Cardiology

Question 1

ECG changes of pericarditis

4 stages

Answer 1

– Stage1–ST elevation and PR depression (occurs during the first two weeks)
– Stage2–normalization of ST changes; generalized T wave flattening (1 to 3weeks)
– Stage3–Inverted T-waves (3 weeks- ???)
– Stage4–ECG returns to normal

Question 2

What is the management of a Tet Spell?

Answer 2

Knee-chest position on parent’s shoulder
• Morphine for sedation – 0.1mg/kg/dose iv or sc
• Oxygen to pulmonary vasodilate

• Fluid bolus (saline) to increase RV end-diastolic pressure
• Phenylephrine to increase systemic vascular resistance
• IV beta blocker to “relax” RV
– Propranolol
– Esmolol
• Admit – arrange for early surgery

Question 3

Which leads represent the following heart regions?
anterior
inferior
lateral 
septal

Answer 3

anterior: V3, V4
inferior: II, III, aVF
lateral: I, aVL, V5, V6
septal: V1, V2

Question 4

When should you do an ECG for syncope?

Canadian Cardio position statement

Answer 4

• history is not diagnostic of vasovagal syncope
• no prodrome before syncope
• midexertional event
• syncope triggered by loud noise or startle
• family history of suddent death or heart disease in young individuals
• abnormal cardiac exam
• new medication with potential cardiac effects

Question 5

Name 4 explanations for why adenosine might not work for SVT

Answer 5

• Not AV re-entry tachycardia
– Wide complex tachycardias in children are those
with QRS duration > 0.09-0.10 sec
– Automatic supraventricular tachycardias
• Not enough adenosine – Up to 300 mcg/kg
• Adenosine not given correctly
– Rapid saline chaser using stopcock
• Need background medication
– Procainamide
– Propranolol
– Digoxin

Question 6

What should you think of when you see a combo of the following on ECG?
Bradycardia
Blocks — e.g. AV block, bundle branch blocks
Bizarre QRS complexes

Answer 6

Hyperkalemia!