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cardiology > general > Flashcards

general Flashcards

1
Q

examples of:
R>L shunt
L>R shunt
mixing CHD
3 each

A

R>L shunt - TOF, TGA, TA
L>R shunt - PDA, ASD, VSD
mixing CHD - truncus, TAPVR, HLH

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2
Q

symptoms / signs of HF (early and late)

A

tachypnoea, tachycardia
poor feeding
poor growth
hepatomegaly
diaphoresis

cyanosis
shock&raquo_space; renal failure, seizures, NEC etc.
pulmonary oedema

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3
Q

when would CHF present?

A

2-6 weeks of age (i.e. later than the others) …kinda same time as VSD/ASD

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4
Q

which 4 conditions are more likely to present with shock for CHF?

A

those needing the PDA to keep systemic perfusion up i.e.
HLHS
coarct
critical AS
interrupted aortic arch

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5
Q

why does differential cyanosis occur and in what conditions does it occur?

A

occurs in CoA, AS, interrupted aortic arch

Results from a R to L shunt at the level of the PDA:
deox blood flows through the DA > lower half of body
ox blood from left heart prox to the obstruction will supply upper half of body

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6
Q

reversed differential cyanosis - when does this occur and why?

A

TGA with coarct / PHTN
most oxygenated blood flow is pumped by the left ventricle out to the pulmonary artery and thus across the PDA

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7
Q

why does VSD only classically become symptomatic at 4-6 weeks of age?

A

PVR falls further at that age

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8
Q

risk of CHD if family member has it

A

2%
10% if bicuspid valve

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9
Q

cyanotic baby and the following findings of CXR = ?
a. Oligaemic lung fields
b. Plethoric lung fields
c. Congestion
d. Massive cardiomegaly

A

a. Oligaemic lung fields = PS, pulmonary atresia etc
b. Plethoric lung fields = TGA
c. Congestion = TAPVR
d. Massive cardiomegaly = Ebstein’s

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10
Q

what is the biggest predictor of a duct dependent lesion?

A

presence of murmur
cyanosis is important but not as much

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11
Q

one contraindication and one relative contraindication to PGE

A

TAPVR – reduction in PVR may lead to increased PBF and exacerbate venous congestion due to obstruction

TGA – often will not change saturations in presence of intact or restrictive atrial septum

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12
Q

PGE is most effective in what time frame?

A

first 96h of life

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13
Q

broad types of duct dependent lesions

A

duct dependent PBF
duct dependent systemic circulation

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14
Q

examples of duct dependent PBF lesions

A

• Ebstein anomaly
• Pulmonary atresia (with intact ventricular septum)
• Critical pulmonary stenosis
• Tetralogy of Fallot*
• Tricuspid atresia*
* Only duct dependent if severe RVOT

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15
Q

examples of duct dependent systemic flow

A

• Critical AS
• Critical coarctation
• Hypoplastic left heart
• Interrupted aortic arch

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16
Q

what is heterotaxy

A

failure of differentiation into right and left sided organs

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17
Q

name 5 types of vascular rings - which is most common

A

double aortic arch (complete) - most common
Right aortic arch with left ligamentum arteriosum
anomalous inominate artery - anterior to trachea
vascular/pul artery sling - ONLY one going anterior to oes
aberrant right subclavian artery - posterior to oes

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18
Q

aberrant right subclavian artery - a/w what?

A

T21 and CHD

19
Q

what kind of study is diagnostic for a vascular ring? what kind is it not diagnostic for?

A

barium swallow
not for inominate - will be normal with no indentations

20
Q

what is the problem with an ALCAPA

A

left coronary arises from pulmonary artery
after birth, PVR falls so blood goes from LCA to pul artery ‘myocardial steal’
so LV becomes dilated, MV shitty
lateral infarct and heart failure

21
Q

PHTN defined by what pressure

A

Pul artery pressure >25

22
Q

S2 in PHTN

A

narrowly split or single loud S2 - bc the pul valve will shut earlier

23
Q

some ddx/systems causes for secondary causes of systemic HTN

A
  • renal
  • cardiovascular
  • endocrine: thyroid, adrenal, phaeochromocytoma
  • other: NF1
  • iatrogenic: steroids
24
Q

BP goal for anti-hypertensive treatment in children

A

i. SBP and DBP <90th centile (if <13 years)
ii. BP < 130/80 (if >13 years)

25
Q

thiazides CI with what disease

A

diabetes - increases glucose

26
Q

most common organisms for IE

A

strep viridans - dental stuff
staph aureus - post op
enterococci - GI stuff

27
Q

when do you need IE prophylaxis

A

dental /skin stuff for high risks only:
• Unrepaired cyanotic heart defects
• Previous endocarditis
• Prosthetics

28
Q

most common causes of myocarditis

A

adenovirus, coxsackieviruses, echoviruses

29
Q

exam cause of constrictive pericarditis

A

TB

30
Q

what age group of KD more likely to get CAA

A

the extremes - <6mo, >5yo

31
Q

most common cause of acquired heart disease in 1st world children

A

KD

32
Q

CAA rates in KD

A

15-20% if not treated
5% in IVIG

33
Q

rheumatic fever organism

A

GAS THROAT not skin

34
Q

criteria to diagnose initial RF

A

Two major, OR
One major + two minor
PLUS evidence of preceding GAS infection

Major = ACHES
A = arthritis - migratory polyarthritis
C = chorea - disappears in sleep, adolescent females
H = heart carditis/valvulitis
E = erythema marginatum
S = subcutaneous nodules - painless, mobile

Minor = TAPE
T = temperature
A = arthralgia
P = PR prolongation
E = elevated acute phase reactants

35
Q

prophylaxis post RF

A

Benzathine penicillin G (BPG) IM 4 weekly for ageeeesss

36
Q

most common valves affected in rheumatic fever

A

mitral > aortic

37
Q

exam answer: Intrapericardial tumour arising near the great arteries is most likely a … ?

A

teratoma

38
Q

exam thoughts: rhabdomyoma, think of what condition

A

tuberous sclerosis

39
Q

exam thoughts: hypertrophic cardiomyopathy with normal LV systolic function, and nystagmus/dysarthria

A

= freidrich’s ataxia

40
Q

exam thoughts: marfan’s think of what 3 cardiac lesions

A

mitral - MR/MVP
AR
aortic dissection

41
Q

exam thoughts: MPS think of what cardiac lesions

A

MR
AR

42
Q

muscular dystrophy causes what kind of cardiomyopathy

A

DCM

43
Q

Noonan vs Turner

A

noonan normal sexual maturity, often mentally retarded

44
Q

pathophys vasovagal

A

paradoxical vagal activation and sympathetic withdrawal resulting in peripheral vasodilation, hypotension + bradycardia

cardiology (6 decks)

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