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Paediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Which syndrome is associated with aortic and pulmonary stenosis?

A

Williams Syndrome

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2
Q

What are the structural features of Tetralogy of Fallot?

A

VSD
Pulmonary stenosis
RVOT
RVH

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3
Q

How do you calculate Pulmonary Vascular Resistance ? (Poiseuille equation)

A

Mean PA p - LA p
————————-
Pulmonary blood flow (l/min/m2)

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4
Q

What is a normal recording for PVR? What is severe and correlates with irreversible pulmonary vascular disease?

A

Normal PVR = 1-2 u/m2

Severe = > 7.9u/m2

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5
Q

How do you calculate Qp (pulmonary blood flow) / Qs (systemic blood flow)

A

Qp/ Qs = (Ao sat - MV sat)
———————
(PV sat - PA sat)

MV sats: take average of SVC and RA
PV sats: same as LA

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6
Q

What is the most common cardiac complication of Duchenne muscular dystrophy?

A

Dilated cardiomyopathy

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7
Q

What congenital cardiac lesion is suggested by a single second heart sound?

A

Truncal atresia (shared root aorta and pulmonary artery)

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8
Q

What cardiac lesion is associated with Turner’s syndrome?

A

Coarctation of the aorta
Bicuspid aortic valve
Aortic stenosis

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9
Q

What cardiac lesion is associated with Di George syndrome?

A

Tetralogy of Fallot

Truncus Arteriosus

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10
Q

What cardiac lesion is associated with Alagille’s syndrome?

A

Peripheral pulmonary artery stenosis

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11
Q

Which cardiac lesion is associated with Noonan’s syndrome?

A

Valvular pulmonary stenosis

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12
Q

What auscultation sign is most indicative of pulmonary hypertension?

A

Loud S2 (Pulmonary valve closes quicker)

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13
Q

Which cardiac malformation is associated with neurofibromatosis?

A

Pulmonary stenosis

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14
Q

Describe the murmur heard for peripheral pulmonary stenosis.

A 
Grade 1-2 
Ejection systolic 
Left upper sternal edge
Radiating to axilla or back 
Benign - due to changes in pulmonary vascular resistance
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15
Q

What cardiac malformation would you suspect for a day 2 neonate becoming cyanosed with no other cardiac findings on examination ?

A

Total Anomalous Pulmonary Vascular Return

Duct dependent

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16
Q

Which syndrome is associated with aortic root dilatation?

A

Turners syndrome

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17
Q

What is the cardiac abnormality seen in Alagille syndrome ?

A

Peripheral pulmonary stenosis

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18
Q

What is the most common cardiac abnormality seen in congenital rubella syndrome?

A

PDA

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19
Q

What cardiac abnormalities are seen in Williams syndrome?

A

Supraaortic valvular stenosis
Peripheral pulmonary stenosis
Systemic arterial stenosis

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20
Q

What is the most common cardiac abnormality in velocardiofacial syndrome?

A

VSD
Right sided aortic arch
TOF

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21
Q

What murmur do you hear in TOF?

A

Harsh ejection systolic murmur over left sternal border (pulmonic area) due to turbulence through R outflow tract
Can also get aortic ejection click, systolic thrill

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22
Q

What is the most common complication of surgically corrected TOF?

A

RBBB (due to widening of RVOT)

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23
Q

What are the clinical findings of tricuspid stenosis?

A

Mid diastolic murmur
Hepatomegaly
Distended neck veins
No respiratory distress

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24
Q

What is the most likely diagnosis: cyanosis presenting in first few hours of life
Normal pulse
No respiratory distress
No murmur

A

TGA

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25
Q

What condition is associated with a fixed splitting of the second heart sound?

A

ASD

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26
Q

What is the most common cardiac defect seen in foetal alcohol syndrome?

A

ASD

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27
Q

What are the clinical and ECG/CXR findings for ASD?

A 
Ejection systolic murmur at left upper sternal edge 
Fixed splitting of S2 
ECG: RBBB 
CXR: cardiomegaly, plethoric lungs 
(Volume overload right heart)
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28
Q

What does upright T wave in V1 indicate? (Age 4 days to 4 years)

A

Right ventricular hypertrophy

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29
Q

Name 2 congenital conditions associated with valvular pulmonary stenosis

A

Noonans syndrome

Neurofibromatosis

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30
Q

Name two syndromes associated with peripheral pulmonary stenosis

A

Alagille’s

Williams

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31
Q

What happens to the murmur of TOF during a tet spell

A 
Gets softer 
(Decreased SVR causes reversal of shunt pushing blood back to right side; fixed obstruction across RVOT- less blood flow)
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32
Q

What is the event that initiated myocardial fibre contraction ?

A

Release of stored calcium from sarcoplasmic reticulum

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33
Q

Name 5 causes of Pulsus paradoxus

A 
Cardiac tamponade
Constructive pericarditis 
Severe asthma 
PE
Tension pneumothorax
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34
Q

Name 3 congenital cardiac lesions that cause cyanosis and plethoric lungs

A

TGA
Truncus arteriosus
TAPVR

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35
Q

Name 3 cyanotic heart lesions that cause oligaemic lungs

A

Tetralogy of Fallot
Pulmonary atresia
Ebsteins anomaly

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36
Q

Name 5 cyanotic heart lesions that are duct dependent

A 
Hypoplastic left heart 
Severe coarctation 
Interrupted aortic arch 
Severe AS 
TAPVR
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37
Q

Name 4 acyanotic heart lesions that cause left to right shunting

A

ASD
AVSD
VSD
PDA

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38
Q

In the foetal circulation what is the output from the right ventricle compared to the left ?

A

RV = 2x LV

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39
Q

In foetal circulation what percentage of blood flow passes through the PDA to the descending aorta ?

A

90%

40
Q

What is the normal pressure for the right ventricle?

A

25/0mmHg

41
Q

What is the difference between antidromic and orthodromic re-entrant tachycardia

A 
Antidromic = broad complex tachy
Orthodromic = barrow complex tachy
42
Q

Which arrhythmias in WPW require an accessory pathway for maintenance and initiation?

A

Antidromic and orthodromic re-entrant tachycardia

43
Q

Which arrhythmia in WPW do NOT require an accessory pathway for initiation and maintenance?

A 
AV nodal re-entrant tachy 
AF 
Atrial flutter 
VT 
VF
44
Q

What is the most common type of VSD - what % does it account for?

A

Perimembranous 70%

45
Q

What is the least common type of VSD? What is the main complication?

A

Type 1
Supracristal / conal
5%
Aortic regurgitation

46
Q

What are the clinical and ECG features of tricuspid atresia ?

A

Cyanosis day 1
No respiratory distress
Pansystolic murmour left sternal edge
Single S2

ECG:
LEFT ventricular hypertrophy (tall R waves V1, deep S waves V6)

47
Q

How do you calculate pulmonary vascular resistance?

A

PVR = (Pa - Pv)/Qp

Pa = Pulmonary arterial pressure 
Pv = Pulmonary venous pressure = left atrial pressure 
Qp = Pulmonary venous flow
48
Q

Specific lung compliance is best standardised by measuring lung compliance at which lung volume ?

A

Functional residual capacity

49
Q

What are the classes of CFTR mutations in CF?

A

Class I: no CFTR production
Class II: defective protein processing
Class III: gate malfunction (Ivacaftor)
Class IV: defective conductance of chloride
Class V: Reduced production of CFTR
Class VI: increased turnover at surface of cell

50
Q

What is an associated congenital heart defect with coronary artery fistulae?

A

Pulmonary atresia with intact septum

51
Q

What is the cardiac lesion ?
ECG: RVH, RBBB
Systolic murmur
Wide fixed splitting S2

A

ASD

52
Q

What cardiac defect is associated with PHACES ?

A

Aberrant subclavian artery

53
Q

What cardiac defect is associated with Char syndrome?

A

PDA

54
Q

What cardiac defect is associated with Alagille syndrome ?

A

Peripheral pulmonary stenosis

Tetralogy of Fallot

55
Q

What cardiac lesion is associated with Fragile X?

A

Mitral valve prolapse

56
Q

Which cardiac lesion is associated with Turner syndrome?

A

Bicuspid aortic valve

Coarctation of the aorta

57
Q

ECG shows complete AV block with junctional escape- what is the most likely explanation ?

A

Precious cardiac surgery eg VSD repair

58
Q

What is the most common cardiac lesion associated with neurofibromatosis 1?

A

Pulmonary stenosis

59
Q

What medication is best to treat long QT?

A

Propranolol

60
Q

What medication is best to treat short QT?

A

Quinidine

61
Q

How do you differentiate between antidromic and orthodromic re entrant tachycardia in WPW?

A

Antidromic - broad complex tachycardia

Orthodromic - narrow complex tachycardia

62
Q

How do you calculate cardiac output ?

A

Oxygen consumption / arterial - venous o2 x 10

63
Q

What does the third heart sound represent ?

A

Rapid ventricular filling

64
Q

What condition should you suspect
6 week infant presenting with pansystolic murmur LLSE
CXR shows cardiomegaly but also narrow mediastinum
ECG shows long QT

A

Di George

  • murmur is VSD
  • CXR narrow mediastinum shows thymic aplasia
  • ECG long QT can be caused by hypocalcaemia
65
Q

What are two causes of cyanotic heart disease that cause LVH?

A

Tricuspid atresia

Truncus arteriosis

66
Q

Name 4 causes of cyanotic heart disease that cause increased pulmonary blood flow

A

TGA
TAPVD
HLHS
truncus arteriosus

67
Q

What is the diagnosis
Bounding pulses
Continuous systolic murmur
Displaced apex beat

A

PDA

68
Q

What is the diagnosis ?
Fixed split S2
ESM LSE
Superior axis

A

ASD

69
Q

Most common type of VSD

A

Membranous

70
Q 
What is the diagnosis 
Single loud S2 
Pansystolic murmur 
Plethoric lungs 
A cyanotic 
Superior axis
A

AVSD

71
Q

What is the diagnosis
ESM radiating to neck
Ejection click at apex

A

Aortic stenosis

72
Q

What is the diagnosis ?
ESM between scapula
Poor femoral pulses

A

Coarctation

73
Q

What is the diagnosis ?
ESM
Mid systolic click LUSB

A

Pulmonary stenosis

74
Q

What is the diagnosis
Single loud S2
Cyanotic
Soft systolic murmur

A

TGA

Egg on the string

75
Q

What is the diagnosis
Cyanotic
ESM LUSB radiating to back
Oligaemic kings

A

TOF

76
Q

What is the management for Tet spells

A 
Keep calm 
Knees to chest 
Oxygen 
IV morphine 
Metaraminol to increase SVR
77
Q

What is the diagnosis
Mild cyanosis
Single S2
Biventricular hypertrophy

A

Truncus arteriosus

78
Q

What is the diagnosis ?
Deep cyanosis
Non specific murmur
Snowman CXR

A

TAPVD

79
Q 
What is the diagnosis 
Dilated RA 
Gallop rhythm 
Cyanotic 
Holosystolic murmur
A

Epstein’s

Lithium

80
Q

What is the inheritance of hypertrophic cardiomyopathy ?

Which mutation is associated with sudden death,

A

Autosomal dominant

TNNT2

81
Q

In the cardiac cycle when does mitral opening snap occur ?

A

Atrial systole

82
Q

When does S3 occur? What does it correlate with?

A

Early diastole

Rapid ventricular filling

83
Q

What is p mitrale on ECG?

A

Bifid p wave

Left atrial dilatation

84
Q

What is a complication of VSD causing diastolic murmur ?

A

Aortic regurgitation

Due to prolapse or right coronary cusp

85
Q

When do duct dependent lesions usually present ?

A

Day 3-5

86
Q

What are some electrolyte causes of long QT?

A

Hypocalcaemia

Hypomagnesaemia

87
Q

What are some drug causes of long QT ?

A

Amitryptilline
Amiodarone
Anti malarials
Macrolides + antifungals

88
Q

What is the inheritance of Jerrold Neilson

A

Autosomal recessive
Associated with deafness

Romano Ward autosomal dominant

89
Q 
What are the heart defects associated with the following teratogens 
Alcohol 
Lithium 
Phenytoin 
Sodium valproate 
Diabetes 
PKU
A 
TGA 
Ebsteins 
Coarctation 
TOF 
TGA 
TOF
90
Q

What are the 3 ECG features of WPW?

A

Short PR
Long QRS
Delta wave

91
Q

What drug should be avoided in WPW?

A

Digoxin

92
Q

What kind of murmur is associated with Blalocl Taissig shunt ?

A

Continuous

Subclavian anastomosed to pulmonary artery

93
Q

what is the treatment for persistent pulmonary hypertension ?

A

Nitric oxide

94
Q

What gender are PDA more common in?

A

Females

95
Q

What gender are coarctation more common in?

A

Males

96
Q

What does hyperkalaemia do to the PR interval ?

A

Prolongs

97
Q

What congenital heart defect is associated with Edwards syndrome ?

A

Coarctation

Paediatrics (17 decks)

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