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Pediatrics > Cardiology > Flashcards

Cardiology Flashcards

0
Q

Congenital causes of CHF?

A
  1. Increased pulmonary bloodflow – VSD, PDA, transposition, truncus arteriosus, TAPVR
  2. Obstructive lesions – valve stenosis, coarctation, hypoplastic left heart syndrome
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1
Q

CHF – definition? Body’s reaction to increased demand?

A

Inadequate oxygen delivery

Compensatory mechanisms lead to increased demand:

  1. Hypoperfusion of end organs – increased contractility and heart rate
  2. General Hypoperfusion – salt/water retention the RAAS
  3. Catecholamine release
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2
Q

Non-congenital, non-metabolic, causes of CHF in children?

A
  1. Severe anemia – high output CHF
  2. Rapid infusion of intravenous fluids
  3. Obstructive airway from enlarged tonsils, laryngealmalacia, cystic fibrosis,
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3
Q

Medical management of congestive heart failure?

A

LMNOP +

  1. Cardiac glycosides (digoxin)
  2. Inotropes (dobutamine, dopamine)
  3. Milrinone (PDE inhibitor)
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4
Q

Atrial-septal defects – types?

A
  1. Ostium premium – defect in lower portion of septum. Down syndrome
  2. Ostium secundum – defect in middle septum. Most common type.
  3. Sinus venosis – high septum, pulmonary veins drain into right atrium or SVC instead of left atrium
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5
Q

Innocent heart murmurs?

A
  1. Still’s murmur – buzzing systolic murmur at left sternal border. Loudest if supine.
  2. Pulmonic systolic murmur – blowing, high-pitched murmur at upper left sternal border. Loudest if supine.
  3. Venus hum – continuous murmur. Not heard If supine.
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6
Q

Complications of ASD? Treatment?

A

Heart failure, pulmonary hypertension, atrial dysrhythmias, paradoxic embolism

Heart surgery

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7
Q

EKG findings in:

  1. Atrial septal defect
  2. Ventricular septal defect
  3. Patent ductus arteriosus
  4. Coarctation
  5. aortic stenosis
  6. Pulmonary stenosis
A
  1. RAE, RVH;
  2. LVH, RVH
  3. LVH, RVH
  4. Normal/LVH
  5. Normsl/LVH
  6. RVH
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8
Q

x-ray findings with coarctation?

A

Rib notching (collateral flow)

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9
Q

Sound of a small versus large VSDs?

A

Louder versus softer

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10
Q

Signs of PDA? Tx?

A
  1. Machine like murmur
  2. Widened pulse pressure
  3. Diastolic rumble
  4. Brisk pulses

Indomethacin

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11
Q

Signs of coarctation? Management?

A
  1. Hypertension in right arm, hypotension and explore extremities
  2. Dampened/delayed femoral pulse
  3. Bicuspid aortic valve
  4. Bruit
  5. Prostaglandin E to open ductus arteriosus
  6. Ionotropes
  7. Surgery/balloon angioplasty
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12
Q

Critical aortic stenosis? Presents when?

A

Inadequate perfusion body 12 to 24 hours after birth (once PDA closes)

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13
Q

Treatment of pulmonary stenosis?

A

Balloon valvuloplasty

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14
Q

Cardiac causes of cyanosis? Test? Definite diagnosis?

A
  1. Tetralogy of fallout
  2. Transposition of great arteries
  3. Tricuspid atresia
  4. Truncus arteriosus
  5. Total anomalous pulmonary venous return

100% oxygen test
Echo

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15
Q

Tetralogy of Fallot?

A

VSD, overriding aorta, pulmonary stenosis, right ventricular hypertrophy

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16
Q

Differentiating features of

  1. Tetralogy of Fallot
  2. Transposition great arteries
  3. Tricuspid atresia
  4. Truncus arteriosus
  5. TAPVR

Which have single S2? Which has SEM?

A
  1. SEM, RVH, boot shaped heart
  2. Single S2, small heart with narrow mediastinum (egg on a string)
  3. Single S2, RAE, LAD, LVH
  4. single S2 and SEM
  5. Pulmonary ejection murmur, RVH/RAE
17
Q

Tet spells? trigger? Symptoms? Compensation

A

Sudden cyanosis in tetralogy of Fallot

Any maneuver the decreases oxygen saturation

Alterations and consciousness/acidosis

Squatting (To decrease right-to-left shunting)

18
Q

Transposition of great arteries – adequate saturation achieved by?

A

Shunting blood through patent foramen ovale, ASD, VSD, PDA

19
Q

Acute management of tetralogy of Fallot?

A
  1. Knee-chest position
  2. Fluids, oxygen
  3. Morphine
  4. Beta blocker to slow heart rate, reduce contractility of right ventricle
  5. IV Bicarb
20
Q

Management of transposition of great arteries?

A
  1. PGE to improve oxygen saturation by keeping ductus patent
  2. Emergent balloon atrial septostomy
  3. Arterial switch operation – great arteries are switched
21
Q

Tricuspid atresia – other abnormal findings? paths of blood? Treatment (and mechanism)?

A

ASD or PFO always present

  1. If no VSD, pulmonary atresia present. Bloodflow through PDA leading to cyanosis
  2. If VSD present, less hypoxia
  3. Glenn shunt – SVC anastomosed to right pulmonary artery
    2 Fontan procedure – IVC flow directed into pulmonary arteries
22
Q

Truncus arteriosus – definition? Other abnormality present?

Can lead to? Management?

A

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

23
Q

Most common cause of acquired heart disease in children in US? Worldwide?

A

Kawasaki; acute rheumatic fever

24
Q

Infective endocarditis – usually occurs in whom? Caused by? Pathophysiology?

A

Patients with underlying heart condition or after cardiac surgery

Gram-positive cocci >gram-negative (HACEK) >fungal

  1. Bacteria infect cardiac endothelium
  2. Fibrin and platelets adhere to site of injury, creating vegetation that affects valve competency
  3. Distant manifestations (embolic phenomenon and immunologic sequelae)
25
Q

Management of endocarditis? Prophylaxis for whom?

A

IV antibiotic therapy AFTER adequate blood cultures obtained

  1. Patients with structural heart disease
  2. Postoperative cardiac surgery patients
26
Q

Purulent pericarditis? Causes? Complications?

A

Bacterial infection of the pericarditis

Staph aureus and strep

Constrictive pericarditis

27
Q

Postpericardiotomy syndrome?

A

Pericarditis post surgery. Unknown cause

28
Q

Clinical features of pericarditis? Diagnosis (three)? Imaging studies? Management?

A
  1. Chest pain relieved when sitting upright
  2. Pericardial friction rub
  3. Distant heart sounds and pulses paradoxes
  4. Hepatomegaly

Pericardiocentesis and ESR

  1. EKG – diffuse ST segment elevations, PR depressions
  2. CXR – enlarged heart shadow
  3. Echo – pericardial effusion

Antibiotics, anti-inflammatory, drainage

29
Q

Infectious disease that is a common cause of sudden-death? Most common viral cause? Fungal? Parasitic? Autoimmune? Bacterial?

A 
Myocarditis
Enteroviruses (Coxsackie)
Candida/Cryptococcus
Chaga's disease
SLE, rheumatic fever, sarcoidosis
Corynebacterium, strep pyogenes staph aureus, TB
30
Q

Myocarditis – symptoms? Physical exam findings? Labs? ECG, echo findings? Management?

A

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

31
Q

Causes of dilated cardiomyopathy?

A
  1. Viral myocarditis
  2. Mitochondrial abnormalities
  3. Carnitine deficiency
  4. Nutritional deficiency – selenium, thyamine
  5. Hypocalcemia
32
Q

Treatment for patient with hypertrophic cardiomyopathy?

A
  1. Beta blockers/calcium channel blockers
  2. Antiarrhythmics
  3. Surgical myomectomy
  4. Dual chambered pacing
33
Q

Causes of restrictive cardiomyopathy? Management?

A
  1. Amyloidosis
  2. Hemachromatosis
  3. Sarcoidosis
  4. Inherited infiltrative disorders – Fabry, Gaucher’s, hemosiderosis
  5. Reduce CVP with diuretics
  6. improved compliance with beta blockers/calcium channel blockers
34
Q

Most common dysrhythmia in childhood? Types?

A

SVT

  1. Atrial ventricular reentrant tachycardia – retrograde conduction through accessory pathway
  2. Atrioventricular node reentrant tachycardia – through the node itself
35
Q

Sinus tachycardia versus supraventricular tachycardia – rate? Variation in heart rate? P waves? Response to adenosine?

A
  1. Over 230 in newborns, over 210 children versus over 250
  2. Present versus absent
  3. Normal versus absent/abnormal
  4. Gradual versus rapid
36
Q

Prolonged SVT in a neonate may lead to symptoms of?

A

CHF

37
Q

WPW – describe EKG findings?

A

Delta waves – slurred upstroke of QRS

38
Q

SVT – ways to slow rhythm?

A
  1. Vagal maneuvers – icepack to face, carotid massage
  2. IV adenosine (propranolol, digoxin, procainamide, amiodarone)
  3. Cardioversion if hemodynamically unstable
  4. Chronic medical management (digoxin, propranolol)
  5. Radiofrequency catheter ablation
39
Q

Can see AV block as a result of? See congenital third-degree AV block in?

A

Post surgery (closure of VSD), bacterial endocarditis

Children born to mothers with SLE

40
Q

long QT syndrome – Congenital? Drugs?

A

Jervell-Lange-Nielsen syndrome – autosomal recessive, deafness

Romano-ward syndrome – autosomal dominant, no deafness

Phenothiazines, tricyclics, erythromycin, terfenadine

Pediatrics (38 decks)

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