Cardiology Flashcards
Congenital causes of CHF?
- Increased pulmonary bloodflow – VSD, PDA, transposition, truncus arteriosus, TAPVR
- Obstructive lesions – valve stenosis, coarctation, hypoplastic left heart syndrome
CHF – definition? Body’s reaction to increased demand?
Inadequate oxygen delivery
Compensatory mechanisms lead to increased demand:
- Hypoperfusion of end organs – increased contractility and heart rate
- General Hypoperfusion – salt/water retention the RAAS
- Catecholamine release
Non-congenital, non-metabolic, causes of CHF in children?
- Severe anemia – high output CHF
- Rapid infusion of intravenous fluids
- Obstructive airway from enlarged tonsils, laryngealmalacia, cystic fibrosis,
Medical management of congestive heart failure?
LMNOP +
- Cardiac glycosides (digoxin)
- Inotropes (dobutamine, dopamine)
- Milrinone (PDE inhibitor)
Atrial-septal defects – types?
- Ostium premium – defect in lower portion of septum. Down syndrome
- Ostium secundum – defect in middle septum. Most common type.
- Sinus venosis – high septum, pulmonary veins drain into right atrium or SVC instead of left atrium
Innocent heart murmurs?
- Still’s murmur – buzzing systolic murmur at left sternal border. Loudest if supine.
- Pulmonic systolic murmur – blowing, high-pitched murmur at upper left sternal border. Loudest if supine.
- Venus hum – continuous murmur. Not heard If supine.
Complications of ASD? Treatment?
Heart failure, pulmonary hypertension, atrial dysrhythmias, paradoxic embolism
Heart surgery
EKG findings in:
- Atrial septal defect
- Ventricular septal defect
- Patent ductus arteriosus
- Coarctation
- aortic stenosis
- Pulmonary stenosis
- RAE, RVH;
- LVH, RVH
- LVH, RVH
- Normal/LVH
- Normsl/LVH
- RVH
x-ray findings with coarctation?
Rib notching (collateral flow)
Sound of a small versus large VSDs?
Louder versus softer
Signs of PDA? Tx?
- Machine like murmur
- Widened pulse pressure
- Diastolic rumble
- Brisk pulses
Indomethacin
Signs of coarctation? Management?
- Hypertension in right arm, hypotension and explore extremities
- Dampened/delayed femoral pulse
- Bicuspid aortic valve
- Bruit
- Prostaglandin E to open ductus arteriosus
- Ionotropes
- Surgery/balloon angioplasty
Critical aortic stenosis? Presents when?
Inadequate perfusion body 12 to 24 hours after birth (once PDA closes)
Treatment of pulmonary stenosis?
Balloon valvuloplasty
Cardiac causes of cyanosis? Test? Definite diagnosis?
- Tetralogy of fallout
- Transposition of great arteries
- Tricuspid atresia
- Truncus arteriosus
- Total anomalous pulmonary venous return
100% oxygen test
Echo
Tetralogy of Fallot?
VSD, overriding aorta, pulmonary stenosis, right ventricular hypertrophy
Differentiating features of
- Tetralogy of Fallot
- Transposition great arteries
- Tricuspid atresia
- Truncus arteriosus
- TAPVR
Which have single S2? Which has SEM?
- SEM, RVH, boot shaped heart
- Single S2, small heart with narrow mediastinum (egg on a string)
- Single S2, RAE, LAD, LVH
- single S2 and SEM
- Pulmonary ejection murmur, RVH/RAE
Tet spells? trigger? Symptoms? Compensation
Sudden cyanosis in tetralogy of Fallot
Any maneuver the decreases oxygen saturation
Alterations and consciousness/acidosis
Squatting (To decrease right-to-left shunting)
Transposition of great arteries – adequate saturation achieved by?
Shunting blood through patent foramen ovale, ASD, VSD, PDA
Acute management of tetralogy of Fallot?
- Knee-chest position
- Fluids, oxygen
- Morphine
- Beta blocker to slow heart rate, reduce contractility of right ventricle
- IV Bicarb
Management of transposition of great arteries?
- PGE to improve oxygen saturation by keeping ductus patent
- Emergent balloon atrial septostomy
- Arterial switch operation – great arteries are switched
Tricuspid atresia – other abnormal findings? paths of blood? Treatment (and mechanism)?
ASD or PFO always present
- If no VSD, pulmonary atresia present. Bloodflow through PDA leading to cyanosis
- If VSD present, less hypoxia
- Glenn shunt – SVC anastomosed to right pulmonary artery
2 Fontan procedure – IVC flow directed into pulmonary arteries
Truncus arteriosus – definition? Other abnormality present?
Can lead to? Management?
Aorta and pulmonary artery originate from common artery.
VSD almost always present
Causes excessive blood flow to the lungs resulting in CHF
Homograft between right ventricle and pulmonary artery
Most common cause of acquired heart disease in children in US? Worldwide?
Kawasaki; acute rheumatic fever
Infective endocarditis – usually occurs in whom? Caused by? Pathophysiology?
Patients with underlying heart condition or after cardiac surgery
Gram-positive cocci >gram-negative (HACEK) >fungal
- Bacteria infect cardiac endothelium
- Fibrin and platelets adhere to site of injury, creating vegetation that affects valve competency
- Distant manifestations (embolic phenomenon and immunologic sequelae)
Management of endocarditis? Prophylaxis for whom?
IV antibiotic therapy AFTER adequate blood cultures obtained
- Patients with structural heart disease
- Postoperative cardiac surgery patients
Purulent pericarditis? Causes? Complications?
Bacterial infection of the pericarditis
Staph aureus and strep
Constrictive pericarditis
Postpericardiotomy syndrome?
Pericarditis post surgery. Unknown cause
Clinical features of pericarditis? Diagnosis (three)? Imaging studies? Management?
- Chest pain relieved when sitting upright
- Pericardial friction rub
- Distant heart sounds and pulses paradoxes
- Hepatomegaly
Pericardiocentesis and ESR
- EKG – diffuse ST segment elevations, PR depressions
- CXR – enlarged heart shadow
- Echo – pericardial effusion
Antibiotics, anti-inflammatory, drainage
Infectious disease that is a common cause of sudden-death? Most common viral cause? Fungal? Parasitic? Autoimmune? Bacterial?
Myocarditis Enteroviruses (Coxsackie) Candida/Cryptococcus Chaga's disease SLE, rheumatic fever, sarcoidosis Corynebacterium, strep pyogenes staph aureus, TB
Myocarditis – symptoms? Physical exam findings? Labs? ECG, echo findings? Management?
CP preceded by Flulike illness
PE – tachycardia, tachypnea, muffled heart sounds, gallops, hepatomegaly
Elevated ESR/CRP, CK
T/ST changes
Global ventricular dysfunction
Supportive, ionotropes, diuretics, IVIg, transplantation
Causes of dilated cardiomyopathy?
- Viral myocarditis
- Mitochondrial abnormalities
- Carnitine deficiency
- Nutritional deficiency – selenium, thyamine
- Hypocalcemia
Treatment for patient with hypertrophic cardiomyopathy?
- Beta blockers/calcium channel blockers
- Antiarrhythmics
- Surgical myomectomy
- Dual chambered pacing
Causes of restrictive cardiomyopathy? Management?
- Amyloidosis
- Hemachromatosis
- Sarcoidosis
- Inherited infiltrative disorders – Fabry, Gaucher’s, hemosiderosis
- Reduce CVP with diuretics
- improved compliance with beta blockers/calcium channel blockers
Most common dysrhythmia in childhood? Types?
SVT
- Atrial ventricular reentrant tachycardia – retrograde conduction through accessory pathway
- Atrioventricular node reentrant tachycardia – through the node itself
Sinus tachycardia versus supraventricular tachycardia – rate? Variation in heart rate? P waves? Response to adenosine?
- Over 230 in newborns, over 210 children versus over 250
- Present versus absent
- Normal versus absent/abnormal
- Gradual versus rapid
Prolonged SVT in a neonate may lead to symptoms of?
CHF
WPW – describe EKG findings?
Delta waves – slurred upstroke of QRS
SVT – ways to slow rhythm?
- Vagal maneuvers – icepack to face, carotid massage
- IV adenosine (propranolol, digoxin, procainamide, amiodarone)
- Cardioversion if hemodynamically unstable
- Chronic medical management (digoxin, propranolol)
- Radiofrequency catheter ablation
Can see AV block as a result of? See congenital third-degree AV block in?
Post surgery (closure of VSD), bacterial endocarditis
Children born to mothers with SLE
long QT syndrome – Congenital? Drugs?
Jervell-Lange-Nielsen syndrome – autosomal recessive, deafness
Romano-ward syndrome – autosomal dominant, no deafness
Phenothiazines, tricyclics, erythromycin, terfenadine
