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Flashcards in Cardiology Deck (58)
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On a neonatal cxr, a narrowed mediastinum is an indication of what pathology?



What is the classic triad of aortic stenosis?

1. Chest pain

2. Breathlessness

3. Syncope


When do you expect the T wave in V1 to be upright?

  • Can be upright until day 4 (RVH is the norm)
  • After day 4 until age 4 yrs upright T=pathological RVH
  • Severe RVH - T wave goes down again due to "strain"


How do you work out QT interval?

Measure the interval from the start of the Q to the end of the T, and then divide by the square root of the preceding R-R interval.

QTc=QT(ms)/sq root R-R interval(ms)

Measured in leads 2 and V5 (particularly not in V2-V4)



What is normal for ST elevation?

  • Up to 1mm is normal.
  • Up to 2mm is normal in V2-V4.


A well 4 year old presents with a murmur.

Pulses are normal, BP 95/60.

RV lift

2-3/6 ESM at LSE

CXR shows cardiomegaly, plethora and prominent PA

ECG below


What is the diagnosis and what is another physical sign to expect?

Atrial Septal Defect

ECG - normal axis Incomplete RBBB

Fixed splitting of the second heart sound may be heard


A well 4 year old presents with a murmur.

Pulses are normal, BP 95/60.

Precordium is normal.

2-3/6 vibratory ESM at upper and lower LSE.

ECG shows normal axis IRBBB.

CXR is normal.

Murmur disappears with the manouvre from the image below.

What is the diagnosis?

Stills murmur (aka vibratory murmur).

A functional murmur most common in the 2-5 year age group.



A well 4 year old presents with a murmur.

There is a 4/6 pansystolic murmur at the LSE.

ECG shown below.

What is the diagnosis?

Ventricular septal defect


Describe this ECG.

Rate ~150bpm

Axis - + in I and AVF = normal

P waves - Sinus, normal

PR - normal

QRS - narrow

V1 - RSR

III and AVF - Q waves in III and AVF -ok

V5 and V6 - Q waves - usual finding

Incomplete RBBB without RV hypertrophy



A well 4 year old presents with a murmur.

The child is slim with a history of regular chest infections.

The pulses are normal, BP 95/60

Overactive precordium

2/6 low pitched PSM at lower LSE, 2/4 mid diastolic murmur at apex

ECG below.

Describe the ECG.

What is the diagnosis?

ECG- Dominant R waves in V1 and V2 with no S waves. Hints at RV hypertrophy.

N/2 at V5 indicate half voltage. Tall R and deep S waves indicate biventricular hypertrophy.

Diagnosis - Large VSD

Flow murmur at apex indicates large left to right shunt.


A 2 year old presents with a loud systolic murmur, cyanosis (SpO2 88%) and the ECG below.

Describe the ECG

What is the diagnosis?

Tetralogy of Fallot

Right axis deviation at approx +150 degrees

QRS - narrow

S waves - deep in V5 and V6 (RVH)

T waves - upright in V1 and V2




What are the cyanotic heart defects?

Tetralogy of Fallot



Truncus arteriosis

Tricuspid atresia


Looking at leads II and V1, what do you expect the P wave to look like in:

A normal heart?

Right atrial hypertrophy?

Left atrial hypertrophy?

Combined atrial hypertrophy?

The first half of the P wave reflects the right atrium, and the second half the left atrium.


In lead II, what changes do you see in the P wave that would assist in diagnosing

1. RAH

2. LAH

3. CAH


What are causes of LAD on ECG?

  • LVH esp with volume overload (eg big VSD)
  • LBBB (QRS Broad)
  • Left anterior hemiblock ("superior axis", QRS narrow)
    • tricuspic atresia
    • AV canal defect
    • LTGA


On ECG, what is the criteria for right atrial chamber enlargement?

p wave amplitude >3mm


On ECG, what is the criteria for LA chamber enlargement?

Bifid p wave and prolonged >.10 secs

ie. 2.5 small squares  (0.08 secs in infants)


What is the criteria for RV chamber enlargement on ECG?

  • R in V1 >20mm, >25mm in neonates
  • S in V6 >7mm


  • upright T wave in V1 after 72 hours and up to 5 years

Severe RVH

  • ST and T wave invert with ST depression, and small Q wave in lead V1


What is the criteria for LV chamber enlargement on ECG?

R in V6 >25mm

Severe - ST depression and T wave inversion V6


When are Q waves normal on a paediatric ECG?

1,2,3, AVF, V5, and V6.

Narrow and up to 7mm deep in 2 and 3


When is a Q wave pathological?

In V1 (except occasionl newborns) and indicate L-TGA, single ventricle, severe RVH or anterior MI (deep and wide)


ESM at upper right sternal edge with carotid thrill = ?

Aortic stenosis


ESM at upper left sternal edge with no carotid thrill =?

Pulmonary stenosis or ASD


ESM at mid/lower LSE =?

Innocent murmur


Long harsh systolic murmur + cyanosis =?

Tetralogy of Fallot


Pansystolic murmur at LLSE +/- thrill +/- mid diastolic apical murmur =?


Mid diastolic murmur due to increased mitral flow if large defect.

If assoc with pulmonary hypertension, loud P2.


Pansystolic murmur at apex =?

Mitral regurgitation


Pansystolic murmur at LLSE (rare) +/- cyanosis =?

Tricuspid regurgitation


Diastolic murmur at LSE/apex (+/- carotid thrill) =?

Aortic regurgitation


In a child with a duct-dependent circulation such TGA or pulmonary atresia, what medication is used to keep the duct patent?

Prostaglandins E1 or E2