Cardiac Disorders Flashcards
Hypertension
Blood pressure consistently above the 95th % for age, gender, and height.
- Measured on 3 separate occasions.
- Cuff size, measure after rest, check upper and lower extremities.
Essential Hypertension
Multifactorial, genetic, familiar, environmental, dietary factors.
Secondary Hypertension
Usually renal vascular in origin, systemic vascular with genetic syndrome, endocrine disorder, excess endogenous catecholamine.
HTN Assessment
BP evaluation, heart sounds.
PE: Dysmorphic features, abnormal retinal exam (papilledema), abnormal growth parameters.
HTN Diagnostics
CBC, UA, UCx, uric acid, BUN, creatinine, electrolytes, lipid panel, renal ultrasound, echocardiography.
HTN Management
Mild Essential HTN: dietary, exercise, weight loss.
Essential HTN: diuretics, vasodilators, beta-blockers, ACE inhibitors (NEVER first line).
Secondary HTN: find and treat underlying cause, referral to cardiology or nephrology.
Kawasaki Syndrome
Acute systemic vasculitis of unknown origin.
- Acute and subacute phases.
S/S: (PRIMARY) Prolonged fever, reddened and indurated palms/soles of feet, erythematous rash, bilateral conjunctival injection, red peeling lips, strawberry tongue, unilateral cervical lymphadenopathy, irritability.
(SECONDARY) May have evidence of vasculitis in other systems: murmur, diarrhea, vomiting, abdominal pain, proteinuria, cough, joint pain, swelling, seizures.
Dx: Based on 5 symptoms with fever > 5 days and 4 of 5 other primary symptoms OR fever > 5 days, 3 other symptoms and coronary aneurysm documented by imaging.
Tx: (Inpatient treatment) IVIG, high dose aspirin, chronic aspirin if indicated, cardiology and ID consults, long-term follow up with echocardiograms.
Rheumatic Fever
Collagen vascular disease of connective tissue resulting in vasculitis. Inflammation of joints and heart. Complication of Group A Streptococcal pharyngitis.
S/S: Presents as migratory polyarthritis with joint pain. Rash: erythema marginatum. Subcutaneous nodules found on elbows, knees, wrists, occiput, or vertebrae. 100% of cases have chorea.
Dx: Modified Jones criteria - 2 major criteria (carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules) OR 1 major and 2 minor criteria (arthralgia, fever, elevated CRP, ESR, WBC), prolonged PR interval (EKG).
Tx: (Acute) PCN, aspirin therapy, bedrest until fever and symptoms resolve, cardiology and ID consults. PCN prophylaxis for prevention.
Cardiomyopathies
Acute or chronic sequelae of a typical viral disease. Dilated cardiomyopathy is most often seen.
S/S: Congestive heart failure and decreased cardiac output. SOB, CXR reveals cardiomegaly, ECHO reveals globally decreased function.
Dx: Workup for anatomic abnormalities, metabolic causes, infectious causes.
Tx: (Acute) support cardiac output with inotropes and vasodilators, diuretics, treat causes (IVIG, antivirals, surgery for ALCAPA - anomalous left coronary artery from the pulmonary artery)
Hypertrophic Obstructive Cardiomyopathy
50% familial, often found on autopsy.
S/S: Acute decompensation, may be with sports or activity.
Tx: Activity restriction, beta-blockers, avoidance of catecholamines.
Long QT Syndrome
Congenital disorder characterized by a prolongation of the QT interval on ECG and a propensity to ventricular tachyarrhythmias, which may lead to syncope, cardiac arrest, or sudden death.
S/S: Usually not diagnosed until child/adolescent has a cardiac event, including syncope or cardiac arrest. Relatives of patients who have died of sudden death require evaluation.
Dx: Potassium, magnesium, and thyroid function. EKG and sometimes echocardiogram indicated.
Tx: Beta-blockade, implantable cardioverter/defibrillator may be needed. Patients should avoid other medications that will prolong the QT interval.
ASD
Opening in the atrial septum.
- Left to right shunting.
S/S: Usually asymptomatic, with soft, systolic ejection murmur with fixed S2.
Dx: EKG may show right axis deviation, RVH, echocardiogram.
Tx: May close spontaneously. Echocardiogram is routine monitoring. Surgery for large lesions.
VSD
Opening in the ventricular septum.
- Left to right shunting.
S/S: Findings are dependent on size of lesion and pulmonary vascular resistance. Signs of CHF, holosystolic murmur, pulmonary hypertension can occur.
Dx: Echocardiogram, CXR, B-type natriuretic peptide serum level, EKG, occasionally cardiac catheterization.
Tx: Control symptoms of CHF prior to surgical correction, nutrition. Surgical correction is usually after the age of one.
Atrioventricular (AV) Canal
Results from the failure of the endocardial cushion to develop normally.
- 3 components: ASD, inlet VSD, abnormal formation of the AV valves.
- Left to right shunting.
S/S: Depend on type and configuration. Tachypnea, poor weight gain, other signs of CHF.
Dx: Echocardiogram, CXR.
Tx: Control CHF and encourage weight gain. Surgical management.
PDA
Vessel connects the left main pulmonary artery to the descending aorta, in utero is part of normal circulation, after birth, lesion closes, if remains open:
- Left to right shunting.
S/S: Depends on extent of shunting. Can result in CHF or pulmonary hypertension. Murmur, widened pulse pressure, low diastolic pressure and bounding pulses.
Tx: In preterm infants, medical management has been efficacious, but recent evidence suggests allowing spontaneous closure. Surgical closure can be accomplished.
