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Pediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

whta are the critical cyanotic CHD lesions

A
  • hypoplastic left heart syndrome
  • pulmonary atresia
  • TOF
  • TAPVR
  • TGA
  • Tricuspid atresia
  • Truncus arteriosus
  • Neonatal coarctation of the aorta
  • Aortic arch hypoplasia/atresia
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2
Q

When is screening of CCHD is performed in newborns?

A

performed between 24 and 48 hour of life and before discharge in asymptomatic newborns

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3
Q

Examples of cardiac lesions causing left to right shunting//increased volume load

A
  • ASD
  • VSD
  • AVSD
  • PDA
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4
Q

The pathophysiologic common denominator in lesions resulting in increased volume load

A

communication between systemic and pulmonary sides of the circulation

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5
Q

the pathophysiologic common denominator of lesions resulting in increased pressure load

A

obstruction to normal blood flow

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6
Q

most common form of ASD

A

ostium secundum defect

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7
Q

characteristic finding in most patients with an ASD

A

second heart sound (S2) is widely split and fixed during all phases of respiration

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8
Q

most common cardiac malformation, accounts for 25% of CHD

A

Ventricular Septal Defect (VSD)

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9
Q

Most common type of VSD

A

Membranous

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10
Q

characteristic murmur of VSD

A

Loud, harsh or blowing holosystolic murmur

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11
Q

Type of VSD that is more likely to close up to 80% of cases

A

muscular VSDs

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12
Q

long term risk in children with small restrictive VSDs who are asymptomatic

A

Infective endocarditis

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13
Q

2 goals of managing large VSD

A
  • Control the heart failure symptoms
  • prevent development of PVD
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14
Q

PDA is associated with this infection during pregnancy

A

maternal rubella infection

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15
Q

why is PDA common in premature infants?

A

because the smooth muscle in the wall of preterm ductus is less responsove to high PO2, hence less likely to constrict after birth

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16
Q

classic murmur of PDA

A

continuous murmur, “machinery like”

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17
Q

if patient with a large PDA does not undergo ductul closure, what will be the usual complication or consequence?

A

Pulmonary hypertension -> Eisenmenger syndrome

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18
Q

rationale for closure in patients with a small PDA

A

bacterial endarteritis

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19
Q

most common right ventricular outflow obstruction cardiac lesion

A

isolated pulmonary stenosis
— accounts for 7-10% of all CHDs

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20
Q

most common cardiac abnormality in Noonan syndrome

A

Pulmonary stenosis

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21
Q

what is a critical pulmonic stenosis

A

Pulmonic stenosis + PFO
—> leads to cyanosis as a result of right to left shunting

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22
Q

what is critical aortic stenosis

A

severe aortic stenosis in early infancy

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23
Q

where is coarctation of aorta mostly occur?

A

98% of cases occur just below the origin of the left subclavian artery at the origin of the ductus arteriosus (juxtaductal coarctation)

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24
Q

what is Shone complex?

A

Coarctation of the Aorta + Supravalvular mitral ring/Parachute mitral valve +
Subaortic stenosis

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25
Q

development of extensive collateral circulation seen in coarctation of the aorta branches from what arteries?

A

Subclavian
Superior intercostal
Internal mammary

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26
Q

classic sign of coarctation of the aorta

A

disparity in pulsation and BP in the arms and legs

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27
Q

this type of cardiac sound suggest a bicuspid aortic valve

A

systolic ejection click or thrill in the suprasternal notch

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28
Q

a blood pressure higher in the right arm than the left arm suggests involvement of what artery

A

subclavian

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29
Q

this is a common xray finding in children with coarctation of the aorta from pressure erosion by enlarged collateral vessels

A

Notching of the inferior border of the ribs

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30
Q

what condition/s should be suspected in a patient with isolated severe mitral insufficiencuy?

A

Endocarditis or rheumatic fever

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31
Q

expected murmur in mitral insufficiency/regurgitation

A

moderately high pitched, apical blowing holosystolic murmur

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32
Q

MVP is common in these conditions

A
  • Marfan Syndrome
  • Straight back syndrome
  • Pectus Excavatum
  • Scoliosis
  • Ehlers-Danlos Syndrome
  • Osteogenesis imperfecta
  • Pseudoxanthoma elasticum
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33
Q

enumerate the 4 components of Tetralogy of Fallot

A
  • 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)
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34
Q

enumerate the 4 components of Tetralogy of Fallot

A
  • 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)
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35
Q

extreme form of TOF

A

complete obstruction of RV outflow —> Tetralogy + pulmonary atresia

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36
Q

hemodynamic present in acyanotic or “pink” TOF

A

when obstruction to RV outflow is mild to moderate and a balanced shunt is present across the VSD

37
Q

other term for tet spell

A

paroxysmal hypercyanotic attack

38
Q

procedures to be instituted during hypercyanotic attacks

A
  • placement of the infant on the abdomen in the knee-chest position
  • administration of oxygen
  • injection of morphine SQ (max: 0.2 mg/kg)
39
Q

characteristic xray appearance resembling boot shape

A

Tetralogy of Fallot

40
Q

sequelae of extreme polycythemia and dehydration in TOF

A

Cerebral thromboses

41
Q

this medication is given in neonates with marked RVOT obstruction in TOF

A

Prostaglandin E1 (PGE1) at 0.01-0.2 ukm
— potent and specific relaxant of ductal smooth muscle
— cause dilation of the ductus arteriosus

42
Q

Describe Blalock-Taussig shunt

A
  • most common aortopulmonary shunt procedure
  • Gore-Tex conduit anastomosed side to side from the subclavian artery to the homolateral branch of the pulmonary artery
43
Q

complications of Blalock Tausig Shunt

A

Chylothorax
Diaphragmatic paralysis
Horner Syndrome

44
Q

10% of patients with repaired tetralogy are at risk of this life threatening condition

A

ventricular arrhythmias

45
Q

CHD characterized when both aorta and pulmonary artery arise from the right ventricle

A

Double-outlet right ventricle
(DORV)

46
Q

50% of patients with d-TGA have this defect which provides for better mixing

A

VSD

47
Q

True or False: TAPVR is a cyanotic lesion

A

True

48
Q

“snowman” appearance in xray

A

TAPVR

49
Q

most common cause of pulmonary hypertension in 40-55% of children

A

associated with congenital heart disease

50
Q

Known complications of Pulmonary Hypertension

A

Arrythmias
Syncope
Sudden death

51
Q

mean age at diagnosis for pulmonary hypertension

A

7-10 years old

52
Q

Definitive therapy of PH

A

Heart-lung or lung transplantation

53
Q

remain the leading causative agents for endocarditis in pediatric patients

A

Viridans-type streptococci and Stphylococcus aureus

54
Q

causative agent of endocarditis that is more common in patients with no underlying heart disease

A

Staphylococcal endocarditis

55
Q

causative agent of endocarditis after dental procedures

A

Viridans group streptococcal infection

56
Q

causative agent of endocarditis more often seen after lower bowel or genitourinary manipulation

A

Group D enterococci

57
Q

causative agent of endocarditis frequently seen in IV drug users

A

Pseudomonas aeruginosa or Serratia marcescens

58
Q

causative agent of endocarditis common in the presence of an indwelling central venous catheter

A

Coagulase-negative staphylococci

59
Q

factor in CHDs which predispose patient to endocarditis

A

turbulent blood flow in the defect -> traumatizes vascular endothelium, creating substrate for deposition of fibrin and platelets -> formation of nonbacterial thrombotic embolus

60
Q

Skin findings found in IE, which develop late in the disease

A

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

61
Q

What criteria is being used to help in the diagnosis of endocarditis?

A

Duke criteria
- should have fulfilled 2 major criteria or 1 major and 3 minor or 5 minor criteria

62
Q

empical therapy for IE

A

Vancomycin + Gentamicin

63
Q

how long is the treatment for Infective endorcarditis

A

a total of 4-6 weeks of treatment is recommended

64
Q

Enumerate the major and minor criteria in diagnosing IE based on Modified Duke Criteria

A

MAJOR
- Blood culture findings positive for IE: Viridans strep, Staph aureus, HACEK group, community acquired enterococci, microorganism consistent with IE from persistently (+) culture findings
- 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

65
Q

cardiac conditions for which prophylaxis with dental procedures is reasonable associated with highest risk of adverse outcome from IE

A
  • 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
66
Q

most important sequela of ARF

A

Rheumatic involvement of the cardiac valves

67
Q

most often affected cardiac valve in RHD

A

mitral valve

68
Q

cardiac output is determined by?

A

HR x SV

69
Q

most common etiology of Myocarditis in children

A

viral infection

70
Q

standard imaging modality for the diagnosis of Myocarditis

A

Cardiac MRI

71
Q

most common symptom of acute pericarditis

A

chest pain

72
Q

Appears as Erlenmeyer flask or water bottle apperance in xray

A

Pericardial effusion

73
Q

what is Pulsus paradoxus?

A

excessive fall of systolic blood pressure (>10 mmHg) with inspirtion
- if greater than 20 mmHg, it is an indicator of cardiac tamponade

74
Q

most common form of cardiomyopathy in children

A

Dilated cardiomyopathy

75
Q

most common etiology of DCM

A

remains idiopathic

76
Q

These are X-linked cardiomyopathies that account for 5-10% of DCM cases

A

Duchenne and Becker muscular dystrophies

77
Q

chemo drug that can cause acute inflammatory myocardial injury, and a cumulative dose exceeding 550 mg/m2 can result to DCM

A

Doxorubicin

78
Q

2D echo findings in DCM

A

LV enlargement
Decreased ventricular contractility
occasional globular (remodeled) LV contour

79
Q

This condition is characterized by the presence of increased LV wall thickness in the absence of structural heart disease or hypertension

A

Hypertrophic cardiomyopathy

80
Q

treatment of choice for patients with Restrictive cardiomyopathy

A

Cardiac transplantation

81
Q

medical treatment of choice for SVTs

A

Adenosine (0.1 mg/kg, max dose 6 mg)

82
Q

Initial drug of choice for Ventricular tachycardia

A

IV Amiodarone, Lidocaine or Procainamide

83
Q

Aside from SLE, what is the other condition that can cause congenital complete AV block?

A

Sjögren Syndrome

84
Q

Known complication of myocardial abscess secondary to endocarditis

A

Complete AV block

85
Q

This type of AV block is characterized by prolonged PR interval but all atrial impulses are conducted to the ventricle

A

First degree AV block

86
Q

AV block characterized by no progressive conduction delay or subsequent shortening of the PR interval after a blocked beat

A

Mobitz Type II (Second degree AV block)

87
Q

this type of AV block is characterized by PR interval increasing progressively until a P wave is not conduction, “dropped beat”

A

Type I (Second degree AV block)
- Wenckebach type

88
Q

this type of AV block is characterized by PR interval increasing progressively until a P wave is not conduction, “dropped beat”

A

Type I (Second degree AV block)
- Wenckebach type

Pediatrics (17 decks)

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