Cardiology Flashcards
What is the most common symptomatic congenital heart disease
VSD’s
Which genetic conditions have increase of VSDs
Downs syndrome
DiGeorge syndrome
What type of shunt is VSD
left to right
Types of murmurs in VSD
small - panystolic at left lower edge, ass. thrill
Medications to treat VSD
diuretics
ACEi
What is the pathophysiology of WPW
Normal heart - insulating fibre tissue between atria and ventricle - signal has to go via AVN node
In WPW - the band of fibre has myocardial cells which becomes accessory pathway
What is the delta wave?
conduction through accessory pathway leads to excitation of the ventricle before conduction of AVN = shortened PR interval
conduction is slower than AVN node which is why it is slurred upstroke of QRS
What is contraindicated in AF and WPW
Adenosine - could lead to VF
Treatment for WPW
slow conduction down
beta-blockers
amiodarone
flecainide
calcium-channel blocker
What is the most common cardiac condition ass. with Noonan syndrome
Hypertrophic cardiomegaly
What does hypertrophy fo LV cause?
reduces LV cavity volume
reduced ability of LV to fill in diastole
What does reduce filling in LV cause?
Rising left-atrial pressure
pulmonary oedema
congestive cardiac failure
What are the forms of hypertrophic cardiomegaly
Obstructive
Non-obstructive - most common
Why does obstructive cardiomegaly form?
Dynamic obstruction of LV outflow by anterior leaflet of mitral valve
Due to abnormality of papillary muscle insertion and abnormal flow in LV
What are most common symptoms in HOCM
angina
dizziness
Examination findings with patients with HCM
Displaced apex and heaving
additional heart sounds S3 S4
ECG changes of ventricular hypertrophy
left axis deviation and large QRS complexes in chest leads = LVH ST segment changes and t wave inversion in V4-V6 left heart strain
right axis devotions and large qrs in II, III, avF, 1-3 = RVH
medications for hypertrophy
beta blockers - slow heart rate, improve filling
diuretics
calcium channel blockers
ACE I
When does ToF present if not detected antenatally
within 1 year with cyanosis and murmur
what sign is seen on CXR for coractation of aorta
rib notching
What murmur is coarctation of aorta associated with
ejection systolic murmur radiates to back
What happens in TGA
Aorta rises from right ventricle
pulmonary artery arises from left ventricle
What increases the incidence of TGA
DiGeorge syndrome
Infant of mum with diabetes
What is CXR sign of TGA
egg on side appearance
pulmonary pleathora
What type of discordance is TGA
ventriculoaterial discordance
What is Marfan’s syndrome associated with?
Aortic root dilatation leading to aortic regurgitation
Phase of cardiac action potential
Phase 0 - influx of sodium
Phase 1 - end of depolarisation - efflux of potatissium
pHASE 2 - Plateau phase - slow influx of calcium
Phase 3- rapid repolarisations - efflux of potassium
Phase 4 - diastole, calcium-sodium efflux, potassium influx
Signs of servere aortic stenosis
Soft S2
second heart sound
So narrowed and calcified - 2nd here sound becomes inaudible
Why is VT broad complex
rhythm starts from ventricle
Is there P waves in VT?
No as SAN isn’t controlling the rhythm
If there is - they will be unrelated to ARS complex
Which aortic arch forms right subclavian artery
right 4th aortic arch
Which aortic arch forms internal carotid artery
third arches
Adenosine doses for SVT
Start adenosine 0.1mg/kg
3mg -> 6mg > 12mg
If shocked - synchorous shock 1joules/kg
