Cardiology

Question 1

Hereditary Angioedema

Answer 1

Reccurent. Fm Hx. Autosomal dominant. Presents as edema and GI cramps/diarrhea (edema of bowel). Airway edema dangerous. Caused by low C1 inhibitor (excess classic complement path) and kinins. Check C4.

Question 2

Ebstein Anomaly

Answer 2

Cognenital: septal leaflet of TV is displaced down. Quadruple gallop, T regurg, mid D murmur, RAH, RV underdeveloped. WPW often.

Question 3

Incidence of congenital heart disease

Answer 3

1-2%. 2-6% with affected relative.

Question 4

marfan heart association

Answer 4

aortic and mitral regurgitation. Dilated aorta.

Question 5

JRA

Answer 5

spiking high fevers, spindle shaped swelling of finger joints and sternoclavicualr joint also affected.

Question 6

Treatment of rheumatic fever

Answer 6

steroids and salicylates (help all but chorea).

Question 7

Wolf Parkinson White

Answer 7

Bundle of Kent, D wave. Causes supraventricular tachy (HR >220). short PR interval. Can have ebstein anomaly.

Question 8

Kawasaki Disease

Answer 8

Conjunctivitis, dry lips, oral erythema, strawberry tongue, limb edema, finger peeling, arthritis, adenopathy, increased platelets. Tx: IVIG once and aspirin.

Question 9

Tricuspid Atresia effects and EKG

Answer 9

Cyanotic. RV hypoplasia with resulting left axis deviation (other cyanotic lesions result in high RV pressure and dilation, causing R shift).

Question 10

Transposition of great arteries

Answer 10

Cyanotic. Egg on string xray. RVH and right axis deviation.

Question 11

Tetralogy of Fallot

Answer 11

Cyanosis takes a few days to come on.

Question 12

Mitral Prolapse

Answer 12

often presents in adolescense. OS then apical systolic murmur. Autosomal domiant inheritance sometimes.

Question 13

Marfan

Answer 13

ectopia lentis (subluxationof the ocular lens), progressive dilatation of the aortic root and ascending aorta, aortic aneurysm, excessive height for age, and disproportionately long and thin extremities, with hypermobility and ligamentous laxity.

Question 14

Down’s heart defects

Answer 14

30 to 50%. Including endocardial
cushion defect (30%), ventricular septal defect (30%), and tetralogy of Fallot (about 30%).

Question 15

Ideopathic Hypertrophic subaortic Stenosis

Answer 15

aka: hypertrophic cardiomyopathy. Cause of death/arrhythmias in young people. Gene mutation, sometimes inherited. Usually asymptomatic till event.

Question 16

Long QT

Answer 16

Usually presents in late childhood or adolescence with syncope. Palpitations.

Question 16

QTc

Answer 16

QT/root of RR interval. Normal is less than 440 ms.

Causes: cardiomyopathy, hypothyroid, hypothermia, hypoCa, CAD, congenital, drugs, other electrolytes.

Question 18

HR calc

Answer 18

60/RR

Question 19

EKG signs of RVH

Answer 19

right axis deviation and V1 R wave greater than S

Question 20

EKG signs of LVH

Answer 20

V1 S wave with R wave in V5/6 greater than 35mm.
R wave in aVL >11mm
R wave in I > 15mm

Question 21

P wave and enlargments

Answer 21

Best seen in Lead II.
Left atrial enlargment best in V1: greater negative deflection than normal.
Right: initial depolarization is larger than normal.

Question 22

QRS and abnormality classification

Answer 22

Normal = 0.12 or 3 boxes

Question 23

EKG RBB signs

Answer 23

Normal RV depolarization interrupted.
initial depolarization of septum is normal: normal V1 R and V6 Q. Sequence is normal as it goes a bit because first part is overwhelmingly LV. RV though is later, widening QRS - get an abnormal terminal upwave (R’).
In V1, this is called rabbit ears.

Question 24

EKG LBB signs

Answer 24

More prominent than RBB.
Normal initial depolarization of septum doesnt occur, causing initial vector to be to the right parts of septum - initial downward spike in V1 and absence of normal q wave in V6.

Question 25

syncope differential

Answer 25

CARDIAC
Obstructive: valvular disease, hypertrophic cardiomyopathy, pulm hypertension, PE, cardiac tamponade, atrial myxoma.
Arrhythmia
Ischemia

Non Cardiac:
Metabolic derangement (hypoNa and HypoGlu)
CNS: stroke, seizure
Peripheral circulation: orthostatic hypotension, hypovolemia, drugs, vasovagal)

Question 26

Orthostatic Hypotension

Answer 26

drop after 3 minutes in standing/sitting of >20mmHg systolic or >10mmHg diastolic.

Question 27

handgrip as clinical maneuver for murmurs

Answer 27

Clench hand 30sec.
Valsalva increases murmur of hypertrophic cardiomyopathy but hand grip decreases it. (systolic)
Decreases murmur of mitral regurgitation (holosytolic)

Question 28

Etiology of tachycardias

Answer 28

1) Supraventricular Tachy: A tachy, A Flutter, A Fib, MAT.
2) Ventricular Tachy: wide QRS
3) Pre-excited Tachycardia: anterograde accessory path (WPW, LGL)

Question 29

Atrial tachycardia

Answer 29

Ectopic focus in atria. Abnormal P wave shape. 100-250 bpm.

Question 30

Atrial flutter

Answer 30

ReEntrant tachy with atrial rates of 250-350 bpm and ventricular rates of 2 or 3:1 (usually around 150bpm)(depends on AV node conduction).

Question 31

Multifocal atrial tachycardia

Answer 31

multiple ectopic foci in atria causing irregular rate. 3 or more p wave shapes. Rate >100 bpm.

Question 32

Diseases that lead to Atrial Fibrillation

Answer 32

hypertension
coronary artery disease
cardiomyopathy
valvular heart disease
hyperthyroidism
Post cardiac surgery, pericarditis, myocarditis
Predisp factors: alcohol, PE, pulm disorders.

Question 33

Mgmt of Atrial fibrillation

Answer 33

Hemodynamically unstable: immediate cardioversion. 
Stable: antiarrhythmics like class 1A (procainamide, disopyramide, quinidine), Class 1C (highest potency): propafenone and flecainide or K channel blockers/class III: amiodaraone, sotalol. 

Control rate to 60 - 80 bpm: Beta blockers, Ca blockes, or digoxin.