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Cardiology Flashcards

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1
Q

Which syndrome is associated with aortic and pulmonary stenosis?

A

Williams Syndrome

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2
Q

What are the structural features of Tetralogy of Fallot?

A

VSD
Pulmonary stenosis
RVOT
RVH

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3
Q

How do you calculate Pulmonary Vascular Resistance ? (Poiseuille equation)

A

Mean PA p - LA p
————————-
Pulmonary blood flow (l/min/m2)

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4
Q

What is a normal recording for PVR? What is severe and correlates with irreversible pulmonary vascular disease?

A

Normal PVR = 1-2 u/m2

Severe = > 7.9u/m2

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5
Q

How do you calculate Qp (pulmonary blood flow) / Qs (systemic blood flow)

A

Qp/ Qs = (Ao sat - MV sat)
———————
(PV sat - PA sat)

MV sats: take average of SVC and RA
PV sats: same as LA

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6
Q

What is the most common cardiac complication of Duchenne muscular dystrophy?

A

Dilated cardiomyopathy

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7
Q

What congenital cardiac lesion is suggested by a single second heart sound?

A

Truncal atresia (shared root aorta and pulmonary artery)

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8
Q

What cardiac lesion is associated with Turner’s syndrome?

A

Coarctation of the aorta
Bicuspid aortic valve
Aortic stenosis

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9
Q

What cardiac lesion is associated with Di George syndrome?

A

Tetralogy of Fallot

Truncus Arteriosus

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10
Q

What cardiac lesion is associated with Alagille’s syndrome?

A

Peripheral pulmonary artery stenosis

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11
Q

Which cardiac lesion is associated with Noonan’s syndrome?

A

Valvular pulmonary stenosis

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12
Q

What auscultation sign is most indicative of pulmonary hypertension?

A

Loud S2 (Pulmonary valve closes quicker)

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13
Q

Which cardiac malformation is associated with neurofibromatosis?

A

Pulmonary stenosis

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14
Q

Describe the murmur heard for peripheral pulmonary stenosis.

A 
Grade 1-2 
Ejection systolic 
Left upper sternal edge
Radiating to axilla or back 
Benign - due to changes in pulmonary vascular resistance
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15
Q

What cardiac malformation would you suspect for a day 2 neonate becoming cyanosed with no other cardiac findings on examination ?

A

Total Anomalous Pulmonary Vascular Return

Duct dependent

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16
Q

Which syndrome is associated with aortic root dilatation?

A

Turners syndrome

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17
Q

What is the cardiac abnormality seen in Alagille syndrome ?

A

Peripheral pulmonary stenosis

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18
Q

What is the most common cardiac abnormality seen in congenital rubella syndrome?

A

PDA

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19
Q

What cardiac abnormalities are seen in Williams syndrome?

A

Supraaortic valvular stenosis
Peripheral pulmonary stenosis
Systemic arterial stenosis

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20
Q

What is the most common cardiac abnormality in velocardiofacial syndrome?

A

VSD
Right sided aortic arch
TOF

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21
Q

What murmur do you hear in TOF?

A

Harsh ejection systolic murmur over left sternal border (pulmonic area) due to turbulence through R outflow tract
Can also get aortic ejection click, systolic thrill

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22
Q

What is the most common complication of surgically corrected TOF?

A

RBBB (due to widening of RVOT)

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23
Q

What are the clinical findings of tricuspid stenosis?

A

Mid diastolic murmur
Hepatomegaly
Distended neck veins
No respiratory distress

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24
Q

What is the most likely diagnosis: cyanosis presenting in first few hours of life
Normal pulse
No respiratory distress
No murmur

A

TGA

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25
What condition is associated with a fixed splitting of the second heart sound?
ASD
26
What is the most common cardiac defect seen in foetal alcohol syndrome?
ASD
27
What are the clinical and ECG/CXR findings for ASD?
``` Ejection systolic murmur at left upper sternal edge Fixed splitting of S2 ECG: RBBB CXR: cardiomegaly, plethoric lungs (Volume overload right heart) ```
28
What does upright T wave in V1 indicate? (Age 4 days to 4 years)
Right ventricular hypertrophy
29
Name 2 congenital conditions associated with valvular pulmonary stenosis
Noonans syndrome | Neurofibromatosis
30
Name two syndromes associated with peripheral pulmonary stenosis
Alagille’s | Williams
31
What happens to the murmur of TOF during a tet spell
``` Gets softer (Decreased SVR causes reversal of shunt pushing blood back to right side; fixed obstruction across RVOT- less blood flow) ```
32
What is the event that initiated myocardial fibre contraction ?
Release of stored calcium from sarcoplasmic reticulum
33
Name 5 causes of Pulsus paradoxus
``` Cardiac tamponade Constructive pericarditis Severe asthma PE Tension pneumothorax ```
34
Name 3 congenital cardiac lesions that cause cyanosis and plethoric lungs
TGA Truncus arteriosus TAPVR
35
Name 3 cyanotic heart lesions that cause oligaemic lungs
Tetralogy of Fallot Pulmonary atresia Ebsteins anomaly
36
Name 5 cyanotic heart lesions that are duct dependent
``` Hypoplastic left heart Severe coarctation Interrupted aortic arch Severe AS TAPVR ```
37
Name 4 acyanotic heart lesions that cause left to right shunting
ASD AVSD VSD PDA
38
In the foetal circulation what is the output from the right ventricle compared to the left ?
RV = 2x LV
39
In foetal circulation what percentage of blood flow passes through the PDA to the descending aorta ?
90%
40
What is the normal pressure for the right ventricle?
25/0mmHg
41
What is the difference between antidromic and orthodromic re-entrant tachycardia
``` Antidromic = broad complex tachy Orthodromic = barrow complex tachy ```
42
Which arrhythmias in WPW require an accessory pathway for maintenance and initiation?
Antidromic and orthodromic re-entrant tachycardia
43
Which arrhythmia in WPW do NOT require an accessory pathway for initiation and maintenance?
``` AV nodal re-entrant tachy AF Atrial flutter VT VF ```
44
What is the most common type of VSD - what % does it account for?
Perimembranous 70%
45
What is the least common type of VSD? What is the main complication?
Type 1 Supracristal / conal 5% Aortic regurgitation
46
What are the clinical and ECG features of tricuspid atresia ?
Cyanosis day 1 No respiratory distress Pansystolic murmour left sternal edge Single S2 ECG: LEFT ventricular hypertrophy (tall R waves V1, deep S waves V6)
47
How do you calculate pulmonary vascular resistance?
PVR = (Pa - Pv)/Qp ``` Pa = Pulmonary arterial pressure Pv = Pulmonary venous pressure = left atrial pressure Qp = Pulmonary venous flow ```
48
Specific lung compliance is best standardised by measuring lung compliance at which lung volume ?
Functional residual capacity
49
What are the classes of CFTR mutations in CF?
Class I: no CFTR production Class II: defective protein processing Class III: gate malfunction (Ivacaftor) Class IV: defective conductance of chloride Class V: Reduced production of CFTR Class VI: increased turnover at surface of cell
50
What is an associated congenital heart defect with coronary artery fistulae?
Pulmonary atresia with intact septum
51
What is the cardiac lesion ? ECG: RVH, RBBB Systolic murmur Wide fixed splitting S2
ASD
52
What cardiac defect is associated with PHACES ?
Aberrant subclavian artery
53
What cardiac defect is associated with Char syndrome?
PDA
54
What cardiac defect is associated with Alagille syndrome ?
Peripheral pulmonary stenosis | Tetralogy of Fallot
55
What cardiac lesion is associated with Fragile X?
Mitral valve prolapse
56
Which cardiac lesion is associated with Turner syndrome?
Bicuspid aortic valve | Coarctation of the aorta
57
ECG shows complete AV block with junctional escape- what is the most likely explanation ?
Precious cardiac surgery eg VSD repair
58
What is the most common cardiac lesion associated with neurofibromatosis 1?
Pulmonary stenosis
59
What medication is best to treat long QT?
Propranolol
60
What medication is best to treat short QT?
Quinidine
61
How do you differentiate between antidromic and orthodromic re entrant tachycardia in WPW?
Antidromic - broad complex tachycardia | Orthodromic - narrow complex tachycardia
62
How do you calculate cardiac output ?
Oxygen consumption / arterial - venous o2 x 10
63
What does the third heart sound represent ?
Rapid ventricular filling
64
What condition should you suspect 6 week infant presenting with pansystolic murmur LLSE CXR shows cardiomegaly but also narrow mediastinum ECG shows long QT
Di George - murmur is VSD - CXR narrow mediastinum shows thymic aplasia - ECG long QT can be caused by hypocalcaemia
65
What are two causes of cyanotic heart disease that cause LVH?
Tricuspid atresia | Truncus arteriosis
66
Name 4 causes of cyanotic heart disease that cause increased pulmonary blood flow
TGA TAPVD HLHS truncus arteriosus
67
What is the diagnosis Bounding pulses Continuous systolic murmur Displaced apex beat
PDA
68
What is the diagnosis ? Fixed split S2 ESM LSE Superior axis
ASD
69
Most common type of VSD
Membranous
70
``` What is the diagnosis Single loud S2 Pansystolic murmur Plethoric lungs A cyanotic Superior axis ```
AVSD
71
What is the diagnosis ESM radiating to neck Ejection click at apex
Aortic stenosis
72
What is the diagnosis ? ESM between scapula Poor femoral pulses
Coarctation
73
What is the diagnosis ? ESM Mid systolic click LUSB
Pulmonary stenosis
74
What is the diagnosis Single loud S2 Cyanotic Soft systolic murmur
TGA Egg on the string
75
What is the diagnosis Cyanotic ESM LUSB radiating to back Oligaemic kings
TOF
76
What is the management for Tet spells
``` Keep calm Knees to chest Oxygen IV morphine Metaraminol to increase SVR ```
77
What is the diagnosis Mild cyanosis Single S2 Biventricular hypertrophy
Truncus arteriosus
78
What is the diagnosis ? Deep cyanosis Non specific murmur Snowman CXR
TAPVD
79
``` What is the diagnosis Dilated RA Gallop rhythm Cyanotic Holosystolic murmur ```
Epstein’s Lithium
80
What is the inheritance of hypertrophic cardiomyopathy ? Which mutation is associated with sudden death,
Autosomal dominant | TNNT2
81
In the cardiac cycle when does mitral opening snap occur ?
Atrial systole
82
When does S3 occur? What does it correlate with?
Early diastole | Rapid ventricular filling
83
What is p mitrale on ECG?
Bifid p wave | Left atrial dilatation
84
What is a complication of VSD causing diastolic murmur ?
Aortic regurgitation | Due to prolapse or right coronary cusp
85
When do duct dependent lesions usually present ?
Day 3-5
86
What are some electrolyte causes of long QT?
Hypocalcaemia | Hypomagnesaemia
87
What are some drug causes of long QT ?
Amitryptilline Amiodarone Anti malarials Macrolides + antifungals
88
What is the inheritance of Jerrold Neilson
Autosomal recessive Associated with deafness Romano Ward autosomal dominant
89
``` What are the heart defects associated with the following teratogens Alcohol Lithium Phenytoin Sodium valproate Diabetes PKU ```
``` TGA Ebsteins Coarctation TOF TGA TOF ```
90
What are the 3 ECG features of WPW?
Short PR Long QRS Delta wave
91
What drug should be avoided in WPW?
Digoxin
92
What kind of murmur is associated with Blalocl Taissig shunt ?
Continuous | Subclavian anastomosed to pulmonary artery
93
what is the treatment for persistent pulmonary hypertension ?
Nitric oxide
94
What gender are PDA more common in?
Females
95
What gender are coarctation more common in?
Males
96
What does hyperkalaemia do to the PR interval ?
Prolongs
97
What congenital heart defect is associated with Edwards syndrome ?
Coarctation

Paediatrics (17 decks)

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