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EOR- PEDS > Cardio > Flashcards

Cardio Flashcards

1
Q

Acute autoimmune inflammatory multi-systemic illness sequela of a beta-hemolytic streptococcal infx of the pharynx

A

Rheumatic fever

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2
Q

Pathophys of Acute rheumatic fever

A

Symptomatic or asymptomatic infection with Group A Streptococcus (aka Strep pyogenes) stimulates antibody production to host tissues & damages organs directly

Children 5-15 years old

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3
Q

Major criteria for acute rheumatic fever

A

JONES = Joint (migratory polyarthritis), Oh (active carditis), Nodules (Subcutaneous), Erythema marginatum (macular erythematous non pruritic annular rash), Sydenham’s chorea

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4
Q

Minor criteria for acute rheumatic fever

A

Arthralgia

Fever 101.3 +

EKG = prolonged PR

Elevated CRP/ESR

Leukocytosis

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5
Q

Dx of acute rheumatic fever

A

Jones criteria for rheumatic fever – 2 Major OR 1 Major + 2 Minor PLUS Supporting evidence of recent strep infx

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6
Q

Tx of rheumatic fever

A

Anti-inflammatory: Aspirin (2-6 weeks with taper) +/- corticosteroids in severe cases & carditis

Penicillin G – antibiotic of choice (or erythromycin if PCN allergic) both in acute phase & after acute episode

Prevention is the most important therapeutic course – therefore all patients should be treated w/ abx

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7
Q

Biggest complication from rheumatic fever

A

Rheumatic valve dz = mitral (75-80%), aortic (30%), tricuspid & pulmonic (5%)

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8
Q

Abnormal opening in the atrial septum between the right & left atrium → volume overload of right atrium & ventricle

A

Atrial septal defect

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9
Q

MC type of atrial septal defect

A

ostium secundum

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10
Q

2nd MC congenital heart dz

A

Atrial septal defect

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11
Q

Sx of atrial septal defect

A

Infants & young children: recurrent respiratory infx, failure to thrive, DOE

Adolescents & young adults: exertional dyspnea, easy fatigability, palpitations, atrial arrhythmias, syncope, heart failure

Over 30 – dyspnea & chest pain, over 50 – afib & RVF

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12
Q

PE findings of atrial septal defect

A

Systolic ejection crescendo-decrescendo flow murmur @ pulmonic area (LUSB – 2nd or 3rd intercostal space)

Wide, fixed split S2 that does not vary with respirations, loud S1 & hyperdynamic right ventricle

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13
Q

Dx of Atrial septal defect

A

Echo = best test

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14
Q

Tx of ASD

A

Small ASD < 5mm may be observed (most small ASD spontaneously close in the first year of life)

Symptomatic treatment: Diuretics, ACE inhibitors, digoxin

Surgical correction: 1cm+/symptomatic (between 2-4 y/o) → perQ transcatheter closure v. surgical intervention

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15
Q

Persistent communication between the descending thoracic aorta & main pulmonary artery after birth

A

Patent ductus arteriosus

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16
Q

Pathophys for PDA

A

Continued prostaglandin E1 production & low arterial oxygen content promotes patency

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17
Q

Acyanotic vs cyanotic heart disease

A

Acyanotic = defect in which oxygen levels delivered to the body remain normal = VSD, PDA, ASD, AV Canal

*VSD = MC Acyanotic type

Cyanotic= Transposition of great arteries, terat of fallot, tricuspid valve abnormalities

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18
Q

Continuous machine-like or “to and fro” murmur loudest @ pulmonic area (LUSB – 2nd intercostal space)

A

PDA

19
Q

Congenital narrowing of the aortic lumen at the distal arch &/ descending aorta, 2x M>F

A

Coarctation of aorta

20
Q

Coarctation associated with

A

Often associated with bicuspid aortic valve (supposed t be 3 not 2) (50% of patients), mitral valve defects, patent ductus arteriosus & Turner syndrome

21
Q

Sx of coarctation of aorta

A

Bilateral claudication, dyspnea on exertion, syncope

Neonatal presentation: failure to thrive in infants, poor feeding 1-2 weeks after birth

22
Q

Late systolic ejection murmur/continuous murmur radiating to the left back, left scapula or chest, heard in the aortic area

A

Coarctation of aorta

23
Q

Upper extremity systolic HTN with lower extremity hypotension &/ diminished/delayed lower extremity pulses (femoral & dorsalis pedis pulse)

A

Coarctation of aorta

24
Q

Tx of coarctation of aorta

A

Corrective surgery or transcatheter-based intervention (eg. Balloon angioplasty w/ or w/out stent placement) preferably in early childhood (between 2 and 4 years)

Emergent surgical repair performed in cases of circulatory shock, cardiomegaly, severe HTN, severe CHF

Prostaglandin E1 (Alprostadil) preoperatively to stabilize the condition – maintains a patent ductus arteriosus, reducing symptoms @ improves lower extremity blood flow

Untreated? Most adults die by 50 y/o d/t aortic rupture, CVA, or aortic dissection

25
Q

MC cyanotic congenital heart disease (associated with a right-to-left shunt d/t pulmonary stenosis)

A

Teratology of fallot

26
Q

Pathophys of tetralogy of fallot

A

Constellation of:

1) pulmonary stenosis (RV outflow obstruction)

2) RV hypertrophy

3) large unrestrictive VSD

4) overriding aorta

27
Q

RF of tetralogy of fallot

A

Risk factors: genetic & environmental factors – associated with chromosome 22 deletion

28
Q

Sx of teratology of fallot

A

Infancy: cyanosis most common presentation (blue baby syndrome)

Tet spells relieved with putting knees to chest in infancy

Older children: exertional dyspnea, cyanosis that worsens with age

Tet spells – paroxysms of cyanosis relieved with squatting (squatting decreases rightto-left shunting, improving oxygenation); develop during crying/feeding

29
Q

harsh systolic murmur @ left mid to upper sternal border (VSD), right ventricular heave (RVH), digital clubbing, cyanosis

A

Tetralogy of fallot

30
Q

Tx of Tet of fallot

A

Surgical repair – ideally in first 4-12 months of life

Prostaglandin infusion prior to surgery to maintain a patent ductus arteriosus – improve circulation

Prophylaxis for bacterial endocarditis

31
Q

MCC of sudden cardiac death in young athletes in the US

A

Hypertrophic cardiomyopathy

32
Q

Tx of hypertrophic cardiomyopathy

A

Focus on early detection, medical tx, surgical tx, & or ICD placement

Medical: beta blockers 1st line medical management

33
Q

Hole in the ventricular septum, assoc. w/ left-to-right shunt

A

Ventricular septal defect

34
Q

MC type of congenital heart dz in childhood

A

VSD

35
Q

What is Eisenmenger syndrome

A

VSD with large (unrestricted) defects may eventually develop a right to left shunt

36
Q

MC type of VSD

A

Perimembranous: most common type – hole in the LV outflow tract near the tricuspid valve

Muscular: usually multiple holes in a “swiss cheese” pattern

Inlet (posterior): located posterior to the septal leaflet of the tricuspid valve

Supracristal (outlet): beneath the pulmonic valve, may have aortic valve insufficiency

37
Q

PE findings of VSD

A

High-pitched harsh holosystolic murmur best heard @ lower left sternal border

Smaller VSDs usually louder & associated w/ more palpable thrills than larger ones

38
Q

Dx and Tx of VSD

A

Dx = Echo

Tx =

Observation: in small, symptomatic VSDs (must close within 12 months)

Patch closure: symptomatic infants or uncontrolled CHF, growth delay, recurrent respiratory infections

Large shunts repaired by 2 years to prevent pulmonary HTN

39
Q

Medium & small vessel necrotizing vasculitis including the coronary arteries

A

Kawasaki dz

40
Q

Pathophys Kawasaki

A

Mucocutaneous vasculitis d/t vessel wall infiltration w/ mononuclear cells & later IgA secreting plasma cells → destruction of tunica media & formation of aneurysms

Unknown cause: increased risk with advanced maternal age, mother of foreign birth, group B strep, early infancy hospitalization d/t infx for bacterial cause, an unidentified respiratory agent/viral pathogen with propensity towards vascular tissue

41
Q

Sx of Kawasaki - Warm + Cream

A

Warm + CREAM = Fever >5 days + 4 out of 5 of the following:

Conjunctivitis

Rash (erythematous or morbilliform or macular)

Extremity changes: edema, erythema, or desquamation of palms & soles; Beau’s lines (transverse nail grooves), arthritis

Adenopathy (cervical)

Mucositis: strawberry tongue, lip swelling, fissures, pharyngeal erythema

42
Q

Tx of Kawasaki

A

IV immunoglobulin + aspirin for fever, joint pain, & prevention of coronary complications; Recurrent: 2nd dose IVIG +CS x3d

43
Q

Complications of Kawasaki

A

Coronary vessel arteritis: coronary artery aneurysm (20% of pts not given tx), MI, pericarditis, myocarditis

EOR- PEDS (9 decks)

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