20: Pediatric Cardiology

Question 1

three majors closures in the heart just after birth

Answer 1

1. foramen ovale
2. ductus arteriosus
3. ductus venosus

Question 2

describe foramen ovale

Answer 2

allows oxygen rich blood from placenta -> directly into LA to bypass lungs

Question 3

describe ductus arteriosus

Answer 3

allows deox blood to flow from pulmonary trunk -> aorta to bypass lungs

Question 4

what do the closed ductus arteriosus and closed ductus venosus form?

Answer 4

1. ductus arteriosus -> ligamentum arteriosum

2. ductus venosus -> ligamentum venosum

Question 5

describe ductus venosus

Answer 5

allows oxygen rich blood from placenta/umbilical vein to enter IVC

Question 6

describe the newborn pulse oximetry test

Answer 6

Check O2 sat pre- and post- ductal timelines to screen for critical congenital heart disease

Question 7

two ways a newborn can fail the newborn pulse oximetry screening test

Answer 7

1. O2 sat anywhere <90%

2. O2 in right hand is <95% or difference between right hand nd a foot is >3%

Question 8

S/S of hemodynamically significant cardiac disease in a newborn

Answer 8

tachypnea, cyanosis, diaphoresis, feeding intolerance, developmental delay, cough, tachycardia, hypoxia, wheezes/crackles, murmur, abnormal pulses

Question 9

S/S of hemodynamically significant cardiac disease in older children

Answer 9

dizziness, near-syncope/syncope, palpitations, CP, diaphoresis, exercise intolerance, poor growth, asthma sx, dyspnea

Question 10

silent tachypnea

Answer 10

RR > 60 without elements of distress

Question 11

DDX for tachypnea in a newborn

Answer 11

1. TTN: transient tachypnea of the newborn - excess lung fluid, resolves spontaneously
2. respiratory distress syndrome
3. meconium aspiration in utero
4. infection
5. congenital heart defect
6. pneumothorax

Question 12

six components to describe a cardiac murmur

Answer 12

1. grade 1-6
2. timing
3. character
4. location
5. radiation
6. change with positioning

Question 13

seven S’s of innocent murmurs in children

Answer 13

1. sensitive: change with position
2. shorter
3. single
4. small
5. soft
6. sweet
7. systolic

Question 14

five T’s of congenital heart disease

Answer 14

1. tetralogy of fallot
2. transposition of great arteries
3. truncus arteriosus
4. total anomalous pulmonary venous return
5. tricuspid valve abnormalities

Question 15

four parts of Tetralogy of Fallot***

Answer 15

1. overriding aorta
2. VSD
3. right ventricular hypertrophy
4. RV outflow obstruction (pulmonary valve issue)

Question 16

what is the most cyanotic congenital heart defect?

Answer 16

tetralogy of fallot

Question 17

two factors that determine normal BP range for kids

Answer 17

age, %ile for height

Question 18

how much of the arm should the blood pressure cuff cover?

Answer 18

2/3 of the pts upper arm

Question 19

what happens with too small vs too large of a BP cuff?

Answer 19

1. too small -> BP artificially high

2. too large -> BP artificially low