Cardiology

Question 1

CCHD screening: 88% on R hand and 99% on R foot. Associated cardiac defect?

Answer 1

Patent ductus arteriosus with REVERSE differential cyanosis = pulmonary hypertension OR aortic arch obstruction + D-transposition of the great arteries.

Oxygenated blood from the pulmonary circulation (LA -> LV -> PA -> PV) enters descending aorta through patent ductus.

Question 2

R hand&raquo_space; R foot on CCHD screen (differential cyanosis)

Answer 2

Differential cyanosis is the result of pulmonary hypertension or aortic obstruction

Question 3

D-transposition of the great arteries requires this type of shunt and operation

Answer 3

Atrial level shunt = balloon atrial septostomy if needed followed by arterial switch operation soon after birth

Question 4

Acute management of aortic dissection

1. Type A or Type B with complications (if a surgical candidate)
2. Type B w/o complications

Answer 4

1. If a candidate for surgery, determine if they need CABG + AoD repair, and once in the suite use TEE to determine if there’s a need for aortic valve or root replacement
2. Decreased BP using beta blockers (esmolol) and nitroprusside if needed; manage pain –> once managed, can then go for a TEVAR (endoscopic stent)

Question 5

Mobitz type 2 following a STEMI -treatment?

What about type I?

Answer 5

Type 2 - (emergent) pacemaker

Type 1 - try holding the beta blocker