Cardiology

Question 1

What are the 5 Ts of cyanotic congenital heart disease?

Answer 1

1. Tetralogy of Fallot
2. Transposition of the great arteries
3. Tricuspid atresia
4. Truncus arteriosus
5. Total anomalous pulmonary venous return

Question 2

What is the most common cyanotic congenital heart disease?

Answer 2

Tetralogy of Fallot

Question 3

Rheumatic fever is common in which age group?

Answer 3

6-15 years

Question 4

What causes rheumatic fever?

Answer 4

Group A beta-hemolytic streptococcal infections of the pharynx

Question 5

What are the major JONES criteria for rheumatic fever?

Answer 5

Polyarthritis (most common) 
Carditis 
Sydenham chorea 
Erythema marginatum 
Subcutaneous nodules 

(preceded by streptococcal infection by 2-4 weeks)

Question 6

What type of antibiotic is used to treat rheumatic fever?

Answer 6

Benzathine penicillin

for long-term prophylaxis, it is given IM every 28 days

Question 7

Kawasaki disease is most commonly associated with which ethnicity?

Answer 7

Asian

Question 8

Which age group is most likely to be affected with kawasaki disease?

Answer 8

Children under 5 years of ago, with a peak between 2-3 years (rare in children older than 7)

Question 9

What is the most important manifestation of kawasaki disease?

Answer 9

Aneurysmal involvement of the coronary arteries

Question 10

What are the main characteristics of the acute phase of kawasaki disease?

Answer 10

fever of unknown origin 
conjuctivitis 
dry, cracked lips w/ strawberry tongue 
cervical lymphadenopathy 
swelling of the hands and feet

Question 11

Which phase of kawasaki disease heralds the onset of coronary artery aneurysms?

Answer 11

Subacute phase (may also appear in the convalescent phase)

Question 12

What are risk factors for the development of coronary artery aneurysms in kawasaki disease?

Answer 12

Prolonged fever, prolonged elevation of inflammatory parameters such as ESR, age less than 1 year or older than 6 years, poor response to therapy and male gender.

Question 13

What is the mainstay treatment for kawasaki disease?

Answer 13

Intravenous immunoglobulin (IVIG)

Question 14

What is used as both an anti-inflammatory and anti-thrombotic in the treatment of kawasaki disease?

Answer 14

Aspirin

Question 15

What is the most common congenital heart defect?

Answer 15

VSD

Question 16

What is the most common type of VSD?

Answer 16

Perimembranous VSD

Question 17

What is the most common congenital heart defect associated with children with trisomy 21?

Answer 17

Atrioventricular septal defect (endocardial cushion defect)

Question 18

What is the most common cause of heart failure in children?

Answer 18

Volume overload

Question 19

The absence of what on a chest x-ray rules out the diagnosis heart failure?

Answer 19

The absence of cardiomegaly

Question 20

What is the largest component of the ventricular septum?

Answer 20

Muscular septum

Question 21

What is part of the initial treatment for moderate to large VSDs?

Answer 21

Diuretics (some doctors use digoxin and/or after load reduction)

Question 22

What is a common form of ASD in Down syndrome?

Answer 22

Ostium primum ASD

Question 23

What is the most common type of ASD?

Answer 23

Secundum ASD (hole in the foramen ovale)

Question 24

What is the treatment of ASDs?

Answer 24

• Medical management is rarely indicated.
• If at 3 y/o, the defect is still present, then closure is recommended.
• Secundum ASDs can be closed with an ASD closure device.
• Primum and sinus venous defects require surgical closure.

Question 25

Why are the murmurs present found in VSD and PDA?

Answer 25

``` VSD = pan-systolic murmur PDA = continuous, machine-like murmur ```

Question 26

What is the treatment of PDAs?

Answer 26

Initial management with diuretics then closure by coil embolization or a PDA closure device

Question 27

What is considered as pulmonary HTN in children?

Answer 27

High pulmonary artery pressure, mean > 25mmHg

Question 28

What is congestive heart failure?

Answer 28

A clinical syndrome defined as inadequate O2 delivery by the heart to meet the metabolic demands of the body.

Question 29

What is the pathophysiology of CHF?

Answer 29

1. Hypoperfusion of end organs stimulate the heart to maximize contractility and HR in an attempt to increase CO. 2. Hypoperfusion also signals the kidneys to retain salt and water through the renin-angiotensin system in an attempt to inc. blood volume. 3. Catecholamines (e.g. adrenaline, epinephrine) released by the sympathetic NS also increase the HR and myocardial contractility.

Question 30

What is the most common cause of CHF in older children and adolescents?

Answer 30

Viral myocarditis

Question 31

What are the common etiologies of CHF?

Answer 31

Congenital heart disease * Increased pulmonary blood flow due to VSD, ASD, PDA, transposition of the great arteries (TGA), truncus arteriosus, and total anomalous pulmonary venous return (TAPVR) * Obstructive lesions due to severe aortic, pulmonary and mitral valve stenosis, coarctation of aorta, interrupted aortic arch and hypoplastic left heart syndrome * Other causes such as arteriovenous malformations and mitral or tricuspid regurgitation (= volume overload in the heart) Acquired heart disease * Viral myocarditis (common in older children and adolescents) * Other cardiac infections (e.g. endocarditis, pericarditis), metabolic disease (e.g. hyperthyroidism), medications (e.g. doxorubicin, a chemotherapeutic agent), cardiomyopathies and ischemic disease * Dysrrhythmias such as tachycardia and bradycardia Miscellaneous * Severe anemia (= high-output CHF) * Rapid infusion of IV fluids (esp. in premature infants) * Obstructive processes of the airway, laryngomalacia, and CF

Question 32

What are the clinical features of CHF?

Answer 32

1. Tachypnea, cough, wheezing, rales and pulmonary edema on CXR (= pulmonary congestion) 2. Tachycardia, sweating, pale skin, diminished urine output and enlarged cardiac silhouette on CXR (= impaired myocardial performance and poor CO) 3. Hepatomegaly and peripheral edema (= systemic venous congestion) 4. FTT, poor feeding (common in newborns) and exercise intolerance (common in older children and adolescents)

Question 33

What is the definitive treatment of CHF secondary to CHD?

Answer 33

Surgical repair

Question 34

What constitutes the medical management plan of CHF?

Answer 34

1. Cardiac glycosides (e.g. digoxin) 2. Loop diuretics (e.g. furosemide) 3. Inotropes (e.g. dobutamine, dopamine, epinephrine) 4. Nutritional (high caloric intake and salt/water restriction)

Question 35

What are common clinical manifestations in left-sided HF vs. right-sided HF?

Answer 35

Left-sided HF: tachypnea, orthopnea, wheezing and pulmonary edema Right-sided HF: hepatomegaly, edema and distended neck veins

Question 36

What is common with ostium primum ASD?

Answer 36

Mitral regurgitation (which can eventually lead to CHF)

Question 37

What can be seen or heard in the physical examination of ASD?

Answer 37

1. Inc. right ventricular impulse 2. Systolic ejection murmur + mid-diastolic murmur 3. Fixed-split S2