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RCPCH TAS/ AKP > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Which are duct dependent cardiac lesions?

A

Present with collapse following duct closure.
Critical aortic stenosis / pulmonary stenosis
Hypoplastic Left Heart
Interrupted aortic arch
Coarctation of the aorta
Pulmonary / Tricuspid Atresia
Transposition of great artery.
TOF

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2
Q

Presentation of Atrial Septal Defect

A
  • Small = Well. Large = Heart failure, recurrently LRTI / wheeze
  • Murmur = ULSE systolic murmur. Fixed wideset HS II
  • ECG = RBBB, superior QRS
  • CXR = cardiomegaly, HF
  • Associations= T21, foetal alcohol
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3
Q

Management ASD

A

Surgical intervention if significant (HF, RV dilatation)

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4
Q

Presentation of Ventricular Septal Defect

A
  • Small = Well, murmur
  • Large = HF, faltering growth, LRTIs
  • Murmur = LLSE loud systolic murmur + thrill (quieter if large)
  • ECG = Biventricular hypertrophy
  • CXR = HF
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5
Q

Management of VSD

A
  • Small will close spontaneously
  • Medical - diuretics, high calorie diet
  • Surgical closure by 12m to avoid Pulm. HTN
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6
Q

What is Eisenmenger syndrome and how does it present?

A
  1. VSD with left to right shunt
  2. Increased pulm. BF –> thick walled and resistant arteries and pulm. HTN
  3. 10-15y, reversal of shunt –> right sided heart failure and cyanosis
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7
Q

Presentation of PDA

A
  • More in prematurity
  • Continuous machinery murmur below left clavicle
  • Bounding / collapsing pulses
  • Wide pulse pressure
  • Swinging sats
  • Large - HF, pulm. HTN, recurrent LRTIs
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8
Q

Presentation of Aortic Stenosis

A
  • Causes: Bicuspid valve, rheumatic fever. Associated with William’s and Turner’s
  • Mild: ASx
  • Neonate: Shock, HF, sudden death
  • Older: Chest pain, syncope
  • ESM right sternal edge –> carotids + carotid thrill. More prominent exhaling/ sitting up
  • CXR = prominent LV
  • ECG = LV Hypertrophy
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9
Q

Management of Aortic stenosis

A
  • Neonate - prostaglandins
  • Surgical repair - open / balloon
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10
Q

Presentation of Coarctation of the Aorta

A
  • Early D1 collapse
  • May be ASx until duct closes a few days later
  • HF, absent pulses, radio-femoral delay, BP 20 mmHg lower in lower limbs
  • Usually no murmur (may have ESM between shoulder blades) but may have murmur of PDA
  • Older Dx - Chest pain, headaches, HTN, visual changes.
  • ECG normal
  • CXR= cardiomegaly
  • Associated with Turner’s
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11
Q

Management of Coarctation of the Aorta

A

Prostaglandin infusion
Stent / surgery

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12
Q

Presentation of Pulmonary Stenosis

A
  • Association: Noonan’s, William’s, Agille
  • Mild - ASx
  • Severe = collapse soon after delivery –> right to left shunt via PFO
  • ESM LUSE –> back. Ejection click.
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13
Q

Management of Pulmonary stenosis

A

Prostaglandin infusion
Surgical repair

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14
Q

Presentation PFO

A

Usually closes 24 hours
Usually ASx with no murmur

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15
Q

Cardiac anomaly associated with Di George

A

Interrupted aortic arch, duct dependent VSD
Presents: Shock, absent femoral pulses

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16
Q

Presentation of transposition of the great arteries

A
  • Cyanosis and collapse day 2 following PDA closure
  • Less severe if also ASD / VSD allowing mixing
  • CXR = “egg on side”
  • No murmur. Loud HS II
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17
Q

Management of transposition of the great arteries

A

Prostaglandins
Surgery - initially create ASD –> arterial switch procedure

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18
Q

What are the 4 elements of Tetralogy of Fallot?

A
  1. Large VSD
  2. Overriding aorta (right to left)
  3. Right ventricular outflow obstruction (subpulmonary stenosis)
  4. Right ventricular hypertrophy
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19
Q

Presentation of Tetralogy of Fallot

A
  • Cyanotic spells on exertion / agitation
  • HF - SOB and pallor
  • Clubbing
  • Harsh ESM LSE
  • CXR = boot shaped
  • ECG initially normal –> RVH
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20
Q

Tetralogy of Fallot management

A

Prostaglandins
Hypercyanotic spells: O2, propranolol, knees to chest
Surgery at 6m

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21
Q

Presentation and management of hypoplastic left heart

A
  • AN Dx or Sick ++ at birth with profound cyanosis, weak / absent pulses
  • Difficulty feeding, faltering growth
  • CXR - Cardiomegaly
  • ECG - weak / absent QRS
  • Tx: prostoglandins, surgery
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22
Q

What is Ebstein Anomaly?

A

Abnormally formed tricuspid valve –> not fully closing –> RA dilatation and HF

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23
Q

What murmur would you expect with mitral regurgitation?

A

Pansystolic –> radiates to axilla

24
Q

What murmur would you expect with Aortic regurgitation?

A

Early diastolic. LLSE / URSE

25
Q

What murmur would you expect with mitral stenosis?

A

Mild diastolic at apex, worse rolling to left

26
Q

How is cardiac output calculated?

A

CO = SV x HR

27
Q

What is the Frank Starling Law?

A

Energy of contraction is proportionate to the initial length of cardiac muscle fibre
More stretch –> most contractility –> increased CV and CO

28
Q

What is Laplace Law?

A

Cardiac wall tension = (Pressure diff x radius) / wall thickness
Ie Dilated cardiomyopathy –> more energy required

29
Q

What do each of the segments from ECG represent in cardiac cycle?

A
  • P waves = atrial depolarisation
  • PR interval = pause before reaching ventricles
  • QRS = Ventricular depolarisation
  • ST segment = Isoelectric
  • T wave = ventricular repolarisation
30
Q

What is a normal axis on an ECG?

A

-30 - 90

31
Q

Management of SVT

A
  1. Vagal manoevers
  2. IV adenosine (opening ACh-K+ channels and blocking Ca++ influx) –> AVN block
  3. Amiodarone
  4. Electrical cardioversion
    Maintenance: Flecainide, sotolol, digoxin, propranolol in WPW
32
Q

ECG sign in WPW

A

Delta wave (slurred R wave)
Short PR
Widened QRS

33
Q

Treatment for tachyarrhythmia in WPW

A

1st line = IV Amiodarone
2nd line = Flecainide.

34
Q

Pathophysiology of WPW

A

Tachyarrhythmia due to accessory pathway (Bundle of Kent) for conduction of electricity between atrium and ventricles. Re-entry pathway –> paroxysms of tachycardia.

35
Q

Definition Long QT syndrome

A

> 440 ms

36
Q

Causes of congenital Long QT Syndromes

A

Delay in K+ out and Ca2+/ Na+ in. CHANNELOPATHIES.
- LQT1. Slow K+ out. Worse on exercise. Link deafness. Broad T wave.
- LQT2. Slowed K+ out. Flatter T wave. NB stress / emotion
- LQT3. Delay Na+ in. Peaked T wave. Sleep trigger

37
Q

Causes of acquire Long QT Syndrome

A

= Prolonged repolarisation
- Drugs - antipsychotics
- Electrolyte balance - low K+/ Na+/ Ca2+/ Mg2+
- Anorexia
- Metabolic / neuro conditions

38
Q

Presentation of Long QT syndrome

A
  • ASx +/- FHx
  • Syncope ESPECIALLY WITH EXERCISE / EMOTION
39
Q

Causes of myocarditis

A

= inflammation and necrosis of myosites
Viral - coxsackie, adenovirus, EBV, CMV, HPV 6
Drugs
Toxins
AI

40
Q

Diagnostic criteria of Rheumatic Fever

A

Recent Group A Beta Haemolytic Strep. infection + 2 major or 1 major + 2 minor
- Major = Carditis, arthritis, erythema marginatum, Sydenham Chorea, s/c nodules
- Minor = Arthralgia, heart block, fever, raised inflammatory markers
–> Anti-inflammatorys +/- Abx

41
Q

Diagnostic criteria for Infective Endocarditis

A

Dukes = 2 major OR 1 major and 3 minor OR 5 minor
- Major = 2x BC with: Staph. aureus, strep. viridans / bovis. Echo findings (vegetation, abscess, dehiscence valvw).
- Minor = Predisposition, fever >38, vasc. phenomenon, immunological phenomenon, +BC (not typical organism), Echo but not major findings

42
Q

Presentation and management of familial hypercholesterolaemia

A

= Genetic (AD) LDL receptor defect
- FHx early cardiac death
- Raised total cholesterol without rise in TG. NB genetic testing
- Tx = statin

43
Q

Pathophysiology HOCM (Hypertrophic Obstructive Cardiomyopathy)

A

Presentation: Chest pain, fatigue, palpitations
Dynamic Murmur due to dynamic obstruction of the LVOT.
Manoevers that increase pre-load eg standing to squatting, passive leg raise, fill the ventricle more –> relieve obstruction –> increase size of ventricle –> open outflow tract –> quieter murmur.
Opposite happens in Valsalva, squatting to standing which reduce the preload.

44
Q

Side effects of Prostoglandin infusions

A

Hypotension / Bradycardia
Apnoeas
Flushing

45
Q

Cardiac catheter data: Normal 02 sats by area

A
  • Vena cava, right atrium, right ventricle, pulmonary artery = 75%
  • Left atrium, left ventricle, aorta = 98%
46
Q

Cardiac catheter data: Normal pressures by area

A
  • VC: 0-5
  • RA: m=3
  • RV: 25/3
  • PA: 25/8
  • LA: m=8
  • LV: 110/8
  • Aorta: 110/65
47
Q

What is hyperoxic test?

A

Pre-ductal ABG taken after breathing 100% o2 for 10-15mins
If fixed = cardiac (right to left shunt)
If improved = respiratory

48
Q

What is Blalock-Taussig shunt and when is it used?

A
  • Connects subclavian artery to pulmonary artery
  • Used if severe reduction to pulmonary flow - pulm. atresia, TOF
    If re-cyanosed post procedure –> VQ scan
49
Q

What is Fontan procedure?

A

Connects IVC/ SVC/ RA to pulmonary arteries –> bypasses RV
Use in tricuspid atresia, single ventricle, pulm. atresia
Complications: RHF, sick sinus syndrome, arrhtymias

50
Q

What is Norwood procedure?

A

Used in HLH
Stage 1= links RV to aorta, PA divided, atrial septostomy. BT shunt.
Stage 2= Fontan procedure

51
Q

What is Glenn procedure

A

Connects SVC to PA, shunt from Norwood removed

52
Q

Cardiac condition associated with Freidrich’s ataxia

A

Hypertrophic cardiomyopathy

53
Q

Cardiac conditions associated with Marfan’s

A

Aortic dissection
Aneurysm
Regurgitation

54
Q

Cardiac condition associated with Tuberous Sclerosis

A

Rhabdomyoma

55
Q

Presentation of cardiomyopathy

A

Chest pain
Syncope
Palpitations
SOB
Usually inherited

56
Q

Signs of hypokalaemia on ECG

A

U waves
Increased p wave amplitude
Prolonged PR
Long QT (fusion of T and U)

RCPCH TAS/ AKP (20 decks)

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