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Cardiology Flashcards

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1
Q

What cardiac lesions present in the 24 hours of life critically unwell?
Why these ones?

A
  • Ebstein anomaly
  • obstructed TAPVD

Severe lesions
Duct is still open- more resp than cardio lesions

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2
Q

What murmurs may present in the first 24 hrs of life?

A

AS PS or AV REGURG

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3
Q

Which cyanotic lesions can present in the first 24 hrs of life?

A

TGAs, single ventricle hearts

Mixing lesions

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4
Q

What are the three main reasons duct dependant lesions present?

A

Depend on the pda for plum flow, systemic flow mixing

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5
Q

When do duct dependant lesions present?

A

24 hrs to 2 weeks

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6
Q

Using the three subgroups, what are examples of duct dependant lesions

A

1) need pda for pulm flow
- severe ps
- pulm atresia
- above in single ventricle

2) need pda for systemic flow
- severe co-arc
- critical as
- HLHS

3) need pda to mix
- TGA

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7
Q

How do lesions at 2-6 weeks present?

A

Congestive cardiac failure

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8
Q

What are examples of lesions presenting at 2-6 weeks

A

Severe vsd or pda
Truncus
Tof with pulm atresia

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9
Q 
dTGA
How does it present 
- murmur
-s2
-CXR
-ECG

Initial management
Repair and timing

A

Cyanosis from birth, fails hyperoxia test

  • none!
  • single
  • egg on a string with increased pulm markings
  • RVH

Prostaglandin
Septostomy then atrial switch-4 weeks

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10
Q

L-TGA
why is it different?
How does it present?

A

Ventricles swap over with the great vessels

Asymptomatic unless associated with another defect

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11
Q

D-TGA

What other lesion is commonly found and how frequently

A

1/3 have coronary artery anomalies

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12
Q

Tricuspid atresia
How do they present
What is seen on ECG

A

Cyanotic at birth with murmur of VSD

Superior axis and LVH (therefore not AVSD)

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13
Q

Ebstein anomaly

Outline the anatomy

A

Hugely dilated right atrium
Abnormal valve
Arterialised ventricle

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14
Q

TOF

What are the 4 lesions?

A

VSD
r ventricle outflow obstruction
Overriding aorta
RVH

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15
Q

In a TOF what determines the degree and magnitide of the shunt?

A

Degree of pulm stenosis

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16
Q

TOF

What are the two ways they can present

A

Blue- Murmur at birth. Progressive cyanosis. Tet spells from 2 months

Pink-Acyanotic- signs of heart failure later

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17
Q

Cyanotic TOF- what is the murmur
S2?
What does the murmur correlate to

A

Long Loud
Ejection systolic with ejection click
Single s2
The pulm stenosis

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18
Q

TOF
ECG findings
Chest X-ray findings

A

RAD and RVH

Boot shaped heart with reduced pulm markers

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19
Q

Physiologically what does a tet spell indicate? Will there be a murmur?

A

Acute right to left shunting

No!!

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20
Q

When will a TOF not have a murmur

A

If there is pulm atresia

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21
Q

How can TOF be conservatively managed (3 things)

When is definitive surgery normally done? What 3 things might make it necessary to do earlier

A

Beta blockers, balloon dilatation of outflow tract obstructions
Modified BT Shunts

6-12 months
Not growing, low sats, lots of TET spells

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22
Q

What maternal medication is ebstein associated with

What arrhythmia is the baby likely to have?

A

Maternal lithium

WPW

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23
Q

Ebstein

What is seen on ECG

A

RAH and likely WPW

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24
Q

Truncus

Outline the anatomy

A

Single trunk overlying a VSD

Abnormal truncal valve

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25
Truncus- what is the murmur | ECG
To and fro murmur- diastolic of truncal regurgitation, systolic of VSD Biventricular hypertrophy
26
Truncus- what syndrome is normally associated
Di George
27
How is truncus repaired (2 methods)
PA banding | Rastelli repair
28
How does TAPVD present- 2 ways | Which type is obstructed
Obstructed- cyanosis from day 1 of life and v unwell Non obstructed- mild cyanosis, mid diastolic rumble and recurrent chest infections Infra diaphragmatic
29
Non obstructed TAPVD- CXr?
Snowman in a snowstorm
30
HLHS | What other lesion is commonly associated?
Severe co-arctation
31
HLHS- how will it present
``` Duct dependant- Cyanosis when duct closes Impalpable femoral No murmurs Single s2 ```
32
Why should sats be kept around 80% in HLHS
Keep pulm vascular resistance high
33
HLHS outline the steps in the staged Norwood
1- make an asd, BT shunt (svc to r PA) and connect pulm artery to aorta (right subclavian) 2- shunt down, svc to r pa (Glenn) 3- ivc to r pa with gortex or suture atrium to ventricle (fontan)
34
AS and PS- where are the murmurs and where do they radiate
Aortic upper right- to neck | Pulm upper left- to back
35
Avsd - ecg findings - partial vs complete
- superior axis - both have mr and primum asd - complete also has a vsd
36
What percentage of VSDs close spontaneously
90% if small | 65% otherwise
37
Which type of Vsd Is more common
Membranous
38
How do large VSDs present | What other murmur might you hear and what does it indicate
When pulm vasc resistance falls (week 2-6) Heart failure Pansystolic murmur Widely split s2 Mid diastolic rumble of relative mitral stenosis
39
What might be an interim surgical technique for VSDs? What can an unrepairwd VSD cause
PA banding- protects the lungs Aortic regurgitation
40
What ratio of qp to Qs indicates the need for surgery?
2:1
41
What are the three types of ASD Where are they found Which is most common
Secundum- at the foramen ovale- most common Primum- endocardial cushion Sinus venison- at the entry of the SVC
42
What murmur and heart sounds are heard in ASD
Fixed split s2 | Ejection systolic murmur
43
What syndrome is supravalvular aortic stenosis associated with What syndrome is a bicuspid aortic valve associated with
``` Williams syndrome (high pitched cry therefore high lesion) Turners ```
44
Aortic stenosis Outline the pathology What is the classical murmur
Tight aortic valve, hypertrophy of the left ventricle, dilation of the aorta Ejection systolic, upper, crescendo/decrescendo radiating to the carotid
45
How does severe AS present | How does critical AS present
Loud murmur with narrow pulse pressure | No murmur but single s2 or narrow split. Poor perfusion. Failure at birth. Can be cyanotic
46
Severe AS How will the ECG look What is seen in CXR
LVH | Prominent aortic notch (right sided). Normal lung fields
47
``` PS What type of lesion is seen in Noonan syndrome Alagille syndrome Rubella infection What other 2 syndromes are associated ```
Noonan- valvular Alagille- peripheral (branch) Rubella- supravalvular NF1 and Williams
48
Pulmonary stenosis | What is the murmur and s2
Upper left eternal edge radiating to the back | Widely split s2
49
PS | What is seen on ecg and cxr
RVH | Prominent pulmonary arch (left sided)
50
Coarctation | What syndrome are they associated with
Turners
51
Coarctation | How do they present in older children.
Headaches Hypertension Murmur at the interscapular area
52
Coarctation | How do they present if severe in babies
No murmur Differential cyanosis Thready peripheral pulses Loud and single s2
53
Coarctation | What is seen on cxr
Inverted E (rib notching)
54
Why will an interrupted arch not present with differential cyanosis Which syndrome is it most likely associated with
Usually have another mixing lesion like a VSD | Di George
54
What is the normal function of the ductus arteriosis and when does it physiologically and anatomically close
Blood from the pulmonary artery into the aortic arch Phys-10-15 hrs of life Anatomically- 2-4 weeks
56
PDA In term babies what does it act like What therefore dictates the direction and severity
An unrestricted VSD | Pulmonary vascular resistance
57
PDA | how and when does a large PDA present in term babies
``` When svr reduces (2-6 weeks) Machinery murmur at the interscapular region Differential cyanosis Bounding pulses Recurrent infections ```
58
PDA What direction is the shunt normally What can happen with a large shunt
Left to right | Also right to left shunting
59
PDA | How is it normally closed in term babies
Via catheter | Surgical
60
PDA | How does it present in preterm babies
Difficult to wean off vent in hyaline membrane disease Continuous systolic murmur at ULSE Bounding pulses
61
What is used to close a pda in premature babies How does it work (2 mechanisms) Side effects
Indomethacin Inhibits COX and PGE2 GI bleeding Hyponatraemia Reduced renal or cerebral blood flow
62
PDA in preterm | When is surgery indicated
If 2x failed attempts at indomethacin
63
Rheumatic fever | How many positive criteria are needed to make the diagnosis
2 major or 1 major and 2 minor
64
What are the mnemonics to remember major and minor criteria in rheumatic fever?
``` Joints O- carditis- sleeping tachy new murmur or conduction defects N- nodules E- erythema marginatum S- Sydenham’s chorea ``` H- hot- fever E- elevated esr or crp L- arthralgia P- PR interval
65
Which valve is most likely to be involved in acute rheumatic fever
Mitral
66
How many positive criteria do you need to diagnose Kawasaki | What are the 5 criteria
Fever more than 5 days plus 4 criteria ``` Non purulent conjunctivitis Unilateral cervical lymphadenopathy Desquamation Strawberry Polymorphic rash ```
67
When do plt elevate in Kawasaki | When is the highest risk phase for coronary artery aneurysms
10d-4w | This stage!!
68
Treatment of kawasaki How long is the aspirin continued for Which MAB might be used in refractory cases
3-4 days or until day 14, whichever comes first | Infliximab
69
IE What is the most common cause on normal valves Damaged valves
Staph epi | Strep viridians
70
What is the cause of brugada syndrome What is seen on ecg What happens
AD Na channel defect ST elevation with negative p wave in v1& 2 Sudden death in sleep
71
What are the 2 differences between jervell Lange nelson and Romano ward
JLN-AR and has SN hearing loss | RW- AD no hearing loss
72
What 3 groups of meds/ chemicals can prolong your QT
1) antipsychotics 2) antibiotics- trimethoprim and erythromycin 3) organophosphates
73
What triggers the following prolonged QT syndromes 1,2,3,4 Which electrolyte imbalance is most likely Which condition is LQT 5
1- fun e.g. swimming 2- boo- emotion 3- sleeep 4 unknown Prolonged K efflux Romano ward
74
How is TOF treated medically
``` Try to increase the SVR Knees up O2 Morphine IV propranolol Iv phenylephrine Emergency shunt or repair ```
75
Svt and cardio version | How do you prevent VT from happening
Synch to the r wave
76
Which asthma drug can cause torsades IN Patients with long QT
Theophylline
77
What medication is given to treat long QT associated with TCA OD
Sodium bicarbonate
78
When is VSD repair contraindicated? | Why?
Severe pulm hypertension | Increased mortality with reduced cardiac output
79
What is the most common cardiac defect seen with na valproate use?
ASD
80
Fetal cardiac circulation | What do the umbilical arteries and veins carry
Arteries- deoxygenated blood from iliac arteries back to the placenta Vein- oxygenated blood to the ductus venosus in the liver
81
What are 2 potential causes of complete vascular rings? How do they present? What is seen on bronch?
Double aortic arch with or without ligamentum Wheeze and stridor from 3m. Later if septum Bilateral compression- pulsatile
82
Incomplete rings What are 2 asymptomatic ones What causes a vascular sling? What is seen on bronch What is seen with anterior tracheal compression
Aberrant left coronary, anomalous right subclavian Anomalous left pulm artery. Deviated trachea Anomalous innominate
83
``` What is the mechanism of the following anti arrhythmics and give examples Class 1 Class 2 Class 3 Class 4 ```
1 sodium blockers- c=flecainide 2- beta blockers- atenolol 3- k blockers- sotalol and amiodarone 4- calcium blockers- verapamil
84
How does digoxin work
Blocks k-ATPase pump | Causes increased contractility
85
Which 2 antiarrhythmics do you never use in WPW
Digoxin and verapamil
86
How are prolonged QT syndromes treated
Beta blockers and ICDs
87
Prolonged QT What is the most likely AD cause What is a cause with associated bilateral SN hearing loss? What is its inheritance
Romano ward | Jervell Lange Nelson-AR
88
Coarctation what is seen on the ECG of infants vs older children
Infants- RVH | Children- LVH
89
Long QT | what triggers type 1,2 and 3 and what shape of QT is seen. Which channels do they involve
1-fun- swimming. Long wide QT. K channels 2- boo- emotion- m shaped QT. K channels 3- sleep- Na channel- narrow and late Qt
90
What are the mean features of right and left isomerism
Left- multiple left lungs and multiple spleens | Right- multiple right lungs and absent spleen
91
What is the difference between the timing of ASOT and DNAse tests?
ASOT- positive for 1-4 weeks | DNAse- positive 4-6w
92
What are the 4 main indications for endocarditis prophylaxis
Previous endocarditis Metalware <6m from last repair Cyanotic disease
93
What does prostaglandin do and how | What are three main side effects
Keeps the ductus arteriosis open- general vasodilator | Reduced plt aggregation, apnoea, tachy or Brady cardia
94
Which 2 lesions have ejection clicks
Aortic and pulmonary stenosis
95
What is seen on ECG of L-TGA
LAD and abnormal Q waves in right sided leads

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