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good paeds > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Where does the vascular supply of a lobar sequestration usually arise from?

A

The aorta

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2
Q

What is the name of an anomalous origin of a pulmonary artery branch from the ascending aorta?

A

Hermitruncus arteriosus

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3
Q

Rendu-Osler weber syndrome is related to what cardiac abnormality?

A

A-v malformations (hereditary haemorrhagic telangiectasia)

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4
Q

What percentage of CHD at term are VSDs?

A

30-60% (excluding 3-5% of small musc)

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5
Q

What happens to the second heart sound in Pulmonary HTN?

A

Loud pulmonary component of S2

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6
Q

Cyanosis with exercise by 5-6 years old with a VSD is called?

A

Eisenmenger syndrome (reversal of shunt)

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7
Q

Septal and posterior leaflets Tricuspid valve displaced towards apex RV in
Massive cardiomegaly on cxr (dilated RA and RV)

A

Ebstein anomaly

If WPW can’t comment on hypertrophy

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8
Q

Typical ECG findings inASD?

A

R axis, rvh, typical rsR or rSR pattern right praetor dial leads and S waves in inferior leads notched

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9
Q

Mid Diastolic low pitched rumble at apex with severe AR called

A

Austin Flint murmur

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10
Q

Shone syndrome

4

A

CoA
AS
Parachute mitral valve
Mitral ring (supravalvular mitral membrane)

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11
Q

Fontan procedure

A

Palliative

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12
Q

Ross procedure

A

AS

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13
Q

Size of aaS when operate if a symptomatic

A

0.65cm2/m2 body surface area (normal 2cm)

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14
Q

Noonan syndrome cardiac defect

A

Specific form of eccentric subaortic stenosis

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15
Q

Asymmetric septal hypertropy ( other hocm and hcm and ihss)

A

Dominant with variable expression

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16
Q

Cardiac defect assoc with Williams syndrome

A

Supraaortic stenosis

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17
Q

CoA assoc cxr feat and what genetic syndrome

A

Turners

3 sign and dilated aorta

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18
Q

Glenn shunt in what cardiac lesion?

A

Tricuspid obstruction

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19
Q

Takayasu disease

A

Aortic vascular is Asian 10-30 y

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20
Q

Ps in which syndrome

A

Noonans

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21
Q

Pulm branch stenosis

A

Allagille syndrome and rubella syndrome

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22
Q

Four components of tetralogy of fallot

A

Right ventricular outflow tract stenosis, vsd, dextroposition of aorta and RVH

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23
Q

Tetralogy of fallot cxr

A

Boot shaped heart with dilated asc aorta

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24
Q

Tetralogy of fallot management

A

Pg2..O2, Treat iron def up to hct 55, tet spell treat with positions (squat or tummy with knees up) and morphine and surgery ~4 months (if not for surg then propranolol)

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25
Q

Taussig-bing anomaly

A

DORV and VSD

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26
Q

Transposition of great arteries cxr finding

A

Egg on string

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27
Q

Three week old baby with cyanosis, heart failure, wide pulse pressure, bounding pulses, loud second heart sound

A

Truncus arteriosis

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28
Q

Di George

A

22q11

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29
Q

Accessory pathways

A

Mahaim pathway, bundle of Kent, atrifasicular connections

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30
Q

Adam stokes attacks

A

Arrhythmia induced syncope

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31
Q

Innocent murmur names

A

Stills murmur, pulmonary flow murmur, venous hum, physiological periph plum stenosis with anaemia

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32
Q

Pulmonary hypertension definition

A

Mean pulmonary artery pressure of greater then 25mmHg or greater than 30 with exercise

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33
Q

Libman sacks endocarditis

A

Non bacterial such as in SLE

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34
Q

Cardiomyopathy

A

Duschenne and Becker muscular dystrophy

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35
Q

HACEK organisms cause IE

A

Haemophilus actinobacillus cardiobacterium eikenella and Kingella

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36
Q

Pickwickian syndrome

A

Obesity hypo ventilation syndrome

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37
Q

Jeune syndrome

A

Dwarf
Small chest with short ribs
Acromelia

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38
Q

Scimitar syndrome cardiac defect

A

PAPVR

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39
Q

Bernoulli equation

A

Pressure density velocity and constant

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40
Q

Mir primary imaging modality for what

A

Ventricular volume measurement and semilunar valve insufficiency

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41
Q

Cardiac catheter primary test for what

A

Evaluating complex physiology in children with abnormal pulmonary vascularure resistance and reactivity, complex single ventricle anatomy, multiple obstructions in r or l heart or lesions pulm arteries not seen on other imaging

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42
Q

Diagnostic catheterisation measures?

A

O2 seats and pressures (saturation vary little through R heart 5% indicates shunt ( gold standard)

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43
Q

Cardiac catheter seats right and left heart?

A

Right 65-80% and left 95-98%

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44
Q

Ficus method calculation

A

Qi = VO2/(Cpv-Cpa)

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45
Q

Vascular resistance equation

A

Rp = (mean PA pressure - PV or LA pressure)/Qp Rs = (mean Ao pressure -?mean RA pressure)/Qs

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46
Q

Syndromes and cardiac lesions: alagille

A

Peripheral pulmonary artery stenosis

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47
Q

Syndromes and cardiac lesions: velocardiofacial/22q11 deletion

A

Conotruncal: interupted aortic arch (50%), truncus, ToF (35%), VSD, pulm atresia, pda,R aortic arch, vascular ring

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48
Q

Syndromes and cardiac lesions: Williams

A

Supra valvular - AS, PA stenosis

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49
Q

Syndromes and cardiac lesions: Noonan

A

PS (dystrophic valve)
HOCM (superior axis)
Assoc with chylothorax

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50
Q

Syndromes and cardiac lesions: turners

A

Aortic root dilation, bicuspid AV, COA

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51
Q

Syndromes and cardiac lesions: Frederick ataxia

A

HOCM

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52
Q

Syndromes and cardiac lesions: NF1

A

PS and CoA

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53
Q

Syndromes and cardiac lesions: downs

A

AVSD, VSD, ASD, ToF

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54
Q

Syndromes and cardiac lesions: charge syndrome

A

Conotuncal

TOF, VSd, ASD, PDA, AVSD

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55
Q

Syndromes and cardiac lesions: vacterl

A

VSD

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56
Q

Syndromes and cardiac lesions: congenital rubella

A

PDA, PA stenosis

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57
Q

Syndromes and cardiac lesions: trisomy 13 and 18

A

ASD, VSD, PDA, CoA, bi AoV

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58
Q

Syndromes and cardiac lesions: Ethes danlos

A

Aneurysm all incl aorta and carotids

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59
Q

Syndromes and cardiac lesions: kartageners

A

Dextrocardia

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60
Q

When to close ASD or VSD

A

QP:Qs> 2;1

Osmium primum unlikely to close

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61
Q

Eisenmenger’s

A

Pulm HTN and Change to R to L shunt

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62
Q

PDA cardiomegaly due to

A

Pressure loading LV

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63
Q

Truncus arteriosis assoc with

A

22q11 deletions

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64
Q

What to never use in WPW

A

Digoxin or verapamil

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65
Q

HOCM in two syndromes

A

Pompe

Noonan

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66
Q

Cyanosed at higher stats with

A

Polycythaemia

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67
Q

Endocarditis prophylaxis in

A

Unrepaired cyanotic

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68
Q

Hypocalcaemia ECG changes

A

Prolonged ST and QT interval

Short in hyper

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69
Q

Long QT congenital and treatment and media to avoid

A

Congenital affects outflow of K
Tornadoes
Beta block
Avoid TCA, macrolide, antipsychotic and antifungal

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70
Q

Reverse split p2 in

A

Severe AS

71
Q

Normal saturations on left and right heart

A

Left 95-98%

Right 65-80%

72
Q

Left heart and right heart pressure

A

Right 5 and 25

Left 10 and 100/10 (aorta 100/60

73
Q

Qp/Qs

A

Systemic says change / pulm says change (flipped!)

Ao-SVC:PV-PA

74
Q

Flick principle

A

O2 consumption = blood flow (Qs) x oxygen extraction

75
Q

Pulmonary plethora in cxr if shunt is

A

2:1 or more

76
Q

TOF cxr finding

A

Minor cardiomegaly
Elevated apex
Oligaemia
25% R sided aortic arch

77
Q

Cxr findings of ebsteins anomaly

A

Cardiomegaly prominent right hart border
Possible enlargement right causing elevated apex
Small MPA and pulm arteries

78
Q

Fontan operation

A

RA connected to pulmonary artery directly

79
Q

VT diagnosis confirmed by

A

Evidence of P wave dissociation

80
Q

Standard ECG voltage

A

1mV = 1cm

81
Q

Confirm sinus rhythm on ECG

A

P wave before every QRS and upright p in I and aVF

82
Q

Tall p wave and wide means

A

Tall is right
Wide is left
Atrial enlargement

83
Q

RV hypertrophy on ECG

A

R in V1 and S V6, upright T V1

84
Q

LV hypertrophy on ECG

A

Q waves, inverted T, s in V1 and r in V6

85
Q

Combined ventricular hypertrophy on ECG

A

Can be from large VSD

Increased r and s V3 or 4

86
Q

WPW found in what CHD

A

1/3rd ebsteins

87
Q

Risk in Cath lab

A

1-3% mortality newborn

88
Q

Duration of penicillin in RF (mild, mod, severe)

A

Mild - 10 years or to 21
Mod - 30-35
Severe - 40

89
Q

Kawasaki management

A

2g/kg IVIG over 10-12 hours (reduce aneurysm 23% to 5%)

90
Q

Characteristic ECG in Av canal defects

A

Superior axis

91
Q

CHD in klinefelter

A

50%
ASD
PDA

92
Q

Q wave in V1 indicates

A

L-TGA, single ventricle, severe RVH or anterior MI

93
Q

Older child with hyper dynamic praecordium, wide split S2, systolic flow murmur

A

ASD

94
Q

Stills murmur usually disappears with

A

Sitting

95
Q

Pulmonary artery wedge pressure close to

A

LA mean

96
Q

Cetus near term ratio r to l heart work

A

2:1

97
Q

Cardiac condition that says improve with oxygen

A

TAPVR

98
Q

Ro and la are what kind of antibodies

A

Extractable nuclear antigens

99
Q

5 causes of widely split and fixed S2

A 
Volume overload (ASD, PAPVR)
Pressure overload PS
Electrical delay RBBB
MR (early aortic closure)
Occ normal child
100
Q

Narrow split S2

A

AS

Pulm HTN

101
Q

Single S2

A

Aortic closure delayed: Severe AS (also causes paradoxically split - LBBB causes paradoxically split S2 also)

P2 not audible: eg TGA TOF severe PS,

One semilunar valve: aortic or pulmonary atresia, truncus

Pulm HTN

102
Q

Boot shaped heart with

A

TOF (some with tricuspid atresia)

103
Q

3 sign on cxr with

A

CoA

104
Q

LAH and RAH ECH changes

A 
LAH W (wide)
RAH T (tall)
105
Q

Primum ASD location

A

Lower part of septum

106
Q

ASD defect unlikely to close if over..

A

8mm

107
Q

RBBB post VSD repair percent

A

50-90%

108
Q

ECG changes with endocardium cushion defect

A

RBBB or RVH, superior axsis, prolonged PR

109
Q

Turners syndrome 30% have which CHD

A

CoA

110
Q

Tet spell prevention with

A

Propranolol

111
Q

% R Aortic arch in persistent truncus arteriosis

A

30

112
Q

Single ventricle in what percent of TGA

A

85%

113
Q

Asplenia and polysplenia in heterotaxy

A

Asplenia has normal IVC and two sinus nodes (none in polysplenia)

Howell jolly and Heinz bodies in asplenia

114
Q

Anomalous origin of left coronary artery (bland-white-garland syndrome) presentation and ECG changes

A

As PA pressure falls presents 2-3 months old with angina, cardiomegaly, CHF, no murmur
ECG shows anterolateral Mi
Deep and wide q waves and inverted t and ST shift lead I and aVL and most precocial leads

115
Q

AV fistula coronary Sx, investigations

A

Asymptomatic, PDA like murmur, normal cxr and ECG

Risk M.I

116
Q

Shone complex is..

A

LVOT obstruction
AS
Aortic arch hypoplasia
CoA

117
Q

Vascular sling barium swallow findings

A

Posterior compression of trachea and anterior oesophagus

118
Q

HOCM in what percent of infants to diabetic mothers

A

10-20%

119
Q

Drugs in HOCM

A

Can use calcium channel and b block

Not digitalis or inotropes

120
Q

Three viral causes of myocarditis

A

Adeno
Echo
Coxsackie

121
Q

Kawasaki disease platelets high or low

A

High to very high (peak at 2 weeks)

122
Q

Chorea drug management

A 
Phenobarbital
Haloperidol 
Valproate
Diazepam
Steroids
123
Q

Hallmark of MVP

A

Posterior leaf

Midsystolic click with or without late systolic murmur at apex

124
Q

P axis derived from

A

Upright in lead II and inverted aVR

125
Q

What ataxia assoc with cardiomyopathy

A

Frederics ataxia

126
Q

Pulmonary HTN defined as

A

Over or equal to 25mmHg

127
Q

Other disorders (not cardiac or resp) that cause pulm HTN (3)

A
  1. Rheumatic/vasculitis diseases such as SLE, rheum arthritis etc
  2. Thromboembolism
  3. Affect pulm vascularise directly such as schistosomiasis histiocytosis sarcoidosis
128
Q

PGI2 and PGE2 are

Cf PGF2alpha and PGA2 are

A

Vasodilator

Vasoconstrictor

129
Q

Endothelin is a vasodilator/vasoconstrictor

A

Potent vasoconstrictor in pulm vessels

130
Q

Six grades of pulmonary hypertension

A

1: medial wall hypertrophy
2: intima hypertrophy
3: intima fibrosis and narrowing
4-6: irreversible

131
Q

Sudden death in sport two top causes

A

HOCM 40%

Congenital and acquired diseases coronary arteries 30%

132
Q

ACEi allowed in pregnancy?

A

No!

133
Q

Measurement best predictor of CV disease

A

Wast circumference

134
Q

Too much blood to lungs (DORV, TOF or ebsteins) operation to reduce cyanosis

A

Modified Blalock-Taussig Shunt - tube to connect pulm artery to branch or aorta

135
Q

HLHS surgery required

A

Modified Blalock-Taussig Shunt

Norwood procedure to make an aorta from pulm vessel

136
Q

Fontan operation

A

palliative surgical procedure used in children with univentricular hearts. It involves diverting the venous blood from the IVC and SVC to the pulmonary arteries

137
Q

Ebsteins related to what teratogen

A

Lithium

138
Q

Turners cardiac issues

A

Bicuspid aortic valve

Risk of aortic dissection

139
Q

Q wave in V1 always pathological and indicates

A 
indicate L-
TGA, single ventricle, severe RVH or 
anterior MI (deep and wide).
140
Q

Superior axsis

A

AV canal

TOF

141
Q

ECG findings on ALCAPA

A

ECG: left axis deviation, qR in I and AVL with deep “Q” in AVL,
ST elevation in inferior leads and depression in lateral leads.
“T” wave inversion in V4

142
Q

Long QT syndrome and management

A

1: males 5-15 swimming
2: females after baby alarm
3: adolescent sleeping male

Tx with advice, b blocker, ICD

143
Q

Mean pulmonary (capillary) wedge pressure most closely approximates what

A

LA mean

144
Q

Magnitude of shunt in secundum ASD most influenced by

A

RV compliance

145
Q

Four week old with right sided failure cyanosis and ejection click single second heart sound +- murmur

A

Truncus arteriosus

146
Q

VT without shock treatment

A

Amiodarone first

147
Q

Junctional ectopic tachycardia after surgery treatment

A

Arrhythmia
Sedation, consider cooling to 35
Medications (amiodarone)

148
Q

Tet spell murmur

A

ESM Softer

PSM louder

149
Q

WPW delta wave and conduction

A

You can see delta waves, the conduction is
therefore not going through the normal AV node and its going through the
accessory pathway before it gets to the AV node i.e. there is pre-excitation. If it
was going through the AV node, you would have a normal PR interval and no
Delta wave

150
Q

S3 made by

S4 made by

A

Rapid ventricular filling

Blood pouring into a Stiff ventricle (late diastole)

151
Q

Wide S2 from (3)

A

ASD
rBBB
PS

152
Q

Loud S2

A

Commonly pulmonary HTN

Also ASD

153
Q

Single S2

A

Severe aortic stenosis, severe aortic regurgitation, congenital absence of pulmonary valve (such as truncus)

154
Q

Hyperoxia test

A

Hyperoxia test: - PaO2 < 70 mmHg, rise by < 30 mmHg or SaO2 unchanged: cardiac cause, TAPV may respond

155
Q

Cyanotic causes

A

Right-to-left shunt
Intracardiac: The 5 T’s: Tetralogy of Fallot, Tricuspid atresia, Transposition of the great arteries, Total anomalous pulmonary venous return, Truncus arteriosus; and pulmonary atresia, Ebsteins anomaly (abnormal tricuspid valve), hypoplastic left heart
Great vessel level: persistent pulmonary, hypertension of the newborn Intrapulmonary level: pulmonary arteriovenous malformation

156
Q

RBBB after what surgery

A

TOF

157
Q

Narrow split S2 in

A

severe pulm HTN

158
Q

Fractional shortening:

A

Distance between walls of ventricle in systole and diastole.

159
Q

Norwood procedure

A

– separating right and left pulmonary arteries
from main pulmonary artery and connecting the main pulmonary
artery to the aorta (DSK procedure), then conduit from subclavian
artery or ventricle to pulmonary arteries (BT shunt or Sano shunt
respectively). Risk of shunt blockage in premature infants,
dehydration or fever and can get subsequent ischaemia. Often on
aspirin and diuretics to reduce pulmonary blood flow because of
increasing shunt as child grows. Saturations will be in the 70ǯs and the
shunt will give a continuous murmur.

160
Q

ebsteins anomaly:

A

downward displacement of abnormal tricuspid valve into
right ventricle. Leaflets often separated. Reduced right ventricular output due
to variable degrees of tricuspid regurgitation, poorly functioning small right
ventricle and right ventricular outflow tract obstruction by valve leaflet.
o Increased risk of WPW.

161
Q

Scimitar syndrome:

A

dextroposition associated with hypoplasia of a lung
and anomalous pulmonary venous return from that lung.

162
Q

Long QT which channel affected 1-10

A

LQTS 1, 2, 5, 6, 7: potassium channel.
LQTS 3, 4, 9, 10: sodium channel.
LQTS 8: calcium channel.

163
Q

Triggers for long QT 1-3

A

There are three common types
Type 1 and 2 respond well to betablocker treatment, because the triggers for type 1 (60%) is exercise; swimming is especially dangerous. For type 2 (30%) the commonest triggers are sudden and loud noise (especially at night), and emotional excitement. In type 3 (10%) events usually occur at night, and defibrillator pacemakers are most commonly needed in this group.

164
Q

Newborn with cyanosis and left axis deviation highly suggestive of

A

Tricuspid atresia (cf ebsteins with P waves changed, RBBB +- WPW right side affected)

165
Q

Pulmonary banding possible indications

A

AVSD
Swiss cheese multiple VSDs
vSD with CoA
Truncus

166
Q

Frederichs ataxia heart problem

A

Hypertrophic cardiomyopathy

167
Q

Continuous murmur at birth pink and blue causes

A

Coronary a fistula

Pulmonary atresia with VSD

168
Q

Asian child with SCN5A and typical ECG

A

Brugada (if fever needs admission) Na channel

169
Q

Upright t RVH age

A

8 days - 8 years

170
Q

2 days severe cyanosis and LAD

A

TA

171
Q

Why is there fixed splitting in ASD

A

The ASD creates a left to right shunt that increases the blood flow to the right side of the heart, thereby causing the pulmonary valve to close later than the aortic valve independent of inspiration/expiration

172
Q

ECG: Negative p axis on I and/or aVf indicates??

A

Situs inversus
Lead reversal
Ectopic atrial tachy

173
Q

Causes of “water hammer pulse” / collapsing pulse

A

Physiological
Fever
Pregnancy

Cardiac lesions
Aortic regurgitation
Patent ductus arteriosus
Systolic hypertension
Bradycardia
Aortopulmonary window
Aneurysm of sinus of Valsalva
Syndromes or high-output states
Anemia
Cor pulmonale
Cirrhosis of liver
Beriberi
Thyrotoxicosis
Arteriovenous fistula

good paeds (19 decks)

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