2 Cardiac Flashcards
Pediatric congenital heart disease
- how does it present?
- how to treat each?
2 presentations:
- Neonate 1-4 weeks (usu week 1) with cyanosis or shocky (ductal dependent pulmonary flow vs ductal dependent systemic flow)
- CHF in 2nd-6th month. FTT, does not want to feed, may have wheezes/retractions/tachypnea
- PGE1, treat for other causes of shock
- Give lasix, supportive care
Baby with CHF symptoms
-think what in addition to congenital heart disease?
Think myocarditis.
get trop, ekg, give abx
worry about fulminant myocarditis
Pediatric tachycardia arrhythmia
- at what rate to suspect?
- what is dose of adenosine?
- what amount of cardioversion charge?
>220 in infant
>180 in child
- 1 mg /kg for adenosine
- 5 - 1 J/kg
Pediatric EKG
-what are normal findings not seen in adults?
-Right heart dominant at birth (looks like R heart strain)
can have RBBB and anterior TWI in V1-3
-can also have Q waves in inferior/left precaordial leads
Pediatric heart rates:
what age has these means?
140, 120, 100, adult rates
140 - neonate
120- age 1
100 - age 5
adult values - age 10
Peds EKG:
how are PR interval different
PR interval increases with age
0.08 -> 0.16 sec
2 -> 4 small boxes
Prolonged QT that is acquired
think what ddx
Drugs
Hypocalcemia
Hypokalemia (think U wave)
Hypomagnesemia (goes with hypokalemia)
Peds EKG
-what is important to know about axis
At birth, normal to see RAD
RV>LV until age 1
If you see LAD at/after infancy, suspect LVH and congenital things like VSD, etc
this is called “superior axis”
Peds EKG
importance of q waves
q waves can be normal in inferior and lateral leads
-typically small and less than 1 box
So, others are pathologic!
Peds EKG
what is juvenile twi?
TWI in v1-3 as child is normal
TWI in v4-6 is not normal! think ischemia
