general Flashcards
(98 cards)
0
Q
What are cardiac issues associated with Lyme
A
AV block
myocarditis
pericarditis
LV dysfunction
1
Q
What are the three clinical phases of Kawasaki
A
acute - d7-10- T, conjunctivtis, mucositis, rash, LN, edema, aseptic meningitis, hepatitis
subacute - d11-21 - coronary aneurysm + desquemation
convalescent stage - 6-8wks- ESR going back to normal
2
Q
What is the treatment for Kawazaki
A
IVIG in fisrt 10 days - decreases risk of anurysm from 25% to 3-5%.
No vacc for 11 mo
ASA high dose - 80-100mg/kg until 48hrs post T resolution
ASA 3-5 mg/kg for another 6-8week, if aneurysm - ASA forlife
ECHO 6 wks
3
Q
What is the treatment for Lyme carditis
A
IV ceftriaxone or pen G for 14 d
or PO if mild with Amox for young and doxy for old
Block responds to Abx
4
Q
Wht are ECG findings for myocarditis
A
sinus tachycardia low QRS voltage ST changes PR and QT prolongations arrythmia
5
Q
what is a PDA
A
connection between the Left pulm artery and the descending aorta distal to the origin of the subclavian artery
6
Q
What are clinical findings in pericarditis
A
- Narrow pulse pressure
- Pulsus paradoxs: abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mmHg.
When the drop is more than 10mm Hg, it is referred to as pulsus paradoxus.
> 20 mmHg - Tamponade - sharp stabby chest pain
7
Q
What are the most common causes of myocarditis?
A
Entrovirus - coxsack adenovirus parvo CMV EBV
8
Q
what is sarnat 1 stage?
A
*hyper alert normal tone normal posture *inc Rfx *myoclonus *strong moro Mydriasis no sz EEG normal less than 24 hrs and do well
9
Q
what is sarnat 2?
A
lethargy hypotonia flexed posture inc rflx myoclonus weak moro miosis SZ are COMMON EEG - low voltage lasts 24n hr to 14 days
10
Q
what is sarnat 3?
A
coma no tone decerebrate posture no rfx no myoclonus no moro poor pupil response EEG - burst suppression days to weeks
11
Q
what are risk factors for neural tube defects
A
- insulin dep DM
- Sz treated with VPA or carbamezapine
- FHx of NTD
12
Q
what is the risk of recurrence of NTD?
A
2-3 % if one sibling, 4-6% if 2 siblings
even if treat with folic acid, still 1%
13
Q
what syndrome is associated with TEF?
A
VACTERL syndrome
14
Q
what are 2 syndromes associated with long QT syndrome
A
- Jervell and Lange-Nielson syndrome - AR, + deafness
2. Romano-Ward syndrome - AD
15
Q
what electrolyte abnormalities might prolong the QTc
A
Low Ca
Low K
Low Mg
16
Q
what are the 3 most common types of LQTS
A
LQT1 - K channel issues, events occur during stress
LQT 2 - also K, mixed pattern
LQT3- Na channel, highest probability of sudden death
17
Q
what are causes of PAC/PVCs?
A
idiopathic fever/infection electrolytes hyperthyroidism drug toxicity FB - catheter
18
Q
when should you get worried if someone has PVCs?
A
do not disappear with exercise
>=2 PVCs in a row
multifocal origin
underlying heart disease
19
Q
what are the features of WPW
A
- short PR intervals
- widened QRS by delta wave
- predisposition to arrythmias - SVT, a. fib, Vfib
20
Q
what is Texidor’s twinge?
A
precordial catch
brief episodes of sharp localized pain - lateral
can occur with bending or slouching
takes breath away
reproduce by palpating bottom ribs inward
recurrent
grow out of
21
Q
what is the management of pt with WPW
A
betablockers if SVT issues
catheter ablation if severe
MUST avoid Digoxin!!!!
22
Q
who is at risk for aortic aneurysms?
A
marfan syndrome
Noonan’s
Turners
23
Q
what is the most common type of ASD?
A
Ostium secundum - 80% - foramen ovale region
Ostium primum - inf portion, near AV val
Sinus venosus - post/sup, often assocated with anomalous pulm venous drainage
24
what are cardiac cause of chest pain?
1. ischemic lesion - coronary blockage , HOCM
2. severe obstructive lesion - aortic/pulm stenosis
3. MVP
3. inflammatory - peri/myocarditis
4. arrythmia
5. cardiomyopathy
6. aortic disection*
7. Cocaine, methamph, sympathomimetic decongestants
25
what is the murmur expected with ASD
wide, fixed split S2 during inspiration - more blood in RV so takes longer for RV to eject
26
What are CXR finding for ASD?
cardiomegaly
RA/RV dilation
prominent vascular marking
prominent PA
27
what are causes of coronary insufficiency?
```
kawasaki
Williams
anomalous origin of of coronary arteries
coronary arteriovenous fistula
coronary cameral fistula
```
28
what maneuvre could help you diagnose Hypertrophic cardiomyopathy
if murmur increase from lying to standing
29
what antibiotics are recommended for IE prophylaxis?
amoxicillin
| if allergic - cephalexin, clindamycin, azithro or clarithromycin
30
what antibiotics would you start with if thinking of IE?
Vancomycin and Gent
31
Can you interpret an ECG if WPW present
No
32
What are pt with WPW at risk for?
SVT
| Sudden death
33
if a patient is confirmed to have HTN, what else should you do after that?
1. Echo for LVH
2. AUS and renal WU - BUN, creat, lytes
3. assess other CVS risk factors - lipids
34
what heart lesions will have a click (3)
1. aortic stenosis
2. pulmonary stenosis
3. MVP - mid-systolic click
35
which lesions have a narrow pulse pressure?
AS
cardiac tamponade
CHF
36
which lesions have wide pulse pressure?
aortopulmonary connection
- PDA
- Truncus A
Volume depletion
37
why do you get a fixed split S2 in an ASD?
due to overload of the right ventricle with prolonged ejection into the pulmonary vasculature
38
what is rheumatic fever?
immunological reaction post GAS pharyngitis
39
in relations to GAS, when does RF occur
2-6 weeks but up to 3 mo
40
How do you Dx rheumatic fever?
revised jones criteria:
evidence of strep infection +
2 majors or
1 major and 2 minors
42
what are major jone criteria for RF
JONES
Joints -Migratory polyarthritis - lasts 2-4 weeks
Carditis (endocarditis for sure) - clinical, tachy, new M, pericarditis, cardiomegaly, CHF
Nodule - chronic and recurrent
Erythema marginatum-macular, serpiginous with central clearing, evanescent
Sydenham disease-Inc emotions, ANA +, emotional, lasts 8 wks up to 6 mon
42
How can we prevent RF?
Abx up to D 9 of symptoms of strep pharyngitis
43
what are minor jones criteria for RF
```
crITERIA
Inflammatory cells (leukocytosis)
Temperature (fever)
ESR/CRP elevated
Raised PR interval
Itself (previous Hx of Rheumatic fever)
Arthritis - cannot use if arthralgia used as major criteria
```
44
Which patients with a Hx of RF are at higher risk of carditis if get GAS again
only if had carditis for 1 st episode
45
what type of RF prophylaxis is recommended if had NO carditis?
until reaches 21 yr of age or until 5 yr have elapsed since the last rheumatic fever attack, whichever is longer
46
what type of RF prophylaxis is recommended if had carditis but no residual valve disease?
10 yr or until 21 yr of age, whichever is longer
47
what type of RF prophylaxis is recommended if had carditis and residual valve disease?
10 yr or until 40 yr of age, whichever is longer, sometimes lifelong prophylaxis
48
What are characteristics of the arthritis associated with RF?
earliest manifestation
large joins-knees, ankles, wrists, and elbows
Red
warm
swollen
exquisitely tender
respond very well to NSAIDS if don't respond = not RF
Inverse relationship between the severity of the arthritis and the carditis
49
What are 4 clinical manoeuvre to assess for RF chorea
(1) demonstration of milkmaid’s grip (irregular contractions of the muscles of the hands while squeezing the examiner’s fingers),
(2) spooning and pronation of the hands when the patient’s arms are extended,
(3) wormian darting movements of the tongue upon protrusion
(4) examination of handwriting to evaluate fine motor movements
50
what is DDx for chorea?
```
CP
Huntington's
SLE
wilson's
tic disorder
```
51
what are CF of myocarditis in neonates and small children
```
fever
CHF
resp distress
tachycardia out of proportion for fever
weak pulse
mitral insuff
```
52
what are CF of myocarditis in teens
```
CHF
ventricular arrythmia
pain
easy fatigability
syncope or near syncope
```
53
what are features of cardiac syncope
```
little or no prodrome
prolonged LOC > 5 min
exercise induced
startle induced
+ chest pain
+ palpitations
Hx of CVS issues: AS, pulm HTN
+ Fhx
```
54
what are important Hx questions when assessing pt for prolonged QT
1. palpitations
2. symptoms during exercise or when startled
3. Sz that are unusual
4. palpitations when swimming
5. deafness
6. FHx
7. Syncope
55
when does torsade de pointe occur
in low Mg
in long QT
Low K
56
patients with long QT are predispositioned to what type of arrythmia?
polymorphic ventricular tach
| = VF and torsade
57
when can you not interpret QT?
if abnormal depolarization is present
- BBB
- WPW
58
what are acquired causes of prolonged QTc
CVS: myocarditis, MVP
Drugs: TCA, antipsychotics, Septra, clarithro, azithro, fluconazole, domperidone
lytes: LOW K, LOW Ca, LOW Mg
59
how do you manage a pt with long QT syndrome
beta blocker
if too brady on beta - may need pacemaker
if no response to beta, or Hx of arrest - Defibrillator needed!
60
what 3 lesions have LEFT axis deviation?
AVSD
tricuspid atresia
Noonan syndrome
61
in Kawasaki, who gets lifelong ASA
if large aneurysm > 6mm or
if multiple segments or
if complex aneurysm
63
what are features of cardiac chest pain
short
sudden onset
occurs at rest too
no other symptoms
64
what are the 4 stages of pericarditis ECG findings
1. ST elevation and PR depression
2. T wave flattening
3. T wave inversion
4. Resolution
65
what can help you differentiate sinus tachy from SVT
if RP is longer than PR = not re-entry and therefore will not respond to adenosine
66
what is Cor pulmonale?
Right heart dysfunction secondary to pulmonary disease
67
what lesions have decreased pulmonary vasculature
TOF
Tricuspid atresia
pulmonary atresia
ebstein's + anomaly of tricuspid V.
68
CXR of snowman?
TAPVD
69
who can be found to have second degree type I AV block?
Wenkeback
- athletes
- sleep
- in AN
- in hypothyroidism
- in head injury
70
when might you see second degree type II heart block?
```
random drop in QRS
- myocarditis
- endocarditis
- lyme dis
- congenital
worrisome because can progress to complete HB
```
71
who gets 3rd degree HB?
maternal SLE
cardiac Sx
myocarditis
Lyme disease
72
what happens to the QT in a patient with QTc syndrome when they exercise?
does not change
| normal person, gest shorter QTc
73
what proportion of population has asymptomatic PFO?
25%
74
what causes pulsus bigeminus?
```
2 beats close together
HOCM
Hypo or hyperkalemia
Hypothyroidism
Betablocker therapy
Digoxin
MI
Destruction or degeneration of the cardiac conduction system or heart muscle cells
Infection
```
75
unstable baby in SVT. Mgnt?
synchronise cardioversion
76
which CHD has cyanosis aggravated by crying?
PS
| ?TOF
77
doxorubicin causes what type of heart issues
dilated cardiomyopathy - months to yrs post
can get acute myocarditis
may see long QT
once get CHF - high fatality
78
what are ECG findings associated with hyperkalemia
1. peaking of the T waves
2. ST-segment depression, an
3. increased PR interval,
4. flattening of the P wave, and
5. widening of the QRS complex
= VF
79
How do you manage hyperkalemia
1. stop K intake
2. ECG
3. Protect the heart - Calcium gluconate
4. Shift potassium into the cells
- IV Na HCO3
- IV insulin and glocuse
- Neb salbutamol
5. Get it out:
Loop diuretic
Kayexalate
if bad - DIALYSIS
80
what are features of digoxin toxicity?
```
Low Na
Low Ca
HIGH K
Bradycardia and heart block
nausea and vomiting
pulsus bigeminus
```
81
How do you treat a digoxin overdose
antidote if called digibind
82
ECG finding of Hypokalemia
flat T waves
depressed ST
U waves
83
how do you Dx IE
2 major
1 major + 3 minor
5 minor
84
what are the DUKE major criteria for IE - 2
1. positive bld culture
| 2. echo +
85
what are the 5 major criteria of IE - FIVE PM
Fever > 38 oC
Immunologic phenomena (glomerulonephritis, Osler's nodes, Roth's spots, Rheumatoid factor)
Vascular phenomena (major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjuntival hemorrhage, Janeway lesions)
Echocardiography findings (suggestive but not definitive)
Predisposition (heart condition or IV drug user)
Microbiologic evidence (Positive blood culture but not meeting major criteria)
86
what criteria are necessary for possible IE
1 major + 1 minor
or
3 minor
87
what are factors associated with dev of coronar artery disease in Kawasaki?
```
fever > 14 d
recurrence of fever after a 48 hr period fever free
Cradiomegaly
male
< 1 yr
> 8 yrs
```
88
AVSD ECG
aVF inverted
89
HLHS ECG
no R in V6
90
TA ECG
LVH - looks like adult ECG
| baby should not have LVH, usually Right dominant
91
ECG of LVH
S in V1
R in V6
deep Q
92
RVH ECG
R axis
R is V1
S in V6
93
If see M in left lead
L bundle branch = myocarditis
94
if M on the right,
Right bundle branch block = VSD repain
95
HOCM ECG
LVH
| abn T waves
96
Single S2 - all end in A
TGA
PA
aortic atresia
Truncus
97
what is the WU for ? prolonged QT
```
Scwarts score
serial ECG
parental ECG
Holter
exercise test
ECHO -some cardiomyopathies have long QT
```
98
baby with cyanosis and an ejection click. Dx
truncus ateriosus
