Cardiology Flashcards
What increases Right to left shunt?
increase PVR , sedation, paralysis, hypoventilation, lower fio2
decrease SVT, milrinione, vasodilators
3 physical findings associated with cardiogenic shock
gallop murmur, pulmonary edema, hepatomegaly
In complex mixing lesions you are conerned not concerned about cyanosis, rather
Congestive Heart Failure
PGE might worsen symptoms in what CHD
Obstructed TAPVR, increases PBF
what are principles or repair of single ventricle?
separate pulmonary and systemic circulations
provide stable source of pulmonary and systemic circulation (not reliant on PDA)
balance pulmonic and systemic circulations
What CHD lesions do you see snowman appearance?
supracardiac form of TAPVC
patients have significant right atrial and right ventricular enlargement
usually have ASD (necessary to maintaining left ventricular output)
What does Alpha 1 do?
Increases SVR
Increases Contractility
What does alpha 2?
Decreases SVR
What does Beta 1 do?
Increases HR, increases Contractility, Increases Conduction
What does Beta 2 do?
Decreases SVR
what effect does epi have on HR
It increases HR at low dose (B1on SA and AV Node)
decreases HR at high dose
What is a Blalock-Taussig shunt?
Connects subclavaian artery to pulmonary artery to provide Pulmonary Blood Flow
What is Norwood procedure?
Creates a neoaorta from pulmonary artery and underdeveloped aortic arch to provide systemic circulation
what kind of heart defect has following:
Auscultation reveals that the infant has a systolic ejection murmur at the upper left sternal border and a low-pitched early diastolic rumble at the lower end of the sternal border. The second heart sound appears to be split.
Complete AV Canal
Where does obstruction occur in infradiaphragmatic TAPVR?
- obstruction of the common pulmonary or vertical vein can occur as it reaches the diaphragm
- at the junction with the portal veins
- or at the ductus venosus as it constricts in the early postnatal period.
which to left sided heart lesions require immediate intervention?
HLHS intact septum, obstructed TAPVR
Why is it important for cardioversion to deliver shock during QRS complex?
want to shock from being delivered during T wave while heart is being depolarized
R on T phenomenon can cause polymorphic tachycardia
why would you be judicious in use of oxygen in Right heart lesions and left heart lesions
- too much oxygen in Left sided lesions decreases flow in systemic circulation, which can lead to acidosis and shock
- too much oxygen in right sided lesion excessive pulmonary blood flow, acidosis and CHF
What is long QT for board purposes?D
450 ms
BPP what do you do if score is 6 and infant is >36 weeks and mother has favorable cervix?
Deliver
highest PaO2 in placenta and umbilical cord
uterine artery (95)> uterine vein (40) > umbilical vein (29) > umbilical artery (18)
Abnormal AFI
< 5 or > 24
normal 8-18
Why is MCA doppler velocity increased with anemia?
fetus with anemia, needs to increase blood flow to brain/heart/adrenal glands.
What do absent and reversed end diastolic flow signify?
increase in placental vascular resistance, and decrease placental blood flow
normally UA flow exists during diastole
in these conditions it does not
Very first sign of placental insufficiency
ductus venous diameter increases, thus increasoing blood flow to heart.
Most common other heart lesions seen in patients with Truncous Arterious?
the most common association is with aortic arch defects. Of these, the most frequent is a right aortic arch (seen in approximately 30% of patients with TA), followed by aortic arch hypoplasia or interrupted aortic arch (in approximately 10-12% of these patients).
How does the diving reflex work?
increases parasympathetic output to the heart via the vagus nerve
Why is neonatal Heart function more dependent on intracellular Calcium for contractility?
neonates have immature Sacroplasmic reticulum
Why do you keep PDA open TGA
to promote atrial level mixing
augment more pulmonary blood flow back to the left atrium
Why does Prostaglandin decrease after birth
Prostaglandins metabolized in lungs do to increase PBF
How does O2 uptake differ from fetus and infant?
in infant decrease in O2 uptake with hypoxemia, in fetus there could be 50% reduction fetal O2 delivery, and still no change in O2 uptake
In utero if there is left obstructed heart lesion, is PDA wider or narrower
It will be wider( due to increased amount of flow)
would be narrower in (Right obstructed lesion due to decreased amount of flow)
Which ventricle supplies most of blood in utero?
Right Ventricle
Which ventricle is better oxygenated in utero, supplies better oxygenated blood
Left ventricle
Why is PDA most important to stay open in HLHS
retrograde flow perfuses coronaries
In what CHD do you see Left Superior QRS axis
Complete AV canal
(deep s wave in AVF), anatomic abnormality of HIS bundle, posterior and inferior rotation of AV node
In what syndromes do you see hypertrophic cardiomyopathy?
Pompe, Hurler, Noonan
What is pathophys of ALCAPA?
left coronary artery arises from pulmonary artery
clinical findings of ALCAPA depend on collaterals, PVR and myocardial effects
How does Milrinone act?
What are some advantages over dopamine, epi and noriepi?
How do Alpha 1, Alpha 2, Beta 1, and Beta 2 act?
Differences between Dopamine and Dobutamine
When would you use dobutamine over dopamine?
Summary of Epi, high and low dose
Summary of noriepi
How would Epi and CHF affect Frank Starling Curve?
QP/QS Formula
What do you see on imaging with vascular ring?
tracheal narrowing on CXR
barium swallow would show indentation of esophagus
