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ctjghjkbgf > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Compression and ventilation rate during CPR

A

8-10 breaths during CPR

15:2, 100-120 compressions/ minute

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2
Q

Characteristics of effective CPR

A

push hard (1/3 chest diameter), fast (100-120), full chest recoil, minimize interruptions (< 10 sec), change rescuers every 2 minutes

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3
Q

List 4 drugs that can be given via ETT

A

LEAN (lidocaine, epinephrine, atropine, naloxone)

10X usual dose of epi: 0.1 mg/kg of 1:10000

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4
Q

Which size of pads to use on defibrillator?

A

Adult pads of defibrillator can be used for > 1 year old, weight > 10 kg

Infant pads if < 1 year old / 10 kg

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5
Q

Which dose to use on AED?

A

> 8 years old: deliver adult dose (150-200J)

1-8 years (< 25kg): use dose-attenuation if available - delivers 50J

< 1 year old – manual defib preferred, but use AED if that’s all that’s available (insufficient evidence)

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6
Q

Good prognostic factors for CPR (list 5)

A

o In hospital arrest (witnessed)
o Early recognition/intervention and initiation of CPR
o High quality CPR
o Good post arrest myocardial function
o Good health status prior to arrest/no underlying cardiac pathology
o ?Return of ROSC in <30 min

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7
Q

Medications to use to treat SVT

A

Adenosine is 1st line

Alternatives = verapamil (CCB, myocardial depression/arrest), procainamide, digoxin, beta-blockers

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8
Q

List the types of shock (list 6)

A

o Obstructive (tamponade, PTX, PE, CHD)
o Hypovolemic (hemorrhage, fluid loss, burns)
o Cardiogenic
o Distributive (sepsis, anaphylaxis, drug ingestions)
o Neurogenic
o Dissociative

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9
Q

Formula to calculate blood pressure

A

BP = CO x SVR

CO = SV x HR
SV depends on preload, afterload, contractility

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10
Q

Characteristics of warm vs. cold shock

A

‘Cold’ Shock: mottled skin, cool extremities, prolonged capillary refill, weak pulses. Most common in pediatric patients.

‘Warm’ Shock: warm extremities, flash cap refill, bounding pulses, wide pulse pressure. Most common in adults.

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11
Q

Definition of SIRS

A

Inflammatory response with 2 or more of following criteria (one of which must be abnormal temperature or leukocyte count):

a. Core temperature >38.5°C or <36°C
b. Tachycardia (or bradycardia if younger than 1 year of age)
c. Tachypnea
d. Increased or decreased leukocyte count

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12
Q

3 ways to administer IV fluids rapidly

A

push-pull syringes, rapid infuser, pressure bag

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13
Q

First line vasopressor

A

o Cold shock: epinephrine

o Warm shock: norepinephrine

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14
Q

Management of catecholamine-resistant shock

A

o Sedate and ventilate (avoid etomidate in septic shock)
o Stress-dose steroids (50-100 mg/m2 of hydrocortisone)
o ECMO

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15
Q

Work-up of cyanotic patient

A

o Arterial PO2
o CBC, metHg level, Carboxyhemoglobin (co-oximetry)
o +/- blood cultures
o +/- CXR, EKG, echo

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16
Q

List 6 cyanotic CHD’s

A 
truncus arteriosus
TGA
tricuspid atresia
TOF
TAPVD
HLHS
critical AS, PS
pulmonary atresia with intact ventricular septum
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17
Q

List 4 characteristics of pathologic murmurs

A
  • diastolic
  • grade 3 and above
  • radiates to axilla, carotids
  • harsh quality
  • heart sounds obscured
  • doesn’t change with position
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18
Q

Physical exam findings of mitral valve prolapse

A

Mid-systolic click and late systolic murmur

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19
Q

Cardiac findings of Marfan’s

A

aortic dilation/ dissection

mitral valve prolapse (up to 50%)+ cardiomyopathy with bilateral ventricular enlargement

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20
Q

Drug/tox causes of chest pain

A

cocaine, methamphetamine, nicotine, triptans, cold medicines, herbal meds

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21
Q

What is Tietze syndrome?

A

benign inflammation of costochondral junction (looks like a mass on the chest wall)

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22
Q

What is slipping rib syndrome?

A

8-10th ribs attached by fibrous band and rub on each other. Popping/clicking, exacerbate pain by hooking lower ribs by the hand and pulling anteriorly

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23
Q

What are the characteristics of precordial catch?

A

common in healthy teens, very brief sharp twinges of chest pain, often relived by position (ie. sitting up straight)

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24
Q

Red flags for chest pain in children (list 6)?

A

acute, crushing, radiation to left arm, awakens at night, associated with exertion, syncope, fever, fatigue, dyspnea, decreased exercise tolerance, palpitations

  • associated with high risk conditions – KD, CF, collagen vascular disease, malignancy
  • Family history of sudden cardiac death
  • Drug use
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25
Q

Clinical characteristics and treatment of POTS?

A

postural orthostatic tachycardia syndrome. Teen girls, chronic fatigue, orthostatic tachycardia, without hypotension. Dx with tilt-table testing

Treatment: hydration, avoid caffeine, inc. salt intake, elevate HOB, reconditioning program

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26
Q

Most common arrhythmia of childhood?

A

Premature atrial contractions (PAC’s)

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27
Q

List 3 concerning features of PVC’s?

A

o Multiform/multifocal PVC’s (ie more than one shape) – may indicate CPVT or ARVD
o PVC’s occurring in couplets
o Increased frequency with exercise

28
Q

List 5 cardiac conditions associated with PVC’s

A 
●	Prolonged QT interval 
●	Cardiomyopathy
●	Myocarditis
●	Myocardial contusion 
●	MI/Ischemia 
●	Mitral valve prolapse
●	Ebstein's anomaly
●	Cardiac tumours
●	Post operative state (especially Tetralogy of Fallot)
29
Q

List 5 NON-cardiac causes of PVC’s

A 
●	Hypoxia and or hypercapnia 
●	Acidosis
●	Hypoglycemia
●	Hypokalemia 
●	Hypomagnesemia 
●	Hypercalcemia 
●	Medications – digoxin, phenothiazines, sympathomimetics
30
Q

List 4 ingestions associated with palpitations

A

caffeine, diet supplements, herbal preparations, sympthomimetics, cocaine, amphetamines

31
Q

List 3 non-cardiac causes of palpitations/ tachycardia

A

anemia, anxiety, exercise, fever, drug-induced, emotional arousal

32
Q

How to measure QTc (and name of the formula)

A

QTc = QT/ sq(RR) > 450 msec (Bazzett’s formula)

measure in lead II or V5/V6

33
Q

List 5 acquired causes of long QT

A

HypoMg, hypoK, HypoCa, hypothyroidism, eating disorders, drugs (sotalol, haloperidol, methadone, pentamidine + many others)

34
Q

Activity recommendations for long QT

A
  • No driving
  • No swimming unattended
  • No baths unattended
  • Avoid intense exercise
  • Until type of Long QT identified: No diving into cold water, loud or sudden noises
35
Q

Starting dose of prostaglandins, and list 3 side effects

A

0.05-0.1 mcg/kg/min (0.01 only if known open ductus, not in shock)

Titrate until palpable femoral pulses, or O2 sats improve. Effect seen within 30 min

Side effects: hypotension, apnea, fever, rash

36
Q

3 stages of palliation for HLHS?

A
  1. Norwood/BT shunt at birth– subclavian to pulmonary artery
  2. Bidirectional Glenn at 3-6 months – SVC to pulmonary artery
  3. Fontan at 2 years old – SVC and IVC to PA
37
Q

How to perform hyperoxia test

A

apply 100% O2 for 10 min then perform an ABG
o PO2 > 150 = normal
o PO2 < 100 = CHD

38
Q

Pathophysiology and treatment of a Tet spell

A

acute increase of RVOTO, preventing blood flow to the lungs. All blood then shunted R –> L, extreme cyanosis.

o Knees to chest / squatting (increases SVR)
o 100% oxygen
o Morphine 0.1 mg/kg (dec agitation)
o NS bolus 5-10 cc/kg (inc preload)
o IV phenylephrine infusion (alpha-agonist, inc SVR)
o Propanolol (beta blocker, relaxes infundibular septum)

39
Q

When NOT to give adenosine

A

Do NOT give adenosine to wide complex, irregular rhythm ie. A.fib with WPW –> blocking AV node can allow conduction via accessory pathway –> V fib.

40
Q

List complications/ contraindications to adenosine

A
  • A. fib with WPW ie. Wide complex irregular rhythm (can lead to V. fib)
  • heart transplant (give 1/3 regular dose)
  • may cause bronchospasm in asthmatics
41
Q

4 causes of wide complex, regular tachycardia

A

VT
SVT with aberrancy
sinus tachycardia with aberrancy/ BBB
antidromic WPW

42
Q

List 4 causes of sinus bradycardia

A

sick sinus syndrome, intoxication (beta-blockers, CCB, seizure meds, sedation meds), hypothyroidism, anorexia nervosa, myocarditis, PAC’s

43
Q

List 4 causes of sudden cardiac death

A
  • Hypertrophic cardiomyopathy (HCM)
  • ALCAPA – can present in infancy when PVR drops, or later in life with ischemic symptoms, SCD
  • Channelopathies: CPVT, LQTS, Brugada syndrome
  • WPW (0.1 % - a. fib –> VF through accessory pathway)
44
Q

List 4 symptoms of CHF in a neonate

A

tachypnea, tachycardia, hepatomegaly, cardiomegaly, crackles, feeding difficulty

45
Q

Etiology of myocarditis?

A

Viral #1 (coxsackie, echovirus, adenovirus, EBV, CMV), also autoimmune, meds, toxic, vasculitis

46
Q

Clinical characteristics of myocarditis?

A

Tachycardia out of proportion to fever, pallor, cyanosis, resp distress, muffled heart sounds, gallop rhythm, hepatomegaly

47
Q

EKG changes seen in myocarditis?

A

sinus tachycardia, low voltage QRS complexes, inverted or low-voltage T-waves

48
Q

Etiology of pericarditis?

A
  • Usually viral cause (coxsackie, echovirus, adenovirus, influenza)
  • Bacterial causes: Staph aureus, strep pneumoniae, H. flu, N. meningidites, TB
  • Other causes: post-pericardiotomy syndrome, acute rheumatic fever
49
Q

4 stages of EKG in pericarditis?

A
  1. diffuse ST elevation and PR depression
  2. normalizing ST and PR intervals
  3. T waves flatten –> invert
  4. T waves normalize
50
Q

CXR and echo findings in pericarditis?

A

CXR: cardiomegaly, or normal, pulmonary edema if failure

Echo: pericardial effusion, +/- tamponade, dec contractility

51
Q

What are the components of Beck’s triad? What condition is it associated with?

A

Tamponade

hypotension, muffled heart sounds, JVD

52
Q

4 indications for the use of amiodarone?

A

pulseless Vtach, Vtach with a pulse, V fib, SVT with aberrancy / transient responsive to adenosine (2nd/3rd line agent)

53
Q

What is the mechanism of action of amiodarone, how can it induce arrest?

A

Class 3 antiarrhythmic – K channel blocker. Prolongs QT interval and can induce arrest

54
Q

4 complications of myocarditis?

A
  1. Dilated cardiomyopathy (acute)
  2. CHF
  3. Pulmonary edema
  4. Arrhythmias, cardiac arrest
55
Q

4 basic steps of using an AED?

A 
POWER ON the AED
Attach electrode pads
Analyze rhythm
Charge the Shock
Clear the victim and press the SHOCK button
56
Q

List 5 cardiac problems in Anorexia nervosa

A 
Structural changes 
●	Decreased cardiac mass
●	Reduced cardiac chamber volumes
●	Mitral valve prolapse
●	Myocardial fibrosis
●	Pericardial effusion
Functional changes 
●	Bradycardia
●	Hypotension
●	QT dispersion (variability in QT interval between ECG leads)
●	Diminished heart rate variability 
●	Long QT syndrome
57
Q

List 2 endocrine causes, 2 drug/toxin causes and 2 cardiac causes of palpitations.

A

2 endo: hyperthyroidism, pheochromocytoma, hypoglycemia

2 drugs, toxins: anticholinergics(benadryl, atropine), sympathomimetics (cocaine, methamphetamines)

2 cardiac: SVT, ventricular tachycardia

58
Q

List 8 causes of PEA

A 
H's and T's:
●	hypoxia
●	hypo/hyperkalemia
●	H+ ions (acidosis)
●	hypovolemia
●	hypoglycemia
●	hypothermia
●	Toxins
●	Trauma
●	Tension pneumothorax
●	Tamponade
●	Thrombosis
59
Q

Dose for synchronized cardioversion?

A

1st attempt -> 0.5-1 joule per kg

60
Q

Dose of epinephrine in cardiac arrest

A

0.01mg/kg or 0.1ml/kg of 1:10,000

61
Q

Dose for defibrillation?

A

2-4J/kg

62
Q

What is the calculation for circulating blood volume in neonates?

A

80 ml/kg

63
Q

When is hypotension seen in children with acute blood loss?

A

Hypotension is a late finding in acute blood loss occurring in Class III or class IV hemorrhagic shock (>30% total blood volume loss)

64
Q

2 cardiac complications of JIA?

A

Pericarditis, small Pericardial effusion, myocarditis, KD-like: coronary artery dilatation

65
Q

2 cardiac complications of sickle cell?

A

Cardiomyopathy (resulting in MI and decreased output), LVH, 1st degree block, prolonged QT, nonspecific ST-T wave changes

66
Q

Incidental murmur in 3 month old baby- what 2 things on history that make you concerned for significant congenital heart disease

A

episodes of cyanosis/hypoxia/diaphoresis

failure to thrive (poor weight gain or poor feeding)

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