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N283B/C Patho > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Caused by the closure of the mitral and tricuspid valves.

Loudest at the apex

A

S1

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2
Q

Caused by the closure of the aortic and pulmonic valves.

Loudest at the base.

A

S2

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3
Q

Diagnostic test: checks the rhythm, can tell you size of chambers

A

EKG

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4
Q

Diagnostic test: can see anatomy, ventricular function, valve function using high frequency sound waves

A

ECHO

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5
Q

Diagnostic test: assess vitals and EKG while you exercise

A

stress test

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6
Q

Diagnostic test: 24-48 hour EKG

A

holter

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7
Q

Diagnostic test: record arrhythmias when infrequent

A

Event Monitor

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8
Q

Diagnostic test: evaluation of anatomy and RV disease, flow measurements

A

CMR

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9
Q

Diagnostic test: adapted for coronary/vessel imaging, shorter time than MRI

A

CT

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10
Q

Diagnostic test: get heart pressures, images with contrast dye

A

cath

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11
Q

Diagnostic test: determine where arrhythmia is coming from

A

EP

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12
Q

3 acyanotic defects. Most children symptomatic or asymptomatic?

A

ASD, VSD, PDA

asymptomatic

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13
Q

Diagnosis?
Grade I-III systolic ejection murmur
Fixed Split S2, EKG: RBBB

A

ASD

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14
Q

What type of ASD is most common and how do you treat?

A

Ostium Secundum: transcatheter device closure

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15
Q

Is ASD more common in males or females?

A

females

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16
Q

Diagnosis?
Harsh, holosystolic murmur heard best at LLSB

EKG would show RVH and LVH if defect is large

A

VSD

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17
Q

If no lifts, heaves, thrills and there’s a Grade 3-4

high pitched, harsh murmur, VSD most likely ___

A

small

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18
Q

If there’s additionally a thrill and heave with a
mitral diastolic murmur indicates higher
pulmonary venous return, VSD likely ____

A

moderate

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19
Q

If there’s additionally precordium and sternum

prominence, VSD likely ___.

A

large

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20
Q

If VSD very large or the pressures on both ventricles are near equal, a murmur ___ be heard

A

cannot

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21
Q

Small VSD < 3 mm treatment?

A

will most likely close on it’s own

85%

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22
Q

Moderate 3-5 mm and asymptomatic VSD tx?

A

follow serially

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23
Q

Large 6-10 mm VSD need surgical repair before age ___

A

2

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24
Q

Diagnosis?
At left 2nd intercostal – crescendo-decrescendo
peaking at S2 continuous murmur through systole and diastole, bounding pulse

• EKG: may be normal or show LVH. If PH caused by increase flow there will be RVH and LVH

A

PDA

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25
Q

CXR for PDA would show left __ and left ___ enlarged

A

Left atria and left ventricle

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26
Q

PDAs close at birth when
1) placenta clamped and prostaglandin levels go ___
2) Oxygen tension increases causing pulmonary
vascular resistance to decrease

A

down

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27
Q

Premature babies have increased frequency of PDA
as they have increased _____ and
pulmonary prematurity leading to hypoxia

A

prostaglandin sensitivity

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28
Q

___ and ____, can be used to tx PDA in premies

A

Indomethacin, prostaglandin inhibitor

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29
Q

Spontaneous closure of PDA is rare after ___ months

A

5

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30
Q

If large PDA, needs repair < ___ yr of age to
prevent development of pulmonary vascular
disease

A

1

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31
Q

How to tx large PDA?

A

If large PDA, will get ligated in hospital

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32
Q

Cyanotic heart defects (5)

A 
TOF
Pulmonary valve stenosis
Aortic stenosis
Coarctation of the aorta
HLHS
TGA
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33
Q

Diagnosis?
– mild to moderate are asymptomatic. Ejection click at 3rd L intercostal space. Moderate can have split S2
– Severe obstruction can develop cyanosis, have a
heave/thrill. Harsh SEM at LUSB
• EKG: RVH and Right axis deviation

A

Pulmonary valve stenosis

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34
Q

Mild Pulmonary stenosis tx?

A

no treatment necessary. Serial follow up

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35
Q

PS causing 2/3 systemic RVp tx?

A

will need cardiac catheterization and balloon valvuloplasty

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36
Q

Diagnosis?
– Ejection click heard at apex. Harsh murmur at 1st
and 2nd intercostals and radiates to suprasternal
notch.
– If stenosis > 80 mmHg, then pulses diminished.
— Can have thrill if moderate-severe.
• EKG: Can show LVH, but usually normal

A

Aortic stenosis

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37
Q

Can aortic stenosis cause a fib?

A

yes

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38
Q

If AS gradient 60-80 mmHg, tx?

If AS turns into developing aortic insufficiency, tx?

A

Cardiac Catheterization –> balloon valvuloplasty

AI: Ross procedure or repair/replace valve

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39
Q

Diagnosis?
—Diminished femoral pulses in infants.
—Older children and older have a radiofemoral
delay.
—Upper extremity SBp >20 mmHg than
lower extremity SBp.
—Systolic murmur heard in left infraclavicular area radiates to back. Ejection click at LLSB

• EKG: RVH in neonates, older children may show LVH

A

Coarctation of the aorta

40
Q

Coarctation of aortic usually occurs where?

A

at proximal thoracic aorta after left subclavian artery, but before the PDA

41
Q

Coarctation of the aorta treatment?

A
  • in infancy, reopen PDA with PGE
    • Surgical repair
    • If recurs can undergo transcatheter stent
    placement
42
Q

Diagnosis?
- cyanotic, III/VI systolic ejection murmur at LUSB
- Tet Spells: cyanosis, dyspnea, altered
consciousness, irritable

• EKG: QRS axis is rightward with RVH

CXR: boot shaped heart

Cath: RVOT obstruction

A

Tetralogy of Fallot (VSD, pulmonary stenosis, hypertrophy of right ventricle, overriding aorta)

43
Q

TOF treatment?

A

• Surgical repair ~3-4 months of age.
• Will usually need additional surgery for PV
replacement or with percutaneous pulmonary
valve placement

44
Q

Note: Coarctation of the aorta is diagnosed by pulse and blood pressure discrepancy of ___ between arms and legs

A

> 20 mm hg

45
Q

Diagnosis?
Children are usually stable at birth, but they deteriorate rapidly as the PDA closes in the first week of life –> cyanosis, shock after ductal closure

  • CXR: pulmonary venous congestion
  • EKG: right axis deviation, RAE, RVH
A

HLHS

46
Q

Diagnosis of HLHS is usually made when?

A

prenatally by fetal echo

47
Q

4 steps of initial tx for HLHS after birth

A

1) Start PGE
2) If inter-atrial restriction: transeptal puncture with
septoplasty or stent placement
3) Respiratory management: PaO2- 30-45 mmHg and SaO2 70-85% to balance Qp:Qs
4) Start Vasodilators

48
Q

3 types of surgical repair for HLHS

A

Norwood, Glenn, Fontan

49
Q

What type of surgical repair for HLHS is this? enlarge aorta, enlarge atrial connection, BT shunt or through RV-PA conduit

A

Norwood

50
Q

What type of surgical repair for HLHS is this? SVC connects to PA and previous shunt takedown

A

Glenn

51
Q

What type of surgical repair for HLHS is this? IVC connects to PA via conduit

A

Fontan

52
Q

Diagnosis?
Many neonates are large (up to 4kg) and profoundly Cyanotic but without respiratory distress or murmur, normal CXR
• EKG: normal

A

Transposition of the Great Arteries

53
Q

TGA treatment: Cardiac Cath interventionist open up the atrial septum to increase interatrial mixing

A

Rashkind balloon atrial septostomy (this is frequently performed)

54
Q

TGA treatment at 4-7 days old?

A

Arterial Switch Operation:
Ascending aorta and pulmonary artery
transected above the valves and switched.
Coronary arteries are excised and reimplanted
with new aorta

55
Q

Which Cardiomyopathy?
- HF symptoms: exercise intolerance, FTT, diaphoresis,
tachypnea
• CXR: cardiomegaly
• EKG: ST segment changes. Check for
supraventricular tachycardia
• ECHO: LV and LA enlargement with decreased
ejection fraction, mitral insufficiency, end
diastolic volume increased
• Cath: check coronaries and endomyocardial
biopsy

A

Dilated Cardiomyopathy

56
Q

Dilated cardiomyopathy treatment - which 4 meds? what other types of surgery/tx

A 
DCM: Treatment
• Medical therapy
– ACE inhibitor to decrease after load
– Lasix or aldactone to diurese
– Digoxin to increase contractility and to prevent
arrhythmias
– Lasix or warfarin for anticoagulants
• If myocarditis, patient may recover. Some pts may
remain stable for years
• If severely depressed function= ICD
• VAD
• Heart Transplantation
57
Q

Which Cardiomyopathy?
• Symptoms: angina, syncope, palpitations,
exercise intolerance, sudden cardiac death
• EKG: LV Hypertrophy, can see ST segment
changes
• ECHO: Asymmetrical septal hypertrophy,
LVOTO, mitral insufficiency, hypercontractile -
> poor contractility and LV dilation, diastolic
dysfunction
• Cardiopulmonary testing: check for ischemia,
arrhythmia
• Cath: Elevated LA pressures

A

Hypertrophic Cardiomyopathy

58
Q

HCM treatment - what meds? when surgery or AICD?

A

– Beta blockers or calcium channel blockers if
moderate to severe obstruction
– Amiodarone for anti-arrhythmias

• Surgery: myotomy or MV replacement

• AICD: pts who have any arrhythmia. 50% are
sudden deaths

• Heart Transplantation

59
Q

Which Cardiomyopathy?
• Symptoms: exercise intolerance, fatigue,
orthopnea
• EKG: will show right and lee atrial
enlargement. Diastolic dysfunction
• ECHO: Will show bilateral atrial enlargement
with normal ventricular size and normal
systolic function
• Catheterization: regular caths to monitor
atrial pressures and PVR

A

restrictive

60
Q

TX for restrictive cardiomyopathy

A

– Lasix for diuresis and to decrease congestion
– Coumadin for anti-coagulation

• AICD: pts who have any arrhythmia. 28% are
sudden deaths
• VAD
• Heart Transplantation

61
Q 
Rate: normal for age
Rhythm: regular
P-waves: normal, sinus
QRS complexes: narrow, <100 ms
P-R relationship: 1:1 with PR interval 70-180 msec
A

normal sinus rhythms

62
Q 
Rate: normal for age
Rhythm: irregular, varies with respirations
P-waves: normal, sinus
QRS complexes: narrow
P-R relationship: normal, 1:1
A

sinus arrhythmia

63
Q 
Rate: fast for age, <220 bpm
Rhythm: regular
P-waves: normal, sinus
QRS complexes: narrow
P-R relationship: normal, 1:1
A

sinus tachycardia

64
Q 
Rate: slow for age, <80 bpm in infants, <60 bpm in child
Rhythm: regular
P-waves: normal, sinus
QRS complexes: narrow
P-R relationship: normal, 1:1
A

sinus bradycardia

65
Q

Rate: normal
Rhythm: irregular – ectopic early beat, followed by pause
P-waves: morphology differs from normal sinus P-wave
QRS complexes: narrow
P-R relationship: normal, 1:1 (except for blocked)

A

Premature Atrial Contractions (PACs)

66
Q 
Rate: very fast, typically >220 bpm
Rhythm: very regular
P-waves: abnormal, difficult to see
QRS complexes: narrow (wide in 10% due to aberrancy)
P-R relationship: 1:1, difficult to see
A

Supraventricular Tachycardia (SVT)

67
Q

Rate: normal to fast
Rhythm: regular or irregular
P-waves: none, F-waves (“saw-tooth” baseline)
QRS complexes: narrow
P-R relationship: fixed or variable ratio of F-waves to R-waves

A

atrial flutter

68
Q

Rate: normal
Rhythm: irregular – ectopic early beat, followed by pause
P-waves: normal, sinus
QRS complexes: wide, bizarre ___
P-R relationship: P-waves march through ___

A

Premature Ventricular Contractions (PVCs)

69
Q 
Rate: fast
Rhythm: irregular
P-waves: difficult to see
QRS complexes: wide, bizarre, but all similar
P-R relationship: none
A

Ventricular Tachycardia

70
Q 
Rate: very fast
Rhythm: irregular
P-waves: none
QRS complexes: fibrillatory waves
P-R relationship: none
A

ventricular fibrillation

71
Q 
Rate: fast
Rhythm: irregular
P-waves: difficult to see
QRS complexes: wide, bizarre, different (“twisting of the \_\_\_”)
P-R relationship: none
A

VT: Torsades de Pointes

72
Q

Normal PR interval:

A

0.12 - 0.20 sec

73
Q

Normal QRS duration:

A

< 0.10 sec

74
Q

Normal QTc:

A

< 0.44-0.46 sec

75
Q

Sustained VT can lead to ____ and ____

A

V fib and sudden collapse

76
Q

How do you treat PACs?

A

no tx necessary

77
Q

How do you treat PVCs

A

tx directed at underlying disorder

78
Q

How do you treat SVT (3)

A
  1. synchronized cardio version (0.5-1J/kg)
  2. adenosine (may cause transient AV block); give 0.1-0.2 mg/kg as a rapid bolus. DO NOT GIVE FOR WPW - leads to VF
  3. Vagal maneuvers (ice to face, valsalva)
79
Q

How do you treat Atrial flutter

A

cardioversion

NO adenosine

80
Q

How do you treat VT with pulse

A

cardio version 0.5-2J/kg

may also attempt cardio version with amiodarone (5mg/kg) or procinamide 15mg/kg

81
Q

How do you treat VF with pulse

A

cardio version 0.5-2J/kg

may also attempt cardio version with amiodarone (5mg/kg) or procinamide 15mg/kg

82
Q

How do you treat long QT syndrome (3)

A

Exercise restriction

Treatment with Beta blockage

Possible placement of internal cardioverter/defibrillator

83
Q

Adenosine does not work to treat ____

A

Atrial flutter

84
Q

How do you treat pulseless VT

A

Defibrillation 2J/kg then 4j/kg

CPR

85
Q

How do you treat VF without pulse

A

Defibrillation 2J/kg then 4j/kg

CPR

86
Q

How do you treat Torsades

A
  1. Immediate defibrillation (2j/kg, 4J/kg)
  2. IV magnesium, lidocaine, esmolol
  3. Repeated ICD shocks

NO epi, no amiodarone

Avoid QT prolonging meds

87
Q

No epi and no amiodarone for ____

A

torsades

88
Q

Electrical depolarization of the atria corresponds to the ___ on EKG

A

p wave

89
Q

Flat interval where the impulse is held onto the AV node before passing to the ventricles corresponds to the ___ on EKG

A

PR interval

90
Q

Ventricular depolarization corresponds to the ___ on EKG

A

QRS complex

91
Q

Ventricular repolarization corresponds to the ___ on EKG

A

T wave

92
Q

Sinus brady is less than ___ bpm for infants, less than ___ bpm for children

A

80 infants

60 child

93
Q

treat sinus bradycardia with ___ ___ or ____ if unstable

A

epi, atropine or cardiac pacing

94
Q

SVT onset: gradual or abrupt?

A

abrupt

95
Q

VT onset: gradual or abrupt

A

gradual

96
Q

Describe heart rate in SVT vs VT

A

SVT: >220
VT: <200

97
Q

Describe R-R intervals in SVT vs VT

A

SVT: regular
VT: variable

N283B/C Patho (3 decks)

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