardiology Flashcards
Tet of fallot infant in which medical mgmt is inadequate but they do not weight enough for definitive surgical repair, what tx?
Place stent across the pulm outflow tract (AKA RV outflow tract) allowed improved pulm blood flow until desired weight is reached
Std surgical repair for tet of fallot?
Transannular patch repair
Note: RV opened and enlarged with a patch while VSD is closed. Removes R -> L shunt and relieved outflow tract obstruction. But this does 1 . impair pulm valve function leading to severe pulm regurg 2. impair the conduction system resulting in R BBB. These children usually require pulm valve replacement in teen year as the right heart becomes less hypertrophied and then dilated over the following decade
What is the most common congenital cardiac defect?
Bicuspid aortic valce
Followed by VSD
Where are VSD more common muscular or septum?
Septum
Note: if muscular they are usually multiple
VSDs are associated with a higher oxygen content in the blood of the right ventricle than the right atrium T/F
T
What is the most common cardiac cause of cyanosis in the first week of life?
TGA
Also: poor response to supplemental oxygen; loud single 2nd heart sound, no murmur, narrow mediastinum
4 abnormalities in tet of fallot?
- Perimembranous VSD
- PS
- Over riding aorta
- Right ventricular hypertrophy
Ebstein anomaly affects what valve?
Tricuspid valve
Holt Oram syndrome is assoc with what cardiac abnormality?
ASD
Hypoplastic left heart
Infective endocarditis is assoc with an up to 20% mortality rate T/F
T
Treatment of a hypercyanotic spell in a patient with tet of F
First simple interventions: manoeuvers, then oxygen, then fluid bolus.
If theses do not work can try dose of morphine, then esmolol infusion
TAR syndrome (thrombocytopenia and absent radius) associated with what cardiac abnormality?
Tetrology
EKG finding to differenciate VSD from complete AV canal?
Superior axis is present in complete AV canal
Both can present with HF and a harsh pansystolic murmur
Which type of cardiac lesion is most likely to present with faltering growth?
Large left to right shunt with pulm oedema
Example: complete AV septal defect or a large VSD
How long does a PDA need to be present to be defined as persistent?
3 months post term
In an infant without any risk factors a PDA is more common in which sex?
More common in females (2:1)
Main risk factor is pre term
Coarctation of the aorta is more common in which sex?
More common in males (2:1)
What is the max dose of adenosine for SVT?
500mcg/kg
or max 6mg for 1st dose and 12mg for second
Note: after this move on to cardioversion 1J/kg
What is the most common cause of myocarditis in the western world?
Viral
Note: of this adenovirus is the most common
Most common type of ASD?
Ostium secundum
What is the mgmt of a persistent asymptomatic ASD?
Interventional cardiac cath at 3 yrs
What % of VSDs close by 1 yr?
90%
What % of pts with Turners syndrome have a coarcation of the aorta?
About 15%
What is the most common cardiac arrest rhythm in children?
Asystole
What is the sex distribution of WPW?
More common in males (60-70%)
WPW is usually associated with congenital heart disease T/F
F - WPW is usually seen in patients with structurally normal hearts (70-80%)
Note: associated with SVT
Are the vast majority of transposition of the great arteries diagnosed ante or postnatally?
Post natal. It is difficult to diagnosis on antenatal USS
When does tet of fallot usually present?
Sometime in the first year of life
Infant with a murmur and blue stellate irises what pathology?
Williams syndrome
What is the most common cardiac defect in those with T21
Atrioventricular septal defect
Which of these complications is most common following cardiac surgery? Endocarditis, heart block, pericardial effusion or myocarditis?
Pericardial effusion -many cardiac units will scan patients at 2 weeks post op/post discharge to screen for this complication as it can initially be asymptomatic
Atrial septal defect what type and location of murmur?
Soft systolic murmur at upper left sternal edge
Note: can present at any age
What ECG findings that may be present in a patient with LV cardiomyopathy?
Inverted T waves in the chest leads (such as V6)
What ECG findings that may be present in a patient with tetralogy of Fallot?
Upright T waves in V1 due to RVH
What the the management of coarctation of aorta in the newborn?
Prostaglandin 0.05 uk/kg/min (duct dependant lesion) followed by corrective surgery when the patient is stable
Note: prostaglandin can also be used in tricuspid or pulmonary atresia (to improve pulmonary blood flow)
Main features of Jervell-Lange-Nielsen syndrome?
Long QT
SN hearing loss
AR inheritance
What is the mechanism of action of adenosine?
Reduced conduction velocity in the AV node
What genetic disorders is hypoplastic left heart associated?
Turner syndrome T 13, 18 or 21 Jacobsen syndrome Holt Oram Rubinstein Taybi syndrome
What is the initial starting dose of adenosine?
100 mcg/kg
Management of pulseless VT vs VT with pulse
Pulseless VT = CPR followed by unsynchronised cardioversion initially at 4 J/kg
VT with pulse and unstable = Synchronised cardioversion initially 2J/kg, followed by 4J/kg. NB to synchronise as do not want to change rhythm to v fib
VT with a pulse and stable = amiodarone
Note: v fib is also unsynchronised cardio version initially at 4J/kg
Rheumatic fever often leads to mitral regurg many years after the acute episode T/F
F - it causes mitral and aortic regurg acutely which can lead to stenosis long term
What feature on exam is indicative of severe aortic stenosis?
A soft S2
As the aortic valve becomes severely stenotic or calcified the 2nd heart sound becomes inaudible
In a patient with TGA without VSD what is the surgical mgmt?
Switch operation
In a patient with a TGA with VSD with is the surgical mgmt?
Rastelli operation (close VSD and do a conduit from RV to pulmonary artery)
Mechanim of action of amiodarone?
K channel blocker
ECG abnormalities with hypoCa
Prolonged QTc or ST interval
PVCs in children usually require a work up T/F
F - common finding, usually benign. Work up only indicated if > 10% of beats on ECG, non uniform morphology, cardiac symptoms or murmur. They also tend to resolve on exercise - reassuring sign.
What does Valsalva do to the HCM murmur intensity?
Increases the intensity
What cyanotic congenital lesion presents with extreme left axis deviation?
Tricuspid atresia
Note: AV canal defects also present with extreme LAD. The deviation seen on ECG in both these conditions is due to altered anatomy of the cardiac conduction systems.
A harsh “crunch like” systolic sound over the precordium during auscultation of the heart is pathognomonic of what?
Pneumomediastinum
This noise is known as Hamman sign. It is accentuated during expiration or when the patient is in the lateral decubitus position.
Unrepaired tetrology of fallot is complicated by left heart failure T/F
F - they get RV hypertrophy from RV outflow obstruction and hence R heart failure. They do not tend to get LVH or L heart failure.
Note: brain abscess, cerebral thrombosis or infective endocarditis are well known complication of unrepaired tet
What is the treatment of precordial catch syndrome?
Reassurance only
Note: typical presentation is very severe, sudden chest pain, usually left sided. Pleuritic. Lasts only 30-60 sec and well afterwards. No other cardiac symptoms. No work up indicated.
Snowman sign on chest xray is seen in what congenital lesion?
TAPVR
What is commotio cordis?
Direct precordial trauma leading to v fib and sudden cardiac death
Note: most commonly occurs in teenage males. trauma is often sports related
Causes of S3 and S4 heart sounds?
S3: large volume of blood filling a dilated left ventricle
s4: blood entering a poorly compliant left ventricle during atrial contraction
1st line medical tx of prolonged QTc in a patient with likely congenital QTc prolongation?
Propranolol
Note: if on meds causing prolonged QTc stop them
Egg on a string on chest xray
d TGA
Marked cardiomegaly; “wall to wall” heart on chest xray
Ebstein anomaly
