Learning Cardiology

Q. Which of the following is false about Takayasu arteritis? A. Strong female predominance B. Increased prevalence in western counties as compared to Asians C. Pulmonary artery involvement is seen in approximately 50% of patients D. Tends to affect younger patients Answer: B. Increased prevalence in western counties as compared to Asians Explanation:  Important points about Takayasu- 1) Takayasu arteritis has strong female predominance (F:M=9:1) 2) Increased prevalence in Asian populations 3) Tends to affect younger patients ( less than 50 years of age) 4) Pulmonary artery involvement is seen in 50% of patients 5) Takayasu was an ophthalmologist

Q. Most common cause of tricuspid regurgitation is? A. Rheumatic heart disease B. Infective endocarditis C. Ebstein's anomaly D. Functional Answer: D. Functional Explanation: Functional TR due to right ventricular dilatation is most common cause of TR. RV dilatation commonly coexists with left sided cardiac pathologies.

Q. True regarding Fontan surgery? A. Bidirectional glenn shunt is usually done within 1 week of birth B. PA banding may be required in patients with significant pulmonary stenosis prior to glenn surgery C. Fenestration decreases post-op pleural effusion D. Peri-operative mortality is around 20% Answer: C. Fenestration decreased post-op pleural effusion Explanation: Fontan surgery is type of single ventricular repair required for some complex congenital heart diseases. It is a multistaged procedure. Also known as Total cavopulmonary connection (TCPC). It separates systemic and pulmonary circulation. 1 st stage procedure is done to normalize pulmonary blood flow (BT shunt in case of decreased pulmonary blood flow situations like PS and PA band in case of increased pulmonary blood flow situations). 2 nd stage is called bidirectional glenn shunt (BDG) or Hemifontan which is done at the age of 4-6 months and final stage is completion of Fontan Advantages:

Q. What is false regarding Fontan circuit? A. Fenestration improves cardiac output and reduces congestion B. Fenestration decreases systemic saturation C. Plastic bronchitis is rare but known complication D. Protein losing enteropathy does not improve after cardiac transplantation Answer: D. Protein losing enteropathy does not improve after cardiac transplantation Explanation:  Fontan procedure

Q. Which of the following is false about Fontan surgery? A. Systemic and pulmonary circulation are separated B. It is a type of univentricular repair C. It is done when PVRI is more than 6 woods units/m 2 D. Ten years survival is 80-85% Answer: C. It is done when PVRI is more than 6 woods units/m2 Explanation:  Fontan procedure

Pulmonary hypertension Pulmonary arterial hypertension is restricted to those with a hemodynamic profile in which high pulmonary pressure is a  result of elevated precapillary pulmonary resistance and normal pulmonary venous pressure which is measured as a pulmonary wedge pressure of 15 mmHg or less. Definition: Resting mean pulmonary artery pressure of 25 mm Hg or more at catheterization of right heart. This is the hemodynamic feature which is shared by all types of pulmonary hypertension in Dana point classification system. CLASSIFICATION OF PULMONARY HYPERTENSION Pulmonary hypertension resulting from heart disease (group 2) implies an increase in pulmonary arterial pressure due to backward transmission of pressure elevation. Precapillary pulmonary hypertension such as that resulting from lung disease is group 3. Chronic thromboembolic pulmonary hypertension is group 4. Disease resulting from multifactorial mechanisms is group 5. Important point to no

Shone complex -Shone complex is a rare combination of subvalvular aortic stenosis, supravalvular mitral membrane, parachute mitral valve, and coarctation of aorta. -A parachute mitral valve occurs when all the chordae arise from a single, fused papillary muscle. -This abnormality is associated with mitral stenosis of various degrees and with Shone syndrome.

Q. What is the life expectancy of a person with aortic stenosis presenting with history of syncope? A. 1 year B. 5 years C. 8 years D. 3 years Answer: D. 3 years Explanation:  Life expectancy of a person with symptomatic severe stenosis: (Mnemonic- A. S. D.) A- Angina- 5 years S- Syncope- 3 years D- Dyspnea (Heart failure)- 2 years

DEEP VEIN THROMBOSIS   (DVT)- Definitions Unprovoked deep vein thrombosis implies that no identifiable provoking environmental event for DVT is evident. Proximal DVT is one that is located in the popliteal, femoral, or iliac veins. Isolated distal DVT has no proximal component, is located below the knee, and is confined to the calf veins (peroneal, posterior, anterior tibial, and muscular veins). TREATMENT -  (1) MEDICAL Anticoagulation is the mainstay of therapy. Acute symptomatic proximal DVT - anticoagulation (Grade 1B), provided the risk of bleeding is not high. Asymptomatic proximal DVT - anticoagulation Symptomatic isolated distal DVT - anticoagulation For select patients with isolated distal DVT (eg, those at high risk of bleeding, negative D-dimer level, asymptomatic or minor symptoms, without risk factors for extension, and/or minor thrombosis of the muscular veins), surveillance with serial ultrasound over a two-week period rather than anticoagulat

Q. Brockenbrough needle is used for? A. Tricuspid valve commissurotomy B. Interatrial septal puncture C. Interventricular septal puncture D. Pulmonary valvotomy Answer: B. Interatrial septal puncture Explanation: Percutaneous mitral valve commissurotomy (PTMC) is required in severe symptomatic noncalcific mitral stenosis. It should be done after ruling out LA/LAA thrombus. For PTMC, right atrium is entered through IVC from right remoral venous access. To reach the left atrium from right atrium, interatrial septum has to punctured at fossa ovalis which is done with the help of Brockenbrough needle . After that Inoue balloon is inflated at level of mitral valve to improve mitral stenosis.