Cardiology Flashcards
ASD
- most common type
- ECG
- most common type secundum
- ECG RAD (sec)
ASD
- auscultation
SEM
Fixed and wide splitting of the 2nd heart sound
VSD - why would you not hear a murmur in the first week
Large VSD’s may be silent and become symptomatic in first few weeks as pulmonary resistance decreases
VSD
- CXR
CXR: increased pulmonary vasculature, cardiomegaly
Aortic Stenosis
- location of murmur
- radiation
- quality of murmur
- ECG
• Systolic ejection murmur at RUSB
radiating to NECK
• Systolic ejection click
• ECG: LAD, LVH, LV ‘strain’
Pulmonary Valve Stenosis
- auscultation
Split S2, proportional to degree of stenosis
Pulmonary ejection click
SEM LUSB, radiating to lung fields
Coarctation of Aorta
- CXR finding
Rib notching
ToF
– VSD
– Overriding Aorta
– Pulmonic Stenosis
– RVH
ToF
- what to do for tet spell
- quiet, calm environment
- knee-chest or squatting position
- Oxygen
- Fluid
- Morphine
- Phenylephrine
- Propranolol
Why does knee-chest/squat help tet spell
– increases afterload thus decreasing R to L shunting
Complications of Fontans
• Arrhythmias – Sinus node dysfunction – Atrial flutter/SVT • Cyanosis – Collaterals – Pulmonary AVM’s • Protein Losing Enteropathy • Plastic Bronchitis • Thromboembolism
What are pathologic murmurs
diastolic, holosystolic, late systolic, continuous
Still’s murmur
– short ejection systolic murmur
– musical or vibratory quality
– heard best between apex and left sternal border
Physiologic pulmonary flow murmur
– located at pulmonic area,
– age 3 years onward
– usually soft systolic ejection murmur, grade I-II in intensity
– well localized to the upper left sternal border.
– louder when the patient is supine or when cardiac output is increased
– must be differentiated from murmurs associated with pulmonary stenosis, ASD, and peripheral pulmonary artery stenosis.
Peripheral pulmonary arterial stenosis
– Newborns (up to 3 mo)
– low-intensity systolic ejection murmur best in lung fields, also back
Rheumatic fever
- prophylaxis
- how long
• Benzathine Penicillin G IM every 3-4 weeks
• Oral Penicillin V 250 mg BID (Sulfadiazine or
Erythromycin if allergic)
- Without carditis: up to 5 years after last acute episode or until age 21 years, whichever longest
- Carditis without sequelae: 10 years from last acute episode or age 25 years
- Carditis with residual valvar lesions: at least age 40 years or life-long
Pompe disease
Cardiomegaly, increased wall thickness, supraventricular tachycardia, short PR interval, extremely tall high QRS voltages.
Infective endocarditis
- bugs
– Alpha-hemolytic streptococcus
– Staphylococcus aureus
– Coagulase neg staphylococcus
– Beta-hemolytic streptococcus – Candida
Infective endocarditis
- diagnostic criteria
2 major
1 major and 3 minor
5 minor
Major:
1) Positive BCx (need 2 separate w bugs that cause endocarditis)
2) Evidence of endocardial involvement (echo)
Minor:
1) Predisposition (heart dz or IVDU)
2) Fever >/= 38
3) Vascular phenomenon
4) Immunologic phenomenon
5) Microbiologic evidence (Bcx not meeting above criteria)
6) Echo findings (not meeting above criteria)
Infective endocarditis
- what type of surgery do you prophylaxis for
- who needs prophylaxis
- all dental procedures that involve manipulation of gingival tissues or periapical region of teeth or perforation of oral mucosa
- procedures on respiratory tract or infected skin, skin structures or musculoskeletal tissue
1) Prosthetic cardiac valve
2) Previous IE
3) CHD:
- unprepared cyanotic CHD
- repaired CHD 6 mo after repair
- repaired CHD w residual defects at site or site adjacent
4) Cardiac transplantation recipients w cardiac valvulopathy
Emergency Treatment of VT
- Synchronized cardioversion
- Intravenous Lidocaine
- Intravenous Amiodarone
- Correct underlying etiology if evident
- Others: Procainamide, Magnesium
interrupted aortic arch is most likely to have which genetic condition
22q11
chest pain worse when supine
pericarditis
Red flags for cardiac cause of syncope
With exercise not assoc w prolonged standing No prodrome Hx palpitations Chest pain Dyspnea Fhx of death at young age
EKG findings of hyperkalemia
1) Peaked T waves
2) P wave widens and flattens, eventually disappears
PR segment lengthens
3) ST segment depressed
4) Sine wave pattern
AV block - types
1st degree:
- Prolonged PR
3rd degree:
- complete heart block
- A and V dissociated
What is the most common cyanotic CHD
Tetrology of Fallot
Long QT syndrome - first line treatment
BBlockers
Most common cause of death in adolescent athletes?
Hypertrophic cardiomyopathy
2 causes of neonatal heart block
Neonatal Lupus
Maternal Sjogren’s
SVT - EKG
HR > 180/220 No variability of HR Absent P waves Narrow QRS (<0.08s) Abrupt onset/offset
SVT treatment
stable (1st, 2nd and 3rd line)
unstable
Stable
Adenosine 0.1 mg/kg
Amiodarone
Procainamide
Unstable
Syncronized cardioversion
0.5-1 J/kg
Ventricular Tachycardia No Pulse -tx
1st Shock 2J/kg
2nd shock 4J/kg
3rd shock 4J/kg
Amiodarone
What is abnormal on CCHD screen?
Borderline?
Abnormal:
Sat < 90% R hand or foot
Borderline:
90-94% in R hand or foot
OR
>3% difference between R hand and foot
Mgmt of a tet spell
Knee to Chest (inc. SVR)
100% Oxygen (dec. PVR)
Morphine 0.1-0.2mg/kg IM (dec PVR)
Fluid Bolus 10-20ml/kg
Phenylephrine 10mcg/kg slow IV push (inc. SVR)
Why do ASD have split S2?
Prolonged RV ejection
William Syndrome
supravalvular aortic stenosis,
truncus arteriosus & hypercalcemia
Anomalous left coronary artery from the pulmonary artery (ALCAPA)
- what is it
- what can it lead to
- EKG
an anomalous coronary artery branches off the aorta thus providing deoxygenated blood to the heart
myocardial ischemia
Q waves in leads I, aVL, V5 and V6
22q11 - cardiac findings
tetralogy of fallot
truncus arteriosus
VSD
interrupted aortic arch
Fontan procedure - complications
Arrhythmia Cyanosis Protein losing enteropathy Plastic Bronchitis Thromboembolism
What is WPW associated with
Ebsteins anomaly
What’s the most common cyanotic congenital heart defect to present in the neonatal period?
TGA
What can cause prolonged QT
Low Ca
low Mg
low K
drugs (TCAs, macrolides)
Venous hum
systolic/diastolic murmur heard in the infraclavicular region (usually right sided) in a sitting or standing patient. Disappearance when the patient lies down or when the examiner applies gentle pressure over the jugular vein = diagnostic
Murmur is caused by blood cascading down the jugular vein
IDM - cardiac complication
- prognoisis
hypertrophic cardiomyopathy
will resolve with time
Clinical signs of Endocarditis
Tachycardia
Embolic phenomenon (Roth spots, petechial rash, splinter nail bed haemorrhages, Osler nodes, CNS or ocular lesions)
Janeway lesions
Risk factors for endocarditis
Structural heart disease
Rheumatic Heart Disease (most common in developing countries)
IV drug use
Presence of an indwelling catheter
ST elevation in V1-3
Brugada syndrome
complication
Sudden death secondary to ventricular arrhythmias
what’s most important to monitor for when giving prostaglandin?
hypoventilation/apnea
also: hypertension fever flushing tacky/bradycardia
POTS
Postural orthostatic tachycardia syndrome
HR increase of >40 beats/min during the 1st 10 min of upright tilt test without associated hypotension
Long QT syndrome
mgmt
Start BBlocker
Restrict vigorous activity
Investigations for cyanotic congenital heart disease
CXR ECG Echo Hyperoxia test Pre and post ductal sats
With hypertension, when do you have to restrict actvitie
significant LVH
Marfan Cardiac findings
most common
most deadly
Most common: Aortic dilation
MVP
PPHN
-predisposing factors
birth asphyxia, MAS, early onset sepsis, RDS, hypoglycemia, polycythemia, maternal NSAID use with PDA construction, maternal 3rd trimester SSRI use, pulmonary hypoplasia 2ndary to CDH, oligohydramnios, amniotic fluid leak, pleural effusion
Mgmt of hypertrophic cardiomyopathy
- Competitive sports and strenuous physical activity should be prohibited (most sudden deaths occur during or immediately after vigorous physical exertion)
- Beta-adrenergic blocking agents (propranolol, atenolol) or CCB (verapamil) may be useful in diminishing ventricular outflow tract obstruction, modifying ventricular hypertrophy and improving ventricular filling
- Innovative interventional procedures to anatomically or physiologically reduce degree of LVOT obstruction has been used
indomethacin side effects
(suppresses renal, cerebral and gastrointestinal blood flow )
- NEC and spontaneous intestinal perforation
- transient renal insufficiency
- increased bleeding risk
- kernicterus (theoretical risk - interfere with binding of albumin to bilirubin)
Congenital cyanotic heart disease w decreased pulmonary BF
PA PS TOF Ebstein anomaly tricuspid atresia
Single S2?
HLHS
First step in mgmt of Coarctation
PGE infusion
Marfan’s inheritance
AD
Acute rheumatic fever
- dx
Dx = GAS evidence + (2 Major or 1major+2minor)
Major: Arthritis (migratory) Carditis Subcutaneous nodules Erythema marginatum Sydenhams chorea
Minor: Arthralgia Fever Prolonged PR Elevated CRP
Complication of Prolonged QT
torsades
WPW assoc with which CHD
ebsteins
TGA
PPHN
- what worsens pulmonary vascular resistance
hypoxia
hypercapnia
acidosis
cold
Causes of PPHN
MAS
RDS
Noonan syndrome CHD
pulmonary valve stenosis
CXR snowman
TAPVR
digeorge
interrupted aortic arch
Right-sided aortic arch
TOF
conotruncals
branchial aortic arch defects (aortic arch)
