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Cardiology Flashcards

1
Q

Tet of fallot infant in which medical mgmt is inadequate but they do not weight enough for definitive surgical repair, what tx?

A

Place stent across the pulm outflow tract (AKA RV outflow tract) allowed improved pulm blood flow until desired weight is reached

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2
Q

Std surgical repair for tet of fallot?

A

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

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3
Q

What is the most common congenital cardiac defect?

A

Bicuspid aortic valce

Followed by VSD

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4
Q

Where are VSD more common muscular or septum?

A

Septum

Note: if muscular they are usually multiple

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5
Q

VSDs are associated with a higher oxygen content in the blood of the right ventricle than the right atrium T/F

A

T

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6
Q

What is the most common cardiac cause of cyanosis in the first week of life?

A

TGA

Also: poor response to supplemental oxygen; loud single 2nd heart sound, no murmur, narrow mediastinum

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7
Q

4 abnormalities in tet of fallot?

A
  1. Perimembranous VSD
  2. PS
  3. Over riding aorta
  4. Right ventricular hypertrophy
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8
Q

Ebstein anomaly affects what valve?

A

Tricuspid valve

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9
Q

Holt Oram syndrome is assoc with what cardiac abnormality?

A

ASD

Hypoplastic left heart

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10
Q

Infective endocarditis is assoc with an up to 20% mortality rate T/F

A

T

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11
Q

Treatment of a hypercyanotic spell in a patient with tet of F

A

First simple interventions: manoeuvers, then oxygen, then fluid bolus.
If theses do not work can try dose of morphine, then esmolol infusion

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12
Q

TAR syndrome (thrombocytopenia and absent radius) associated with what cardiac abnormality?

A

Tetrology

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13
Q

EKG finding to differenciate VSD from complete AV canal?

A

Superior axis is present in complete AV canal

Both can present with HF and a harsh pansystolic murmur

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14
Q

Which type of cardiac lesion is most likely to present with faltering growth?

A

Large left to right shunt with pulm oedema

Example: complete AV septal defect or a large VSD

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15
Q

How long does a PDA need to be present to be defined as persistent?

A

3 months post term

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16
Q

In an infant without any risk factors a PDA is more common in which sex?

A

More common in females (2:1)

Main risk factor is pre term

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17
Q

Coarctation of the aorta is more common in which sex?

A

More common in males (2:1)

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18
Q

What is the max dose of adenosine for SVT?

A

500mcg/kg

or max 6mg for 1st dose and 12mg for second

Note: after this move on to cardioversion 1J/kg

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19
Q

What is the most common cause of myocarditis in the western world?

A

Viral

Note: of this adenovirus is the most common

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20
Q

Most common type of ASD?

A

Ostium secundum

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21
Q

What is the mgmt of a persistent asymptomatic ASD?

A

Interventional cardiac cath at 3 yrs

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22
Q

What % of VSDs close by 1 yr?

A

90%

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23
Q

What % of pts with Turners syndrome have a coarcation of the aorta?

A

About 15%

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24
Q

What is the most common cardiac arrest rhythm in children?

A

Asystole

25
Q

What is the sex distribution of WPW?

A

More common in males (60-70%)

26
Q

WPW is usually associated with congenital heart disease T/F

A

F - WPW is usually seen in patients with structurally normal hearts (70-80%)

Note: associated with SVT

27
Q

Are the vast majority of transposition of the great arteries diagnosed ante or postnatally?

A

Post natal. It is difficult to diagnosis on antenatal USS

28
Q

When does tet of fallot usually present?

A

Sometime in the first year of life

29
Q

Infant with a murmur and blue stellate irises what pathology?

A

Williams syndrome

30
Q

What is the most common cardiac defect in those with T21

A

Atrioventricular septal defect

31
Q

Which of these complications is most common following cardiac surgery? Endocarditis, heart block, pericardial effusion or myocarditis?

A

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

32
Q

Atrial septal defect what type and location of murmur?

A

Soft systolic murmur at upper left sternal edge

Note: can present at any age

33
Q

What ECG findings that may be present in a patient with LV cardiomyopathy?

A

Inverted T waves in the chest leads (such as V6)

34
Q

What ECG findings that may be present in a patient with tetralogy of Fallot?

A

Upright T waves in V1 due to RVH

35
Q

What the the management of coarctation of aorta in the newborn?

A

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)

36
Q

Main features of Jervell-Lange-Nielsen syndrome?

A

Long QT
SN hearing loss
AR inheritance

37
Q

What is the mechanism of action of adenosine?

A

Reduced conduction velocity in the AV node

38
Q

What genetic disorders is hypoplastic left heart associated?

A 
Turner syndrome
T 13, 18 or 21
Jacobsen syndrome
Holt Oram 
Rubinstein Taybi syndrome
39
Q

What is the initial starting dose of adenosine?

A

100 mcg/kg

40
Q

Management of pulseless VT vs VT with pulse

A

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

41
Q

Rheumatic fever often leads to mitral regurg many years after the acute episode T/F

A

F - it causes mitral and aortic regurg acutely which can lead to stenosis long term

42
Q

What feature on exam is indicative of severe aortic stenosis?

A

A soft S2

As the aortic valve becomes severely stenotic or calcified the 2nd heart sound becomes inaudible

43
Q

In a patient with TGA without VSD what is the surgical mgmt?

A

Switch operation

44
Q

In a patient with a TGA with VSD with is the surgical mgmt?

A

Rastelli operation (close VSD and do a conduit from RV to pulmonary artery)

45
Q

Mechanim of action of amiodarone?

A

K channel blocker

46
Q

ECG abnormalities with hypoCa

A

Prolonged QTc or ST interval

47
Q

PVCs in children usually require a work up T/F

A

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.

48
Q

What does Valsalva do to the HCM murmur intensity?

A

Increases the intensity

49
Q

What cyanotic congenital lesion presents with extreme left axis deviation?

A

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.

50
Q

A harsh “crunch like” systolic sound over the precordium during auscultation of the heart is pathognomonic of what?

A

Pneumomediastinum

This noise is known as Hamman sign. It is accentuated during expiration or when the patient is in the lateral decubitus position.

51
Q

Unrepaired tetrology of fallot is complicated by left heart failure T/F

A

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

52
Q

What is the treatment of precordial catch syndrome?

A

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.

53
Q

Snowman sign on chest xray is seen in what congenital lesion?

A

TAPVR

54
Q

What is commotio cordis?

A

Direct precordial trauma leading to v fib and sudden cardiac death

Note: most commonly occurs in teenage males. trauma is often sports related

55
Q

Causes of S3 and S4 heart sounds?

A

S3: large volume of blood filling a dilated left ventricle

s4: blood entering a poorly compliant left ventricle during atrial contraction

56
Q

1st line medical tx of prolonged QTc in a patient with likely congenital QTc prolongation?

A

Propranolol

Note: if on meds causing prolonged QTc stop them

57
Q

Egg on a string on chest xray

A

d TGA

58
Q

Marked cardiomegaly; “wall to wall” heart on chest xray

A

Ebstein anomaly

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