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Cardiology Flashcards

1
Q

List 3 indications for infective endocarditis prophylaxis

A
  1. Prosthetic cardiac valve or prosthetic material used for valve repair
  2. Previous Infective Endocarditis
  3. Cardiac transplant recipients who develop valvulopathy
  4. Unrepaired CHD (including palliative shuts and conduits)
  5. Completely repaired CHD with prosthetic material/device during first 6mo after procedure
  6. Repaired CHD with residual defects at site or adjacent to site of patch/device
  7. Significant residual valvular disease 2˚ rheumatic heart disease
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2
Q

What is the most common underlying condition that predisposes patients to infective endocarditis?

A

Mitral valve prolapse

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3
Q

Is the mortality risk in infective endocarditis higher with prosthetic valves or native valves?

A

Prosthetic valves

(20% vs 5% with native)

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4
Q

List 2 instances where infective endocarditis prophylaxis is required

A
  1. Dental procedures involving manipulation of gingival tissue, periapical region of teeth or perforation of oral mucosa (not required for dental XR, routine anethestic [non-infected tissue], placing or adjusting orthodontic appliances or brackets, shedding deciduous teeth, bleeding from trauma to lips or oral mucosa)
  2. Incision or biopsy of respiratory mucosa (like a T+A) (not required for bronchoscopy unless incision of mucosa planned)
  3. Procedures on infected skin, skin structure or MSK tissue

Consider for UTI procedure (cystoscopy etc) that is not elective.

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5
Q

You decide your patient requires infective endocarditis prophylaxis. Provide instructions on how to take.

What if they cannot tolerate oral antibiotics?

A

Administer dose of amoxicillin (cephalexin, clinda or azithro if allergic) 30-60 minutes before the procedure or up to 2 hours afterwards.

If unable to tolerate PO antibiotics, give IV ampicillin, ceftriaxone or cefazolin. (can also consider clindamycin if ampicillin allergic)

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6
Q

Describe one way that individuals can decrease their incidence of bacteremia from daily activities.

A

Maintenance of optimal oral health and hygiene

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7
Q

Which of the following are indications for prophylaxis?

  • Bicuspid aortic valves
  • Mitral valve prolapse
  • Previous infective endocarditis
  • Patent ductus arteriosus
  • Significant residual valvular disease 2˚ rheumatic heart disease
  • Cardiac transplant recipients with cardiac valvulopathy
  • Hypertrophic cardiomyopathy
  • Calcified aortic stenosis
  • Prosthetic cardiac valves
A
  • Previous infective endocarditis
  • Cardiac transplant recipients with cardiac valvulopathy
  • Prosthetic cardiac valves
  • Significant residual valvular disease 2˚ rheumatic heart disease
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8
Q

Which of the following are indications for prophylaxis?

  • Palliative shunt
  • Coarctation of the aorta
  • Previous Kawasaki disease
  • Rheumatic heart disease if prosthetic valves or prosthetic material used in valve repair
  • Implanted defibrillator
  • CHD repaired with prosthetic material 3 months ago
  • Previous CABG
  • ASD/VSD
  • Repaired CHD with residual defect next to prosthetic patch
  • Pulmonic stenosis
  • Cardiac pacemaker
  • Appendectomy
A
  • Palliative shunt
  • Rheumatic heart disease if prosthetic valves or prosthetic material used in valve repair
  • CHD repaired with prosthetic material 3 months ago
  • Repaired CHD with residual defect next to prosthetic patch
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9
Q

List 4 risk potential cardiac risk factors for sudden cardiac death among children starting stimulant medication.

A
  1. SOBOE or poor exercise tolerance without alternative explanation
  2. Fainting or seizures with exercise, startle or fright
  3. Palpitations brought on by exercise
  4. Family history (1+2˚) of sudden unexplained death in <35yo (SIDS, unexplained drowning, unexplained MVCs)
  5. Personal or Family history (1+2˚) of nonischemic heart disease, long QT syndrome, familial arrhythmia, WPW, cardiomyopathy, heart transplant, pulmonary HTN, ICD
  6. Hypertension
  7. Sternotomy incision
  8. Pathologic sounding murmur
  9. Absent or delayed femoral pulses
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10
Q

Which structural CHD conditions are associated with sudden death?

A
  1. Tetralogy of Fallot
  2. Dextro-transposition of the great arteries (d-TGA) - particularly after Mustard or Senning procedures
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11
Q
  1. To what gestational age does the CCHD Screen apply?
  2. When should CCHD screening be performed?
  3. Where should the pulse oximeters be placed?
A
  1. ≥34 weeks being cared for in locations outside the NICU
  2. Between 24-36 hours postbirth
  3. Right hand and either foot
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12
Q

List 5 conditions that are detectable using pulse oximetry screening in newborns (CCHD)

A

Most consistently cyanotic

  • 5Ts
    • Truncus arteriosus (1 big trunk)
    • Transposition of the great arteries (2 interchanged vessels)
    • TRIcuspid atresia
    • TETRAlogy of Fallot
    • TAPVR (total anomalous pulmonary venous return) - 5 words
  • Pulmonary atresia with intact ventricular septum
  • Hypoplastic left heart syndrome

May be cyanotic

  • Coarctation of the aorta
  • DORV (double outlet right ventricle)
  • Ebstein’s anomaly
  • Interrupted aortic arch
  • Defects with single ventricle physiology
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13
Q

What is considered NORMAL, BORDERLINE and ABNORMAL on a CCHD test?

What do you do if you have each of these results?

A
  • NORMAL = ≥95% AND ≤3% difference
    • Continue with normal newborn care
  • BORDERLINE = 90-94% OR >3% difference
    • Repeat in 1 hour x 2, if BORDERLINE a 3rd time = FAILED screen
  • ABNORMAL = <90%
    • FAILED screen
      • assessment by MRP including 4 limb BP, ECG and CXR
      • If most likely cause appears to have cardiac origin or remains unclear, consult paediatric cardiology followed by echocardiogram
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14
Q

List 3 “red flags” for cardiac-related syncope

A
  1. Loss of consciousness without prodromal symptoms
  2. Syncope in response to loud noise, surprise or emotional distress (suspicious for long QT)
  3. Syncope during exercise
  4. Syncope while lying flat
  5. FMHx sudden death, LQTS/arrthymias, cardiomyopathy
  6. Syncope with an abnormal ECG

Additional from Hamilton Review

  1. Prolonged loss of consciousness (>5 min)
  2. Associated with palpitations or chest pain
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15
Q

List 3 features concerning for a pathologic murmur

A
  1. History concerning for cardiac disease
  2. Systolic murmur that intensifies with standing
  3. Presence of holosystolic or diastolic murmur
  4. ≥3/6
  5. Abnormal S2 or audible click
  6. Young age (neonate or young infant)
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16
Q

List 4 different types of innocent murmurs of childhoos

A
  1. Still’s murmur
  2. Venous hum (~3-8yo, louder when sitting up, disappears when lies down)
  3. Pulmonary flow murmur
  4. Peripheral pulmonic stenosis (0-6mo)
  5. Aortic systolic murmur
  6. Supraclavicular or brachiocephalic systolic murmur
  7. Mammary artery soufflé (teens/pregnancy)
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17
Q

Describe why a hyperoxia test is performed, how to perform the test and what the results indicate.

A

Hyperoxia test determines whether the presence of cyanosis is due to lung disease or CHD.

An ABG is obtained while the infant is breathing room air and then is repeated after 10min of receiving 100% FiO2.

  • >300 = Normal
  • ≥150-300 = likely respiratory disease, CNS disorder or methemoglobinemia
  • ≥100-150 = PPHN or cardiac mixing lesion w/increased pulmonary blood flow
  • <100 = cardiac mixing lesion with restricted pulmonary blood flow OR cardiac conditon with parallel circulation
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18
Q

What are common complications associated with PDA ligation?

A
  1. Vocal cord paralysis (injury to recurrent laryngeal nerve)
  2. Diaphragm paralysis (injury to phrenic nerve)
  3. Chylothorax (injury to thoracic duct)
  4. Later-onset scoliosis related to thoracotomy
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19
Q

Match the following murmurs to their condition

A
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20
Q

What condition does this demonstrate?

A

Coarctation of the aorta

Classic “3” sign.

Cardiomegaly

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21
Q

What condition does this demonstrate?

A

Transposition of the Great Arteries

“egg on a string” CXR

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22
Q

What condition does this demonstrate?

A

Total anomalous pulmonary venous return

“snowman” sign

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23
Q

What condition does this demonstrate?

A

Tetralogy of Fallot

“boot-shaped” heart

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24
Q

List 4 risk factors for persistent pulmonary hypertension of the newborn.

A
  1. Polycythemia
  2. C-section delivery
  3. Postterm delivery
  4. Meconium aspiration syndrome
  5. Maternal SSRI use
  6. Hypoglycemia
  7. Cyanotic heart disease (especially obstructed TAPVR)
  8. Sepsis
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25
Q

What is the most common cause of infective endocarditis?

A

1st: Group A streptococcus (Streptococcus viridans)
2nd: Staphylococcus aureus

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26
Q

What is required to clinically diagnose infective endocarditis?

A

MODIFIED DUKE CRITERIA

Must have (one of) for Clinical Diagnosis:

  • 2 MAJOR
  • 1 MAJOR, 3 MINOR
  • 5 MINOR

MAJOR CRITERIA:

  1. Blood culture positive for IE
    • 2 positive BCx
    • Persistently positive BCx
    • 1 positive BCx for Coxiella burnetii
  2. Evidence of endocardial involvement
  3. Positive Echo
    • Vegetation
    • Abscess
    • New partial dehiscence of prosthetic valve
  4. New valvular regurgitation

MINOR CRITERIA

  1. Predisposing condition (indications for prophylaxis, IVDU)
  2. Fever ≥38˚C
  3. Immunologic signs
    • Glomerulonephritis
    • Osler nodes
    • Roth spots
    • Positive RF
  4. Vascular phenomena
    • Major arterial emboli
    • Septic pulmonary infarcts
    • Mycotic aneurysm
    • Intracranial hemorrhage
    • Conjunctival hemorrhage
    • Janeway lesions
  5. 1 positive blood culture (not meeting major criteria)
  6. Positive Echo (not meeting major criteria)
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27
Q

Identify the following dermatological features and the diagnosis they are associated with.

A

INFECTIVE ENDOCARDITIS

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28
Q

What is required to clinically diagnose rheumatic fever?

A

REVISED JONES CRITERIA

Must have:

  • Evidence of recent GAS infection (+rapid strep antigen test, throat culture, rising ASOT or DNase B titre)
  • Either
    • 2 MAJOR
    • 1 MAJOR+2 MINOR
  • Recurrent: as above or 3 MINOR

MAJOR

  1. Polyarthritis
  2. Carditis (MR most common, AI usually in combo w/MR)
  3. Sydenham chorea
  4. Erythema marginatum
  5. Subcutaneous nodules

MINOR

  1. Prolonged PR interval (only if no evidence of carditis)
  2. Fever ≥38.5˚C
  3. Polyarthralgia (only if no arthritis)
  4. ESR ≥60 (≥30 in endemic areas) or CRP ≥30
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29
Q

Describe your management plan for rheumatic fever

A
  • Eradicate streptococcal infection
    • IM pen G x 1
    • PO pen V BID-TID OR amoxicillin daily x 10 days
  • High-dose ASA for mild-moderate carditis
    • PO prednisone for severe carditis
  • Consider need for long-term prophylaxis
    • Carditis w/valvular disease = until 40yo, sometimes lifelong (whichever is longer)
    • Carditis w/o valvular disease = 10y or until 21yo (whichever is longer)
    • No carditis = 5y or until 21yo (whichever is longer)
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30
Q

What is the most common cause of myocarditis

A

Viral infection

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31
Q

Describe features associated with Long QT syndromes

A
  1. Family history of sudden death (including Romano-Ward)
  2. Sensorineural hearing loss (Lange-Neilsen)
  3. Triggers
    • Stress or exertion, especially swimming (LQT1)
    • Auditory triggers (horns, alarms) (LQT2)
    • Postpartum (LQT2)
    • Sleep (LQT3)

FYI

  • tx beta-blockers + avoidance of QT prolonging medications
  • Schwartz score can be used
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32
Q

Describe symptoms associated with CHF

A
  • Inadequate CO: Cool extremities, exercise intolerqnce, fatigue, gallop rhythm
  • Pulmonary Overload: Tachypnea, coarse breath sounds, feeding difficulties
  • Systemic Overload: Edema, hepatomegaly
  • Acute heart failure: Hypotension, tachycardia, poor perfusion
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33
Q

Match the cardiac defect with the associated syndrome

A
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34
Q

A child presents with SVT and poor perfusion.

  1. Describe your initial management.
  2. What pharmacological intervention is indicated (be specific)?
A
  1. Initial Management
    • Maintain open/patent airway, assist breathing and provide O2 as needed
    • Attach monitors for cardiac rhythm, O2 saturation and blood pressure
    • Establish IV/IO access
    • Obtain 12-lead ECG
  2. Adenosine (0.1mg/kg, max 6mg) as bolus with rapid flush technique using 2 syringes
    • If not effective, can try Adenosine (0.2mg/kg, max 12mg) with same technique
    • If not effective, attempt synchronized cardioversion (0.5-1J/kg) while recording and monitoring the ECG continuously before, during and immediately after each cardioversion attempt
    • If not effective, provide synchronized cardioversion (2J/kg)
    • If not effective, consult cardiology
      • Prepare amiodarone or procainamide
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35
Q

Name 2 genetic conditions associated with secundum-type ASDs

A
  1. Noonan syndrome
  2. Treacher Collins syndrome
  3. TAR (thrombocytopenia with absent radius) syndrome
  4. Holt-Oram syndrome
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36
Q

What structural heart lesion is associated with this ECG finding? Name 3 auscultatory findings AND 2 long-term complications seen with it if not repaired

A

Atrial Septal Defect

  • RSR’ pattern in V1

Auscultatory findings

  • Wide, fixed split S2
  • Systolic ejection murmur loudest to LUSB
  • Diastolic rumble at LLSB

Long-term complications

  • Atrial arrhythmias (particularly AFib [also AFlutter and SVT])
  • Pulmonary HTN and Eisenmenger syndrome
  • Paradoxical embolization → stroke
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37
Q

List 4 ductal-dependent congenital heart defects

A
  1. Hypoplastic left heart syndrome
  2. Critical Aortic Stenosis
  3. Critical Coarctation of the Aorta
  4. Interrupted Aortic Arch
  5. Tetralolgy of Fallot w/ pulmonary atresia
  6. Pulmonary atresia w/intact interventricular septum
  7. Critical Pulmonic Stenosis
  8. Transposition of the Great Arteries
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38
Q

What condition is associated with this ECG?

A

ALCAPA

(Anomalous Left Coronary Artery from the Pulmonary Artery)

ECG appears as a anterolateral wall MI (QR pattern followed by inverted T waves in I and aVL, Q waves in V5, V6)

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39
Q

What is the most common cardiac lesion in an infant of a diabetic mother?

A

1st: Hypertrophic cardiomyopathy (resolves in weeks to months)
2nd: VSD

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40
Q

What is the diagnostic criteria for Postural Orthostatic Tachycardia Syndrome (POTS)?

A
  • REQUIRES
    • Symptoms while upright
    • DAILY orthostatic symptoms
  • HR increase >40bpm during 1st 10min of upright tilt test without associated hypotension while replicating orthostatic symptoms that occur when upright
  • Improvement of symptoms in supine position

Symptoms associated with POTS: lightheadedness, orthostatic nausea, fatigue, tunnel vision, brain fog, 20-30% have syncope

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41
Q

What comorbidities are associated with Postural Orthostatic Tachycardia Syndrome (POTS)? List 2.

A
  1. Sleep issues (usually delayed onset of sleep)
  2. Frequent awakening, not feeling refreshed in morning
  3. Aches in different parts of the body
  4. Abdominal pain
  5. Headaches and migraines
  6. Nausea and vomiting
  7. Raynaud-like symptoms
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42
Q
  1. Describe the BEST investigation to diagnose Postural Orthostatic Tachycardia Syndrome (POTS)
  2. Provide treatment recommendations for POTS
A
  1. Head-up tilt table test for at least 10 min
    • Requires replication of day-to-day symptoms while upright, not just increased HR
  2. Nonpharmacologic
    • Regular aerobic exercise program
      • Start with water exercises + recumbent aerobic activities (rowing or recumbent bike)
      • Slowly increase time to 45min at least 5X/wk
      • When tolerance increases, advance to more upright aerobic activities + combine with light core- limb-strengthening activities
    • Fluids (>80oz/day)
    • Salt supplementation (2g in morning and early afternoon)
    • Compression garments (thigh or waist high)

Medications (if nonpharmacologic not sufficient)

  • Fludrocortisone
  • Midodrine
  • Metoprolol
  • Propranolol
  • Pyridostigmine - very useful if consipation present
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43
Q

Describe the mechanism causing infants with VSD to present after 1 month of life.

A

PVR initially elevated→ falls in the first few weeks→ increase of L-R shunt

Pulmonary HTN due to large communication allowing exposure of pulmonary circulation to systemic pressure → pulmonary vascular obstructive disease

Once PVR/SVR ratio approaches 1:1, bidirectional shunt occurs →heart failure symptoms lessen → Eisenmenger physiology →cyanosis

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44
Q
  1. Hypermetabolic demand
  2. Unable to feed adequately due to increased tachypnea + WOB during feeds
  3. Decreased suck strength due to fatigue from hypoxia
  4. Hypoxia leading to decreased ability to coordinate suck-swallow reflex
A

4 reasons a child has FTT with congenital heart disease

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45
Q

List 3 causes of a prolonged QT interval.

List 2 genetic disorders that are associated with prolonged QT interval.

A

CAUSES

  1. Electrolyte disturbances
    • Hypocalcemia
    • Hypomagnesemia
  2. Medications
    • Antimicrobials (TMP/SMX, Macrolides, Fluoroquinolones, azoles)
    • SSRI (also seen in neonates with maternal SSRI use)
    • Cisapride
    • Amiodarone
    • Antipsychotics
    • Loperamide
    • Methadone
    • Sotalol
  3. Arsenic poisoning
  4. Starvation (including bulimia and anorexia nervosa)

ASSOCIATIONS

  1. Long QT syndrome
  2. Marfan syndrome
  3. Duchenne Muscular Dystrophy
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46
Q

What is an association with Wolff-Parkinson-White syndrome?

Explain the pathophysiology of WPW?

A
  1. Hypertrophic cardiomyopathy
  2. Epstein’s anomaly
  3. L-TGA or CCTGA (congenitally corrected)

Accessory AV pathway allows “early” depolarization of ventricles (pre-excitation).

Can cause:

  • SVT (retrograde conduction through accessory pathway)
  • Sudden death (rapid antegrade condultion of atrial arrhythmia)
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47
Q

You are seeing a patient with “repaired” CHD in your office. List 5 concerns associated with this population.

A
  1. Ongoing disease (AS)
  2. Growth and nutrition
  3. Arrhythmia (scar acts as a focus)
  4. Genetics (for family planning; recurrence ~4% (up to 10% w/left sided lesions; higher when part of syndrome)
  5. Development
    • Increased risk of specfic learning disorders, ADHD (especially if open heart surgery in 1st year of life)
  6. Dental hygiene (may require SBE prophylaxis)
  7. Scoliosis (if thoracotomy)
  8. Post-pericardiotomy syndrome (first 4 weeks) - associated with fever, pericardial and pleural effusions
  9. If Fontans procedure:
    • Protein losing enteropathy
    • Plastic bronchitis
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48
Q

When is the highest risk of coronary aneurysm with Kawasaki disease?

What are 2 risk factors for coronary artery involvement and treatment resistance.

A

Weeks 4-6 after onset of fever.

RISK FACTORS

  1. Young age (<6mo)
  2. Abnormal echocardiogram at presentation
  3. Severe disease (MAS, shock)
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49
Q

List 3 causes of cyanosis in an infant

A
  1. Cyanotic congenital heart disease
  2. Severe congestive heart failure
  3. Intrapulmonary R→L shunt
    • Parenchymal
      • RDS
      • Pneumonia
      • Pulmonary hemorrhage
    • Non-parenchymal (space occupying issues)
      • Pleural effusion
      • CPAM
      • CDH
  4. Central hypoventilation
  5. Polycythemia
  6. Methemoglobinemia
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50
Q

Describe your initial management of an infant with cyanosis.

A
  • Maintain open/patent airway, assist breathing and provide O2 as needed
  • Attach monitors for cardiac rhythm, O2 saturation and blood pressure
  • Establish IV access
  • Obtain 12-lead ECG
  • Transilluminate if air entry discrepancy
  • Obtain a CXR
  • Obtain bloodwork: CBC/diff, culture, glucose, lytes, extended lytes
  • Start antibiotics
  • If no response to oxygen and no other obvious cause, start prostaglandin (0.05mcg/kg/min)
    • Monitor continuously for apnea
    • Intubate if necessary
  • URGENT consult to cardiology
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51
Q

What is the most common cause of pericarditis?

Describe classic features on history and physical exam.

What are the expected ECG findings?

Outline management for pericarditis.

A

Most common cause = viral infection

Other causes: idiopathic, leukemia/lymphoma, JIA, SLE

  • History:
    • Sharp, stabby or squeezing chest pain
    • Worse lying down, better sitting
    • Often pleuritic
  • Physical Examination
    • Pericardial friction rub
    • Narrow pulse pressure
    • Pulsus paradoxus ≥15mmHg
  • ECG (4 stages):
    • ST elevation
    • PR depression
    • T wave flattening
    • T wave inversion
    • Resolution
  • Management
    • If stable: NSAIDs with regular echo follow-up
    • If persistent: steroids, colchicine
    • Pericardiocentesis if tamponade or persistence on medication
    • Antibiotics if suppurative pericarditis (would be VERY sick)
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52
Q

Describe non-pharmacological and pharmacological strategies in the management of CHF.

A
  • Non-pharmacological
    • Keep head elevated (↓respiratory distress)
    • Tube feeds (↓cardiac workload)
    • high caloric formula (limits free water)
    • salt restriction in older children (avoids excess preload)
    • fluid restriction - if severe
  • Pharmacological
    • Improve contractility
      • Dopamine, dobutamine, milrinone, epinephrine, norepinephrine
    • Decrease preload
      • Diuretics (spironolactone and furosemide)
    • Decrease afterload
      • ACEi/ARBs
    • Minimize ongoing damage
      • Beta blockers
  • Preventative
    • Immunizations - RSV, influenza
  • Surgical correction
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53
Q
  1. Which of the following pulse profiles matches the diagnosis given: a. pulsus alternans-constrictive pericarditis b. atrial fibrillation-hypothyroidism c. pulsus bigeminus-digoxin toxicity d. dicrotic pulse-mitral stenosis
A

c. pulsus bigeminus-digoxin toxicity Pulsus Alternans (regular rhythm but varying volume of pulse) - Myocardial failure (left), aortic stenosis, hypertension, asthma, large pericardial effusion Pulsus Bigeminus - Two heartbeats close together followed by longer pause (normal heart beat then a premature beat) -conduction issue - Causes: HOCM, digoxin toxicity, hypothyroidism, K abnormalities

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54
Q

In what conditions do you see pulsus paradoxus?

A
  • cardiac tamponade, asthma, constrictive pericarditis, pericardial effusion
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55
Q

What are causes of atrial fibrillation?

A

PIRATES Pulmonary Embolus or Pulmonary Disease (COPD) o Ischemia o Rheumatic or Regurgitation (mitral) o Anemia or Atrial Myxoma o Thyrotoxicosis or Toxins o Electrolytes or Ethanol o Sepsis or Stimulants

56
Q
  1. List 3 causes of cyanotic congenital heart disease with decreased pulmonary blood flow
A

TOF tricuspid atresia pulmonary stenosis

57
Q
  1. A term IDM newborn is seen at 48 hours of age with a grade 3/6 SEM at the LSB. On echo there is hypertrophy of the septal muscle but no decrease in function. What is the clinical course: a. Will resolve with no treatment b. corticosteroids
A

a. Will resolve with no treatment IDMs have increased risk of transient hypertrophic cardiomyopathy - associated with inter ventricular septal hypertrophy and decreased ventricle size (increased risk for LVOTO) - resolves spontaneously as plasma insulin levels normalize (2-3 weeks), usually asymptomatic, may have resp distress

58
Q
  1. Which of the following are true? ( a) fetal p02 is 25-30 (b) the incidence of asymptomatic PFO in the adult population is 10%
A

( a) fetal p02 is 25-30 *15-25% of adults have asymptomatic PFOs

59
Q

An ECG is shown. Left axis deviation, increased forces, ST-T changes with T-wave inversion. a) LVH b) RVH c) heart block d) Wolff-Parkinson-White e) ST-T changes associated with digoxin therapy

A

a) LVH changes in keeping with LVH: - depression of ST segments and inversion of T waves in left precordial leads (V5, V6) - left ventricular strain pattern - suggest presence of a severe lesion - deep Q wave in left precordial leads - deep S wave in V1 - tall R wave in V6

60
Q

What are ECG changes in keeping with RVH?

A
  • right axis deviation - *note in first week of life need serial ECGs to determine if there is RVH beyond what is physiologically normal for a neonate (right ventricular dominance) - tall R waves in V1 - deep S waves in V6 - upright T waves in V1 and V4R
61
Q

Which type of heart block is most concerning for progression to complete heart block?

A

Second degree, type II (mobitz II): no progressive prolongation of PR interval; a P wave is predictably non-conducted in a specific pattern (e.g. every 2 beats, every 3 beats)

62
Q

ECG features of WPW and why do we worry about it?

A
  • short PR interval - slow upstroke of the QRS (delta wave) - increased risk of a fib leading to v fib and death *usually the heart is normal, but can be associated with HOCM or Epstein’s anomaly of the tricuspid valve
63
Q
  1. You are seeing a teenager with a history of recurrent syncopal episodes. What is the best screening test for prolonged QT syndrome. a) EKG b) exercise EKG c) Holter monitor d) echocardiogram e) electrolytes
A

a) EKG Findings: - QTc>0.47 seconds is highly indicative, >0.44 is suggestive - notched T waves in 3 leads - T-wave alternans (beat to beat variation in amplitude or shape of the T wave) - low resting heart rate for age

64
Q

What are 2 syndromes associated with long QT?

A

Romano-Ward Jervell-Lange-Nielsen (associated with congenital SNHL)

65
Q

Romano-Ward and Jervell-Lange-Neilsen are 2 syndromes associated with what?

A

Long QT

66
Q

What are some medications that can cause long QT?

A
  • antibiotics: erythro/clarithro/azithro, septra, fluoroquinolones - TCAs, SSRIs - antipsychotics: haldol, risperidone, chlorpromazine - lasix, ondansetron
67
Q

How do you treat long QT syndrome?

A

Beta blockers (to blunt HR response to exercise) - propranolol and nodal used - may then need pacemaker for drug induced bradycardia - if still syncopal on beta blockers or have had cardiac arrest, need ICD

68
Q
  1. 3 day infant cyanosis with crying, investigation a ECG b CXR c ABG d bld cx e echo
A

e echo Worry about cyanotic heart disease, especially TOF given cyanosis with crying

69
Q
  1. Kid with down’s syndrome and previous CHD repair, now many years later going for surgery. List 2 considerations
A
  • potential C spine instability (atlanto-axial) - upper airway obstruction (hypotonia) - current cardiac condition and need for endocarditis prophylaxis - risk of pulmonary hypertension - risk of heme abnormalities - suggested screening: ECG, echo, CBC
70
Q
  1. Management of hypercholesterolemia (+Fhx)
A

Fam Hx includes MI/stroke before age 55, CAD, peripheral vascular disease, coronary intervention, parent with hyperlipidemia (>6.2 - 99% of people with LDL >6.2 have FH) 1. evaluate for secondary causes: obesity, hyper/hypothyroid, hypercortisol, diabetes, biliary cirrhosis, nephrotic syndrome, meds (cyclosporine, estrogen, isotretinoin (accutane)) 2. diet and lifestyle modifications: - all kids over 2 should follow step 1 diet (<10% calories from sat fat, <30% calories from fat, <300mg/day cholesterol) - if patient’s fasting LDL is high, should switch to step 2 diet (<7% calories from sat fat, <200mg cholesterol) - refer to dietician for assistance - 60 minutes of mod-vigorous activity daily - re-evaluate in 6 months and if still high then start statin 3. medication therapy: statins, bile acid resins

71
Q
  1. Newborn diagnosed with interrupted aortic arch, what to start? a. dopamine b. prostaglandin c. nitric oxide d. indomethacin
A

b. prostaglandin

72
Q
  1. Name 4 side effects of prostaglandin E.
A

Hypotension apnea fever edema pyloric stenosis

73
Q

Neonate with PDA treated with indocid. List four side effects of indocid

A

Indocid= Indomethacin ● Decreased platelet function: GI bleed, IVH ● NEC ● Transient renal insufficiency ● Spontaneous GI perforation

74
Q
  1. 6 wk old with pansystolic murmur, increasing respiratory distress and liver edge down. CXR shows increased pulmonary markings. Which medication would you consider to help his symptoms? a. propanolol b. furosemide c. digoxin d. adenosine
A

b. furosemide

75
Q
  1. Newborn baby with cyanotic congenital heart disease. Most consistent physical exam finding: a) bounding/dynamic precordium b) normal pulses and quiet precordium c) decreased pulses and poor perfusion d) tachypnea and nasal flaring e) palpable thrill
A

b) normal pulses and quiet precordium o Cyanosis- most have no murmur and no distress ▪ TGA, pulm or tricuspid atresia

76
Q
  1. A 3 day old is tachypneic, cyanosed despite 100% O2. Bilateral crackles on exam with weak peripheral pulses and no heart murmur. What is the diagnosis: a) HLHS b) Sepsis c) AV fistula
A

a) HLHS Most are acutely ill within first days/weeks of life (as PDA closes) o Lactic acidosis o HF o Cardiogenic shock o Cyanosis o Poor pulses o Hyperdynamic cardiac impulse Mgmt: start PGE, surgical palliation (Norwood, Glenn, Fontan) or transplant

77
Q
  1. Child with supravalvular aortic stenosis, prominent lips, developmental delay, and hypercalcemia. This is indicative of: 1. DiGeorge 2. Williams 3. Noonans 4. Downs 5. Fetal alcohol syndrome
A
  1. Williams o Narrowing above level of coronary arteries o Systolic murmur at base and toward neck o May have higher BP in right arm than left (because of direction of blood flow) aka Coanda effect
78
Q

What congenital cardiac defect is associated with Williams syndrome?

A

supravalvular aortic stenosis Other features: ▪ ID, cocktail party personality, elf-like facies,hypercalcemia ▪ Narrowing of peripheral systemic and pulmonary arteries (may have hypertension)

79
Q
  1. 15 y o boy for regular check up and exam shows Ht > 95 th , Wt 50%, arm span > ht, + pectus, flat feet. What is the most likely cardiac defect that could be found. a. Mitral valve prolapse b. Bicuspid Ao valve c. Dilatation Ascending aorta d. VSD
A

Dilatation of aortic root Dissection of ascending aorta Also (involvement, not major criteria): mitral valve prolapse c. Dilatation Ascending aorta a. Mitral valve prolapse *either could be correct

80
Q

What is the revised Ghent criteria for Marfan if no family history?

A
  1. Aortic root dilatation z score 2+ or dissection AND ectopia lentis = diagnosis of Marfan 2. Aortic root dilatation z score 2+ or dissection AND FBN1 mutation = diagnosis of Marfan 3. Ectopia lentia AND FBN1 mutation that is associated with aortic disease = diagnosis of Marfan 4. Aortic root dilatation z score 2+ or dissection AND systemic score of 7+ points = diagnosis
81
Q

What is the revised Ghent criteria for Marfan if positive family history?

A
  1. Ectopia lentis + family history = Marfan diagnosis 2. Systemic score of 7+ AND family histroy = Marfan 3. Aortic root dilatation z score 3+ (for ppl under age 20) AND family history = Marfan
82
Q

What are the components of the systemic score in Ghent criteria when evaluating for Marfan syndrome?

A

Wrist and thumb sign Pectus carinatum/excavatum/chest asymmetry Hindfoot deformity Plain flat foot Spontaneous pneumothorax Dural ectasia (widening of sac around spinal cord) Protrucio acetabluae (displacement of acetabulum and femoral head) Scoliosis, thoracolumbar kyphosis Reduced elbow extension Skin striae Myopia Mitral valve prolapse Reduced upper:lower segment or increased arm span:height 3/5 facial features: dolicocephaly, downward slanting palpebral fissures, enopthalmus, retrognathia, malar hypoplasia

83
Q

A newborn baby has tachypnea and cyanosis. With 100% O2 the O2sat improves from 80% to 85%. On CXR the pulmonary vasculature is normal and there are no other abnormalities noted. Which lesion is this most consistent with: a. HLHS b. TOF c. Tricuspid atresia d. TGA

A

c. Tricuspid atresia - decreased pulmonary vascular markings, no other CXR findings HLHS - increased pulmonary vascular markings, pulmonary edema TOF - decreased pulmonary vascular markings, boot shaped heart, 25% right aortic arch TGA - increased pulmonary vascular markings, egg shaped heart

84
Q

3-day-old infant with congenital heart disease whose cyanosis is aggravated by crying. Most likely from choice? Most likely not included in these choices?: a) TGA b) VSD c) ASD d) PDA e) PS

A

e) PS Per Dr. Wong this is most likely actually describing TOF, but given the choices PS is the most correct

85
Q

Patients with ASDs have a fixed split S2. This is due to: a) pulmonary hypertension b) abnormal pulmonary valve c) pooling of blood in the pulmonary vasculature d) late eruption of the right atrium e) prolonged right ventricle ejection

A

e) prolonged right ventricle ejection - mild left precordial bulge on examination of chest wall - right ventricular systolic lift at left sternal border - pulmonic ejection click may be heard - classic finding is fixed split S2 during all phases of respiration - systolic ejection murmur, medium pitch, harsh, at left middle and LUSB (produced by increased flow through right ventricular outflow tract, NOT by flow through the actual ASD) - potential rumbling mid diastolic murmur at LLSB produced by increased flow of blood across tricuspid valve (best heard with bell)

86
Q

Infant with large VSD. The murmur cannot be heard. What is the cause? a) VSD has closed b) there is increased pulmonary outflow obstruction c) pulmonary arterial pressures have increased

A

c) pulmonary arterial pressures have increased - known complication of unrepaired VSD VSD has closed - large VSD unlikely to close spontaneously There is increased pulmonary outflow obstruction - possible but occurs infrequently

87
Q

What is the most common physical examination finding in congenital cyanotic heart disease?

A

Most often asymptomatic.

88
Q

Newborn with meconium stained fluid, needed resuscitation, poor apgars. Cyanotic and in 100% O2 had a PO2 of 70 with a normal CO2 (Rt Radial A) . Cord gas had O2 of 30. CXR normal sized heart and decreased vascularity. Most likely diagnosis a) PPHN b) TGA c) TAPVD d) Mec aspiration syndrome

A

a) PPHN (BW implied that pre sat higher than post) Why others are wrong: b) TGA (increased vascularity) c) TAPVD (increased vascularity) d) Mec aspiration syndrome (cyanosis improve with oxygen if no PPHN)

89
Q

What are secondary causes of PPHN?

A

Abnormal pulmonary vascular development (pul resistance up) - Chronic fetal hypoxia/Asphyxia - Maternal DM - Alveolar Capillary Dysplasia Pulmonary Hypoplasia: - Congenital Diaphragmatic Hernia - Potter’s Syndrome - Prolonged Oligohydraminos - Renal agenesis Post-natal elevation in pul vasoconstrictors - Sepsis - Pneumonia - MAS - Perinatal Asphyxia

90
Q

Long term complications of PPHN?

A

hearing loss, developmental delay, intellectual disability

91
Q

Cyanotic baby, presents at 5 days of age. His sats increase from 79 to 81 with oxygen. His RR – 50s, HR 180s. On exam he has single S2 loud, no murmur. Chest X-ray shows narrow mediastinum and mildly increased pulmonary markings. EKG shows mild right ventricular hypertrophy. What is your diagnosis? What is one medication you can give for treatment? What are four complications of this treatment.

A

Diagnosis: TGA (Single S2, no murmur because no turbulence, cyanotic) Mgmt: Prostaglandin E1 Complications: apnea, hypotension, pyloric stenosis, fever, edema

92
Q
  1. What is most characteristic of a Still’s murmur: a. vibratory murmur b. increases with sitting c. often radiates to axilla
A

a. vibratory murmur Louder when lying LLSB toward apex

93
Q

What are the features of a venous hum on physical exam?

A

– Whining, roaring, whirring Gr 1-6, continuous, systolic/diastolic murmur (3-8y) – Supra/infraclavicular (R>L) – Sitting or standing (disappears when supine or applied pressure to jugular vein, or with rotation of head) – Caused by blood cascading down jugular vein, louder in diastole as atrium empties – DDx PDA

94
Q
  1. A 3 year old child is referred to your office after a murmur is picked up by the family doctor on routine physical examination. You hear a harsh continuous murmur in the right infraclavicular area that is loudest when sitting and disappears on lying flat. The remainder of her cardiac exam is within normal limits. What is this most consistent with: a. PDA b. Venous hum c. Still’s murmur
A

b. Venous hum

95
Q

A 12 month old child is seen in your ED with a cough and fever. A RLL consolidation is seen on CXR. On examination of the heart, you hear a loud S1, a fixed split S2 and a SEM over the LUSB. What is the cause of the child’s heart murmur: a. Increased flow secondary to the pneumonia b. PS c. ASD d. Still’s murmur

A

c. ASD

96
Q

An infant is referred for evaluation of a heart murmur heard on day 2 of life. Birth history is unremarkable. Feeding well. Good colour and perfusion with RR 50. Grade II/VI systolic murmur heard at the left sternal border. Your plan: a) send back to family doctor with no follow-up b) follow closely c) cardiology consult d) urgent echocardiogram e) start prostaglandin infusion

A

b) follow closely - most likely pulmonary flow murmur of newborn - systolic murmur (early to mid systolic) - loudest at LUSB, with radiation to axilla and back - grade 1-2/6 - blowing quality - usually disappears by 1-2 months

97
Q

3/6 systolic murmur with ejection click in left upper sternal border. Quiet S2. Kid is 3y/o. a. PS b. PDA c. TET d. Coarctation

A

a. PS Pulmonary Stenosis: high pitched high grade murmur over pulmonic, radiate to L carotid, widely split S2 with decreased P2 +/- ejection click Tetralogy of Fallot: Single S2, harsh systolic ejection murmur of PS. PDA: continuous machine like murmur

98
Q

Teen is at a concert and feels dizzy and then passes out briefly. You suspect that this is vasovagal syncope. List 4 signs and symptoms that would make you suspicious for a cardiac origin of syncope.

A
  1. Syncope mid exertion 2. Syncope in the context of a family history of sudden death 3. Syncope without a prodrome 4. Abnormal Cardiac exam 5. History of heart disease 6. New medication with potential cardiotoxicity
99
Q

7 y with viral URTI 2 weeks ago. Now presents in CHF and a maculopapular rash. What is the most likely diagnosis? a. Viral myocarditis b. Acute rheumatic fever c. Subacute bacterial endocarditis

A

a. Viral myocarditis - DDx o Infectious ▪ Viral most common ● Coxsackie, Parvovirus, other entero/adeno, EBV, CMV, influenza ● Present with heart failure or chest pain o Immune o Toxic

100
Q

List 4 other signs of endocarditis in a child with a fever, murmur, tachycardia and hepatospenomegaly.

A

Embolic findings: - Roth spots (hemorrhage in retina) - petechiae - splinter hemorrhages - Osler nodes - Janeway lesions Arthritis Heart failure Clubbing Arrhythmias Hematuria

101
Q

When is endocarditis prophylaxis indicated?

A

When undergoing a dental procedure which manipulates the gums or perforates the oral mucosa, incision or biopsy of resp mucosa (tonsillectomy or adenoidectomy, bronch with biopsy), never for GI/GU procedures: - prosthetic cardiac valve - previous IE - unprepared cyanotic congenital heart disease (including partially repaired like palliative shunts) - completely repaired CHD with prosthetic material or device within 6 months of surgery - repaired CHD with residual defects adjacent to prosthetic material - heart transplant recipients with valvulopathy - rheumatic heart disease if prosthetic valve or material used in repair

102
Q

List 5 diagnostic criteria for Kawasaki disease.

A

5 days of fever bilateral non purulent conjunctivitis lymphadenopathy >1.5cm swelling/redness of hands or feet mucosal involvement (strawberry tongue, cracked red lips, pharyngitis) rash (not vesicular, bullous, petechial)

103
Q

4 week in obvious CHF. Huge voltages on EKG, short pr interval. Hypotonic and progressive weakness. Hepatosplenomegaly and large tongue. What does this child have?

A

Pompe Disease - Example of inherited form of hypertrophic cardiomyopathy - Type 2 glycogen storage disease Treat with enzyme replacement

104
Q

Meds with prolonged QT e. Hypercalcemia f. Hypokalemia g. Clarithromycin h. Digoxin

A

f. Hypokalemia g. Clarithromycin Both can prolong QT; also HYPOcalcemia, hypoMg, TCAs, anti-arrhythmics (procainamide, amiodarone, sotalol)

105
Q

An 11 month old child with PEA. What to give: 1. Epi 1cc of 1:1000 IV 2. Epi 1cc of 1:10000 IV 3. Atropine 4. Amiodarone

A
  1. Epi 1cc of 1:10000 IV (0.1ml/kg)
106
Q

Picture of narrow complex tachycardia, no palpable pulse with poor perfusion: a. Carotid massage b. Asynchronous cardioversion c. Adenosine d. Verapamil

A

b. Asynchronous cardioversion - no pulse means you’re on the cardiac arrest algorithm SVT with poor perfusion - go right to cardioversion as opposed to adenosine

107
Q

An infant is in shock with paroxysmal supraventricular tachycardia. You would give: a) bag of ice to face b) synchronous DC cardioversion c) asynchronous cardioversion d) verapamil e) digoxin

A

b) synchronous DC cardioversion (assuming there is a pulse)

108
Q

Neonatal goiter. What anti-arrhythmic was mom on? a. Digoxin b. Procainimide c. Amiodarone d. Sotalol

A

c. Amiodarone Congenital goitre: Fetal T4 defect or maternal antithyroid drugs/ iodides - mom and baby have hypothyroid ● Amiodarone (37% iodine content) can also cause congenital goiter with hypothyroidism

109
Q

First line treatment of a child with pulseless Ventricular tachycardia.

A

Defibrillate (unsynchronized) with 2J/kg

110
Q

First line treatment of a child with asystole:

A

epinephrine (PEA or asystole - not a shockable rhythm)

111
Q

First line treatment of a child with bradycardia

A

epinephrine, then atropine

112
Q

First line treatment of a child with SVT

A

adenosine

113
Q

First line treatment of a child with V tach with pulse

A

amiodarone

114
Q

First line treatment of a child with V tach without a pulse

A

epinephrine, the amiodarone or lidocaine (same as V fib)

115
Q

2 year old with signs of CHF. EKG looks like SVT. Give 3 things that would suggest SVT on EKG

A
  1. HR >200 2. Absent or abnormal p waves (abnormal axis)→ “absent” more common in neonates 3. Unvarying rate Also: narrow QRS
116
Q

An infant is irritable and is feeding poorly. Your EKG looks something like this (but much faster! - SVT): The child is stable . What are TWO things that you would do for management?

A
  1. Vagal manuvers (ice, valsalva, breath holding) 2. Adenosine *remember adenosine can cause a fib so be ready for DC cardioversion
117
Q

Name 3 EKG finding of Hyperkalemia. Name 3 ways to treat hyperkalemia

A

Three findings on ECG: 1. Tall peaked T waves 2. Prolonged PR 3. Wide QRS 4. Flattened/absent p waves Progresses to v fib or asystole Mgmt: 1. Calcium gluconate 10% solution, 1ml/kg IV over 3-5mins 2. NaHCO3 1-2mEq/kg IV over 5-10 mins 3. regular insulin 0.1U/kg with 50% glucose solution 1ml/kg over 1 hour 4. Ventolin (5mg neb) 5. Kayexalate 6. Consider if dialysis needed

118
Q

Newborn with persistent bradycardia. ECG given. Looks like heart block… identify the problem. What 2 things is this child at risk for?

A

Congenital heart block usually secondary to maternal autoimmune disease (i.e. SLE, Sjogren’s RA). At risk for: 1. Cytopenias → anemia, leukopenia (less TCP) 2. Light sensitive annular or macular rash 3. Hepatitis

119
Q

A 3 week old infant presents with 3 days of progressive difficulty feeding, vomiting and tachypnea. On examination his HR is 260, BP is 80/50, CR is 3s and the liver is 5 cm below the costal margin. What is the most likely etiology: a. SVT b. Myocarditis c. VSD

A

a. SVT

120
Q

SVT in neonates is most commonly associated with: a) hypocalcemia b) hyperthyroidism c) electrolyte disturbances d) ventricular septal defect e) structurally normal heart

A

e) structurally normal heart

121
Q

Concerning complete AV block, all are true EXCEPT: a) may be a cause of syncopal episodes b) ventricular rate of 30-60 bt/min c) if you hear a systolic murmur then it is associated with a congenital heart lesion d) diagnosis is confirmed by ECG e) may be present in infants born to mothers with SLE

A

c) if you hear a systolic murmur then it is associated with a congenital heart lesion

122
Q

Neonate with complete heart block. ECHO normal. List 2 causes.

A

o Maternal SLE o Maternal Sjogren Syndrome Structural associations if echo was not normal: ASD (mutation in homeobox gene described w/ ASD lesions) o Post VSD closure complication o Abnormal development of conduction system o Myocardial Tumour o Myocarditis o Complication of myocardial abscess secondary to endocarditis

123
Q

A full term infant is diagnosed with meconium aspiration syndrome. He is desaturating despite 100% oxygen. An echocardiogram shows normal cardiac anatomy and R to L shunting at the ductus and atrial level. Which of the following interventions may be effective: a. dopamine b. indomethacin c. nitric oxide d. prostaglandins

A

c. nitric oxide

124
Q

Two heart lesions with a single S2.

A
  1. TGA or transposition or malposition of the great arteries 2. Pulmonary atresia
125
Q

What is the most common cyanotic cardiac disease in the newborn period?

A

TGA ● Cyanosis is apparent within the first few hours of life and is not responsive to oxygen. CXR: egg on a string

126
Q

Initial management of an infant with suspected TGA?

A

Start PGE1 - may need balloon atrial septostomy if not responding

127
Q

Child with cyanosis, O2 sat 80% doesn’t improve with oxygen. Pansystolic murmur grade III/VI. CXR normal and ECG shows right axis deviation. What is the diagnosis?

A

TOF - pansystolic murmur is probably from VSD - do see RAD on ECG

128
Q

A teenager is seen in the ER with shortness of breath. He has distended neck veins,hepatomegaly and an S3 and an S4. What are TWO abnormalities on this CXR? (Cardiomegaly and a left sided pleural effusion). What are TWO possible diagnoses?

A

Findings on CXR in right sided heart failure 1. Cardiomegaly 2. Prominence of the pulmonary veins in the hilar region 3. Enlarged right atrium & ventricle 4. Loss of pulmonary vasculature in the periphery 5. Pleural effusion DDx - likely acquired in a teen: 1. myocarditis 2. cardiomyopathy (hypertrophic or dilated) 3. infective endocarditis (acquired valve disease) - acute HTN (glomerulonephritis) - thyrotoxicosis - sickle cell anemia

129
Q

A 2-day-old infant presents in congestive heart failure. He has hydrocephalus. He has a seizure 1 hour after admission. Most likely cause: a) vein of Galen aneurysm b) intraventricular hemorrhage c) hypoxic ischemic encephalopathy d) cerebral abscess e) meningitis

A

a) vein of Galen aneurysm AVMs are most common cause of hemorrhagic stroke in children O/E: continuous murmur when listen over fontanelle Basically there is no capillary bed separating arteries from vein, so the blood flows really quickly and easily from the artery into the venous system. The heart has to pump harder and faster to increase CO to keep up with this much faster flow of blood through the brain. The baby then develops high output cardiac failure

130
Q

Which of the following is associated with an increased risk of necrotizing fasciitis? a) parvo virus b) roseola c) Kawasaki disease d) varicella e) rosacea

A

d) varicella Varicella is a risk factor for group A strep infection which causes neck fasc Other risk factors: diabetes HIV IVDU chronic pulmonary or cardiac disease

131
Q

A 14 year old boy was found unresponsive in a park the morning after the overnight temperature dropped to -3°C. He has been receiving resuscitation in the ER for 30 minutes. Which of the following would be an indication to stop the resuscitation? a. Rectal temperature of 30°C b. Barbiturates found on toxicology screen c. Refractory ventricular fibrillation d. Electromechanical dissociation / PEA

A

d. Electromechanical dissociation / PEA Temp - needs to be warmed up Drugs - need to wait for effects to wear off or reverse if toxins are an explanation

132
Q

4 risk factors for atherosclerosis.

A
  1. Hypertension 2. Obesity 3. Diabetes 4. Family history of premature coronary artery disease 5. Smoking
133
Q

What is the most common cardiac finding in Marfans?

A

Aortic root dilation

second most common = mitral valve prolapse

134
Q

What are the cardinal signs for congestive heart failure (triad)?

A
  • Tachycardia
  • Tachypnea
  • Hepatomegaly
135
Q

What is the lesion to rule out if pre ductal sat is lower than post ductal sat?

A

Transposition of Great Arteries

136
Q

Name the lesion based on murmur characteristics:

  • Fixed split S2
  • Loud single S2
  • SEM radiating to neck
  • SEM radiating to back
  • Radiating to axilla
  • Regurgitant at apex
  • Regurgitant at LLSB
  • Worse with valsalva/squatting
  • Louder when upright
  • Quieter when upright
  • Louder leaning forward
A

Lesions:

  • Fixed split S2 = ASD
  • Loud single S2 = pulm HTN
  • SEM radiating to neck = AS
  • SEM radiating to back = coarctation, PS
  • Radiating to axilla = pulmonary
  • Regurgitant at apex = MR >>> VSD
  • Regurgitant at LLSB = VSD >>> TR
  • Worse with valsalva/squatting = MR with mitral prolapse
  • Louder when upright = HOCM
  • Quieter when upright = still’s murmur, benign
  • Louder leaning forward = aortic regurg

RC Study Cards (23 decks)

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