Stupid Cardiology Flashcards
What is the 3rd most common ~cyanotic~ heart lesion
Tricuspid atresia
After an arterial switch operation for transposition of the great arteries, is there a good survival rate?
Yes over 95%
Where do you best hear pulmonary flow murmur?
ULSB
What treatment is ESSENTIAL AND LIFE SAVING before a patient with hypoplastic left heart syndrome has surgery?
Prostaglandin E1
What is meant by the “honeymoon period” of hypoplastic left heart syndrome?
When the baby is first born, he’s pretty stable while the ductus is patent.
(Crashes rapidly as soon as ductus closes)
What are some other findings you may see with atrial septal defect?
Failure to thrive
Fatigue
RV heave
Wide fixed split S2
What is this:
aorta and pulmonary artery fail to separate, and a single artery arises from the heart
Truncus arteriosus
What are the conditions under cyanotic congenital heart disease?
Tetralogy of Fallot
Transposition of the great arteries
Tricuspid atresia
Truncus arteriosus
Total anomalous pulmonary venous return
Hypoplastic left heart syndrome
(5 T’s plus hypoplastic left heart)
What extra heart sound may be heard with hypertrophic cardiomyopathy?
S4
What does a ventricular septal defect sound like?
Blowing
Harsh
Holosystolic
What causes the foramen ovale to close?
Pressure increase in left atrium
What is the most common ~cyanotic~ cardiac lesion?
Tetralogy of fallot
What should you think if peripheral pulse are bounding?
Patent ductus arteriosus (PDA)
What is this:
Absence of tricuspid valve. NO communications between Right atrium and right ventricle
Tricuspid atresia
What are the treatment options for a patent ductus arteriosus?
Prostaglandin E1 or Indomethacin to keep it open/close it
Surgical ligation
Percutaneous transcatheter occlusion
How do you best diagnose a ventricular septal defect?
Echocardiogram. Can tell you where it is, how big it is, and what the presssure gradient is like.
What is the leading cause of sudden cardiac death in young people
Hypertrophic cardiomyopathy
Does transposition fo the great arteries have a murmur
No
What is eisenmenger syndrome?
This is when a patient has a patent ductus arteriosus, and due to high pulmonary presssures, it switches directions and shunts blood from the pulmonary artery to the aorta (bypassing the lungs)
EMERGENCY
Wat is the major cardiac complication of Kawasaki disease
Coronary artery aneurysms
What ages get stills murmur
2-7
What does an atrial septal defect sound like?
Midsystolic pulmonary ejection murmur
Fixed and widely split S2 at pulmonary area***
What is another diagnostic study you could do to diagnose an atrial septal defect? (In addition to echo)
Chest X Ray- can help you see an enlarged heart (Right side dilation), as well as increased pulmonary vascularity
*THIS SLIDE HAD A HEART AT THE BOTTOM WHATEVER THAT MEANS
What other murmur can pulmonary flow murmur mimic?
ASD
How many extremities should we take BP in?
All 4
What does stills murmur sound like?
Musical
Short
High pitch
(Loudest supine)
What illness do you have before you get acute rheumatic fever?
Group A Strep throat infection
What is the mnemonic to know what is included in Kawasaki disease
Warm CREAM
NEEDS: warm- fever more than 5 days
PLUS 4 of these:
Conjunctivitis
Rash
Erythema on hands and soles
Adenopathy
Mucous membrane-strawberry tongue
What are the other findings you will see with tricuspid atresia?
Atrial septal defect
RV hypoplasia
(Also YOU must keep ductus arteriosus open)
When is stills murmur loudest?
When patient is supine
Disappears when they sit up or inhale
What are the Jones criteria used for
Diagnosis rheumatic fever
What are some other findings you may see with patent ductus arteriosus?
Wide pulse pressure
Hyper-dynamic apical pressure
What does the ductus arteriosus do?
Connects the aorta with the pulmonary artery. Shunts blood away from lungs
What can cause a wide S2 split?
ASD
Pulmonary stenosis
What are the pathognomic chest x ray findings in a baby with transposition of the great arteries?
“Egg on a string”
Globular heart, and a narrow mediastinum
What heart defects are common with fetal alcohol syndrome?
VSD
ASD
What can cause a narrow S2 split?
Pulmonary HTN
What is the most common innocent murmur of early childhood?
Stills
What does a pulmonary flow murmur sound like and when is it loudest?
Soft
Loudest supine
What defect is associated with the term “blue babies”
Transposition of the great arteries
What is the #1 most helpful and important tool for diagnosis cardiac problems
Echocardiogram*******
What does coarctation of the aorta sound like?
Blowing systolic murmur in the back or left armpit
What drug can we give to make a patent ductus arteriosus close?
IV Indomethacin- will lead to closure in up to 80% of premature babies
(Indomethacin is a prostaglandin inhibitor)
*******
What are the two classifications of atrial septal defect?
Ostium primum
Ostium secundum (most common)
What is always present when there’s truncus arteriosus?
A ventricular septal defect
What are the 4 conditions in acyanotic congenital heart disease?
VSD
ASD
PDA
Coarctation of the aorta
What is coarctation of the aorta?
Narrowing in the aortic arch, usually in the proximal descending aorta near the ductus arteriosus
What is total anomalous pulmonary venous return?
Abnormal configuration of the pulmonary vein, leading to cyanosis
What is hypoplastic left heart syndrome?
Hypoplasia of the Left ventricle
+stenosis or atresia of mitral and aortic valves
What does a patent ductus arteriosus sound like?
Continuous machinery
What will be interesting about a patient’s blood pressure if they have coarctation of the aorta?
Femoral pulses diminished
Systolic pressures in the upper extremities will be at least 20mm higher than the ones in the legs
What murmur can venous hum mimic?
Patent ductus arteriosus
How will a baby with transposition of the great arteries present?
Profoundly cyanotic WITHOUT respiratory distress or murmur
“Blue babies”
What will you see on chest X ray of someone with tetralogy of fallot?
Boot shaped heart
RV gets so thick, the apex becomes upturned
Which type of ASD is always large: secundum or primum?
Primum.
Secundums vary in size
What drug can we give to keep a patent ductus arteriosus open?
IV Prostaglandin E1*****
Where is stills murmur best heard?
LLSB
What makes venous hum go away?
Laying down
Where is a ventricular septal defect heard best?
Left lower sternal border
What will you hear with truncus arteriosus?
Narrow S2 split**
Systolic ejection murmur at LLSB
Loud single S2
Prominent ejection click
What chromosome abnormality is associated with coarctation of the aortA?
Turner syndrome
45, XO
What does an S4 indicate?
Hypertrophic cardiomyopathy
Other diastolic dysfunction
Can cardaic catheterization be diagnostic and interventional?
Yes, you can use it to visualize or you can use it to place stents/balloons
How do you treat tetralogy of fallot?
They get heart surgery by age 1, but in the meantime:
Give prophylactic antibiotics to prevent endocarditis
For ACUTE Tet spells: give O2, put them in knee-chest position, IV morphine, IV fluids, IV beta-blockers, IV phenylephrine
Do you have to treat asymptomatic ventricular septal defect right away?
No, you can wait and see, as it may spontaneously close
What does the foramen ovale do?
Shunts blood from the R atrium into the L atrium
90% of Kawasaki disease patient are less than ___ years of age
5
What is the range of grades for heart murmurs?
1-6
What does a tetralogy of fallot sound like>?
Harsh systolic ejection
Crescendo-decrescndo
Upper left sternal border
Are males or females more likely to have coarctation of the aorta?
Males 3:1
BUT it is seen in 5-15% of patients with Turner syndrome (XO females)
What will you see on a chest X ray of a patient with coarctation of the aorta?
Figure 3 sign
Rib notching
*******
What valves are most affected by acute rheumatic fever?
Mitral and aortic
What heart defects are common with maternal rubella?
PDA
Pulmonary stenosis
What grades of murmur are associated with a palpable thrill?
4, 5, and 6
**
If a pt has weak/absent femoral pulses, what should you think?
Coarctation of aorta
Where is an atrial septal defect heard best?
Upper left sternal border
VSD was in LLSB duh
What are the jones criteria?
Major: Pancarditis Polyarteritis Sydenham chorea SubQ nodules Erythema marginatum
Minor: Fever Arthralgia Prolonged PR interval Increased ESR Leukocytosis
Two major or 1 major and 2 minor must be present to diagnose rheumatic fever.
(Idk about this slide the only thing that was circled was pancarditis and the thing about how many criteria must be present)
What are Tet spells?
Hyper cyanotic episodes in kids with tetralogy of fallot:
Sudden onset or worsening of cyanosis
Dyspnea
Alterations in consciousness
Decrease of systolic murmur as the RV outflow tract becomes completely obstructed
When does the ductus arteriosus close?
7-14 days of age in normal babies
Innocent or pathological murmur:
Holosystolic or diastolic
Grade 3 or more
Harsh/blowing
Abnormal pulses, hepatomegaly, MSK abnormalities
Possible family history
Pathological lol
How tf does a baby with transposition of the great arteries get oxygen before it gets corrective surgery?
Patent ductus arteriosus
Cardiac catheterization to make a hole between the atria
What heart defects are common with trisomy 21
AtrioVentricular septal defect
Tetralogy of Fallot
Patent ductus arteriosus
What are the 3 innocent murmurs discussed?
Stills
Pulmonary flow
Venous hum
Innocent or pathological murmur:
Short systolic
Grade 2 or less
Musical
Innocent
What will your see on chest X-ray of truncus arteriosus?
Boot shaped heart
Also was on tetralogy of fallot
What is necessary for someone to survive with total anomalous pulmonary venous return?
A R –> L shunt
You may have to create an ASD
What is the 2nd most common ~cyanotic~ congenital heart defect?
Transposition of the great arteries
What are the 4 things you see in tetralogy of fallot?
- Right ventricle hypertrophy
- Ventricular septal defect
- Overriding aorta (aorta is straddles over the VSD)
- Right ventricle outflow obstruction (a narrowed pulmonary artery)
What is the most common cause of hypertrophic cardiomyopathy
Familial
What must ABSOLUTELY be present for survival with hypoplastic left heart syndrome?
A patent ductus arteriosus**
What murmur can Stills sound like?
VSD
What is the most common innocent murmur in older children and adults?
Pulmonary flow murmur
Ages 3+
What ages get a venous hum?
2 and up
What medications do you use to treat the congestive heart failure caused by ventricular septal defect?
Diuretic***
ACE inhibitor
+/- Digoxin
What are the treatment options for atrial septal defect?
Percutaneous transcatheter closure
Surgical repair
What could cause HTN in the upper extremities only?
Coarctation of the aorta
What ages get pulmonary flow murmur?
3+
What does it mean if an S3 sound does not go away when the kid lays down?
Poor cardiac function
Where is venous hum heard?
Right or Left upper sternal border
Or low anterior neck
What might you see a kid do to try to get relief if he’s having a tet spell
Squat**
Increases systemic vascular resistance and pushes blood into the pulmonary artery
What heart defects are commonly associated with turner syndrome
Bicuspid aortic valve
VSD
ASD
Coarctation of the aorta***
Dilated aortic root
HTN
How do you diagnose tricuspid atresia?
Echo**
How many heart sounds do you hear with tricuspid atresia?
Just one (S2)
What direction does blood flow with tetralogy of fallot?
R —> L
Not much blood goes to lungs
What is the cardinal sign of right heart failure?
Hepatomegaly
Ascites too
What medication do you HAVE to give to your patient with transposition of the great arteries?
Prostaglandin E1
*** must keep ductus arteriosus patent until they get surgery (by their 7th day of life)
Any murmur in diastole is _____
Pathological
Except for venous hum
Which type of atrial septal defect is associated with having other defects: ostium primum or secundum?
Primum
What is the most common of all congenital heart defects?
Ventricular septal defect
What is the most important major criteria in the “Jones criteria” used to diagnose acute rheumatic fever?
Pancarditis
Pericarditis, endocarditis, myocarditis
When is venous hum loudest?
Diastole
And when sitting with head extended
What does a venou hum murmur sound like?
Continuous musical hum
What is the main tool used to diagnose heart problems in babies even in utero?
Echocardiography
At what age do kids with tetralogy of fallot start experiencing tet spells
4-6 months
What is the test of choice to diagnose an atrial septal defect?
Echocardiogram (TTE/TEE)
-establishes size and type of defect
- measures shunt volume and ratios
- measures pulmonary artery pressures
- detects other anomalies
*THIS SLIDE HAD A HEART AT THE BOTTOM
What does the ductus venosus do?
Takes blood for the umbilical vein and puts it in the IVC (liver bypass)
Does the size of the defect matter in ventricular septal defect?
Yes. Small VSDs may be asymptomatic, while large ones can cause failure to thrive, shortness of breath, and frequent respiratory infections
How do you diagnosis hypoplastic left heart syndrome?
ECHO
(You will see hypoplastic aorta and LV with stenosis/atresia of mitral and aortic valves)
***** this was put in big bold letters
How do you treat tricuspid atresia?
Initial: prostaglandin E1 to maintain PDA**
Definitive: 3 surgeries done from birth to age 3
