Cardiology

Question 1

What are the features of DiGeorge syndrome?

Answer 1

22q11 deletion, autosomal dominant
C- cardiac anomalies (TOF most common, truncus arteriosus, coarctation of the aorta)
A - Abnormal facies (retrognathia, micrognathia, broad nasal bridge, long facies)
T- Thymus aplasia, T-cell deficiency/SCID
C - cleft palate
H - hypocalcemia
22 - 22q11 deletion

Question 2

Who needs endocarditis antibiotic prophylaxis?

Answer 2

• Unrepaired cyanotic heart disease
• Congenital heart disease that has been repaired with prostethic material for the first 6 months post surgery
• Repaired heart disease with residual defects such as persistent leaks or abnormal flow at or adjacent to a prostethic patch or device

Question 3

What are individuals with long QT syndrome at risk of?

Answer 3

Torsades de pointes

Question 4

What are the normal QTc parameters?

Answer 4

Boys <450ms and girls <470ms

Question 5

Management of kids with long QT syndrome

Answer 5

1. Beta blocker therapy (especially if QTc >470ms)
2. Exercise restriction (no swimming for LQT1)
3. Avoid QTc prolonging meds

Question 6

What is WPW and what are the features on ECG?

Answer 6

Wolff-Parkinson White = accessory atrioventricular pathway allowing for earlier and quicker depolarization of ventricle.
Short PR interval (<0.12s), delta wave, wide QRS

Question 7

What are some causes of LAD on ECG?

Answer 7

AVSD, Noonan syndrome, small RV (tricuspid atresia), congenitally corrected TGA

Question 8

What are the Jones Criteria for acute rheumatic fever?

Answer 8

New: 2 Major or 1 Major + 2 Minors
Recurrent: 2 Major OR 1 major and 2 minors OR 3 minors

Major:

• Carditis
• Polyarthritis
• Chorea
• Erythema marginatum
• Subcutaneous nodules

Minor:

• Fever (>38.5 in low risk, >38 in high risk)
• Polyarthralgia
• Prolonged PR interval/signs of heart block
• Elevated acute phase reactants (ESR >60 and CRP> 3mg/dL)

All need evidence of GAS infection

Question 9

Name the 6Ts and 2As of cyanotic heart disease

Answer 9

Tricuspid atresia
Truncus arteriosus
TGA
Total anomalous pulmonary venous return
TOF
Single ventricle

As
Pulmonary atresia
Ebstein anomaly (abnormal tricuspid leaflet leading to regurgitation, dilated RV and presence of ASD so shunt right to left)

Question 10

What are the features of pulmonary hypertension on physical exam?

Answer 10

• Features of CHF
• RV heave
• Single S2
• TR and PR murmurs (Graham Steel murmur of high pitched, early diastolic decrescendo murmur)
• Pulsatile liver

Question 11

What is infective endocarditis and what are the criteria?

Answer 11

• Endocardial infection due to staph aureus, streptococcus viridans, HACEK group (Hemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella), coxiella burnetti
• 2 major criteria OR One major and 3 minor OR 5 minor criteria
• Major Criteria:
  
  • Positive blood culture for IE
    
    • Organism consistent with IE with 2 separate positive cultures
      
      • Staph aureus, viridians streptococci, streptococcus gallolyticus, HACEK group
    • OR single positive blood culture for Coxiella burnetii
  • Endocardial involvement
    
    • Positive ECHO
    • New valvular regurgitation
• Minor Criteria:
  
  • Predisposition - IV drug use or presence of a predisposing heart condition
  • Fever
  • Vascular phenomenon
    
    • Major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhage or Janeway lesions (on palms and soles, hemorrhagic macular or papular lesions)
  • Immunologic phenomenon
    
    • Glomerulonephritis, Osler nodes (immune complex deposition), Roth spots or rheumatoid factor
  • Microbiologic evidence
    
    • Positive blood cultures that do not meet major criteria OR serologic evidence of active infection with organism consistent with IE

Question 12

What are the criteria for POTS?

Answer 12

Postural orthodontic tachycardia syndrome is diagnosed with a heart rate increase of 40 in those age 12-19 years, with no change in blood pressure (absence of orthostatic hypotension), symptoms longer then 6 months, symptoms worsen with standing and improve with lying down