Cardiology Flashcards
what are the critical cyanotic CHD lesions
- hypoplastic left heart syndrome
- pulmonary atresia
- TOF
- TAPVR
- TGA
- Tricuspid atresia
- Truncus arteriosus
- Neonatal coarctation of the aorta
- Aortic arch hypoplasia/atresia
When is screening of CCHD is performed in newborns?
performed between 24 and 48 hour of life and before discharge in asymptomatic newborns
Examples of cardiac lesions causing left to right shunting//increased volume load
- ASD
- VSD
- AVSD
- PDA
The pathophysiologic common denominator in lesions resulting in increased volume load
communication between systemic and pulmonary sides of the circulation
the pathophysiologic common denominator of lesions resulting in increased pressure load
obstruction to normal blood flow
most common form of ASD
ostium secundum defect
characteristic finding in most patients with an ASD
second heart sound (S2) is widely split and fixed during all phases of respiration
most common cardiac malformation, accounts for 25% of CHD
Ventricular Septal Defect (VSD)
Most common type of VSD
Membranous
characteristic murmur of VSD
Loud, harsh or blowing holosystolic murmur
Type of VSD that is more likely to close up to 80% of cases
muscular VSDs
long term risk in children with small restrictive VSDs who are asymptomatic
Infective endocarditis
2 goals of managing large VSD
- Control the heart failure symptoms
- prevent development of PVD
PDA is associated with this infection during pregnancy
maternal rubella infection
why is PDA common in premature infants?
because the smooth muscle in the wall of preterm ductus is less responsive to high PO2, hence less likely to constrict after birth
classic murmur of PDA
continuous murmur, “machinery like”
if patient with a large PDA does not undergo ductul closure, what will be the usual complication or consequence?
Pulmonary hypertension -> Eisenmenger syndrome
rationale for closure in patients with a small PDA
prevention of bacterial endarteritis
most common right ventricular outflow obstruction cardiac lesion
isolated pulmonary stenosis
— accounts for 7-10% of all CHDs
most common cardiac abnormality in Noonan syndrome
Pulmonary stenosis
what is a critical pulmonic stenosis
Pulmonic stenosis + PFO
—> leads to cyanosis as a result of right to left shunting
what is critical aortic stenosis
severe aortic stenosis in early infancy
where is coarctation of aorta mostly occur?
98% of cases occur just below the origin of the left subclavian artery at the origin of the ductus arteriosus (juxtaductal coarctation)
what is Shone complex?
Coarctation of the Aorta + Supravalvular mitral ring/Parachute mitral valve + Subaortic stenosis
development of extensive collateral circulation seen in coarctation of the aorta branches from what arteries?
Subclavian
Superior intercostal
Internal mammary
classic sign of coarctation of the aorta
disparity in pulsation and BP in the arms and legs
this type of cardiac sound suggest a bicuspid aortic valve
systolic ejection click or thrill in the suprasternal notch
a blood pressure higher in the right arm than the left arm suggests involvement of what artery
subclavian
this is a common xray finding in children with coarctation of the aorta from pressure erosion by enlarged collateral vessels
Notching of the inferior border of the ribs
what condition/s should be suspected in a patient with isolated severe mitral insufficiency?
Endocarditis or rheumatic fever
expected murmur in mitral insufficiency/regurgitation
moderately high pitched, apical blowing holosystolic murmur
MVP is common in these conditions
- Marfan Syndrome
- Straight back syndrome
- Pectus Excavatum
- Scoliosis
- Ehlers-Danlos Syndrome
- Osteogenesis imperfecta
- Pseudoxanthoma elasticum
enumerate the 4 components of Tetralogy of Fallot
- obstruction to right ventricular (RV) outflow (Pulmonary stenosis)
- malalignment type of VSD
- dextroposition of the aorta so that is overrides the ventricular septum
- Right ventricular hypertrophy (RVH)
enumerate the 4 components of Tetralogy of Fallot
- obstruction to right ventricular (RV) outflow (Pulmonary stenosis)
- malalignment type of VSD
- dextroposition of the aorta so that is overrides the ventricular septum
- Right ventricular hypertrophy (RVH)
extreme form of TOF
complete obstruction of RV outflow —> Tetralogy + pulmonary atresia
hemodynamic present in acyanotic or “pink” TOF
when obstruction to RV outflow is mild to moderate and a balanced shunt is present across the VSD
other term for tet spell
paroxysmal hypercyanotic attack
procedures to be instituted during hypercyanotic attacks
- placement of the infant on the abdomen in the knee-chest position
- administration of oxygen
- injection of morphine SQ (max: 0.2 mg/kg)
characteristic xray appearance resembling boot shape
Tetralogy of Fallot
sequelae of extreme polycythemia and dehydration in TOF
Cerebral thromboses
this medication is given in neonates with marked RVOT obstruction in TOF
Prostaglandin E1 (PGE1) at 0.01-0.2 ukm
— potent and specific relaxant of ductal smooth muscle
— cause dilation of the ductus arteriosus
Describe Blalock-Taussig shunt
- most common aortopulmonary shunt procedure
- Gore-Tex conduit anastomosed side to side from the subclavian artery to the homolateral branch of the pulmonary artery
complications of Blalock Tausig Shunt
Chylothorax
Diaphragmatic paralysis
Horner Syndrome
10% of patients with repaired tetralogy are at risk of this life threatening condition
ventricular arrhythmias
CHD characterized when both aorta and pulmonary artery arise from the right ventricle
Double-outlet right ventricle
(DORV)
50% of patients with d-TGA have this defect which provides for better mixing
VSD
True or False: TAPVR is a cyanotic lesion
True
“snowman” appearance in xray
TAPVR
most common cause of pulmonary hypertension in 40-55% of children
associated with congenital heart disease
Known complications of Pulmonary Hypertension
Arrythmias
Syncope
Sudden death
mean age at diagnosis for pulmonary hypertension
7-10 years old
Definitive therapy of PH
Heart-lung or lung transplantation
remain the leading causative agents for endocarditis in pediatric patients
Viridans-type streptococci and Staphylococcus aureus
causative agent of endocarditis that is more common in patients with no underlying heart disease
Staphylococcal endocarditis
causative agent of endocarditis after dental procedures
Viridans group streptococcal infection
causative agent of endocarditis more often seen after lower bowel or genitourinary manipulation
Group D enterococci
causative agent of endocarditis frequently seen in IV drug users
Pseudomonas aeruginosa or Serratia marcescens
causative agent of endocarditis common in the presence of an indwelling central venous catheter
Coagulase-negative staphylococci
factor in CHDs which predispose patient to endocarditis
turbulent blood flow in the defect -> traumatizes vascular endothelium, creating substrate for deposition of fibrin and platelets -> formation of nonbacterial thrombotic embolus
Skin findings found in IE, which develop late in the disease
Osler Nodes - tender, pea-sized intradermal nodules in the pads of the fingers and toes
Janeway Lesions - painless, small erythematous or hemorrhagic lesions on the palms and soles
Splinter hemorrhages - linear lesions beneath the nails
What criteria is being used to help in the diagnosis of endocarditis?
Duke criteria
- should have fulfilled 2 major criteria or 1 major and 3 minor or 5 minor criteria
empical therapy for IE
Vancomycin + Gentamicin
how long is the treatment for Infective endorcarditis
a total of 4-6 weeks of treatment is recommended
Enumerate the major and minor criteria in diagnosing IE based on Modified Duke Criteria
MAJOR
- Blood culture findings positive for IE
> Typical microorganisms from 2 separate blood cultures: Viridans strep, Strep gallolyticus, Staph aureus, HACEK group, community acquired enterococci
> Microorganism consistent with IE from persistently (+) culture findings: >2 positive culture findings drawn >12 hr apart, 3 or most of >4 separate culture findings of blood, single positive blood culture for Coxiella burnetii or anti-phase I IgG titer >1:800
- Evidence of endocardial involvement
> Oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets or on implanted material in the abscence of an alternative anatomic explanation or
> Abscess or
> New partial dehiscence of prosthetic valve
New valvular regurgitation; worsening or changing of preexisting murmur not sufficient
MINOR
- Predisposition, predisposing heart condition or IV drug use
- Fever: Temp >38
- Vascular phenomena, major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, ICH, conjunctival hemorrhages, Janeway lesions
- Immunologic phenomena: GN, Osler nodes, Roth spots, RF
- Microbiologic evidence: (+) blood culture finding but does not meet a major criterion or serologic evidence of active infection with organism consistent with IE
Clinical criteria: 2 Maj / 1 Maj + 3 Min / 5 Min
Possible IE: 1 Maj + 1 Min / 3 Min
cardiac conditions for which prophylaxis with dental procedures is reasonable associated with highest risk of adverse outcome from IE
- prosthetic cardiac valve/prosthetic material used for cardiac valve repair
- previous infective endocarditis
- certain CHDs
> unrepaired cyanotic CHD
> completely repaired CHD with prosthetic material or device
> repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device
> Cardiac transplantation recipients who develop cardiac valvulopathy
most important sequela of ARF
Rheumatic involvement of the cardiac valves
most often affected cardiac valve in RHD
mitral valve
cardiac output is determined by?
HR (heart rate) x SV (stroke volume)
most common etiology of Myocarditis in children
viral infection
standard imaging modality for the diagnosis of Myocarditis
Cardiac MRI
most common symptom of acute pericarditis
chest pain
Appears as Erlenmeyer flask or water bottle appearance in xray
Pericardial effusion
what is Pulsus paradoxus?
excessive fall of systolic blood pressure (>10 mmHg) with inspiration
- if greater than 20 mmHg, it is an indicator of cardiac tamponade
most common form of cardiomyopathy in children
Dilated cardiomyopathy
most common etiology of DCM
remains idiopathic
These are X-linked cardiomyopathies that account for 5-10% of DCM cases
Duchenne and Becker muscular dystrophies
chemo drug that can cause acute inflammatory myocardial injury, and a cumulative dose exceeding 550 mg/m2 can result to DCM
Doxorubicin
2D echo findings in DCM
LV enlargement
Decreased ventricular contractility
occasional globular (remodeled) LV contour
This condition is characterized by the presence of increased LV wall thickness in the absence of structural heart disease or hypertension
Hypertrophic cardiomyopathy
treatment of choice for patients with Restrictive cardiomyopathy
Cardiac transplantation
medical treatment of choice for SVTs
Adenosine (0.1 mg/kg, max dose 6 mg)
Initial drug of choice for Ventricular tachycardia
IV Amiodarone, Lidocaine or Procainamide
Aside from SLE, what is the other condition that can cause congenital complete AV block?
Sjögren Syndrome
Known complication of myocardial abscess secondary to endocarditis
Complete AV block
This type of AV block is characterized by prolonged PR interval but all atrial impulses are conducted to the ventricle
First degree AV block
AV block characterized by no progressive conduction delay or subsequent shortening of the PR interval after a blocked beat
Mobitz Type II (Second degree AV block)
this type of AV block is characterized by PR interval increasing progressively until a P wave is not conduction, “dropped beat”
Type I (Second degree AV block)
- Wenckebach type
this type of AV block is characterized by PR interval increasing progressively until a P wave is not conducted, “dropped beat”
Type I (Second degree AV block)
- Wenckebach type
current screening recommendation for healthy children for BP monitoring start at what age?
3 years old, to be done annually
These children are at higher risk and should have BP monitoring at every healthcare encounter
Renal or urologic disease
History of prematurity or LBW
Solid-organ transplant recipients
Oncologic disease
Systemic illnesses associated with hypertension
Increased ICP
Cardiac disease
continuous murmur often described as “machinery-like” and usually heard at the left upper sternal border is seen in this cardiac condition
Patent Ductus Arteriosus
30% of patients with Turner Syndrome has this cardiac defection
Coarctation of the Aorta
