Cardiology Flashcards
1
Q
S1
A
mitral/tricuspid (AV) vales closure; aortic/pulmonic (semilunar) valves open
2
Q
S2
A
aortic/pulmonic (semilunar) valves closure; mitral/tricuspid (AV) vales open
3
Q
S1 and S2 sounds occur during to
A
valves CLOSING
4
Q
Systole
A
period between S1 and S2
5
Q
Diastole
A
period between S2 and S1
6
Q
S3
A
“Ken-tuck-y”
Increased fluid states (ie CHF, pregnancy)
7
Q
S4
A
“Ten-ne-ssee”
Stiff ventricular wall (ie MI, L ventricular hypertrophy, chronic hypertension)
8
Q
Which side of the heart has more pressure?
A
L side has more pressure
L side has oxygenated blood going to body
9
Q
Aortic auscultatory area
A
R upper sternal border (RUSB)
10
Q
Pulmonic auscultatory area
A
L upper sternal border (LUSB)
11
Q
Aortic or mitral auscultatory area
A
Apex (Erb’s point)
12
Q
Ventricular septal defect or tricuspid auscultatory area
A
L lower sternal border (LLSB)
13
Q
Blood flows from
A
higher to lower pressure
14
Q
Murmur loudness scale
A
I-VI Systolic
15
Q
Ventricular septal defect (VSD)
A
Thrill
16
Q
Obstructive defects
A
Ejection clicks d/t turbulence
Reffered or radiated sound noted
17
Q
Fetal resistance and flow
A
Increased pulmonary vascular resistance (PVR), decreased systemic vascular resistance (SVR)
No lung flow
18
Q
Neonatal resistance and flow
A
Decreased pulmonary vascular resistance, increased systemic vascular resistance
Lung flow
19
Q
Pneumonic for heart valves
A
TPMA Tricuspid Pulmonic Mitral Aortic
20
Q
Congenital Heart Diseases/Defects
A
A variety of cardiovascular malformations resulting from abnormal structural development in the 1st trimester.
Etiology is multifactorial and includes chromosomal abnormalities, adverse environmental conditions, and unknown factors.
Congestion heart disease occurs in 8:1,000 births
Heart defects noted congenitally:
- Acyanotic lesions (L to R shunting)
- Cyanotic lesions (R to L shunting)
- Obstructive lesions
21
Q
Most common congenital heart defect
A
VSD - comprises up to 30% of all congenital heart defects
22
Q
3 Acyanotic heart defects
A
L to R shunting
- Atrial Septal Defect (ASD)
- Ventricular Septal Defect (VSD)
- Patient ductus arteriosus (PDA)
23
Q
Atrial Septal Defect (ASD)
A
Murmur: Grade II - III/VI systolic ejection murmur (may or may not be heard)
**Heard best at he L upper sternal board
EKG: R ventricular hypertrophy
Xray: Cardiomegaly, increased pulmonary vascular markings (big heart)
24
Q
Ventricular Septal Defect (VSD)
A
Murmur: Grade II - V/VI systolic ejection murmur
**A holosystolic THRILL may be felt at LLSB (throughout systole)
EKG: LVH progressing to biventricular hypertrophy if large VSD
Xray: Cardiomegaly, increased pulmonary vascular markings
25
Patient ductus arteriosus (PDA)
5-10% of congenital heart defects in term infants; very common in premature infants
Murmur: LUSB II - IV/VI holosystolic
**"Machinery" sound
EKG: LVH to biventricular hypertrophy
Xray: Cardiomegaly, increased pulmonary vascular markings
26
2 Cyanotic heart defects
R to L shunting -- unoxygenated blood going to the L side and then out to body
1. Transposition of the Great Arteries
2. Tetralogy of Fallot
27
Transposition of the Great Arteries
Murmur: Grade II - V/VI systolic ejection murmur
**A holosystolic THRILL may be felt at LLSB (throughout systole) -- same as VSD
EKG: RVH
Xray: "Egg on a string" with cardiomegaly, and increased pulmonary vascular markings
*turns blue quickly after birth
28
4 defects of Tetralogy of Fallot
1. Large VSD
2. Pulmonary stenosis
3. Overriding aorta
4. RVH
29
Tetralogy of Fallot
Murmur: Loud systolic ejection click at the middle and upper L sternal border
EKG: Right axis deviation and RVH
X-ray: Boot-shaped heart, no cardiomegaly or pulmonary vascular markings
*Tet spells
30
Tet spells
Hypercyanotic episode
see kids pulls knees up -- helps circulation
31
3 Obstructive Lesions
1. Aortic Stenosis
2. Pulmonic Stenosis
3. Coaractation of the Aorta
32
Aortic Stenosis
Murmur: Systolic thrill at the RUSB; systolic ejection click present which does not vary with respirations; grade II - IV/VI
EKG: LVH
Xray: Usually normal, CHF is severe
33
Pulmonic Stenosis
Murmur: Systolic, loudest at LUSB; grade II - V/VI ejection click; intensity of click decreases with inspiration and increases with expiration; thrill at the LUSB radiating to the back and sides
EKG: RVH
Xray: Usually normal
34
Coaractation of the Aorta
Murmur: II - III/VI systolic ejection murmur with radiation to the L interscapular area; may have an ejection click at the apex and RUSB if the bicuspid valve is involved
EKG: RVH progressing to LVH
Xray: cardiomegaly, pulmonary venous congestion, rib notching d/t collateral circulation ***
35
Decreased or absent pulses in the lower extremities is the cardinal finding of what heart defect?
Coaractation of the Aorta
BP & pulse ox in lower extremities will be lower than upper extremities
36
Associated Cardiac Defects of DiGeroge syndrome
Aortic arch anomalies
37
Associated Cardiac Defects of Trisomy 18/Edwards and Trisomy XX1/Down syndrome
Atrioventricular septal defects, VSD
38
Associated Cardiac Defects of Marfan syndrome
Aortic regurgitation, mitral valve prolapse
39
Associated Cardiac Defects of Turner syndrome
Coaractation of the aorta, biscuspid aortic valve
40
Presenting S/S of a child with a cardiac defect
Prenatal, birth, and family history of heart defects, and evaluate for the following:
- frequent respiratory infections
- exercise intolerance
- color changes; cyanosis
- tachypnea during sleep
- feeding problems
- diarphoresis
- abnormal heart sounds
- edema
- clubbing
- CHF
41
Management of a child with a cardiac defect
1. Referral to pediatric cardiologist
2. Ensure optimal primary care and anticipatory guidance
**Get CMP, ECHO, EKG, and chest X-ray - THEN REFER or send to ER
42
Innocent Murmurs
= functional, bengin, or physiologic
No associated symptoms, FTT, or cyanosis
Occurs in > 50% of children:
- thin chest wall
- more angulated great vessels
- more dynamic circulation
Low intensity SYSTOLIC murmurs (Grades I - III/VI)
May vary with position (sit > standing)
No radiation to neck/back
Sinus arrhythmia: HR varies upon inspiration and expiration
43
2 types of Innocent Murmurs
1. Still's Murmur
| 2. Venous Hum
44
Still's Murmur
- Most common innocent murmur
- Musical systolic murmur
- Heard best between LLSB and apex
- D/t turbulence in the L ventricular outflow tract
- SYSTOLIC ejection murmur
45
Venous Hum
- Continuous humming murmur
- RUSB
- Heard best in the sitting position; disappears in the supine position
- Also obliterated by turning head and/or compressing neck ipsilaterally
* @ carotid, turn head and it goes away
46
Heart Failure
Heart is unable to pump enough blood to the body to meet its needs
47
Causes of Heart Failure
Infants: Volume overload-VSD, PDA, AV canal
Older children: Ventricular dysfunction, pressure overload
48
S/S of Heart Failure across childhood
- diaphoresis
- poor activity
- FTT
- rales/crackles
- hepatomegaly
- displaced apical impulse
- S3 or S4
- tachypnea
- tachycardia
- wheezing/dyspnea
- poor perfusion
49
S/S of Heart Failure in infant/very young child
- poor feedings/prolonged feedings
- edema: periorbital/back
- quiet tachypnea: nasal flaring, retractions
- lethargy or irritability
- reflux
- chronic cough
- poor weight gain
50
S/S of Heart Failure in older child/adolescent
- exercise intolerance
- edema: peripheral
- jugular venous distension
- abdominal pain
- palpitations
- chest pain
- syncope
51
3 Acquired Heart Diseases seen in pediatrics
1. Hypertension
2. Rheumatic Fever/Heart Disease
3. Kawasaki Disease
52
Hypertension
A persistent elevation of average systolic/diastolic BP > 95th percentile with measurements obtained at least THREE separate occasions per published tables for ages and sex.
Is MOST common in children as a symptom of other organ dysfunction (aka secondary hypertension - hypertension d/t something else)
53
S/S of Hypertension
- HAs
- Visual problems
- Dizziness
- Respriatory distress
- Irritability
- Nosebleed
54
Labs/diagnostics for Hypertension
1. Chest Xray (PA and lateral)
2. Plasma aldosterone level to r/o aldosteronism
3. Morning and evening cortisol levels to r/o Cushing's syndrome
4. UA, BMP, CBC, cholesterol, and triglycerides
5. EKG for dysrhythmias, BBB, or LVH
...then REFER
55
Management for Hypertension
Referral to a cardiologist (after labs/diagnostics are done)
56
Rheumatic Fever/Heart Disease
A post-infectious inflammatory disorder that can affect the heart, joint, and central nervous system
- follows a group "A" strep infection of the upper respiratory tract
- most common in 6-15 yo
- the mitral valve is the most commonly affected
57
S/S Rheumatic Fever/Heart Disease
Diagnosis of an initial attack of rheumatic fever plus 2 major or 1 major + 1 minor Jones' criteria
58
Jones' criteria MAJOR manifestations of Rheumatic Fever
- carditis
- polyarthritis
- chorea
- erythema marginatum
- subcutaneous nodules
**think MUSCLES
59
Jones' criteria MINOR manifestations of Rheumatic Fever
- arthralgia w/o objective inflammation
- fever > 102.2F (39C)
- elevated levels of acute phase reactants (ESR and CRP)
- prolonged PR interval on EKG w/ evidence of a group "A" beta-hemolytic Streptococcus infection
**think everything to do with an INFECTION
60
Labs/diagnostics for Rheumatic Fever
1. Acute phase reactants: positive throat culture for strep, positive rapid strep assay, increased or rising strep antibody titer
2. EKG
3. Echocardiogram
61
Management of Rheumatic Fever
1. Refer to a pediatric cardiologist
2. Aggressive management of the strep infection (PCN or amoxicillin/augmentin)
3. Bed rest if acute carditis is present
4. Prophylactic antibiotics for invasive procedures, as indicated (will be decided by cardiologist)
62
Kawasaki Disease
Acute febrile syndrome causing VASCULITIS
- the leading cause of coronary artery disease in children of an infectious etiology
- most commonly noted in children < 2 yo and those of Asian ethnicity
63
Diagnostic Criteria for Kawasaki Disease
The patient must have a fever, as well as at least 4 of the criteria below:
- fever for at least 5 days
- bilateral conjunctival injection without exudate
- polymorphous rash (urticarial or pruritic) (aka lots of different shapes and sizes)
- inflammatory changes of the lips and oral cavity **bright red and looks like strawberry seeds on the tongue
- changes in extremities (erythema, edema in hands; swollen and desquamation)
- cervical lymphadenopathy
**If the patient has more than 4 of the criteria, coronary vessel involvement is most likely
64
Pneumonic for diagnostic criteria for Kawasaki Disease
Fiery CRASH
Fever for 5 days +
- conjunctiva
- rash
- adenopathy
- strawberry
- hands
65
Labs/diagnostics for Kawasaki Disease
1. CBC
2. ESR
3. Postive C-reactive protein
4. EKG changes: prolonged PR or QT interval
Do assessment, order labs, then call cardiologist/ER
66
Management of Kawasaki Disease
1. Immediate referral to cardiovascular specialist***
2. High dose acetylsalicylic acid (ASA) therapy -- for immediate vasodilation and to prevent cloths
- 80-100 mg/kg/day until afebrile for 48 hours
- then, lower ASA dose (3-5 mg/kg/day) for antiplatelet response
- D/C ASA therapy in collaboration with cardiologist
3. IgG - IVIG in patient
