Cardiology Flashcards
Egg on a string
Transposition of the Great Arteries
Boot-shaped heart
Tetralogy of Fallot
Four structural heart defects in ToF
- Overriding Aorta (aorta goes anterior to septal wall)
- VSD
- Pulmonic stenosis/outflow obstruction
- Right ventricular hypertrophy
Pathophysiology behind Tet spells
Increased R –> L shunting across VSD leading to circulation of deoxygenated blood; can overcome this by increasing venous return/systemic vascular resistance to overcome shunt
Most common cyanotic heart disease to present in the newborn period?
Transposition of the Great Arteries
Most common cyanotic congenital heart disease in general?
Tetralogy of Fallot (but usually presents around 3-5 months of age, not immediately).
ASD murmur?
Fixed wide split of S2, loudest at the LUSB due to increased flow across the pulmonary valve
SEM audible at the LUSB with thrill radiating to the back, varies with respiration
Pulmonic stenosis
SEM audible at the RUSB with thrill at the sternal notch, does not vary with respiration?
Aortic stenosis
A single second heart sound
Tetralogy of Fallot (pulmonic valve sound virtually absent)
During a Tet spell, which of the two is correct?
- Previous murmur is not audible
- Auscultation of a new murmur
Previous murmur (pulmonic stenosis murmur) is not audible because of lack of RV outflow
Which heart diseases presents with a single S2 heart sound? How can you differentiate the two HDs?
Tetralogy of Fallot (virtually minimal pulmonic outflow so no natural delay in P2 sound) & TGA
ToF– decreased pulmonary vascularity
TGA– increased pulmonary vascularity
CHD where lower extremity sats may be higher than the upper extremity sats?
Transposition of the great arteries–
1) RV –> aorta (upper extremities
(2) LV–> pulmonary artery –> PDA –> (lower extremities)
William Syndrome heart defect?
Supravalvular aortic stenosis
Noonan Syndrome heart defect?
Supravalvular pulmonic stenosis
Turner Syndrome heart defect?
Bicuspid aortic valve, coarctation of the aorta
22q11 deletion related heart defect?
Conotruncal defects and VSD
Down Syndrome related heart defect?
AV canal defects
Marfan Syndrome related heart defect?
Aortic root dissection, mitral valve prolapse
Features of WPW and increased risk for precipitating what type of arrhythmia?
Shortened PR interval and delta wave, risk for precipitating SVT
Digoxin and other AV nodal agents (beta-blockers, Ca-channel blockers) are contraindicated in the management of which arrhythmia?
SVT or A-fib in WPW; can slow down the normal signal conduction through the AV node and promote signal conduction down the accessory pathway–> can lead to SVT–> VT/Vfib
Why is prolonged QT interval bad?
If the next heart beats starts before the last ends–> disorganized rhythms such as pulseless VT or V-fib
Most common murmur to occur with Rheumatic Fever?
Mitral valve regurgitation
Major and minor JONES criteria?
Acute Rheumatic Fever
Major– Polyarthritis, Carditis, Subcutaneous Nodules, Erythema marginatum, Sydenham Chorea (just chorea itself may be enough to diagnose ARF)
Minor- High Temp, Elevated ESR, ArthraLgia, Prolonged PR interval (HELP)
1 major and 2 minor or 2 major; also history of Strep + sydenham chorea also enough
How to treat ARF?
PCN, aspirin (for fever and joint pain), +/- steroids for carditis; Haldol for chorea
What test do you order to diagnose endocarditis?
Blood culture (not echo); you have to isolate the pathogen in the blood
Pulsus paradoxus is seen in which heart conditions?
Pericarditis, pericardial tamponade, pericardial effusion; drop in the SBP by more than 10mmHg with inhalation
What is cardiac tamponade?
When enough fluid fills the pericardial sac to prevent proper filling of the heart (especially affects right heart filling).
Radiologic sign for TAPVR?
Snowman sign– blood from the pulmonary vein drains into the RA instead of the LA–> causes out-pouching of the SVC and right ventricular border, as well as collateral vessels
Five cyanotic congenital heart diseases?
Truncus arteriosus TGA Tricuspid atresia Tetralogy of Fallot TAPVR
Boxed-shaped heart is a radiographic description describing what heart disease?
Ebstein’s anomaly
Description of wall-to-wall heart with decreased pulmonary markings?
Tricuspid regurgitation 2/2 Ebstein’s anomaly (also described as a box shaped heart)
What is the most common cause of SVT in an infant vs in an older child/adolescent?
AVRT (infant/neonate) vs AVnRT (older child/adolescent)
True or False– HOCM is an inherited condition
True– autosomal dominant mutation in sarcomere proteins (myosin, troponin)
Persistent stridor and concerns of difficult swallowing solids?
Pulmonary sling (the left pulmonary artery branches distally off of the right PA and goes in between the trachea and the esophagus, compressing the esophagus); normally both PAs branch off of the main PA and pass in front of the trachea
Definition of prolonged QTc?
QTc >0.45 seconds
What is the treatment for prolonged QT?
Beta-blocker (propranolol)–> slows down conduction through the AV node to prevent firing of a new action potential prior to ventricular repolarization; prolonged QT causes prolonged ventricular repolarization and there is the risk of an AP firing prior to the ventricles completing repolarization
What stimulus can trigger an arrhythmia in a patient with prolonged QT?
Sudden emotions, startling, exercise (syncopal episodes, can also see seizures due to loss of blood supply to the brain)
Why does amiodarone and procainamide work for stopping SVT if adenosine does not work?
Both medications with prolong ventricular repolarization
Infective Endocarditis prophylaxis indications?
- Complete repair of cyanotic heart disease, even if repaired with prosthetic material– only for the first 6 months after repair
- Heart transplant with a residual cardiac valve defect
- Prosthetic heart valves
- Unrepaired cyanotic heart disease
- Repaired cyanotic heart disease with residual defect at or near the site of prosthetic material
What type of procedures is infective endocarditis prophylaxis indicated for?
Dental procedures or procedures involving manipulation of oral or respiratory mucosa; not indicated for GI/GU procedures.
Pattern of T-wave inversion per age group?
Starts off upright in right precordial leads, then inverted in right leads after 1 week of life, then back to being upright in later childhood/adolescence
Drugs that can induce drug-induced lupus?
Procainamide and Hydralazine
rsR’ pattern in V1-V4
RVH
Greater S waves than R waves in V1-4
LVH
