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RACP Paediatrics Exam > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What do class 1 antiarrhythmics do?

A

Block Na channels
eg. Flecainide
Prolongs depolarisation - how long the ventricle takes to contract (Prolongs QRS)

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2
Q

What do class 2 antiarrythmic agents do?

A

Beta blockers
Slow AV node conduction

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3
Q

What do class 2 antiarrythmic agents do?

A

Potassium channel blockers
Eg. amiodarone, sotalol
Prolong QT

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4
Q

What do class 4 antiarrythmic agents do?

A

Calcium channel blockers
Prolong AV node conduction
eg. Verapamil

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5
Q

Side Effects of Flecainide?

A

Tingling and constipation
Proarrhythmic
QRS widening
Milk can decrease GI absorption

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6
Q

Most serious side effect in Sotalol?

A

QTc prolongation
Bradycardia and lethargy

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7
Q

Which anti arrhythmic is contraindicated in infants <1year?

A

Verapamil
Also contraindicated in WPW

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8
Q

Which medications are contraindicated in WPW?

A

Verapamil
Digoxin

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9
Q

What is multifocal atrial tachycardia?

A

When there are 3 or more different non sinus P wave morphologies?
Tx with Antiarrhythmics class 1 or 3

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10
Q

What is the management of atrial flutter?

A

Synchronised DC cardioversion
If that doesn’t work Amiodarone or Sotalol
If giving flecainide MUST be given with beta blocker.

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11
Q

What does orthodromic mean?

A

When the electrical activity goes down through the AV node and then back up through the accessory pathway (narrow QRS complex)

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12
Q

What does antidromic mean?

A

When the electrical activity goes down through the accessory pathway and then back up through the AV node (broad QRS complex - looks like VT)

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13
Q

What structural abnormality is WPW associated with?

A

Ebsteins Anomaly

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14
Q

WPW

A

Antegrade conduction down an accessory pathway.

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15
Q

What is permanent junctional reciprocating tachycardia?

A
  • Variant of AVRT with orthodromic conduction
    Hallmarks
  • Incessant tachycardia (usually slower rate 200bpm)
  • Long RP interval
  • Inverted P waves inferior leads
    Accessory pathway with slow retrograde conduction
    (decremental)

You see deep inverted P waves in the inferior leads

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16
Q

What is AV nodal re-entrant tachycardia?

A
  • Re-entrant circuit within the normal AV node
  • Typical or atypical
  • Slow pathway and fast pathways (dual AV node physiology)
17
Q

When would you consider giving Verapamil in a child <12months?

A

Fascicular ventricular tachycardia
Usually more narrow QRS complex with RBBB pattern and superior axis

18
Q

What is Long QT syndrome?

A

Delayed myocardial repolarisation.

19
Q

What is the channel involved in Long QT 1 and 2?

A

Potassium channel
One - KCNQ1 - Slow potassium channel low function
Two - KCNH2 - Potassium channel low functioning means it takes longer for potassium to repolarise the cell

20
Q

What is the channel involved in Long QT 3?

A

Three - SCN5A - Gain of function in sodium channel meaning it stays open causing depolarisation for longer

21
Q

What does the ECG look like in long QT type one?

A

Broad T wave

22
Q

What does the ECG look like in long QT type two?

A

Flattened T wave

23
Q

What does the ECG look like in long QT type three?

A

Peaked T wave that is delayed

24
Q

What is the treatment for long QT syndrome?

A

Lifestyle modification - reducing adrenaline surges
B blocker - Nadolol (most effective)
Avoid medications that prolong the QT interval eg. ondansetron

25
Q

What gene is involved in Brugada syndrome?

A

SCN5A - loss of function in the sodium channel

26
Q

Diagnosis of Brugada syndrome?

A

Diagnosis based on the presence of a spontaneous or drug-induced coved-type ST
segment elevation in V1 or V2 (Type 1 morphology)
* ST elevation ≥2mm
* Gradually descending ST segment
* Terminates with negative T wave

27
Q

What is the criteria for rheumatic fever?

A

Two major or one major and two minor manifestations
plus
Evidence of a preceding Group A streptococcus infection
Major:
Carditis (including subclinical evidence of rheumatic valve disease on echocardiogram)
Polyarthritis or aseptic mono-arthritis or polyarthralgia
Sydenham chorea
Erythema marginatum
Subcutaneous nodules
Minor:Fever
ESR ≥30 mm/hr or CPR ≥30 mg/L
Prolonged P-R interval on ECG

28
Q

Diagnostic criteria for Kawasaki disease?

A

Fever for 5+ days
Plus 4 of 5 of:
No exudative Conjunctival injection (>90%) - perilimbic sparing
Mucositis - cracked lips, strawberry tongue
Extermity changes (70-98%) - swelling, erythematous, desquamation, beaus lines across finger nails
Polymorphous rash - usually maculopapular
Cervical lymphadenopathy (25-50%) - >1.5cm

29
Q

How long after IVIG do you need to delay live immunisations for?

A

11 months

30
Q

Does IVIG cause raised ESR or CRP?

A

ESR therefore use CRP to monitor inflammatory response

31
Q

What type of medication is sildenofil?

A

Phosphodiesterase type 5 inhibitor which increased cGMP and nitric oxide causing vasodilation

32
Q

Most common cardiac lesions in 22q11 deletion?

A

Tetralogy of fallout (35%)
Interrupted aortic arch (20%)
Truncus arteriosus (10%)

33
Q

What cardiac complication are children with Noonan Syndrome at risk of?

A

Hypertrophic cardiomyopathy (20%)
Up to 50% have pulmonary stenosis

34
Q

What do you see on ECG with hypocalcaemia?

A

Prolonged QTc

35
Q

What is pulmonary hypertension?

A

PAP >20mmHg

36
Q

How do you calculate cardiac output?

A

Qp (Cardiac output)= VO2/ (Sats PV - Sats PA) x Hb x 1.36
Qs = VO2 /(Sats Ao - Mixed venous Sats) x Hb x 1.36

Qp:Qs
Aosats - MV sats/PV sats - PA sats

37
Q

What are the ECG findings you would see for a patient with congenitally corrected TGA?

A

Left axis deviation
Deep Q waves V1, II and III, with no Q waves in the left precordial leads V5 and V6.
(This indicates abnormal depolarisation of the inter ventricular septum from right to left)

RACP Paediatrics Exam (25 decks)

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