Cardiology

Question 1

Tet of fallot infant in which medical mgmt is inadequate but they do not weight enough for definitive surgical repair, what tx?

Answer 1

Place stent across the pulm outflow tract (AKA RV outflow tract) allowed improved palm blood flow until desired weight is reached

Question 2

Std surgical repair for tet of fallot?

Answer 2

Transannular patch repair

Note: RV opened and enlarged with a patch while VSD is closed. Removes R -> L shunt and relieved outflow tract obstruction. But this does 1 . impair palm valve function leading to severe palm regurg 2. impair the conduction system resulting in R BBB. These children usually require palm valve replacement in teen year as the right heart becomes less hypertrophied and then dilated over the following decade

Question 3

What is the most common congenital cardiac defect?

Answer 3

Bicuspid aortic valce

Followed by VSD

Question 4

Where are VSD more common muscular or septum?

Answer 4

Septum

Note: if muscular they are usually multiple

Question 5

VSDs are associated with a high oxygen content in the blood of the right ventricle than the right atrium T/F

Answer 5

T

Question 6

What is the most common cardiac cause of cyanosis in the first week of life?

Answer 6

TGA

Also: poor response to supplemental oxygen; loud single 2nd heart sound, no murmur, narrow mediastinum

Question 7

4 abnormalities in tet of fallot?

Answer 7

1. Perimembranous VSD
2. PS
3. Over riding aorta
4. Right ventricular hypertrophy

Question 8

Ebstein anomaly affects what valve?

Answer 8

Tricuspid valve

Question 9

Holt Oram syndrome is assoc with what cardiac abnormality?

Answer 9

ASD

Hypoplastic left heart

Question 10

Infective endocarditis is assoc with an up to 20% mortality rate T/F

Answer 10

T

Question 11

Treatment of a hypercyanotic spell in a patient with tet of F

Answer 11

First simple interventions: manoeuvers, then oxygen, then fluid bolus.
If theses do not work can try dose of morphine, then esmolol infusion

Question 12

TAR syndrome (thrombocytopenia and absent radius) associated with what cardiac abnormality?

Answer 12

Tetrology

Question 13

EKG finding to differenciate VSD from complete AV canal?

Answer 13

Superior axis is present in complete AV canal

Both can present with HF and a harsh pansystolic murmur

Question 14

Which type of cardiac lesion is most likely to present with faltering growth?

Answer 14

Large left to right shunt with pulm oedema

Example: complete AV septal defect or a large VSD

Question 15

How long does a PDA need to be present to be defined as persistent?

Answer 15

3 months post term

Question 16

In an infant without any risk factors a PDA is more common in which sex?

Answer 16

More common in females (2:1)

Main risk factor is pre term

Question 17

Coarctation of the aorta is more common in which sex?

Answer 17

More common in males (2:1)

Question 18

What is the max dose of adenosine for SVT?

Answer 18

500mcg/kg

or max 6mg for 1st dose and 12mg for second

Note: after this move on to cardioversion 1J/kg

Question 19

What is the most common cause of myocarditis in the western world?

Answer 19

Viral

Note: of this adenovirus is the most common

Question 20

Most common type of ASD?

Answer 20

Ostium secundum

Question 21

What is the mgmt of a persistent asymptomatic ASD?

Answer 21

Interventional cardiac cath at 3 yrs

Question 22

What % of VSDs close by 1 yr?

Answer 22

90%

Question 23

What % of pts with Turners syndrome have a coarcation of the aorta?

Answer 23

About 15%

Question 24

What is the most common cardiac arrest rhythm in children?

Answer 24

Asystole

Question 25

What is the sex distribution of WPW?

Answer 25

More common in males (60-70%)

Question 26

WPW is usually associated with congenital heart disease T/F

Answer 26

F - WPW is usually seen in patients with structurally normal hearts (70-80%)

Question 27

Are the vast majority of transposition of the great arteries diagnosed ante or postnatally?

Answer 27

Post natal. It is difficult to diagnosis on antenatal USS

Question 28

When does tet of fallot usually present?

Answer 28

Sometime in the first year of life

Question 29

Infant with a murmur and blue stellate irises what pathology?

Answer 29

Williams syndrome

Question 30

What is the most common cardiac defect in those with T21

Answer 30

Atrioventricular septal defect

Question 31

Which of these complications is most common following cardiac surgery? Endocarditis, heart block, pericardial effusion or myocarditis?

Answer 31

Pericardial effusion -many cardiac units will scan patients at 2 weeks post op/post discharge to screen for this complication as it can initially be asymptomatic

Question 32

Atrial septal defect what type and location of murmur?

Answer 32

Soft systolic murmur at upper left sternal edge Note: can present at any age

Question 33

What ECG findings that may be present in a patient with LV cardiomyopathy?

Answer 33

Inverted T waves in the chest leads (such as V6)

Question 34

What ECG findings that may be present in a patient with tetralogy of Fallot?

Answer 34

Upright T waves in V1 due to RVH

Question 35

What the the management of coarctation of aorta in the newborn?

Answer 35

Prostaglandin 0.05 uk/kg/min (duct dependant lesion) followed by corrective surgery when the patient is stable

Question 36

Main features of Jervell-Lange-Nielsen syndrome?

Answer 36

Long QT SN hearing loss AR inheritance

Question 37

What is the mechanism of action of adenosine?

Answer 37

Reduced conduction velocity in the AV node

Question 38

What genetic disorders is hypoplastic left heart associated?

Answer 38

``` Turner syndrome T 13, 18 or 21 Jacobsen syndrome Holt Oram Rubinstein Taybi syndrome ```

Question 39

What is the initial starting dose of adenosine?

Answer 39

100 mcg/kg

Question 40

Management of pulseless VT vs VT with pulse

Answer 40

Pulseless VT = CPR followed by unsynchronised cardioversion initially at 4 J/kg VT with pulse = Synchronised cardioversion initially 2J/kg, followed by 4J/kg. NB to synchronise as do not want to change rhythm to v fib Note: v fib is also unsynchronised cardio version initially at 4J/kg

Question 41

Rheumatic fever often leads to mitral regurg many years after the acute episode T/F

Answer 41

F - it causes mitral and aortic regurg acutely which can lead to stenosis long term

Question 42

What feature on exam is indicative of severe aortic stenosis?

Answer 42

A soft S2 As the aortic valve becomes severely stenotic or calcified the 2nd heart sound becomes inaudible

Question 43

In a patient with TGA without VSD with the surgical mgmt?

Answer 43

Switch operation

Question 44

In a patient with a TGA with VSD with is the surgical mgmt?

Answer 44

Rastelli operation (close VSD and do a conduit from RV to pulmonary artery)

Question 45

Mechanim of action of amiodarone?

Answer 45

K channel blocker