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Neo Board Review > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Where does the heart arise from?

A

Mesoderm

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2
Q

By which week is heart formation complete?

A

7-8 weeks

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3
Q

Which organ received the greatest amount of fetal cardiac blood flow?

A

Placenta (45%)

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4
Q

When do most cardiac abnormalities develop by?

A

Week 8, during embryogenesis

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5
Q

Patency of the ductus arteriosus in utero is maintained by?

A

Prostaglandins (PGE-2)
Prostacyclin (PGI2)
Thromboxane A2

Note: Postnatally PGE-1 is the IV prostaglandin used for ductal patency

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6
Q

Which factor determines the width of the ductus arteriosus in utero?

A

The amount of flow.

In right sided obstructive lesions with low flow, the PDA will be narrow. Opposite is true for L sided obstructive lesions.

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7
Q

Dominant ventricle in utero?

A

Right ventricle. Responsible for 65-70% of total cardiac output

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8
Q

Where is the highest oxygen content in the fetus?

A

Umbilical veins, oxygen saturation 70-80%

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9
Q

Factors leading to postnatal closure of PDA?

A
  1. Higher O2 content of room air
  2. Bradykinin in the lungs
  3. Lower prostaglandin E (loss of placental production and increase in breakdown by the lungs)
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10
Q

Definition of cardiac output

A

Volume of blood ejected from the ventricle per minute

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11
Q

Formula for cardiac output

A

Stroke volume x HR

Systemic blood pressure/total peripheral vascular resistance

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12
Q

Factors leading to increase in cardiac output

A 
Increase in heart rate
Increase in stroke volume -> this is achieved by:
Increase in preload
Increase in contractility
Decrease in afterload
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13
Q

What does Qp/Qs >1 mean?

A

L to R shunt. If greater than 2, very large shunt

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14
Q

What does Qp/Qs <1 mean?

A

R to L shunt. If less than 0.7, very large shunt

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15
Q

Most common congenital heart defect?

A

VSD

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16
Q

Most common CHD beyond infancy?

A

TOF

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17
Q

Most common CHD to present in the 1st week of life?

A

TGA

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18
Q

Which CHD is the most common cause of mortality in the 1st week of life?

A

HLHS

Also the 2nd most common CHD presenting in the 1st week of life, after TGA

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19
Q

Name the cyanotic CHDs (hint: there are 9)

A

5 Ts, DO, ESP
5 Ts: Transposition, TOF, Truncus, Tricuspid atresia, TAPVR
DO: Double Outlet RV
ESP: Ebstein’s anomaly, Single ventricle, Pulmonary atresia

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20
Q

Ebstein’s anomaly is associated with an increased risk of?

A

Pulmonary hypoplasia because of large R heart in utero

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21
Q

Single ventricle is associated with an increased risk of?

A

Asplenia or polysplenia

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22
Q

Most common type of TAPVR?

A

Supracardiac (drain into SVC)

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23
Q

Most common type of TAPVR to be obstructive?

A

Infracardiac (subdiaphragmatic)

Presents with cyanosis, respiratory distress (requiring intubation soon after birth), decreased systemic perfusion

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24
Q

Snowman silhouette on CXR

A

Supracardiac TAPVR

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25
Q

What determines the clinical symptoms in DORV?

A

Presence or absence of VSD and pulmonic stenosis

VSD needed for blood flow out of the LV
Pulmonic stenosis determines the pulmonary blood flow (and overcirculation)

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26
Q

MCC of congestive heart failure after the 2nd week of age?

A

VSD

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27
Q

Most common type of VSD?

A

Perimembranous (70%)

Out of these, trabecular region is most common

28
Q

When does functional closure of PDA occur and what is it dependent on?

A

Occurs by 48 hours (2 days) of age in 90% of term infants

It depends on vasoconstriction in the medial smooth muscles

29
Q

When does anatomical closure of the PDA occur and what is it dependent on?

A

Occurs by 2-4 weeks of age

Depends on low blood flow through the lumen, relative hypoxia

30
Q

PDA dilators?

A

Prostaglandin E1, prostaglandin I2 (prostacyclin), acidosis, hypoxemia

31
Q

PDA constrictors?

A

Bradykinin, oxygen, acetylcholine, PGF2

32
Q

What are term infants with a persistent PDA at risk for?

A

Recurrent pneumatosis

33
Q

Type of ASD and VSD in AVCD?

A

Ostium primum ASD
Inlet VSD
Common AV valve

34
Q

What other cardiac anomalies is an aortic coarctation associated with?

A

Bicuspid aortic valve, VSD

30% of patients have Turner’s

35
Q

Most common location for pulmonic stenosis?

A

Valvular

36
Q

What kind of pulmonic stenosis is associated with TOF?

A

Subvalvular/infundibular

37
Q

What kind of pulmonic stenosis is associated with Williams syndrome and rubella?

A

Supravalvular

38
Q

Where does the L main coronary artery arise from in ALCAPA?

A

Pulmonary artery

39
Q

What’s the most common primary cardiac tumor in neonates?

A

Rhabdomyoma

40
Q

What conditions is hypertrophic cardiomyopathy seen with?

A

Noonan syndrome, Pompe’s, Hurler

Also in IDM and postnatal steroids

41
Q

Most common neonatal tachyarrhythmia?

A

SVT (70-80%)

42
Q

What does the development of hydrops in SVT depend on?

A

Duration of tachycardia (does NOT depend on rate of SVT)

Degree of immaturity

43
Q

1st line intrauterine management for SVT?

A

Digoxin

Can also use flecainide or amiodarone

44
Q

Side effects of antiarrhythmics to monitor for in the neonate

A

Hyperbilirubinemia
Anemia from bone marrow suppression
Higher risk for NEC

45
Q

What is an AV block in a fetus with otherwise normal cardiac anatomy associated with?

A

Maternal SSA or SSB antibodies

46
Q

When would you see reverse differential cyanosis?

A

D-TGA, PDA and one or more of the following: PPHN, coarctation of the aorta, or an interrupted arch

47
Q

What causes the widely fixed, split second heart sound in ASD?

A

Delayed RV depolarization, and little change in venous return to the R atrium with respiration

48
Q

Which vessels in the fetus have the highest and lowest oxygen content?

A

Highest is in umbilical vein

Lowest is in SVC (high brain extraction)

49
Q

Normal position designation of cardiac structures?

A

S (atria), D (ventricles), S (great arteries)

50
Q

Why is the oxygen content in the SVC low?

A

Because of high extraction by the brain

51
Q

Most common cause of complete vascular ring?

A

Double aortic arch, results from prevailing R and L 4th branchial arches

52
Q

Mechanism of action of milrinone

A

PDE3 inhibitor

Inotrope, decreases afterload

53
Q

Mechanism of action of digoxin

A

Inhibits Na/K ATPase pump
Negative chronotrope
+ inotrope

54
Q

Which receptors does dobutamine act on

A

B1»B2, little activity on A

+Chronotrope and Inotrope

55
Q

Which receptors does dopamine act on

A

Low dose: dopaminergic
2-6: B1 and dopaminergic: inotropic and inc HR
6-20: B1 and some A1
>20 A1

Causes release of endogenous norepi, so less effective with prolonged use

56
Q

Which receptors does epinephrine

A

B1 and B2>A1

SVR effect is dose dependent (increases with increasing A1 activity)

57
Q

Rashkind procedure

A

Increase foramen ovale size for improving inter-atrial mixing (eg in D-TGA)

58
Q

BT shunt

A

Subclavian artery to pulmonary artery conduit (in cases of inadequate pulmonary flow)
Eg: Pulmonary atresia, Pulmonary stenosis, TOF

59
Q

Most common pediatric symptomatic arrhythmia

A

SVT

60
Q

Most common cardiac anomalies in VACTERL

A

VSD

61
Q

Most common cause of HTN in a neonate

A

Renovascular disease

62
Q

When is fetal congenital heart block in maternal SLE diagnosed?

A

16-24 weeks in utero

63
Q

When do maternal SLE antibodies disappear from the baby?

A

6-8 months of life

64
Q

The effect of epinephrine during neonatal resuscitation is a result of stimulation of mainly which receptors?

A

Alpha-adrenergic receptors and the peripheral vasoconstriction

65
Q

Which receptor are infantile hemangiomas associated with?

A

GLUT-1

66
Q

Preferred vasoactive treatment for septic shock>

A

Norepinephrine

Neo Board Review (16 decks)

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