Cardiology

Question 1

What type of aortic coarctation is associated with other cardiac defects?

Answer 1

Preductal CoA

Question 2

When does postductal CoA present?

Answer 2

Later in life than preductul (can be adult or older children). often has collaterals. “Rib notching”.

Question 3

What percent of Turner syndrome pts have CoA?

Answer 3

30%, over 50% with bicuspid aortic valve, also with inc risk VSD

Question 4

What EKG change is seen with AV canal defect?

Answer 4

Superior QRS axis (due to anatomical abnormality of HIS bundle)

Question 5

What type of abnormality causes a widely split, fixed S2?

Answer 5

ASD (2/2 delayed RV depolarization)

Question 6

When does PDA close in term infants?

Answer 6

48 hours (functional), 2-4 weeks (anatomic)

Question 7

What are PDA constrictors?

Answer 7

PGFa2, acetycholine, bradykinin, oxygen

Question 8

What are PDA dilators?

Answer 8

Acidosis, hypoxia, PGE1, PGI2 (prostacyclin)

Question 9

What is the most common congenital heart disease?

Answer 9

VSD (also most common cause of CHF after 2nd week of life)

Question 10

Most common type of VSD

Answer 10

Perimembranous (70%). Less likely to close than muscular

Question 11

How many infants with CHD will have other non-cardiac anomalies?

Answer 11

25%

Question 12

What is higher risk for inheritance, mother or father with CHD?

Answer 12

Mother - risk 6.7%, father - risk 1.5-3%

Left sided obstructive lesions are most inheritable

Question 13

What defect is egg on a string?

Answer 13

D-TGA (narrow mediastinum 2/2 anterior posterior aorta and MPA), also with involuted thymus

Question 14

What medicatiom causes Ebsteins anomaly?

Answer 14

Lithium

Question 15

How to calculate mean BP

Answer 15

Diastolic BP + 1/3 (SBP - DBP)

Question 16

What organ recieves highest percentage of fetal cardiac output?

Answer 16

Placenta (45%)

Question 17

What keeps PDA open in utero?

Answer 17

PGE2, PGI2 (prostacyclin), thromboxane A2. ** PGE1 used postnatally

Question 18

Most common primary cardiac tumor

Answer 18

Rhabdomyoma (usuallly multiple, associated with tuberous sclerosis)

Question 19

Is polysplenia or asplenia worse?

Answer 19

Asplenia (always has severe cardiac anomalies, 90% with TAPVR) polysplenia has less severe cardiac anomalies (70% TAPVR, 40% dextrocardia)

Question 20

What causes boot shaped heart?

Answer 20

Tetraology of fallot (RVH causes apex to rotate upward)

Question 21

Snowman heart of CXR

Answer 21

Supracardiac TAPVR (dilated vertical vein and SVC, increased PBF)

Question 22

What are treatments for fetal SVT?

Answer 22

1. digoxin (IV more reliable)
2. Amiodarone (if fetus sick), oral better
3. procainamide, flecainide, sotalol (all if fetus less sick). High mortality rate.

Question 23

What are postnatal complications of fetuses treated with maternal antiarrythmics?

Answer 23

Hyperbilirubinemia, NEC, anemia from bone marrow suppression

Question 24

How to treat fetal atrial flutter?

Answer 24

1. Digoxin (IV begger)
2. Sotalol - treatment of choice if refractory
   Do NOT use amiodarone (slows rate, does not impact rhythm)

Question 25

What is difference between 2 types of second degree AV block?

Answer 25

Mobitz type 1: Wenckebach (progressive increase in PR interval until beat dropped)
Mobitz type 2: stable PR, abrupt beat drop (more severe, can progress to complete heart block)

Question 26

What is dose for cardioversion?

Answer 26

0.25-0.5 j/kg for SVT and atrial dysrrthmias. Increase 50-100% each time, max 2 j/kg

Question 27

What is dose for electrical defibrillation?

Answer 27

Start with 1-2 j/kg and max dose of 4 j/kg

Question 28

What anomalies is WPW associated with?

Answer 28

Most common: structurally normal heart; also with Ebsteins anomaly, L-TGA

Question 29

What EKG change does hypercalcemia cause? Hypocalcemia?

Answer 29

Hypercalcemia: Shortened QT interval
Hypocalcemia: Prolonged QT interval

Question 30

What ekg changes does hypokalemia cause?

Answer 30

Widened QRS, very low K (<1.0) with flattened T waves, if sustained may develop prolonged PR interval and sinoatrial block

Question 31

Cardiac defects from thalidomide

Answer 31

Conotruncal malformations

Question 32

Cardiac defects from warfarin

Answer 32

PDA, PPS

Question 33

Cardiac defects from valproic acid

Answer 33

ASD, VSD, AS, Pulm atresia with intact septum, CoA, TOF

Question 34

Cardiac effect of ethanol

Answer 34

VSD, ASD, TOF, CoA

Question 35

What are cardiac effects of aspirin and SSRIs?

Answer 35

Pulmonary hypertension

Question 36

What are the top 2 most common causes of vascular ring?

Answer 36

1. Double aortic arch (40%)

2. Right aortic arch with PDA or ligamentum arteriosus (30%)

Question 37

What pressor causes cyanide toxicity?

Answer 37

Nitroprusside

Question 38

What is most common cardiac defect in VACTERL?

Answer 38

VSD (over 50% of the heart lesions in vacterl)

Question 39

What embryonic week does endocardial septum form?

Answer 39

Week 7-8

Question 40

What embryonic structure gives rise to the ductus arteriosus?

Answer 40

Left 6th aortic arch (proximal portions of bilateral 6th arches become proximal branch pulm arteries). Left 4th arch -> part of aortic arch

Question 41

Most common brain MRI finding after cardiac surgery

Answer 41

White matter injury

Question 42

What are risk factors for brain injury after cardiac surgery?

Answer 42

1. Type of lesion
2. Cardaic bypass time
3. Use of deep hypothermic cardiac arrest

Question 43

What suggests right atrial enlargement on ekg?

Answer 43

Tall peaked P waves

Question 44

What are common findings in DiGeorge Syndrome?

Answer 44

Conotruncal cardiac defects, hypocalcemia, hypoplastic thymus, cleft palate, immunodeficiency