Cardiology Flashcards
medium to high pitched grade 1-2 mid-systolic murmur, soft ejection at birth to one week until 3-4 months
neonatal PPS from small pulmonary arteries - innocent
Murmur axillae and back, birth 2-3 months, grade 1-2
Pulmonary branch stenosis
low pitched 1-3 mid systolic vibratory musical buzzing murmur loudest when child is lying down but goes away if standing, from 1-10 yrs with vibration in LVOT
Still’s - innocent
Continuous grade 1-3/6 murmur, heard best at clavicle from 2-10 yrs, increased when upright, abolished by head turn or jugular compression
Venous hum - innocent
widely split S2
ASD
loud single S2
pulmonary htn
3 Pansystolic murmurs
VSD, TR, MR
Harsh murmurs (3)
VSD, valve stenosis, outflow tract obstruction
systolic clicks (3)
aortic or pulmonic stenosis, MVP
% w DS w/ CHD? and types?
40-50%, AV canal defect or primum ASD
Turner and CHD, % and types
30%, coarctation of Ao, bicuspic aortic, aortic stenosis, later w/ dissection/aneurysm
the high and common ASD?
Ostium secondum
Noonan % w/ CHD and type
80-90%, Pulm stenosis, ASD, HOCM! (Right heart)
William’s syndrome, %/CHD type
supravalvar aortic stenosis, Coarct (Left sided) 60%
22q11, %/type of CHD
Conotruncal 35%, interrupted aortic arch, truncus arteriosus, TOF
Alagille syndrome CHD %
95%, pulm art stenosis, TOF
CHD in Fetal alcohol
VSD, ASD, TOF
CHD and CHARGE?
ASD, VSD
De Lange and CHD?
TOF, VSD
Cri-du-chat and CHD?
Various CHD
CHD in fetal hydantoin?
ASD, VSD, Coarct
CHD and Infant of DM mother?
Hypertrophic cardiomyopathy, VSD, TGA
Laurence Moon Biedl and CHD?
TOF, VSD
Marfan and CHD?
Aortic root aneurysm, mitral prolapse
Rubella and CHD?
PDA, peripheral pulmonary stenosis
Rubinstein-Taybi and CHD?
PDA
Holt-Oram and CHD?
ASD, VSD
Treatment of hypercyanotic spell (5) (TET spell)
knee-chest, O2, sedation, fluids, phenylephrine
Prevention of hypercyanotic spells
no dehydration, treat iron def, B-blocker
most common cyanotic lesion in newborn?
TGA
BT shunt?
Aorto-pulmonary
EKG w/ q waves in 1, avl, V5, V6, ST elevation in V5, V6. Sweating, SOB w/ feeding?
Also has holosystolic murmur
Coronary problem: ALCAPA. Murmur from MR (from ischemia of papillary muscles)
what is ALCAPA
coronaries from pulm artery instead of Ao
Anomalous left coronary artery from right aortic (not left) aortic sinus? Causes what in teens?
sudden death! exertional chest pain/syncope
Test if vascular ring is suspected?
barium swallow or CT
Two most common bugs in infective endocarditis
Strep viridans,»_space; Staph aureus
Dental prophylaxis for heart disease? which ones?
What tx?
- unrepaired cyanotic CHD (shunt/conduit)
- complete repair w/ prosthetic material in 6 mos
- repaired but residual defect at site of lesion or prosthetic
- transplant w/ valve issue
AMOX
Criteria for ARF?
JONES: joints (arthritis), carditis, nodules, erythema marginatum, Sydenham’s chorea are major
Tx of ARF?
Benzathine PCN G (IM)
no NSAIDS until dx established
ASA 100mg/kg/day in 4-6 divided doses
RArely steroids
murmur in carditis in ARF?
regurgitation: Mitral or aortic
dx req for Kawasaki?
Fever!
4/5
% of coronary artery aneurysm in Kawasaki/
15-20%
Diagnostic test in suspected pericarditis? Finding?
ECG: diffuse ST elevation segment and PR segment depression:
% FH in HOCM?
30%
acute tx of SVT
cardioversion if unstable
vagal maneuvers
Adenosine: 0.1mg/kg IV bolus. Can repeat and double. Max 12mg
Drug never to use in baby <2y w/ arrhythmia?
Verapamil
short PR interval, wide QRS, delta wave
Dx?
Complications?
WPW
prob: SVT, life threatening afib w/ rapid ventricular rate/sudden death
acute tx of ventricular tachycardia
cardiovert, amiodarone
two causes of congenital heart block
mom w/ SLE aBs: anti-Ro/SSA, anti-La/SSB
L transposition of Great arteries
most common wide QRS tachycardia in kids?
SVT with a bundle branch block
long QTC?
> 470-480 (99%)
borderline is 440-470
inheritance in long QT?
autosomal dominant usually if not assoc w/ deafness
syncope without prodrome or with emotional / physical stress
EKG with tachycardia w/ polymorphic VT
long QT!
hallmark arrhythmia in long QT syndrome?
torsades, polymorphic vtach
recommendation if you see WPW in teen?
Any tests?
Management issue?
Do echo, because could be assoc w. CHD
Sports restriction
Not typically genetic/hi risk to other family members
neonatal PACs cause what? Tx?
p buried in T, PAC causes bradycardia b/c it gets blocked. Benign. observe.
CHD with sat in hand LESS than foot?
HAS to be TGA, with postductal saturation high, open ductus.
valve prob assoc w/ coarctation and Ao
bicuspid aortic valve
consider this in younger child w/ cardiomyopathy and systemic weakness
Becker! Less severe than Duchenne but with out of proportion cardiomyopathy, and sometimes initial presentation
Most common CHD presenting in late teen with cyanosis?
Tetrology (pink tet) if mild pulm stenosis
infant with cyanosis, no CHD and no resp distress. Well water
methemoglobinemia
normal sized heart cyanosis pulm edema short systolic murmur, single S2 Full term baby
TAPVR
normal sats on rt side of heart vs left?
right: 70s
Left: close to 100
cyanosis on day 1-2, tachypnea, lack of increased vascular markings?
likely PDA closing, w/ ductal dependent lesion
asx till 3-5 mos palpable right ventricular impulse Single S2 RVH boot heart Dx?
TOF
4 components of TOF?
Pulm stenosis
overriding aorta
VSD
RVH
what often triggers hypercyanotic hypoxic episode?
Cause?
TET spell
often anemia triggered
incr R–>L shunting
5 treatments for TET spell
- knee to chest
- morphine
- phenylephrine
- propanolol
- volume expansion
precordial hyperactivity
loud S2 but NO murmur
very enlarged heart
Hypoplastic Left Heart: looks huge b/c all RV
common presentation of hypoplastic left heart?
Tx?
10 d newborn with cardiogenic shock, tx: PGE1 to keep ductus open
egg shaped heart
single S2
incr pulm vascularity on CXR
tachypnea and cyanosis in newborn
tga
Single S2: Two disorders and how to distinguish?
TGA: increased pulm vascularity
TOF: no incr pulm vascularity
generalized facial swelling, fatigue, wt loss, nt sweats, dusky color?
venous stasis from Superior Vena Cava syndrome
managing Digoxin?
about borderline 1st degree heart block with PR of about 200. Not blood levels.
diastolic murmur on right OR systolic ejection click at apex
Dx?
endocarditis
tender lesions on pads of fingers / toes
Osler nodes
nontender red nodules on palms, soles
janeway lesions
best study to confirm endocarditis
blood culture (not echo)
most common bug in acute bacterial endocarditis
S aureus
most common bug in subacute endocarditis
strep viridans
most common bug in viral myocarditis
coxsackie group B
pulsus paradoxus, EKG w/ low volt, abnormal T wave, ST depression,
DX?
Tx?
myocarditis
No steroids
pericardial friction rub but no change in sound w/ change in position, non-positional
purulent pericarditis
Very good murmurs?
Vs: Very good, venous hum, vibratory, and Vascular (carotid bruit)
pansystolic murmur left lower sternal border OR single loud S2 and hyperdynamic precordium
VSD
Fetal alcohol causes what two heart defects
ASD, VSD
bad systolic murmurs?
pan or late systolic
“normal” third heart sound?
disappears when child sits up from lying
Superior QRS axis (30-90 degrees) found in what?
AV canal (conduction goes around the large middle defect)
two disorders causing left axis dev?
tricuspid atresia and AV Canal Defect
two populations when PACs are not okay
<1y or children on digoxin
Digoxin contraindicated when?
WPW
SVT: beware of two drugs?
Verapamil in babies < 1yr: cardiac arrest
Digoxin: contraindicated in WPW
major prognostic indicator with AV block?
if its a wide QRS complex in which case: risk of seizure and syncope
left axis deviation : 2 causes and ddx them
Tricuspid atresia, endocardial cushion defect.
Tricuspid atresia is cyanotic. ECC is not.
