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CPNP Boards > Cardiology > Flashcards

Cardiology Flashcards

1
Q

S1

A

mitral/tricuspid (AV) vales closure; aortic/pulmonic (semilunar) valves open

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2
Q

S2

A

aortic/pulmonic (semilunar) valves closure; mitral/tricuspid (AV) vales open

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3
Q

S1 and S2 sounds occur during to

A

valves CLOSING

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4
Q

Systole

A

period between S1 and S2

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5
Q

Diastole

A

period between S2 and S1

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6
Q

S3

A

“Ken-tuck-y”

Increased fluid states (ie CHF, pregnancy)

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7
Q

S4

A

“Ten-ne-ssee”

Stiff ventricular wall (ie MI, L ventricular hypertrophy, chronic hypertension)

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8
Q

Which side of the heart has more pressure?

A

L side has more pressure

L side has oxygenated blood going to body

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9
Q

Aortic auscultatory area

A

R upper sternal border (RUSB)

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10
Q

Pulmonic auscultatory area

A

L upper sternal border (LUSB)

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11
Q

Aortic or mitral auscultatory area

A

Apex (Erb’s point)

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12
Q

Ventricular septal defect or tricuspid auscultatory area

A

L lower sternal border (LLSB)

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13
Q

Blood flows from

A

higher to lower pressure

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14
Q

Murmur loudness scale

A

I-VI Systolic

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15
Q

Ventricular septal defect (VSD)

A

Thrill

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16
Q

Obstructive defects

A

Ejection clicks d/t turbulence

Reffered or radiated sound noted

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17
Q

Fetal resistance and flow

A

Increased pulmonary vascular resistance (PVR), decreased systemic vascular resistance (SVR)

No lung flow

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18
Q

Neonatal resistance and flow

A

Decreased pulmonary vascular resistance, increased systemic vascular resistance

Lung flow

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19
Q

Pneumonic for heart valves

A 
TPMA
Tricuspid
Pulmonic
Mitral
Aortic
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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
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21
Q

Most common congenital heart defect

A

VSD - comprises up to 30% of all congenital heart defects

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22
Q

3 Acyanotic heart defects

A

L to R shunting

  1. Atrial Septal Defect (ASD)
  2. Ventricular Septal Defect (VSD)
  3. Patient ductus arteriosus (PDA)
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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)

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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

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25
Q

Patient ductus arteriosus (PDA)

A

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

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26
Q

2 Cyanotic heart defects

A

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
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27
Q

Transposition of the Great Arteries

A

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
Q

4 defects of Tetralogy of Fallot

A
  1. Large VSD
  2. Pulmonary stenosis
  3. Overriding aorta
  4. RVH
29
Q

Tetralogy of Fallot

A

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
Q

Tet spells

A

Hypercyanotic episode

see kids pulls knees up – helps circulation

31
Q

3 Obstructive Lesions

A
  1. Aortic Stenosis
  2. Pulmonic Stenosis
  3. Coaractation of the Aorta
32
Q

Aortic Stenosis

A

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
Q

Pulmonic Stenosis

A

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
Q

Coaractation of the Aorta

A

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
Q

Decreased or absent pulses in the lower extremities is the cardinal finding of what heart defect?

A

Coaractation of the Aorta

BP & pulse ox in lower extremities will be lower than upper extremities

36
Q

Associated Cardiac Defects of DiGeroge syndrome

A

Aortic arch anomalies

37
Q

Associated Cardiac Defects of Trisomy 18/Edwards and Trisomy XX1/Down syndrome

A

Atrioventricular septal defects, VSD

38
Q

Associated Cardiac Defects of Marfan syndrome

A

Aortic regurgitation, mitral valve prolapse

39
Q

Associated Cardiac Defects of Turner syndrome

A

Coaractation of the aorta, biscuspid aortic valve

40
Q

Presenting S/S of a child with a cardiac defect

A

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
Q

Management of a child with a cardiac defect

A
  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
Q

Innocent Murmurs

A

= 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
Q

2 types of Innocent Murmurs

A
  1. Still’s Murmur

2. Venous Hum

44
Q

Still’s Murmur

A
  • 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
Q

Venous Hum

A
  • 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
Q

Heart Failure

A

Heart is unable to pump enough blood to the body to meet its needs

47
Q

Causes of Heart Failure

A

Infants: Volume overload-VSD, PDA, AV canal

Older children: Ventricular dysfunction, pressure overload

48
Q

S/S of Heart Failure across childhood

A
  • diaphoresis
  • poor activity
  • FTT
  • rales/crackles
  • hepatomegaly
  • displaced apical impulse
  • S3 or S4
  • tachypnea
  • tachycardia
  • wheezing/dyspnea
  • poor perfusion
49
Q

S/S of Heart Failure in infant/very young child

A
  • poor feedings/prolonged feedings
  • edema: periorbital/back
  • quiet tachypnea: nasal flaring, retractions
  • lethargy or irritability
  • reflux
  • chronic cough
  • poor weight gain
50
Q

S/S of Heart Failure in older child/adolescent

A
  • exercise intolerance
  • edema: peripheral
  • jugular venous distension
  • abdominal pain
  • palpitations
  • chest pain
  • syncope
51
Q

3 Acquired Heart Diseases seen in pediatrics

A
  1. Hypertension
  2. Rheumatic Fever/Heart Disease
  3. Kawasaki Disease
52
Q

Hypertension

A

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
Q

S/S of Hypertension

A
  • HAs
  • Visual problems
  • Dizziness
  • Respriatory distress
  • Irritability
  • Nosebleed
54
Q

Labs/diagnostics for Hypertension

A
  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
Q

Management for Hypertension

A

Referral to a cardiologist (after labs/diagnostics are done)

56
Q

Rheumatic Fever/Heart Disease

A

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
Q

S/S Rheumatic Fever/Heart Disease

A

Diagnosis of an initial attack of rheumatic fever plus 2 major or 1 major + 1 minor Jones’ criteria

58
Q

Jones’ criteria MAJOR manifestations of Rheumatic Fever

A
  • carditis
  • polyarthritis
  • chorea
  • erythema marginatum
  • subcutaneous nodules

**think MUSCLES

59
Q

Jones’ criteria MINOR manifestations of Rheumatic Fever

A
  • 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
Q

Labs/diagnostics for Rheumatic Fever

A
  1. Acute phase reactants: positive throat culture for strep, positive rapid strep assay, increased or rising strep antibody titer
  2. EKG
  3. Echocardiogram
61
Q

Management of Rheumatic Fever

A
  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
Q

Kawasaki Disease

A

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
Q

Diagnostic Criteria for Kawasaki Disease

A

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
Q

Pneumonic for diagnostic criteria for Kawasaki Disease

A

Fiery CRASH

Fever for 5 days +

  • conjunctiva
  • rash
  • adenopathy
  • strawberry
  • hands
65
Q

Labs/diagnostics for Kawasaki Disease

A
  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
Q

Management of Kawasaki Disease

A
  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

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