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FOP/TAS > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

Pathophysiology of rheumatic fever

A

Delayed immunological sequelae of Group A beta-haemolytic strep throat infection

GAS produces enzymes e.g. streptolysin O that is toxic to cardiac cells

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2
Q

Main systems that rheumatic fever affects

A

cardiac
skin
cns
joints

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3
Q

diagnostic criteria rheumatic fever

A

duckett-jones criteria
2x major OR 1x major and 2x minor

MAJOR
- migratory polyarthritis
-subcutaneous nodules
- carditis
- sydenham’s chorea
- erythema marginatum

MINOR
- arthralgia
- fever
- elevated ESR or CRP
- prolonged PR interval

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4
Q

erythema marginatum

A

non-itchy macular lesions with pale centres, normally trunk & limbs

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5
Q

Ix for rheumatic fever

A

throat swab - antistreptolysin O titres

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6
Q

Rx rheumatic fever

A

penicillin - for eradicating the infection

Carditis - aspirin
Evidence of HF - diuretics, ACEi, digoxin
Chorea - diazepam
Arthritis - aspirin & NSAID

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7
Q

Prophylaxis following rheumatic fever

A

timings depend on the presence of cardiac involvement

No cardiac -
Prophylactic penicillin for 5 years or until age 21

Cardiac -
Monthly penicillin for at least 10 years or until age 21

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8
Q

Presentation of ASD

A

Most are asymptomatic

Ejection systolic murmur at upper left sternal edge
Fixed splitting of the 2nd HS

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9
Q

Reason for murmur in ASD

A

Ejection systolic at LUSE

  • turbulence is mostly generated by blood flowing across the pulmonary valve during systole
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10
Q

why do you get splitting of the 2nd heart sound in ASD

A

equal L & R filling

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11
Q

Management ASD

A

Monitor until school age

Then surgical closure
- advised for all patients even if asymptomatic

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12
Q

Murmur in VSD

A

pansystolic murmur - LLSE +/- parasternal thrill

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13
Q

Rx VSD

A

Majority will close spontaenously
Rx medically if HF present
Rx surgically if HF severe or causing pulmonary hypertension

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14
Q

Eisenmenger syndrome

A

presence of pulmonary hypertension causes pulmonary vascular disease and cyanosis due to reversal of flow

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15
Q

Pharmacological closure of a PDA in term infants is effective T or F

A

False - only effective in preterm infants

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16
Q

Murmur aortic stenosis

A

Ejection systolic murmur RIGHT upper sternal edge - radiates to the neck/carotids

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17
Q

Mx aortic stenosis

A

most cases - conservative

If high resting pressure gradient (>60) then do balloon valvuloplasty

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18
Q

Murmur pulmonary stenosis

A

Ejection systolic murmur LUSE - radiates to back

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19
Q

Mx pulmonary stenosis

A

transvenous balloon dilatation

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20
Q

Most common congenital heart defect

A

bicuspid aortic valve

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21
Q

Pathophysiology of coarctation of the aorta

A

extension of prostaglandin sensitive tissue from the ductus arteriosus around the insertion of the aorta

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22
Q

types of coarctation of the aorta

A

Critical a.k.a pre-ductal

Non-critical a.k.a. post-ductal

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23
Q

associated cardiac defect with coarctation

A

bicuspid aortic valve

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24
Q

what GI pathology are coarctation’s at risk of

A

NEC - reduced blood flow through abdominal aorta

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25
ECG signs of coarctation
signs of LVH - deep S wave V1 - tall R wave V6
26
commonest cyanotic HD detected in 1st year of life
ToF
27
Pathophysiology of ToF
anterior displacement of the outflow tract septum that separates the single outflow tract into the aorta & pulmonary artery >> large aorta and small pulmonary artery and VSD >> pulmonary stenosis & RVH >> normal systemic venous return to the R side >> R to L shunting 2y to pulmonary stenosis through the VSD into the aorta >> low O2 sats & cyanosis N.B. if pulmonary stenosis and therefore RV outflow obstruction is moderate then there can be a balanced VSD and cyanosis can be mild or absent
28
Cardinal features of ToF
Large VSD Overriding aorta RV outflow obstruction RVH
29
Murmur in ToF
Ejection systolic murmur LUSE (due to pulmonary stenosis)
30
ToF hypercyanotic spells underyling pathology
Increase in pulmonary vascular resistance, usually during activity >> increases the R-L shunt which worsens cyanosis
31
What does Rx of 'cyanotic spells' in ToF aim to do
aims to increase pulmonary blood flow by reducing pulmonary vascular resistance and reduce systemic blood flow by increasing SVR in order to reduce the R>L shunt
32
Rx cyanotic spells in ToF
Knee-to-chest position High flow O2 Pressure over femoral pulses IV saline bolus Morphine B blockers
33
ECG appearance in ToF
Signs of RVH Upright T wave V1 RAD Dominant S wave in V5/6
34
most common cause of cyanotic HD in the neonatal period
TGA
35
most common defects associated with TGA
VSD and pulmonary stenosis
36
Rx TGA
PGE infusion to maintain duct patency Maintain body temp - hypoxaemia worsens metabolic acidosis Balloon atrial septostomy Then definitive arterial switch in 1st 2 weeks of life
37
Describe flow of blood in tricuspid atresia
systemic blood coming back to RA is shunted across to LA via the PFO and then travels to the LV >> deoxygenated blood back to the systemic circulation
38
Rx tricuspid atresia
PGE to maintain duct patency to maximise oxygenation of blue blood BT shunt - neonatal period Pulm artery banding (neonatal period) Glenn shunt (6m) Fontan procedure (preschool)
39
Ebstein's anomaly
inferiorly displaced tricuspid valve more inferior >> smaller RV >> diminished capacity to pump >> compromised flow to lungs >> cyanosis at birth
40
Rx hypoplastic left heart syndrome
PGE to maintain duct patency 1. Norwood procedure then 2. Fotann procedure
41
What is a norwood procedure
Creation of a 'neo-aorta' by fusing the pulmonary artery to the atretic ascending aorta. the main pulmonary artery is therefore disconnected from the branch pulmonary arteries BT shunt is placed to secure pulmonary blood flow The RV acts as the single systemic ventricle
42
what is a fontan procedure
anastomosis of the IVC directly to the pulmonary arteries to create a passive systemic venous return to the pulmonary circulation
43
how is cardiac arrest induced during a norwood procedure
using cardioplegia solution - high conc of potassium - increases the resting membrane potential of the myocardium - causes slow activation of the Na channels - leads to cardiac arrest in diastole - the solution is cold, reducing the O2 demand of the myocardium
44
what is TAPVD
total anomalous pulmonary venous drainage the 4 pulmonary veins drain to a confluence into the systemic circulation, instead of the L atrium therefore all blood returning to the heart (pulm and systemic) returns to the R side of the heart need a PFO or ASD in order to for survival
45
most common causative organism infective endocarditis
staph aureus
46
what are osler nodes and what causes them
painful nodes on the dorsum of hands - secondary to dermal immune complex deposition
47
what are janeway lesions and what causes them
painless haemorrhagic lesions on palms and soles - secondary to micro abscess formation from septic emboli
48
what are roth spots and what causes them
red spots with pale centres on fundoscopy - immunological phenomena of the retina
49
what are splinter haemorrhages and what causes them
micro-emboli necrosis under the nails
50
diagnostic criteria endocarditis
Modified Duke Criteria 2x major ; 1x major + 3x minor ; 5x minor Major - 2x +ve BC 12h apart - +ve echo findings Minor - predisposing criteria - fever >38 - vascular > arterial emboli/brain haemorrhage etc - immunologic phenomena > osler nodes etc
51
types of SVT
atrial tachycardia AVN/junctional tachycardia AV re-entrant tachycardia
52
what is atrial tachycardia
an area of the atrium takes over the pacemaker activity of the heart most common post cardiac surgery
53
what is AVN/junctional tachycardia
abnormal re-entrant pathway within the AV node, so the AVN has pacemaker ability
54
most common form of SVT > 8 years
AVNRT
55
most common form of SVT <8 year
AVRT
56
what is AV re-entrant tachycardia
there is an accessory conduction pathway joining the atria and ventricles forming a re-entry circuit e.g. WPW
57
Rx SVT if shock present
sync DC shock 1J/kg then sync DC shock 2J/kg then continue sync at 2J/kg and consider amiodarone
58
Rx sVT if no shock present
vagal manouevre then adenosine 100mcg/kg then adenosine 200mcg/kg then adenosine 300mcg/kg
59
prophlyaxis SVT
verapamil 40mg tds
60
Rx WPW
amiodarone radiofrequency ablation
61
causes of congenital heart block
maternal lupus - anti-ro or anti-la antibodies isolated anomaly congenital heart disease acquired following cardiac surgery
62
viral causes of myocarditis
coxsackie virus adenovirus
63
Rx pericarditis
NSAIDS Pericardiocentesis - if causing tamponade
64
size of arteries affected in kawasaki disease
medium sized vasculitis
65
'strawberry tongue'
kawasaki disease
66
diagnostic criteria for kawasaki disease
Prolonged fever (>5 days) + 4 of ... - non purulent conjunctivitis - oromucosal changes - strawberry tongue - polymorphous rash - cervical lymphadenopathy - arthritis - D&V - cough
67
symptoms of atypical/incomplete kawasaki disease
suspect if <6m with fever >7 days and no other features suspect if fever >5 days and 2-3 clinical features
68
Rx kawasaki disease
IVIG + aspirin May need 2nd dose IVIG and IVMP
69
inheritance of Long QT
AD
70
Different mutations causing HOCM
Troponin T mutation Beta myosin (MYH7) in heavy chains mutation Myosin-binding protein C mutation Myosin light chain kinase (MYLK2) mutation
71
Examination findings in HOCM
displaced and/or heaving apex beat additional HS S3 + S4 - due to non compliant LV quiet S2 with ejection systolic murmur
72
What germ layer does the heart develop from
Mesoderm
73
What weeks do the pharyngeal arches form
4+5
74
when does cleavage of the aortic and pulmonary trunk occur
week 5&6
75
when does the AV valves form
week 6&7
76
what is the crista terminalis and when does it form
eventually forms the pathway from the SA node to the AV node forms in week 6&7
77
when do the intraventricular foramen close
week 7
78
describe the venous systems to the primordial heart
Vitelline system - returns poorly oxygenated blood from the yolk sac Cardinal system - carrys poorly oxygenated blood from the body of the embryo Umbilical system - carries well oxygenated blood from the placenta
79
What does the vitelline system become after birth
the portal system
80
what does the umbilical vein carry
oxygenated blood from the placenta to the baby
81
when does the arterial CVS system develop
weeks 6-8
82
list what arteries the pharyngeal arches form
1&2 - form some of the smaller vessels of the neck and face 3rd arches - internal carotid 4th right - forms the right subclavian artery left - forms the aortic arch between the L common carotid and the terminus of the ductus arteriosus 5th arches - dont form or regress completely 6th arches - form the pulmonary vasculature
83
which artery can regress abnormally and form an aberrant origin
right subclavian artery arising from the 4th pharyngeal arch

FOP/TAS (25 decks)

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