Cardiology Flashcards
The majority of atrial septal defects are secondary to what pathologic opening remaining open?
The ostium secundum
A 15-year-old boy presents to his pediatrician for a routine pre-athletics physical screening. He has a history of occasionally feeling like he is going to faint after strenuous workouts. A screening ECG is ordered and notable for down-sloping ST segments and T wave inversions, concerning for left ventricular hypertrophy. Which of the following is the best diagnostic study to confirm this diagnosis?
A) Cardiac catheterization
B) Cardiovascular magnetic resonance
C) Echocardiography
D) Exercise testing
Echocardiography
Hypertrophic cardiomyopathy is a genetically inherited condition that leads to development of left ventricular hypertrophy. This pathology can lead to left ventricular outflow obstruction, diastolic dysfunction, mitral regurgitation, and myocardial ischemia.
What is the diagnostic lab test for mononucleosis?
heterophile antibody test (monospot)
A 12-year-old boy presents for tiring easily, weakness in his legs, nosebleeds, and headaches. He has no known past medical history. On physical examination, blood pressure is 140/90 mm Hg and distal pulses are diminished. A CT scan of the chest confirms the suspected diagnosis.
What is the preffered treatment?
Balloon Angioplasty
Key characteristics of aortic coarctation are a difference in blood pressure between the upper and low extremities, muscle weakness, leg cramps, hypertension, nose bleeds, and weak pulses in the distal extremities. A balloon angioplasty is performed with plus or minus stent placement to prevent any further complications (e.g., congestive heart failure, coronary artery disease, or intercerebral hemorrhage).
Rheumatic fever develops in children and adolescents following what infection?
Pharyngitis with grouw A strep
The Jones Criteria is used to assess rheumatic heart disease
What is included under the major criteria?
- Carditis
- Chorea
- Erythema marginatum
- Polyarthritis
- Subcutaneous nodules
The Jones Criteria is used to assess rheumatic heart disease
What is included in the minor criteria?
- Arthralgia
- Elevated ESR or C-reactive protein
- Fever
- Prolonged PR interval on ECG
- Leukocytosis
What is the treatment for rheumatic heart disease?
PCN in the acute phase + Asparin
Case: A 4-year-old child presents with fatigue and shortness of breath during play. On examination, you notice a systolic murmur best heard at the left upper sternal border.
Question: What is the most likely diagnosis, and which diagnostic test would be most appropriate to confirm this diagnosis?
Ventricular Septal Defect; Echo
The description of the murmur’s location and the child’s symptoms are indicative of a ventricular septal defect (VSD), a common congenital heart defect where there is a hole between the left and right ventricles. This defect allows blood to mix between the two chambers, leading to increased pulmonary blood flow and symptoms of heart failure such as fatigue and shortness of breath.
The test of choice for a VSD is an Echo
A 6-month-old infant is brought to the clinic with a history of failure to thrive and excessive sweating, especially during feeding. An echocardiogram reveals a large defect in the ventricular septum. Which complication is this infant most at risk for developing?
A) Eisenmenger syndrome
B) Bacterial endocarditis
C) Congestive heart failure
D) Pulmonary embolism
Congestive Heart Failure
In the case described, an infant presents with failure to thrive and excessive sweating, particularly during feeding, and an echocardiogram reveals a large defect in the ventricular septum, indicative of a significant ventricular septal defect (VSD). These symptoms are characteristic of heart failure in infants, which is a common complication of large VSDs.
What congenital heart defect can present with diaphoresis during feeds?
Is the murmur systolic or diastolic?
Ventricular Septal Defect
Holosystolic murmur best heard at lower left sternal border
A 3-year-old child presents to your clinic with frequent episodes of shortness of breath and easy fatigability. The parents mention that the child often squats after running. On auscultation, you notice a harsh systolic murmur best heard at the left lower sternal border. What is the most likely diagnosis and the underlying pathophysiological mechanism?
A) Patent Ductus Arteriosus; delayed closure of fetal circulation
B) Tetralogy of Fallot; combination of VSD, pulmonary stenosis, right ventricular hypertrophy, and overriding aorta
C) Ventricular Septal Defect; abnormal blood flow between the heart chambers
D) Atrial Septal Defect; improper formation of the interatrial septum
B) Tetralogy of Fallot; combination of VSD, pulmonary stenosis, right ventricular hypertrophy, and overriding aorta
Tetralogy of Fallot is characterized by four defects: ventricular septal defect (VSD), pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta. The symptom of squatting after exertion is particularly indicative of Tetralogy of Fallot, as squatting increases systemic vascular resistance and improves the blood flow to the lungs.
An 8-month-old infant is referred for evaluation of a heart murmur and failure to thrive. Physical examination reveals a diastolic rumble at the apex and signs of congestive heart failure. Which diagnostic test will best evaluate this infant’s condition?
A) Chest X-ray
B) Echocardiography
C) Electrocardiogram (ECG)
D) MRI of the heart
Echocardiology
Echocardiography is the most useful diagnostic tool for evaluating heart murmurs and structural abnormalities in infants. This infant likely has an atrioventricular septal defect (AVSD).
During a routine visit, a pediatric patient with a diagnosed coarctation of the aorta shows a significant blood pressure gradient between the arms and legs. The patient is asymptomatic. What is the most appropriate next step in management?
A) Immediate surgical referral
B) Start antihypertensive medication
C) Schedule for annual monitoring without intervention
D) Perform cardiac catheterization
Perform cardiac catheterization
A newborn is diagnosed with transposition of the great arteries immediately after birth due to cyanosis and a murmur. The baby undergoes an arterial switch operation.
What long-term complication is most commonly associated with this condition post-surgery?
A) Ventricular septal defect
B) Pulmonary stenosis
C) Neo-aortic root dilation
D) Residual atrial septal defect
Neo-aortic root dilation
After an arterial switch operation for transposition of the great arteries, the most common long-term complication is neo-aortic root dilation. This condition arises from the physiological stress and anatomical changes imposed on the aorta after it is repositioned during surgery, potentially leading to dilation and aortic valve dysfunction.
A 2-year-old presents with episodes of cyanosis, particularly during crying or feeding. Physical examination reveals a systolic murmur heard best at the right upper sternal border and clubbing of the fingers.
Which of the following is the most likely diagnosis?
A) Pulmonary stenosis
B) Tetralogy of Fallot
C) Ventricular septal defect
D) Atrial septal defect
Tetralogy of Fallot
The symptoms described in the case, including episodes of cyanosis during crying or feeding, systolic murmur best heard at the right upper sternal border, and clubbing of the fingers, are characteristic of Tetralogy of Fallot. This congenital defect includes four key components: pulmonary stenosis, ventricular septal defect, right ventricular hypertrophy, and an overriding aorta, which lead to the symptoms mentioned.
A 6-year-old child presents with fainting spells during exercise. The child has a family history of sudden cardiac death. Physical examination reveals a harsh systolic murmur that worsens with standing.
What is the first diagnostic test that should be performed?
A) Holter monitor
B) Echocardiogram
C) Exercise stress test
D) Cardiac MRI
Echocardiogram
Given the child’s history of fainting spells during exercise and a family history of sudden cardiac death, the best initial diagnostic test is an echocardiogram. This test can help evaluate the structure and function of the heart, particularly looking for hypertrophic cardiomyopathy or other structural abnormalities that could explain the symptoms and are associated with the risk of sudden cardiac death.
A newborn diagnosed with hypoplastic left heart syndrome is stabilized in the neonatal intensive care unit.
What is the most appropriate initial management approach for this condition?
A) Immediate heart transplantation
B) Prostaglandin E1 infusion to maintain ductal patency
C) Surgical repair within the first week of life
D) Palliative care
Prostaglandin E1 infusion to maintain ductal patency
In newborns diagnosed with hypoplastic left heart syndrome, maintaining ductal patency with Prostaglandin E1 infusion is critical to ensure blood flow across the patent ductus arteriosus. This treatment helps support systemic circulation until more definitive surgical interventions can be planned.
An infant born with a large patent ductus arteriosus undergoes surgical closure of the ductus at 6 months of age. The infant recovers well initially but presents at age 3 with exercise intolerance and differential blood pressure in the upper and lower extremities.
What complication is most likely in this patient?
A) Recurrence of the patent ductus arteriosus
B) Pulmonary hypertension
C) Coarctation of the aorta
D) Residual ventricular septal defect
Coarctation of the aorta
The symptoms of exercise intolerance and differential blood pressure in the upper and lower extremities suggest the possibility of coarctation of the aorta, particularly if the aortic arch was distorted or narrowed after the surgical closure of a large patent ductus arteriosus. This condition could have been either exacerbated or unmasked by changes in the aortic anatomy following surgery.
A newborn is diagnosed with Tetralogy of Fallot. The child is stable, but with moderate cyanosis.
Question: What is the initial management approach for this newborn?
A) Immediate surgery within the first days of life
B) Prostaglandin E1 infusion to maintain ductal patency
C) Start diuretics and digitalis therapy
D) Observation and elective repair within the first year
Observation and elective repair within the first year
For newborns diagnosed with Tetralogy of Fallot who are stable but cyanotic, the initial management often involves careful observation and planning for elective repair within the first year of life. Immediate surgery is usually reserved for those with severe symptoms or complications. Prostaglandin E1 infusion is typically used in conditions where ductal patency is critical, which is not primarily the case with Tetralogy of Fallot.
What genetic pattern is hypertrophic cardiomyopathy?
Autosomal Dominant
What class of medications should be avoided in HOCM?
Diuretics
What are the hallmark signs of Kawasaki’s Disease?
Strawberry Tongue and persistent fevers
A child presents with high fever lasting more than five days, red eyes without discharge, a rash on the trunk, and red, swollen hands and feet.
Question: What is the most likely diagnosis?
A) Measles
B) Scarlet Fever
C) Kawasaki Disease
D) Rheumatic Fever
Kawasaki Disease
