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*Review TD 2020 > Cardiology > Flashcards

Cardiology Flashcards

1
Q

ASD

  • most common type
  • ECG
A
  • most common type secundum

- ECG RAD (sec)

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2
Q

ASD

- auscultation

A

SEM

Fixed and wide splitting of the 2nd heart sound

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3
Q

VSD - why would you not hear a murmur in the first week

A

Large VSD’s may be silent and become symptomatic in first few weeks as pulmonary resistance decreases

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4
Q

VSD

- CXR

A

CXR: increased pulmonary vasculature, cardiomegaly

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5
Q

Aortic Stenosis

  • location of murmur
  • radiation
  • quality of murmur
  • ECG
A

• Systolic ejection murmur at RUSB
radiating to NECK
• Systolic ejection click
• ECG: LAD, LVH, LV ‘strain’

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6
Q

Pulmonary Valve Stenosis

- auscultation

A

Split S2, proportional to degree of stenosis
Pulmonary ejection click
SEM LUSB, radiating to lung fields

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7
Q

Coarctation of Aorta

- CXR finding

A

Rib notching

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8
Q

ToF

A

– VSD
– Overriding Aorta
– Pulmonic Stenosis
– RVH

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9
Q

ToF

- what to do for tet spell

A
  • quiet, calm environment
  • knee-chest or squatting position
  • Oxygen
  • Fluid
  • Morphine
  • Phenylephrine
  • Propranolol
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10
Q

Why does knee-chest/squat help tet spell

A

– increases afterload thus decreasing R to L shunting

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11
Q

Complications of Fontans

A 
• Arrhythmias
– Sinus node dysfunction 
– Atrial flutter/SVT
• Cyanosis
– Collaterals
– Pulmonary AVM’s
• Protein Losing Enteropathy 
• Plastic Bronchitis
• Thromboembolism
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12
Q

What are pathologic murmurs

A

diastolic, holosystolic, late systolic, continuous

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13
Q

Still’s murmur

A

– short ejection systolic murmur
– musical or vibratory quality
– heard best between apex and left sternal border

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14
Q

Physiologic pulmonary flow murmur

A

– 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.

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15
Q

Peripheral pulmonary arterial stenosis

A

– Newborns (up to 3 mo)

– low-intensity systolic ejection murmur best in lung fields, also back

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16
Q

Rheumatic fever

  • prophylaxis
  • how long
A

• 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
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17
Q

Pompe disease

A

Cardiomegaly, increased wall thickness, supraventricular tachycardia, short PR interval, extremely tall high QRS voltages.

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18
Q

Infective endocarditis

- bugs

A

– Alpha-hemolytic streptococcus
– Staphylococcus aureus
– Coagulase neg staphylococcus
– Beta-hemolytic streptococcus – Candida

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19
Q

Infective endocarditis

- diagnostic criteria

A

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)

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20
Q

Infective endocarditis

  • what type of surgery do you prophylaxis for
  • who needs prophylaxis
A
  • 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

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21
Q

Emergency Treatment of VT

A
  • Synchronized cardioversion
  • Intravenous Lidocaine
  • Intravenous Amiodarone
  • Correct underlying etiology if evident
  • Others: Procainamide, Magnesium
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22
Q

interrupted aortic arch is most likely to have which genetic condition

A

22q11

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23
Q

chest pain worse when supine

A

pericarditis

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24
Q

Red flags for cardiac cause of syncope

A 
With exercise
not assoc w prolonged standing
No prodrome
Hx palpitations
Chest pain
Dyspnea
Fhx of death at young age
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25
Q

EKG findings of hyperkalemia

A

1) Peaked T waves
2) P wave widens and flattens, eventually disappears
PR segment lengthens
3) ST segment depressed
4) Sine wave pattern

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26
Q

AV block - types

A

1st degree:
- Prolonged PR

3rd degree:

  • complete heart block
  • A and V dissociated
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27
Q

What is the most common cyanotic CHD

A

Tetrology of Fallot

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28
Q

Long QT syndrome - first line treatment

A

BBlockers

29
Q

Most common cause of death in adolescent athletes?

A

Hypertrophic cardiomyopathy

30
Q

2 causes of neonatal heart block

A

Neonatal Lupus

Maternal Sjogren’s

31
Q

SVT - EKG

A 
HR > 180/220
No variability of HR
Absent P waves
Narrow QRS (<0.08s)
Abrupt onset/offset
32
Q

SVT treatment
stable (1st, 2nd and 3rd line)
unstable

A

Stable
Adenosine 0.1 mg/kg
Amiodarone
Procainamide

Unstable
Syncronized cardioversion
0.5-1 J/kg

33
Q

Ventricular Tachycardia No Pulse -tx

A

1st Shock 2J/kg
2nd shock 4J/kg
3rd shock 4J/kg
Amiodarone

34
Q

What is abnormal on CCHD screen?

Borderline?

A

Abnormal:
Sat < 90% R hand or foot

Borderline:
90-94% in R hand or foot
OR
>3% difference between R hand and foot

35
Q

Mgmt of a tet spell

A

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)

36
Q

Why do ASD have split S2?

A

Prolonged RV ejection

37
Q

William Syndrome

A

supravalvular aortic stenosis,

truncus arteriosus & hypercalcemia

38
Q

Anomalous left coronary artery from the pulmonary artery (ALCAPA)

  • what is it
  • what can it lead to
  • EKG
A

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

39
Q

22q11 - cardiac findings

A

tetralogy of fallot
truncus arteriosus
VSD
interrupted aortic arch

40
Q

Fontan procedure - complications

A 
Arrhythmia
Cyanosis
Protein losing enteropathy
Plastic Bronchitis
Thromboembolism
41
Q

What is WPW associated with

A

Ebsteins anomaly

42
Q

What’s the most common cyanotic congenital heart defect to present in the neonatal period?

A

TGA

43
Q

What can cause prolonged QT

A

Low Ca
low Mg
low K
drugs (TCAs, macrolides)

44
Q

Venous hum

A

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

45
Q

IDM - cardiac complication

- prognoisis

A

hypertrophic cardiomyopathy

will resolve with time

46
Q

Clinical signs of Endocarditis

A

Tachycardia
Embolic phenomenon (Roth spots, petechial rash, splinter nail bed haemorrhages, Osler nodes, CNS or ocular lesions)
Janeway lesions

47
Q

Risk factors for endocarditis

A

Structural heart disease
Rheumatic Heart Disease (most common in developing countries)
IV drug use
Presence of an indwelling catheter

48
Q

ST elevation in V1-3

A

Brugada syndrome

complication
Sudden death secondary to ventricular arrhythmias

49
Q

what’s most important to monitor for when giving prostaglandin?

A

hypoventilation/apnea

also:
hypertension
fever
flushing
tacky/bradycardia
50
Q

POTS

A

Postural orthostatic tachycardia syndrome

HR increase of >40 beats/min during the 1st 10 min of upright tilt test without associated hypotension

51
Q

Long QT syndrome

mgmt

A

Start BBlocker

Restrict vigorous activity

52
Q

Investigations for cyanotic congenital heart disease

A 
CXR
ECG
Echo
Hyperoxia test
Pre and post ductal sats
53
Q

With hypertension, when do you have to restrict actvitie

A

significant LVH

54
Q

Marfan Cardiac findings
most common
most deadly

A

Most common: Aortic dilation

MVP

55
Q

PPHN

-predisposing factors

A 
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
56
Q

Mgmt of hypertrophic cardiomyopathy

A
  • 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
57
Q

indomethacin side effects

A

(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)
58
Q

Congenital cyanotic heart disease w decreased pulmonary BF

A 
PA
PS
TOF
Ebstein anomaly
tricuspid atresia
59
Q

Single S2?

A

HLHS

60
Q

First step in mgmt of Coarctation

A

PGE infusion

61
Q

Marfan’s inheritance

A

AD

62
Q

Acute rheumatic fever

- dx

A

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
63
Q

Complication of Prolonged QT

A

torsades

64
Q

WPW assoc with which CHD

A

ebsteins

TGA

65
Q

PPHN

- what worsens pulmonary vascular resistance

A

hypoxia
hypercapnia
acidosis
cold

66
Q

Causes of PPHN

A

MAS

RDS

67
Q

Noonan syndrome CHD

A

pulmonary valve stenosis

68
Q

CXR snowman

A

TAPVR

69
Q

digeorge

A

interrupted aortic arch
Right-sided aortic arch
TOF

conotruncals
branchial aortic arch defects (aortic arch)

*Review TD 2020 (16 decks)

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