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Paeds Exam Cram > Cardiology > Flashcards

Cardiology Flashcards

1
Q

ECG squares

A

Small square = 1mm = 0.04sec

Big square = 5mm = 0.2sec

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2
Q

ECG axis

A

Look at lead I + aVF

Lead I + aVF positive = normal axis
Lead I positive + aVF negative = left axis deviation (always abnormal)

Lead I negative + aVF positive = right axis deviation
Lead I negative + aVF negative = north west axis deviation (always abnormal)

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3
Q

P waves

A

3mm tall + 2mm wide

Tall P wave = right atrial hypertrophy
Wide P wave = left atrial hypertrophy

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4
Q

PR interval

A

3-4/4-5mm

Short = Wolf Parkinson White
Long = first degree heart block, myocarditis, high potassium
Variable = second degree heart block Mobitz 1, second degree heart block Wencheback 2, third degree heart block
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5
Q

QRS

A

Low amplitude = pericarditis, myocarditis
High amplitude = ventricular hypertrophy

Narrow <2mm = SVT
Broad >3mm = bundle branch block, Wolf Parkinson White

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6
Q

ECG - Right ventricular hypertrophy

A

RAD
Tall R aVR, V1
Deep S V5, V6
Upright T V1, V3, V4R

8do-8yo: TOF, VSD, PVS, CoA - newborn

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7
Q

ECG - Left ventricular hypertrophy

A

LAD
S V1 > 2x R V5, R V5 + V6 (taller)
S V1 > V6

AS, CoA, HOCM, AR, MR

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8
Q

ECG - LBBB

A

AS
High K
WPW
Dilated cardiomyopathy

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9
Q

ECG - RBBB

A

RVH
Myocarditis
CHD
TOF repair

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10
Q

QT

A

Short: hypercalcaemia
Long: congenital, hypocalcaemia, myocarditis, drugs

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11
Q

T waves

A

Upright V1-3: <8d >8y (if upright in between = RVH)
Peaked: hyperkalaemia, LVH
Flat: normal, hypokalaemia, pericarditis, myocarditis
Alternating: long QT

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12
Q

ECG - Pericarditis

A

ST elevation
PR depression
Flat T waves

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13
Q

ECG - Myocarditis

A

Long PR
Low amplitude QRS
Low amplitude T waves

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14
Q

ECG - Hypokalaemia

A

Flat T waves
Long QT
U waves

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15
Q

ECG - Hyperkalaemia

A

Peaked T waves

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16
Q

ECG - Wolf Parkinson White

A

Short PR
Qide QRS
Slurred upstroke QRS (Delta waves)

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17
Q

ECG - ALCAPA

A

ST elevation

Inverted T waves aVL, V5, V6

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18
Q

ECG - APVD

A

RAD
RVH
RAH

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19
Q

ECG - Aortic stenosis

A

LVH

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20
Q

ECG - ASD

A

Primum: superior axis
Secudum: RBBB, RAD, first degree heart block 50%

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21
Q

ECG - VSD

A

Small: normal
Moderate: LVH
Severe: RVH

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22
Q

ECG - CoA

A

<6m: RBBB/RVH

>6m: LVH or RBBB

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23
Q

ECG - Ebstein

A

RAH
RBBB
RVH disappears when exercising

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24
Q

ECG - HLHS

A

RVH

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25
Q

ECG - MS

A

RAD
RVH
RAH

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26
Q

ECG - PDA

A

Moderate: LVH
Large: LAH
Severe: RVH

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27
Q

ECG - TOF

A

RAD

RVH

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28
Q

ECG - Tricuspid atresia

A

Superior QRS

LVH

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29
Q

ECG - TGA

A

RAD
RVs + LVH
Complete heart block

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30
Q

SVT

A

Retrograde bundle of Kent

Treatment:
Vagal stimulation
Adenosine, DC shock
Long term - beta blocker, digoxin

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31
Q

Atrial fibrillation

A

Amiodarone
Cardioversion
Ablation

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32
Q

Ventricular tachycardia

A

Amiodarone

DC shock

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33
Q

Ventricular fibrillation

A

In long QT, Brugada, cardiomyopathy - defibrillation

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34
Q

Brugada

A

Coned ST elevation
LBBB

Death in sleep
Fever = emergency
Males, Asian

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35
Q

Wolf Parkinson White

A 
Anterograde conduction accessory AV pathway before conduction through AV node
Re-entrant
Pre-excitation
Sotalol, flecainide
Avoid digoxin + calcium channel blockers
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36
Q

Long QT syndrome

A

AD
Deafness
Seizures/syncope

Treatment:
Beta blockers
No competitive sports
Screen Family
Avoid macrolides, TCA, antipsychotics, antifungals

Think of DiGeorge if neonate

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37
Q

Long QT type 1

A

KVLQT1
Low K efflux
Exercise triggered

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38
Q

Long QT type 2

A

HERG/KCHN2
K channel gene
Stress

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39
Q

Long QT type 3

A

SCN5A
High Na/defect Na channel gene
Triggered by rest or sleep

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40
Q

Mobitz type 1/Wenkebach

A

Progressive prolonging of PR until one drops

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41
Q

Mobitz type 2

A

Constant PR but periodic drops 2:1 3:1

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42
Q

Complete heart block

A

No connection between P and WRS
Associated with TGA
Pacemaker

43
Q

RUSE murmur (aortic)

A

Aortic stenosis: harsh, radiates to neck, wide split S2
Coarctation: radiates interscapular
Aortic regurgitation: diastolic

44
Q

LUSE murmur (pulmonary)

A 
ASD: click, fixed split S2
PDA: continuous
Coarctation: radiates interscapular
Pulmonary stenosis: click, fixed widely split S2
TAPVD/PAPVD
45
Q

LLSE murmur (tricuspid)

A 
VSD: pan systolic, can have diastolic
AVSD
HOCM: louder with exercise/valsalva, softer with squatting S3+S4
TR: pansystolic
TS: diastolic
Ebsteins: wide S2, extra S3, S4
46
Q

Apex murmur (mitral)

A

MR: pansystolic
MV prolapse
MS: diastolic

Pulmonary hypertension: loud S2
Myocarditis: S3 gallop rhythm

47
Q

Cardiac conditions associated with T21

A

AVSD
ASD
VSD
TOF

48
Q

Cardiac conditions associated with Williams

A

Supravalvular AS

Peripheral PS

49
Q

Cardiac conditions associated with DiGeorge

A 
Interrupted aortic arch
TA
TOF
VSD
Long QT
50
Q

Cardiac conditions associated with Noonans

A

Valvular PS
ASD
HOCM

51
Q

Cardiac conditions associated with Turners

A

CoA
Bicuspid aortic valve
AS

52
Q

Cardiac conditions associated with Alagille

A

Pulmonary artery stenosis
TOF
PS

53
Q

Cardiac conditions associated with Foetal Alcohol Syndrome

54
Q

Cardiac conditions associated with Marfans

A

Aortic root aneurysm
MVP
MVR
AR

55
Q

Cardiac conditions associated with Ehlers Danlos

A

Aortic/carotid aneurysms

56
Q

Cardiac conditions associated with Friedrich Ataxia

57
Q

Cardiac conditions associated with congenital rubella

A

PDA

Peripheral PS

58
Q

Cardiac conditions associated with TS

A

Cardiac rhabdomyoma

59
Q

Cardiac conditions associated with NF1

60
Q

Cardiac conditions associated with GDM

A

HOCM
VSD
TGA

61
Q

Cardiac conditions associated with VACTERL

62
Q

Cardiac conditions associated with T13 (Patau) / T18 (Edwards)

A

ASD, AVSD, PDA, CoA, HLHS

63
Q

Cardiac conditions associated with Kartageners

A

Dextrocardia
TGA

(AR ciliary disorder triad - situs inversus, chronic sinusitis, bronchiectasis)

64
Q

Cardiac conditions associated with Jevell Lange Neilsen

A

Long QT (AR, SNHL)

65
Q

Cardiac conditions associated with Romano Ward

A

Long QT (AD)

66
Q

Cardiac conditions associated with PHACES

67
Q

Cardiac conditions associated with lithium in pregnancy

68
Q

Cardiac conditions associated with phenytoin in pregnancy

A

Peripheral PS

69
Q

Conditions associated with VSD

A 
T21
DiGeorge
FAS
GDM
T13 (Patau) or T18 (Edward)
VACTERL
70
Q

Conditions associated with ASD

A

T21
FAS
Noonans

71
Q

Conditions associated with AVSD

A

T21, CHARGE

72
Q

Conditions associated with aortic stenosis

A

Williams (supravalvular)

Turners

73
Q

Conditions associated with PDA

A

Congenital rubella

T13 (Patau) or T18 (Edward)

74
Q

Conditions associated with CoA

A

Turners
Kabuki
PHACES
NF1

75
Q

Conditions associated with pulmonary stenosis

A

Noonans (valvular)
Williams (peripheral)
DiGeorge
NF1

76
Q

Conditions associated with peripheral pulmonary stenosis

A

Alagille
Williams
Congenital rubella

77
Q

Conditions associated with bicuspid aortic valve

78
Q

Conditions associated with long QT

A

DiGeorge
Romano Ward
Jevell Lange Neilsen

79
Q

Conditions associated with TOF

A

T21
DiGeorge
FAS

80
Q

Conditions associated with TGA

A

GDM

Kartageners

81
Q

Conditions associated with mitral valve prolapse

82
Q

Conditions associated with HOCM

A

Friedrich ataxia

GDM

83
Q

Conditions associated with interrupted aortic arch

84
Q

Conditions associated with cardiac rhabdomyoma

A

Tuberous sclerosis

85
Q

Conditions associated with dextrocardia

A

Kartageners

86
Q

Conditions associated with Ebsteins

A

Lithium in pregnancy

87
Q

Conditions associated with HLHS

A

T13 (Patau) + T18 (Edward)

88
Q

PDA

A

Continuous machinery murmur
Bounding pulses
Failure
ECG - LVH

Treatment:
NSAIDs, coil/device
Don’t spontaneously close

89
Q

ASD

A

Primum: worse, can affect mitral
Secundum: better, can spontaneously close

Can be asymptomatic, failure if premium/large
ESM LUSE fixed splitting of SR (relative PS)
CXR: cardiomegaly
ECG: RBBB, RAD (secundum), superior axis (primum)
Size of shunt depends on RV compliance
Recurrence 2.5%, 40% spontaneously close

Treatment:
Device 4-5y for secundum if Sx or failure
Patch closure for primum or large R-L shunt

90
Q

VSD

A

Large presents with heart failure 6-8/52 when PVR falls
Pansystolic and diastolic/thrill if bad
Size of shunt depends on PVR
CXR: cardiomegaly with increased markings
ECG: RVH or LVH if severe, no axis deviation

Treatment:
Perimembranous doesn’t close, more common
Muscular 40% spontaneously close
Closure patch, device if strain at 3-6/12

91
Q

AVSD

A 
Think trisomy 21
Heart failure
FTT, repeated respiratory infections
Thrill LLSE, 3-4/6 pan systolic murmur, mid diastolic rumble
CXR: increased pulmonary markings
ECG: superior axis

Treatment:
Patch 3-6/12
ECG post op: RBBB + RVH

92
Q

TOF

A
  1. Pulmonary stenosis/RVOT
  2. VSD (perimembranous)
  3. RVH
  4. Overriding aorta
Think DiGeorge
Not duct dependent
Harsh ejection systolic murmur, LLSE
CXR: boot shaped heart
ECG: RVH

Treatment:
Shunt/patch repair then complete repair
ECG post op: RBBB, also aortic regurg post op

Tet spells - knee to chest, O2, morphine, IVF, vasoconstrictors

93
Q

TGA

A 
Think GDM
Duct dependent (if no VSD)
Difference pre- + post- ductal sats
ESM LSE
ECG: LVH/RVH/complete heart block
CXR: egg on string

Needs PDA or VSD to survive

Treatment:
Prostaglandin
Balloon septostomy, atrial switch later

94
Q

TAPVD

A 
Supracardiac - SVC
Infracardiac - IVC
Needs ASD/VSD for mixing
Duct dependent if obstructed
Ejection systolic LUSE gallop rhythm
CXR: snowman supracardiac, small heart obstructed

Treatment:
Surgery in newborn if obstructed

95
Q

Truncus arteriosus

A 
Both great arteries same origin
Cyanotic at birth
Not duct dependent
Heart failure in weeks
Bounding pulses
Harsh systolic murmur

Treatment:
Needs complete repair in 6/12 with conduit and close VSD

96
Q

Tricuspid atresia

A

No connection between RA+RV
Cyantoic
Needs VSD or ASD to survive
ECG: superior QRS, LVH

Treatment:
Shunt early, Bidirectional Cavo Pulmonary Connection (BCPC) 2yo, Fontan definitive

97
Q

Aortic stenosis

A

Valvular (bicuspid valve), supravalvular, subvalvular
Cyanotic
Duct dependent if critical
Heart failure
Harsh ejection systolic RUSE, S2 ejection click, widened split +/- thrill
CXR: dilated aorta
ECG: LVH

Treatment:
Balloon valvotomy
Replacement

98
Q

CoA

A

If interrupted aortic arch, think DiGeorge
Cyanotic
Duct dependent if critical
UL - hypertension and bounding pulses
LL - hypotension and weak pulses
RUSE ESM radiates interscapular
CXR: cardiomegaly vascular marking, “3” sign prominent vessels L of mediastinum, notching of ribs

Treatment:
Surgical flap or balloon

99
Q

Pulmonary stenosis

A 
Think Noonans (dysplastic), Williams (peripheral)
Valvular 90%, supravalvular, subvalvular
Cyanotic if critical
Don't get heart failure
Mild PS -> severe PA dilatation
ESM LUSE radiates to back and side
Wide split S2, loud S2
ECG: RVH

Treatment:
Balloon dilatation

100
Q

HLHS

A 
Cyanotic
Duct dependent
Presents in days
Heart failure
Weak pulses
ECG: RVH

Treatment:
Norwood
Shunt/Bidirectional Cavo Pulmonary Connection (BCPC)/Fontan

101
Q

Aortic atresia

A 
Usually with HLHS
LVOT
Duct dependent
Absent pulses
Heart failure
CXR: boot shaped heart
102
Q

ALCAPA

A

L coronary arises from pulmonary artery instead of aorta
Presents 6-8/52 when PVR drops
Think of in a baby unsettled with feeds, FTT + cardiomegaly
ECG: ST elevation and T wave inversion aVL, V5, V6

Treatment: surgery

103
Q

Ebsteins

A

Abnormal tricuspid, tricuspid regurgitation
Massive RA
90% have ASD
Murmur systolic LLSE S3, S4 wide split S2
CXR: box/square shaped heart
ECG: WPW, RBBB, RAH, RVH disappears when exercising

104
Q

HOCM

A

AD
LVH -> LVOTO
Think Noonans, GDM
Presents with exercise intolerance, syncope with exercise, sudden death
ESM louder with exercise valsalva, softer with squatting S3 + S4
ECG: LVH

Treatment:
Surgical myectomy
Restrict contact sports

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