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PEDS > Cardiac > Flashcards

Cardiac Flashcards

1
Q

what’s an easy screen to look closer for heart disease.

A

fall off the growth curve

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2
Q

when will you see prominence of pulmonary vasculature.

A

Pulmonary overcirculation

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3
Q

What does an “egg on a string” indicate on an x-ray?

A

Transposition of the great arteries

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4
Q

What does a boot shaped heart indicate?

A

Tetrology of Fallot

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5
Q

what does an active precordium indicate?

A

cardiomegaly or large right side of the heart

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6
Q

what can differential pulses indicate?

A

Coarctation of the aorta

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7
Q

what can bounding pulses indicate?

A

Run off lesions

Left to right PDA shunt, AI

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8
Q

what can weak pulses indicate?

A

cardiogenic shock or coarctation of the aorta

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9
Q

is an exaggerated SBP drop with inspiration → tamponade or bad asthma

A

Pulsus paradoxus

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10
Q

altering pulse strength → LV mechanical dysfunction

A

Pulsus alternans

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11
Q

closing of mitral and tricuspid valves, LLSB or apex

A

S1

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12
Q

closing of aortic (A2)and pulmonic (P2) valves

A

S2

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13
Q

heard in diastole ,related to rapid ventricular filling , can be normal, or abnormal -accentuated with dilated ventricles

A

S3

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14
Q

late in diastole just before S1 – always bad.

Decreased vent compliance / heart failure

A

S4

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15
Q

Heart murmurs which occur in the absence of anatomic or physiologic abnormalities of the heart or circulation

A

Innocent Heart Murmurs

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16
Q

a louder murmur is going through what type space?

A

a smaller space

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17
Q

signs for concern with a murmur

A

Easy fatigability, including difficulty with feeding in infants
Claudication
Symptoms that worsen with exertion
Growth failure

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18
Q

Common functional murmur in a newborn

A

first days of life LLSB

1-2/6, gone by 2-3 weeks of life

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19
Q

Functional murmur that is often in the newborn period from branching PA. Heard in axillae and back short, high pitched 1-2/6

A

Peripheral pulmonary artery stenosis

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20
Q

when will the murmur be the loudset?

A

When the blood is coming toward the stethoscope from where the blood is coming.

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21
Q

most common murmur of early childhood. Heard ages 2-7yrs. Musical, vibratory, mid to lower LLSB, 1-3/6. loudest when patient supine.

A

Still murmur

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22
Q

most common innocent murmur in older children, ages 3 yrs and up. ULSB, soft ejection murmur , 1-2/6.

A

Pulmonary ejection murmur

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23
Q

heard after age 2, infraclavicular R>L, Continuous musical hum. Best heard sitting. Comes from turbulence at confluence of subclavian and jugular vein.

A

Venous Hum

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24
Q

older child and adolescent. Rt supraclavicular area, harsh, 2-3/6.

A

innomiate or carotid bruit

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25
Q

do you have to “work up” a murmur is hx and PE are UNL?

A

No

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26
Q

if syncope is heart related, what will the problem be?

A

arrhythmia or CHD

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27
Q

is chest pain common in children?

A

No, usually MSK

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28
Q

most common arrhythmia in kids?

A

PACs

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29
Q

Some conducted, some non-conducted. Slight not-quite compensatory pause before next beat. Benign

A

PACs

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30
Q

wide QRS, no compensatory pause, typically benign unless they come several in a row

A

PVCs

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31
Q

3 PVC’s in a row

A

V tach

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32
Q

how do you treat Vtach?

A

cardioverting

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33
Q

280-300 bpm, well tolerated in kids (unless underlying heart dz)

A

Supraventricular tachycardia (SVT)

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34
Q

Wolff-Parkinson-White Syndrome

A

Re-enterant tachycardia

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35
Q

how do you manage SVTs?

A

beta blockers

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36
Q

how do you stop supraventricular tachycaria?

A

adenosine

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37
Q

what’s another symptoms that can put someone in SVT?

A

prolonged QTC syndrome

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38
Q

heart block with prolonged PR

A

first degree

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39
Q

what normally causes heart block in kids?

A

maternal lupus (3rd degree)

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40
Q

Block where not all P waves are conducted.

A

second degree block

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41
Q

types of second degress block where there are progressively longer PR intervals until a QRS is dropped.

A

Type 1 second degree block

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42
Q

what is a second degree heart block where PR intervals are equal but there is an occasional QRS dropped

A

Type 2 second degree heart block

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43
Q

block with complete dissociation of SA with AV

A

third degree heart block

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44
Q

Children’s heart disease , particularly congenital heart disease is due to _______________________

A

structural abnormalities

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45
Q

causes of congenital heart dz.

A

multifactorial

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46
Q

What viruses can lead to mycoarditis?

A

coxsackie B, Parvovirus

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47
Q

what can ibuprofen taken by the mother cause in the baby?

A

Pulmonary HTN

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48
Q

what can lupus in mom cause?

A

congenital heart block

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49
Q

what can diabetes in mom cause in baby

A

TGA
VSD
ventricular hypertrophy

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50
Q

what Trisomy 21 lead to in the heart?

A

AV septal defect

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51
Q

what can turner’s syndrome have to the heart?

A

CoA, biscupsid aortic valve

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52
Q

what can marfan syndrome cause in the heart?

A

MVP, dilated aortic root, MR

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53
Q

what is the most common CHD that presents in the first week of life?

A

Transposition of the great arteries

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54
Q

what is the second most common presenting heart condition in the first week of life?

A

hypoplastic left heart dz

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55
Q

what is the most common CHD presenting beyond infancy?

A

tetraology of fallot

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56
Q

differences b/w fetal heart and normal heart?

A 
open ducuts arteriosus
open foramen ovale
increased pulmonary pressure
most blood routed around lungs
oxygenation in placenta, not lungs
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57
Q

how does oxygen help the PDA close

A

mild vasoconstrictor

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58
Q

if a baby is acyanotic, what type shunt must there be?

A

Left to right

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59
Q

If a baby is cyanotic what must the shunt be?

A

Right to left shunt

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60
Q

If pulmonary flow is increased, what type shunt is it?

A

left to right shunt

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61
Q

if there is decreased pulmonary flow what type shunt will you have?

A

right to left shunt

62
Q

what is the most common noncyanotic CHD?

A

VSD

63
Q

list the nonxyanotic CHD problems

A

ASD, VSD, PDA

pulmonary stenosis, aortic stenosis, aortic coarctation

64
Q

Presents in childhood w/ murmur or exercise intolerance. RA and RV volume overload (enlargement). Physical findings of RV lift, persistently split S2, diastolic flow over tricuspid valve

A

ASD

65
Q

ASDs that persistent after how many years will not close?

A

2 years

66
Q

what finding goes with a persistently split S2?

A

ASD

67
Q

will present with poor growth, SOB, easy fatigue, may have recurrent respiratory infections. Can has a “boudning” precordial activity, holosystolic mumur.

A

VSD

68
Q

tx for VSD

A

observation
anti-congestive HF meds (diuretics)
fortified diet
surgery

69
Q

can kids increase rate and stroke volume?

A

No, only can increase rate

70
Q

tx for PDA

A

indocin/ ibuprofen or sx

71
Q

how can you keep PDAs open?

A

prostaglandins

72
Q

is pulmonic stenosis progressive?

A

no

73
Q

what is the first sign of aortic stenosis?

A

Murmur (ejection click, basilar ejection murmur, precordial or suprasteneral thrill)

74
Q

Will present with chest pain, dizziness, syncope (especially with exertion)

A

Aortic stenosis

75
Q

tx for aortic stenosis

A

most are progressive, can need a valve replacement

76
Q

blowing systolic in left axilla. Neonates will have severe congestive cardiac failure. older children will have HTN, absent or weak femoral pulses.

A

CoA

77
Q

what are cyanotic CHD problems? (5 T’s)

A 
Tetraology of Fallot
Triscupsid atresia
total anamalous pulmonary venous return (RAPVR)
truncut arteriosus
transposition of the great vessels 
hypoplastmic left heart syndrome (HLH)
pulmonary atresia (PA)
double outlet right ventricle (DORV)
78
Q

if a one week up sepsis in the ER what should you have on your ddx

A

sepsis
inborn error
cOA

79
Q

does truncus arteriosis increase or decrease pulmonary blood flow?

A

increase pulmonary blood flow

80
Q

does tetraology of fallot increase or decrease blood flow?

A

decrease pulmonary blood flow.

81
Q

what can worsen with the closure of a PDA and can have “tet spells”

A

tetraology of fallot

82
Q

4 things with tetraology of fallot

A
  1. narrowing of pulmonary valve
  2. thickening of wall of right ventricle
  3. displacement of aorta over VSD
  4. VSD
83
Q

what is the most common cyanotic lesion

A

tetraology of fallot

84
Q

what will kids with tetraology of fallot do?

A

squat

85
Q

when are most patietns with TOF cyanotic by?

A

4 months

86
Q

tx for TOF

A

surgical correction, fix VSD

can get prostaglandins

87
Q

tx for TGA

A

form a ASD, give prostaglandins, tx

88
Q

will you hear a murmur with TGA?

A

no

89
Q

bacteria pneumonia tends to look like what on a x-ray?

A

lobar, consolidated

90
Q

what are responsible for atypical pneumonias?

A

Chlamydia and mycoplasm

91
Q

how will atypical pneumoniae present?

A

x-rays will be normal, or interstitial (perihilar streakiness, etc)

92
Q

from ages 1-5 what type of causes of pneumoniae are common?

A

Viruses

93
Q

Over 5 what are the most common causes of pneumonia?

A

strep pneumo and mycoplasma

94
Q

Acyanotic heart lesions

A

3 Ds (VSD, ASD, PDA)

95
Q

cyanotic heart lesions

A 
12345
1 trunk
2 (vessel switch)
3 (tricupsid insufficiency)
4- tetraology of fallot
5 (TAPVR) total anomalous pulmonary venous return
96
Q

what does a hypoplastic left heart need to get blood to the body?

A

PDA with an ASD

97
Q

How do you treat hypoplastic left heart?

A

prostaglandins

98
Q

what will happen with a hypoplastic left heart without tx?

A

Death at 5-7 days untreated

Shock and acidosis

99
Q

what are some non-ductal dependent conditions?

A

mild-moderate AS, CoA or PS

100
Q

Presents in infants with dyspnea, fatigue, poor feeding, FTT, tachycardia, gallop rhythm, hepatomegaly

A

heart failure

101
Q

In an older kid due exercise intolerance, somnolence, anorexia, (cough, wheeze, crackles in late failure)

A

heart failure

102
Q

how is a chest x-ray helpful in heart failure?

A

if it is negative, but not helpful with fluid in lungs (could be pneumonia or heart failure)

103
Q

heart sound associated with heart failure?

A

S4

104
Q

what is the best study for heart failure?

A

Echo

105
Q

what is the most common type of cardiomyopathy?

A

dilated then

hypertrophic

106
Q

Increased ventricle size with decreased contractility

no evidence of coronary,valvular or pericardial disease

A

Dilated cardiomyopathy

107
Q

what will happen with dilated cardiomyopathy?

A

leaky valvues (mitral insufficiency)

108
Q

tx for cariomyopathy

A 
Diuretics
inotropic meds (help squeeze)
afterload reducers (vasodilation)
109
Q

what is hypertrophic cardiomyopathy associated with?

A

prolonged QT interval

110
Q

what does a narrow pulse pressure indicate?

A

systolic is very close to diastolic

111
Q

what is a case of widened pulse pressure?

A

PDA

112
Q

what is a cause of a narrow pulse pressure?

A

dilated cardiomyopathy

113
Q

what will the pulses be like with dilated cardiomyopathy?

A

weak

114
Q

what can cause viral myocarditis?

A

echovirus

coxsackie B

115
Q

are EKGs helpful with cardiomyopathies?

A

yes, will be abnormal but will be nonsprcific

116
Q

if pericarditis is bacterial what can cause it?

A

Staph A

Strep Pneumo

116
Q

if pericarditis is bacterial what can cause it?

A

Staph A

Strep Pneumo

117
Q

What is the best test for pericarditis?

A

echo

117
Q

What is the best test for pericarditis?

A

echo

118
Q

what is the most often cause of pericarditis?

A

Viral

118
Q

what is the most often cause of pericarditis?

A

Viral

119
Q

what labs can do you for pericarditis?

A

viral titers, antistreptolysin O titers ASO (blood)

119
Q

what labs can do you for pericarditis?

A

viral titers, antistreptolysin O titers ASO (blood)

120
Q

what do vegetations on valves in endocarditis do?

A

create clots

120
Q

how do you treat pericarditis

A

anti inflammatories (viral)

121
Q

infection on endothelial surface of heart- make vegetations. Typically a complication of CHD and surgery. Present with nonspecific symptoms- fever, malaise, weight loss, tachycardia, new or changed murmur

A

endocarditis

121
Q

tx for infective endocarditis?

A

high dose penicillin + aminoglycoside

122
Q

patient presents with polyarthritis, syndenham’s chorea, erythema marginatum, subq nodules. had a previous hx of strep.

A

Acute rheumatic fever

123
Q

what are some systemic symptoms of endocarditis?

A 
Anemia
pallor
splinter hemorrhage in nailbeds
clubbing
retinal infarcts
124
Q

what do vegetations on valves in endocarditis do?

A

create clots

125
Q

most common organisms for endocarditis?

A

strep viridans

staph aureus

126
Q

Labs for endocarditis?

A

CBC- luekocytosis, anemia
blood culture
ESR and CRP often elevated

127
Q

tx for infective endocarditis?

A

high dose penicillin + aminoglycoside

128
Q

patient presents with polyarthritis, syndenham’s chorea, erythema marginatum, subq nodules. had a previous hx of strep.

A

Acute rheumatic fever

129
Q

when after strep does acute rheumatic fever present?

A

1-3 weeks following group A beta-hemolytic strep

130
Q

what is prophylaxis for ARF?

A

Pen V BID or PEN G IM q 4 wekks until low risk

131
Q

what is the criteria used to decide if it is rheumatic fever or not?

A

Modified jones criteria

132
Q

what are major criteria for the JOhnes criteria?

A 
migratory polyarthritis
carditis 
Sydenham's chorea
erythema marginatum 
SubQ nodules
133
Q

treatment for Kawasaki’s

A

IVIG at high dose

high dose ASA

134
Q

tx for ARF

A

Penicillin
antistrep prophylaxis and bacterial endocarditis prophylaxis
aspirin for pain and dever

135
Q

how do you tx severe carditis

A

corticosteroids for severe carditis

136
Q

3 stages of kawasaki’s?

A

acute- fever, mucocutaneous symptoms (up to 2 weeks)
subacute- thrombocytosis, coronary artery changes (2-4 weeks)
chronic- slow resolution (2 months) `

137
Q

what are the 5 stymptoms of kawasaki’s dz?

A
  1. fever (min 5 days)
  2. conjunctivitis (no exudate, painless)
  3. rash
  4. changes in hand and feet- ersythema and desquamation
  5. mucous membrane involvement (strawberry tongue, pharyngitis)
  6. Cervical adenopathy- often unilateral
    Plus coronary aneurysms
138
Q

what type shunts are always cyanotic?

A

right to left

139
Q

joint pain + fever + murmur indicates what?

A

rheumatic fever

140
Q

9 year old with “fluttering” in chest after soccer game- what do you suspect?

A

Supraventricular Tachycardia
asthmatic
anemia

141
Q

another name of kawasaki disease?

A

mucocutaneous lymph node syndrome

142
Q

3 stages of kawasaki’s?

A

acute- fever, mucocutaneous symptoms
subacute- thrombocytosis, coronary artery changes
chronic- slow resolution

144
Q

what type shunts are always cyanotic?

A

right to left

145
Q

joint pain + fever + murmur indicates what?

A

rheumatic fever

146
Q

9 year old with “fluttering” in chest after soccer game- what do you suspect?

A

Supraventricular Tachycardia

asthmatic

149
Q

what are the 5 symptoms of kawasaki’s dz?

A
  1. fever (min 5 days)
  2. conjunctivitis (no exudate, painless)
  3. rash
  4. changes in hand and feet- ersythema and desquamation
  5. mucous membrane involvement (strawberry tongue, pharyngitis)
  6. Cervical adenopathy- often unilateral
    Plus coronary aneurysms

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