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Paeds Exam Cram > Cardiology > Flashcards

Cardiology Flashcards

(104 cards)

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1
Q

ECG squares

A

Small square = 1mm = 0.04sec

Big square = 5mm = 0.2sec

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2
Q

ECG axis

A

Look at lead I + aVF

Lead I + aVF positive = normal axis
Lead I positive + aVF negative = left axis deviation (always abnormal)

Lead I negative + aVF positive = right axis deviation
Lead I negative + aVF negative = north west axis deviation (always abnormal)

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3
Q

P waves

A

3mm tall + 2mm wide

Tall P wave = right atrial hypertrophy
Wide P wave = left atrial hypertrophy

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4
Q

PR interval

A

3-4/4-5mm

Short = Wolf Parkinson White
Long = first degree heart block, myocarditis, high potassium
Variable = second degree heart block Mobitz 1, second degree heart block Wencheback 2, third degree heart block
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5
Q

QRS

A

Low amplitude = pericarditis, myocarditis
High amplitude = ventricular hypertrophy

Narrow <2mm = SVT
Broad >3mm = bundle branch block, Wolf Parkinson White

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6
Q

ECG - Right ventricular hypertrophy

A

RAD
Tall R aVR, V1
Deep S V5, V6
Upright T V1, V3, V4R

8do-8yo: TOF, VSD, PVS, CoA - newborn

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7
Q

ECG - Left ventricular hypertrophy

A

LAD
S V1 > 2x R V5, R V5 + V6 (taller)
S V1 > V6

AS, CoA, HOCM, AR, MR

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8
Q

ECG - LBBB

A

AS
High K
WPW
Dilated cardiomyopathy

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9
Q

ECG - RBBB

A

RVH
Myocarditis
CHD
TOF repair

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10
Q

QT

A

Short: hypercalcaemia
Long: congenital, hypocalcaemia, myocarditis, drugs

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11
Q

T waves

A

Upright V1-3: <8d >8y (if upright in between = RVH)
Peaked: hyperkalaemia, LVH
Flat: normal, hypokalaemia, pericarditis, myocarditis
Alternating: long QT

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12
Q

ECG - Pericarditis

A

ST elevation
PR depression
Flat T waves

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13
Q

ECG - Myocarditis

A

Long PR
Low amplitude QRS
Low amplitude T waves

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14
Q

ECG - Hypokalaemia

A

Flat T waves
Long QT
U waves

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15
Q

ECG - Hyperkalaemia

A

Peaked T waves

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16
Q

ECG - Wolf Parkinson White

A

Short PR
Qide QRS
Slurred upstroke QRS (Delta waves)

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17
Q

ECG - ALCAPA

A

ST elevation

Inverted T waves aVL, V5, V6

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18
Q

ECG - APVD

A

RAD
RVH
RAH

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19
Q

ECG - Aortic stenosis

A

LVH

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20
Q

ECG - ASD

A

Primum: superior axis
Secudum: RBBB, RAD, first degree heart block 50%

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21
Q

ECG - VSD

A

Small: normal
Moderate: LVH
Severe: RVH

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22
Q

ECG - CoA

A

<6m: RBBB/RVH

>6m: LVH or RBBB

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23
Q

ECG - Ebstein

A

RAH
RBBB
RVH disappears when exercising

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24
Q

ECG - HLHS

A

RVH

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25
ECG - MS
RAD RVH RAH
26
ECG - PDA
Moderate: LVH Large: LAH Severe: RVH
27
ECG - TOF
RAD | RVH
28
ECG - Tricuspid atresia
Superior QRS | LVH
29
ECG - TGA
RAD RVs + LVH Complete heart block
30
SVT
Retrograde bundle of Kent Treatment: Vagal stimulation Adenosine, DC shock Long term - beta blocker, digoxin
31
Atrial fibrillation
Amiodarone Cardioversion Ablation
32
Ventricular tachycardia
Amiodarone | DC shock
33
Ventricular fibrillation
In long QT, Brugada, cardiomyopathy - defibrillation
34
Brugada
Coned ST elevation LBBB Death in sleep Fever = emergency Males, Asian
35
Wolf Parkinson White
``` Anterograde conduction accessory AV pathway before conduction through AV node Re-entrant Pre-excitation Sotalol, flecainide Avoid digoxin + calcium channel blockers ```
36
Long QT syndrome
AD Deafness Seizures/syncope ``` Treatment: Beta blockers No competitive sports Screen Family Avoid macrolides, TCA, antipsychotics, antifungals ``` Think of DiGeorge if neonate
37
Long QT type 1
KVLQT1 Low K efflux Exercise triggered
38
Long QT type 2
HERG/KCHN2 K channel gene Stress
39
Long QT type 3
SCN5A High Na/defect Na channel gene Triggered by rest or sleep
40
Mobitz type 1/Wenkebach
Progressive prolonging of PR until one drops
41
Mobitz type 2
Constant PR but periodic drops 2:1 3:1
42
Complete heart block
No connection between P and WRS Associated with TGA Pacemaker
43
RUSE murmur (aortic)
Aortic stenosis: harsh, radiates to neck, wide split S2 Coarctation: radiates interscapular Aortic regurgitation: diastolic
44
LUSE murmur (pulmonary)
``` ASD: click, fixed split S2 PDA: continuous Coarctation: radiates interscapular Pulmonary stenosis: click, fixed widely split S2 TAPVD/PAPVD ```
45
LLSE murmur (tricuspid)
``` VSD: pan systolic, can have diastolic AVSD HOCM: louder with exercise/valsalva, softer with squatting S3+S4 TR: pansystolic TS: diastolic Ebsteins: wide S2, extra S3, S4 ```
46
Apex murmur (mitral)
MR: pansystolic MV prolapse MS: diastolic Pulmonary hypertension: loud S2 Myocarditis: S3 gallop rhythm
47
Cardiac conditions associated with T21
AVSD ASD VSD TOF
48
Cardiac conditions associated with Williams
Supravalvular AS | Peripheral PS
49
Cardiac conditions associated with DiGeorge
``` Interrupted aortic arch TA TOF VSD Long QT ```
50
Cardiac conditions associated with Noonans
Valvular PS ASD HOCM
51
Cardiac conditions associated with Turners
CoA Bicuspid aortic valve AS
52
Cardiac conditions associated with Alagille
Pulmonary artery stenosis TOF PS
53
Cardiac conditions associated with Foetal Alcohol Syndrome
VSD ASD TOF
54
Cardiac conditions associated with Marfans
Aortic root aneurysm MVP MVR AR
55
Cardiac conditions associated with Ehlers Danlos
Aortic/carotid aneurysms
56
Cardiac conditions associated with Friedrich Ataxia
HOCM
57
Cardiac conditions associated with congenital rubella
PDA | Peripheral PS
58
Cardiac conditions associated with TS
Cardiac rhabdomyoma
59
Cardiac conditions associated with NF1
PS | CoA
60
Cardiac conditions associated with GDM
HOCM VSD TGA
61
Cardiac conditions associated with VACTERL
VSD
62
Cardiac conditions associated with T13 (Patau) / T18 (Edwards)
ASD, AVSD, PDA, CoA, HLHS
63
Cardiac conditions associated with Kartageners
Dextrocardia TGA (AR ciliary disorder triad - situs inversus, chronic sinusitis, bronchiectasis)
64
Cardiac conditions associated with Jevell Lange Neilsen
Long QT (AR, SNHL)
65
Cardiac conditions associated with Romano Ward
Long QT (AD)
66
Cardiac conditions associated with PHACES
CoA
67
Cardiac conditions associated with lithium in pregnancy
Ebsteins
68
Cardiac conditions associated with phenytoin in pregnancy
Peripheral PS
69
Conditions associated with VSD
``` T21 DiGeorge FAS GDM T13 (Patau) or T18 (Edward) VACTERL ```
70
Conditions associated with ASD
T21 FAS Noonans
71
Conditions associated with AVSD
T21, CHARGE
72
Conditions associated with aortic stenosis
Williams (supravalvular) | Turners
73
Conditions associated with PDA
Congenital rubella | T13 (Patau) or T18 (Edward)
74
Conditions associated with CoA
Turners Kabuki PHACES NF1
75
Conditions associated with pulmonary stenosis
Noonans (valvular) Williams (peripheral) DiGeorge NF1
76
Conditions associated with peripheral pulmonary stenosis
Alagille Williams Congenital rubella
77
Conditions associated with bicuspid aortic valve
Turners
78
Conditions associated with long QT
DiGeorge Romano Ward Jevell Lange Neilsen
79
Conditions associated with TOF
T21 DiGeorge FAS
80
Conditions associated with TGA
GDM | Kartageners
81
Conditions associated with mitral valve prolapse
Marfans
82
Conditions associated with HOCM
Friedrich ataxia | GDM
83
Conditions associated with interrupted aortic arch
DiGeorge
84
Conditions associated with cardiac rhabdomyoma
Tuberous sclerosis
85
Conditions associated with dextrocardia
Kartageners
86
Conditions associated with Ebsteins
Lithium in pregnancy
87
Conditions associated with HLHS
T13 (Patau) + T18 (Edward)
88
PDA
Continuous machinery murmur Bounding pulses Failure ECG - LVH Treatment: NSAIDs, coil/device Don't spontaneously close
89
ASD
Primum: worse, can affect mitral Secundum: better, can spontaneously close Can be asymptomatic, failure if premium/large ESM LUSE fixed splitting of SR (relative PS) CXR: cardiomegaly ECG: RBBB, RAD (secundum), superior axis (primum) Size of shunt depends on RV compliance Recurrence 2.5%, 40% spontaneously close Treatment: Device 4-5y for secundum if Sx or failure Patch closure for primum or large R-L shunt
90
VSD
Large presents with heart failure 6-8/52 when PVR falls Pansystolic and diastolic/thrill if bad Size of shunt depends on PVR CXR: cardiomegaly with increased markings ECG: RVH or LVH if severe, no axis deviation Treatment: Perimembranous doesn't close, more common Muscular 40% spontaneously close Closure patch, device if strain at 3-6/12
91
AVSD
``` Think trisomy 21 Heart failure FTT, repeated respiratory infections Thrill LLSE, 3-4/6 pan systolic murmur, mid diastolic rumble CXR: increased pulmonary markings ECG: superior axis ``` Treatment: Patch 3-6/12 ECG post op: RBBB + RVH
92
TOF
1. Pulmonary stenosis/RVOT 2. VSD (perimembranous) 3. RVH 4. Overriding aorta ``` Think DiGeorge Not duct dependent Harsh ejection systolic murmur, LLSE CXR: boot shaped heart ECG: RVH ``` Treatment: Shunt/patch repair then complete repair ECG post op: RBBB, also aortic regurg post op Tet spells - knee to chest, O2, morphine, IVF, vasoconstrictors
93
TGA
``` Think GDM Duct dependent (if no VSD) Difference pre- + post- ductal sats ESM LSE ECG: LVH/RVH/complete heart block CXR: egg on string ``` Needs PDA or VSD to survive Treatment: Prostaglandin Balloon septostomy, atrial switch later
94
TAPVD
``` Supracardiac - SVC Infracardiac - IVC Needs ASD/VSD for mixing Duct dependent if obstructed Ejection systolic LUSE gallop rhythm CXR: snowman supracardiac, small heart obstructed ``` Treatment: Surgery in newborn if obstructed
95
Truncus arteriosus
``` Both great arteries same origin Cyanotic at birth Not duct dependent Heart failure in weeks Bounding pulses Harsh systolic murmur ``` Treatment: Needs complete repair in 6/12 with conduit and close VSD
96
Tricuspid atresia
No connection between RA+RV Cyantoic Needs VSD or ASD to survive ECG: superior QRS, LVH Treatment: Shunt early, Bidirectional Cavo Pulmonary Connection (BCPC) 2yo, Fontan definitive
97
Aortic stenosis
Valvular (bicuspid valve), supravalvular, subvalvular Cyanotic Duct dependent if critical Heart failure Harsh ejection systolic RUSE, S2 ejection click, widened split +/- thrill CXR: dilated aorta ECG: LVH Treatment: Balloon valvotomy Replacement
98
CoA
If interrupted aortic arch, think DiGeorge Cyanotic Duct dependent if critical UL - hypertension and bounding pulses LL - hypotension and weak pulses RUSE ESM radiates interscapular CXR: cardiomegaly vascular marking, "3" sign prominent vessels L of mediastinum, notching of ribs Treatment: Surgical flap or balloon
99
Pulmonary stenosis
``` Think Noonans (dysplastic), Williams (peripheral) Valvular 90%, supravalvular, subvalvular Cyanotic if critical Don't get heart failure Mild PS -> severe PA dilatation ESM LUSE radiates to back and side Wide split S2, loud S2 ECG: RVH ``` Treatment: Balloon dilatation
100
HLHS
``` Cyanotic Duct dependent Presents in days Heart failure Weak pulses ECG: RVH ``` Treatment: Norwood Shunt/Bidirectional Cavo Pulmonary Connection (BCPC)/Fontan
101
Aortic atresia
``` Usually with HLHS LVOT Duct dependent Absent pulses Heart failure CXR: boot shaped heart ```
102
ALCAPA
L coronary arises from pulmonary artery instead of aorta Presents 6-8/52 when PVR drops Think of in a baby unsettled with feeds, FTT + cardiomegaly ECG: ST elevation and T wave inversion aVL, V5, V6 Treatment: surgery
103
Ebsteins
Abnormal tricuspid, tricuspid regurgitation Massive RA 90% have ASD Murmur systolic LLSE S3, S4 wide split S2 CXR: box/square shaped heart ECG: WPW, RBBB, RAH, RVH disappears when exercising
104
HOCM
AD LVH -> LVOTO Think Noonans, GDM Presents with exercise intolerance, syncope with exercise, sudden death ESM louder with exercise valsalva, softer with squatting S3 + S4 ECG: LVH Treatment: Surgical myectomy Restrict contact sports

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