Cardiac

Question 1

first sign of L to R shunt / CHF in children

Answer 1

hepatomegaly

Question 2

R to L shunt first sx

Answer 2

cyanosis, squatting improves

Question 3

Eisenmenger

Answer 3

L to R shunt turns into R to L shunt

Question 4

causes of congenital L to R shunt

Answer 4

VSD, ASD, PDA

Question 5

causes of congenital R to L shunt

Answer 5

tetralogy of Fallot

Question 6

PDA patent ductus arteriosus connection

Answer 6

descending aorta to LEFT pulmonary artery (shunt away from lungs inutero)
becomes ligamentum arteriosum

Question 7

neonatal ductus venosum

Answer 7

connection from portal vein and IVC (shunt away from liver in utero)

Question 8

foramen ovale

Answer 8

shunt blood away from lungs; in between R and L atria

Question 9

MC congenital heart defect

Answer 9

VSD

Question 10

dx of VSD

Answer 10

ECHO

80% close spontaneously by 6 mo

if large enough, can cause CHF in 4-6 wks of life with FTT as pulmonary vascular resistance decreases and shunt increases

Question 11

mgmt of VSD

Answer 11

LARGE > 2.5cm: 1 YO
medium 2-2.5cm: 5 YO
or… as soon as failure to thrive

can start med therapy as: diuretics and digoxin

Question 12

types of atrial septal defect

Answer 12

ostium secundum 80% centrally located > ostium primum

Question 13

ostium primum associated with what else

Answer 13

Downs syndrome, MV/TV issues, cushion defect, AV canal defects

Question 14

dx ASD

Answer 14

ECHO

CHF if >2 cm in kids, otherwise emboli in adults

Question 15

mgmt ASD

Answer 15

1-2 YO if found (earlier if associated with canal defects)

Question 16

meidical mgmt of asd and vsd

Answer 16

diuretics and digoxin

Question 17

4 parts of Tetralogy of fallot

Answer 17

1. VSD
2. pulmonary stenosis
3. overriding aorta
4. RV hypertrophy

Question 18

mgmt of Tetralogy

Answer 18

B-blocker + repair @ 3-6 mo

Question 19

repair of Tetralogy of fallot

Answer 19

remove RVOT obstruction, enlarge the outflow tract and repair the VSD

Question 20

PDA patent ductus arteriosus sx

Answer 20

BOUNDING pulses, widened pulse pressure, machine like murmur

Question 21

mgmt PDA

Answer 21

indomethacin in neonates
otherwise, L thoracotomy surgical ligation

Question 22

aortic coarcation dx

Answer 22

suspect in HTN young person; hypotensive legs
CXR with scalloping from big intercostals
CTA to confirm

Question 23

mgmt of coarctation

Answer 23

resect the narrowing

Question 24

vascular ring presentation

Answer 24

difficulty swallowing, respiratory distress, neck hyperextnsion (TRACHEA AND ESOPHAGUS ARE ENCIRCLES BY AORTIC ARCHES

Question 25

vascular ring dx

Answer 25

barium swallow with bronchoscopy

Question 26

mgmt of vascular ring

Answer 26

divide the smaller of the two arches

Question 27

indications for CABG (L main vs others)

Answer 27

70% for most arteries 50% for left main

Question 28

efficacy of stent/grafting coronaries

Answer 28

IMA (off SCA) 95% 20 yr patency > saph vein 80% 5 yr patency > DES 80% 1 yr patency

Question 29

worst risk factor for CABG

Answer 29

preop CARDIOGENIC SHOCK >>> emergency operation, age, low EF

Question 30

bioprosthetic contraindication

Answer 30

only lasts 10-15 years so don't use in kids

Question 31

indication for AS valve repair

Answer 31

symptomatic (worst sx is syncope > angina > DOE) correlates with peak gradient >50mm Hg, valve area < 1.0 cm

Question 32

MC valve lesions

Answer 32

AS from calcification/degeneration

Question 33

MR cause

Answer 33

leaflet prolapse

Question 34

MR indication to repair

Answer 34

symptomatic (mostly pulmonary congestion, Afib)

Question 35

MS alternative to replacement

Answer 35

balloon commissurotomy (do this as first procedure before OR)

Question 36

constrictive pericarditis square root sign

Answer 36

during RHC. equalization of right atrial = right venticular = pulmonary artery = wedge = left ventricular diastolic pressures!

Question 37

mgmt of constrictive pericarditis

Answer 37

pericardiectomy

Question 38

MC sites for endocarditis

Answer 38

AV for prosthetic, MV for native

Question 39

MC bug for endocarditis

Answer 39

S. aureus (also for IVDU) per Fiser

Question 40

MC valve affected in IVDU

Answer 40

RIGHT !!

Question 41

mgmt of endocarditis

Answer 41

MEDICINE FIRST then, valve replacement (if fails, valve failure, abscess, pericarditis)

Question 42

MC met to heart

Answer 42

LUNG ca

Question 43

MC primary benign and malignant of heart

Answer 43

benign: myxoma malignant: angiosarcoma

Question 44

indication to open the chest after sternotomy

Answer 44

>500cc in 1st hour >250 cc/hr x 4 hours

Question 45

Aortic valve replacement indication?

Answer 45

Aortic valve area nL 3-4 cm2... so <1 cm2 needs to be fixed. Typically concurrent with aortic jet velocity > 4m/sec or transvalvular gradient >40 mm Hg

Question 46

2 operative indications for blunt cardiac injury?

Answer 46

1. cardiac tamponade and 2. disrupted cardiac valves

Question 47

MC EKG abnormality in BCI

Answer 47

ST and PVCs

Question 48

less common abnormality BCI

Answer 48

T or ST segment changes sinus brady AV conduction defects RBBB Afib Vtach VFib

Question 49

what MUST you get if dysrhythmia or HD instability after BCI?

Answer 49

Echo

Question 50

tamponade physiology 3 phases

Answer 50

1 elevated pericardial pressure & decreased vetricular diastolic filling = increased HR 2. decreased diastolic filling, decreased coronary perfusion, decreased SV = pallor, anxiety, diaphoresis 3. loss compensation and coronary perfusion = cardiac arrest

Question 51

icd for surgery

Answer 51

pacer in asynchronous defib turn oFF can just put magnet over to get reset pacer and turn off defib as well

Question 52

post MI ventricular septal rupture

Answer 52

hypotn, pansystolic murmur 3-7 days after STEP UP IN OXYGEN CONTENT BETWEEN RA AND PA (L to R shunt) dx on Echo tx: IABP and patch it

Question 53

post MI papillary muscle rupture

Answer 53

severe mitral regurgitation with hypotension and pulmonary edema 3-7 days after dx echo tx IABP and replace valve

Question 54

DES restenosis in 1 yr

Answer 54

20%

Question 55

worst px AS sx

Answer 55

syncope (mean survival 3 yrs )