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Pediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

what is cardiomegaly?

A

Enlarged left heart or right heart

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2
Q

what if pulm circulation is overcirculated?

A

prominence of pulmonary vasculature

“wet appearing” lung ,

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3
Q

Egg on a String - shaped heart..

A

Transposition of the great arteries

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4
Q

Boot shaped heart

A

T of F

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5
Q

what does an echo show?

A

Structures

  • Blood flow
  • Estimates of pressure in chambers
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6
Q

Increased precordial activity –

A

cardiomegay lg right side of heart

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7
Q

Displaced PMI

A

enlarged

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8
Q

RV heave =

A

rv HTN

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9
Q

liver size enlargement

A

enlarged from congestion

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10
Q

extremities what do you look for?

A

perfusion, edema, clubbing

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11
Q

Wk LE pulse

A

CoA

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12
Q

bounding pulse

A

run-off lesions (L→R PDA shunt, AI )

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13
Q

Weak pulses

A

cardiogenic shock or CoA

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14
Q

what is Pulsus paradoxus and what does it indicate

A

exaggerated SBP drop with inspiration → tamponade or bad asthma

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15
Q

what is pulses alterans? indicates?

A

altering pulse strength → LV mechanical dysfunction

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16
Q

what is S1

A

closing of mitral and tricuspid valves, LLSB or apex

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17
Q

what is S2

A

closing of aortic (A2)and pulmonic (P2) valves

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18
Q

what is S3

A

– heard in diastole ,related to rapid ventricular filling , can be normal, or abnormal -accentuated with dilated ventricles

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19
Q

what is S4?

A

Always bad..late in diastole just before S1 – always bad.

Decreased vent compliance / heart failure

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20
Q

Ejection click

A

AS or PS

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21
Q

Mid-systolic click

A

MVP

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22
Q

Loud S2

A

Pulmonary HTN

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23
Q

Single S2

A

= one semilunar valve (truncus), anterior aorta (TGA), pulmonary HTN

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24
Q

Fixed, split S2

A

ASD, PS

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25
Q

Gallop (S3)

A

may be due to cardiac dysfunction/ volume overload

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26
Q

Muffled heart sounds and/or a rub

A

pericardial effusion ± tamponade

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27
Q

innocent heart murmurs?

A

Heart murmurs which occur in the absence of anatomic or physiologic abnormalities of the heart or circulation

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28
Q

heart murmur described based on

A

Location and radiation
Relationship to cardiac cycle and duration
Intensity
Quality

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29
Q

heard first days of life, LLSB , 1-2/6 , gone by 2-3 weeks of life

A

newborn

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30
Q

often in newborn period from branching PA. Heard in axillae and back short, high pitched 1-2/6

A

Peripheral pulmonary arterial stenosis (PPS

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31
Q

most common murmur of early childhood. Heard ages 2-7yrs. Musical, vibratory, mid to lower LSB, 1-3/6. loudest when patient supine.

A

Still murmur

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32
Q

most common innocent murmur in older children, ages 3 yrs and up. ULSB, soft ejection murmur , 1-2/6.

A

Pulmonary ejection Murmur –

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33
Q

heard after age 2, infraclavicular (where blood is coming together from jug and subclav) R>L, Continuous musical hum. Best heard sitting. Comes from turbulence at confluence of subclavian and jugular vein.

A

Venous Hum

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34
Q

older child and adolescent. Rt supraclavicular area, harsh, 2-3/6.

A

Innominate or carotid Bruit

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35
Q

LOC and muscle tone

Usually benign

A

syncope

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36
Q

in kids syncope is d/t

A

Vasovagal or neurocardiogenic

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37
Q

what Usually has prodrome of pallor, lightheadedness

Can be in response to pain, heat, blood, fright

A

syncope

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38
Q

if syncope is d/t cardiac disease…

A

BAD - arrhythmia or CHD

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39
Q

if syncope is d/t circuation what is it?

A

Hypovolemia, orthostatic hypotension

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40
Q

chest pain in child is…

A

rarely cardiac…;Usually musculoskeletal
Pulmonary origin
GERD
asthma

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41
Q

if CP is d/t cardiac?

A

ischemia, inflammation, arrhythmia

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42
Q

what is common. Some conducted, some non-conducted. Slight not-quite compensatory pause before next beat. Benign

A

PACs

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43
Q

what has wide QRS, no compensatory pause, typically benign unless they come several in a row

A

PVC’s

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44
Q

very uncommon in young children

Seen occasionally in older children and adolescents…

A

PVC

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45
Q

3 PVC’s in a row means

A

Vtach , uncommon, unstable, needs cardioverting

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46
Q

most common arrhythmia in kids

A

PAC

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47
Q

Supraventricular Tachycardia (SVT) is defined as

A

280-300 bpm Well tolerated unless underlying heart disease

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48
Q

what is Wolff-Parkinson-White Syndrome

A

Re-entrant tachycardia - Abrupt onset and termination

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49
Q

how do you stop SVT?

A

adenosine

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50
Q

how do you manage SVT

A

B blocker

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51
Q

Prolonged QTc syndrome

A

can but someone in SVT also but not as common as reentrant

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52
Q

what is the most common SVT in kids

A

Re-entrant tachycard

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53
Q

what causes congenital heart block

A

Maternal Lupus

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54
Q

what is result of first degree heart block?

A

prolonged PR

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55
Q

what is 2nd degree heart block?

A

not all P waves are conducted

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56
Q

what is type 1 second degree HB?

A

progressively longer PR interval until a QRS is dropped

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57
Q

what is type 2 second degree HB?

A

same PR interval, occasional QRS droppedThird Degree – complete dissociation of SA with AV

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58
Q

what is 3rd degree HB

A

Av node does not transmit message from SA

from maternal lupus CHB –>moms lupus damages the AV node of baby

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59
Q

Children’s heart disease is particularly d/t

A

congenital heart disease is due to structural abnormalities

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60
Q

what is the number one cause of congenital heart disease?

A

multifactorial>genetic>Maternal infections and diseases and teratogens:

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61
Q

what are examples of maternal infections and diseases and teratogens that cause CHD

A

Examples: fetal alcohol syndrome, Down syndrome, Trisomy 13 and Trisomy 18, Turner syndrome, congenital rubella syndrome, Maternal Lupus

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62
Q

Coxsackie B in mom causes

A

Myocarditis

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63
Q

parvo in mom causes

A

Myocarditis

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64
Q

rubella in mom causes

A

PDA, PS, AS, TOF

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65
Q

Lithium in mom causes

A

ebsteins

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66
Q

ibuprofen antinatally

A

PHTN

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67
Q

ETOH antenatally

A

VSD, ASD, TOF, CoA

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68
Q

phenytoin

A

ASD, VSD, CoA, PDA, PS, TOF

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69
Q

Retinoic Acid

A

TGA, TOF, DORV, TA, AA probs, HLHS

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70
Q

Lupus in mom

A

Congenital Heart Block

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71
Q

diab in mom

A

TGA, VSD, ventricular hypertrophy

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72
Q

5%, most common CHD presenting in the first week of life

A

Transposition of Great Arteries

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73
Q

1%, second most common presenting in the first week of life

A

Hypoplastic Left Heart Syndrome

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74
Q

10%, most common CHD presenting beyond infancy

A

TOF

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75
Q

For the fetus the ____ is the oxygenator so the lungs do little work

A

placenta

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76
Q

in fetus _____ contribute equally to the systemic circulation and pump against similar resistance

A

RV and LV

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77
Q

what are the shunts in the fetus needed for survival? 3

A 
ductus venosus (bypasses liver)
 foramen ovale (R→L atrial level shunt)
 ductus arteriosus (R→L arterial level shunt)
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78
Q

what is ductus venosus

A

by passes liver

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79
Q

what is foramen ovale

A

R–>L atria

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80
Q

ductus arteriosis

A

R–>L arteral shunt

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81
Q

what happens to the fetal heart at birth? 3 things.. what constricts ductus arteriosis, and closes foramen ovale?

A
  1. Mechanical expansion of lungs and increased arterial PO2 decreases pulmonary vascular restrictive
  2. Over several days the increased PaO2 constricts the ductus arteriosis
  3. The increased plmonary blood flow returning to left atrium increases pressure in LA leading to closure of PFO.
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82
Q

Cyanotic CHD?

A

= R –> L shunt ( blood bypasses lungs)

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83
Q

Acyanotic CHD

A

L –> R shunt

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84
Q

what are obstructions in CHD?

A

Coarctation, stenosis

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85
Q

what are mixing/ reversal of flow CHD?

A

Septal defects, patent fetal paths

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86
Q

what are parallel circuit of CHD?

A

Transposition of the Great Vessels

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87
Q

If acyanotic?

A

Left to Right shunt or
Obstruction to outflow

ex. of l–> shuntopening in the VSD –>blood will flow from l to r during systole

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88
Q

if cyanotic…

A

Right to Left shunt or

Parallel circuit

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89
Q

if increase pulmonary flow

A

Left to Right shunt – blood flows to chamber with lower

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90
Q

if decreased pulmonary flow

A

right to left shunt

ie pulm valve is stenotic

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91
Q

symptoms of decrease pulm flow in infant..

A

Cyanosis
Squatting
Loss of Consciousness

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92
Q

symptoms of decrease pulm flow in older child

A

Dizziness

syncope

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93
Q

symptoms of increased pulm flow in infant

A

Tachypnea with activity/feeds
Diaphoresis
Poor weight gain

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94
Q

symptoms of increased pulm flow in older child?

A

Exercise intolerance

Dyspnea on exertion/diaphoresis

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95
Q

acyanotc CHDs 6 types

A 
Atrial septal defects (ASD)10%
Ventricular septal defects (VSD) 25%
Patent ductus arteriosus (PDA) 5-10%
Obstruction to blood flow
Pulmonic stenosis (PS)10%
Aortic stenosis (AS) 5%
Aortic coarctation 10%
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96
Q

how does ASD present

A

childhood w/ murmur or exercise intolerance

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97
Q

what is going on in ASD?

A

Flow is from L > R

  • RA and RV volume overload (enlargement)
  • Increased pulmonary blood flow
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98
Q

ASD is not a problem when?

A

at birth –> problem shows up later

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99
Q

Clincal findings of SD - growth, symptoms, heart sounds, murmur?

A

-Most children are asymptomatic
-May be undergrown
-Easy fatigueability in older children /adults
-Acyanotic, RV lift, normal pulses
-Persistently split second heart sound (S2)
Pulmonary ejection murmur
Diastolic flow murmur over tricuspid valve

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100
Q

what finding is consistent with split S2?

A

ASD

101
Q

how do you treat ASDs?

A

ASDs may be closed either by device placement during catheterization or surgically

102
Q

ADSs after ___y/o will not close alone

A

2

103
Q

what is VSD

A

opening in the ventrical

104
Q

what happens in the VSD?

A

-L –>R shunt because of low pulmonary vascular resistance
-Increased pulmonary blood flow - Increased pressure
-Pulmonary venous congestion
Left sided overload (enlargement) and hypertrophy – back up of flow.
-Pulmonary hypertension
- Primarily right sided problem

105
Q

What are VSD symotoms and at inc risk for what?

A 
Congestive heart failure
Poor growth
Shortness of breath/Increased respiratory effort
Easy fatigue
Recurrent respiratory infections
106
Q

what are clinical findings of VSD? growth, resp, precordial, murmors?

A 
Growth and development may be delayed
Respiratory effort and heart rate may be increased if heart failure
Precordial activity may be “bounding”
Holosystolic murmur –holosystolic, harsh
LLSB, +/- thrill
Systemic and pulmonary venous congestion
107
Q

how do you treat VSD

A 
30%  will close spontaneously
Observation
Anti-congestive heart failure medications
diuretics
Fortified diet
Surgery (open heart defect)
108
Q 
Endocardial cushion defect
AV valve insufficiency
Heart Failure over 6-8 weeks
Poor growth
Trisomy 21... what is this?
A

AVSD

109
Q

what is the treatment of AVSD

A

surgery

110
Q

what is a PDA treatment

A

indocin/ibuprofen….. surgery

111
Q

what if a pt has symp of T21 what is the murmur d/t

A

AVSD

112
Q

what do you give to keep PDA like in coarc?

A

PG

113
Q

what does persistent PDA cause?

A

increase pulmonary flow; pulmonary overload

114
Q

murmur of PDA

A

Soft murmur LLSB 1-3/6

115
Q

pulmonic stenosis

A

cant get blood out into Pulm art very well so back up to r side of heart

116
Q

aortic stenosis is primarily

A

bicuspid valve

117
Q

what is: Obstruction of LV output
LV hypertrophy
Low cardiac output
LV failure

A

aortic stenosis

118
Q

what is first sign of AS

A

Heart murmur is usually the first sign
Ejection click
Basilar ejection murmur
Precordial or suprasternal thrill

119
Q

what may AS cause if severe

A

low cardiac output or congestive heart failure

Neonatal heart failure

120
Q

older child with AS presents with…

A

chest pain, dizziness, syncope (especially with exertion)

121
Q

how do you treat mild A stenosis?

A

may not req tx

122
Q

how do you treat AS

A

All treatment is palliative
Balloon valve angioplasty
Surgery , valve replacement
Life style alterations

123
Q

what is the physiology of CoA?

A

Narrowing near where the ductus enters the aorta

124
Q

what other defect is CoA associated with

A

bicuspid aortic valve

125
Q

Pt with CoA has what?

A

Poor perfusion, left ventricular failure

126
Q

when does CoA present

A

mostly in infants

127
Q

what is CoA thought to be from?

A

Not closing of PDA

128
Q

neonates CoA present with

A

severe congestive cardiac failure and cardiovascular collapse

129
Q

Older kids with CoA present with

A

hypertension, absent or weak femoral pulses, leg cramps, chronic pulmonary congestion, headaches, epistaxis

130
Q

CoA murmur?

A

blowing systolic in left axilla

131
Q

Lower body is cooler(less pulses) than upper body

A

CoA

132
Q

what has a blowing systolic murmur in left axilla

A

CoA

133
Q

treatment of CoA

A

surgery

134
Q

Cyanotic CHD - 8

A 
Tetralogy of Fallot (TOF)
Tricuspid atresia (TA)
Total anomalous pulmonary venous return (TAPVR)
Truncus arteriosus
Transposition of the great vessels
5 T’s
Hypoplastic left heart syndrome (HLH)
Pulmonary atresia (PA) / critical PS
Double outlet right ventricle (DORV)
135
Q

what is truncus arterioisis? shunt and PBF?

A

R–>L shunt increase PBF

136
Q

how does truncus art present?

A

Presents more often with heart failure (except TGA)

Pulmonary congestion worsens as neonatal PVR lowers

137
Q

what is the shunt of TOF? PBF?

A

R–> L decreased

138
Q

how does TOF present? xray?

A

Presents more often with cyanosis

See oligemic lung fields (black –> more blood)

139
Q

what makes TOF worse?

A

PDA closure

140
Q

what are the 4 things of TOF

A

Ventricular septal defect
Pulmonic valve stenosis
Right ventricular hypertrophy
Overriding aortic valve

141
Q

what are the typical features of TOF?

A

Cyanosis after the neonatal period
Hypoxemic spells during infancy
Right-sided aortic arch in 25% of all patients
Systlic ejection murmur at the upper LSB

142
Q

what is the murmor of TOF

A

Systlic ejection murmur at the upper LSB

143
Q

what is a hallmark of TOF

A

tet spells

144
Q

what is a tet spell? 4 things

A

Sudden onset or deepening of cyanosis
Sudden onset of dyspnea
Alterations of consciousness
Decrease in intensity of systolic murmur

145
Q

what happens to blood in TOF?

A

Limitation of pulmonary blood flow.. Right to left shunting

146
Q

how does a child present with TOF? color, murmur, symptoms, other

A 
Cyanosis
Loud murmur (LUSB)
Irritability, poor feeding, poor growth
Hypercyanotic ‘spells’
Squatting
147
Q

how do you treat TOF?

A

Treatment is dependent upon age, anatomy and degree of cyanosis:
PGE1 (prostaglandin )
(Emergency) systemic to pulmonary shunt
Complete repair

148
Q

what is Transposition of the Great Arteries

A

2 trunks but they are on the wrong sides…

149
Q

how does TGA present? color, murmur, labs?

A

Varying degrees of cyanosis
Typically no murmur
Tachypnea
Normal ECG for age

150
Q

how do you treat TGA?

A 
Balloon septostomy
Create ASD
Prostaglandin infusion
Ductal dependent
Surgical Correction
151
Q

Infants WITH TGA whose ____ has closed and who have a small ___ will be intensely cyanotic

A

PDA, ASD

152
Q

what causes obstruction to blood flowing out to lungs?

A

pulmonary stenosis

153
Q

what causes obstruction to blood flowing out to body?

A

Aortic stenosis

154
Q

what is a ductal dependent obstructive lesion?

A

requires open PDA to get blood beyond the obstruction

155
Q

what are 3 ductal dependent obstructive lesions?

A

Critical PS/AS
Critical CoA/IAA
HLHS

156
Q

how do you ductal dependent obstructive lesions present? and what is the treatment? at what age?

A

in CV shock at 2-3 days of age when PDA closes
+/- cyanosis
Needs PGE1

157
Q

what are 3 non-ductal dependent obstructive lesions?

A

Mild-moderate AS
Mild-moderate CoA
Mild-moderate PS

158
Q

how does non-ductal dependent obstructive lesions present? in what age?

A

Presents in older child w/ murmur, exercise intolerance, or HTN (in CoA)
Not cyanotic

159
Q

what is hypoplastic left heart? what if you dont treat? how do you treat?

A 
mitral atresia
Aortic atresia
Both.
Death at 5-7 days untreated
PGE
160
Q

how does hypoplastic l heart present?

A

Shock and acidosis

161
Q

hw does nonductal dependent present?

A

Presents in older child w/ murmur, exercise intolerance, or HTN (in CoA)
Not cyanotic

162
Q

in infants with HF how do they present?

A

dyspnea, fatigue, poor feeding, FTT, tachycardia, gallop rhythm, hepatomegaly

163
Q

heart sound associated with HF is

A

S4

164
Q

in older children with HF how do you present?

A

exercise intolerance, somnolence, anorexia, (cough, wheeze, crackles in late failure)

165
Q

what is cough wheeze and rales?

A

long standing HF with fluid in lungs

166
Q

what is the best study for HF?

A

ECHO

167
Q

ECHO measures?

A

heart size, function, structure

168
Q

an infant with hepatomegaly and murmur what do you think?

A

long standing HF

169
Q

what is the most common cardiomyopathy in kids?

A

dilated

170
Q

what is dilated cardimyopathy?

A

Increased ventricle size with decreased contractility

(no evidence of coronary,valvular or pericardial disease

171
Q

what other heart things are associated with dilated cardiomyopathy

A

Mitral insufficiency, ventricular ectopy, tachyarrhythmias

172
Q

how do ppl present with dilated cardiomyopathy?

A

SOB, exercise intolerance, Fatigue

173
Q

how do we treat dilated cardiomyopathy?

A

ACEI, B-blockers, Digoxin

174
Q

dilated cardiomyopathy s/s?

A

inadequate CO and HF
Tachycard and pnea
Narrow pulse pressure
Rales may be audible

175
Q

what is dilated cardiomyopathy caused by?

A

Often idiopathic
infection - echovirus and coxsackie B
Familial or 2ndary to systemic disease (lupus) or drugs

176
Q

Cardiomyopathy on xrays show…

A

cardiomegaly

177
Q

EKG of cardiomyopathies show

A

always abn but nonspecific:

Abd St-T wave seg, LV hypertrophy

178
Q

Treatment for cardiomyopathies

A

diuretics, inotropic meds, afterload meds

179
Q

what are 4 acquired heart diseases?

A

Myocarditis – Viral
Endocarditis , Pericarditis
Rheumatic Heart Disease
Kawasaki Disease

180
Q

what is pericarditis caused by?

A

Most often viral

If bacterial: Staph A, Strep Pneumo

181
Q

what are symptoms of pericarditis?

A

related to pericardial effusion

182
Q

what is the best test for pericarditis?

A

ECHO best test

183
Q

what does pericarditis show on CXR

A

cardiomegaly

184
Q

how do you treat pericarditis

A

anti-inflammatories

185
Q

how is at high risk for infective endocarditis?

A

with CHD not with simple ASD

186
Q

what is infective endocarditis?

A

Vegetations on valves

Create clots

187
Q

how does endocarditis present?

A

Fever , Anemia, Pallor, Splinter hemorrhages in nailbeds, clubbing, retinal infarcts

188
Q

what is the number one cause of infective endocarditis? 2nd?

A 
Strep Viridans (30-40%), Staph Aureus (25-30%)
Need GOOD dental hygiene for prevention
189
Q

how do you treat infective endocard?

A

high dose PCN and aminoglyc

190
Q

what are tests for infective endocarditis?

A

: blood cluture ESR and CRP

CBC – leukocytosis, anemia

191
Q

what are complications of infective endocarditis?

A

heart damage and clots

192
Q

what is the most common cause of acquired HD?

A

kawasaki

193
Q

what organs does RF affect?

A

heart, jts, brain, skin, subq nodules

194
Q

how does RF affect heart?

A

Heart muscle & valves – myocarditis & endocarditis (pericarditis rare w/o the others)

195
Q

how does RF affect joints

A

polyarth

196
Q

how does RF affect brain?

A

Sydenham’s Chorea (“milkmaid’s grip” or better yet, “motor impersistance”)

197
Q

how does RF affect skin?

A

erythema marginatum (serpiginous border) due to vasculitis

198
Q

how does RF affect nodules?

A

non-tender, mobile and on extensor surfaces

199
Q

what are pk ages of RF?

A

5-15

200
Q

what is onset of RF

A

1 – 3 weeks following group A beta-hemolytic strep throat / pharynx infection

201
Q

what is the patho of RF?

A

Abnormal immune response of B lymphocytes leading to antibodies/ complexes that cross-react with antigens on cardiac muscle -> inflammation of myocardium and valves, and other tissue
Also affects connective tissue and perivascular tissue
Arthritis , skin (subcutaneous nodules or erythema marginatum), CNS (chorea)

202
Q

what question should you ask for RF

A

recent strep infection?

203
Q

what are PE findings with RF?

A

Symptoms such as rashes, arthritis,

Heart rhythms or murmurs (pericardial rub)

204
Q

what are labs to run for RF?

A

ESR and CRP (non specific) often elevated
Antistreptococcal antibody titer –difficult to obtain and interpret
Throat culture
ECG if signs of heart failure (call cardiology)

205
Q

kid has gangrene on 3rd toe… what might it be?

A

Lesions from emboli

From endocarditis.. RF

206
Q

what are 5 major jones criteria?

A

Migratory polyarthrits and carditis

chorea, erythma marginatum and subq nodules

207
Q

what is the most common finding of RF?

A

migratory polyarthritis

208
Q

what is Pink, slightly raised, non-pruritic rings on trunk and inner surfaces of extremities

A

erythema marginatum

209
Q

what are minor findings for RF 4

A

Arthralgia (Cannot consider if patient also has arthritis)
Fever
Elevated acute phase reactants (ESR, CRP)
Prolonged P-R interval

210
Q

how do you treat RF - 6

A

Benzathine penicillin G 0.6-1.2 million units IM x 1
Continuous antistreptococcal prophylaxis
Bacterial endocarditis prophylaxis
Aspirin for symptoms of pain and fever (2-4wks)
Corticosteroids for severe carditis and cardiac Rx for congestive heart failure
Prophylaxis- Pen V BID PO or Pen G IM q 4weeks until low risk.

211
Q

what is a systemic vasculitis?

A

kawasaki disease

212
Q

how do you tx kawasaki disease?

A

CBC, CMP, CRP, ESR, EKG, ECHO

213
Q

how do you treat kawasaki disease?

A

IVIG - decreases coronary art dilation

214
Q

what is mucocutaneous lymphnode syndrome?

A

kawasaki disease

215
Q

what are the 3 phases of kawasaki disease? symptoms of all

A

Acute – Fever, mucocutaneous symptoms (up to 2 wks)
Subacute – Thrombocytosis, coronary artery changes (wk 2-4)
Chronic – Slow resolution (2 months)

216
Q

how do you treat kawasaki?

A

IVIG and high dose aspirin

217
Q

what is the criteria of dx KD?

A

Must have fever PLUS 4 of the 5 other symptoms OR coronary aneurysms

218
Q

what are the 6 symptoms of KD? describe them..

A

Fever – minimum 5 days
Conjunctivitis – injection without exudate, painless
Rash – polymorphous, usually urticarial, may be scarlatiniform
Changes in hands and feet – erythema and swelling, followed by desquamation
Mucous membrane involvement – swollen lips, pharyngitis, “strawberry tongue”
Cervical adenopathy – Often unilateral

219
Q

what heart defect is associated with down syndrome

A

AVSD

220
Q

what heart defect is associated with Turner syndrome?

A

CoA, bicuspid aortic valve

221
Q

what heart defect is associated with Marfan syndrome

A

MVP, dilated aortic root, MR

222
Q

what heart defect is associated with FAS?

A

VSD, PPS

223
Q

what heart defect is associated with maternal rubella?

A

PDA, PPS

224
Q

what heart defect is associated with T18?

A

VSD, AVSD, AS

225
Q

what heart defect is associated with T13?

A

TOF ASD VSD

226
Q

what heart defect is associated with VACTERL

A

VSD, TOF

227
Q

what cyanotic HD have increased PBF? 4

A

Truncus arteriosus
Total anomalous pulm. venous return (TAPVR)
Transposition of the great arteries (TGA)
Tricuspid Atresia with large VSD

228
Q

what cyanotic HD have decreased PBF? 4

A

Pulmonary Stenosis / Atresia
Tetralogy of Fallot
Tricuspid atresia
HLHS

229
Q

what is heard in first days of life at the LLSB 1-2/6 and gone by the first 2-3 wks of life?

A

newborn murmur - common functional murmur

230
Q

what is often in newborn period from a branching pulmonary artery. Heard in the axillae and back, short high pitched 1-2/6

A

peripheral pulmonary artery stenosis

231
Q

what is the most common murmur of early childhood?

A

still murmur

232
Q

what is heard in ages 2-7, described as musical vibratory mid-lower LSB 1-3/6 and loudest when the pt is supine?

A

still murmur

233
Q

what are 4 signs of concerning murmurs as far as hx?

A

easy fatiguability, claudication, worse on exertion, FTT

234
Q

what are the 6 most common fxnl murmurs

A

newborn murmur, peripheral pulmonary artery stenosis, still murmur, pulmonary ejection murmur, venous hum, innominate or carotid bruit.

235
Q

what is most common innocent murmur in older children ages 3 and up?

A

pulmonary ejection murmur

236
Q

what is heard at the ULSB soft ejection murumr 1-2/6?

A

pulm ejection murmur

237
Q

what is heard after age 2, infraclavicular R>L, Continuous musical hum. Best heard sitting. Comes from turbulence at confluence of subclavian and jugular vein.

A

venous hum

238
Q

what is heard in older child and adolescent. Rt supraclavicular area, harsh, 2-3/6.

A

innomate or carotid bruit

239
Q

what are signs of concerning murmur on PE?

A

-Unequal pulses/pressures
-Hyperactive precordium, displaced Point of Maximum Impulse (PMI)
-Murmur itself
Holosystolic or continuous
Grade IV or higher
Other

240
Q

what has s&s of inadequate output and HF, tachycardia and tachypnea, a narrow pulse pressure, and may have audible rales?

A

dilated cardiomyopathy

241
Q

what are causes of dilated cardiomyopathy?

A

idiopathic or infection (echovirus or coxackie B) or could be familial or secondary to systemic disease (lupus) or meds

242
Q

what is the most common cardiomyopathy?

A

dilated

243
Q

what has increase in ventricle size with decreased contractility?

A

dilated cardiomyopathy

244
Q

what cardiomyopathy has an assoc prolonged QT interval

A

hypertrophic

245
Q

what does the xray show on cardiomyopathies

A

cardiomegaly

246
Q

what may be the initial presentation of cardiomyopathy in older children

A

sudden death

247
Q

what cardiomyopathy has LV hypertrophy?

A

hypertrophic

248
Q

what is the treatmenf of all cardiomyopathies?

A

Diuretics, inotropic medications, afterload reducers

Pediatrics (9 decks)

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