Cardiac Emergencies - Kantner Flashcards
Cardiomyopathy
there is a lot of overlap between CM and myocarditis
Pulm over circulation syndrome
unrepaired VSD,
unrepaired AV Canal
unrepaired PDA
Large Av malformation
Pump failure -
Myocarditis
CM
Incessant arrhythmia
ALCAPA
Obstructive L H lesions
Critical CoA
Critical aortic valve stenosis
Hypoplastic L heart syndrome
LH failure symtpoms
abdominal pain, cramping, vomiting ( impaired git perfusion )
Fussiness, Poor feeding FTT
Decreased energy
Resp symptoms is later finding
LH failure physical findings -
Tachycardia, poor perfusion pulm congestion, rales, rhonchi gallop rhythm hypotension
CXR when to be concerned about heart size
Heard border > 1/2 thorax
AP portable film will tend to oversize heart size
Compensatory mechanisms for dilation/ decreased contractility
Increased HR - will compensate for SV loss
In an infant - the most stress they get is during feeding
Dopamine used more compared to epinephrine because
less chromotropic effects
Lucotropic effects
reduced heart stifness ( seen with milrinone)
How to support cardiac patients
HF to support pulm edema
Avoid sedation because they are catecholamine depleted
Acute myocarditis - most common viral cause
Coxsackie B
ALCAPA
anomalous, L Ca off the PA
ALCAPA presentatiion
85% present in first 1-2 months fussiness with feeds pallor general irritability - when Mom picks up before and after feeding - child is irritable Tachycardia
Later symptoms of ALCAPA
CHF - tachycardia diaphoresis, poor feeding , FTT
Mortality in 1st year
ALCAPA EKG
Deep Q waves in 1 and AVL - this is what you need to look for
ST changes in lateral leads
ALCAPA pathophys
At birth - they have high PVR - PA pressures high - so adequate perfusion pressure along cap bed
As PVR and PA pressure falls in first few weeks - progressive ischemia ensures
Surgical repair is curative ( arterial switch operation0
L coronay flow is poor and also going backwards
Arrhythmias
Very fast - SVT , At flutter( 1:1 conduction) - dimnished vent filling
Fast - EAT, JET A flutter with 2:1 rate at about 150 - gradually develop CHF symptoms
Slow - Congenital CHB / Lupus
Ectopic atrial tachycardia
Look for unusual P-wave morphology, consistent rate at 150 regardless of rest - no physiological variation
What is EAT
just another focus in atrium that is beating fast
Atrial flutter
Generrally will have 2 or 3 q waves for every qrs - will have a regular occurence
Adenosine dose and how to give
50-100mcg Use your stop cock rapid push adenosine - needs to be flushed 12 lead before and after with continuous monitoring or let the 12 lead run the whole time
