Cardiology

Question 0

Congenital causes of CHF?

Answer 0

1. Increased pulmonary bloodflow – VSD, PDA, transposition, truncus arteriosus, TAPVR
2. Obstructive lesions – valve stenosis, coarctation, hypoplastic left heart syndrome

Question 1

CHF – definition? Body’s reaction to increased demand?

Answer 1

Inadequate oxygen delivery

Compensatory mechanisms lead to increased demand:

1. Hypoperfusion of end organs – increased contractility and heart rate
2. General Hypoperfusion – salt/water retention the RAAS
3. Catecholamine release

Question 2

Non-congenital, non-metabolic, causes of CHF in children?

Answer 2

1. Severe anemia – high output CHF
2. Rapid infusion of intravenous fluids
3. Obstructive airway from enlarged tonsils, laryngealmalacia, cystic fibrosis,

Question 3

Medical management of congestive heart failure?

Answer 3

LMNOP +

1. Cardiac glycosides (digoxin)
2. Inotropes (dobutamine, dopamine)
3. Milrinone (PDE inhibitor)

Question 4

Atrial-septal defects – types?

Answer 4

1. Ostium premium – defect in lower portion of septum. Down syndrome
2. Ostium secundum – defect in middle septum. Most common type.
3. Sinus venosis – high septum, pulmonary veins drain into right atrium or SVC instead of left atrium

Question 5

Innocent heart murmurs?

Answer 5

1. Still’s murmur – buzzing systolic murmur at left sternal border. Loudest if supine.
2. Pulmonic systolic murmur – blowing, high-pitched murmur at upper left sternal border. Loudest if supine.
3. Venus hum – continuous murmur. Not heard If supine.

Question 6

Complications of ASD? Treatment?

Answer 6

Heart failure, pulmonary hypertension, atrial dysrhythmias, paradoxic embolism

Heart surgery

Question 7

EKG findings in:

1. Atrial septal defect
2. Ventricular septal defect
3. Patent ductus arteriosus
4. Coarctation
5. aortic stenosis
6. Pulmonary stenosis

Answer 7

1. RAE, RVH;
2. LVH, RVH
3. LVH, RVH
4. Normal/LVH
5. Normsl/LVH
6. RVH

Question 8

x-ray findings with coarctation?

Answer 8

Rib notching (collateral flow)

Question 9

Sound of a small versus large VSDs?

Answer 9

Louder versus softer

Question 10

Signs of PDA? Tx?

Answer 10

1. Machine like murmur
2. Widened pulse pressure
3. Diastolic rumble
4. Brisk pulses

Indomethacin

Question 11

Signs of coarctation? Management?

Answer 11

1. Hypertension in right arm, hypotension and explore extremities
2. Dampened/delayed femoral pulse
3. Bicuspid aortic valve
4. Bruit
5. Prostaglandin E to open ductus arteriosus
6. Ionotropes
7. Surgery/balloon angioplasty

Question 12

Critical aortic stenosis? Presents when?

Answer 12

Inadequate perfusion body 12 to 24 hours after birth (once PDA closes)

Question 13

Treatment of pulmonary stenosis?

Answer 13

Balloon valvuloplasty

Question 14

Cardiac causes of cyanosis? Test? Definite diagnosis?

Answer 14

1. Tetralogy of fallout
2. Transposition of great arteries
3. Tricuspid atresia
4. Truncus arteriosus
5. Total anomalous pulmonary venous return

100% oxygen test
Echo

Question 15

Tetralogy of Fallot?

Answer 15

VSD, overriding aorta, pulmonary stenosis, right ventricular hypertrophy

Question 16

Differentiating features of

1. Tetralogy of Fallot
2. Transposition great arteries
3. Tricuspid atresia
4. Truncus arteriosus
5. TAPVR

Which have single S2? Which has SEM?

Answer 16

1. SEM, RVH, boot shaped heart
2. Single S2, small heart with narrow mediastinum (egg on a string)
3. Single S2, RAE, LAD, LVH
4. single S2 and SEM
5. Pulmonary ejection murmur, RVH/RAE

Question 17

Tet spells? trigger? Symptoms? Compensation

Answer 17

Sudden cyanosis in tetralogy of Fallot

Any maneuver the decreases oxygen saturation

Alterations and consciousness/acidosis

Squatting (To decrease right-to-left shunting)

Question 18

Transposition of great arteries – adequate saturation achieved by?

Answer 18

Shunting blood through patent foramen ovale, ASD, VSD, PDA

Question 19

Acute management of tetralogy of Fallot?

Answer 19

1. Knee-chest position
2. Fluids, oxygen
3. Morphine
4. Beta blocker to slow heart rate, reduce contractility of right ventricle
5. IV Bicarb

Question 20

Management of transposition of great arteries?

Answer 20

1. PGE to improve oxygen saturation by keeping ductus patent
2. Emergent balloon atrial septostomy
3. Arterial switch operation – great arteries are switched

Question 21

Tricuspid atresia – other abnormal findings? paths of blood? Treatment (and mechanism)?

Answer 21

ASD or PFO always present

1. If no VSD, pulmonary atresia present. Bloodflow through PDA leading to cyanosis
2. If VSD present, less hypoxia
3. Glenn shunt – SVC anastomosed to right pulmonary artery
   2 Fontan procedure – IVC flow directed into pulmonary arteries

Question 22

Truncus arteriosus – definition? Other abnormality present?

Can lead to? Management?

Answer 22

Aorta and pulmonary artery originate from common artery.

VSD almost always present

Causes excessive blood flow to the lungs resulting in CHF

Homograft between right ventricle and pulmonary artery

Question 23

Most common cause of acquired heart disease in children in US? Worldwide?

Answer 23

Kawasaki; acute rheumatic fever

Question 24

Infective endocarditis – usually occurs in whom? Caused by? Pathophysiology?

Answer 24

Patients with underlying heart condition or after cardiac surgery Gram-positive cocci >gram-negative (HACEK) >fungal 1. Bacteria infect cardiac endothelium 2. Fibrin and platelets adhere to site of injury, creating vegetation that affects valve competency 3. Distant manifestations (embolic phenomenon and immunologic sequelae)

Question 25

Management of endocarditis? Prophylaxis for whom?

Answer 25

IV antibiotic therapy AFTER adequate blood cultures obtained 1. Patients with structural heart disease 2. Postoperative cardiac surgery patients

Question 26

Purulent pericarditis? Causes? Complications?

Answer 26

Bacterial infection of the pericarditis Staph aureus and strep Constrictive pericarditis

Question 27

Postpericardiotomy syndrome?

Answer 27

Pericarditis post surgery. Unknown cause

Question 28

Clinical features of pericarditis? Diagnosis (three)? Imaging studies? Management?

Answer 28

1. Chest pain relieved when sitting upright 2. Pericardial friction rub 3. Distant heart sounds and pulses paradoxes 4. Hepatomegaly Pericardiocentesis and ESR 1. EKG – diffuse ST segment elevations, PR depressions 2. CXR – enlarged heart shadow 3. Echo – pericardial effusion Antibiotics, anti-inflammatory, drainage

Question 29

Infectious disease that is a common cause of sudden-death? Most common viral cause? Fungal? Parasitic? Autoimmune? Bacterial?

Answer 29

``` Myocarditis Enteroviruses (Coxsackie) Candida/Cryptococcus Chaga's disease SLE, rheumatic fever, sarcoidosis Corynebacterium, strep pyogenes staph aureus, TB ```

Question 30

Myocarditis – symptoms? Physical exam findings? Labs? ECG, echo findings? Management?

Answer 30

CP preceded by Flulike illness PE – tachycardia, tachypnea, muffled heart sounds, gallops, hepatomegaly Elevated ESR/CRP, CK T/ST changes Global ventricular dysfunction Supportive, ionotropes, diuretics, IVIg, transplantation

Question 31

Causes of dilated cardiomyopathy?

Answer 31

1. Viral myocarditis 2. Mitochondrial abnormalities 3. Carnitine deficiency 4. Nutritional deficiency – selenium, thyamine 5. Hypocalcemia

Question 32

Treatment for patient with hypertrophic cardiomyopathy?

Answer 32

1. Beta blockers/calcium channel blockers 2. Antiarrhythmics 3. Surgical myomectomy 4. Dual chambered pacing

Question 33

Causes of restrictive cardiomyopathy? Management?

Answer 33

1. Amyloidosis 2. Hemachromatosis 3. Sarcoidosis 4. Inherited infiltrative disorders – Fabry, Gaucher's, hemosiderosis 1. Reduce CVP with diuretics 2. improved compliance with beta blockers/calcium channel blockers

Question 34

Most common dysrhythmia in childhood? Types?

Answer 34

SVT 1. Atrial ventricular reentrant tachycardia – retrograde conduction through accessory pathway 2. Atrioventricular node reentrant tachycardia – through the node itself

Question 35

Sinus tachycardia versus supraventricular tachycardia – rate? Variation in heart rate? P waves? Response to adenosine?

Answer 35

1. Over 230 in newborns, over 210 children versus over 250 2. Present versus absent 3. Normal versus absent/abnormal 4. Gradual versus rapid

Question 36

Prolonged SVT in a neonate may lead to symptoms of?

Answer 36

CHF

Question 37

WPW – describe EKG findings?

Answer 37

Delta waves – slurred upstroke of QRS

Question 38

SVT – ways to slow rhythm?

Answer 38

1. Vagal maneuvers – icepack to face, carotid massage 2. IV adenosine (propranolol, digoxin, procainamide, amiodarone) 3. Cardioversion if hemodynamically unstable 4. Chronic medical management (digoxin, propranolol) 5. Radiofrequency catheter ablation

Question 39

Can see AV block as a result of? See congenital third-degree AV block in?

Answer 39

Post surgery (closure of VSD), bacterial endocarditis Children born to mothers with SLE

Question 40

long QT syndrome – Congenital? Drugs?

Answer 40

Jervell-Lange-Nielsen syndrome – autosomal recessive, deafness Romano-ward syndrome – autosomal dominant, no deafness Phenothiazines, tricyclics, erythromycin, terfenadine