Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Royal Super 4th Year Brain > Cardiology > Flashcards

Cardiology Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards The Brain flashcards
1
Q

Acceptable upper limit for a normal QTc for boys and girls

A

<0.45 boys

<0.47 females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Treatment for long QT Syndrome

A

Beta blockers

Avoid prolonging medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

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

A

Polymorphic VT

Long QT, hypoMg, hypoK, anti-arrhythmic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What arrhythmia do we worry about with WPW?

A

SVT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

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

A
  • 4-6 weeks after onset of fever
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

4 stages of ECG changes for pericarditis

A
  • ST elevation with PR depression
  • T wave flattening
  • T wave inversion
  • Resolution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

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

A

Think left to right shunts!!

  • VSD
  • PDA
  • AVSD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CHF - causes in older children (3)

A

Think pump failure

  • Dilated cardiomyopathy
  • Myocarditis
  • Tachycardias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CHF - how to improve contractility?

A
  • epinephrine, norepinephrine, dopamine, dobutamine, milrinone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CHF - how to decrease preload?

A

Diuretics

Fluid restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CHF - how to decrease after load?

A

ACEi, ARBs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Path finding for rheumatic fever

A

Aschoff bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Definition of cor pulmonale

A

Right heart dysfunction secondary to pulmonary disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Findings of PHTN on ECG

A

RVH and RV strain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Characteristic cardiac feature of Tuberous Sclerosis

A

Cardiac rhabdomyoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

WAGR Syndrome

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

HCM - genetic syndromes

A
  • noonan syndrome
  • BW
  • Costello
  • cardiofaciocutaneous
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

HCM - metabolic disorders

A
  • lysosomal disorders - Pompeii disease

- mitochondrial disorder - freidrich’s ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Prostaglandin SE (top 3)

A
  • apnea
  • hypotension
  • hypoglycaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

First line for long QT syndrome

A

Beta blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What cyanotic heart lesion has decreased pulmonary blood flow?

A

TOF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

TOF - genetic syndrome

A

DiGeorge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Snowman XR

A

TAPVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Egg on string

A

Transposition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Ebsteins -maternal medication

A

Lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What kind of murmur does TGA have?

A

No murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What does TGA require to live?

A

ASD

PDA - give prostaglandin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Why are tricuspid atresia kids blue?

A

Right to left shunting at atrial level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

3 obstructive critical lesions

A

Critical AS
Critical coarctation
HLHS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What genetic syndrome is associated with coarctation?

A

Turners

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Dose of prostaglandin in emergency situation

A

0.1 mcg/kg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Does perimbranous vs membranous VSD close spontaneously usually?

A

Membranous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What ECG finding is seen in AVSD?

A

Superior axis deviation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What cardiac lesion presents with a wide pulse pressure?

A

PDA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

How long do you treat pericarditis with NSAIDS for?

A

Ibuprofen for 2-3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Where will you here a HCM murmur?

A

LLSB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What murmur is located at the apex?

A

Mitral regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What murmur gets worse with standing?

A

HCM

Venous hum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Classically what is HR for infants and children in SVT?

A

> 220

>180

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

Royal Super 4th Year Brain (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions