Cardiac Boards Review

P wave= ______ ; this is when the atria will _____ forcing blood into the _____

QRS wave= _______ during this the ventricles _____ & push the blood into the _______ or _____. during the QRS wave is also about when _________ or _______ occurs

During the plateau phase of the EKG your at the __________ and your beginning to relax

Ventricular repolarization happens throughout the _____ phase & the ______; during the T wave you see a more ______

Long QT syndrome is a delay in the ______ process with a QTc > _____ seconds

Long QT can also be acquired & is usually a result of _______

Patients with _______, ______ & _______ can also develop long QT syndrome

Hypertrophic cardiomyopathy occurs when the heart muscle (usually ventricles & septum) ______ & ______ creating _______ of the ventricles making it hard for the heart to ______

Hypertrophic cardiomyopathy can also result in _______ of the ventricles leading to problems with your ______ valve

Dilated cardiomyopathy is the ___________ causing _______ of the ventricular wall in the ventricular septum so the muscle is very weak and don't pump effectively leading to _____

Restrictive Cardiomyopathy develop b/c the ventricle walls and septum become ____ but don't necessarily ____ and don't allow the ventricles to ________ to normal volume

The etiology of cardiomyopathies they can be congenital, assoc. w/ diff. malformation syndromes, such as ______ and ________ and other neuromuscular disorders. Also, different inborn errors of metabolism

The definition of shock is an imbalance between

Cardiogenic shock is the inability to deliver oxygen effectively because

Cardinal signs of cardiogenic shock include _______, _______, ______, _________

Pulses paradoxus is a decrease in their _______ blood pressure during ________ > 10, usually as a result of cardiac tamponade

Ionized calcium is essential for _______

Children < 1 y.o have less calcium stores in their myocardium, so we generally like their ionized calcium to be > _______. kids > 1y.o it should be > ________

What electrolytes are important to monitor in a pt. in cardiogenic shock?

Cardiogenic shock will sometimes present with a _____ CVP pre fluid resuscitation. These patients require _____ and ______ NOT fluids

Milrinone helps improve you ____ and ____ of your heart, helping it to work better

Inotropes help with the ______ of the heart

Chronotropes help with sustaining the ______ of the heart

Lusitropy is increasing the hearts ability to _____

For a patient who has a decreased CO but an increased SVR (ex. HF), you need to start them on an ________ ± a _______

For a patient who has an increased CO and decreased SVR, you need to start them on a ________

For a patient who has a decreased CO and decreased SVR, you need to start them on an _______ and a ______

Digoxin (Digitalis) MOA

Digoxin (Digitalis) is a _____ used to tx _____

Adverse effects of Digoxin include arrhythmias, __________ , ________, N/V, anorexia, diarrhea, _______, ________, & fatigue

ACE inhibitors & angiotensin receptor blockers (ARBs) both ________ Which therefore decreases the ___________ and therefore lowers the blood pressure

Sympathoplegic Agents (ex. Clonidine) dec BP by decreasing your ______ and _______ by working on _______ and _____ receptors that are centrally located. These can cause _______ side effects

Direct vasodilators work directly at the site of Arterial or venous ______ and force them to ______ therefore dec BP

The main category of drugs you'll see in this direct vasodilator are the __________ . Other drugs include _______, __________, & ______

Sodium channel blockers reduce the uptake of sodium into the cell prolonging the ______ and the _______ helping to space out that rhythm. These drugs include ______ & ______

Beta Blockers decrease the _________ through the heart, thereby ___________ , and also reset the heart conduction to prevent or break arrhythmias

Potassium channel blockers prolong the ________ duration of that cell thereby reduce or correct any arrhythmias

Calcium channel blockers slow the ___________ through the calcium channels. They especially affects the _____ node therefore decreasing the ______ through the heart. They work by _________ and are recommended for children with ______

Endocarditis occurs when there is an injury to the endothelium (usually the valves) leading to infection and then _______. It will also increase the ________ of the heart

Complications of endocarditis include ________ , structural injury, __________, or ________

Myocarditis is an inflammation or infection of the myocardium as well as ________

Cardiac Muscle Action Potential Phase 0: _______ occurs with which there is an _______ of your _____ & ______ that goes into the cell

Cardiac Muscle Action Potential Phase 1: _____ channels close

Cardiac Muscle Action Potential Phase 2: Influx of ______ and then _____ will rapidly come out of the cell

Cardiac Muscle Action Potential Phase 3: Rapid ________ where your ____ channels close and an influx of ____ into the cell

Cardiac Muscle Action Potential Phase 4: you go below into your ______

AV node is the communication between the ____ and the _____ and it provides the ________. It also represents your ______ on EKG

Bundle of His and Purkinje fibers have a ______ intrinsic rate. Has it's own dominant(backup) rate to provide CO in case the ______. It also provides ______

SA node is the _____ of the heart; represents your _______ on EKG

The QRS represents the flow going down your _______ on EKG

The Purkinje fibers represent your _______ process or _______ wave

P wave represents _______ of the ______ in response to ____ node triggering

PR interval represents delay of ____ node to allow _______

QRS complex represents _______ of the _______; also in that process your triggering the _______ to _______ and allow blood to go into ventricles

ST segment represents the beginning of ________; It should be ______

T wave represents when the _______ actually _____

12 lead EKG Septal view: _____ and _____

12 lead EKG Anterior view: _____ and _____

12 lead EKG Lateral view: _____, _____ and _____, _____ and _____

12 lead EKG Inferior view: _____, and _____, _____

*Mitral valve prolapse (MVP) is the most common cause of ________ and has a ________ murmur with a ______ click

Patients with mitral valve prolapse may present with ______, ______, or ________

Patients with mitral valve prolapse are more likely to suffer from both ________ and ________

Mitral valve prolapse is more frequent in patients with _________, _________, and _______

A 6-month-old presents to the ED w, SVT. HR= 200 bpm w/ a cap refill > 2 sec, BP 63/40, and a faint brachial pulse. She is lethargic and mottled. Adenosine is ineffective, and expert consultation is delayed. What is the next step in the treatment of this infant?

Criteria for Kawasaki disease Mnemonic = Warm CREAM

Pt. w/ Kawasaki dz need to be assessed for evidence of _______ or _______ via __________

Transesophageal echocardiography is used to assess for ________ associated with rheumatic fever and infectious endocarditis

TOF is comprised of four heart defects:
1.
2.
3.
4.

The most common murmur in newborns with TOF is primarily due to the _______ obstruction. It is a __________ murmur heard at the _________ border due to _________

Kawasaki disease is a ______ of medium and small vessels that can lead to ________. It is initially treated with _____ and ______

What is the best treatment option for Wolff Parkinson White syndrome?

Innocent murmurs are most common in children _______ y.o. They are often _______ , _________ murmurs at the _________ or ________ border w/o radiation & are loudest in the _____ position due to changes in afterload decreasing the effects of gravity in the aorta.

Hypertrophic obstructive cardiomyopathy (HOCM) is a significant cause of sudden cardiac death in _______

The most appropriate management in Hypertrophic obstructive cardiomyopathy (HOCM) is

Right to left shunting is when you have _______ blood that shunts to the ________ circulation; aka _______

Left to right shunting is when ________ blood shunts to the ________ circulation; aka ______

PDA is the connection between _________ and __________ ~5 to 10mm distal to the subclavian artery

In utero - PVR is ______ causing blood to shunt from the _______ to the ______. Out of utero - PVR _______ causing blood to shunt from the _______ to the _______.

The PDA functionally closes _______ and anatomically closes around ______ d/t reduction of _______

In utero - septum formation occurs between the _____ and ______ week of gestation

ASD causes predominately _______ shunting

Symptoms of an ASD appear to worsen once _________ in first few weeks of life & pt are at risk for right ventricle to _____ & ________

S/S of a PDA include tachycardia, ________ murmur , __________, failure to thrive, may see cardiomegaly on CXR in large PDAs

S/S of ASD include _________ & ________, tachycardia, May see cardiomegaly on CXR, ________ murmur

ASD Post op complications include arrhythmias - _________ & _______ ; _________ syndrome

post-pericardiotomy syndrome have discrete symptoms such as fever, chest pain, __________ , generalized weakness. Risk is reduced with prophylactic use of ________

Eisenmenger syndrome is a major risk with ______. It causes an increase in _______ pressure, resulting in _______ shunting causing ______

S/S of VSD include __________, symptoms of ___________ , _________ murmur, CXR may see increase in pulmonary vascular markings (pulmonary overcirculation)

Medication tx for VSD: Initially - manage symptoms of CHF w/ diuretics, _________ (______), optimize nutrition

Post- op management of VSD: may need _______ infusion and/or pacing d/t risk for arrhythmias such as ______ & _____; initiation of _____

Atrioventricular Septal Defect (AVSD) more frequently seen in pt. with ______ & _____

AVSD is the failure of the central portion of the anterior/posterior cushions to fuse causing underdevelopment of _______ & _____ valve. These valves are termed _______

Complete AVSD includes a VSD, ASD, ________ and __________

In pt. with AVSD, PVR _______ leading to ________

PVR is often persistently _______ in those with complete AVSD and Tri. 21, reducing speed of development of CHF but often more ________ d/t _______ shunting

Tx of AVSD include diuretics, _____ agents, and avoid ______

Post-op considerations for AVSD: it is imperative to prevent ______ and ________

Truncus Arteriosis is when the _______, _______, and _______ arise from a single vessel with a ______ present

Truncus Arteriosis is most commonly associated with _________

In pt. w/ Truncus Arteriosis you usually see significant ______ shunting d/t large ______ causing inc. risk for _______ into pulmonary vascular beds leading to _________

Total Anomalous Pulmonary Venous Return (TAPVR) has ________ return somewhere other than the _______

In TAPVR, if PVs are NOT obstructed it produces ________ shunting

On CXR, Total Anomalous Pulmonary Venous Return (TAPVR) will show a ______ sign

Coarctation of the Aorta is a _________ of the descending aorta often at the level of the _______, distal to the _____ artery d/t an infolding of the ________

Coarctation of the Aorta results in _________ from severe ______ to the ____. ---> ______ shunting across the ________

Pt. with Coarctation of the Aorta are at risk for _______, _________, & _______

In sever cases of Coarctation of the Aorta, neonates may need ______ to help with antegrade flow across coarc

In pt. with Coarctation of the Aorta you need to monitor ________ . preductal reflects saturations of the _______

A chest radiograph in pt. w/ Coarctation of the Aorta will reveal ______, but the _______ is the diagnostic test of choice

Coarctation of the aorta can be identified later in childhood with

Coarctation of the Aorta post-op management: manage HTN d/t risk for ______ and _______; Consider ENT evaluation for risk of accidental ________ injury

Interrupted Aortic Arch is the complete ______ between the ______ & _____ ends of the aortic arch. commonly associated with ____ in 70% of the cases

An Interrupted Aortic Arch is ________ dependent. if closure of PDA and no ASD/VSD, likely develop ________, _________, and ________ d/t no way to properly perfuse ______ part of body. Encourage _________ shunting across the PDA

Interrupted Aortic Arch CXR will show ______, ______, ______

Oxygen saturations in a pt. w/ Interrupted Aortic Arch will be ______ on upper half of the body and _______ in the lower half of the body

Single ventricle is a spectrum of cardiac abnormalities with hallmark of _______ of the ______ & _____. ______ & _____ valves often abnormal, large _____ usually present

Stage 1 Procedure: Norwood/Hybrid complications include _____, _____, _______

Stage II: Glenn complications include ______, ______, _____, ______

Stage III: Fontan complications include _____, ____, ____

Pulmonary stenosis is associated with _______

In Pulmonary valve stenosis the right ventricle often _______ with ________ at the main PA

Critical Pulmonary Stenosis is _____ dependent with ______ shunting

Subvalvular pulmonary stenosis will have a _______ right ventricle d/t diffuse ________ of the infundibular portion of the RV

Pulmonary stenosis frequently seen in ________ syndrome and _________ syndrome

There are concerns for __________ with pulmonary stenosis

4 major components of Tetralogy of Fallot (TOF)

Blood flow in TOF is usually provided by the ____ and/or ______

S/s of TOF include cyanosis within ______ hours of life (can vary depending on MAPCAs), respiratory distress and tachypnea, _______ murmur in ______ sternal border but is quiet during ________

In pt. with TOF you'll see a _______ heart on CXR due to _______

Treatment goal for TOF: relieve the _________ and close the _____. If pulmonary atresia - will need ___

“TET spell” management goals: increase ____ & ___, provide oxygen and _____ to decrease ______, fluid bolus to _______, _______ to increase SVR, and knees to chest

TOF post-op management: will likely have _____ and will need _______. Risk of ______

Pulmonary Atresia with Intact Ventricular septum will have an atretic pulmonary valve with NO ____, usually with an ____, and abnormal _____ valve

Pulmonary Atresia with Intact Ventricular septum: _____ shunting necessary for systemic blood flow and blood is oxygenated via the _______

D-TGA (Dextro): Flipping of the ____ and the ____ artery. Aorta arises from the _____ and pulmonary artery arises from the _____

L-TGA (Levo): Flipping of the ______ & the _____

Treatment of TGA: _____ until atrial septostomy is performed, Atrial septostomy to ________, _______ to assess outflow tract obstructions and coronaries, Atrial switch performed in ________

TGA Post-op managment: High risk for ________ -> ischemia/infarction, Monitor for ______ changes

Ebstein Anomaly of the Tricuspid Valve is failure of the tricuspid valve leaflets to _______ from the
_______. Creates a _______ of the anterior leaflet

S/S of Ebstein Anomaly of the Tricuspid Valve: varies based on the _______ and _____. ______ heart on CXR

Tx of Ebstein Anomaly of the Tricuspid Valve: Often need to avoid _______. Surgical repair often involves ______

Vascular Ring: Aortic arch causes _______ of the ________

S/S of Vascular Ring include ______, ______, and ____

The immediate goal of therapy for a hypertensive crisis is to decrease the BP to a safe level with the use of IV medications including ________. You should reduce the BP no more than _____

______ is the most common symptom of acute endocarditis and can be high with hemodynamic instability

Infants and children have different presentations of CHF. Children will present with ______. , whereas infants will have ______

The ________ after cardiac transplant are the most critical in terms of risk factors and procedure success

______ & _______ are the most common reasons for early transplant failure. Primary management goals in this time frame include...

Torsades de pointes is commonly associated with ______. _______ is the first-line therapy.

Pericarditis occurs when the layers of the pericardium become inflamed as a result of many different etiologies, including

The symptoms of acute pericarditis include

The treatment of pulmonary hypertension is focused on managing the acute events by providing a stable environment and

Milrinone is a nonspecific vasodilating agent like sildenafil and prostaglandin which would be used first line in the treatment of pulmonary hypertension.

Sildenafil and tadalafil, otherwise known as Viagra and Cialis, are phosphodiesterase type 5 inhibitors which affect the nitric oxide pathway. These medications increase pulmonary artery vasodilation and inhibit vascular remodeling, thus lowering pulmonary arterial pressure and pulmonary vascular resistance

Postpericardiotomy syndrome is ___________ which can occur following cardiac surgical procedures as well as other thoracic surgery. Laboratory findings will include....

The typical dosing of epinephrine is ________, but higher dosing has been used, up to 5 μg/kg/minute. When using higher doses, the....

Complete heart block is best managed with a pacemaker that is set at _______. The individual letters relate to _____.