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Cardiology > general > Flashcards

general Flashcards

0
Q

What are cardiac issues associated with Lyme

A

AV block
myocarditis
pericarditis
LV dysfunction

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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

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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

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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

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4
Q

Wht are ECG findings for myocarditis

A 
sinus tachycardia
low QRS voltage
ST changes
PR and QT prolongations
arrythmia
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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

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6
Q

What are clinical findings in pericarditis

A
  1. Narrow pulse pressure
  2. 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
  3. sharp stabby chest pain
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7
Q

What are the most common causes of myocarditis?

A 
Entrovirus - coxsack
adenovirus
parvo
CMV
EBV
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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
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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
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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
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11
Q

what are risk factors for neural tube defects

A
  1. insulin dep DM
  2. Sz treated with VPA or carbamezapine
  3. FHx of NTD
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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%

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13
Q

what syndrome is associated with TEF?

A

VACTERL syndrome

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14
Q

what are 2 syndromes associated with long QT syndrome

A
  1. Jervell and Lange-Nielson syndrome - AR, + deafness

2. Romano-Ward syndrome - AD

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15
Q

what electrolyte abnormalities might prolong the QTc

A

Low Ca
Low K
Low Mg

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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

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17
Q

what are causes of PAC/PVCs?

A 
idiopathic
fever/infection
electrolytes
hyperthyroidism
drug toxicity
FB - catheter
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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

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19
Q

what are the features of WPW

A
  1. short PR intervals
  2. widened QRS by delta wave
  3. predisposition to arrythmias - SVT, a. fib, Vfib
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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

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21
Q

what is the management of pt with WPW

A

betablockers if SVT issues
catheter ablation if severe

MUST avoid Digoxin!!!!

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22
Q

who is at risk for aortic aneurysms?

A

marfan syndrome
Noonan’s
Turners

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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

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24
Q

what are cardiac cause of chest pain?

A
  1. ischemic lesion - coronary blockage , HOCM
  2. severe obstructive lesion - aortic/pulm stenosis
  3. MVP
  4. inflammatory - peri/myocarditis
  5. arrythmia
  6. cardiomyopathy
  7. aortic disection*
  8. Cocaine, methamph, sympathomimetic decongestants
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25
Q

what is the murmur expected with ASD

A

wide, fixed split S2 during inspiration - more blood in RV so takes longer for RV to eject

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26
Q

What are CXR finding for ASD?

A

cardiomegaly
RA/RV dilation
prominent vascular marking
prominent PA

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27
Q

what are causes of coronary insufficiency?

A 
kawasaki
Williams
anomalous origin of of coronary arteries
coronary arteriovenous fistula
coronary cameral fistula
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28
Q

what maneuvre could help you diagnose Hypertrophic cardiomyopathy

A

if murmur increase from lying to standing

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29
Q

what antibiotics are recommended for IE prophylaxis?

A

amoxicillin

if allergic - cephalexin, clindamycin, azithro or clarithromycin

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30
Q

what antibiotics would you start with if thinking of IE?

A

Vancomycin and Gent

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31
Q

Can you interpret an ECG if WPW present

A

No

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32
Q

What are pt with WPW at risk for?

A

SVT

Sudden death

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33
Q

if a patient is confirmed to have HTN, what else should you do after that?

A
  1. Echo for LVH
  2. AUS and renal WU - BUN, creat, lytes
  3. assess other CVS risk factors - lipids
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34
Q

what heart lesions will have a click (3)

A
  1. aortic stenosis
  2. pulmonary stenosis
  3. MVP - mid-systolic click
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35
Q

which lesions have a narrow pulse pressure?

A

AS
cardiac tamponade
CHF

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36
Q

which lesions have wide pulse pressure?

A

aortopulmonary connection
- PDA
- Truncus A
Volume depletion

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37
Q

why do you get a fixed split S2 in an ASD?

A

due to overload of the right ventricle with prolonged ejection into the pulmonary vasculature

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38
Q

what is rheumatic fever?

A

immunological reaction post GAS pharyngitis

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39
Q

in relations to GAS, when does RF occur

A

2-6 weeks but up to 3 mo

40
Q

How do you Dx rheumatic fever?

A

revised jones criteria:
evidence of strep infection +
2 majors or
1 major and 2 minors

42
Q

what are major jone criteria for RF

A

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
Q

How can we prevent RF?

A

Abx up to D 9 of symptoms of strep pharyngitis

43
Q

what are minor jones criteria for RF

A 
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
Q

Which patients with a Hx of RF are at higher risk of carditis if get GAS again

A

only if had carditis for 1 st episode

45
Q

what type of RF prophylaxis is recommended if had NO carditis?

A

until reaches 21 yr of age or until 5 yr have elapsed since the last rheumatic fever attack, whichever is longer

46
Q

what type of RF prophylaxis is recommended if had carditis but no residual valve disease?

A

10 yr or until 21 yr of age, whichever is longer

47
Q

what type of RF prophylaxis is recommended if had carditis and residual valve disease?

A

10 yr or until 40 yr of age, whichever is longer, sometimes lifelong prophylaxis

48
Q

What are characteristics of the arthritis associated with RF?

A

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
Q

What are 4 clinical manoeuvre to assess for RF chorea

A

(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
Q

what is DDx for chorea?

A 
CP
Huntington's
SLE
wilson's
tic disorder
51
Q

what are CF of myocarditis in neonates and small children

A 
fever
CHF
resp distress
tachycardia out of proportion for fever
weak pulse
mitral insuff
52
Q

what are CF of myocarditis in teens

A 
CHF
ventricular arrythmia
pain
easy fatigability
syncope or near syncope
53
Q

what are features of cardiac syncope

A 
little or no prodrome
prolonged LOC > 5 min
exercise induced
startle induced
\+ chest pain
\+ palpitations
Hx of CVS issues: AS, pulm HTN
\+ Fhx
54
Q

what are important Hx questions when assessing pt for prolonged QT

A
  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
Q

when does torsade de pointe occur

A

in low Mg
in long QT
Low K

56
Q

patients with long QT are predispositioned to what type of arrythmia?

A

polymorphic ventricular tach

= VF and torsade

57
Q

when can you not interpret QT?

A

if abnormal depolarization is present

  • BBB
  • WPW
58
Q

what are acquired causes of prolonged QTc

A

CVS: myocarditis, MVP
Drugs: TCA, antipsychotics, Septra, clarithro, azithro, fluconazole, domperidone
lytes: LOW K, LOW Ca, LOW Mg

59
Q

how do you manage a pt with long QT syndrome

A

beta blocker
if too brady on beta - may need pacemaker
if no response to beta, or Hx of arrest - Defibrillator needed!

60
Q

what 3 lesions have LEFT axis deviation?

A

AVSD
tricuspid atresia
Noonan syndrome

61
Q

in Kawasaki, who gets lifelong ASA

A

if large aneurysm > 6mm or
if multiple segments or
if complex aneurysm

63
Q

what are features of cardiac chest pain

A

short
sudden onset
occurs at rest too
no other symptoms

64
Q

what are the 4 stages of pericarditis ECG findings

A
  1. ST elevation and PR depression
  2. T wave flattening
  3. T wave inversion
  4. Resolution
65
Q

what can help you differentiate sinus tachy from SVT

A

if RP is longer than PR = not re-entry and therefore will not respond to adenosine

66
Q

what is Cor pulmonale?

A

Right heart dysfunction secondary to pulmonary disease

67
Q

what lesions have decreased pulmonary vasculature

A

TOF
Tricuspid atresia
pulmonary atresia
ebstein’s + anomaly of tricuspid V.

68
Q

CXR of snowman?

A

TAPVD

69
Q

who can be found to have second degree type I AV block?

A

Wenkeback

  • athletes
  • sleep
  • in AN
  • in hypothyroidism
  • in head injury
70
Q

when might you see second degree type II heart block?

A 
random drop in QRS
- myocarditis
- endocarditis
- lyme dis
- congenital
worrisome because can progress to complete HB
71
Q

who gets 3rd degree HB?

A

maternal SLE
cardiac Sx
myocarditis
Lyme disease

72
Q

what happens to the QT in a patient with QTc syndrome when they exercise?

A

does not change

normal person, gest shorter QTc

73
Q

what proportion of population has asymptomatic PFO?

A

25%

74
Q

what causes pulsus bigeminus?

A 
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
Q

unstable baby in SVT. Mgnt?

A

synchronise cardioversion

76
Q

which CHD has cyanosis aggravated by crying?

A

PS

?TOF

77
Q

doxorubicin causes what type of heart issues

A

dilated cardiomyopathy - months to yrs post
can get acute myocarditis
may see long QT
once get CHF - high fatality

78
Q

what are ECG findings associated with hyperkalemia

A
  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
Q

How do you manage hyperkalemia

A
  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
Q

what are features of digoxin toxicity?

A 
Low Na
Low Ca
HIGH K
Bradycardia and heart block
nausea and vomiting
pulsus bigeminus
81
Q

How do you treat a digoxin overdose

A

antidote if called digibind

82
Q

ECG finding of Hypokalemia

A

flat T waves
depressed ST
U waves

83
Q

how do you Dx IE

A

2 major
1 major + 3 minor
5 minor

84
Q

what are the DUKE major criteria for IE - 2

A
  1. positive bld culture

2. echo +

85
Q

what are the 5 major criteria of IE - FIVE PM

A

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
Q

what criteria are necessary for possible IE

A

1 major + 1 minor
or
3 minor

87
Q

what are factors associated with dev of coronar artery disease in Kawasaki?

A 
fever > 14 d
recurrence of fever after a 48 hr period fever free
Cradiomegaly
male
< 1 yr
> 8 yrs
88
Q

AVSD ECG

A

aVF inverted

89
Q

HLHS ECG

A

no R in V6

90
Q

TA ECG

A

LVH - looks like adult ECG

baby should not have LVH, usually Right dominant

91
Q

ECG of LVH

A

S in V1
R in V6
deep Q

92
Q

RVH ECG

A

R axis
R is V1
S in V6

93
Q

If see M in left lead

A

L bundle branch = myocarditis

94
Q

if M on the right,

A

Right bundle branch block = VSD repain

95
Q

HOCM ECG

A

LVH

abn T waves

96
Q

Single S2 - all end in A

A

TGA
PA
aortic atresia
Truncus

97
Q

what is the WU for ? prolonged QT

A 
Scwarts score
serial ECG
parental ECG
Holter
exercise test
ECHO -some cardiomyopathies have long QT
98
Q

baby with cyanosis and an ejection click. Dx

A

truncus ateriosus

Cardiology (3 decks)

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