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*Review TD 2020 > Cardiology > Flashcards

Cardiology Flashcards

(69 cards)

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1
Q

ASD

  • most common type
  • ECG
A
  • most common type secundum

- ECG RAD (sec)

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2
Q

ASD

- auscultation

A

SEM

Fixed and wide splitting of the 2nd heart sound

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3
Q

VSD - why would you not hear a murmur in the first week

A

Large VSD’s may be silent and become symptomatic in first few weeks as pulmonary resistance decreases

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4
Q

VSD

- CXR

A

CXR: increased pulmonary vasculature, cardiomegaly

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5
Q

Aortic Stenosis

  • location of murmur
  • radiation
  • quality of murmur
  • ECG
A

• Systolic ejection murmur at RUSB
radiating to NECK
• Systolic ejection click
• ECG: LAD, LVH, LV ‘strain’

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6
Q

Pulmonary Valve Stenosis

- auscultation

A

Split S2, proportional to degree of stenosis
Pulmonary ejection click
SEM LUSB, radiating to lung fields

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7
Q

Coarctation of Aorta

- CXR finding

A

Rib notching

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8
Q

ToF

A

– VSD
– Overriding Aorta
– Pulmonic Stenosis
– RVH

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9
Q

ToF

- what to do for tet spell

A
  • quiet, calm environment
  • knee-chest or squatting position
  • Oxygen
  • Fluid
  • Morphine
  • Phenylephrine
  • Propranolol
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10
Q

Why does knee-chest/squat help tet spell

A

– increases afterload thus decreasing R to L shunting

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11
Q

Complications of Fontans

A 
• Arrhythmias
– Sinus node dysfunction 
– Atrial flutter/SVT
• Cyanosis
– Collaterals
– Pulmonary AVM’s
• Protein Losing Enteropathy 
• Plastic Bronchitis
• Thromboembolism
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12
Q

What are pathologic murmurs

A

diastolic, holosystolic, late systolic, continuous

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13
Q

Still’s murmur

A

– short ejection systolic murmur
– musical or vibratory quality
– heard best between apex and left sternal border

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14
Q

Physiologic pulmonary flow murmur

A

– located at pulmonic area,
– age 3 years onward
– usually soft systolic ejection murmur, grade I-II in intensity
– well localized to the upper left sternal border.
– louder when the patient is supine or when cardiac output is increased
– must be differentiated from murmurs associated with pulmonary stenosis, ASD, and peripheral pulmonary artery stenosis.

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15
Q

Peripheral pulmonary arterial stenosis

A

– Newborns (up to 3 mo)

– low-intensity systolic ejection murmur best in lung fields, also back

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16
Q

Rheumatic fever

  • prophylaxis
  • how long
A

• Benzathine Penicillin G IM every 3-4 weeks
• Oral Penicillin V 250 mg BID (Sulfadiazine or
Erythromycin if allergic)

  • Without carditis: up to 5 years after last acute episode or until age 21 years, whichever longest
  • Carditis without sequelae: 10 years from last acute episode or age 25 years
  • Carditis with residual valvar lesions: at least age 40 years or life-long
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17
Q

Pompe disease

A

Cardiomegaly, increased wall thickness, supraventricular tachycardia, short PR interval, extremely tall high QRS voltages.

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18
Q

Infective endocarditis

- bugs

A

– Alpha-hemolytic streptococcus
– Staphylococcus aureus
– Coagulase neg staphylococcus
– Beta-hemolytic streptococcus – Candida

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19
Q

Infective endocarditis

- diagnostic criteria

A

2 major
1 major and 3 minor
5 minor

Major:

1) Positive BCx (need 2 separate w bugs that cause endocarditis)
2) Evidence of endocardial involvement (echo)

Minor:

1) Predisposition (heart dz or IVDU)
2) Fever >/= 38
3) Vascular phenomenon
4) Immunologic phenomenon
5) Microbiologic evidence (Bcx not meeting above criteria)
6) Echo findings (not meeting above criteria)

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20
Q

Infective endocarditis

  • what type of surgery do you prophylaxis for
  • who needs prophylaxis
A
  • all dental procedures that involve manipulation of gingival tissues or periapical region of teeth or perforation of oral mucosa
  • procedures on respiratory tract or infected skin, skin structures or musculoskeletal tissue

1) Prosthetic cardiac valve
2) Previous IE
3) CHD:
- unprepared cyanotic CHD
- repaired CHD 6 mo after repair
- repaired CHD w residual defects at site or site adjacent
4) Cardiac transplantation recipients w cardiac valvulopathy

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21
Q

Emergency Treatment of VT

A
  • Synchronized cardioversion
  • Intravenous Lidocaine
  • Intravenous Amiodarone
  • Correct underlying etiology if evident
  • Others: Procainamide, Magnesium
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22
Q

interrupted aortic arch is most likely to have which genetic condition

A

22q11

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23
Q

chest pain worse when supine

A

pericarditis

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24
Q

Red flags for cardiac cause of syncope

A 
With exercise
not assoc w prolonged standing
No prodrome
Hx palpitations
Chest pain
Dyspnea
Fhx of death at young age
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25
EKG findings of hyperkalemia
1) Peaked T waves 2) P wave widens and flattens, eventually disappears PR segment lengthens 3) ST segment depressed 4) Sine wave pattern
26
AV block - types
1st degree: - Prolonged PR 3rd degree: - complete heart block - A and V dissociated
27
What is the most common cyanotic CHD
Tetrology of Fallot
28
Long QT syndrome - first line treatment
BBlockers
29
Most common cause of death in adolescent athletes?
Hypertrophic cardiomyopathy
30
2 causes of neonatal heart block
Neonatal Lupus | Maternal Sjogren’s
31
SVT - EKG
``` HR > 180/220 No variability of HR Absent P waves Narrow QRS (<0.08s) Abrupt onset/offset ```
32
SVT treatment stable (1st, 2nd and 3rd line) unstable
Stable Adenosine 0.1 mg/kg Amiodarone Procainamide Unstable Syncronized cardioversion 0.5-1 J/kg
33
Ventricular Tachycardia No Pulse -tx
1st Shock 2J/kg 2nd shock 4J/kg 3rd shock 4J/kg Amiodarone
34
What is abnormal on CCHD screen? Borderline?
Abnormal: Sat < 90% R hand or foot Borderline: 90-94% in R hand or foot OR >3% difference between R hand and foot
35
Mgmt of a tet spell
Knee to Chest (inc. SVR) 100% Oxygen (dec. PVR) Morphine 0.1-0.2mg/kg IM (dec PVR) Fluid Bolus 10-20ml/kg Phenylephrine 10mcg/kg slow IV push (inc. SVR)
36
Why do ASD have split S2?
Prolonged RV ejection
37
William Syndrome
supravalvular aortic stenosis, | truncus arteriosus & hypercalcemia
38
Anomalous left coronary artery from the pulmonary artery (ALCAPA) - what is it - what can it lead to - EKG
an anomalous coronary artery branches off the aorta thus providing deoxygenated blood to the heart myocardial ischemia Q waves in leads I, aVL, V5 and V6
39
22q11 - cardiac findings
tetralogy of fallot truncus arteriosus VSD interrupted aortic arch
40
Fontan procedure - complications
``` Arrhythmia Cyanosis Protein losing enteropathy Plastic Bronchitis Thromboembolism ```
41
What is WPW associated with
Ebsteins anomaly
42
What’s the most common cyanotic congenital heart defect to present in the neonatal period?
TGA
43
What can cause prolonged QT
Low Ca low Mg low K drugs (TCAs, macrolides)
44
Venous hum
systolic/diastolic murmur heard in the infraclavicular region (usually right sided) in a sitting or standing patient. Disappearance when the patient lies down or when the examiner applies gentle pressure over the jugular vein = diagnostic Murmur is caused by blood cascading down the jugular vein
45
IDM - cardiac complication | - prognoisis
hypertrophic cardiomyopathy | will resolve with time
46
Clinical signs of Endocarditis
Tachycardia Embolic phenomenon (Roth spots, petechial rash, splinter nail bed haemorrhages, Osler nodes, CNS or ocular lesions) Janeway lesions
47
Risk factors for endocarditis
Structural heart disease Rheumatic Heart Disease (most common in developing countries) IV drug use Presence of an indwelling catheter
48
ST elevation in V1-3
Brugada syndrome complication Sudden death secondary to ventricular arrhythmias
49
what's most important to monitor for when giving prostaglandin?
hypoventilation/apnea ``` also: hypertension fever flushing tacky/bradycardia ```
50
POTS
Postural orthostatic tachycardia syndrome | HR increase of >40 beats/min during the 1st 10 min of upright tilt test without associated hypotension
51
Long QT syndrome | mgmt
Start BBlocker | Restrict vigorous activity
52
Investigations for cyanotic congenital heart disease
``` CXR ECG Echo Hyperoxia test Pre and post ductal sats ```
53
With hypertension, when do you have to restrict actvitie
significant LVH
54
Marfan Cardiac findings most common most deadly
Most common: Aortic dilation MVP
55
PPHN | -predisposing factors
``` birth asphyxia, MAS, early onset sepsis, RDS, hypoglycemia, polycythemia, maternal NSAID use with PDA construction, maternal 3rd trimester SSRI use, pulmonary hypoplasia 2ndary to CDH, oligohydramnios, amniotic fluid leak, pleural effusion ```
56
Mgmt of hypertrophic cardiomyopathy
- Competitive sports and strenuous physical activity should be prohibited (most sudden deaths occur during or immediately after vigorous physical exertion) - Beta-adrenergic blocking agents (propranolol, atenolol) or CCB (verapamil) may be useful in diminishing ventricular outflow tract obstruction, modifying ventricular hypertrophy and improving ventricular filling - Innovative interventional procedures to anatomically or physiologically reduce degree of LVOT obstruction has been used
57
indomethacin side effects
(suppresses renal, cerebral and gastrointestinal blood flow ) - NEC and spontaneous intestinal perforation - transient renal insufficiency - increased bleeding risk - kernicterus (theoretical risk - interfere with binding of albumin to bilirubin)
58
Congenital cyanotic heart disease w decreased pulmonary BF
``` PA PS TOF Ebstein anomaly tricuspid atresia ```
59
Single S2?
HLHS
60
First step in mgmt of Coarctation
PGE infusion
61
Marfan's inheritance
AD
62
Acute rheumatic fever | - dx
Dx = GAS evidence + (2 Major or 1major+2minor) ``` Major: Arthritis (migratory) Carditis Subcutaneous nodules Erythema marginatum Sydenhams chorea ``` ``` Minor: Arthralgia Fever Prolonged PR Elevated CRP ```
63
Complication of Prolonged QT
torsades
64
WPW assoc with which CHD
ebsteins | TGA
65
PPHN | - what worsens pulmonary vascular resistance
hypoxia hypercapnia acidosis cold
66
Causes of PPHN
MAS | RDS
67
Noonan syndrome CHD
pulmonary valve stenosis
68
CXR snowman
TAPVR
69
digeorge
interrupted aortic arch Right-sided aortic arch TOF conotruncals branchial aortic arch defects (aortic arch)

*Review TD 2020 (16 decks)

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