Cardiology

Question 1

What increases Right to left shunt?

Answer 1

increase PVR , sedation, paralysis, hypoventilation, lower fio2
decrease SVT, milrinione, vasodilators

Question 2

3 physical findings associated with cardiogenic shock

Answer 2

gallop murmur, pulmonary edema, hepatomegaly

Question 3

In complex mixing lesions you are conerned not concerned about cyanosis, rather

Answer 3

Congestive Heart Failure

Question 4

PGE might worsen symptoms in what CHD

Answer 4

Obstructed TAPVR, increases PBF

Question 5

what are principles or repair of single ventricle?

Answer 5

separate pulmonary and systemic circulations
provide stable source of pulmonary and systemic circulation (not reliant on PDA)
balance pulmonic and systemic circulations

Question 6

What CHD lesions do you see snowman appearance?

Answer 6

supracardiac form of TAPVC
patients have significant right atrial and right ventricular enlargement

usually have ASD (necessary to maintaining left ventricular output)

Question 7

What does Alpha 1 do?

Answer 7

Increases SVR
Increases Contractility

Question 8

What does alpha 2?

Answer 8

Decreases SVR

Question 9

What does Beta 1 do?

Answer 9

Increases HR, increases Contractility, Increases Conduction

Question 10

What does Beta 2 do?

Answer 10

Decreases SVR

Question 11

what effect does epi have on HR

Answer 11

It increases HR at low dose (B1on SA and AV Node)
decreases HR at high dose

Question 12

What is a Blalock-Taussig shunt?

Answer 12

Connects subclavaian artery to pulmonary artery to provide Pulmonary Blood Flow

Question 13

What is Norwood procedure?

Answer 13

Creates a neoaorta from pulmonary artery and underdeveloped aortic arch to provide systemic circulation

Question 14

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.

Answer 14

Complete AV Canal

Question 15

Where does obstruction occur in infradiaphragmatic TAPVR?

Answer 15

1. obstruction of the common pulmonary or vertical vein can occur as it reaches the diaphragm
2. at the junction with the portal veins
3. or at the ductus venosus as it constricts in the early postnatal period.

Question 16

which to left sided heart lesions require immediate intervention?

Answer 16

HLHS intact septum, obstructed TAPVR

Question 17

Why is it important for cardioversion to deliver shock during QRS complex?

Answer 17

want to shock from being delivered during T wave while heart is being depolarized
R on T phenomenon can cause polymorphic tachycardia

Question 18

why would you be judicious in use of oxygen in Right heart lesions and left heart lesions

Answer 18

1. too much oxygen in Left sided lesions decreases flow in systemic circulation, which can lead to acidosis and shock
2. too much oxygen in right sided lesion excessive pulmonary blood flow, acidosis and CHF

Question 19

What is long QT for board purposes?D

Answer 19

450 ms

Question 20

BPP what do you do if score is 6 and infant is >36 weeks and mother has favorable cervix?

Answer 20

Deliver

Question 21

highest PaO2 in placenta and umbilical cord

Answer 21

uterine artery (95)> uterine vein (40) > umbilical vein (29) > umbilical artery (18)

Question 22

Abnormal AFI

Answer 22

< 5 or > 24
normal 8-18

Question 23

Why is MCA doppler velocity increased with anemia?

Answer 23

fetus with anemia, needs to increase blood flow to brain/heart/adrenal glands.

Question 24

What do absent and reversed end diastolic flow signify?

Answer 24

increase in placental vascular resistance, and decrease placental blood flow

normally UA flow exists during diastole
in these conditions it does not

Question 25

Very first sign of placental insufficiency

Answer 25

ductus venous diameter increases, thus increasoing blood flow to heart.

Question 26

Most common other heart lesions seen in patients with Truncous Arterious?

Answer 26

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).

Question 27

How does the diving reflex work?

Answer 27

increases parasympathetic output to the heart via the vagus nerve

Question 28

Why is neonatal Heart function more dependent on intracellular Calcium for contractility?

Answer 28

neonates have immature Sacroplasmic reticulum

Question 29

Why do you keep PDA open TGA

Answer 29

to promote atrial level mixing augment more pulmonary blood flow back to the left atrium

Question 30

Answer 30

Question 31

Why does Prostaglandin decrease after birth

Answer 31

Prostaglandins metabolized in lungs do to increase PBF

Question 32

How does O2 uptake differ from fetus and infant?

Answer 32

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

Question 33

In utero if there is left obstructed heart lesion, is PDA wider or narrower

Answer 33

It will be wider( due to increased amount of flow) would be narrower in (Right obstructed lesion due to decreased amount of flow)

Question 34

Which ventricle supplies most of blood in utero?

Answer 34

Right Ventricle

Question 35

Which ventricle is better oxygenated in utero, supplies better oxygenated blood

Answer 35

Left ventricle

Question 36

Why is PDA most important to stay open in HLHS

Answer 36

retrograde flow perfuses coronaries

Question 37

In what CHD do you see Left Superior QRS axis

Answer 37

Complete AV canal (deep s wave in AVF), anatomic abnormality of HIS bundle, posterior and inferior rotation of AV node

Question 38

In what syndromes do you see hypertrophic cardiomyopathy?

Answer 38

Pompe, Hurler, Noonan

Question 39

What is pathophys of ALCAPA?

Answer 39

left coronary artery arises from pulmonary artery clinical findings of ALCAPA depend on collaterals, PVR and myocardial effects

Question 40

How does Milrinone act? What are some advantages over dopamine, epi and noriepi?

Answer 40

Question 41

How do Alpha 1, Alpha 2, Beta 1, and Beta 2 act?

Answer 41

Question 42

Differences between Dopamine and Dobutamine

Answer 42

Question 43

When would you use dobutamine over dopamine?

Answer 43

Question 44

Summary of Epi, high and low dose

Answer 44

Question 45

Summary of noriepi

Answer 45

Question 46

How would Epi and CHF affect Frank Starling Curve?

Answer 46

Question 47

QP/QS Formula

Answer 47

Question 48

What do you see on imaging with vascular ring?

Answer 48

tracheal narrowing on CXR barium swallow would show indentation of esophagus