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Cardiology Flashcards

1
Q

What is the EKG finding for right atrial enlargement?

A

P-wave is peaked in V1

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2
Q

What is the EKG findings in left atrial enlargement?

A

P-wave is shaped like an M in V1

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3
Q

When do you see a negative T-wave?

A
  • T wave is positive or upright in newborns in lead V1

- T-wave becomes negative after the first week of life

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4
Q

What can cause a long QT interval?

A 
"MELT PCs"
Magnesium low
Erythromycin 
Levofloxacin
TCAs
Potassium low
Calcium low
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5
Q

What are the clinical features of supraventricular tachycardia (SVT)?

A
  • HR > 240
  • Try Vagal maneuvers x 20 seconds (including ice to face)
  • If unstable, DC cardiovert
  • IV adenosine x 2
  • In children older than 12 months, Diltiazem or Verapamil (Contraindicated in < 12 months)
  • Long term: beta blocker for one year to prevent recurrence
  • If resistant, radiofrequency ablation
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6
Q

What is Wolff Parkinson White syndrome?

A
  • Accessory pathway that bypasses the AV node and connects atrium to the ventricle
  • Accessory pathway conducts more rapidly
  • Delta wave is seen on EKG
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7
Q

What can prolonged QT interval lead to?

A
  • Torsades de Pointes

- May be the cause in any patient who has loss of consciousness, drowning, syncope, seizure

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8
Q

What is the EKG finding in a first-degree AV block?

A

Prolonged PR interval (>0.2 s).

Benign

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9
Q

What are the EKG findings in the two different kinds of second degree AV blocks?

A
  • Type I = Mobitz Type I = Wenckebach: PR interval widens until there is a dropped QRS complex
    • Benign
    • Won (one) = widening = Wenckebach
  • Type II = Mobitz Type II = intermittent nonconducted P waves, may progress to complete heart block
    • Pacer might be indicated
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10
Q

What are the EKG findings in a third degree AV block?

A
  • P waves and QRS complexes are completely independent of one another
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11
Q

What is the murmur associated with an ASD?

A
  • Fixed split S2
  • Soft LUSB mid-systolic murmur
  • Parasternal heave
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12
Q

What are the two types of ASDs?

A
  1. Secundum ASD:
    • Most common
    • Repair only if L->R shunt becomes >2:1
  2. Ostium Primum ASD:
    • Less common
    • More serious
    • Needs repair early
    • Ok to get pregnant if L->R shunt is <2:1
    • Pregnancy is contraindicated if -> Eisenmenger’s Syndrome
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13
Q

What is Eisenmenger’s Syndrome?

A

When and ostium primum ASD becomes a right to left shunt

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14
Q

What is the murmur associated with a VSD?

A
  • Holosystolic
  • LLSB thrill/murmur
  • None if the VSD is very large
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15
Q

Which type of VSD is more likely to close on its own?

A
  • Muscular

- Membranous is less likely to close on its own

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16
Q

VSDs are associated with which syndromes?

A

Cri-du-chat
Trisomy 13
Trisomy 18
Trisomy 21

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17
Q

What murmur is heard with pulmonary stenosis?

A
  • Crescendo-decrescendo
  • Harsh LUSB murmur
  • Widely split S2
  • Possible thrill or click
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18
Q

What murmur is heard with mitral stenosis?

A
  • Opening snap
  • Mid-diastolic
  • Best heard at apex
  • Associated with chronic rheumatic heart disease
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19
Q

What murmur is heard with tricuspid stenosis?

A
  • Opening snap
  • Mid diastolic murmur
  • Heard at LLSB
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20
Q

What murmur is heard with aortic stenosis?

A
  • Harsh, mid systolic murmur
  • Heard best at RUSB
  • Thrill at suprasternal notch
  • Paradoxical split (S2 is single with inspiration and split with expiration)
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21
Q

What are the clinical findings of aortic stenosis?

A
  • Progressive
  • Associated with significant risk of sudden death, exertional chest pain, syncope
  • EKG: LVH
  • Tx: balloon dilation
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22
Q

What murmur is heard with mitral regurgitation?

A
  • Holosystolic blowing apical murmur
    • Blowing = high-pitched
  • May radiate to axilla
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23
Q

What syndromes are associated with mitral regurgitation?

A
  • Marfan syndrome

- Ehlers-Danlos syndrome

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24
Q

What murmur is heard with mitral valve prolapse?

A
  • Mid-systolic click
  • Mid-late systolic murmur
  • Increases with:
    • Standing
    • Valsalva
    • Hand grip
  • Decreases with:
    • Squatting
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25
Q

What murmur is heard with hypertrophic cardiomyopathy?

A
  • Harsh crescendo-decrescendo systolic murmur
  • Increases with:
    • Standing
    • Valsalva
  • Decreases with:
    • Squatting
    • Hand grip
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26
Q

What murmur is heard with aortic regurgitation?

A
  • Apical
  • Early diastolic

PE:

  • Bounding pulses
  • Associated with Marfan syndrome
27
Q

What are the eight cyanotic congenital heart diseases?

A
  1. Truncus arteriosus
  2. Transposition of the great arteries
  3. Tricuspid atresia
  4. Tetralogy of fallot
  5. Total anomalous pulmonary venous return
  6. Hypoplastic left heart
  7. Pulmonary atresia
  8. Persistent pulmonary hypertension
28
Q

What does prostaglandin administration do when given to a newborn?

A
  • aka, alprostadil

- Keeps the ductus arteriosus open

29
Q

What does indomethacin do when given to a newborn?

A

Closes a patent ductus arteriosus

30
Q

What are the clinical features of coarctation of the aorta?

A
  • Not a cyanotic defect
  • Can result in congestive heart failure symptoms
  • Blood pressure differential between right arm and right leg (lower in right leg)
31
Q

What are the features of truncus arteriosus?

A
  • Single trunk coming off the ventricular chambers
  • EKG: biventricular hypertrophy
  • CXR: cardiomegaly
  • Mild cyanosis
  • Severe CHF within months to one year
32
Q

What is the most common cardiac cause of cyanosis on DOL 1?

A

Transposition of the great arteries

33
Q

What are the clinical features of transposition of the great arteries?

A
  • EGG SHAPE ON CXR
  • LV -> PA
  • RV -> Aorta
  • EKG: RVH
  • Parallel circuits
  • Usually associated with a VSD, if not, a septal defect needs to be created
  • Need PDA
34
Q

What are the clinical features of tetralogy of fallot?

A
  • BOOT SHAPE ON CXR
  • 4 findings (PROVe it):
    1. Pulmonary stenosis
    2. RVH
    3. Overriding aorta
    4. VSD
  • R->L shunt through VSD due to PS
  • Clear CXR
  • Give PGE for L->R shunting at PDA
35
Q

What is a “tet spell?”

A
  • Acute increase in right to left shunting resulting in cyanosis, possible syncope, death
  • Older kids squat, younger kids put knees to chest to increase systemic vascular resistance and decrease shunting
36
Q

What are the clinical findings in total anomalous pulmonary venous return?

A
  • SNOWMAN shape on CXR
  • Oxygenated blood returns to RA and never enters systemic circulation
  • Not compatible with life unless PFO/ASD are present (allowing blood to go to LA)
37
Q

What are the clinical features of hypoplastic left heart?

A
  • Everything on left is small: left ventricle, mitral valve, aortic valve, aorta
  • CHF, which gets worse after PDA closes
38
Q

What are the clinical features of tricuspid atresia?

A
  • Tricuspid valve did not form -> no functional RV unless there is a VSD
  • Pulmonary circulation is maintained through PDA
39
Q

What are the clinical features of pulmonary atresia?

A
  • Pulmonary valve did not form -> RV blood cannot flow from right ventricle to lung -> tricuspid regurgitation
  • PDA is needed
40
Q

What are the three ways of diagnosing rheumatic fever?

A
  • Evidence of previous Group A Strep infection is required
    1. 2 of the major Jones criteria
    2. 1 major and 2 minor criteria
    3. History of acute rheumatic fever or rheumatic heart disease and meets 3 minor criteria
41
Q

What are the major Jones criteria for acute rheumatic fever?

A 
J = asymmetric migratory polyarthritis of the large joints
O = signs of carditis: valves, myocardium, pericardium
N = painless, firm subcutaneous nodules
E = erythema marginatum: transient, erythematous, macular and light colored; margins progress as the center clears
S = sydenham's chorea
42
Q

What are the minor Jones criteria for acute rheumatic fever?

A

A: arthralgias
E: elevated ESR and CRP
F: fever
P: prolonged PR

43
Q

What is the treatment for rheumatic fever?

A
  • PCN VK PO x 10 days
  • Benzathine PCN (IM/IV) x 1
  • If evidence of carditis, give aspirin and prednisone
  • High risk of recurrence: give monthly penicillin to prevent GAS pharyngitis
    • May discontinue after age 21
44
Q

What are Aschoff bodies?

A
  • Nodules on the heart or aorta

- Pathognomonic for acute rheumatic ever

45
Q

What is the most common murmur of rheumatic fever?

A

Mitral regurgitation

46
Q

What are the diagnostic criteria for Kawasaki disease?

A 
"THERMAL"
Temp for 5 days
Hand findings (erythema of hands/feet)
Eye findings: non-exudative conjunctivitis 
Rash: non-vesicular
Mucosal involvement: strawberry lips/tongue
Adenopathy
LAD
47
Q

What is the treatment for Kawasaki disease?

A
  • IVIG
  • High dose Aspirin (80mg/kg) until afebrile for at least 48 hours
  • Continue aspirin for six weeks
48
Q

What are the etiologies of endocarditis?

A

In the order of how frequently they cause infections:

  1. Strep viridans
  2. Staph aureus
  3. Staph epidermidis
49
Q

What are the signs and symptoms of endocarditis?

A
  • Fever
  • New murmur
  • Petechiae
  • Splenomegaly (from CHF)
  • Osler’s nodes: tender nodules on fingers/toes
  • Janeway lesions: nontender macules on palms/soles
50
Q

What is the most common cause of acute bacterial endocarditis?

A

Staph aureus

  • Toxic presentation
  • High fever
51
Q

What is the most common cause of subacute bacterial endocarditis?

A

Strep viridans

  • Vague symptoms for weeks
  • Aortic valves are especially vulnerable
52
Q

What must you have to diagnose endocarditis?

A

A positive blood culture

53
Q

What is used to treat native valve endocarditis?

A

Ampicillin + Gentamicin

  • Treat “native” like “nativity” like a baby
54
Q

How do you treat endocarditis caused by penicillin sensitive strep?

A
  • Single antibiotic x 4 weeks
    • PCN, Ampicillin, CTX
  • Dual therapy x 2 weeks
    • Ampicillin + Gentamicin
  • If allergic to penicillin, use vancomycin
55
Q

How do you treat endocarditis cause by penicillin insensitive strep species?

A

Ampicillin + Gentamicin

56
Q

How do you treat endocarditis caused by MRSA?

A

Vancomycin + Gentamicin +/- Rifampin

57
Q

How long do you treat prosthetic valve endocarditis?

A

IV antibiotics x 6 weeks

58
Q

What do you do for a patient with a prosthetic valve who develops endocarditis within 2 months of placement?

A

Acute!

Treat with emergent surgery

59
Q

How do you treat subacute prosthetic valve endocarditis infected with MRSA?

A

Vancomycin + Gentamicin + Rifampin

60
Q

How do you treat subacute prosthetic valve endocarditis infected with Staph aureus?

A

Gentamicin + Oxacillin/Nafcillin/Cefazolin

61
Q

Which patients receive lifelong prophylaxis for subacute bacterial endocarditis?
(4)

A
  1. History of endocarditis
  2. Any prosthetic valve or prosthetic material used for valve repair
  3. Repaired CHD with residual defect
  4. Unrepaired cyanotic CHD
62
Q

Which patients receive six months of prophylaxis for subacute bacterial endocarditis?

A

Patients who have any prosthetic material in the heart and not part of the valve

63
Q

With what syndrome is dextrocardia seen?

A

KARTAGENER SYNDROME = Primary Ciliary Dyskinesia

  • Autosomal recessive
  • Dextrocardia
  • Situs inversus
  • Dysfunctional cilia in respiratory tract -> frequent sinus or pulmonary infections
  • Nasal polyps
  • Immotile sperm
  • Dx: electron microscopy of nasal scrapings
64
Q

What labs do you check when you suspect pheochromocytoma?

A
  • Serum metanephrines (elevated)

- Urine VMA (elevated)

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