CARDIOLOGY Flashcards
Newborn with cyanosis, pulse oximetry changed
from 60% to 64% only on 100% oxygen
Cardiac (most likely)
Newborn with cyanosis, pulse oximetry changed
from 60% to 88% on 100% O2
Pulmonary (most likely)
What is the reason that left to right shunt lesions may not present until 1 month of age?
The pulmonary vascular resistance drops to
normal levels at that time
A 1-day-old infant with a history of maternal
diabetes, cyanosis, and tachypnea, poor response to supplemental oxygen, loud single second heart sound, no murmur, chest radiograph shows narrow mediastinum with small heart tipped on side, increased pulmonary vascularity
Transposition of great vessels
What is the next best step in a newborn with
suspected transposition of the great vessels?
Prostaglandin E1 to keep the patent ductus
arteriosus (PDA) open, followed by +/− balloon
atrial septostomy and surgery
The most common cause of cyanotic heart disease presenting a few days after birth
Transposition of the great vessels
Newborn presents with cyanosis in the lower
extremities, tachycardia, respiratory distress, and loud single S2 sound
Persistent pulmonary hypertension (R→L
shunting across the PDA)
A 1-day-old newborn presents with cyanosis,
single first and second heart sounds, chest
radiograph, shows decreased lung markings, and electrocardiogram shows left axis deviation
Tricuspid atresia with pulmonary atresia
Newborn presents with cyanosis (mother was on a medicine for severe bipolar disorder), chest radiograph shows cardiomegaly and right atrial enlargement
Ebstein anomaly
Newborn presents with severe cyanosis, systolic
ejection murmur, and a single second heart sound, chest radiograph shows decreased pulmonary vascular markings
Severe pulmonary stenosis
Newborn presents with intense cyanosis and
respiratory distress, chest radiograph shows a
“snowman” shaped heart
Supracardiac total anomalous pulmonary venous return
An 8-week-old boy presents with feeding
difficulties, poor weight gain, episodes of bluish
discoloration of the skin while feeding and crying, a harsh systolic ejection murmur (SEM) is heard over the pulmonic area and left sternal border; chest radiograph shows diminished vascularity in the lungs and diminished prominence of the pulmonary arteries, a boot-shaped heart (coeur en sabot)
Tetralogy of Fallot
During the first 48 h of life, a newborn rapidly
develops cyanosis, tachypnea, respiratory distress, pallor, lethargy, metabolic acidosis, oliguria, weak pulses in all extremities, hepatosplenomegaly, and no murmur
Hypoplastic left heart (as PDA closes)
A 2-year-old with a history of tetralogy of Fallot
has progressive agitation, increasing cyanosis, and increased fussiness
Hypercyanotic spell (Tet spell)—next step is the
knee-chest position
What is the next best step for the newborn in the previous case with suspected hypoplastic left heart?
Prostaglandin E1
A 2-week-old boy develops congestive heart
failure, severe metabolic acidosis, and poor
perfusion of the lower extremities
Coarctation of the aorta
Newborn presents with shock; the echocardiogram shows coarctation of the aorta. What is the drug of choice?
Prostaglandin E1
A 12-year-old presents with hypertension,
occasional headache, leg cramps, weak and
delayed femoral pulse, and blood pressure in the upper limb is higher than the lower limb, chest radiograph shows rib notching and scalloping on the undersurface of posterior ribs
Coarctation of the aorta
Newborn presents with shock; the echocardiogram shows coarctation of the aorta. What is the drug of choice?
Prostaglandin E1
A 12-year-old presents with hypertension,
occasional headache, leg cramps, weak and
delayed femoral pulse, and blood pressure in the upper limb is higher than the lower limb, chest radiograph shows rib notching and scalloping on the undersurface of posterior ribs
Coarctation of the aorta
A girl with Turner syndrome presents with
hypertension, weak and delayed femoral pulse
Coarctation of the aorta
Newborn infant presents with a soft, harsh systolic ejection murmur, best heard at the axillae, and precordium and no symptoms
Peripheral pulmonary stenosis (PPS)
Newborn infant presents with a soft, harsh systolic ejection murmur, best heard at the axillae, and precordium and no symptoms
Peripheral pulmonary stenosis (PPS)
The most common cardiac lesion associated with trisomy 21 (Down syndrome)
Endocardial cushion defect O. I. Naga
The most common cardiac lesion associated with Turner syndrome
Bicuspid aortic valve
The most common cardiac lesion associated with trisomy 18
Ventricular septal defect (VSD)
The most common cardiac lesion associated with Williams syndrome
Supravalvar aortic stenosis
The most common cardiac lesion associated with Noonan syndrome
Pulmonary stenosis
The most common cardiac lesion associated with DiGeorge syndrome
Tetralogy of Fallot
The most common cardiac lesion associated with Alagille syndrome
Branch pulmonary stenosis
The most common cardiac lesion associated with cri du chat syndrome
VSD
The most common cardiac lesion associated with Holt–Oram syndrome
Atrial septal defect (ASD)
The most common cardiac lesion in fetal alcohol
syndrome
VSD, ASD
The most common cardiac lesion associated with lithium teratogen
Ebstein anomaly
The most common cardiac lesion associated with supraventricular tachycardia
Ebstein anomaly
The most common cardiac lesion associated with the infant of a diabetic mother
Ventricular hypertrophy
The most common cardiac lesion associated with tuberous sclerosis
Cardiac rhabdomyoma
The most common valvular lesion associated with acute rheumatic fever
Mitral regurgitation
The most common cardiac lesion associated with Marfan syndrome
Aortic root dilation (risk for dissection)
The most common congenital cardiac lesion
overall
VSD
The syndrome that is associated with true
interrupted aortic arch
DiGeorge syndrome
Adolescent routine physical exam, apical midsystolic non-ejection click, and late systolic
murmur; the murmur is louder when goes from a supine to a standing position, and the murmur becomes softer when squatting
Mitral valve prolapse
Child routine physical exam, systolic murmur with a vibratory character, best heard in the lower sternal border, varies with changes in respiration and position
Still’s murmur
A 6-year-old with a continuous murmur, lowpitched sound, best heard in the infraclavicular region, disappears when supine and with gentle pressure on the jugular vein
Venous hum
While having her hair brushed, a 15-year-old girl
develops cold sweats, pallor, and palpitations and loses consciousness for 10 s
Vasovagal syncope
While running, a 15-year-old girl lost
consciousness
Thorough cardiac evaluation and referral to a
cardiologist
The most common cause of sudden cardiac death in an athlete
Hypertrophic cardiomyopathy
Newborn fails hearing screen; EKG shows a very
prolonged QT interval
Jervell and Lange-Nielsen syndrome
A 5-year-old, heart rate is 230 beats/min, chest
discomfort; the heart rate decreases to 80 beats/ min after ice is applied to the face
Supraventricular tachycardia (SVT)
A 15-year-old girl faints while running and has a
positive family history of deafness and sudden
death
Long QT syndrome
What is the definitive treatment for SVT?
Radiofrequency ablation
Child presents with a history of intermittent
tachycardia; EKG shows a short PR interval,
slurred and slow rise of the initial upstroke of QRS (delta wave), widened QRS complex
Wolff–Parkinson–White syndrome (WPW)
Child presents with chest pain, fever, friction rub; EKG shows diffuse ST-segment elevation, had upper respiratory infection 10 days before
Pericarditis
Adolescent diagnosed with influenza presents with fever, tachycardia, edema, and gallop; chest radiograph shows pulmonary edema, cardiomegaly, low-voltage EKG
Myocarditis
An athlete presents with dyspnea while playing;
systolic ejection crescendo-decrescendo murmur best heard at the apex and left sternal border, and radiates to the suprasternal notch; the murmur is louder while standing and with Valsalva maneuver
Hypertrophic cardiomyopathy
A football player presents with chest pain with
exertion and several near syncope episodes during his football game. Next best step?
Restrict from sports then EKG and
echocardiogram
EKG in a 12-day-old shows negative T wave in V6
Left ventricular hypertrophy
A 15-year-old boy with a history of recurrent chest pain during exercise faints and dies while playing basketball; hypertrophic cardiomyopathy ruled out as a cause of death. What is the next likely cause?
Anomalous left coronary artery is most likely
What is the most common organism responsible for infective endocarditis in pediatric patients with or without congenital heart disease?
Staphylococcus aureus
History of repaired VSD with a small residual VSD next to the VSD patch, going in for dental work. Is subacute bacterial endocarditis (SBE) prophylaxis indicated?
Antibiotic prophylaxis
Child with prosthetic mitral valve going for
surgery; is SBE prophylaxis indicated?
Antibiotic prophylaxis
Child with mitral regurgitation and VSD, going in
for dental work. Is SBE prophylaxis indicated?
No antibiotic prophylaxis
Child with a previous history of endocarditis; is
SBE prophylaxis indicated?
Antibiotic prophylaxis
A mildly desaturated child with tetralogy of Fallot going in for dental work; is SBE prophylaxis indicated?
Antibiotic prophylaxis
Tall, peaked T waves in precordial leads indicates
Hyperkalemia
An infant of diabetic mother presents a few hours after birth with jitteriness, hypoglycemia, cyanosis; EKG shows prolonged QT interval
Hypocalcemia
EKG shows sinus tachycardia, widened QRS
complex with an interval greater than 100 ms, in a child who presents with altered mental status after accidentally ingesting grandmother’s medication
Tricyclic antidepressant (TCA) toxicity
EKG shows normal PR intervals and periodic drop in QRS
Type II second degree AV block (Mobitz II)
EKG shows progressive prolongation of PR
interval followed by a drop in QRS
Type I second degree AV block (Mobitz I or
Wenckebach)
A 6-month-old infant with failure to thrive,
diaphoresis, and hepatomegaly. Echocardiogram shows a large VSD. Next best step?
Surgical correction
An asymptomatic adolescent with blood pressure 137/87, all labs normal, renal US and chest radiograph normal. What is the next best step?
Salt restriction in diet
A late complication of an untreated ASD or VSD
that results in desaturation
Eisenmenger syndrome—shunt becomes a right
to left shunt
A 4-year-old boy with physical examination
significant for widely split and fixed S2 and
crescendo-decrescendo systolic ejection murmur heard in the second intercostal space at the upper left sternal border. EKG shows a RSR1 pattern in V1. What is the most likely diagnosis?
Atrial septal defect
A premature infant with a continuous machine-like murmur and bounding pulses
PDA
Which medication is used to close a PDA in a
premature infant?
Indomethacin
What are some common side effects of
indomethacin?
Thrombocytopenia
GI bleeding
Necrotizing enterocolitis
Renal failure
Systolic murmur most commonly heard at the right upper sternal border radiates to the neck and is associated with an ejection click
Aortic stenosis
Most common valve abnormality associated with aortic stenosis
Bicuspid aortic valve
What is the most likely etiology of an early highpitched diastolic murmur associated with bounding pulses in a patient with Marfan syndrome?
Aortic regurgitation
High-pitched holosystolic blowing murmur heard loudest at the apex and radiates to the axilla
Mitral valve regurgitation
What is the most feared complication of Kawasaki disease?
Coronary artery aneurysm
Late crescendo systolic murmur associated with a mid-systolic click, may be seen in adolescents
Mitral valve prolapse
Late diastolic rumbling murmur with an opening
snap heard at the apex
Mitral valve stenosis
A 10-year-old male presents with sharp chest pain; the pain is reproducible on physical exam
Costochondritis
An 8-year-old presents with sharp stabbing nonspecific chest pain at rest that resolves shortly. There are no other symptoms and no past medical history
Reassurance (precordial catch syndrome)
At what ages is lipid screening universally
recommended in the pediatric population?
Once between 9 and 11 and again between 17
and 21
What is the initial management for an obese
adolescent with elevated cholesterol levels?
Diet and lifestyle modifications, and if
cholesterol is still elevated after 6 months, then
start statin
