Cardio Flashcards
inadequate oxygen delivery by the myocardium to meet metabolic demands of the body
CHF
3 compensatory mechanisms that cause CHF
hypo perfusion of end organs, increased renin angiotensis system, catecholamine release
what may cause high output CHF
anemia
rapid infusion of IV fluids in premature infants may cause
CHF
these drugs increase the efficiency of myocardial contractions and relieve tachycardia
digoxin (cardiac glycosides)
drugs that reduce Intravascular volume by maximizing sodium loss
Loop diuretics
treatment of CHF secondary to CHD
surgical repair
murmurs caused by turbulent flow that are not caused by structural heart disease and have no hemodynamic significance
innocent heart murmurs
3 types of innocent heart murmurs
Stills murmur, pulmonic systolic murmur, venous hum
This is the type of innocent heart murmur heard at the mid left sternal board in ages 2-7, loudest supine and with excersize
Stil’s murmur
this innocent heart murmur is heard at the upper left sternal board, peaks early in systole, blowing high pitched, loudest supine and with exersice
Pulmonic systolic murmur
innocent heart murmur heard neck and below clavicles at any age, continuous and heard only sitting or standing, not heard SUPINE or with neck flexion or extension
Venous hum
type of ASD in lower portion of atrial septum w/ possible mitral regurg and common in DOWN syndrome
ostium primum
ASD defect in middle portion of atrial septum and most common overall ASD
ostium secundum
type of high ASD where right plum vein drain into the right atrium or SVC
sinus venosus
what may children with an osmium primum defect w/ mitral regurg develop?
CHF
physical findings include Increased right ventricular impulse, fixed S2 split w/ diastolic rumble and lower left sternal border
ASD
VSD pathophysiology
Bc of decreased pulmonary resistance and increased systemic resistance blood flows from the left ventricle into the right ventricle
as the size of the VSD decreases the intensity of the murmur _______?
increases
holosystolic murmur heard at apex
VSD
Eisenmenger syndrome
when PVR is greater than systemic resistance resulting in a switch from left to right to RIGHT TO LEFT shunt
large VSDs w/ pulmonary hypertension are closed at what age?
3-6 months
small vsd’s are closed at what age?
2-6 years
continuous machine like murmur at the upper left sternal border w/ widened pulse pressure
PDA
what is used to close a PDA?
indomethacin
narrowing of aortic arch below subclavian artery
coarctation of the aorta
patient w/ severe coarctation may depend on what anomaly for perfusion of lower thoracic and descending aorta?
right to left shunt through PDA
hypertension in right arm and reduced blood pressure in lower extremity
PDA
what else may someone w/ coarctation have?
bicuspid aortic valve
in coarctation of the aorta does the femoral pulse precede the radial pulse?
no, femoral pulse is DELAYED.
treatment of coarctation in neonate
IV prostaglandin E (to keep pda open) and inotropic medication (dopamine)
what is the therapy of choice in recurrent cocarctation?
balloon angioplasty
ross procedure
aortic stenotic valve is replaced w/ pulmonary valve
why does severe aortic stenosis cause left ventricular hypoplasia in the neonate?
impaired fetal left ventricular development w/ myocardial ischemia
aortic stenosis symptoms in older children
chest pain, syncope and sudden death
high aortic valve pressure gradient
> 50-70
high pulmonary valve pressure gradient
> 35-40
what can be seen on chest x ray with patent ductus arterioles
cardiomegaly w/ increased pulmonary vascular marking
ejection click w/ systolic ejection murmur at base that radiates to the upper right sternal border and carotids
aortic stenosis
vasomotor instability and vasoconstriction causes
peripheral cyanosis
5 cardiac causes of central cyanosis
tetralogy of fallout, transposition of great arteries, tricuspid atresia, truncus arterioles and total anomalous pulmonary venous connection
tetralogy of flow components
Pulmonary stenosis, right ventricular hypertrophy, overiding aorta, VSD,
boot shaped heart
tetrallogy of fallow
what may a child w/ tetralogy of fallot do?
squat ( tet spells) increases venous return to heart and SVR decreasing the right to left shunt
graft imposed between subclavian and ipsilateral plum artery to improve pulm growth w/ tetralogy of fallot
blalock taussig shunt
definitive management of tetralogy of fallot
complete surgical repair at 4-8 months.
results in pulmonic and systemic circulations in parallel rather than in series
transposition of the great arteries
what do patients need to survive w/ transposition of the great arteries?
shunting blood through a patent foramen ovale, ASD, VSD or
acute management of a TET spell
- squat position
- IV fluid bolus
- oxygen
- morphine (stops agitation
- propranolol
- Sodium bicarb
- transfusion for anemia
- surgery
central cyanosis, SINGLE s2, no murmur
transposition
2 initial managements of transposition of great vessels
PGE and emergent balloon atrial septostomy (rashkind procedure)
what does the rash kind procedure do?
increases the size of the ASD or PFO
condition in which an ASD or PRO is always present and a plate of tissue is on the floor of the right atrium?
tricuspid atresia
the only cause of cyanosis in the newborn period that results in LAD and LVH
tricuspid atresia
fontan procedure
treatment of tricuspid atresia where flow from inferior vena cava is directed into pulmonary arteries
most common acquired heart disease in children in US , asian males
kawasaki disease
kawasaki disease symptoms
5 day fever, bilateral conjunctivitis, oropharyngeal changes, cervical adenopathy, rash, red, cracked swollen lips, erythematous palms and soles.
causes of infective endocarditis?
strep viridans and staph introduced during an invasive proedure
what can be seen on valves during infective endocarditits?
vegetations
roth spots, janeway lesions and osier nodes are seen in?
bacterial endocarditis
most sensitive way to detect vegetations in infetive endocarditis?
transesophageal echocardiography
most common bacterial causes of pericarditis?
staph aureus and strep pneumo
chest pain most intense while supine and relieved when sitting upright, pericardial friction rub, distant heart sounds and pulses paradoxes , hepatomegaly
pericarditis
management of pericarditis?
- antibiotics, 2. antiinflam, 3. drainage
common cause of death in young athletes
myocarditis
elevated ESR, CK MB fraction and C reactive protein
lab results for myocarditis
identification of organism of myocarditis?
PCR or viral serology of endomyocardial biopsy specimens
type of cardiomyopathy that is autosomal dominant w/ asymmetric septal hypertrophy
hypertrophic cardiomyopathy
most common cause of death in young athletes?
hypertrophic cardiomyopathy
valsalva and standing will increase or decrease the ejection murmur of cardiomyopathy?
increase
type of cardiomyopathy seen w/ amyloidosis and inherited infiltrative disorders?
restrictive cardiomyopathy
type of cardiomyopathy seen w/ carnitine and nutrition deficiency or mitochondrial abnormalities?
dilated cardiomyopathy
neonatal heart rate greater than 250?
SVT
delta wave on EKG?
WPW (sudden cardiac death)
SVT management?
vagal maneuvars, ice pack, carotid massage, IV ADENOSINE, chronic digoxin and propanolol, radio frequency catheter ablation
babies born to SLE moms typically have what kind of AV block?
third degree
prolongation of PR interval?
1st degree AV block
second degree type 1 block
wenkebock, progressive prolongation of PR interval
second degree type 2 block
more than one PR interval but no prolongation
treatment of AV block?
pacemaker
autosomal recessive syndrome associated w/ deafness and long QT?
jervel, lange, neilsen
autosomal recessive syndrome w/ long QT and no deafness?
Romano ward syndrome
causes an enlarged heart in older children w/ supra cardiac drainage “snow man appearance” w/ RVH and RAE
TAPVC
