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BPT exams > Cardiology > Flashcards

Cardiology Flashcards

1
Q

S1 is associated with closure of which valves?

A

Mitral and tricuspid

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2
Q

Wide splitting of S1 is associated with which conditions?

A

RBBB and Ebstein’s Anomaly

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3
Q

In inspiration there is increased systemic venous return to the heart and thus there is delayed closure of ______ valve

A

Pulmonary valve; delayed P2 sound

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4
Q

Widely split S2 occurs in conditions with prolonged _____ ventricular ejection time; Which conditions do you see this in?

A

ASD, PAPVR, Pulmonary stenosis, RBBB

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5
Q

You may also see wide S2 split in conditions with shortened LV ejection in conditions like ____

A

MR

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6
Q

Narrowly split S2 occurs when ____ valve closes early. It is associated with _______.

It may also be seen in conditions where _____ valve closure is delayed like _____.

A

Pulmonary valve closes early and associated with pulmonary hypertension.

It may also be seen when AV closure is delayed in conditions like Aortic Stenosis

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7
Q

Single S2 can occur when there is only one semilunar valve (i.e. conditions like _____ or ______ or _______); or when P2 is not audible (i.e. ____ or ____ or _______) or when P2 is early (in pulmonary hypertension)

A

Single S2 when only one semilunar valve is present (aortic or pulmonary atresia or truncus arteriosus); when P2 not audible (TGA, TOF, severe PS), when aortic closure is delayed (severe AS), or P2 is early (pulm htn)

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8
Q

Paradoxical split is when aortic closure follows pulmonary closure and LV ejection is greatly delayed. In which conditions is this seen?

A

Severe AS, WPW, LBBB

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9
Q

There is increased intensity of P2 with which condition?

A

Pulmonary hypertension

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10
Q

S3 is a low frequency sound heard in early diastole. This is related to ____________.
It can be normal but can also be associated if ventricular compliance is decreased in conditions like __________.

A

S3 is due to rapid ventricular filling, hear at apex or LL sternum.

This may be normal, but can be associated in conditions with dilated ventricles - Large VSD, CCF

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11
Q

S4 is a sound in late diastole. Is it always pathological?

A

Always pathological and associated with decreased ventricular compliance

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12
Q

Boot shaped heart is associated with which condition?

A

TOF

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13
Q

Paracrine regulation of blood flow:

  • Vasodilatation is due to ______, _______ and _______
  • Vasoconstriction is due to _______
A

Vasodilatation is due to Nitric oxide, bradykinin and prostacyclin.

Vasoconstriction is due to endothelin-1.

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14
Q

Name 5 extrinsic factors/regulators which cause increase vasoconstriction/vascular resistance?

A

Alpha-adrenergic sympathetic nerves, Angiotensin II, ADH (Vasopressin), Prostaglandin H2, Thromboxane (released by platelets due to decrease blood flow to injured vessels)

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15
Q

Name 4 extrinsic regulators of Vasodilatation?

A

Cholinergic sympathetic response, Parasympathetic NS, Histamine (localised vasodilatation in inflammation and allergic reactions), Prostaglandin I2

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16
Q

Increased Co2 or decreasedO2 causes ______ of cerebral blood vessels with aim to ______

A

Dilatation of cerebral blood vessels with aim to increase cerebral blood flow

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17
Q

4 common ECG changes seen with hypothyroidism?

A

Sinus bradycardia
Long QT interval
Flat or inverted T waves
Low voltage QRS complexes

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18
Q

3 common ECG changes with hyperthyroidism?

A

Sinus tachycardia
Increased QRS voltages
Atrial fibrillation

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19
Q

J waves on an ECG are seen in ______

A

Takotsubo cardiomyopathy
Hypercalcaemia
Hypothermia

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20
Q

A short QT interval is seen with hyper or hypothermia?

A

Hyperthermia

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21
Q

ECG features in hypocalcaemia?

A

Long ST segment, Long QTc interval

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22
Q

Prominent U waves are seen with?

A

Hypokalaemia

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23
Q

In Mitral Regurgitation you get a pansystolic murmur with an additional ___________ murmur in severe MR.

A

You get development of a mid diastolic rumble; this occurs because of increased blood flow over the thickened mitral valve.

AKA Carey Coombs murmur

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24
Q

In Atrial regurgitation you get _________ murmur

A

HDM +/‐ Austin flint

murmur

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25
Q

What are the ECG findings in Brugada syndrome?

A

Patients have ECG findings of ‘coved’ ST elevation in V1/V2 and pseudo-RBBB. Tachy-arrhythmias may be triggered by fever.

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26
Q

What are the most common CHD seen in William’s Syndrome?

A

Supravalvular aortic stenosis (75%)
Peripheral pulmonary stenosis (40%)
Supravalvular pulmonary stenosis (20%)
Coarctation of the aorta 2-70%

Beware of coronaries 5-10% risk of sudden death

and also screen for Renal arteries

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27
Q

What are the most common CHD seen in Noonan syndrome?

A 
Pulmonary stenosis (dysplastic pulmonary valve) - 50%
HOCM 20%
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28
Q

What are the most common CHD seen in Alagille syndrome?

A

Branch/peripheral pulmonary stenosis - 70%
Tetrology of fallot - 10%
ASD/VSD
Aortic stenosis

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29
Q

Differences in situs inversus vs situs ambiguous?

A

Situs inversus - everything flipped

Situs ambiguous - intermediate configuration of thoracic and abdominal viscera = heterotaxy syndrome

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30
Q

In situs inversus - 3-5% have CHD with most common association between ______.

20% have ________ syndrome

A

Associated with L-TGA

20% have associated Kartageners syndrome

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31
Q

Left atrial isomerism is associated with 4 common things….

A

Polysplenia - multiple small spleen (non-functioning)
Central transverse liver
Interrupted IVC (azygous/hemi-azygous continuation)
CHD - less common (50%) and simple acyanotic

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32
Q

Right atrial isomerism is associated with 4 common things…

A
  • Asplenia
  • Central/transverse liver
  • Bilateral right atria and right lungs
  • CHD - very common (90%) and complex cyanotic + anomalous pulmonary venous return
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33
Q

Blue Trisomy 21 = ______

A

tetrology of fallot

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34
Q

Turner’s syndrome = _______

A

Left heart lesions (bicuspid aortic valve)

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35
Q

William’s syndrome = ___________

A

Supravalvular problems (AS/PS/Peripheral PS)

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36
Q

Stretched marfan = _______________

A

Stretched aorta and/or mitral valve

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37
Q

Noonan syndrome associated with _____ axis

A

Superior axis

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38
Q

50% of kids with interrupted arch have _____

A

22q11 deletion syndrome

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39
Q

In WPW, _____ or ________ may increase rate of anterograde conduction and should be avoided.

A

Avoid Digoxin and CCB

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40
Q

What medication is used for SVT refractory to Adenosine in a haemodynamically stable patient?

A

Amiodarone

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41
Q

What is the medication of choice in a stable patient with VF or VT?

A

Stable patient, IV procainamide, sotalol, or amiodarone is acceptable. Amiodarone is preferred in patients with impaired left ventricular function or in patients with heart failure.

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42
Q

What is the treatment of choice for multifocal atrial tachycardia?

A

Sotalol

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43
Q

Name 4 common findings with hypokalaemia?

A

Prolongation of QT interval
ST-segment depression
T-wave flattening
Appearance of U waves

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44
Q

__________- closes from top to bottom on the right side of the heart;

Foramen ovale is created by a gap in the __________.

(ASD related)

A

Septum primum closes from top to bottom;

Foramen ovale is created by a gap in the septum secundum.

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45
Q

Most ASD cases are due to _________; failed closure

A

Ostium secundum

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46
Q

What ASD defects are most commonly seen in down syndrome?

A

Defects due to Ostium Prmum and thus relates to AVSD

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47
Q

Sinus venosus ASD are almost always associated with ……

A

Partial anomalous right sided pulmonary venous drainage

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48
Q

Most common type of VSD?

A

Perimembranous VSD (80%)

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49
Q

Inlet VSD associated with _____

A

AVSD

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50
Q

AVSD is typically a combination of….

A

Primum ASD and inlet VSD

if only one of the above, then partial AVSD

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51
Q

Once AVSD repaired complications can be ?

A

AV valve regurgitation

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52
Q

ECG for AVSD can uniquely show…

A

AVSD has a superior QRS axis deviation

53
Q

In _____ side valve replacement is never with mechanical unless it is HLHS

Right or left?

A

Right - don’t need warfarin

Left side has higher pressures and thus needs mechanical

54
Q

Noonan syndrome associated very commonly with?

A

Supravalvular pulmonary stenosis

55
Q

Common syndrome associated with interrupted aortic arch?

A

DiGeorge Syndrome

56
Q

How do you treat TET spells?

A

Knee to chest position

In hospital:

  • Oxygen, morphine, propanolol
  • IV fluid bolus
57
Q

What does a BT shunt do?

A

It connects the L) subclavian artery to the pulmonary artery

58
Q

Glen procedure occurs at what age _____

Fontan occurs at what age _____

A

Glen at 3-4mo

Fontan after 4yo typically

59
Q

What is a Glen Shunt?

A
  • Same as BCPC

- Connects the SVC to the Lungs

60
Q

What syndromes is Pulmonary stenosis related to?

A

Noonan syndrome
LEOPARD syndrome (lentigines, electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retardation of growth, deafness syndrome)
Allagile syndrome

61
Q

Positive T wave in ____ in a young child is a sign of RVH even in the absence of voltage criteria.

A

Positive T wave in V1

62
Q

Which drainage anomalies present with greatest risk of obstruction in TAPVR?

A

Infracardiac nearly always cause obstruction

R) SVC drainage causes obstruction 75% of time

63
Q

Snowman heart seen in _________

A

TAPVR (++ pulmonary oedema periphilarly and small heart)

64
Q

Which is more common in infancy?

AV N RT or AVRT

A

AVRT

AVNRT more common in older children

65
Q

The QRS complexes are wide, and the potential for more serious arrhythmias (ventricular fibrillation) is greater, especially if atrial fibrillation occurs.

Is true for Antidromic (retorgrade) or Orthodromic AVRT

A

This is true for Antidromic AVRT

may also see RBBB morphology

66
Q

Syncope in which LQT syndrome is most commonly associated with:

  • Sleep?
  • Exercise?
  • Emotional stress?
A

Exercise - LQTS1
Emotional stress - LQTS2
Sleep - LQTS3

67
Q

Differentiating pericarditis and myocarditis?

A

Low voltage seen on ECG in myocarditis.

Children with myocarditis often more sicker and can have trop

68
Q

Which cardiac complication do you screen for in children with Rett Syndrome?

A

Long QTS

69
Q

Right ventricular heave associated with ….

A

Associated with right ventricular hypertrophy - likely Pulmonary stenosis .

Heave s a sign of pressure overload. Other conditions - pulmonary hypertension.

70
Q

Palpable S2 is associated with …

A

Eisenmenger syndrome

A palpable S2 in the second left intercostal space correlates with pulmonary hypertension.

71
Q

ECG changes in AVSD?

A

Superior axis deviation with right ventricular hypertrophy

RVH more common, but can also see LVH

72
Q

What conditions can commonly have LAD?

A

Noonan syndrome, Primum ASD, Tricuspid atresia, inlet VSD, AVSD

73
Q

Suprasternal thrill associated with…

A

Aortic stenosis

74
Q

Mitral regurgitation can have a click when associated with …

Other features of mitral regurgitation?

A

Mitral valve prolapse

Other features of MR:

  • Mid diastolic murmur (due to increased flow)
  • Thrill at the apex
  • Left parasternal heave if associated pulmonary hypertension
75
Q

Double aortic arch can often have a dominant right aortic arch which forms a ring around the airway; they can present with stridor/barking cough - which is a feature of _______

A

Tracheomalacia

76
Q

What are the 5 big causes of single S2?

A

Pulmonary atresia, Aortic atresia, TOF, TGA, Pulmonary hypertension

Also Truncus

77
Q

2 main CHD that can present in months?

A

1) L-> R shunts

2) ALCAPA

78
Q

6 main CHD conditions that present in days?

A

1) TGA with intact VS
2) ToF
3) PDA
4) TAPVR
5) Truncus arteriosus
6) SV with increased PBF

79
Q

Collapsing pulse seen in?

A

Acyanotic - PDA, Ao regurgitation

Cyanotic - Truncus arteriosus

80
Q

Fixed split S2 seen with?

A

Acyanotic - ASD

Cyanotic - TAPVD, common atrium

81
Q

ECG changes of hypokalaemia?

A
  • ST depression and T wave inversion
  • Prominent U waves
  • Long QT (fusion of T and U waves)
  • Prolonged PR interval
  • Increased amplitude and width of P waves
  • VT
82
Q

What are features of hyperkalaemia?

A
  • Peaked T waves
  • P wave widens and flattens and eventually disappears
    (opposite of hypokalaemia)
  • PR prolongation
  • Bizarre QRS morphology

-> Asystolic arrest (compared to hyperkalaemia, which leads to SVT/VT)

83
Q

Which conditions have:

Differential cyanosis - so better sats post ductally?

A

Differential cyanosis
- Coarctation with PDA with right to left

Reversed differential cyanosis - Coarctation
- TGA (because

84
Q

What are the auscultatory findings of Eisenmenger?

A

Loud S2 - given the pulmonary hypertension

85
Q

Aortic opening click occurs in which phase?

A

Early ventricular ejection

86
Q

In Frank Starlings law, stroke volume corresponds to?

A

Preload

87
Q

Acyanotic CHD with ________ pulmonary blood flow present with ejection systolic murmur

A

Decreased pulmonary blood flow - ejection systolic murmur

Increased pulmonary blood flow - flow murmur

88
Q

Does tetralogy have single S2 or widely split S2?

A

Single S2

89
Q

Coarctation of the aorta alongside mitral valve abnormalities (a supravalvular mitral ring or parachute mitral valve) and subaortic stenosis are potential associated lesions - these left sided obstruction anomalies together are called ______

A

Shone complex

90
Q

LAD on ECG + cyanosis is highly suggestive off ______

A

Tricuspid atresia

91
Q

Name 4 common late complications of the Fontan procedure …

A
  • Stenosis of the superior or inferior vena cava anastomosis, vena cava or pulmonary artery thromboembolism
  • Protein-losing enteropathy,
  • Plastic bronchitis
  • Immune deficiency

Supraventricular arrhythmias (atrial flutter, paroxysmal atrial tachycardia), and hepatic cirrhosis (and possibly hepatic carcinoma) as a result of persistently elevated central venous pressures

92
Q

AVSD often has no murmur; but the two types of murmurs you may see are:

A
  • Ejection systolic - due to turbulent flow through the pulmonary valve
  • Pansystolic - due to VSD murmur
93
Q

Most common cardiac defect in Turner’s syndrome?

A

Bicuspid aortic valve

THEN

Coarctation of the aorta

94
Q

Most common cardiac defect in Fragile X syndrome?

A

Bicuspid aortic valve, coarctation of the aorta

95
Q

Which cardiac anomalies commonly occur in CHARGE syndrome

A

ToF and VSD

96
Q

What is the most common cardiac defect in VACTRL?

A

VSD and ToF

97
Q

What is the most common heart anomaly with fetal alcohol syndrome?

A

ASD and then VSD

98
Q

Fetal valproate syndrome is associated with which cardiac anomaly?

A

Aortic coarctation, hypoplastic left heart (Left heart defects)

99
Q

Which syndrome?

TAPVR + right lung hypoplasia with dextroposition of heart, can have pulmonary sequestration

A

Scimitar syndrome

100
Q

Most common cardiac anomaly with Kabuki syndrome?

A

Coarctation of the aorta, bicuspid aortic valve

101
Q

Most common cardiac anomaly with NF1?

A

Pulmonary stenosis, cardiomyopathy

102
Q

Superior axis + HOCM = ____

A

Noonan Syndrome

103
Q

Presence of Q weaves in III, aVF and V1 is suggestive of …

A

CC-TGA

104
Q

AVSD and Tricuspid atresia can both have LAD or Superior axis deviation on ECG -> what may be other differentiating feature?

A

AVSD -> ECG would have R) heart dominance; whereas Tricuspid atresia would present with L) heart dominance

105
Q

Common ECG findings in Ebsteins anomaly?

A

R) AD and RBBB

106
Q

What does the Q wave represent?

A

Septal depolarisation

107
Q

What does QRS segment represent?

A

Ventricular depolarisation

108
Q

What does ST segment represent?

A

Refractory period

109
Q

What does the T wave represent?

A

Ventricular re-polarisiation

110
Q

How do manage neonatal flutter if adenosine does not work?

A

Electrical cardioversion

111
Q

Why do you get diastolic murmur with truncus arteriosus?

A

Because regurgitation from truncal valve (crap valve)

112
Q

Afterload is affected by _______

A

Systemic vascular resistance

Thus Ace inhibitors help with afterload by reducing peripheral resistance

113
Q

Fredreich’s ataxia, Pompe’s is associated with which cardiac anomaly?

A

Hypertrophic cardiomyopathy

114
Q

Noonan’s and Fabre’s disease is associated with which cardiac anomaly?

A

Hypertrophic cardiomyopathy

115
Q

If an ECG has P waves, before the QRS with tachycardia (long RP tachycardia) - what sort of ventricular arrhythmia is this consistent with?

A

Atrial ectopic tachycardia

Other ddx: Sinus tachycardia (Sinus tachy would have beat to beat variability -> and would have sudden change to sinus tachycardia)

116
Q

Short RP tachycardia (distance from RP versus PR is shorter) is associated with which arhythmia?

A

Associated with AVRT or AVNRT

117
Q

In SVT APLS management -> how many doses of Adenosine do you give before a large (400-500microg/kg) dose of Adenosine or DC shock or amiodarone?

A

3 escalating doses fo Adenosine -> 100 -> 200 -> 300

118
Q

IN VT with pulse + no shock -> how do you manage?

A

Given 5mg/kg of Amiodarone over 30mins

119
Q

U waves associated with?

A

Hypokalaemia

120
Q

Branch peripheral artery stenosis?

A

Alagille Syndrome and then William syndrome

121
Q

Wave and fixed split of S2?

Wide and variable split of S2?

A

Wave and fixed split of S2 - ASD

Wide and variable split of S2 - Pulmonary stenosis

*TYPICALLY

122
Q

Right atrial isomerism?

A

Asplenia

123
Q

Left atrial isomerism?

A

1) Polysplenia

2) Complete heart block

124
Q

Situs inversus associated commonly with?

A

Bilobed right lung

125
Q

If in V2-V3 we have tall R and S waves that are equal ->

A

Suggestive of biventricular hypertrophy

126
Q

Sensorihearing loss + LQTS =

A

Jervell and Lange Nielsen syndrome (Autosomal recessive)

Most other long QTS are autosomal dominant

127
Q

1) Prostacyclin
2) Endothelin
3) Nitric oxide

What role do each of the above play with vaso-contriction/dilatation and management of PPHN?

A

1) Prostacyclin - Vasodilatation -> prostacyclin/glandin given to activate cAMP and lead to vasodilatation (-ol)
2) Endothelin - Vasocontriction -> thus endothelin receptor antagonist given to cause vasodilatation (-entan)
3) Nitric oxide - vasodilatation - Nitric oxide and phosphodiesterase inhibitors (sildenafil) given to activate cGMP

128
Q

Which channel anomalies are seen:

  • LQTS 1
  • LQTS 2
  • LQTS 3
A
  • LQTS 1: prolonged potassium eflux
  • LQTS 2: prolonged potassium eflux
  • LQTS 3: prolonged sodium influx
129
Q

SCN5A mutation is associated with?

A

LQT3 syndrome

BPT exams (24 decks)

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