Cardio

Question 1

Acute rheumatic fever presentation

Answer 1

Jones criteria: 2 major and 1 minor

Major → carditi, erythema marginatum, subcutanoues nodules, chorea, polyarthritis

Minor → fever, polyarthralgias, reversible prolongation of PR interval, rapid erythrocyte sedimentation rate or CRP

Question 2

Acute rheumatic fever etiology

Answer 2

Systemic immune resp 2-3 wks following β-hemolytic strep pharyngitis

MC 5-15 yo

Question 3

Acute rheumatic fever tx

Answer 3

Strict bed rest until stable

IM penicillin and erythromycin

Salicylates to ↓ fever and relieve joint pain, corticosteroids can also help w/ joint pain

Prevent w/ early tx of strep

Question 4

Atrial Septal Defect presentation

Answer 4

Systolic ejection murmur at 2nd LICS; early to middle systolic rumble

Failure to thrive, fatigability, RV heave, wide fixed split S2

Question 5

Atrial Septal Defect definition

Answer 5

Opening between the right and left atria

MC = ostium
secundum

Acyanotic

Question 6

Atrial Septal Defect tx

Answer 6

Refer to pediatric cards for echo

Surgical repair at age 2-3 for most

Small defects in boys don’t need closure if RV size is normal

Question 7

Coarctation of the Aorta presentation

Answer 7

Systolic, LUSB and L interscapular area, may be continuous

Infants may present
with CHF

Older chil- dren may have systolic hypertension or murmur or underdeveloped lower extremities

Diff betwn arterial pulses and BP in UE and LE pathognomonic

Question 8

Coarctation of the Aorta tx

Answer 8

Refer for echo

Reopen truncus arteriosus within 4 d of birth w/ prostaglandins

Question 9

Coarctation of the Aorta definition

Answer 9

Obstructive

Narrowing in the proximal thoracic aorta

Question 10

Hypertrophic Cardiomyopathy definition

Answer 10

autosomal dom

Massive hypertrophy (particularly of the septum), small left ventricle,
systolic anterior mitral motion, and diastolic dysfunction

Question 11

Hypertrophic Cardiomyopathy presentation

Answer 11

L ventricular hypertrophy

LV outflow obstruction, diastolic dysfunction, MR, MI

LVOT murmur = harsh crescendo-decrescendo systolic murmur that begins slightly after S1 and is heard best at the apex and lower left sternal border

MR murmur = mid-late systolic murmur at the apex

HF, chest pain, or arrhythmias, fatigue, dyspnea, chest pain, palpitations, syncope/presyncope

Question 12

Hypertrophic Cardiomyopathy tx

Answer 12

Initial tx → β-blockes or CCB
Disopyramide is used for its neg
inotropic effects

Surgical or nonsurgical ablation of the hypertrophic septum may be required

Dual-chamber pacing, implantable defibrillators, or mitral valve replacement may be indicated

Cardiac transplantation may be indicated for severe disease

Question 13

Kawasaki disease presentation

Answer 13

< 5 yo

Fever > 5 days + at least 4 of the following: conjunctivi-
tis, lip cracking and fissuring, strawberry tongue, or inflammation of the oral mucosa, cervical lymphade- nopathy, (usually unilateral), polymorphous exanthem, or redness and swelling of the hands and feet w/ subsequent desquamation

Question 14

Kawasaki disease tx

Answer 14

IV immunoglobulin and high-dose aspirin

Early tx will ↓ chance of cardiac events

Pts with cardiac disease should receive LT aspirin therapy and annual follow-up

Monitor through serial electrocardio, chest radiography and echocardio until recoverd

Question 15

Patent Ductus Arteriosus definition

Answer 15

Acyanotic

Failed or delayed closure of the channel bypassing the lungs, which allows placental gas exchange during the fetal state

Question 16

Patent Ductus Arteriosus presentation

Answer 16

Harsh continuous machine murmur

Usually asymptomatic

May have exertional dyspnea or heart failure

Wide pulse pressure

Question 17

Patent Ductus Arteriosus tx

Answer 17

Refer to pediatric cards for echo and for meds to make ductal tissue regress or surgical repair

IV indomethacin

Question 18

Syncope

Answer 18

A sudden, transient LOC not resulting from trauma

Question 19

Common causes of syncope

Answer 19

Common causes include arrhythmias, aortic stenosis, carotid sinus hypersensitivity, myocardial infarction, hypoglycemia, orthostatic hypotension, postprandial hypotension, psychogenic disorders, pulmonary embolus, and vagal faint

Question 20

Tetralogy of Fallot definition

Answer 20

Pulmonary stenosi → RV hypertroph, VSD, overriding aorta

VSD may be R to R or L to R

Question 21

Tetralogy of Fallot presentation

Answer 21

Progressive

May appear healthy and pink at birth

Cyanotic “tet spells” where child turns blue, squats to valsalva

Crescendo–decrescendo holosystolic at LSB, radiating to back

Cyanosis, clubbing, increased RV impulse at LLSB, loud S2

Question 22

Tetralogy of Fallot tx

Answer 22

Surgical correction in early infancy

Question 23

Ventricular Septal Defect presentation

Answer 23

Holosystolic murmur at LLSB

May have thrill or diastolic rumble

Heart failure

(MC dx congenital heart defect)

Question 24

Ventricular Septal Defect tx

Answer 24

Most will get smaller and disappear on their own

Surgical repair indicated for intractable CHF, failure to thrive