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FRACP > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What cardiac lesions present in the 24 hours of life critically unwell?
Why these ones?

A
  • Ebstein anomaly
  • obstructed TAPVD

Severe lesions
Duct is still open- more resp than cardio lesions

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2
Q

What murmurs may present in the first 24 hrs of life?

A

AS PS or AV REGURG

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3
Q

Which cyanotic lesions can present in the first 24 hrs of life?

A

TGAs, single ventricle hearts

Mixing lesions

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4
Q

What are the three main reasons duct dependant lesions present?

A

Depend on the pda for plum flow, systemic flow mixing

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5
Q

When do duct dependant lesions present?

A

24 hrs to 2 weeks

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6
Q

Using the three subgroups, what are examples of duct dependant lesions

A

1) need pda for pulm flow
- severe ps
- pulm atresia
- above in single ventricle

2) need pda for systemic flow
- severe co-arc
- critical as
- HLHS

3) need pda to mix
- TGA

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7
Q

How do lesions at 2-6 weeks present?

A

Congestive cardiac failure

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8
Q

What are examples of lesions presenting at 2-6 weeks

A

Severe vsd or pda
Truncus
Tof with pulm atresia

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9
Q 
dTGA
How does it present 
- murmur
-s2
-CXR
-ECG

Initial management
Repair and timing

A

Cyanosis from birth, fails hyperoxia test

  • none!
  • single
  • egg on a string with increased pulm markings
  • RVH

Prostaglandin
Septostomy then atrial switch-4 weeks

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10
Q

L-TGA
why is it different?
How does it present?

A

Ventricles swap over with the great vessels

Asymptomatic unless associated with another defect

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11
Q

D-TGA

What other lesion is commonly found and how frequently

A

1/3 have coronary artery anomalies

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12
Q

Tricuspid atresia
How do they present
What is seen on ECG

A

Cyanotic at birth with murmur of VSD

Superior axis and LVH (therefore not AVSD)

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13
Q

Ebstein anomaly

Outline the anatomy

A

Hugely dilated right atrium
Abnormal valve
Arterialised ventricle

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14
Q

TOF

What are the 4 lesions?

A

VSD
r ventricle outflow obstruction
Overriding aorta
RVH

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15
Q

In a TOF what determines the degree and magnitide of the shunt?

A

Degree of pulm stenosis

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16
Q

TOF

What are the two ways they can present

A

Blue- Murmur at birth. Progressive cyanosis. Tet spells from 2 months

Pink-Acyanotic- signs of heart failure later

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17
Q

Cyanotic TOF- what is the murmur
S2?
What does the murmur correlate to

A

Long Loud
Ejection systolic with ejection click
Single s2
The pulm stenosis

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18
Q

TOF
ECG findings
Chest X-ray findings

A

RAD and RVH

Boot shaped heart with reduced pulm markers

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19
Q

Physiologically what does a tet spell indicate? Will there be a murmur?

A

Acute right to left shunting

No!!

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20
Q

When will a TOF not have a murmur

A

If there is pulm atresia

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21
Q

How can TOF be conservatively managed (3 things)

When is definitive surgery normally done? What 3 things might make it necessary to do earlier

A

Beta blockers, balloon dilatation of outflow tract obstructions
Modified BT Shunts

6-12 months
Not growing, low sats, lots of TET spells

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22
Q

What maternal medication is ebstein associated with

What arrhythmia is the baby likely to have?

A

Maternal lithium

WPW

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23
Q

Ebstein

What is seen on ECG

A

RAH and likely WPW

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24
Q

Truncus

Outline the anatomy

A

Single trunk overlying a VSD

Abnormal truncal valve

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25
Q

Truncus- what is the murmur

ECG

A

To and fro murmur- diastolic of truncal regurgitation, systolic of VSD

Biventricular hypertrophy

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26
Q

Truncus- what syndrome is normally associated

A

Di George

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27
Q

How is truncus repaired (2 methods)

A

PA banding

Rastelli repair

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28
Q

How does TAPVD present- 2 ways

Which type is obstructed

A

Obstructed- cyanosis from day 1 of life and v unwell
Non obstructed- mild cyanosis, mid diastolic rumble and recurrent chest infections

Infra diaphragmatic

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29
Q

Non obstructed TAPVD- CXr?

A

Snowman in a snowstorm

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30
Q

HLHS

What other lesion is commonly associated?

A

Severe co-arctation

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31
Q

HLHS- how will it present

A 
Duct dependant- 
Cyanosis when duct closes
Impalpable femoral 
No murmurs 
Single s2
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32
Q

Why should sats be kept around 80% in HLHS

A

Keep pulm vascular resistance high

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33
Q

HLHS outline the steps in the staged Norwood

A

1- make an asd, BT shunt (svc to r PA) and connect pulm artery to aorta (right subclavian)

2- shunt down, svc to r pa (Glenn)

3- ivc to r pa with gortex or suture atrium to ventricle (fontan)

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34
Q

AS and PS- where are the murmurs and where do they radiate

A

Aortic upper right- to neck

Pulm upper left- to back

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35
Q

Avsd

  • ecg findings
  • partial vs complete
A
  • superior axis
  • both have mr and primum asd
  • complete also has a vsd
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36
Q

What percentage of VSDs close spontaneously

A

90% if small

65% otherwise

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37
Q

Which type of Vsd Is more common

A

Membranous

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38
Q

How do large VSDs present

What other murmur might you hear and what does it indicate

A

When pulm vasc resistance falls (week 2-6)
Heart failure
Pansystolic murmur
Widely split s2

Mid diastolic rumble of relative mitral stenosis

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39
Q

What might be an interim surgical technique for VSDs?

What can an unrepairwd VSD cause

A

PA banding- protects the lungs

Aortic regurgitation

40
Q

What ratio of qp to Qs indicates the need for surgery?

A

2:1

41
Q

What are the three types of ASD
Where are they found
Which is most common

A

Secundum- at the foramen ovale- most common
Primum- endocardial cushion
Sinus venison- at the entry of the SVC

42
Q

What murmur and heart sounds are heard in ASD

A

Fixed split s2

Ejection systolic murmur

43
Q

What syndrome is supravalvular aortic stenosis associated with
What syndrome is a bicuspid aortic valve associated with

A 
Williams syndrome (high pitched cry therefore high lesion)
Turners
44
Q

Aortic stenosis
Outline the pathology
What is the classical murmur

A

Tight aortic valve, hypertrophy of the left ventricle, dilation of the aorta
Ejection systolic, upper, crescendo/decrescendo radiating to the carotid

45
Q

How does severe AS present

How does critical AS present

A

Loud murmur with narrow pulse pressure

No murmur but single s2 or narrow split. Poor perfusion. Failure at birth. Can be cyanotic

46
Q

Severe AS
How will the ECG look
What is seen in CXR

A

LVH

Prominent aortic notch (right sided). Normal lung fields

47
Q 
PS 
What type of lesion is seen in 
Noonan syndrome 
Alagille syndrome
Rubella infection 
What other 2 syndromes are associated
A

Noonan- valvular
Alagille- peripheral (branch)
Rubella- supravalvular

NF1 and Williams

48
Q

Pulmonary stenosis

What is the murmur and s2

A

Upper left eternal edge radiating to the back

Widely split s2

49
Q

PS

What is seen on ecg and cxr

A

RVH

Prominent pulmonary arch (left sided)

50
Q

Coarctation

What syndrome are they associated with

A

Turners

51
Q

Coarctation

How do they present in older children.

A

Headaches
Hypertension
Murmur at the interscapular area

52
Q

Coarctation

How do they present if severe in babies

A

No murmur
Differential cyanosis
Thready peripheral pulses
Loud and single s2

53
Q

Coarctation

What is seen on cxr

A

Inverted E (rib notching)

54
Q

Why will an interrupted arch not present with differential cyanosis
Which syndrome is it most likely associated with

A

Usually have another mixing lesion like a VSD

Di George

54
Q

What is the normal function of the ductus arteriosis and when does it physiologically and anatomically close

A

Blood from the pulmonary artery into the aortic arch
Phys-10-15 hrs of life
Anatomically- 2-4 weeks

56
Q

PDA
In term babies what does it act like
What therefore dictates the direction and severity

A

An unrestricted VSD

Pulmonary vascular resistance

57
Q

PDA

how and when does a large PDA present in term babies

A 
When svr reduces (2-6 weeks) 
Machinery murmur at the interscapular region 
Differential cyanosis 
Bounding pulses
Recurrent infections
58
Q

PDA
What direction is the shunt normally
What can happen with a large shunt

A

Left to right

Also right to left shunting

59
Q

PDA

How is it normally closed in term babies

A

Via catheter

Surgical

60
Q

PDA

How does it present in preterm babies

A

Difficult to wean off vent in hyaline membrane disease
Continuous systolic murmur at ULSE
Bounding pulses

61
Q

What is used to close a pda in premature babies
How does it work (2 mechanisms)
Side effects

A

Indomethacin
Inhibits COX and PGE2

GI bleeding
Hyponatraemia
Reduced renal or cerebral blood flow

62
Q

PDA in preterm

When is surgery indicated

A

If 2x failed attempts at indomethacin

63
Q

Rheumatic fever

How many positive criteria are needed to make the diagnosis

A

2 major or 1 major and 2 minor

64
Q

What are the mnemonics to remember major and minor criteria in rheumatic fever?

A 
Joints 
O- carditis- sleeping tachy new murmur or conduction defects 
N- nodules 
E- erythema marginatum 
S- Sydenham’s chorea

H- hot- fever
E- elevated esr or crp
L- arthralgia
P- PR interval

65
Q

Which valve is most likely to be involved in acute rheumatic fever

A

Mitral

66
Q

How many positive criteria do you need to diagnose Kawasaki

What are the 5 criteria

A

Fever more than 5 days plus 4 criteria

Non purulent conjunctivitis 
Unilateral cervical lymphadenopathy 
Desquamation 
Strawberry 
Polymorphic rash
67
Q

When do plt elevate in Kawasaki

When is the highest risk phase for coronary artery aneurysms

A

10d-4w

This stage!!

68
Q

Treatment of kawasaki
How long is the aspirin continued for
Which MAB might be used in refractory cases

A

3-4 days or until day 14, whichever comes first

Infliximab

69
Q

IE
What is the most common cause on normal valves
Damaged valves

A

Staph epi

Strep viridians

70
Q

What is the cause of brugada syndrome
What is seen on ecg
What happens

A

AD Na channel defect
ST elevation with negative p wave in v1& 2
Sudden death in sleep

71
Q

What are the 2 differences between jervell Lange nelson and Romano ward

A

JLN-AR and has SN hearing loss

RW- AD no hearing loss

72
Q

What 3 groups of meds/ chemicals can prolong your QT

A

1) antipsychotics
2) antibiotics- trimethoprim and erythromycin
3) organophosphates

73
Q

What triggers the following prolonged QT syndromes 1,2,3,4
Which electrolyte imbalance is most likely
Which condition is LQT 5

A

1- fun e.g. swimming
2- boo- emotion
3- sleeep
4 unknown

Prolonged K efflux

Romano ward

74
Q

How is TOF treated medically

A 
Try to increase the SVR 
Knees up
O2
Morphine
IV propranolol 
Iv phenylephrine 
Emergency shunt or repair
75
Q

Svt and cardio version

How do you prevent VT from happening

A

Synch to the r wave

76
Q

Which asthma drug can cause torsades IN Patients with long QT

A

Theophylline

77
Q

What medication is given to treat long QT associated with TCA OD

A

Sodium bicarbonate

78
Q

When is VSD repair contraindicated?

Why?

A

Severe pulm hypertension

Increased mortality with reduced cardiac output

79
Q

What is the most common cardiac defect seen with na valproate use?

A

ASD

80
Q

Fetal cardiac circulation

What do the umbilical arteries and veins carry

A

Arteries- deoxygenated blood from iliac arteries back to the placenta

Vein- oxygenated blood to the ductus venosus in the liver

81
Q

What are 2 potential causes of complete vascular rings?
How do they present?
What is seen on bronch?

A

Double aortic arch with or without ligamentum
Wheeze and stridor from 3m. Later if septum
Bilateral compression- pulsatile

82
Q

Incomplete rings
What are 2 asymptomatic ones
What causes a vascular sling? What is seen on bronch
What is seen with anterior tracheal compression

A

Aberrant left coronary, anomalous right subclavian
Anomalous left pulm artery. Deviated trachea
Anomalous innominate

83
Q 
What is the mechanism of the following anti arrhythmics and give examples 
Class 1
Class 2
Class 3 
Class 4
A

1 sodium blockers- c=flecainide
2- beta blockers- atenolol
3- k blockers- sotalol and amiodarone
4- calcium blockers- verapamil

84
Q

How does digoxin work

A

Blocks k-ATPase pump

Causes increased contractility

85
Q

Which 2 antiarrhythmics do you never use in WPW

A

Digoxin and verapamil

86
Q

How are prolonged QT syndromes treated

A

Beta blockers and ICDs

87
Q

Prolonged QT
What is the most likely AD cause
What is a cause with associated bilateral SN hearing loss? What is its inheritance

A

Romano ward

Jervell Lange Nelson-AR

88
Q

Coarctation what is seen on the ECG of infants vs older children

A

Infants- RVH

Children- LVH

89
Q

Long QT

what triggers type 1,2 and 3 and what shape of QT is seen. Which channels do they involve

A

1-fun- swimming. Long wide QT. K channels
2- boo- emotion- m shaped QT. K channels
3- sleep- Na channel- narrow and late Qt

90
Q

What are the mean features of right and left isomerism

A

Left- multiple left lungs and multiple spleens

Right- multiple right lungs and absent spleen

91
Q

What is the difference between the timing of ASOT and DNAse tests?

A

ASOT- positive for 1-4 weeks

DNAse- positive 4-6w

92
Q

What are the 4 main indications for endocarditis prophylaxis

A

Previous endocarditis
Metalware
<6m from last repair
Cyanotic disease

93
Q

What does prostaglandin do and how

What are three main side effects

A

Keeps the ductus arteriosis open- general vasodilator

Reduced plt aggregation, apnoea, tachy or Brady cardia

94
Q

Which 2 lesions have ejection clicks

A

Aortic and pulmonary stenosis

95
Q

What is seen on ECG of L-TGA

A

LAD and abnormal Q waves in right sided leads

FRACP (23 decks)

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