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Nicu Brodsky+Pediatrix+NeoReview Questions > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Most common cause of vascular ring?

A

double aortic arch

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2
Q

Fetal circulation - what has lowest amount of O2?

A

SVC - lots of extraction by brain. LV > RV bc blood in LA is mixture of UV and L pulmonary blood flow

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3
Q

Blood pressure = _____ x ______

A

CO x SVR

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4
Q

Infants with high lying UAC show fewer / more clinically obvious ischemic complications. HTN is ______ in upper and lower catheters.

A

High lying catheters = fewer complications.

HTN is SAME in upper and lower

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5
Q

MCC HOCM in neonates and children under 4 years old

A

Noonan syndrome. Autosomal dominant. Pulmonic stenosis, hypertelorism, downward slanting palpebral fissures, short webbed neck, cryptorchidism

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6
Q

Oxygen causes ______ of PDA

A

vasoconstriction of PDA

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7
Q

first line treatment for atrial flutter?

A

digoxin

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8
Q

Etiology of TOF

A

multifactorial; overall 3% recurrence rate

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9
Q

When does cardio genesis begin?
First heart beat?

A

5th week - formation of paired heart tubes. Tubes fuse and fold
Heart beat starts at 6 weeks
Separation occurs b/w embryonic 7-8 weeks

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10
Q

Conotruncal abnormalities?

A

DORV, TOF, TGA
AV canal is AV septal defect

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11
Q

Embryologic origin of PDA?

A

L 6th aortic arch
1-2 arch: disappear early in gestation, 1st becomes maxillary
3rd: carotid artery
R 4th: R subclavian, L 4th becomes aortic arch
5th involutes
Bulbus cordis is part of primitive heart and is known as conotruncus

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12
Q

_______ is source of prostaglandins that maintain ductus in utero

A

placenta

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13
Q

Congenital heart disease is more common in donor or recipient in TTTS

A

RECIPIENT. 3x increase in frequency of CHD. Most frequent defects are VSDs, pulmonary stenosis

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14
Q

Shunt equation =

A

Qs (blood shunted away from lungs) / Qt (total blood volume) = (CcO2 pulmonary capillary - pulmonary arterial) / (pulmonary capillary - pulmonary venous)

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15
Q

Prolonged use of dopamine can result in _____

A

reduced inotropic effect due to depletion of NE stores in myocardium

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16
Q

epinephrine side effects

A

lactic acidosis, hyperglycemia (beta 2)

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17
Q

Most clinically significant PDA _______ in first few days of life

A

clinically silent; but, most common time for pulmonary hemorrhage is first 72 hrs

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18
Q

Wide pulse pressure is NOT helpful in looking for PDAs. What is?

A

global hypotension

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19
Q

Digoxin mechanism of action

A

positive inotrope and negative chronotrope. Inhibits sarcolemma Na/K ATP –> enhances contractility by increasing intracellular sodium and calcium. Decreased chronotropy due to prolonged sinoatrial conduction rates.

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20
Q

Most common congenital heart disease

A

VSD

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21
Q

Most common CHD in VACTERL

A

VSD (50%)

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22
Q

Endocardial cushion defect —> _____ axis deviation

A

superior

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23
Q

Egg shaped cardiac silhouette and narrow mediastinum is _______

A

D-TGA

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24
Q

Most common type of VSD is

A

perimembranous

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25
Q

Normal QRS axis in term neonates

A

+55 to +200

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26
Q

Before birth, predominant substrate taken up and oxidized by fetal heart are

A

glucose and lactate prenatally
postnatally, primarily fatty acids

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27
Q

Primary endothelial products for pulmonary vascular changes during transition are _______

A

NO and arachidonic acid metabolites

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28
Q

Describe ectopic atrial tachycardia

A

distinguished by “warms up” and “slows down”, atrial rates 180-240

29
Q

Where does vasopressin act in kidney

A

V2 receptor = water retention in renal tubule

30
Q

Most common association with non-renal HTN in neonates is

A

BPD. 13-43%.
Mechanism - increased systemic arterial stiffness

31
Q

Treatment for fetal SVT

A

digoxin

32
Q

Hydrocortisone mechanisms on CV action

A

Inhibition of expression of inducible nitric oxide synthase and vasodilatory prostaglandin action

Up regulation of CV adrenergic receptors —> vasoconstriction, increased CO, increased BP

Upregulate Angiotensin II receptors and their second messenger systems

Inhibit catecholamine metabolism, release of vasoactive factors

Increase in intracellular calcium concentration, enhancing myocardial and vascular responsiveness to catecholamines

33
Q

Most common abnormality on pre-surgical MRI for patients with complex CHD

A

white matter injury + infarction

34
Q

3 subtypes of HLHS are

A

mitral atresia + aortic atresia (30%), mitral stenosis and aortic atresia (25%), mitral stenosis and aortic stenosis (45%)
Mitral stenosis + aortic atresia —> high risk bc presence of coronary-cameral fistulas

35
Q

How is hypercapnia-induced vasodilation mediate?

A

extracellular H+, which requires basal level of nitric oxide

36
Q

Mutations for HLHS are? Recurrence risk?

A

HAND1 and NOTCH1
Sibling recurrence risk is 8% for HLHS and 22% for any CHD

37
Q

Association with CHD and arrhythmias?

A

60% of patients with epstein’s anomaly have WPW, 70-80% have RBBB

38
Q

Most commonly affected gene in long QT is

A

KCNQ1

39
Q

IDM increases risk for

A

VSD, DORV, truncus

40
Q

Typical course of HOCM associated with maternal DM

A

regression/resolution of ventricular hypertrophy at 1 month of age

41
Q

Syndromes associated with HLHS

A

Jacobsen and Holt-oram syndrome

42
Q

How to determine adequacy of atrial communication on doppler

A

pulmonary venous flow

43
Q

Where does dobutamine act?

A

Dobutamine is a synthetic sympathomimetic that acts directly on alpha and beta receptors without the release of NE

44
Q

Primary target of CCHD screening

A

HLHS, pulmonary atresia with IVS, TOF, TAPVR, TGA, TA, Truncus arteriosus

45
Q

CCHD will miss ______ neonates. most false negatives are?

A

1 in 5;
coarct, IAA

46
Q

What gene mutation is associated with cases of TOF? (not diverge)

A

Variation in ALDH1A2, enzyme important for retinoid acid production

47
Q

What genes associated with TGA?

A

TGA - ZIC3, PITX2C, FOG2, NODAL, NKX2-5, FOXH1

48
Q

Mechanism for epi drip

A

nonselective alpha-agonist, activation of both beta1 and beta 2 —> increases BP and systemic blood flow

49
Q

What mediates uptake of glucose in fetal heart?

A

glucose transporters GLUT1 and GLUT4

50
Q

What causes differential vs reverse differential cyanosis

A

Differential cyanosis is usually caused by severe coarct or IAA
Reverse differential cyanosis = TGA with PDA in presence of severe coarct, IAA, or pulmonary HTN

51
Q

MCC neonatal HTN

A

coarctation

52
Q

Pass vs fail CCHD

A

Fail screening is <90%, SPO2 < 95 on 3 measurements separated 1 hr apart, difference is greater than 3 on 3 measurements, each separated by 1 hr
Pass screening: > 94, <4% diff

53
Q

Features on echo for DCM

A

SF < 25%, EF < 40%, LV dimension z score > 2

54
Q

Blood pressure at birth is ____ and ____ over first few days

A

low, increases

55
Q

Physical exam feature of HLHS

A

hyper dynamic precordial activity

56
Q

What enzyme regulates fatty acid oxidation by fetal and newborn heart

A

Carnitine palmitoyltransferase

57
Q

Describe Norwood procedure

A

Norwood: main PA is transected and reconstructs aortic arch.
Then Put in BT shunt to connect subclavian or innominate artery to ipsilateral pulmonary artery (pulmonary blood flow)
100a

58
Q

What is wandering atrial pacemaker?

A

shift of pacemaker from usual location in sinus node to other sites in atrium and in AV junction

59
Q

Tuberous sclerosis gene

A

chromosomes 9 + 16

60
Q

Why does NO not cause systemic vasodilation?

A

When the gaseous nitric oxide molecules reach the vasculature, they bind to hemoglobin, become oxidized to NO2 and NO3, and are inactivated. Thus, peripheral vasodilation does not occur following administration of inhaled nitric oxide

61
Q

MC type of VSD

A

Perimembranous VSD (70%) is MCC; muscular is 25%; these two often close spontaneously

62
Q

What is Wenkebach?

A

Mobitz Type I; increasing PR interval and then non-conduction

63
Q

XR - egg shaped heart, narrow mediastinum

A

D-TGA; single loud S2 (PV is farther from chest), limiting ability to detect P2

64
Q

Endocardial cushion defect, T21 ECG

A

superior axis deviation

65
Q

First line tx for atrial flutter

A

digoxin

66
Q

Cardiogenesis embryopathy

A

Cardiogenesis begins week 5 - paired heart tubules. Tubes fuse and fold shortly after.
Heartbeats at week 6
Septation at weeks 7-8

67
Q

What receptor causes side effects from epinephrine

A

Epi causes lactic acidosis, hyperglycemia, tachycardia due to BETA2

68
Q

How long before dopamine causes depletion of NE in myocardium?

A

12 hrs
side effects: decreased thyrotropin, prolactin, thyroxine, increased PVR

69
Q

What do tall peaked P waves mean?

A

R atrial enlargement = abnormal = needs investigation

Nicu Brodsky+Pediatrix+NeoReview Questions (14 decks)

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