Cardiology Flashcards
1
Q
What can an ECG identity?
A
Arrhythmia
Myocardial ischaemia and infarction
Pericarditis
Chamber hypertrophy
Electrolyte disturbance
Drug toxicity
2
Q
Risk factors for atherosclerosis?
A
Increasing age
Male
Family history
Obesity
Type 2 diabetes mellitus
Smoking
Hypertension
Hypercholesterolemia
3
Q
How are atherosclerotic plaques distributed?
A
Peripheral and coronary arteries
Focal distribution along length of artery
4
Q
What are the components of an atherosclerotic plaque?
A
Lipid
Necrotic core
Connective tissue
Fibrous cap
5
Q
What is angina?
A
Chest pain caused by reversible myocardial ischaemia
6
Q
What is the most common cause of angina?
A
Atherosclerotic narrowing
7
Q
Types of angina?
A
Printzmetal
Stable
Unstable
8
Q
What are the features of stable angina?
A
Induced by effort
Relieved by rest
9
Q
What is unstable angina?
A
Angina of recent onset
Symptoms at rest, not relieved by rest or GTN spray
Creshendo pattern of increasing severity of symptoms
10
Q
What is the cause of prinzmetals angina?
A
Coronary artery spasm
11
Q
What is the aetiology of angina?
A
Atherosclerosis
Valvular disease
Arrhythmia
Anaemia
12
Q
What is the pathophysiology of angina?
A
Atherosclerotic narrowing reduces blood flow to myocardium
Vessel undergoes adaptation to maximise blood flow to myocardium
Vessel adaptations are exhausted and myocardium is deprived from oxygen causing symptoms of angina
13
Q
Risk factors for atherosclerotic cardiovascular disease?
A
Male
Family history
Increasing age
Hyperlipidaemia
Hypertension
Diabetes mellitus
Lack of exercise
Poor diet
Smoking
Obesity
Illicit drug use
14
Q
Clinical presentation of angina?
A
Central crushing chest pain, relieved by rest/ GTN and exacerbated by exertion
Exertional dyspnoea
Perspiration
Fatigue
15
Q
Investigations performed to diagnose angina?
A
Resting ECG
Bloods; FBC, lipid profile, troponin, glucose
Exercise ECG
16
Q
Differentials for angina?
A
Aortic dissection
Pericarditis
PE
Pneumonia
Pneumothorax
Oesophagitis/ oesophageal spasm
GORD
Peptic ulcer disease
17
Q
Management for angina?
A
Lifestyle modification; healthier diet, stop smoking, exercise and optimise risk factors
GTN spray for symptom relief
Antiplatelet and statin therapy based on Q-RISK score
18
Q
What are the monitoring requirements for angina?
A
Follow-up every 4-6 months until stable, then convert to annual review
Monitor adherence to lifestyle modification
19
Q
Complications of angina?
A
Heart failure
Ischaemic cardiomyopathy
Sudden cardiac death
Myocardial infarction
Stroke
Peripheral arterial disease
20
Q
Prognosis of angina?
A
58% of patients will be angina free within a year of starting treatment
Dynamic process, even with therapy there can be declining symptoms and progression of disease
21
Q
What is ACS?
A
STEMI
NSTEMI
Unstable angina
22
Q
What is the difference between MI and unstable angina?
A
In UA there is no myocardial necrosis and hence no rise in cardiac enzymes and loss of cardiac tissue
23
Q
What is unstable angina?
A
Myocardial ischaemia at rest or on minimal exertion in absence of acute cardiac necrosis
24
Q
Aetiology of unstable angina?
A
Non occlusive disruption of atherosclerotic plaque
Coronary artery spasm
25
Pathophysiology of unstable angina?
Atherosclerotic lesion narrows blood flow through coronary artery
Acute narrowing, significantly more than normal results in rapid onset anginal symptoms
Resulting in myocardial ischaemia and chest pain with no infarction
26
Clinical presentation of unstable angina?
Prolonged angina lasting longer than 20 minutes
Crescendo pattern; increasing frequency, duration
Epigastric, central chest pain
Sweating
Dyspnoea
Syncope
27
Investigations performed in unstable angina?
ECG; normal, non specific changes
Bloods; FBC, U+E, LFT, TFT, CRP, glucose, cardiac enzymes
Chest X-ray
28
What are cardiac enzyme levels in unstable angina?
Normal, not elevated
29
Differentials for unstable angina?
Stable angina
Prinzmetal angina
STEMI/ NSTEMI
Congestive cardiac failure
Pericarditis
Myocarditis
Aortic dissection
PE
Pneumothorax
Pleuritis
30
Management of unstable angina?
Aspirin
Statin
GTN
Consider angiography and revascularisation is symptomatic and high risk of cardiac event
31
Monitoring requirements in unstable angina?
Re-evaluate symptoms 2-6 weeks after discharge and assess need for angiography/ revascularisation
32
Complications of unstable angina?
Bleeding risk
Thrombocytopenia
Congestive heart failure
Ventricular arrythmias
33
Prognosis of unstable angina?
Depends on management and progression of disease
34
What is a myocardial infarction?
Acute compromise of myocardial blood flow resulting in tissue ischaemia, necrosis and death
35
What is the epidemiology of MI?
STEMI incidence is declining and NSTEMI incidence is increasing
More common in males and older people
36
What is the aetiology of MI?
Acute vaso-occlusive event; Atherosclerotic plaque rupture causing complete occlusion of vessel
Dynamic occlusion; Focal coronary artery spasm
Supply demand mismatch; anaemia, blood loss, arterial inflammation
37
Pathophysiology of MI?
Inflammatory mediator mismatch leads to rupture of fibrous cap on atherosclerotic plaque
Thrombus forms after exposure to underlying collagen, which may grow to occlude lumen, equally a fragment may embolise and cause blockage distal to to thrombus
38
What is the pathophysiology of STEMI?
Complete, prolonged occlusion of a major coronary vessel resulting in transmural infarction
39
What is the pathophysiology of NSTEMI?
Severe narrowing or transient occlusion of a major vessel or complete occlusion of a minor vessel resulting in partial thickness infarction
40
Classification of MI?
Type 1; spontaneous MI due to pathological process in wall of coronary artery
Type 2; MI secondary to increased O2 demand or decreased supply
Type 3; sudden unexpected cardiac death before biomarkers can be obtained
Type 4; MI associated with PCI, stent thrombosis, restenosis
Type 5; MI associated with CABG
41
Clinical presentation of MI?
Chest pain; retrosternal srushing, heavy pain, radiating to left arm, neck and jaw, may be intermittent/ constant
Nausea/ vomiting
Dyspnoea
Syncope
Palpitations
Pallor
42
Investigations to diagnose MI?
ECG
Cardiac biomarkers
Baseline bloods; glucose, FBC, U+E, CRP, lipids
Chest X-ray
43
In which lead would anterior wall changes be seen?
V1-V4
44
In which lead would inferior wall changes be seen?
II, III, aVF
45
In which lead would lateral wall changes be seen?
I, aVL, V5-V6
46
Differentials for MI?
Unstable angina
Aortic dissection
Pulmonary embolism
Pneumothorax
Pneumonia
Pericarditis, myocarditis
GORD, Oesophageal spasm
Anxiety, panic attack
47
Management of STEMI?
ABCDE
Initial management; Morphine, Oxygen, Antiplatelet loading dose, Nitrates
Primary PCI if available within 120 minutes of symptom onset
If PPCI is not available then proceed with thrombolysis
48
What is the loading dose of aspirin?
300mg
49
What is the post STEMI management?
DAPT for 12 months
Statin
Beta blocker
ACE-i
Cardiac rehab
50
What is the management of NSTEMI?
Same initial management as STEMI
Invasive coronary angiography is should be offered within 72 hours
51
Monitoring recommendations post MI?
See in clinic 2 weeks post MI and every 6 months until lipids are stable
52
What is the guidance for driving after MI?
No driving for 4 weeks
53
Complications of MI?
Dressler's syndrome
Cardiac arrhythmias
Acute heart failure
Cardiogenic shock
Ventricular aneurysm/ rupture
Mitral reguargitation
VTE
In-stent thrombosis
54
Poor prognostic factors in MI?
ST depression in NSTEMI
Duration of ischaemia and time to reperfusion
Extent of underlying atherosclerosis
Presence of collateral blood flow
Diameter of affect coronary vessel
Degree of occlusion
Presence of co-morbidities
Elderly with established left ventricular dysfunction
55
What is Dressler's syndrome?
Pericardial inflammation as a result of of immune response to damaged myocardium in context of infarction, surgery or trauma
56
Epidemiology of Dressler's syndrome?
0.1% of MI patients will develop dressler's syndrome
57
Aetiology of Dressler's syndrome?
Post MI, cardiac surgery or traumatic insult to chest
58
Risk factors for Dressler's syndrome?
Heart attack
Cardiac surgery
Chest trauma
Previous use of prednisone
Viral infection
Previous case of pericarditis
59
Clinical presentation of Dressler's syndrome?
Fatigue
Weakness
Fever
Chest pain; worse when lying down, relieved by leaning forward, radiates to shoulder, exacerbated by exertion
Exacerbated by exertion
Dyspnoea
Palpitations
Painful joints
Loss of appetite
60
Investigations to diagnose Dressler's syndrome?
Bloods; FBC and ESR
ECG
Echocardiogram
Chest X-ray
CMR/ CT
61
Management of Dressler's syndrome ?
NSAIDs
Colchicine
Prednisolone
Pericardiocentesis in severe effusion
62
Complications of Dressler's syndrome?
Cardiac tamponade
Constrictive pericarditis
Complications of pericardiocentesis
63
Complications of Pericardiocentesis?
Damage to heart or nearby organs
Collapsed lung
Arrhythmia
Cardiac arrest
Bleeding
64
Prognosis of Dressler's syndrome?
Majority of patients will make a full recovery
In 10% of patients dressler’s syndrome can reoccur
65
How can Dressler's syndrome be avoided?
Colchicine dose before planned intervention/ surgery
66
What is pericarditis?
Inflammation of the pericardium
Can be dry (fibrinous) or effusive with purulent/ serous/ haemorrhagic exudate
67
Epidemiology of pericarditis?
Acute pericarditis is common between age 20 and 50
Most common disease of pericardium
68
Aetiology of pericarditis?
Viral infection
Systemic autoimmune disease
Secondary immune response
Post myocardial infarction
Myocarditis
Neoplasm/ Paraneoplastic syndrome
Trauma
Metabolic disorder
Medications
69
Pathophysiology of pericarditis?
Inflammation of pericardial tissue results in pain as pericardium is highly innervated
Effusion is a result of inflammatory cytokine release causing water to enter the pericardium
70
Classification of pericarditis?
Acute pericarditis; new onset, <4-6 weeks
Incessant pericarditis; more than 6 weeks but less than 3 months
Recurrent pericarditis; symptom free intervals
Chronic pericarditis; symptoms more than 3 months
71
Risk factors for pericarditis?
Male sex
Age between 20 and 50 years
Transmural myocardial infarction
Cardiac surgery
Neoplasm
Viral/ bacterial infections
Uraemia/ dialysis
Systemic autoimmune disorders
Pericardial/ mediastinal injury
72
Clinical presentation of pericarditis?
Chest pain; acute onset, sharp, pleuritic pain, relieved by sitting up or leaning forward, may radiate to shoulders
Fever
Malaise
Pericardial rub
73
How can ischaemic pain be differentiated from pericarditis?
Pericarditis pain does not respond to nitrates
74
Investigations performed in pericarditis?
ECG
Bloods; troponins, CRP, ESR, U+E, FBC, LFT
Chest X-ray
Echocardiogram
Pericardiocentesis
75
Differentials for pericarditis?
Pulmonary embolism
Myocardial infarction
Pneumonia
Pneumothorax
Costochondritis
76
Management of pericarditis?
Supportive care
Exercise restriction
NSAIDS
Colchicine
Consider steroids in severe cases
Consider pericardiocentesis in severe cases and risk of tamponade
77
Monitoring requirements in pericarditis?
Long term surveillance is not necessarily
Repeat imaging maybe required inpatients with associated effusion or suspicion of constrictive pericarditis
78
Complications of pericarditis?
Chronic constrictive pericarditis
Cardiac tamponade
79
Prognosis of pericarditis?
Generally a self limiting disease
Poor prognostic factors; evidence of large pericardial effusion, high fever, sub-acute course, failure to respond to NSAIDs
80
What is cardiac tamponade?
Accumulation of pericardial fluid, blood, pus or air within pericardial space resulting in increased intra-pericardial pressure causing impaired cardiac output and reduced diastolic function
81
Epidemiology of cardiac tamponade?
More common in middle and older populations
More common in patients with specific underlying cause rather than idiopathic pericarditis
82
Aetiology of cardiac tamponade?
Iatrogenic; cardiac surgery, intervention
Trauma
Malignancy
Idiopathic effusion
Viral, bacterial infection
Radiation
Connective tissue disease
83
Pathophysiology of cardiac tamponade?
Accumulation of fluid in pericardial space results in increased pressure
This can rise above chamber pressure impairing cardiac function causing pressures in heart to rise to prevent collapse
Eventually equalisation of pressures can result in collapse of cardiac chambers
84
Risk factors for cardiac tamponade?
Malignancy
Aortic dissection
Purulent pericarditis
Large idiopathic pericardial effusion
Iatrogenic- related haemorrhage
Tuberculosis
Autoimmune disease
Hypothyroidism
Uraemia and renal failure
Anticoagulation
85
Clinical presentation of cardiac tamponade?
Becks triad
Dyspnoea
Tachycardia
Pulsus paradoxus
86
What is beck's triad?
Elevated JVP
Muffled heart sounds
Hypotension
87
Investigations performed in cardiac tamponade?
ECG; low voltage QRS
TTE
Chest X-ray
Bloods; FBC, ESR, cardiac enzymes
88
What is seen on TTE?
Large pericardial effusion, >20mm of echo free space in diastole
Chamber collapse
89
Differentials for cardiac tamponade?
Constrictive pericarditis
Restrictive cardiomyopathy
Cardiogenic shock
90
Management of cardiac tamponade?
Supportive management
NSAIDs
Pericardiocentesis
Surgical drainage
91
Monitoring requirements in cardiac tamponade?
Serial follow-up to check for recurrence
92
Complications of cardiac tamponade?
Recurrent/ refractory pericarditis and pericardial effusion
Cardiac arrest
Organ hypoperfusion
Effective constrictive pericarditis
93
Prognosis of cardiac tamponade?
Patients with underlying malignancy have highest mortality
Penetrating chest wounds/ idiopathic causes have best outcome
Without drainage will progress to cardiovascular collapse
94
What is a congenital heart defect?
Abnormality of the heart structure and anatomy which the patient is born with usually due to abnormalities in embryological development
95
Examples of acyanotic heart defects?
VSD
ASD
Patent ductus arteriosus
Coarctation of aorta
96
Examples of cyanotic heart defects?
Tetralogy of fallot
Transposition of great arteries
Truncus arteriosus
97
What is Eisenmenger's syndrome?
A reversal in a previous left to right shunt due to pressure overload on right side of the heart.
Pressures between two sides equalise and eventually right heart pressure increases above left heart so the shunt now becomes right to left
98
DWhat is a VSD?
Congenital or acquired defect in the interventricular septum resulting in communication between right and left ventricle
99
Epidemiology of VSD?
Perimembranous is most common type
Associated with down's syndrome
100
Aetiology of VSD?
Congenital; developmental abnormalities, genetics (Down's syndrome)
Acquired; acute MI, penetrating/ blunt trauma
101
What determines haemodynamic effect of a congenital heart defect?
Size of defect
Pulmonary vascular resistance
102
Risk factors for VSD?
102
Pathophysiology of VSD?
Hole in the interventricular septum creates a channel between ventricles
Creates a left to right shunt and is acyanotic
102
Pathophysiology of VSD?
Hole in the interventricular septum creates a channel between ventricles
Creates a left to right shunt and is acyanotic
103
Risk factors for VSD?
Family history of congenital heart disease
Downs Syndrome
Maternal consumption of alcohol during pregnancy
Recurrent pulmonary infections
Recent myocardial infarction (usually 2-5 days)
Recent trauma
104
Clinical presentation of VSD?
Failure to thrive
Shortness of breath
105
What murmur is heart in VSD?
Systolic murmur at left parasternal region
Holosystolic murmur that does not increase with inspiration
106
Investigations performed to diagnose VSD?
Echocardiogram
Chest X-ray
ECG
107
Differentials for VSD?
Atrial septal defect
Patent ductus arteriosus
Mitral regurgitation
Tricuspid regurgitation
Tetralogy of Fallot
Pulmonic stenosis
108
Management of VSD?
Watch and wait if small VSD
Closure of defect
Heart and lung transplantation if Eisenmenger's syndrome has developed
Prophylactic antibiotics before dental procedures
109
Monitoring requirements in VSD?
Asymptomatic patients should be followed annually
After shunt repair monitor for residual shunt, development of heart block and other arrhythmias
110
What should be monitored in routine follow up for VSD?
Development of aortic/ tricuspid regurgitation
Assess degree of left to right shunt
Ventricular function
Pulmonary pressures
111
Complications of VSD?
Aortic regurgitation
Surgical complications
Infective endocarditis
112
Prognosis of VSD?
Restrictive VSD closes spontaneously in ~ 50%
In moderate defects if left untreated can develop congestive heart failure and pulmonary hypertension
Large non restrictive defects require closure and have high risk of Eisenmenger's syndrome
113
What is an ASD?
Congenital cardiac defect as a result of incomplete separation between right and left atrium
114
Types of ASD?
Secundum
Ostium primum
Sinus venosus
Coronary sinus
Vestibular
115
Epidemiology of ASD
Secundum defects are responsible for 80% of interatrial communications
More common in women
Mostly occur sporadically with no family history
116
Aetiology of ASD?
Mutations in NKX2.5 and TBX5
Genetic syndromes; trisomy 21, Holt-Oram syndrome, Noonan syndrome
117
What genetic condition is commonly associated with congenital heart disease?
Down's syndrome `
118
Pathophysiology of ASD?
Communication between right and left atrium results in a left to right shunt
In severe defects Eisenmenger's syndrome can occur
119
Risk factors for ASD?
Female sex
Maternal alcohol consumption
Genetic syndromes
120
Clinical presentation of ASD?
Can be asymptomatic
Failure to thrive
Dyspnoea
Syncope
121
Differentials for ASD?
Partial anomalous pulmonary venous drainage
Ventricular septal defect
Patent ductus arteriosus
Pulmonary stenosis
Right bundle branch block
122
Investigations to diagnose ASD?
Chest X-ray
Echocardiogram
123
What murmur is heard in ASD?
Systolic ejection murmur radiating to back
Fixed splitting of second heart sound
124
Management of ASD?
Corrective closure
Consider pulmonary vasodilator
Prophylactic antibiotics
125
What is echocardiography used to assess in ASD?
Size of defect
Location of defect
Shunt size
Shunt pressure
Chamber size and hypertrophy
126
Monitoring requirements for ASD?
Serial echo to assess RV function and residual shunting
ECG to assess for arrhythmias
127
Complications of ASD?
Device erosion
Pulmonary vascular obstructive disease
Pericardial effusion/ tamponade
Paradoxical embolisation
Congestive heart failure
Infective endocarditis
Atrial fibrillation
128
Prognosis of ASD?
Majority of ASD have good prognosis, many remain asymptomatic
In large defects with Eisenmenger's is associated with poorer prognosis
129
What is patent ductus arteriosus?
Persistence of fetal ductus arteriosus resulting in communication between aorta and pulmonary artery
130
Epidemiology of PDA?
More common in pre-term infants
Higher incidence in females and babies born at higher altitudes
131
Pathophysiology of PDA?
Patency of ductus is maintained by low oxygen environment and circulating prostaglandins
After birth saturations rise causing constriction of the duct through action of potassium channels and reduction in prostaglandins
These mechanisms malfunction and the ductus remains open resulting in a left to right shunt
To compensate there is degree of LV hypertrophy and dysfunction
132
Risk factors for PDA?
Prematurity
Maternal rubella
Female sex
Respiratory distress syndrome
High altitude
Family history
Black race
133
Clinical presentation of PDA?
Tachypnoea, dyspnoea, apnoea
Low diastolic pressure
Failure to thrive
Diaphoresis
Hyperdynamic precordium
Bounding peripheral pulse
134
What murmur is heard in PDA?
Machine like murmur
Third heart sound at apex
Mid diastolic rumble at apex
135
Investigations performed in PDA?
Chest X-ray
ECG
Echocardiogram
136
Differentials for PDA?
Venous hum
Coronary artery fistula
Left to right shunt
Aortic regurgitation
137
Management for PDA?
Ibuprofen or indomethacin
Percutaneous catheter device closure
surgical ligation
138
At what age can ibuprofen be given to an infant?
32 weeks and older
139
Monitoring requirements for PDA?
Pre-mature infants need closer monitoring
Follow-up between every 3 months - 2 years depending on individual circumstances
140
Complications of PDA?
Respiratory distress syndrome
Necrotising enterocolitis in premature infants
Pulmonary haemorrhage in premature infants
Pulmonary hypertension
Congestive heart failure
Aneurysm of the duct
141
Prognosis of PDA?
Prematurity is associated with poorer prognosis and associated with chronic lung disease, pulmonary haemorrhage
Spontaneous closure after 3 months of age is rare
142
What is coarctation of aorta?
Narrowing of the aorta
143
What is the most common location for aortic coarctation?
Site of insertion of ductus, distal to left subclavian artery
144
Epidemiology of coarctation of aorta?
6-8% of all congenital heart defects
More common in men
Associated with Turner's syndrome
145
Aetiology of aortic coarctation?
Congenital malformation
Acquired; takayasu arteritis, severe atherosclerotic disease
146
Risk factors for aortic coarctation?
Male sex
Turner’s syndrome
DiGeorge syndrome
Hypoplastic left heart syndrome
Shone’s complex
Family history
147
Clinical presentation of coarctation of aorta?
Hypertension at young age, resistant to treatment
Diminished lower extremity pulses
Differential upper and lower extremity blood pressure
Radio- femoral delay
148
Investigations performed in coarctation of aorta?
ECG
Chest X-ray
Echocardiogram
149
Differentials for coarctation of aorta?
Aortic stenosis
Interrupted aortic arch
Left ventricular outflow tract obstruction
Essential hypertension
Renal artery stenosis
Phaeochromocytoma
150
Management for coarctation of aorta?
Maintain ductus patency; prostaglandin E1
Surgical repair
Percutaneous balloon angioplasty
Stent placement
151
Monitoring requirements for coarctation of aorta?
Lifelong follow up with frequency determined on case basis
Upper and lower extremity blood pressure should be check every visit
Periodic echocardiograms
152
Complications of coarctation of aorta?
Coronary artery disease
Systemic hypertension
Re-coarctation after repair
Aortic aneurysm
153
Prognosis of coarctation of aorta?
Isolated coarctation has an excellent prognosis
Re-coarctation is seen following repair hence require lifelong follow up
154
What is tetralogy of fallot?
Congenital cyanotic heart malformation consisting of 4 abnormalities
155
What abnormalities are found in tetralogy of fallot?
Ventricular septal defect
Overriding aorta
Pulmonary stenosis
Right ventricular outflow obstruction resulting in RVH
156
Epidemiology of tetralogy of fallot?
Male predominance
Most common cyanotic heart defect
Occurs in 3 out of 10,000 live births
157
Aetiology of tetralogy of fallot?
Genetics; trisomy 13, 18, 21
Maternal diabetes
158
What determines degree of cyanosis in tetralogy of fallot?
Degree of pulmonary obstruction
159
Classification of tetralogy of fallot?
Cyanotic tetralogy of fallot
Acyanotic tetralogy of fallot
Pulmonary atresia/ VSD
Absent pulmonary valve syndrome
160
What is the gold standard investigation in congenital heart defects?
Echocardiogram
161
Risk factors for tetralogy of fallot?
Trisomy 21, 18, 13
DiGeorge syndrome
MKX2.5 gene
Family history of congenital heart disease
Maternal diabetes, use of retinoids
162
What murmur is heard in tetralogy of fallot?
Harsh ejection systolic murmur loudest at left sternal border
163
Clinical presentation of tetralogy of fallot?
Tachypnoea
Cyanosis
Hypercyanotic tet spells; crying and deep breathing baby, murmur disappears
164
What is seen on echo in tetralogy of fallot?
Infundibular pulmonary stenosis
Overriding aorta
Non restrictive VSD
Concentric right ventricular hypertrophy
165
Investigations performed in tetralogy of fallot?
Pulse oximetry
Echocardiogram
Chest X-ray
166
What shaped heart is seen on chest X-ray in tetralogy of fallot?
Boot shaped
167
Differentials for tetralogy of fallot?
Other cyanotic congenital heart defects
Pulmonary stenosis
Ventricular septal defect
Primary pulmonary disease
168
Management of tetralogy of fallot?
Manoeuvres to increase systemic venous return; keep infant calm, in parents arms, beta blockers and phenylephrine
Prostaglandins to maintain duct patency
Surgical repair
ECMO to reverse cyanosis
169
In what scenarios would patency of ductus need to be maintianed?
Tetralogy of fallot
Coarctation of aorta
Cyanotic heart defects
170
Monitoring requirements in tetralogy of fallot?
Monitored by paediatric cardiologist
Routine echo/ CMR
171
Complications of tetralogy of fallot?
Cyanotic spells
Paradoxical emboli
Progressive pulmonary regurgitation and RVF
Ventricular arrhythmias
Sudden cardiac death
Congestive heart failure
172
Prognosis of tetralogy of fallot?
After repair prognosis is good
Some patients may require further surgery
173
What are the reasons for reoperation in tetralogy of fallot?
Pulmonary obstruction
Pulmonary regurgitations
174
What is mitral stenosis ?
Narrowing of the mitral valve orifice resulting in poor flow of blood from left atrium to ventricle
175
What is the epidemiology of Mitral stenosis?
Uncommon in western world due to eradication of rheumatic fever
More common in females
Prevalent in developing countries with people living in poverty
176
Most common cause of mitral stenosis?
Rheumatic fever
177
Aetiology of mitral stenosis?
Rheumatic fever/ rheumatic heart disease
Congenital deformity
Amyloidosis
SLE, rheumatism, arteritis
Mitral annular calcification
