CARDIO Flashcards
MC cause of pediatric heart failure in children
Congenital heart disease
Volume overload lesions (VSD, ASD, PDA) MC in the first 6mos of life
Heart failure management (6)
IDAPAS
1. Inotropes: to improve cardiac contractility
2. Diuretics: reduce pulmo congestion
3.ACE/ARBs: reduce afterload
4. Penicillin/Prednisone
5. Aspirin/Antibx
5. Support
> high back rest
> Appropriate fluid therapy
> O2, ventilatory support
> Nutrition
MC pediatric cardiac tumor
Rhabdomyomas
> asstd w tuberous sclerosis
Matching type:
A. pressure work
B. volume load
C. intrinsic myocardial function
Afterload, Preload, Contractility
A. pressure work: Afterload
B. volume load: Preload
C. intrinsic myocardial function: Contractility
Saccular aneurysms seen in what phase of Kawasaki Disease?
1st phase: neutrophilic necrotizing arteritis
2nd phase: subacute/chronic vasculitis - Fusiform aneurysm
Principle criteria of Kawasaki Disease
CRASH+ Burn
1. Fever 38deg, at least 5 days
2. Conjunctivitis, bilateral non exudative w limbal sparing
3. Rash - polymorphic
4. Adenopathy - unilateral cervical at least >1.5cm
5. Strawberry tongue - erythema of oral and pharyngeal mucosa, dry cracked cherry lips
6. Hands and feet - edema and erythema
Highest risk of sudden death is seen in which phase of Kawaski disease?
- Subacute phase
* periungual desquamation of fingers and toes: 2-3 wks
* thrombocytosis
* development of CAA
* highest risk of sudden death
* lasts 3 weeks - acute febrile phase
* fever lasting 1-2wks
* acute phase: perineal desquamation - Convalescent phase
* all clinical signs of illness disappeared
* continues until ESR returns to normal
* 6-8wks after onset of illness
Diagnostic criteria for RHD
MAJOR (JONES)
1. Polyarthritis
2. Carditis
3. Subcutaneous nodules
4. Erythema maginatum
5. Syndenham chorea
MINOR (CAFE PAL)
1. elev CRP
2. Arthralgia- must not included if arthritis is included
> monoarthralgia in mid/high risk pop
3. Fever
Mod/High risk: >38degC
Low risk: >38.5degC
4. elev ESR
- >30mm/hr in mod/high risk
- >60mm/hr in low risk
5. Prolonged PR interval
6. Grp A Strep
> culture
> rapid ag tests
> ab titers
Circumstances where ARF diagnosis can be made WITHOUT strict criteria adherence
CIR
1. Chorea is the only major manifestation
2. Indolent carditis is the only manifestation in patients who first come to medic attention ony months after the apparent onset of ARF
3. Recurrences of ARF in high risk populations
Minimum # criteria to fulfil RHD diagnosis?
Initial attack:
Recurrent attacks:
Initial attack:
Evidence of GAS inx PLUS
> 2 major
> 1 major 2 minor
Recurrent attacks:
Evidence of GAS inx PLUS
> 2 major
> 1 major 2 minor
> or 3 minor in mod/high risk population
TRUE or FALSE. Myocarditis and/or pericarditis without evidence of endocarditis is almost never RHD.
TRUE
A substernal thrust indicates __.
A. LVH
B. RVH
C. RAE
D. LAE
B. RVH
An apical heave indicates __.
A. LVH
B. RVH
C. RAE
D. LAE
A. LVH
Murmur grading: I-VI
I: barely audible
II: medium intensity
III: loud, NO thrill
IV, loud with THRILL
V. very loud
VI: loud enough w stethoscope above the chest
Characteristics of innocent mumurs
INNOCENT MURMURS- 7S
1. soft
2. short
3. single
4. sweet (musical)
5. sensitive
6. small
7. systolic
- medium pitched
- vibratory
- musical
- short systolic ejection murmur
- at the LL or MSB
- bet 3-7yo
MC CHD in infancy
VSD
MC CHD beyond infancy
TOF
Components of TOF
DROP
1. VSD: shunting L –> R
2. RVH
3. Overriding of the VSD by the aorta
4. PS
Murmur of TOF is caused by:
A. VSD
B. PS
C. MR
D. PR
Pulmonary stenosis
> caused by the turbulence in the RVOT
> less audible during tet spell because blood is shunted away from RVOT via AV
Rib notching is appreciated in what CHD
A. VSD
B. TGA
C. TAPVR
D. COA
COA
Complications of uncorrected TOF (3)
Cerebral thromboses
Brain abscess
Bacterial endocarditis
Pathophy of tet spells
Pag agitated, crying, dehydrated, fever, exercise or play, there is an increase in pulmo vascular resistance. Therefore, walang BF sa already stenotic na Pulmo valve – kaya nawawala yung murmur ng PS
Squatting:
kinks the BV of the LE to increase systemic vascular resistance to decrease shunting of blood from right to left, therefore increasing BF to the pulmonary artery.
The primary developmental defect in tetralogy of Fallot that is responsible for the characteristic 4 cardiac defects is what?
A. Anomaly in arch development
B. Anterior displacement of the infundibular septum
C. Downward displacement of the tricuspid valve
D. Downward displacement of the tricuspid valve
B. Anterior displacement of the infundibular septum
> Tetralogy of Fallot is one of the conotruncal family of heart lesions in which the primary defect is an anterior deviation of the infundibular septum (the muscular septum that separates the aortic and pulmonary outflows)
Which cardiac defect has the worst prognosis, without immediate surgical correction?
A. d-TGA with no associated defects
B. l-TGA with no associated defects
C. d-TGA with large ASD
D. d-TGA with restrictive VSD
E. l-TGA with restrictive VSD
A. d-TGA with no associated defects
d-Transposition of the great arteries is a medical emergency. Cyanosis and tachypnea are most often recognized within the 1st hours or days of life. If it is not treated, the vast majority of these infants would not survive the neonatal period. Hypoxemia is usually moderate to severe, depending on the degree of atrial level shunting and whether the ductus is partially open or totally closed. Infants who remain severely hypoxic or acidotic despite prostaglandin infusion should undergo Rashkind balloon atrial septostomy. A successful Rashkind atrial septostomy should result in a rise in PaO2 to 35-50 mm Hg and elimination of any pressure gradient across the atrial septum. Some patients with TGA and VSD may require balloon atrial septostomy because of poor mixing, even though the VSD is large. If the VSD associated with d-TGA is small, the clinical manifestations, laboratory findings, and treatment are similar to those described previously for transposition with an intact ventricular septum. When the VSD is large and not restrictive to ventricular ejection, significant mixing of oxygenated and deoxygenated blood usually occurs and clinical manifestations of cardiac failure are seen. The degree of cyanosis may be subtle and sometimes may not be recognized until an oxygen saturation measurement is performed. The physiology of l-TGA is quite different from that of d-TGA. The double inversion of the atrioventricular and ventriculoarterial relationships result in desaturated right atrial blood appropriately flowing to the lungs and oxygenated pulmonary venous blood appropriately flowing to the aorta. The circulation is thus physiologically “corrected.” Without other defects, the hemodynamics would be nearly normal.
Criteria for infective endocarditis
Two major criteria, 1 major and 3 minor, or 5 minor criteria suggest definite endocarditis.
Major criteria
(1) positive blood cultures (2 separate cultures for a usual pathogen, 2 or more for less typical pathogens)
(2) evidence of endocarditis on echocardiography (intracardiac mass on a valve or other site, regurgitant flow near a prosthesis, abscess, partial dehiscence of prosthetic valves, or new valve regurgitant flow).
Minor criteria:
> fever
> embolic-vascular signs
> immune complex phenomena (glomerulonephritis, arthritis, rheumatoid factor, Osler nodes, Roth spots)
> a single positive blood culture or serologic evidence of infection
> echocardiographic signs not meeting the major criteria.
A modification of the Duke criteria may increase sensitivity while maintaining specificity. The following minor criteria are added to those already listed
> the presence of newly diagnosed clubbing, splenomegaly, splinter hemorrhages, and petechiae
> a high erythrocyte sedimentation rate
> a high C-reactive protein level
> the presence of central nonfeeding lines, peripheral lines, and microscopic hematuria
MC cause of Pulmonary HTN in children
Congenital heart disease (40-55%)
MC mechanism of SVT in infants
A. Atrioventricular reciprocating tachycardia (AVRT)
B. Atrioventricular node reentry tachycardia (AVNT)
C. Ectopic/autonomic tachycardias
A. Atrioventricular reciprocating tachycardia (AVRT)
> reetrant tachycardia with accessory pathway
MC cause of death in the athletic adolescent
A. Dilated CM
B. Hypertrophic CM
C. Restrictive CM
B. Hypertrophic CM
Leading causative agent for bacterial endocarditis
A. Viridans strep
B. Group A hemolytic strep
C. Staph aureus
D. A and B
E. All
All
> Staph endocarditis more often seen in patients w no underlying heart dse
Viridans strep: after dental procedures
Group D enterococci after lower bowel or geitourinary manipulation
Pseudomonas aeruginosa and Serratia marcesens: IV drug users
Fungal: after open heart surgery
CONS: indwelling central venous catheter
Etiologic agent causing infective endocarditis in after dental sugery
Viridans strep
Etiologic agent causing infective endocarditis in after lower bowel or genitourinary surgery
Grp D enterococci
Etiologic agent causing infective endocarditis in patients w no underlying heart disease
Staphylococcus
Etiologic agent causing infective endocarditis in IV drug users
P. aeruginosa
S. marcesens
Etiologic agent causing infective endocarditis in after open heart surgery
Fungi
Many of the classic skin findings in IE develop _ in the disease
Early
Late
Late
Tender, pea-sized intradermal nodules in the pads of the fingers and toes
Osler
O- peas
O-ouch - painful
Painless, small erythematous or hemorrhagic lesions on the palms and soles
Janeway lesions
Janeway lesions and Osler nodes are seen what disease entity?
Bacterial endocarditis
Modified Duke Criteria
BE TIMER
MAJOR
1. Bacterial culture
2. Evidence of endocardial involvement: echo
MINOR
1. Temp: Fever >38degC
2. Immunologic phenomena: Osler nodes, Roth spots, GN
3. Microbiologic evidence: culture positive not fulfilling major criteria
4. Emboli phenomena, vascular phenomena
5. Risk factors: CHD, prosthetic device, IV drug users
Minimum criteria for Definitive endocarditis
2 major
1 major, 3 minor
5 minor
Minimum criteria for Possible endocarditis
1 major 1 minor
3 minor
Treatment of choice for restrictive CM
Cardiac transplant
Pharma management are of limited use
MC symptom of acute pericarditis
chest pain
> sharp/stabbing positional, worse with inspiration, relieved by sitting upright or prone.
Definition of HTN for children (AAP 2017)
NORMAL: <90p for age, sex, ht or
< 120/80 for adol
Elevated: 90 - <95p for age, sex, ht or
120-129 / <80 for adol
Stage 1 HTN: >95p for age sex and ht up to 95p +11mmHg or 130-139 / 80-89 for adol
Stage 2 HTN: >95p +12mmHg for age sex and ht or >140/90 for adol
BP measurement is recommended to be included in every consult starting at age _
3yo
Small BP cuff size will result in _ results
Large BP cuff sizes will result in _ results
BP cuff length should cover _ of upper arm circumference and width _ of the arm circumference
High
Low
80-100%
40%
Closure of PDA
Functional
Physiologic
Functional: 14 hrs
Physiologic: 14 weeks
