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CH > Cardiology > Flashcards

Cardiology Flashcards

1
Q

How may congenital heart disease present?

A

Antenatal screening
Detection of a heart murmur (innocent vs pathological)
Cyanosis
Heart failure (usually from L–>R shunt)
Shock (when duct closes in severe L heart obstruction)

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2
Q

What is the epidemiology and clinical course of an ASD?

A
  • Most likely congenital heart defect to be found in adulthood
  • Significant mortality: 50% dead by 50 years old
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3
Q

What are the two types of ASD?

A

Ostium Secundum

Ostium Primum

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4
Q

What are the clinical features of an ASD?

A

Ejection systolic murmur
Fixed splitting of S2
Embolisation may pass from venous system to L side of heart causing stroke

CXR: cardiomegaly

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5
Q

What are the features of ostium secundum on ECG?

A

RBBB with RAD

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6
Q

What are the features of ostium primum on ECG?

A

Present earlier
RBBB with LAD
Increased PR interval

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7
Q

What is the epidemiology of VSD?

A
  • Most common cause of congenital heart disease

- Close spontaneously in 50%

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8
Q

What congenital conditions is VSD associated with?

A

DS, Edward’s Syndrome, Patau Syndrome

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9
Q

What are the clinical features of a VSD?

A

Pan-systolic murmur which is louder in smaller defects

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10
Q

What are some of the complications of VSD?

A 
Aortic regurgitation 
IE
Eisenmenger's complex
Right HF
Pulmonary hypertension
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11
Q

How does PDA arise?

A
  • Classified as acyanotic, can however eventually lead to late cyanosis in the lower extremities (terminal cyanosis) if uncorrected
  • Connection between the pulmonary trunk and descending aorta
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12
Q

What are the risk factors for PDA?

A

More common in premature babies, born at high altitude or maternal rubella infection in 1st trimester

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13
Q

What are the clinical features of PDA?

A 
Left subclavicular thrill
Continuous machinery murmur 
Large volume, collapsing pulse
Wide pulse pressure
Heaving apex beat
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14
Q

What is the tx and complication of PDA?

A

Tx: Indomethacin

-Risk of failure for DA to close by 1month

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15
Q

What is the epidemiology of tetralogy of Fallot?

A
  • Most common cause of cyanotic congenital heart disease

- Typically presents at 1-2months (up to 6months)

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16
Q

What are the 4 characteristic features of TOF?

A
  1. VSD
  2. Right ventricular hypertrophy
  3. Right ventricular outflow obstruction, pulmonary stenosis
  4. Over-riding aorta
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17
Q

What determines the degree of cyanosis and clinical severity in TOF?

A

The severity of the right ventricular outflow tract obstruction

18
Q

What are the clinical features of TOF?

A
  • Cyanosis
  • R–> L shunt
  • Ejection systolic murmur due to pulmonary stenosis
  • R sided aortic arch seen in 25% patients
19
Q

What is seen on CXR and ECG in TOF?

A

CXR: ‘boot-shared’ heart
ECG: Right ventricular hypertrophy

20
Q

What is the tx of TOF?

A
  • Surgical repair undertaken in two parts at 6-9months

- Cyanotic episodes may be helped by beta-blockers to decrease infundibular spasm.

21
Q

What happens in transposition of the great arteries?

A
  • The aorta is connected to the R ventricular and the pulmonary artery to the L ventricle.
  • Unoxygenated blood is returned to the body and oxygenated blood returned to the lungs: two parallel circuits.
22
Q

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

A
  • Cyanosis is the predominant symptom.
  • May be profound and life-threatening.
  • Presentation usually on day 2 of life when ductal closure leads to a marked decrease in mixing of the desaturated and saturated blood.
  • 2nd HS is often loud and singular–> usually no murmur
23
Q

What is seen on CXR in transposition of the great arteries?

A

Narrow upper mediastinum

‘Egg on side’ appearance of cardiac shadow

24
Q

What is the aim of tx in transposition of the great arteries?

A
  • Aim to improve mixing in sick, cyanotic neonate.
  • Maintain patency of DA with prostaglandin infusion.
  • Balloon atrial septostomy is a life-saving procedure.
  • All neonates will require surgery–> arterial switch procedure in neonatal period.
25
Q

How does Eisenmenger’s Syndrome arise?

A
  • Describes the reversal of a L–>R shunt in a congenital heart defect due to pulmonary hypertension.
  • Occurs when an uncorrected L–>R shunt leads to remodelling of the pulmonary microvasculature–> eventually causing obstruction to the pulmonary blood and pulmonary hypertension.
26
Q

What is Eisenmenger’s Syndrome associated with?

A

ASD, VSD, PDA

27
Q

What are the clinical features of Eisenmenger’s Syndrome?

A
  • Original murmur may disappear
  • Cyanosis
  • Clubbing
  • R ventricular failure
28
Q

What is the tx of Eisenmenger’s Syndrome?

A

Heart-lung transplantation required

29
Q

What is coarctation of the aorta?

A
  • Congenital narrowing of the descending aorta

- M>F

30
Q

What are the clinical features of coarctation of the aorta?

A
  • Infancy: heart failure
  • Adult: hypertension
  • Radio-femoral delay
  • Mid systolic murmur, maximal over back
  • Atypical click from aortic valve
31
Q

What are the associations with coarctation of the aorta?

A

Turner’s Syndrome
Bicuspid aortic valve
Berry aneurysms
Neurofibromatosis

32
Q

What are the clinical features of coarctation of the aorta?

A
  • Exam on 1st day of life usually normal
  • Neonates present with acute circulatory collapse at 2 days of age when duct closes.
  • VSD usually present.
33
Q

What is the tx of coarctation of the aorta?

A

Complete correction with closure of VSD and repair of aortic arch usually performed within the first few days of life.

34
Q

How does Rheumatic fever arise?

A
  • Now rare in the developed world
  • Immunological reaction to Strep pyogenes
  • Affects children aged 5-15y/o
35
Q

What are the clinical features of Rheumatic fever?

A
  • After a latent interval of 2-6wks following a pharyngeal infection, poly arthritis, mild fever and malaise develop.
  • Jones criteria
36
Q

What is Kawaski Disease?

A

Vasculitis affecting children 6months–> 5 years

37
Q

What are the clinical features of Kawaski Disease?

A
  • High grade fever >5 days, resistant to antipyretics
  • Bright red, cracked lips
  • Strawberry tongue
  • Cervical lymphadenopathy
  • Red palms of hands and soles of feet which peel.
38
Q

What is the tx of Kawaski Disease?

A

High dose aspirin
IV immunoglobulin
Echo

39
Q

Name some causes of acyanotic heart disease

A

L–>R shunt

  • VSD
  • PDA
  • Pulmonary stenosis
  • ASD
  • Coarctation of the aorta
  • Aortic stenosis
40
Q

Name some causes of cyanotic heart disease

A

R–> L shunt

Tetralogy of Fallot
Transposition of the great arteries

CH (7 decks)

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