Cardiology Flashcards
Describe murmur of venous hum
Continuous, soft blowing, in right and left infraclavicular areas. Increased by sitting, standing, decreased by supine or turning head. Produced by flow in jugular veins
Describe pulmonary flow murmur
midsystolic, soft blowing best heard at 2nd LICS, 2/2 to flow in RVOT, increased when supine, expiration. heard at age 7-10 and persists into adulthood
Which congenital heart lesions typically present with heart failure in first 6 weeks of life
Obstructive lesions of the left side of the heart - aortic stenosis, coartation of the aorta, hypoplastic left heart. Also large shunt lesions cause pulmonary overcirculation and symptoms of heart failure.
Most common form of congenital heart disease?
Bicuspid Ao valve, then VSD
When is surgery for VSD performed?
3-6 months
Why do u get a fixed second heart sound in ASD?
Usually right ventricle empties slightly later than the left therefore get P2. The split is increased in inspiration because of more venous return. In an ASD, the right ventricle is always volume overloaded in expiration and inspiration this fixed second heart sounds.
What is EKG sign of right ventricle volume overload
RSR’ in V1
Signs of PDA in newborns
continuous machinery-like murmur at left infraclavicular area, wide pulse pressure, bounding pulses,
4 features of TOF
- Overriding aorta, 2. VSD, 3. Pulm stenosis or RVOF 4. RV hypertrophy
tet spell
Murmur is actually softer because less blood across RV OFT. . Treatment - assume knee-chest position, fluids, oxygen.
Egg on a string heart
Transposition of great arteries, directanterior posterior relationship of the arteries
Treatment of transposition of the great arteries
atrial septostomy, then arterial switch in first couple weeks of life
TAPVR
Pulmonary veins drain into the systemic venous system. Can get supracardiac - svc or innominate vein, cardiac - drainage into coronary sinus, infracardiac - into IVC.
Obstructed TAPVR
Not getting enough blood back to heart, pulmonary congestion and need emergent surgical repair
Who needs prophy antibiotics?
Prostetic cardiac heart valve, previous infective endocarditis, Unrepaired cyanotic CHD, including shunts and conduits, Completely repaired CHD with prostetic material or device within 6 months or with residual defects.
Jones Criteria
MAJOR: Carditis, Polyarthritis, Chorea, subq nodules, erythema marginatum MINOR: fever, prolonged PR interval, elevated Acure phase reactants, arthralgia, previour acute rheumatic fever. Need 2 major, 1 major and 2 minor PLUS evidence of recent strep test.
Kawasaki Disease Criteria
Fever for 5 days PLUS 4 of: Rash, conjunctivitis, mucosal changes, Lymphadenopathy, extremity erythema, edema
Treatment of acute rheumatic fever
ASA and pcn. Steroid only for severe carditis or symptoms not improved with asa
Why do you not want to use oxygen in pulmonary over circulation congenital heart syndrome?
Bc oxygen is a pulmonary vasodilator and systemic vasoconstrictor
Signs and symptoms of PDA
Wide pulse pressure bc have systolic and diastolic shunt and runoff in diastole. Bounding pulses. Machinery like murmur
What is the snowman sign on chest X-ray?
Total anomalous pulmonary venous return
What is the effect on oxygen on pulmonary and systemic circulation?
pulmonary vasodilator (therefore dont want to use in VSD or anything with increase pulm flow) systemic vasoconstrictor.
When do you start a statin in a kid with high cholesterol?
When they are over the age of 8 and have one of the following: 1.) LDL >190, 2.) LDL>160 and family member with premature CAD or 2 CAD risk factors. 3.) LDL>130 and diabetes
What does cyanosis of preductal structures suggest?
transposition of the great vessels.
Describe the murmur of physiologic peripheral pulmonic stenosis
due to fetal anatomy - pulmonary arteries come off very acutely and are small. Creates turbulence. Causes soft, harsh, SEM heard in the axilla. disappears by 12 months
What drug should never be used in Aflutter for patients < 1 and why?
verapamil bc it can cause heart failure or hypotension
Which drugs can worsen torsades de pointes?
quinidine or procainamide can worsen
What conditions should you avoid verapamil?
young infants, afib with WPW, a flutter, wide complex tachycardias, beta blockers
What class is quinidine and what are major side effects?
Ia, prolongs QT segment -> torsades, diarrhea, hearing loss and tinnitis
What class is procainamide and what are major side effects?
prolongs QT and QRS. Can cause blood dyscrasias, drug induced lupus, caution in HF patients
What class is lidocaine and what are major side effects?
class Ib. Seizures
What class is amio and what are major side effects?
class III; very long half life. Corneal deposits, pulm fibrosis, sun sensitivity. No hematologic changes
which conditions worsen dig toxicity?
hypokalemia or hypercalcemia
What cardiac lesion is noonan syndrome associated with?
pulmonic stenosis or HCOM
What cardiac lesion is apert syndrome associated
VSD or coarct
What cardiac lesion is holt-oram syndrome associated
ASD, VSD
What cardiac lesion is alagille syndrome associated
pulmonic stenosis
What cardiac lesion is cri-du-chat syndrome associated
ASD
What cardiac lesion is trisomy 13 syndrome associated
VSD
What cardiac lesion is trisomy 18 syndrome associated
VSD
Where are VSDS most likely in kids <1
muscular septum
Where are VSDs most likely in kids >1
membranous septum
Most common form of ASD
ostrium secundum
How do you distinguish ASDs in ostium secundum from primum on EKG?
primum have left axis deviation and RVH (secundum only have RVH, no LAD)
In what lesion does paradoxic splitting occur?
aortic stenosis because increased LV load takes longer to get out.
Which congenital lesion can cause increased bp of 15mmHg in right arm?
supravalvular aortic stenosis
What are the congenital heart defects with left axis deviation
ostium primum ASD, complete AV canal, tricuspid atresia
snowman or figure 8 shaped heart
TAPVR without obstruction
Egg shaped heart
transposition of the great arteries
boot shaped heart
TOF
What is right atrial isomerism?
bilateral right-sidedness with bilateral 3 lobed lungs, a horizontal liver, no spleen. bilateral RA with 2 sinus nodes, common bowel malrotations and other congenital heart disease
Left atrial isomerism
bialteral left sidedness - 2 lobed lungs, polysplenia, increased risk of bowel malrotation and congenital heart disease
Which syndromes is right aortic arch common?
TOF and truncus arteriosus
what syndrome is aortic arch abnormalities associated with?
Digeorge syndrome
what is anomalous origin of the left coronary artery
left coronary artery comes off of the pulmonary artery
Kussmaul sign
Increased JVP with inspiration because right heart cannot accomodate increased venous return and it backs up, usually JVP decreased with inspiration. Seen in tamponade and constrictive pericarditis
Pulsus paradoxus
normally with inspiration, bp falls 4-10mmHg. With tamponade, the aortic pressure will fall 10-15mmHg
Becks triad
Increased JVP, dropping systolic bps, muffled heart sounds = tamponade physiology
What happens to chamber pressures in tamponade and constrictive pericarditis?
end diastolic pressure equalize
Dobutamine effects
B1 adrenergic effects - increases contractility without increasing HR or BP
Epinephrine effects
stimulates both alpha and beta adrenergic receptors
Dopamine effects
increases myocardial contractility by stimulating NE release. dilates peripheral beds at low dose, alpha adrenergic at higher doses
Milrinone
noncatecholamine - inotropic and vasodilator by inhibitis phosphodiesterase
what meds increase digoxin levels
quinidine, verapamil, amiodarone, beta blockers, tetracycline, erythromycin
Describe digoxin toxicity
arrythmias, color vision changes, confusion, vertigo, n/v/d. ignore dig levels
What are criteria for acute rheumatic fever?
Proof of group A strep infection. 2 Major, or 1Major and 2 minor.
Major Jones criteria for ARF are polyarthritis, carditis, Sydenham chorea, subcutaneous nodules, and erythema marginatum.
Minor Jones criteria for ARF are fever, arthralgia, prolonged PR interval on electrocardiograph, and elevated acute-phase reactants.
first and second most common causes of SCD in young athletes
HCOM and anomalous coronary artery
side effects of spironolactone
gynecomastia, hyperkalemia
Which infection can put you at risk for pneumothorax
pcp pneumonia
Who needs SBE prophylaxis
prosthetic heart valve, previous endocarditis, unrepaired cyanotic heart disease, repair congenital diz with prosthetic material <6 mos post op, heart transplant pts with valvulopathy
What is used for SBE prophy is pcn allergic?
clindamycin or keflex or azithro
Most common age for kawasakis
6 months to 5 years
How long after IVIG for kawasakis do you need to postpone vaccines?
live attenuated for 11 months. Can give other routine vaccines. Important to give killed flu vaccine to decrease risk of Reyes while on ASA
What do you need to think about before giving O2 to baby with possible cyanotic disease?
O2 will close PDA faster, decrease vascular resistance in lungs causing increased pulmonary blood flow to the lungs. Also O2 is a systemic vasoconstrictor, forcing more blood to the pulmonary circulation
Snowman heart
TAPVR
supravalvular aortic stenosis is associated with what genetic syndrome
Williams syndrome
Holt-Oran syndrome heart defect
ASD, VSD
should lasix be given fast or slow IV?
slow - fast associated with otoxocity
Which heart arrhythmia is associated with drownings?
Long Qtc syndrome
What is the incidence of CHD in patients with Downs?
50%
Jervell and Lange-Neilsen syndrome
long Qt syndrome and SNHL
