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Pediatrics > Cardiac > Flashcards

Cardiac Flashcards

0
Q

What is the importance of prostaglandins?

A

keeps the ductus arteriosus open

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1
Q

What is the importance of ductus arteriosus?

A

connects the blood from the pulmonary artery and aorta to mix to provide O2 to the trunk and lower extremities of the body

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2
Q

When does prostaglandins start to drop?

A

FUNCTIONAL closure of the ductus arteriosus

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3
Q

When does the functional closure of the ductus arteriousus occur?

A

12-15hrs after birth

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4
Q

What happens during the functional closure of the ductus arteriousus?

A
  • smooth muscle constricts

- drop of prostaglandins

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5
Q

When does the anatomic closure of the ductus arteriousus occur?

A

2-3 wks

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6
Q

How does the foramen ovale close after birth?

A

the pressure in the lungs increase causing a shunt from L to R; there is an increased pressure on the L atrium

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7
Q

What to check for in newborns - cardiac?

A 
CAPIG
Color
Auscultation
Pulse/palpitation 
Inspection
General appearance
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8
Q

What is more concerning regarding cyanosis?

A

central is more alarming than peripheral cyanosis

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9
Q

What is acrocyanosis?

A

peripheral cyanosis

benign

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10
Q

What murmur will have a thrill?

A

4+/6

loud HARSH murmur

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11
Q

How do you take peripheral pulses?

A

take 2 from different areas
ie) femoral + femoral OR femoral + brachial
check the two pulses and if they is a delay –> suspect cardiac stenosis

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12
Q

How do you check for perfusion and what is normal?

A

press firmly for 5 sec

normal: <2 sec

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13
Q

How do you grade murmurs?

A

1-3: NO thrill
4: 3 PLUS thrill
5-6: no need stethoscope

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14
Q

Which is more concerning: systolic or diastolic murmur?

A

DIASTOLIC

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15
Q

What to check for BP?

A

1) RECHECK ANY ABNORMAL BP
2) always compare upper and lower BP
3) keep in mind of baby’s: ht, wt, and age

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16
Q

What can cx false low O2 readings?

A 
severe anemia
carbon monoxide
hypotension
hypothermia
nail polish
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17
Q

What is normal pulse grade?

A

2+
1+: diminished
3+: hyperactive

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18
Q

What is the hyperoxia test?

A

1) give pt O2
if there is improvement –> respiratory defect
if there is NO improvement –> cardiac defect
*USED TO DIFFERENTIATE IF PROB IS FROM THE LUNGS OR THE CARDIAC

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19
Q

What should you check for re: CXR?

A 
LVSSR (l-o-v-rs)
Location
Vasculature (lungs)
Shape
Size
Ribs
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20
Q

CT ratio: neonates vs infant/child?

A

neonates: <45%

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21
Q

What does rib notching suggest?

A

masses

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22
Q

What is S1 and S2?

A

S1: mitral and tricuspid
S2: aorta and pulmonary

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23
Q

What do you hear in ASD?

A

FIXED SPLIT: valve is not working

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24
Q

What can you hear upon inspiration?

A

splitting

BUT FIXED SPLITTING = ASD

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25
Q

What is a murmur?

A

the turbulence that is heard from the chambers and valve

abnormal in adults but normal in kids

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26
Q

At what age are murmurs concerning (abnormal)?

A

usually all benign murmurs heard in newborns and infants

after 8yo- NOT normal

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27
Q

Whats the steps when you hear a murmur?

A

1) murmur heard
2) refer
3) cardio does an echo

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28
Q

What is a functional murmur?

A

when the murmur that is heard is BENIGN and normal and NOT pathologic

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29
Q

What are the common benign murmurs?

A

Peripheral pulmonary stenosis
Stills
Venous humm

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30
Q

At what age can you typical hear the peripheral pulmonary stenosis murmur?

A

newborn to 2yo

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31
Q

At what age can you hear the Stills murmur?

A

2-8yo

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32
Q

At what age can you hear the venous hum murmur?

A

3-6yo

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33
Q

Which murmur sounds like a musical/vibration?

A

Stills

b/c the chordae tendinae are vibrating

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34
Q

Which benign murmur is heard the loudest in SUPINE?

A

Stills

35
Q

Which benign murmur is heard the loudest in SITTING position?

A

Venous Hum murmur

b/c gravity is pulling the blood down from the brain –> internal jugular –> subclavian vein = MORE TURBULENCE

36
Q

What is the Venous Hum murmur?

A

the turbulence of the internal jugular vein AND subclavian vein that goes into the superior

37
Q

What is concerning murmur?

A 
over 8yo
murmur does NOT change w/ position (supine/siting, etc)
grade is 4 (b/c there is a thrill involved)
murmur is heard with: 
-growth failure
-click
-cyanosis
-has other congenital anomalies
38
Q

What are the categories of congenital heart dz?

A

cyanotic: right -> left, parallel, and mixed
acyanotic: left -> right, obstructive

39
Q

What are the right to left congential heart dz?

A

tetralogy of fallot

tricuspid

40
Q

What is parallel congenital heart dz?

A

transposition of great vessels

total anomalous pulmonary return

41
Q

What is mixed congenital heart dz?

A

Truncus arteriousus

42
Q

What is tertalogy of fallot?

A 
POVER
Pulmonary stenosis
Override aorta
VSD
RVH
43
Q

Tetralogy of Fallot - sx?

A

pink- mild stenosis and able to send blood back

blue- severe stenosis and blood is shunted to systemic

44
Q

Tetralogy Fallot - labs?

A

CXR: boot shpaed/egg on side

45
Q

What is tet spell?

A

peripheral cyanosis

crying on the side in fetal position

46
Q

Tetralogy Fallot - tx?

A

morphine to calm down

Phenlephrine to increase systemic vascular resistance and pulmonary circulation

47
Q

What is transposition of the great vessel?

A

COMPLETELY TWO DIFFERENT CIRCUITS
R atria and ventricle pumps to the systemic
L atria and ventricle pumps to the lungs
NEVER crosses

48
Q

What is tricuspid atresia?

A

missing the tricuspid valve so there is no connection between the right atria and ventricle
it is important to keep the foreman ovale and the ductus arteriosus open because it is the only way that the blood is able to flow between the right and left chambers of the heart (give them PROSTAGLANDINS!)

49
Q

What is total anamlous pulmonary return?

A

all the blood from the pulmonary veins drain into the systemic veins or right atrium and does NOT into the venous circulation

50
Q

What is truncus arteriosus?

A

the aorta and the pulmonary artery are ONE

51
Q

Which cyanotic congenital heart dz has VSD?

A

Truncus arteriosus
Tricuspid Atresia
Tetralogy of Fallot

52
Q

What are the cyanotic congenital heart dz?

A 
Truncus
Transitional
Tricuspid
Tetra
Total Anamous
Hypoplastic
53
Q

What is hypoplastic left heart syndrome?

A

cyanotic
mitral valve is closed and the left ventricle is small
relies on the ductus arteriosus –> if closed –> bad news bear

54
Q

What are the acyanotic congenital heart dz?

A

L to right

obstructive

55
Q

What are the left to right congenital heart dz?

A

ASD
VSD
PDA

56
Q

What is ASD?

A

atrial septal defect

right atria has blood from the left atria

57
Q

What is VSD?

A

acyanotic

right ventricle has mixing of the blood from the left ventricle

58
Q

What is PDA?

A

acyanotic
patent ductus arteriosus
aorta blood is mixing in with the pulmonary artery

59
Q

What are the obstructive congenital heart dz?

A

coarctation of aorta
aortic stenosis
pulmonary stenosis

60
Q

What is coarctation of the heart?

A

obstructive
acyanotic
there is a obstruction/squeeze of the aorta AFTER brachio, left common, and left subclavian –> upper extremities are perfused BUT lower extremities are NOT

61
Q

Coarctation of the aorta - sx?

A

UE pulses stronger than LE

RIGHT radial/brachial is STRONG

62
Q

Aortic stenosis and pulmonary stenosis?

A

narrowing of the aorta and pulmonary artery
acyanotic
obstructive

63
Q

When do you need to administer prophylaxis bacterial endocartitis?

A

prosthetic valve
hx of infective endocarditis
congenital heart dz

64
Q

What is the most common cause for HTN in kids?

A

renal dz (secondary HTN)

65
Q

HTN in kids - sx?

A

HA

nosebleeds

66
Q

What is the normal BP %?

A

below 90%

67
Q

What is preHTN %?

A

90-95%

68
Q

What is HTN %?

A

greater than 95%

69
Q

When do you start checking for BP in kids?

A

3 yo

70
Q

What if kid is OVERWT but under BP 95%?

A

HTN

71
Q

What if kid is skinny with BP 95%?

A

HTN

72
Q

If kid is 95% what labs would you order?

A 
you're trying to find the cause of the HTN:
1) compare the BP UE and LE 
2) UA
3) CBC
4) BMP (BUN, Cr)
5) Lipid
6) Renal
ANYTHING TO CLUE IN OR R/O RENAL FAILURE
73
Q

HTN - tx?

A

LIFESTYLE MODIFICATIONS

but if cause of HTN is secondary - start drugs (ACE, etc)

74
Q

What are the causes of sudden cardiac death in children?

A 
MAAHT
Myocarditis
Arrhthmias
Aberrant coronary artery
Hypertrophic cardiomyopathy
Trauma to chest
75
Q

What is hypertrophic cardiomyopathy?

A

most common cause of sudden cardiac death in children
autosomal dominant
murmur is LOUD sitting > supine

76
Q

Hypertrophic cardiomyopathy - sx?

A

on exertion:
chest pain
palpitation
sycnope

77
Q

What are the arrhythmias that cause sudden cardiac death?

A

long QT

WPW

78
Q

What strucutral or fxnal heart dz can cause sudden cardiac death?

A

myocarditis
marfan
aortic stenosis
ARDS

79
Q

What can cx long QT?

A

abx - quinolones

80
Q

What should be asked when doing a PRE sports physical to prevent sudden cardiac death?

A

family hx of early death
deafness
chest pain w/ syncope
med hx of ADHD

81
Q

What is commotio cordis?

A

when kid is hit in the chest during a sport

82
Q

What is Marfan sx?

A

genetic dz

83
Q

Marfan - sx?

A 
long fingers - arachnodactyly
ectopia lentis - lens are subluxed
early scoliosis
AA
dral extasia
pneumothorax
84
Q

Marfan sx - PE?

A

steinberg sign

walker sign

Pediatrics (12 decks)

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