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Cardiology Flashcards

1
Q

What skin finding for hyperlipidemia?

A

Tendon xanthoma

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2
Q

What fmhx would prompt lipid testing?

A

Early coronary artery disease 240 total chol

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3
Q

What test to screen if family Hx has hi chol?

A

Total cholesterol random

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4
Q

What test to screen if early CAD?

A

Lipid profile fasting

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5
Q

Official recommendation for screening every kid.

A

Random chol at 8 to 9 and again at 15yr

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6
Q

What is considered Hi chol?

A

Total >200, LDL >130

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7
Q

What is considered borderline chol?

A

Total 170-199

LDL 110-129

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8
Q

Indication for statins?

A

1) Diet II tried for 6-12mo
2) LDL still >190
3) LDL >160 + FMHX CAD or 2+ risk factors* *HDL

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9
Q

What are secondary causes of high chol?

A

Drugs: AED, Accutane, thiazides, beta-blockers, steroid

DM, HypoTH, chronic liver/renal

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10
Q

Sx of Kawasaki

A

Fever, conjunctivitis, swollen lips, strawberry tongue, lymphadenopathy, desquamation of fingers, truncal rash, CAA, sterile pyuria

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11
Q

Rx for Kawasaki

A

1x IVIg 2g/kg
Hi dose aspirin 80-100mg/kg/day Q6h w/IVIg.
2-3 days after fever reduced, ASA 3-5mg/kg/day.
8 wks -> ECHO -> stop ASA -> ECHO 6-12mo

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12
Q

If Kawasaki patient is untreated, what percentage get Kawasaki?

A

25%

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13
Q

Pattern: sinus tachy, gallop rhythm, LV enlargement

A

CHF/myocarditis

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14
Q

Pattern: muffled heart sound, reduced QRS voltages

A

pericardial effusion

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15
Q

Pattern: prolonged PR interval

A

arrhythmias

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16
Q

Pattern: fever, high ESR, arthralgias, chest pain, arm HTN, poor pulses in legs and long systolic murmur heard over the back and abdomen

A

Takayasu arteritis

coarct with fever, high ESR

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17
Q

What is cause of rheumatic fever?

A

delayed immune response to group A beta hemolytic strep pharyngitis (GAS)

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18
Q

How soon after pharyngitis can you see rheumatic fever?

A

2 to 4 wks

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19
Q

What are the major Jones criteria?

A

Polyarthritis, carditis, subQnodules, erythema marginatum, chorea

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20
Q

What are the minor Jones criteria?

A

fever, arthralgia, previous rheumatic fever, ESR/CRP, leukocytosis, prolonged PR

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21
Q

Rheumatic fever involve which valve disease?

A

aortic and mitral valves

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22
Q

What antibiotics for carditis?

A

Penicillin

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23
Q

What antibiotics for secondary prevention after rheumatic fever?

A

Benzathine penicillin G IM 9 month, penicillin V 250mg BID

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24
Q

Rx with CHF from rheumatic fever?

A

bed rest, digoxin and diuretics

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25
Q

What are causes of pericarditis?

A

viral, bacteria, TB, collagen vascular JRA/SLE, majority POST-PERICARDIOTOMY (1-2 WKS)

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26
Q

Pattern: fever, chest pain, respiratory distress, leans forward

A

Pericarditis

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27
Q

What EKG finding for pericarditis?

A

ST segment elevation

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28
Q

What complication of pericarditis should be treated?

A

Effusions
Small - anti-inflammatory meds
Large - pericardiocentesis

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29
Q

What is the most common cause of myocarditis?

A

Coxsackie A/B

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30
Q

Pattern: tachypnea, poor feeding, preceding illness, lethary, S3 gallop, increased HR, RR, decreased BP, cool, clammy, mottled

A

Myocarditis

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31
Q

Pattern: Diffuse low voltage, arrhythmias on EKG

A

Myocarditis

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32
Q

What lab results are associated with myocarditis?

A

Increased WBC, ESR, CK, troponin, dilated heart and poor function on ECHO, cardiomegaly on CXR

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33
Q

Rx for severe CHF from myocarditis.

A

Dobutamine, DA, milrinone

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34
Q

Rx for mild CHF from myocarditis

A

Digoxin, Lasix, captopril

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35
Q

Prognostic counseling for recovery of CHF

A

1/3 recover, 1/3 chronic, 1/3 death/transplant

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36
Q

What are causes of infective endocarditis?

A

CHD, central line, immune deficiency, IVDA, strep viridins, staph aureus

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37
Q

Pattern: flu-like, fever, wt loss, fatigue, myalgia, joint pain

A

subacute infective endocarditis

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38
Q

Pattern: fever, malaise, new changing murmur, Janeway lesion, Osler’s nodes, Roth spots, splinter hemorrhage (all from embolic)

A

acute infective endocarditis

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39
Q

Which genetic disorder often associated with valvular disease?

A

William - supravalvar aortic stenosis and coronary osteal stenosis

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40
Q

Who should get ppx antibiotics for infective endocarditis?

A
  1. Previous endocarditis
  2. Transplant pt
  3. Unrepaired cyanotic disease, including palliative shunt and conduit
  4. Repaired with residual defects or no endothelization
  5. Device, shunt, valve replacement in last 6 months
  6. Valve with prosthetic material
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41
Q

What Rx for ppx for infective endocarditis?

A

amoxicillin 30-60 min prior to procedure

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42
Q

Pattern: tachycardic, decreased CO –> decreased BP, presentation to hypovolemic shock

A

CHF

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43
Q

Rx high preload in CHF

A

diuretics

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44
Q

Rx for decrease in contractility

A

Digoxin, beta-agonists, phosphodiesterase, dobutamine, milrinone, epinephrine

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45
Q

Rx for high afterload in CHF

A

vasodilators, ACE inhibitors, milrinone

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46
Q

What are symptoms of digoxin toxicity?

A

heart block, SVT, VT, nausea, vomiting, lethargy, hypoKalemia

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47
Q

Rx for digoxin toxicity

A

charcoal, lavage, Digibind (Fab)

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48
Q

Rx for heart block with CHF

A

atropine

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49
Q

Rx for SVT with CHF

A

phenytoin or beta-block

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50
Q

Rx for VT with CHF

A

lidocaine or phenytoin

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51
Q

What don’t you want to do to treat SVT/VT with CHF?

A

Cardiovert, worsens it

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52
Q

Pattern: sudden death, S3 murmur softer lying down, chest pain, exertional syncope, ventricular gallop

A

HOCM

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53
Q

What is pathophysiology of HOCM?

A

AD familial in 1/2 cases causing abnormal thickening of ventricle, decreasing diastolic function, limitation of systolic function

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54
Q

What do you see in HOCM EKG?

A

LAD, LVH, ST-T wave changes

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55
Q

Rx for HOCM

A

B-blocker, Ca channel blocker, AICD, surgery

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56
Q

What is the sequelae of HOCM?

A

endocarditis - so ppx antibiotics (but only moderate risk - so not absolutely required)

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57
Q

What is considered acceptable chol?

A

LDL

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58
Q

Describe AHA diet I

A

1) Sat fat

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59
Q

Describe AHA diet II

A

1) Sat fat

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60
Q

What cardiac condition is associated with Down?

A

AV canal

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61
Q

What cardiac condition is associated with Turner?

A

bicupsid aortic valve, coart

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62
Q

What cardiac condition is associated with DiGeorge?

A

TOF, truncus arteriosus

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63
Q

What cardiac condition is associated with Williams

A

supravalvular AS

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64
Q

What cardiac condition is associated with Marfan

A

dilated aorta, MVP

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65
Q

What cardiac condition is associated with Holt-Oram (limb/thumb)

A

ASD, VSD

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66
Q

What cardiac condition is associated with Frederick’s ataxia

A

Cardiomyopathy

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67
Q

What cardiac condition is associated with Noonan

A

pulmonary stenosis

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68
Q

Which of the 5 T’s in CHD?

Most common cyanotic at birth, seen in large 1st born male

A

Transposition of the great vessels

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69
Q

Which of the 5 T’s in CHD? Loud, 2nd heart sound

70
Q

Which of the 5 T’s in CHD? CXR, egg on string, narrow mediastinum

71
Q

What is EKG like in TGA?

72
Q

What saves kids of TGA?

A

oxygenation dependent on mixing of blood via PFO and PDA

73
Q

How do you improve mixing in kids with TGA?

A

prostaglandin, balloon septostomy, surgical correction

74
Q

What is most common sequelae of TGA correctional operation?

A

Pulmonary stenosis, aortic insufficiency from stretching during surgery
Coronary artery stenosis from kinking

75
Q

4 features of Tetrology of Fallot

A

1) VSD
2) Pulm stenosis
3) Overriding aorta
4) RVH

76
Q

With TOF, presentation is dependent on what two features?

A

degree of pulmonary stenosis and timing of ductal closure

77
Q

Rx for TOF

A

PGE1 and surgical correction as newborn

78
Q

What additional features are seen in truncus arteriosus?

A

VSD, abnormal truncal valve - stenotic +/- regurgitant

79
Q

What does CXR look like for truncus arteriosus?

A

cardiomegaly and increased pulmonary flow

80
Q

Pattern: 2 week to 2 month old with CHF, systolic murmur LUSB, single S2

A

Truncus arteriosus

81
Q

Pattern: cardiomegaly and increased pulmonary blood flow

A

Tricuspid atresia

82
Q

With tricuspid atresia and small VSD, what symptom?

83
Q

With tricuspid atresia and large VSD, what symptom?

84
Q

Pattern: cyanosis shortly after birth, respiratory distress, no mumur, CXR normal heart, severe pulmonary edema, ground glass, snowman

A

total anomalous pulmonary venous return

85
Q

Pattern: fixed split S2, systolic murmur, EKG could show WPW, RBBB, RAE, CXR wall to wall heart

A

Ebstein’s anomaly of tricuspid valuve

86
Q

Pattern: opening click and systolic murmur, RVH CXR shows decreased pulmonary blood flow

A

Pulmonary stenosis

87
Q

What do you do for pulmonary stenosis?

A

PGE1 if cyanotic newborn period, balloon valvuloplasty or surgical valvotomy

88
Q

Rx for PDA

A

Indomethacin or catheter intervention

89
Q

Contraindication for indomethacin

A

renal, platelet dysfunction

90
Q

Pattern: Harsh, holosystolic murmur in left sternal border, PMI is displaced, diastolic rumble, precordium is hyperdynamic

91
Q

What is sequelae of VSD and if not repaired in first year?

A

1) CHF

2) Pulm HTN

92
Q

Pattern: fixed split S1 on respiration

93
Q

Sequelae of unrepaired ASD

A

1) atrial arrhythmias, sick sinus (can occur despite)
2) PHTN
3) 50% mortality by 37yrs from stroke and heart failure

94
Q

Pattern: LUSB crescendo/decrescendo murmur radiating to midscapular

A

Coarctation

95
Q

Pattern: higher blood pressure in R arm than leg

A

Coarctation

96
Q

Rx for coarctation

A

PGE1 in infants with shock, beta blockers in older children

97
Q

Pattern: shock or cyanosis, sudden death in young

A

Aortic stenosis

98
Q

Rx for aortic stenosis

A

balloon valvuplasty, surgical valvotomy, valve replacement

99
Q

Pattern: opening click or split first heart sound, most common valvular disease

A

bicupsid aortic valve

100
Q

Rx for bicuspid aortic valve

A

anti-hypertensive and valve replacement

101
Q

Pain with touch of chest

A

costochondritis

102
Q

Stabbing chest pain, sudden in onset, lasting a few second to minutes, worsened by inspiration

A

precordial catch syndrome (pinched nerve, pleuritic pain)

103
Q

Pain w/ palpitations

104
Q

Pain relieved with tripod

A

Pericarditis

105
Q

Constant pain

A

myocarditis

106
Q

Pain and nausea with exercise

A

anomalous right coronary artery

107
Q

What are red flags for cardiac cause of syncope?

A

1) No preceding symptoms
2) Injury from LOC
3) During exertion or emotional stress
4) While sitting or supine, during activity

108
Q

Pattern: murmur radiates to carotids, associated with opening click (split 1st)

A

Bicuspid aortic valve

109
Q

Pattern: flow murmur across R (ventricular outflow tract, split 2nd)

A

Atrial septal defect

110
Q

Pattern: grade 2-3/6 high pitch, one frequency, higher with fever or exercise

A

Stills’ murmur

111
Q

Pattern: Murmur louder in axilla than centrally

A

Peripheral pulmonic stenosis

112
Q

Pattern: venous hum, changes with repositioning

A

Continuous murmur that is benign

113
Q

How fast is heart rate in sinus tachycardia?

114
Q

What does EKG look like in sinus tachycardia?

A

Normal QRS, P wave normal, but may be hidden

115
Q

What test should you do if sinus tach is diagnosed?

116
Q

How fast is HR in SVT?

117
Q

Describe EKG of SVT

A

QRS narrow, LBBB, p waves abnormal and multiple for each QRS

118
Q

Rx for SVT

A

Start with adenosine 50-100mcg/kg then double with each injection, verapamil, DC cardioversion for low cardiac output, antiarrhythmic if refractory

119
Q

What EKG pattern for WPW?

A

short PR interval, widened QRS, slurred upstroke

120
Q

What is atrial and ventricular rate with atrial flutter?

A

> 300 atrial, 150-250 ventricular

121
Q

In an older child with atrial flutter, what do you worry about?

A

atrial conduction problem (sick sinus syndrome/myocarditis)

122
Q

Rx for atrial flutter

A

Amiodarone, sotalol, class I (procainamide, flecanide), DC convert

123
Q

What should be given first before class I anti-arrhythimic?

A

Digoxin, because they will incrase conduction via AV node, so block first with dig

124
Q

Pattern: wide abnormal QRS, T waves in opposite direction from QRS, steady rate

A

Ventricular tachycardia

125
Q

Rx for ventricular tachycardia

A

Amiodarone, procainamide, cardioversion

126
Q

What are causes of sinus brady?

A

athletes, sedation, Cushing’s Triad, hypoxemia

127
Q

What are causes of SA node dysfunction?

A

S/p atrial surgery for ASD, Mustard, Fontan

128
Q

What else is typically seen with SA node dysfunction?

A

tachy/brady syndrome, junctional or ventricular escape rhythm

129
Q

Pattern: prolonged PR interval, narrow QRS

A

Primary heart block

130
Q

Pattern: PR interval lengthens and then drops

A

Secondary heart block - Mobitz I benign seen in athletes or in sleep

131
Q

Pattern: PR drops without any changes to interval

A

Mobitz II - not benign

132
Q

Pattern: no correlation between P and QRS

A

3rd degree heart block

133
Q

What diseases are typically associated with congenital heart block?

A

any heart disease, SLE, connective tissue (Sjogren’s)

134
Q

Pattern: variation in P-P and R-R interval due to changes in cardiac filling during respiration

A

Sinus arrhythmia

135
Q

What other abnormality is typically associated with sick sinus syndrome?

A

secundum ASDs

136
Q

Pattern: delta wave in sinus rhythm, narrow QRS

137
Q

Pattern: early/abnormal P wave with normal QRS

138
Q

Rx for PACs

139
Q

Pattern: early, wide QRS without preceding P wave

140
Q

Pattern: Wide QRS, P wave present, V1 QRS up, V6 QRS down

141
Q

Pattern: Wide QRS, + P wave, V1 QRS down, V6 QRS up

142
Q

EKG HypoK

143
Q

EKG 6-7.5 K+

A

elevated T

144
Q

EKG 7.5-9 K+

A

increase dip of RS and elevated T

145
Q

EKG >9 K+

A

sinusoidal

146
Q

Pattern: shortened PR interval, large tongue

A

glycogen storage disease

147
Q

EKG hypoCa

A

shortened ST seg

148
Q

EKG hyperCa

A

lengthened ST seg

149
Q

What fmhx should make you concern for long QT syndrome?

A

FmHx of syncope, seizure, sudden death, with emotional stress or exercise

150
Q

How to calc QTc

A

QT/RR interval (seconds)

151
Q

How do you roughly estimate if QT is normal?

A

if HR 70-100bpm, if QT interval is

152
Q

What is the AD genetic disorder associated with prolonged QT?

A

Romano-Ward

153
Q

What is the AR genetic disorder for prolonged QT? What is the associated symptom?

A

Jervell-Lange-Neilsen; congenital deafness

154
Q

Pattern: absent p wave, pause is 2x P-P interval

A

sinus exit block

155
Q

Describe criteria for results of hyperoxia test

A

pO2 150 cardiac unlikely

156
Q

How do you workup cynosis?

A

1) Hyperoxia test

2) pCO2 - normal in cyanotic heart disease and hemoglobinopathy; hi in pulmonary and neurologic disorders

157
Q

Describe triggering situations and physiology of TET spell

A

Agitation, anger, dehydration, sickness –> inc HR –> incr RVOT obstruction and decr SVR

158
Q

What are Rx (3 categories for TET spell)

A

Decr RVOT Morphine, propanolol, sedation, IV/IM ketamine
Incr SVR knee to chest, phenylephrine
Incr O2 delivery volume, pRBC, oxygen, bicarb

159
Q

What is body’s response to CHF?

A

Decr CO = incr HR x decr SV (due to incr preload, decr contractility, inc afterload)

160
Q

When do PDA, ductus venosus, PFO close?

A

PDA - hrs to days
DV - min to days
PFO - min to months

161
Q

What are parameters of correct pressure cuff?

A

Width of cuff >40% of arm circumference

Bladder length should cover 80-100% of arm

162
Q

When should bp be measured?

A

Starting at 3 yo right arm

163
Q

If bp is at >90% what do you do?

164
Q

If confirmed bp is 90-95% what do you do?

A

Recheck in 6 months, begin weight management

165
Q

If confirmed bp is 95-99% what do you do?

A

recheck in 1 wk, treatment and weight management

166
Q

If confirmed bp is >99th% what do you do?

A

eval/treat in 1 wk

167
Q

Workup for HTN

A

ECHO, renal US, UA, creatinine, K+

168
Q

Pulse ox screening in >24hr baby -

169
Q

Pulse ox screening in R hand/foot >24hr baby or >3% change in R hand/foot - 90-95%

170
Q

Pulse ox screening in >24hr baby >95% in R hand/foot or

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