Cardiology Flashcards
1
Q
Where does the vascular supply of a lobar sequestration usually arise from?
A
The aorta
2
Q
What is the name of an anomalous origin of a pulmonary artery branch from the ascending aorta?
A
Hermitruncus arteriosus
3
Q
Rendu-Osler weber syndrome is related to what cardiac abnormality?
A
A-v malformations (hereditary haemorrhagic telangiectasia)
4
Q
What percentage of CHD at term are VSDs?
A
30-60% (excluding 3-5% of small musc)
5
Q
What happens to the second heart sound in Pulmonary HTN?
A
Loud pulmonary component of S2
6
Q
Cyanosis with exercise by 5-6 years old with a VSD is called?
A
Eisenmenger syndrome (reversal of shunt)
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
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
9
Q
Mid Diastolic low pitched rumble at apex with severe AR called
A
Austin Flint murmur
10
Q
Shone syndrome
4
A
CoA
AS
Parachute mitral valve
Mitral ring (supravalvular mitral membrane)
11
Q
Fontan procedure
A
Palliative
12
Q
Ross procedure
A
AS
13
Q
Size of aaS when operate if a symptomatic
A
0.65cm2/m2 body surface area (normal 2cm)
14
Q
Noonan syndrome cardiac defect
A
Specific form of eccentric subaortic stenosis
15
Q
Asymmetric septal hypertropy ( other hocm and hcm and ihss)
A
Dominant with variable expression
16
Q
Cardiac defect assoc with Williams syndrome
A
Supraaortic stenosis
17
Q
CoA assoc cxr feat and what genetic syndrome
A
Turners
3 sign and dilated aorta
18
Q
Glenn shunt in what cardiac lesion?
A
Tricuspid obstruction
19
Q
Takayasu disease
A
Aortic vascular is Asian 10-30 y
20
Q
Ps in which syndrome
A
Noonans
21
Q
Pulm branch stenosis
A
Allagille syndrome and rubella syndrome
22
Q
Four components of tetralogy of fallot
A
Right ventricular outflow tract stenosis, vsd, dextroposition of aorta and RVH
23
Q
Tetralogy of fallot cxr
A
Boot shaped heart with dilated asc aorta
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)
25
Taussig-bing anomaly
DORV and VSD
26
Transposition of great arteries cxr finding
Egg on string
27
Three week old baby with cyanosis, heart failure, wide pulse pressure, bounding pulses, loud second heart sound
Truncus arteriosis
28
Di George
22q11
29
Accessory pathways
Mahaim pathway, bundle of Kent, atrifasicular connections
30
Adam stokes attacks
Arrhythmia induced syncope
31
Innocent murmur names
Stills murmur, pulmonary flow murmur, venous hum, physiological periph plum stenosis with anaemia
32
Pulmonary hypertension definition
Mean pulmonary artery pressure of greater then 25mmHg or greater than 30 with exercise
33
Libman sacks endocarditis
Non bacterial such as in SLE
34
Cardiomyopathy
Duschenne and Becker muscular dystrophy
35
HACEK organisms cause IE
Haemophilus actinobacillus cardiobacterium eikenella and Kingella
36
Pickwickian syndrome
Obesity hypo ventilation syndrome
37
Jeune syndrome
Dwarf
Small chest with short ribs
Acromelia
38
Scimitar syndrome cardiac defect
PAPVR
39
Bernoulli equation
Pressure density velocity and constant
40
Mir primary imaging modality for what
Ventricular volume measurement and semilunar valve insufficiency
41
Cardiac catheter primary test for what
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
42
Diagnostic catheterisation measures?
O2 seats and pressures (saturation vary little through R heart 5% indicates shunt ( gold standard)
43
Cardiac catheter seats right and left heart?
Right 65-80% and left 95-98%
44
Ficus method calculation
Qi = VO2/(Cpv-Cpa)
45
Vascular resistance equation
Rp = (mean PA pressure - PV or LA pressure)/Qp Rs = (mean Ao pressure -?mean RA pressure)/Qs
46
Syndromes and cardiac lesions: alagille
Peripheral pulmonary artery stenosis
47
Syndromes and cardiac lesions: velocardiofacial/22q11 deletion
Conotruncal: interupted aortic arch (50%), truncus, ToF (35%), VSD, pulm atresia, pda,R aortic arch, vascular ring
48
Syndromes and cardiac lesions: Williams
Supra valvular - AS, PA stenosis
49
Syndromes and cardiac lesions: Noonan
PS (dystrophic valve)
HOCM (superior axis)
Assoc with chylothorax
50
Syndromes and cardiac lesions: turners
Aortic root dilation, bicuspid AV, COA
51
Syndromes and cardiac lesions: Frederick ataxia
HOCM
52
Syndromes and cardiac lesions: NF1
PS and CoA
53
Syndromes and cardiac lesions: downs
AVSD, VSD, ASD, ToF
54
Syndromes and cardiac lesions: charge syndrome
Conotuncal
| TOF, VSd, ASD, PDA, AVSD
55
Syndromes and cardiac lesions: vacterl
VSD
56
Syndromes and cardiac lesions: congenital rubella
PDA, PA stenosis
57
Syndromes and cardiac lesions: trisomy 13 and 18
ASD, VSD, PDA, CoA, bi AoV
58
Syndromes and cardiac lesions: Ethes danlos
Aneurysm all incl aorta and carotids
59
Syndromes and cardiac lesions: kartageners
Dextrocardia
60
When to close ASD or VSD
QP:Qs> 2;1
| Osmium primum unlikely to close
61
Eisenmenger's
Pulm HTN and Change to R to L shunt
62
PDA cardiomegaly due to
Pressure loading LV
63
Truncus arteriosis assoc with
22q11 deletions
64
What to never use in WPW
Digoxin or verapamil
65
HOCM in two syndromes
Pompe
| Noonan
66
Cyanosed at higher stats with
Polycythaemia
67
Endocarditis prophylaxis in
Unrepaired cyanotic
68
Hypocalcaemia ECG changes
Prolonged ST and QT interval
| Short in hyper
69
Long QT congenital and treatment and media to avoid
Congenital affects outflow of K
Tornadoes
Beta block
Avoid TCA, macrolide, antipsychotic and antifungal
70
Reverse split p2 in
Severe AS
71
Normal saturations on left and right heart
Left 95-98%
| Right 65-80%
72
Left heart and right heart pressure
Right 5 and 25
| Left 10 and 100/10 (aorta 100/60
73
Qp/Qs
Systemic says change / pulm says change (flipped!)
Ao-SVC:PV-PA
74
Flick principle
O2 consumption = blood flow (Qs) x oxygen extraction
75
Pulmonary plethora in cxr if shunt is
2:1 or more
76
TOF cxr finding
Minor cardiomegaly
Elevated apex
Oligaemia
25% R sided aortic arch
77
Cxr findings of ebsteins anomaly
Cardiomegaly prominent right hart border
Possible enlargement right causing elevated apex
Small MPA and pulm arteries
78
Fontan operation
RA connected to pulmonary artery directly
79
VT diagnosis confirmed by
Evidence of P wave dissociation
80
Standard ECG voltage
1mV = 1cm
81
Confirm sinus rhythm on ECG
P wave before every QRS and upright p in I and aVF
82
Tall p wave and wide means
Tall is right
Wide is left
Atrial enlargement
83
RV hypertrophy on ECG
R in V1 and S V6, upright T V1
84
LV hypertrophy on ECG
Q waves, inverted T, s in V1 and r in V6
85
Combined ventricular hypertrophy on ECG
Can be from large VSD
| Increased r and s V3 or 4
86
WPW found in what CHD
1/3rd ebsteins
87
Risk in Cath lab
1-3% mortality newborn
88
Duration of penicillin in RF (mild, mod, severe)
Mild - 10 years or to 21
Mod - 30-35
Severe - 40
89
Kawasaki management
2g/kg IVIG over 10-12 hours (reduce aneurysm 23% to 5%)
90
Characteristic ECG in Av canal defects
Superior axis
91
CHD in klinefelter
50%
ASD
PDA
92
Q wave in V1 indicates
L-TGA, single ventricle, severe RVH or anterior MI
93
Older child with hyper dynamic praecordium, wide split S2, systolic flow murmur
ASD
94
Stills murmur usually disappears with
Sitting
95
Pulmonary artery wedge pressure close to
LA mean
96
Cetus near term ratio r to l heart work
2:1
97
Cardiac condition that says improve with oxygen
TAPVR
98
Ro and la are what kind of antibodies
Extractable nuclear antigens
99
5 causes of widely split and fixed S2
```
Volume overload (ASD, PAPVR)
Pressure overload PS
Electrical delay RBBB
MR (early aortic closure)
Occ normal child
```
100
Narrow split S2
AS
| Pulm HTN
101
Single S2
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
Boot shaped heart with
TOF (some with tricuspid atresia)
103
3 sign on cxr with
CoA
104
LAH and RAH ECH changes
```
LAH W (wide)
RAH T (tall)
```
105
Primum ASD location
Lower part of septum
106
ASD defect unlikely to close if over..
8mm
107
RBBB post VSD repair percent
50-90%
108
ECG changes with endocardium cushion defect
RBBB or RVH, superior axsis, prolonged PR
109
Turners syndrome 30% have which CHD
CoA
110
Tet spell prevention with
Propranolol
111
% R Aortic arch in persistent truncus arteriosis
30
112
Single ventricle in what percent of TGA
85%
113
Asplenia and polysplenia in heterotaxy
Asplenia has normal IVC and two sinus nodes (none in polysplenia)
Howell jolly and Heinz bodies in asplenia
114
Anomalous origin of left coronary artery (bland-white-garland syndrome) presentation and ECG changes
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
AV fistula coronary Sx, investigations
Asymptomatic, PDA like murmur, normal cxr and ECG
| Risk M.I
116
Shone complex is..
LVOT obstruction
AS
Aortic arch hypoplasia
CoA
117
Vascular sling barium swallow findings
Posterior compression of trachea and anterior oesophagus
118
HOCM in what percent of infants to diabetic mothers
10-20%
119
Drugs in HOCM
Can use calcium channel and b block
| Not digitalis or inotropes
120
Three viral causes of myocarditis
Adeno
Echo
Coxsackie
121
Kawasaki disease platelets high or low
High to very high (peak at 2 weeks)
122
Chorea drug management
```
Phenobarbital
Haloperidol
Valproate
Diazepam
Steroids
```
123
Hallmark of MVP
Posterior leaf
| Midsystolic click with or without late systolic murmur at apex
124
P axis derived from
Upright in lead II and inverted aVR
125
What ataxia assoc with cardiomyopathy
Frederics ataxia
126
Pulmonary HTN defined as
Over or equal to 25mmHg
127
Other disorders (not cardiac or resp) that cause pulm HTN (3)
1. Rheumatic/vasculitis diseases such as SLE, rheum arthritis etc
2. Thromboembolism
3. Affect pulm vascularise directly such as schistosomiasis histiocytosis sarcoidosis
128
PGI2 and PGE2 are
| Cf PGF2alpha and PGA2 are
Vasodilator
| Vasoconstrictor
129
Endothelin is a vasodilator/vasoconstrictor
Potent vasoconstrictor in pulm vessels
130
Six grades of pulmonary hypertension
1: medial wall hypertrophy
2: intima hypertrophy
3: intima fibrosis and narrowing
4-6: irreversible
131
Sudden death in sport two top causes
HOCM 40%
| Congenital and acquired diseases coronary arteries 30%
132
ACEi allowed in pregnancy?
No!
133
Measurement best predictor of CV disease
Wast circumference
134
Too much blood to lungs (DORV, TOF or ebsteins) operation to reduce cyanosis
Modified Blalock-Taussig Shunt - tube to connect pulm artery to branch or aorta
135
HLHS surgery required
Modified Blalock-Taussig Shunt
| Norwood procedure to make an aorta from pulm vessel
136
Fontan operation
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
Ebsteins related to what teratogen
Lithium
138
Turners cardiac issues
Bicuspid aortic valve
| Risk of aortic dissection
139
Q wave in V1 always pathological and indicates
```
indicate L-
TGA, single ventricle, severe RVH or
anterior MI (deep and wide).
```
140
Superior axsis
AV canal
| TOF
141
ECG findings on ALCAPA
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
Long QT syndrome and management
1: males 5-15 swimming
2: females after baby alarm
3: adolescent sleeping male
Tx with advice, b blocker, ICD
143
Mean pulmonary (capillary) wedge pressure most closely approximates what
LA mean
144
Magnitude of shunt in secundum ASD most influenced by
RV compliance
145
Four week old with right sided failure cyanosis and ejection click single second heart sound +\- murmur
Truncus arteriosus
146
VT without shock treatment
Amiodarone first
147
Junctional ectopic tachycardia after surgery treatment
Arrhythmia
Sedation, consider cooling to 35
Medications (amiodarone)
148
Tet spell murmur
ESM Softer
| PSM louder
149
WPW delta wave and conduction
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
S3 made by
| S4 made by
Rapid ventricular filling
| Blood pouring into a Stiff ventricle (late diastole)
151
Wide S2 from (3)
ASD
rBBB
PS
152
Loud S2
Commonly pulmonary HTN
| Also ASD
153
Single S2
Severe aortic stenosis, severe aortic regurgitation, congenital absence of pulmonary valve (such as truncus)
154
Hyperoxia test
Hyperoxia test: - PaO2 < 70 mmHg, rise by < 30 mmHg or SaO2 unchanged: cardiac cause, TAPV may respond
155
Cyanotic causes
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
RBBB after what surgery
TOF
157
Narrow split S2 in
severe pulm HTN
158
Fractional shortening:
Distance between walls of ventricle in systole and diastole.
159
Norwood procedure
– 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
ebsteins anomaly:
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
Scimitar syndrome:
dextroposition associated with hypoplasia of a lung
and anomalous pulmonary venous return from that lung.
162
Long QT which channel affected 1-10
LQTS 1, 2, 5, 6, 7: potassium channel.
LQTS 3, 4, 9, 10: sodium channel.
LQTS 8: calcium channel.
163
Triggers for long QT 1-3
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
Newborn with cyanosis and left axis deviation highly suggestive of
Tricuspid atresia (cf ebsteins with P waves changed, RBBB +\- WPW right side affected)
165
Pulmonary banding possible indications
AVSD
Swiss cheese multiple VSDs
vSD with CoA
Truncus
166
Frederichs ataxia heart problem
Hypertrophic cardiomyopathy
167
Continuous murmur at birth pink and blue causes
Coronary a fistula
| Pulmonary atresia with VSD
168
Asian child with SCN5A and typical ECG
Brugada (if fever needs admission) Na channel
169
Upright t RVH age
8 days - 8 years
170
2 days severe cyanosis and LAD
TA
171
Why is there fixed splitting in ASD
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
ECG: Negative p axis on I and/or aVf indicates??
Situs inversus
Lead reversal
Ectopic atrial tachy
173
Causes of "water hammer pulse" / collapsing pulse
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
```
