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PHM Board Review > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Describe the murmur heard in patients with Hypertrophic Cardiomyopathy

A

HOCM is a LVOT obstruction, so murmur will increase with increased afterload or decreased pre-load
Systolic Murmur, increases with valsalva (increased afterload) as well as hand grip/standing (decreased pre-load).
The murmur decreases with increasing pre-load (squatting)

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2
Q

Which congenital heart lesion is associated with:
Di-George
Noonan Syndrome
Trisomy 21
Trisomy 18
Trisomy 13
Turner Syndrome
Williams syndrome

A

DiGeorge (22 q 11) = truncus arteriosus
Trisomy 21 = AV canal defects
Noonan = dysplastic pulmonary valve
T 18 = VSD
T13 = PDA, VSD, ASD
Turner = aortic coarctation
Williams Syndrome = Supra-aortic stenosis, pulmonary atresia

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3
Q

List the 4 components of TOF

A

VSD
Overriding aorta
Pulmonary stenosis
RV hypertrophy

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4
Q

How do you diagnose vascular sling

A

left pulmonary artery sling = anterior indentation on the esophagus seen on a VFSS or an upper GI. Chest CTA is an acceptable alternative.

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5
Q

What are the indications for endocarditis prophylaxis?

A

Prophylaxis for procedures with high risk for bacteremia (dental, resp, soft tissue, cardiac)
Use amoxicillin/ampicillin or cephalexin, clinda, azithro if allergic
1) Prior endocarditis
2) Unrepaired cyanotic congenital heart disease or repaired with residual defect
3) any prosthetic material

Note: not indicated for h/o rheumatic fever, kawasaki, valve disease, HCM

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6
Q

You are treating a patient with a prosthetic valve who presents with fever, murmur, and small non-blanching lesions on her hands. What is the most likely causative organism and what is the appropriate empiric treatment?

A

S. Aureus.
Ampicillin and gentamycin for synergy.
Add rifampin when organism is identified.

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7
Q

What is the workup for HTN

A

labs (cmp, lipids)
UA
renal US if age <6 or abnormal UA/labs
echo if you are planning to treat with medications

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8
Q

Which congenital heart defects feature ductal dependent systemic circulation?

A

Those with left sided outflow tract obstruction including:
1. Hypoplastic left heart
2. Severe aortic valve stenosis
3. Severe coarctation or interrupted arch.

(Transposition of the great vessels also relies on the PDA to pass oxygenated blood to the systemic circulation.)

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9
Q

How do patients with ductal dependent systemic circulation present as the ductus artieriosus closes?

A

Shock and circulatory collapse with accompanying grey/cyanotic/mottled appearance.

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10
Q

How do patients with ductal dependent pulmonary circulation present as the ductus arteriosus closes?

A

Severe hypoxia/cyanosis.

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11
Q

What congential heart defects feature ductal dependent pulmonary circulation?

A

Those with right sided outflow tract obstruction including:

  1. TOF with severe pulmonary stenosis
  2. Isolated severe pulmonary stenosis or atresia
  3. Ebstein’s anomaly

(Transposition of the great vessels also relies on the PDA to pass oxygenated blood to the systemic circulation.)

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12
Q

What are the most common causes of viral myocarditis

A
  1. Enterovirus (esp. coxsackie group B)
  2. Adenovirus
  3. Parvovirus B19
  4. EBV
  5. CMV
  6. HSV
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13
Q

What is the treatment for myocarditis?

A

Supportive care, careful fluid management, and (possibly) IVIG

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14
Q

What are the EKG findings suggestive of pericarditis?

A

Widespread ST elevation with PR depression.

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15
Q

What are the diagnostic criteria for pericarditis?

A
  1. Pleuritic chest pain.
  2. Friction rub on auscultation.
  3. Suggestive EKG changes.
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16
Q

Di-George syndrome is associated most commonly with what heart defect?

A

Truncus arteriosus (Twenty Two - Truncus Too)

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17
Q

What is the treatment for pericarditis?

A

First line: NSAIDS
Then: Colchicien
Then: Maybe steroids
Then (for recurrence): Immuno-modulators or surgical procedure.

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18
Q

What are the congenital heart defects commonly seen in patients with Trisomy 21?

A

AV Canal defects

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19
Q

Coarctation of the aorta is commonly seen in patients with which chromosomal abnormality?

A

Turner Syndrome (45,X,O)

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20
Q

What are the congenital heart defects most commonly seen in patients with Williams Syndrome?

A

Supra-aortic stenosis, pulmonary atresia

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21
Q

What is the congential heart defect most often seen in patients with Alagille Syndrome?

A

Peripheral pulmonary artery stenosis

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22
Q

What is the initial workup for syncope?

A

History and physical, EKG, orthostatics

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23
Q

What are historical red flags in a patient with syncope?

A

Family history of sudden cardiac death
Known heart abnormality
Electrolyte abnormalities
Symptoms with exertion
Lack of prodrome
Palpitations

(Remember: FaKE SLaP)

24
Q

What class of antihypertensive should absolutely be avoided in pediatric patients with presumed essential hypertension?

A

ARBs or ACE inhibitors (unless renal artery stenosis has been ruled out, which it probably hasn’t been if following the recommended workup for a hypertensive child who is not demonstrating hypertensive urgency/emergency. Also do not use ACE inhibitor if patient of reproductive age.)

25
Q

What are the most common organisms responsible for rheumatic fever?

A
  1. Strep
  2. Staph
  3. HACEK:
    - Haemophilus (not H. Flu)
    - Aggregatibacter
    - Cardiobacterium hominus
    - Eikenella corodin
    - Kingella
26
Q

What are the minor Duke criteria

A
  • Predisposing heart condition or injection drug use
  • Fever: temperature >38°C
  • Vascular phenomena: (Septic or vascular emboli, Janeway lesions, etc)
  • Immunologic phenomena: (GN, Osler’s nodes, etc.)
  • Microbiological evidence: single positive blood culture with organism consistent with infective endocarditis
27
Q

What are the major Duke criteria?

A
  • Two blood cultures positive for organism consistent with infective endocardiits (Strep / Staph / HACEK)
  • Echocardiographic evidence of endocarditis
28
Q

What are the diagnostic criteria for “Definite Infectious Endocarditis”

A
  • 2 major clinical criteria, OR
  • 1 major and 3 minor clinical criteria, OR
  • All 5 minor clinical criteria
29
Q

What are the diagnostic criteria for “Possible Infectious Endocarditis”

A
  • Presence of 1 major and 1 minor clinical criteria OR
  • Presence of 3 minor clinical criteria
30
Q

How is infectious endocarditis ruled out?

A
  • Clear alternative diagnosis OR
  • Resolution of symptoms after 4 or less days of antibiotics OR
  • Criteria for definite or possible infectious endocarditis not met.
31
Q

You are called to the bedside of a 4 day old infant who is in severe respiratory distress, is grey and mottled, has a heart rate of 180 on the monitor, but does not have palpable pulses. (1) If the patient has a congenital heart defect, is it more like affecting pulmonary or systemic outflow? (2) Which would be the most common congenital heart defect presenting in this way?

A

(1) Systemic outflow
(2) Hypolastic left heart

32
Q

What is the indication for an implanted pace maker / defibrillator in a patient with hypertrophic cardiomyopathy?

A

Unexplained syncope

33
Q

What are the classifications of heart failure (AHA)?

A

A: Increased risk, but normal function.
B: Abnormal function but no symptoms
C. Past or current symptoms but responsive to therapy.
D. Symptoms at rest despite maximum therapy.

34
Q

What is the hierarchy of pharmacologic treatment for heart failure with ventricular dysfunction?

A

ACE –> (ARB if cannot tolerate ACE) –>
Add spironolactone –>
Add diuretic (typically lasix) for overload and digoxin for symptom relief –>
Add beta blocker –>
IV diuretics and inotropes –>
(Mechanical support and transplantation).

35
Q

What is the initial treatment for hypertrophic obstructive cardiomyopathy (without syncope)?

A

Beta blocker, unless contraindicated (e.g. asthma), in which case use nondihydropyridine calcium channel blocker (e. g. verapamil).

Note that this is different than heart failure with impaired ventricular function, for which ACE inhibitors are first line.

36
Q

What is the treatment for hypertrophic obstructive cardiomyopathy with syncope or a family history of sudden cardiac death?

A

Implanted cardiac defibrillator

37
Q

What is the treatment of heart failure with normal ventricular function?

A

Surgical or interventional correction of the anatomic defect leading to the failure.

38
Q

You are called to the bedside of a 4 day old infant who is in severe respiratory distress, is grey and mottled, has a heart rate of 180 on the monitor, but does not have palpable pulses. What urgent interventions are indicated?

A

Intubate
IV access
Fluid administration
Prostaglandin E1

39
Q

What are the definitions of elevated BP, Stage 1 HTN, and Stage 2 HTN

A

Elevated: 90th-95th percentile or 120-129 / <80
Stage 1: 95th percentile - 95th percentile + 12 or 130 - 139 / 80 - 89
Stage 2: > 95th percentile + 12 or > 140/90
(Note that elevated DBP is more predictive of secondary HTN vs. primary)

40
Q

What is the treatment algorithm for asymptomatic essential hypertension?

A
  1. Recheck BP
  2. Lifestyle changes
  3. Long acting CCB (or ACE if patient does not have renal artery stenosis)
41
Q

What is the goal of therapy for a hypertensive patient with evidence of acute end organ damage?

A

Decrease BP by 25% within first 8 hours.

42
Q

What are suitable agents to give in a hypertensive emergency?

A
  1. Hydralazine (no drip)
  2. Labetalol (contra-indicated if patient has heart failure or asthma)
  3. Nicardipine
43
Q

What are the indications for synchronized cardioversion?

A

Clinically unstable (or adenosine refractory) SVT or V-Tach

44
Q

What is the dose for syncronized cardioversion?

A

0.5-1J/kg. Increase to 2 J/kg if not effective

45
Q

What is the indication and dosing for adenosine in the treatment of cardiac arrhythmias?

A

Clinically stable SVT or V-tach (with a pulse), 0.1 mg/kg, followed by 0.2 mg/kg if needed. (Max dose is 6 and 12mg, respectively.)

46
Q

What is the treatment for viral myocarditis?

A

IVIG (maybe)

47
Q

What are the auscultation signs of hypertrophic obstructive cardiomyopathy?

A

Systolic ejection murmur increasing with valsalva maneuver.

48
Q

What heart malformation is associated with sudden cardiac death in teenagers?

A

Hypertrophic obstructive cardiomyopathy.

49
Q

What are the SIRS criteria?

A

Two or more of:
Fever
Tachycardia
Tachypnea
Leukocytosis or leukopenia

50
Q

What are the ECG findings in hyperkalemia?

A

Peaked t-waves
Flattened and prolonged p-waves
Prolonged QRS

51
Q

What are the ECG changes associated with hypercalcemia?

A

Biphasic T waves, prominent U waves, short Q-T interval, elevated S-T

52
Q

What are the ECG changes associated with hypocalcemia?

A

Prolonged Q-T interval

53
Q

What is the initial treatment for symptomatic hyperkalemia?

A

Calcium, either in the form of calcium chloride (preferred, but needs central line), or calcium gluconate. Adjunct treatments include albuterol, insulin and dextrose, kayexalate

54
Q

What is the initial treatment for symptomatic hypercalcemia?

A

NS bolus, subcutaneous calcitonin, and bisphosphanate.

55
Q

You are called to the bedside of a 10 day old infant who is grey and mottled, in only minimal respiratory distress, has a heart rate of 180 on the monitor, but does not have palpable pulses. (1) If the patient has a congenital heart defect, is it more like affecting pulmonary or systemic outflow? (2) Which would be the most common congenital heart defect presenting in this way?

A

(1) Systemic
(2) Aortic stenosis (as opposed to HLHS which can present similarly, but with more respiratory distress and much earlier).

PHM Board Review (15 decks)

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