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RC Review > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Fixed Split S2

A

ASD

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2
Q

Loud Single S2

A

Pulmonary HTN
TGA

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3
Q

Ejection Click

A
  • constant = aortic valve
  • intermittent = pulmonary valve
  • mid-systolic = mitral valve prolapse
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4
Q

Ejection murmur radiating to the neck

A

AS radiating through carotids

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5
Q

Ejection murmur radiating to the back

A

pulmonary stenosis

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6
Q

Findings in Coarctation

A
  • Harsh murmur louder in back (due to collaterals)
  • sBP arm > leg by 20mmHg
  • rib-notching on CXR
  • lower extremity saturation < upper extremity saturation (supplied by PDA)
  • R arm HTN compared to 4 limbs
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7
Q

Regurgitant murmur at the apex

A

Mitral regurgitation&raquo_space; VSD

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8
Q

Regurgitant murmur at LLSB

A

VSD&raquo_space;> tricuspid regurgitation

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9
Q

Continuous murmurs

A
  • PDA (most common)
  • coronary artery fistula
  • venous hum (goes away when supine)
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10
Q

Louder murmur when upright

A

hypertrophic cardiomyopathy

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11
Q

Quieter murmur when upright

A

Still’s murmur
(most murmurs follow this)

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12
Q

Louder murmur with squatting

A

MR with MVP

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13
Q

Easier to hear murmur when leading forward

A

aortic insufficiency

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14
Q

Pulsus paradoxus

A
  • > 10mmHg fall in SPB with inspiration
  • due to tamponade
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15
Q

Left parasternal heave

A

RV dilation

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16
Q

Apex beat with inferior or lateral displacement

A

LV dilation

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17
Q

Indications for ECG in Syncope

A
  • history not diagnostic of vasovagal (no prodrome, mid-exertional)
  • family history of SUCD or heart disease in young individuals
  • abnormal cardiac exam
  • new medication with cardiac effects
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18
Q

Innocent murmurs of childhood

A
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19
Q
A

Sinus arrhythmia
- irregular, variations with inspiration
- asymptomatic, no treatment

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20
Q
A

Third degree heart block
- congenital, structural
- asymptomatic, fatigue or syncope
- treat if reversible, pacemaker if symptomatic

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21
Q
A

WPW
- palpitations during tachycardia
- can have syncope and sudden death
- acute - vasovagal, adenosine, cardioversion
- chronic - beta blocker, ablation

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22
Q
A

Long QT Syndrome
- 1: exertion, swimming
- 2: auditory triggers and post-partum
- 3: sleep trigger
- Treatment with beta blocker, ICD if indicated, exercise restrictions changing
- leads to VT or torsades de pointes

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23
Q

Management of SVT

A
  • vagal maneuvers (expire against closed glottis)
  • ice to face (human dive reflex)
  • adenosine 0.1mg/kg then 0.2mg/kg
  • synchronized cardioversion (first line if unstable)
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24
Q
A

Premature Atrial Contractions
- need a P before every QRS
- normal width QRS
- no treatment unless reversible cause

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25
Q
A

Premature ventricular contractions
- wide QRS
- no p wave before the QRS
- only treat reversible causes

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26
Q

Bundle Branch Block on ECG

A
  • RBBB: rabbit ears in V1
  • LBBB: rabbit ears in V6
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27
Q

ECG changes in ventricular hypertrophy

A
  • LVH: Tall R wave in V6, seep S in V1
  • RVH: tall R in V1, Deep S in V6, Q wave in V1 and abnormal T in V1
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28
Q

Features of Marfan syndrome

A

3 points:
- thumb sign
- wrist sign

2 points:
- pectus
- hindfoot valgus
- protrusion of acetabulum
- pneumothorax
- dural ectasia

3 points:
- arm span : height > 1.05
- myopia
- facial features
- MV prolapse
- striae
- scoliosis/kyphosis
- reduced elbow extension

29
Q

Cardiac finding in T21

A

AVSD

30
Q

Cardiac finding in Turner Syndrome

A

CoA, bicuspid aortic valve, AS, HLHS

31
Q

Cardiac Finding in 22q11.2

A

TOF, TA, aortic arch anomalies

32
Q

Cardiac Finding in William’s Syndrome

A

Supravavlular aortic stenosis

33
Q

Cardiac finding in Noonan Syndrome

A

Pulmonary stenosis, Hypertrophic cardiomyopathy

34
Q

Cardiac finding in Alagile Syndrome

A

Peripheral pulmonary stenosis

35
Q

What causes aortic dilation?

A
  • Marfan
  • Ehlers Danlos
  • Loeys-Dietz
36
Q

Cardiac Finding in VATER/VACTERL

A

VSD, TOF, TGA

37
Q

Cardiac Finding in CHARGE

A

VSD, ASD, TOF, DORV

38
Q

What syndromes are associated with cardiomyopathies?

A
  • Frederich/s Ataxia
  • Noonans
  • Pompe
  • DMD
39
Q

What cardiac finding is associated with NF1

A

CoA

40
Q

What is the cardiac finding in TS?

A

rhabdomyomas

41
Q

What are the cardiac findings associated with Kabuki syndrome?

A

CoA, ASD, AS, MS, HLHS

42
Q

Cardiac finding in FASD

A

VSD

43
Q

Cardiac finding in T13

A

PDA, septal defects, aortic stenosis

44
Q

Cardiac findings in T18

A

VSD, polyvalvular disease

45
Q

Cardiac findings in Holt-Oram syndrome (limb defects)

A

ASD

46
Q

Cardiac findings in Ellis-Van Creveld (polydactyly)

A

ASD

47
Q

Cardiac finding in infant of a diabetic mother (IDM)

A

Hypertrophic cariomypathy, transient septal hypertrophy

48
Q

CHD with increased pulmonary flow

A
  • ASD
  • VSD
  • AVSD
  • PDA
  • AV malformation
  • TAPVR
  • TA
  • TGA
49
Q

CHD with decreased pulmonary vascularity

A
  • TOF
  • TA
  • Ebstein’s
  • Pul HTN
  • TGA with PS
50
Q

CHD with normal pulmonary vascularity

A
  • AS
  • CoA
  • Congenital MS
  • PV stenosis
51
Q

What is Eisenmenger physiology?

A

Increased pulmonary blood flow (ASD, VSD) leads to pulmonary HTN, and increased PVR causes reversal of shunting from R to L leading to cyanosis

52
Q

What is the most common congenital heart lesion?

A

VSD

53
Q

Indications for prostaglandins?

A
  • critical PS
  • critical CoA
  • TGA (improves mixing, can make worse if blood flow closes the PFO)
  • HLHS
  • Ebstein’s anomaly
54
Q

How do you treat a tet spell?

A
  • remove stressors
  • knee chest/squat position (increased afterload and decrease R to L shunt)
  • oxygen (drop PVR)
  • fluid (increased preload)
  • morphine (treat hyperpnea and decrease systemic catecholamines)
  • phenylephrine (increased SVR)
  • propranolol (lessen RV outflow obstruction)
55
Q

Complications of the Fontan Procedure

A

Arrythmias
- sinus node dysfunction
- atrial flutter/SVT

Cyanosis
- collaterals
- pulmonary AVMs

PLE
Plastic bronchitis
Thromboembolism

56
Q

CHD with a normal CXR

A
  • AS
  • CoA
  • HLHS
  • TA
  • PS
  • TGA (CAN have a normal CXR sometimes)
57
Q

Features of pathologic murmurs

A
  • diastolic
  • continuous
  • holosystolic
  • late systolic
58
Q

ECG changes of rheumatic fever

A
  • prolonged PR interval
  • LA enlargement
59
Q

Jones Criteria for Acute Rheumatic Fever

A

MAJOR
- carditis (valve involvement - MR > AR > MS > AS)
- migratory polyarthritis
- chorea
- erythema marginatum
- subcutaneous nodules

MINOR
- fever > 38.5
- arthralgia
- history of previous ARF
- elevated ESR > 60 /CRP > 30
- prolonged PR on ECG

Criteria: evidence of recent strep infection and 2 major or 1 major and 2 minor

60
Q

Treatment of ARF

A
  • Penicillin x 10 days to eradicate GAS
  • Bed rest - 1-2 weeks for arthritis, 4 weeks for carditis
  • High dose ASA for carditis (prednisone if severe)
  • ASA or naproxen for arthritis (uniquely sensitive to ASA)
  • Pen V BID for prevention
61
Q

How long do you continue secondary prevention in ARF?

A
  • no carditis: 5 years or until 21
  • carditis: lifelong

*whatever is longer

62
Q

ECG changes in cardiomyopathy?

A
  • Dilated: wide ST changes
  • Hypertrophic: big voltages
  • Restrictive: HUGE bilateral atrial voltages
63
Q

Cardiac clinical features of Pompe Disease

A
  • cardiomegaly
  • increased wall thickness
  • can lead to SVT
  • ECG has short PR interval, extremely tall WRS voltages
64
Q

ECG Change in brudaga syndrome?

A
  • coved ST segment in right precordial leads and RBB
  • sudden unexplained nocturnal death syndrome with malignant ventricular arrythmias
65
Q

Medications causing long QT

A
  • Antiarrhythmic
  • antihistamines (diphenhydramine)
  • antibiotics and antifungals (macrolides, septra, clinda, azoles)
  • psychotropic drugs (TCAs, carbamazepine, risperidone, haldol)
  • others
66
Q

Duke Criteria for Endocarditis

A

2 major OR 1 major + 3 minor OR 5 minor

MAJOR
- positive culture (typical bug x 2) or ECHO evidence (vegetation, abscess)

MINOR
- fever > 38
- vascular phenomena (emboli, conjunctival hemorrhage, janeway lesions)
- immune (glomerulonephritis, Osler nodes, roth spots, RF)
- +ve cultures not meeting major criteria
- high risk (IVDU or known cardiac risk factor)

67
Q

Indications for endocarditis prophylaxis?

A

WHO
- prosthetic heart valves
- Cyanotic (single ventricle, TOF)
- completely repaired with prosthetic material or device for 1st 6 months post repair
- history of endocarditis
- repaired CHD with residual defects (leak, abnormal flow near patch or device)

WHEN
- dental - when gums will be injured, tooth extraction, dental abscess, bleeding anticipated, oral suture removal, oral biopsy, placement of orthodontic bands, fillings
- Resp - T&A, biopsy during bronchoscopy
- surgery through an infected area (skin, GI/GU

NOT
- dental - injury to lips/gums, loss of baby teeth, injection of anesthetic, placement of removable appliances
- resp - intubation, ear tubes, nosebleeds
- Skin - skin suturing, circumcision
- GI/GU - scopes, catheter insertions, strictura dilations, biopsies
- C?S, deliveries

68
Q

Physical exam findings in pulmonary hypertension

A
  • precordial bulge, RV heave
  • loud single S2
  • TR and PR murmurs
  • pulsatile liver, hepatomegaly
  • edema

RC Review (26 decks)

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