Year 4 Cardiology

Question 1

what is a heave?

Answer 1

force pushes flat hand off the chest

Question 2

what is a thrill?

Answer 2

palpable murmur

Question 3

what is acrocyanosis?

Answer 3

hands and feet are blue

perioral blueness indicates peripheral cyanosis

Question 4

what is intermittent central cyanosis a sign of?

Answer 4

tetralogy of Fallot

Question 5

characteristics of murmurs?

Answer 5

timing
location
intensity
radiation
quality
positional change

Question 6

how is intensity of a murmur graded?

Answer 6

1-6

Question 7

acyanotic heart disease causes

Answer 7

VSD
ASD
PDA
pulmonary stenosis
coarctation
aortic stenosis

Question 8

cyanotic heart disease causes

Answer 8

tetralogy of fallot

transposition of great arteries

Question 9

pansystolic murmur causes

Answer 9

mitral regurgitation
tricuspid regurgitation
VSD

Question 10

ejection systolic murmur causes

Answer 10

aortic stenosis
pulmonary stenosis
HOCM

Question 11

what is an ASD?

Answer 11

hole between the left and right atria

Question 12

what does an ASD cause?

Answer 12

oxygenated blood shunts from the left atrium into the right which causes enlargement of the atria, pulmonary artery and RV

Question 13

classification of ASD

Answer 13

1. secundum= middle of the wall

2. primum= lower part of the septum

Question 14

ASD murmur presentation

Answer 14

EJECTION SYSTOLIC with FIXED SPLIT of 2nd HS

Question 15

ASD presentation

Answer 15

recurrent resp infections
fatigue post feed
failure to thrive
SOB syncope
fatigue

Question 16

diagnosis of ASD

Answer 16

ECG
CXR
ECHO is diagnostic

Question 17

management of ASD

Answer 17

surgery

pulmonary vasodilators

Question 18

complications of ASD

Answer 18

AF
atrial flutter
pulmonary hypertension
right heart failure
Eisenmenger

Question 19

what is Eisenmenger’s syndrome

Answer 19

pulmonary pressure increases beyond systemic pressure so blood flows from right > left

Question 20

why should Eisenmenger’s be avoided in pregnancy?

Answer 20

develops faster

Question 21

what is a VSD?

Answer 21

interruption between interventricular septum

Question 22

presentation of VSD

Answer 22

4-6 weeks with increased sweating (during feeding), failure to thrive, fatigue after feed and recurrent resp

Question 23

murmur in VSD

Answer 23

pansystolic murmur in LLSE and diastolic murmur in mitral area

Question 24

what does VSD have increased risk of?

Answer 24

IE so give prophylactic antibiotics in surgery

Question 25

what is a complete AVSD?

Answer 25

hole between all 4 chambers of the heart (common valve due to failure to differentiate)

Question 26

what is partial AVSD

Answer 26

both valves are usually present but one does not work

Question 27

murmur AVSD

Answer 27

holosystolic murmur at LLSE and mid-diastolic rumble

Question 28

what conditions are associated with AVSD?

Answer 28

T21 heterotaxy syndrome Kartagner's

Question 29

what happens as a consequence of Eisenmenger's sydnrome?

Answer 29

polycythaemia causing plethoric complexion and increased risk of thrombus formation

Question 30

management in Eisenmenger's

Answer 30

``` heart-lung transplant sildenaful for pulmonary hypertension venesection anticoagulation antibiotics ```

Question 31

management of coarctation of the aorta

Answer 31

surgical repair prostaglandin E to keep duct open balloon dilation +/- stenting

Question 32

four features in tetralogy of Fallot

Answer 32

overriding aorta (blood from right and left ventricles) VSD RV hypertrophy pulmonary stenosis

Question 33

what conditions is tetralogy of Fallot associated with?

Answer 33

T21 T18 T13 22q11 (DiGeorge)

Question 34

presentation of tetralogy of Fallot

Answer 34

cyanosis poor feeding failure to thrive tets spell

Question 35

what is a tets spell?

Answer 35

sudden cyanosis as more blood goes right than left

Question 36

what can precipitate a tets spell?

Answer 36

walking physical exertion crying

Question 37

murmur in tetralogy of Fallot

Answer 37

ejection systolic 2nd left sternal border due to pulmonary stenosis

Question 38

CXR of tetralogy of Fallot

Answer 38

boot heart

Question 39

management of tets spell

Answer 39

``` squat/ bend babies legs to increase systemic vascular resistance morphine beta blockers adrenaline IV fluids oxygen ```

Question 40

management of tetralogy of fallot

Answer 40

total surgical repair at 6 months

Question 41

CXR in transposition of the great arteries

Answer 41

egg on side appearance of the heart

Question 42

what is Ebstein's anomaly?

Answer 42

congenital heart condition where the tricuspid valve is set lower in the right side of the heart causing a bigger RA and small RV leading to poor flow to the pulmonary vessels

Question 43

presentation of Ebstein's anomaly

Answer 43

gallop rhythm cyanosis SOB

Question 44

PDA murmur

Answer 44

continuous crescendo-decrescendo machinery murmur wide pulse pressure bounding pulse murmur between clavicles

Question 45

how long is PDA monitored?

Answer 45

first year of life

Question 46

management of PDA

Answer 46

fluid restriction ibuprofen indomethacin surgery

Question 47

what is Kawasaki's disease?

Answer 47

type 2 hypersensitivity reaction that can affect the coronary arteries causing aneurysms

Question 48

presentation of Kawasaki's

Answer 48

``` high temp maculopapular rash (blanches) conjunctivitis strawberry tongue cracked lips lymphadenopathy desquamation of hands and feet ```

Question 49

management of Kawasaki's

Answer 49

immunoglobulin | high dose aspirin

Question 50

why is aspirin normally avoided in children?

Answer 50

risk of Reye syndrome

Question 51

diagnosis of Kawasaki's

Answer 51

serial echos for coronary artery aneurysms

Question 52

major criteria for rheumatic fever

Answer 52

``` carditis fever polyarthritis erythema marginatum sydenham's chorea subcutaneous nodules ```

Question 53

management of rheumatic fever

Answer 53

penicillin