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Royal Super 4th Year Brain > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

Acceptable upper limit for a normal QTc for boys and girls

A

<0.45 boys

<0.47 females

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2
Q

Treatment for long QT Syndrome

A

Beta blockers

Avoid prolonging medications

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3
Q

Inheritance pattern and hearing for two most common congenital long QT syndromes

A

Romano-Ward = autosomal dominant, normal hearing

Jarvell and Lange Nielsen = autosomal recessive, SNHL

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4
Q

What is Torsades de Pointes and what situations can it occur in?

A

Polymorphic VT

Long QT, hypoMg, hypoK, anti-arrhythmic drugs

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5
Q

What arrhythmia do we worry about with WPW?

A

SVT

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6
Q

What to look for on an ECG for hypertrophy?

A 
RVH = tall R in V1 and deep S in V6
LVH = tall R in V6 and deep S in V1
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7
Q

What to look for on an ECG in a patient where tachycardia (?SVT) has resolved?

A

Findings of WPW: short PR (<120), wide QRS (>110), and delta wave

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8
Q

Steps included in a Norwood procedure

A

Ligate PDA
Make ASD
Make neo aorta out of PA
Connect RV with L PA with Sano shunt (or subclavian to PA with BT shunt)

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9
Q

Risk factors for coronary artery involvement in KD

A
  • Late dx, delayed tx
  • Age <1 y/o or >9 y/o
  • Male
  • Fever >14d
  • Na <135, WBC >12
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10
Q

Timeline when children are at highest risk for coronary aneurysm development after fever

A
  • 4-6 weeks after onset of fever
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11
Q

Indications for SBE prophyalxis

A
  • Prosthetic heart valve or who have had a heart valve repaired with prosthetic material
  • History of endocarditis
  • Heart transplant with abnormal heart valve function
  • Congenital heart defects including: Cyanotic congenital heart disease, congenital heart defect that has been completely repaired with prosthetic material or a device for the first 6 months after the repair procedure, repaired congenital heart disease with residual defects
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12
Q

x8 cyanotic CHD lesions

A

6 T’s:

  • Transposition of the great arteries
  • TOF
  • Tricuspid atresia
  • Total anomalous pulmonary venous connections
  • Truncus arteriosus
  • “Tingle” ventricle (single ventricle)

2 A’s:

  • Pulmonary atresia
  • Ebstein’s anomaly
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13
Q

4 stages of ECG changes for pericarditis

A
  • ST elevation with PR depression
  • T wave flattening
  • T wave inversion
  • Resolution
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14
Q

CHF - ethology in the first week of life (6)

A

Think of obstructive!!

  • HLHS
  • Severe AS
  • Coarctation
  • Asphyxia
  • Severe MR and TR
  • Uncontrolled tachycardias
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15
Q

CHF - causes for week 2-6 of life (3)

A

Think left to right shunts!!

  • VSD
  • PDA
  • AVSD
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16
Q

CHF - causes in older children (3)

A

Think pump failure

  • Dilated cardiomyopathy
  • Myocarditis
  • Tachycardias
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17
Q

CHF - how to improve contractility?

A
  • epinephrine, norepinephrine, dopamine, dobutamine, milrinone
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18
Q

CHF - how to decrease preload?

A

Diuretics

Fluid restriction

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19
Q

CHF - how to decrease after load?

A

ACEi, ARBs

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20
Q

Path finding for rheumatic fever

A

Aschoff bodies

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21
Q

Criteria for Rheumatic Fever

A

For new diagnosis = x2 major OR x1 major plus 2 minor
Major = carditis, polyarthritis, chorea, subcutaneous nodules, erythema marginatum
Minor = fever, polyarthralgia, prolonged PR, elevated acute phase reactants

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22
Q

Definition of cor pulmonale

A

Right heart dysfunction secondary to pulmonary disease

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23
Q

Findings of PHTN on ECG

A

RVH and RV strain

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24
Q

Characteristic cardiac feature of Tuberous Sclerosis

A

Cardiac rhabdomyoma

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25
Q

WAGR Syndrome

A

Wilms tumor, aniridia, GU abnormalities, intellectual disability (retardation)

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26
Q

ASD heart sounds - and why?

A
  • mid systolic pulmonary flow or ejection murmur accompanied by the fixed split second heart sound
  • murmur = from more blood flowing across pulmonic valve (not from ASD itself)
  • split S2 = because more blood passing across PV so delayed closure
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27
Q

What position is best to listen to S2?

A

Both supine and sitting - as normal children can have a relatively wide S2 split when supine

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28
Q

Types of AV heard block?

A

1st degree: Prolonged PR
2nd degree: Gradually longer PR until QRS drop (type 1), normal PR but dropped QRS (type 2)
3rd degree: No P wave conducted to ventricles

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29
Q

HCM - genetic syndromes

A
  • noonan syndrome
  • BW
  • Costello
  • cardiofaciocutaneous
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30
Q

HCM - metabolic disorders

A
  • lysosomal disorders - Pompeii disease

- mitochondrial disorder - freidrich’s ataxia

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31
Q

Prostaglandin SE (top 3)

A
  • apnea
  • hypotension
  • hypoglycaemia
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32
Q

First line for long QT syndrome

A

Beta blockers

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33
Q

What cyanotic heart lesion has decreased pulmonary blood flow?

A

TOF

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34
Q

TOF - genetic syndrome

A

DiGeorge

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35
Q

Snowman XR

A

TAPVR

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36
Q

Egg on string

A

Transposition

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37
Q

Ebsteins -maternal medication

A

Lithium

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38
Q

What kind of murmur does TGA have?

A

No murmur

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39
Q

What does TGA require to live?

A

ASD

PDA - give prostaglandin

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40
Q

Why are tricuspid atresia kids blue?

A

Right to left shunting at atrial level

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41
Q

Are we more worried about supracardiac TAPVR or infracardiac?

A

Infra because vein can go behind the heart to the IVC through the ductus venousus - more likely to be obstructed

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42
Q

3 obstructive critical lesions

A

Critical AS
Critical coarctation
HLHS

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43
Q

What genetic syndrome is associated with coarctation?

A

Turners

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44
Q

Dose of prostaglandin in emergency situation

A

0.1 mcg/kg/min

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45
Q

Does perimbranous vs membranous VSD close spontaneously usually?

A

Membranous

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46
Q

What ECG finding is seen in AVSD?

A

Superior axis deviation

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47
Q

What cardiac lesion presents with a wide pulse pressure?

A

PDA

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48
Q

When does ALCAPA present and why?

A

Not for weeks until PVR falls

Then coronary artery coming off PA has blue blood and lower pressures

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49
Q

How long do you treat pericarditis with NSAIDS for?

A

Ibuprofen for 2-3 weeks

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50
Q

Where will you here a HCM murmur?

A

LLSB

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51
Q

What murmur is located at the apex?

A

Mitral regurgitation

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52
Q

What murmur gets worse with standing?

A

HCM

Venous hum

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53
Q

Classically what is HR for infants and children in SVT?

A

> 220

>180

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54
Q

What is the concern for WPW apart from SVT?

A

At risk for sudden cardiac death - if have atrial fibrillation or flutter they have an accessory pathway to send fast signals to ventricles —> VT or Vfib

55
Q

How do you give adenosine for SVT?

A

Via right arm with flush very quickly

56
Q

With what QTc length are you at greater risk for torsades?

A

> 500 ms

57
Q

What to give In an emergency situation for torsades?

A

Magnesium sulphate

58
Q

Major differential diagnosis for TOF

A

TGA

59
Q

Causes of myocarditis

A

Infection: viral, bacterial, fungal
Autoimmune/inflammatory: SLE, KD, RA
Chemicals/drugs: Radiation, doxorubicin, lead, scorpion

60
Q

Indications for IE dental procedure prophylaxis

A
  • Prosthetic valve
  • Previous IE
  • CHD: unrepaired lesion (including palliative shunts), <6 mo post-repair with prosthetic material/device, residual defect post-repair
  • Cardiac transplant with valvulopathy
  • Rheumatic disease if prosthetic valve/material
61
Q

4 classic and “fun” CXR findings for specific CHD

A
  • Rib notching = coarct
  • Boot = TOF
  • Egg on string = TGA
  • Snowman = TAPVR
62
Q

4 bony abnormalities on CXR that increase likelihood of CHD

A
  • Hemivertebrae + rib anomaly = VACTERL
  • 11 rib pairs = Down’s syndrome
  • Chest deformities (pectus excavatum, scoliosis) = Marfan’s
  • Rib notching = coarct
63
Q

x2 cardiac complications of maternal rubella

A

PDA + pulmonary stenosis

64
Q

Cardiac complication of lithium

A

Epstein

65
Q

Difference between vascular ring vs sling. Clinical presentation.

A

Ring = completely encircled. Sling = compression. Presentation = stridor, respiratory distress, feeding difficulty, swallowing dysfunction

66
Q

Investigations to consider for ?vascular ring/sling

A

Echo, CXR (R aortic arch), upper GI swallowing study, MRI

67
Q

SVT - most common cause, ECG findings, and associated lethal arrhythmia

A
  • WPW
  • ECG = short PR (bypassing AV node), slurred QRS (delta wave), wide QRS, ST + T wave non-specific changes
  • Lethal = a.fib leads to rapid ventricular responses given accessory pathway –> Vfib
68
Q

Causes of prolonged QT

A
  • Congenital = hereditary (e.g., ion channelopathies), sporadic
  • Acquired = drug induced, metabolic/lyte abN (hypoCa, hypoK, nutrition), CNS/autonomic d/o (head trauma, stroke), CVS (myocarditis, coronary artery disease)
69
Q

ECG findings for hyper/hypoK

A 
Hyper = tall peaked T waves, prolong PR, wide QRS
Hypo = depressed ST, flat T waves, long QT
70
Q

ECG findings for hyper/hypoCa

A 
Hyper = short QT
Hypo = long QT
71
Q

Cardiac lesion for 22q11?

A

TOF

72
Q

Cardiac lesions (x2) for Marfan?

A

Aortic dilation > mitral valve prolapse

73
Q

Cardiac lesions (x2) for Turner syndrome?

A
  • BAV

- CoA

74
Q

Cardiac lesion for Noonan syndrome?

A

Pulmonary stenosis

75
Q

Cardiac lesion for William’s syndrome?

A

Supra-valvular AS

76
Q

Loud single S2

A
  • Pulmonary hypertension

- TGA

77
Q

Regurg at LLSB vs apex

A

LLSB: VSD&raquo_space; TR
Apex: MR&raquo_space; VSD

78
Q

Top x3 most common cardiac causes of sudden death in athletes?

A
  1. Hypertrophic cardiomyopathy
  2. Coronary anomaly
  3. Myocarditis
79
Q

Top x3 cardiac questions on family history for syncope?

A
  • Pacemaker/ICD implant
  • Death <50 years old from heart problem, seizure, drowning/car accident, SIDS
  • Any HCM, Marfan’s, Brugada, LQT
80
Q

Definition of pulmonary hypertension?

A

Elevated PA pressures above normal - mean PA pressure >25mmHg

81
Q

What might you hear on cardiac exam for a patient with pulmonary HTN?

A
  • Single S2

- TR or PR murmurs

82
Q

Most common type Long QT Syndrome

A

LQT1

83
Q

Triggers for the types of long QT syndrome

A
  • LQT1: exercise
  • LQT2: arousal
  • LQT3: rest
84
Q

Acquired causes of heart block (x4)

A

Athletes, high vagal tone, hypothyroidism, anorexia

85
Q

Congenital causes of heart block (x7)

A

Neuromuscular, myocarditis, cardiomyopathy, neonatal SLE, lyme disease, rheumatic fever, idiopathic

86
Q

What % of children with KD will have coronary artery involvement if not treated vs treated?

A

20% vs 5%

87
Q

Length of ASA treatment (+ additional treatments) for KD?

A

-No coronary involvement: 6-8 weeks
-Small aneurysm (z = 2.5-5): ASA until resolves
-Medium aneurysm (z = 5-10, <8mm): ASA for life
-Large aneurysm (Z = >10, >8mm): ASA for life + LMWH
+clopidrogrel if high risk patient

88
Q

High risk lesions for SBE prophylaxis

A
  • Prosthetic heart valve or who have had a heart valve repaired with prosthetic material
  • History of endocarditis
  • Heart transplant with abnormal heart valve function
  • Congenital heart defects including: Cyanotic congenital heart disease, Congenital heart defect that has been completely repaired with prosthetic material or a device for the first 6 months after the repair procedure, Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch/device
89
Q

First line for SBE prophylaxis?

A

Amoxicillin

90
Q

How can you differentiate a re-entry circuit vs ectopic focus for a narrow complex rhythm?

A

Look at R-P interval compared to PR interval

  • Short R-P interval = re-entry circuit
  • Long R-P interval = ectopic focus
91
Q

What narrow complex rhythm will adenosine work and what one will it not work?

A
  • Good for re-entry circuit

- Not responsive for ectopic focus

92
Q

Dose of adenosine

A

0.1 mg/kg –> then double the dose

93
Q

Investigations for palpitations

A
  • Labs: Lytes, Ca, Mg, TSH
  • ECG (goal to correlate with symptoms)
  • Holter
  • Home ECG device
  • Exercise testing
94
Q

Criteria for hypertrophy on ECG

A
  • RVH: Tall R wave in V1, deep S wave in V6

- LVH: Tall R wave in V6, deep S wave in V1

95
Q

What would strain look like on an ECG with hypertrophy?

A

T wave inversion or flattening

96
Q

What to look for on ECG for RBBB and LBBB?

A
  • RBBB = bunny ears V1

- LBBB = bunny ears V6

97
Q

Difference between complete BBB vs incomplete BBB?

A
  • Complete = wide QRS

- Incomplete = only bunny ears, normal QRS

98
Q

Duke Criteria

A
  • Need clinical OR pathologic criteria
  • Clinical criteria = 2 major OR 1 major + 3 minor OR 5 minor
  • Major (2) = positive culture (with typical bug), echo evidence (veg, abscess, new regurg)
  • Minor (5) = fever, vascular (emboli, conjunctival hemorrhage, Janeway lesions), immune (GN, Osler nodes, Roth spots, RF), positive culture (non-typical bug), high risk patient (IVDU, known cardiac RF)
  • Pathologic criteria = histological evidence, +gram stain/Cx from specimen
99
Q

What endocarditis derm lesion is painful?

A

Osler nodes

100
Q

RF Jones criteria

A
  • Need 2 major OR 1 major+2 minor
  • Major: Carditis, polyarthritis, chorea, subcutaneous nodules, erythema marginatum
  • Minor: Fever, polyarthralgia, prolonged PR, elevated acute phase reactants
101
Q

How long do patients need to be on antibiotic prophylaxis for in RF?

A

10 years - until 21 yo

102
Q

What part of the heart is affected in RF carditis?

A

All parts - peri/myo/endocardium

103
Q

List of cyanotic congenital heart lesions

A
  • 6 T’s: Tingle ventricle, truncus arteriosus, transposition, tricuspid atresia, TOF, total anomalous pulmonary venous return
  • 2 A’s: Epstein’s anomaly, pulmonary atresia
104
Q

For truncus arteriosus - what would the CXR look like and what would pre-post saturations be?

A
  • CXR = increased pulmonary vascularity

- Pre/post saturations = the same

105
Q

What does HLHS need to stay “stable”?

A

-ASD + PDA

106
Q

CXR finding in HLHS

A

Increased pulmonary vascularity

107
Q

CXR for TOF (in terms of vascularity)

A

Decreased pulmonary vascularity

108
Q

How to address a TOF tet spell

A
  • Quiet/calm
  • Knee-chest or squatting (to increase afterload to decrease R to L shunting)
  • O2, fluid
  • Morphine, phenylephrine, propranolol
109
Q

CXR for tricuspid atresia

A

Decreased pulmonary vascularity

110
Q

What is Ebstein anomaly?

A

Apical displacement of the tricuspid valve –> atrialized right ventricle

111
Q

CXR for transposition

A

Increased pulmonary vascularity

112
Q

Complications of a Fontan procedure

A
  • Aplastic bronchitis
  • Protein losing enteropathy
  • Thromboembolism
  • Arrhythmias
  • Cyanosis (collaterals, pulmonary AVMs)
113
Q

Aspects of Norwood procedure

A
  • Create ASD
  • Close PDA
  • BT shunt (subclavian to PA) or sano shunt (RV to PA)
  • Neo aorta
114
Q

Aspects of Glenn procedure

A

-Connect SVC to PA

115
Q

Aspects of Fontan

A

Connect IVC to PA

116
Q

What is the typical cardiac lesion for (a) double inlet and (b) double outlet?

A

(a) DILV

(b) DORV

117
Q

CHF etiology in the first week

A
  • think obstruction*
  • HLHS
  • Severe aortic stenosis
  • Coarctation
  • Asphyxia or hypoxic ischemic injury
  • Severe mitral or tricuspid regurg
  • Uncontrolled tachy
118
Q

CHF etiology in 2-6 weeks of life

A
  • think L to R shunt*
  • VSD, AVSD
  • PDA
119
Q

x3 cardinal features of CHF in infants

A
  • Tachycardia
  • Tachypnea
  • Hepatomegaly
120
Q

Management plan for CHF

A
  • Supportive: HOB elevated, fluid + salt restriction, O2, tube feeds, high cal formula, immunization
  • Pharma: improve contractility (dopamine, ER, NER, milrinone), decreased preload (diuretics), decrease afterload (ARB/ACEi), minimize ongoing damage (B-blockers)
  • Surgery
121
Q

What x2 cardiac lesions could present with cyanosis on day 2 of life? And what would be the most common presentation:

(a) bounding pulses/active precordium
(b) poor perfusion + pulses
(c) tachypnea + nasal flaring

A
  • TOF + TGA

- Resp distress = c

122
Q

Dx of POTS

A
  • Orthostatic changes
  • Normal supine HR
  • HR change of at least 40 bpm during 10 minute stand test (or tilt table) with no hypotension
123
Q

Characteristics of a venous hum (+how to differentiate from PDA)

A
  • Best heard superior to R clavicle
  • Radiates to back
  • Continuous murmur
  • Goes away when supine
124
Q

In the setting of an ASD, what is an ECG most likely to show?

A

RV overload - R axis deviation, hypertrophy, and large P waves

125
Q

What cardiac defect are you most likely to get in fetal alcohol syndrome?

A

Septal defects

126
Q

Best treatment for hypertrophic cardiomyopathy? And why?

A

Beta blockers - slows the heart down to allow for a full heart + slow enough rate to allow for filling

127
Q

What to think about for an infant with left-sided ischemia on ECG (with Q waves)

A

ALCAPA

128
Q

What is the most common cardiac lesion in IDM?

A

Transient hypertrophic cardiomyopathy

129
Q

x3 steps of pharmacological treatment for SVT

A
  1. Adenosine 0.1 mg/kg
  2. Adenosine 0.2 mg/kg
  3. Amiodarone
130
Q

Features on auscultation of ASD murmur

A
  • Wide fixed S2
  • SEM to LUSB (pulmonary flow)
  • Diastolic rumble at LSB (tricuspid overflow)
131
Q

Long term complications of a large, unrepaired ASD

A
  • pHTN (Eismenger)
  • RV dilation + dysfunction
  • Atrial arrhythmias
  • MR + TR
  • Paradoxical emboli
132
Q

What dx do you think of with right aortic arch (+ then what other structure to look for)?

A

DiGeorge - vascular ring

133
Q

Dx of Marfan - criteria

A

-Top 4 most important: aortic root dilation, ectopia lentis, family history, systemic features (=/> 7)
Systemic features: MVP, scoliosis, myopia, facial features, reduced US/LS with increased arm/height, wrist + thumb sign, PTX, hind foot abnormality, pectus carnitatum, dural ectasia, protrusion acetabuli, striae, reduced elbow extension

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