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Pediatric Board Review > Cardiology > Flashcards

Cardiology Flashcards

0
Q

Murmur ID:

  • MLSB or between LLSB and apex
  • grade 2-3/6
  • “twanging string”, groaning, squeaking or musical
  • ages 3-6yrs, occasionally in infancy
A

Classic vibratory/Still’s murmur

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1
Q

Characteristics of innocent murmurs:

A

Short duration
Low intensity (grade I/II)
Vibratory or musical in quality

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2
Q

Murmur ID:

  • ULSB
  • Early to midsystolic ejection murmur
  • 1-3/6
  • “blowing”
  • ages 8-14yrs
A

Pulmonary ejection murmur

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3
Q

Murmur ID:

  • Premature and full-term newborns
  • Usually disappears by 3-6mos
  • ULSB
  • transmits to axilla and back
  • 1-2/6
A

Pulmonary flow murmur of newborn (PPS?)

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4
Q

Murmur ID:

  • continuous, grade 1-2/6
  • R or L supraclavicular and infraclavicular areas
  • inaudible in supine position
  • intensity changes with rotation of the head and compression of the jugular vein
  • ages 3-6yrs
A

Venous hum

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5
Q

Murmur ID:

  • R supra-clavicular area and over the carotids
  • 2-3/6
  • occasional thrill over carotid
  • any age
A

Carotid brunt (systolic)

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6
Q

Time of functional closure of the ductus arteriosus?

A

12-24hrs of life

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7
Q

Time of anatomic closure of the ductus arteriosus?

A

2-3 weeks of age

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8
Q

Types of CHD that present with shock?

A

2/2 left heart obstruction:

  • CoA
  • HLHS
  • interrupted Ao arch
  • critical AS
  • obstructive TAPVR

(systemic perfusion dependent on PDA, symptoms worsen after PDA closure)

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9
Q

Treatment of shock 2/2 CHD

A
  1. PGE1
  2. Avoid excess O2 –> pulm vasodilation (decr PVR) –> increased left to right shunting
  3. Gentle fluid resuscitation (10mL/kg boluses etc)
  4. Inotropic agents to improve CO (dobutamine, dopamine, epi)
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10
Q

Most common causes of central cyanosis?

A

CHD, pulmonary disease, and CNS depression

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11
Q

Amt of hgb that must be reduced to perceive cyanosis.

A

5g/dL

  • In infants with nml hgb levels, apparent at 75-80%
  • In polycythemic infants, cyanosis at higher O2 saturations
  • In anemic infants, no cyanosis until more significant desaturation occurs
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12
Q

How do you interpret a hyperoxia test?

A

PO2>100mmHg or incr in PO2>30mmHg above on RA = pulmonary etiology likely

PO2L shunt (CHD or PPHN) or a mixing lesion

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13
Q

Preductal > postductal saturations

A

PPHN and cardiac conditions with decr systemic pressures (LV obstructive lesions = AS, interrupted arch, CoA)

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14
Q

Postductal>preductal saturations

A

TGA with obstruction (interrupted arch or CoA)

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15
Q

Acyanotic Congenital Heart Defects

A
  • VSD
  • PDA
  • ASD
  • AV canal (complete endocardial cushion defect)
16
Q

Name the CHD:

  • asymptomatic to CHF at 6-8wks of age
  • loud, harsh, holosystolic murmur at LLSB +/- thrill (+/- in newborn period)
  • CXR = cardiomegaly, incr PVM
  • EKG = LVH +/- LAE
  • Most common CHD requiring f/u and intervention
A

VSD

17
Q

Name the CHD:

  • Asymptomatic to hemodynamically unstable (preterm infants)
  • Continuous machinery-like murmur at LUSB
  • Bounding pulses with wide pulse pressure
  • CXR = cardiomegaly, incr PVM
  • EKG = LVH, BVH with large lesion
A

PDA

  • normally closes by 72HOL
  • treated with surgery, indomethicin or ibuprofen
18
Q

Name the CHD:

  • rarely symptomatic before 30-40’s
  • may present with CHF and pulm HTN
  • wide, fixed split S2 +/- SEM at the LUSB
  • CXR = cardiomegaly +/- RA and RV enlargement
  • EKG = RAD, RVH, RBBB (rsR’ in V1)
  • Can lead to atrial arrhythmias in adults
A

ASD

19
Q

Name that CHD:

  • CHF at 4-6wks of age
  • holosystolic murmur of VSD
  • CXR = cardiomegaly with four-chamber enlargement, incr PVM
  • EKG = superior QRS axis, RVH or RBBB
  • common in pts with Down syndrome
A

Complete endocardial cushion defect (AV canal)

20
Q

Name that CHD:

  • critical lesions –> cyanosis, tachypnea, exertional dyspnea, fatigue, CHF
  • loud SEM at ULSB radiating to back and lung fields
  • CXR - prominent PA segment, normal to decreased PVM
  • EKG - RAD, RVH
A

Pulmonary stenosis (PS)

  • treated with PGE1 to incr pulmonary perfusion and ultimately balloon valvuloplasty for surgical correction
21
Q

Name that CHD:

  • Neonates: hypoperfusion, resp distress, cyanosis with R–>L ductal flow
  • Children: chest pain, syncope, dyspnea
  • Ejection click, harsh midsystoloic murmur, systolic thrill at suprasternal notch
  • CXR = cardiomegaly, incr PVM
  • EKG = LVH +/- strain
A

Aortic stenosis

  • PGE1/balloon valvuloplasty or surgical correction
  • supravalvular AS is common in Williams Syndrome
22
Q

Name that CHD:

  • Infants: CHF, respiratory distress, shock, diminished pulses and cyanosis of the lower extremities, BP differential (RA>leg)
  • Children: HTN in right arm, decr femoral pulses
  • no murmur in 50% VS ejection click, SEM
  • CXR: cardiomegaly, incr PVM, E-shaped esophagus on barium esophagram, rib notching
  • EKG: LAD, LVH
  • 70% with associated aortic valve abnormality
A

Coarctation of the aorta (CoA)

  • surgery, then balloon angioplasty for recoarctation
  • present in 30% of pts with Turner’s syndrome
23
Q

Name that cyanotic CHD:

  • initially cyanosis/dyspnea on exertion, later hypoxic spells
  • single S2; long, loud SEM at MULSB
  • CXR: decr PVM, “BOOT-SHAPED” heart, R aortic arch in 25%
  • EKG: RAD, RVH
  • degree o cyanosis and symptoms is related to severity of PS
  • MOST COMMON CYANOTIC CHD
A

Tetralogy of Fallot:

  • large VSD
  • RVOT obstruction (PS)
  • RVH
  • overriding aorta
  • PGE1 if cyanotic, primary surgical repair, occasionally palliative Blalock-Taussig shunt (subclavian artery to ipsilateral PA)
24
Q

Name that cyanotic CHD:

  • severe cyanosis and tachypnea in pt with normally related great vessels
  • murmur from associated lesions (VSD, PDA)
  • CXR: decr PVM
  • EKG: leftward or superior QRS axis, RAE, minimal positive forces in V1 and V2
  • 30% with TGA
A

Tricuspid Atresia

  • PGE1, rare balloon atrial septostomy, BT shunt 1st stage of repair, definitive repair is a single ventricle Fontan-type repair
  • Associated mixing defects needed for survival
25
Q

Name that cyanotic CHD:

  • severe cyanosis and tachypnea n the neonatal period
  • intra-atrial communication necessary for survival
  • single S2, murmur absent +/- PDA murmur
  • decr PVM, dark lung fields
  • EKG = LVH, RAH
  • commonly associated with coronary artery anomalies
A

Pulmonary atresia with intact ventricular septum

26
Q

Name that cyanotic CHD:

  • cyanosis, arrhythmias (SVT). ASD or PFO always present
  • triple or quadruple rhythm (wide split S2 +/- split S1, S3 or S4)
  • CXR: decr PVM, massive cardiomegaly with BALLOON-SHAPED HEART
  • EKG: RBBB, RAH, 1st degree AV block, delta wave
  • Frequently associated with WPW
A

Epstein’s anomaly = downward displacement of TV, resulting funcitonal RV hypoplasia

27
Q

Name the cyanotic CHD:

  • severe cyanosis, signs of CHF in the 1st week of life
  • single S2, often no murmur
  • CXR = incr PVM, EGG-SHAPED HEART, or EGG ON A STRING
  • EKG = RAD, RVH
  • VSD present in 30-40%
A

Transposition of the great arteries

28
Q

Name that cyanotic CHD:

  • mild cyanosis immediately after birth, CHF in days to weeks
  • large VSD located beneath truncal valve
  • single S2, systolic ejection click at the apex, murmur of VSD
  • bounding pulses with wide pulse pressure
  • CXR = incr PVM, cardiomegaly, R aortic arch in 30%
  • EKG = BVH
  • Coronary artery anomalies are common
A

Truncus arteriosus

  • Digeorge syndrome in 1/3 of pts
29
Q

Name that cyanotic CHD:
- resp distress, CHF
- types vary with vessel insertion:
Supracardiac - SVC = most common
Cardiac - RA or coronary sinus
Infracardiac - portal veins, IVC; commonly leads to obstruction of venous return
- quadruple rhythm (S1, widely splitS2, and S3 or S4, hepatomegaly)
- CXR = cardiomegaly, sign incr PVM, SNOWMAN SIGN or FIGURE 8 SIGN
- EKG = RVH, rsR’ in V1

A

Total anomalous pulmonary venous return (TAPVR)

  • PGE1 may worsen condition in obstructed TAPVR
30
Q

Name that cyanotic CHD:

  • respiratory distress, shock and CHF within the 1st week of life
  • loud single S2, commonly no murmur, hepatomegaly
  • CXR = incr PVM, pulmonary venous congestion, edema +/- cardiomegaly
  • EKG = RVH, RAE, minimal positive forces in V5 and V6
A

Hypoplastic left heart syndrome (HLHS)

31
Q

Causes of CHF in 1st week of life?

A

Severe obstructive CHD = HLHS, critical AS or PS, obstructive TAPVR, interrupted aortic arch

TGA

Volume overload = severe tricuspid or pulmonary insufficiency, systemic arterio-venous fistula

Genetic or metabolic cardiomyopathy

32
Q

Causes of CHF at 1-4 weeks of life

A

Less severe obstructive lesions = coarctation, AS or PS, TAPVR

Truncus arteriosus

Genetic or metabolic cardiomyopathy

33
Q

Causes of CHF in infants >1 month of age:

A

Large L–>R shunts = ECD @ 4-6wks, large VSD or PDA at 6-8wks

Arrhythmias (SVT)

Myocarditis

Genetic or metabolic cardiomyopathy

34
Q

Causes of CHF in older children

A

Inflammatory - Kawasaki, myocarditis, rheumatic fever

Acute HTN (HUS)

Genetic or metabolic cardiomyopathy

35
Q

List the JONES criteria for rheumatic heart disease:

A

Laboratory evidence of prior streptococcal infection PLUS 2 major criteria or 1 major and 2 minor criteria

J = joints (migratory, polyarthritis of large joints)
O = carditis (1 Endocarditis, 2 myocarditis, 3 pericarditis)
N = nodules (SQ, on extensor surfaces of extremities, "Aschoff bodies" on histology)
E = erythema marginatum
S = sydenham chorea

MINOR CRITERIA: arthralgia, prolonged PR interval, fever, elevated ESR +/- CRP, elevated WBC, previous rheumatic fever

Pediatric Board Review (17 decks)

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