Cardiology Flashcards
(114 cards)
1
Q
Chest pain is a frequent pediatric complaint & is most often related to what?
A
musculoskeletal in origin
2
Q
CP & older children are most likely to have what type of reason for it?
A
psychogenic
3
Q
younger CH are more likely to have CP d/t what?
A
respiratory dz: cough, asthma, pneumonia
4
Q
etiologies of CP
A
MS idiopathic psychogenic/psychiatric respiratory d/o's GI cardiac breast pulmonary vascular d/o's toxic exposure
5
Q
approach to CP
A
acute vs. chronic pleuritic vs. non-pleuritic co-morbid risk factors herald signs of serious causes r/o severe distress
6
Q
heral signs of serious causes
A
CP w/ exertion
acute pain that is acutely worsening
acute onset of fever w/ CP
findings on hx or exam referable to cardiac or respiratory systmes
7
Q
chest tenderness is very reassuring against what?
A
cardiac source
8
Q
initial workup for CP usually starts w/ what?
A
EKG
chest plain film
9
Q
MS sources of CP
A
chest tenderness w/ or w/o mvnt overuse injury/strain of chest wall m. direct trauma slipping rib syndrome precordial catch (Texidor's twinge) costochondritis
10
Q
direct trauma & CP
A
rib fracture
contusion of chest wall
11
Q
slipping rib syndrome
A
involves 8th, 9th, 10th ribs slipping & impinging on intercostal n.
12
Q
precordial catch (Texidor’s twinge)
A
sharp pain at the left sternal border, lasts < 3 mins
13
Q
costochondritis
A
pain at sites of costal cartilage reproduced by eliciting tenderness over the costochondral junctions or with AP compression of the chest
14
Q
pleurisy
A
involves pleuritic CP
infectious
15
Q
respiratory source of CP
A
illnesses w/ persistent/forceful cough pneumonia +/- pleural effusion asthma +/- pneumomediastinum spontaneous pneumothorax pleurisy
16
Q
some causes of spontaneous pneumothorax
A
asthma
cystic fibrosis
Marfan’s syndrome
17
Q
pulmonary vascular d/o’s as sources of CP
A
pulmonary embolism
pulmonary HTN
acute chest syndrome
18
Q
pulmonary embolism
A
rare in CH but can occur in those with risk factors
classic presentation= acute onset of pleuritic CP, dyspnea, hypoxia- presentation not always classic
19
Q
risk factors for pulmonary embolism in CH
A
oral contraceptives
termination of pregnancy
trauma, particularly of lower extremities
20
Q
pulmonary HTN
A
pain typically related to underlying heart or lung dz
21
Q
acute chest syndrome
A
chest source crisis in pts w/ sickle cell dz
22
Q
psychogenic source of CP
A
anxiety d/o or conversion d/o
hyperventilation
23
Q
anxiety d/o or conversion d/o
A
relative or friend w/ cardiac dz
FH of depression, somatization
triggered by stress
24
Q
GI source of CP
A
reflux esophagitis
intrathoracic FB
pill esophagitis
25
reflux esophagitis sx's
burning, substernal pain- worse w/ reclining or certain pain
may be assoc. w/ esophageal spasm (mimicks angina)
severe cases complicated by esophageal candidiasis
26
mammary source of CP
females: mastitis, thelarche, pregnancy, fibrocystic dz
males: gynecomastia
27
cardiac source of CP
rare cause of CP in CH
co-morbid risk factors raise likelihood of cardiac-source CP
cardiac ischemia
myocardial infarction
mitral valve prolapse
pericarditis & myocarditis
hypertrophic obstructive cardiomyopathy (HOCM)
28
what are some co-morbid risk factors that raise the likelihood of cardiac-source CP
DM
Kawasaki's dz
chronic anemia
stimulant use- cocaine, amphetamines
29
cardiac ischemia may result from
anomalous coronary arteries
left ventricular outflow tract obstruction (LVOTO)- coarctation of the aorta, aortic dissection
cardiac infxn
embolic phenomena- endocarditis, aneurysm d/t Kawasaki dz
medium vessel vasculitis
pulmonary HTN, valvular dz (congenita or acquired), cardiomyopathy, subaortic stenosis, arrhythmia
30
myocardial infarction
rare in CH
| herald sign- pain w/ exertion
31
what is a herald sign
pain w/ exertion
32
hypertrophic obstructive cardiomyopathy (HOCM)
autosomal dominant inheritance
systolic murmur worsening w/ change from lying to standing or w/ squat/Valsalva (procedures that reduce blood return to ventricles-reduced preload)
pain w/ exertion
33
pericarditis
```
fever
respiratory distress
sharp, stabbing substernal CP
often unable to lie flat (pain improves w/ sitting up or leaning forward)
friction rub, distant heart sounds
jugular venous distension
pulsus paradoxus
```
34
what are you looking for in pre-sports physicals?
hypertrophic obstructive cardiomyopathy (HOCM)
35
if a murmur worsens with reduced preload, most likely d/t what?
hypertrophic obstructive cardiomyopathy (HOCM)
36
myocarditis
```
pain develops over a few days
fever
systemic symptoms (vomiting, lightheadedness, etc.)
gallop rhythm (S3, S4 sounds)
tachycardia
orthostatic HoTN
CXR- cardiomegaly
abnormal EKG
```
37
what is the MC pediatric dysrhythmia?
supraventricular tachycardia
38
pediatric arrhythmias
sinus arrhythmia can be very pronounced in CH- HR slows w/ expiration
39
mechanisms of pediatric arrhythmias include
intra-atrial reentry
AV nodal reentrant tachycardia
AV accessory conduction- Wolff-Parkinson-White syndrome, slurred upstroke of the QRS (delta wave)
40
murmur description
intensity (grade I-VI)
quality
timing- relationship to cardiac cycle, duration
location
variation w/ position- increase in intensity w/ lying to standing or Valsalva in generally concerning for HOCM
41
intensity
```
how loud it is
I- can barely hear it w/ stethoscope
II
III
IV
V
VI- can hear w/o stethoscope
```
42
quality
harsh & soft
43
timing
holosystolic- you don't hear S2
| midsystolic/earlysystolic- you hear the heart beat in between
44
location
will localize to specific valves
45
all murmurs that come from the heart that are normal are?
systolic murmurs
46
SEM
systolic ejection murmur
47
systolic murmurs
SEM
| Pansystolic
48
SEM fall into 2 categories
normal & abnormal
49
normal SEM
Still's
Pulm eject
carotid bruit
50
abnormal SEM
```
aortic stenosis
pulmonic stenosis
coarctaion
ASD
HOCM
```
51
pansystolic murmurs
VSD
MR
TR
52
diastolic murmurs are always
abnormal (except venous hum)
53
continuous murmurs
abnormal &
| PDA, AP window, AVM
54
innocent is synonymous w/ what terms?
functional
benign
flow
55
innocent murmurs
```
newborn murmur
peripheral pulmonic stenosis
Still's (vibratory) murmur
adolescent ejection murmur
venous hum
carotid bruit
```
56
all innocent murmurs are what?
systolic ejection murmurs
57
all vibratory murmurs are?
innocent
58
newborn murmur
heard during 1st few days of life (neonate)
grade I-II
soft, short, vibratory (newborn Still's)
LLSB (lower/upper easy to distinguish in neonates)
w/o radiation
59
peripheral pulmonic stenosis (PPS)
```
caused by the change in direction of the branches of the pulmonary aretery
grade I-II
soft, short, high pitched
loudest over LUSB
radiates to back & axillae
```
60
murmur best heard in LLSB
newborn murmur
61
which murmur is loudest over LUSB?
peripheral pulmonic stenosis
62
Still's (vibratory) murmur
```
heard from age 2+
grade I-III
musical, vibratory, short
LLSB to apex
loudest when pt is in supine position; diminishes when pt sits or stands
```
63
adolescent ejection murmur
```
heard from age 8+
grade I-II in intensity
soft
well localized to the LUSB
louder when pt is supine
```
64
venous hum
heard after age 2
continuous musical hum
located at the upper right & left sternal borders (usually louder on the right)
intensity changes w/ turning of the neck
65
carotid bruit
```
any age-more common in older child & adolescent
grade II-III
long, systolic ejection murmur
heard in right supraclavicular area
radiates to neck
```
66
systemic (left) & pulmonary (right) circuits generally operate in ?
series
67
a shunt implies...
a connection that allows communication bet. the 2 systems
68
shunting proceeds down__________in pressure
gradient
69
how long do newborns have high pulmonary pressure (high pulmonary resistance) for
until 2-8 wks of life
| left-to-right shunts commonly become evident in this period
70
right to left shunts cause?
cyanosis
71
mixing lesions my have either (or both) directions of______present
shunt
72
acyanotic congenital heart dz
ASD, VSD (25% of all CHD), PDA
semilunar valvular defects
coarctation of the aorta
73
ASD or PFO (patent foramen ovale) places pts at risk for what?
systemic embolism & altitude sickness
74
aortic stenosis & pulmonic stenosis are
uncommon
| AS 5% of all CHD, PS 10% of all CHD
75
AS & PS at risk for
endocarditis
76
small VSD
80-85% of VSDs
asymptomatic
generally close on own w/o surgery
77
moderate VSD
may shunt left-to-right
or pressures equal on right & left creates situation of no flow across VSD (no pulmonary HTN, no CHF)
serially monitored by cardiologist
78
large VSD w/ nml pulmonary vascular resistance
left-to-right shunting as pulmonary vascular resistance naturally decreases (2-8 wks of life)
infant develops CHF- FTT, difficulty feeding, labored breathing/pulmonary edema
79
Eisenmenger's Syndrome
an untreated large VSD which causes pulmonary overcirculation-->pulmonary HTN
nml left2right shunt reverse to right2left shunt as pulmonary system pressures surpass systemic pressures
prolonged cyanosis
80
prolonged cyanosis can lead to
organ & vascular damage
platelet dysfunction
treatable only w/ heart transplant
81
coarctation of the aorta is d/t
main artery to body is stenotic or interrupted
82
coarctation of the aorta causes what
upper extremity HTN & reduced flow to abdominal organs & lower extremities
83
newborns screened for femoral pulses to check for
coarctation of the aorta
| suspicion prompts 4 extremity BP & O2 saturation measurements
84
mild cases of coarctation of the aorta may have long term growth problems such as
aortic valve abnormalities audible on exam
| may have chronic leg discomfort or lower extremity wasting
85
in non-mild cases_________needs to be kept open to ensure survival
PDA
| if PDA closes, shock & acidosis ensue rapidly
86
cyanotic congenital heart dz
tetralogy of Fallot
| not presented: tricuspid atresia, truncus arteriosus, TGA, TAPVR, hypoplastic left heart
87
cyanotic CHD is separated into
lesions w/ obstructive lesions leading to nml pulmonary blood flow
lesions w/ increased pulmonary blood flow
88
prolonged cyanosis leads to polycythemia assoc. w/ cyanotic CHD
enables easier visual recognition of cyanosis
89
five MC cyanotic CHD
```
tetralogy of Fallot
tricuspid atresia
transposition of the great arteries
truncus arteriosus
total anomalous pulmonary venous return
```
90
tetralogy of Fallot caused by what?
misplaced migration of neural crest to form the supracristal septum
91
rheumatic fever follows a previous infection w/
S. pyogenes (GAbetaHS)
| rate in untreated is approx. 3%
92
rheumatic fever typically occurs between ages?
5-15yo
93
pathophys of rheumatic fever
sensitization of B lymphocytes
formation of anti-streptococcal Ab's
formation of immune complexes
myocardial & valvular inflammatory response
94
four components to defect of tetralogy of Fallot
ventricular septal defect
pulmonary stenosis
right ventricular hypertrophy
overriding aorta- sometimes w/ dextroposition of aorta
95
child may be pink with tetralogy of Fallot if?
pulmonic stenoisis mild & VSD shunts left to right
96
what is a "tet spell"
pt grows cyanotic, progressively worse w/ age- infants become agitated, tachypneic & have difficulty feeding, toddlers may squat to resolve Tet spell
97
what type of murmur will you hear in tetralogy of Fallot
long systolic ejection murmur (from PS)
98
classic CXR appearance of tetralogy of Fallot
boot shaped heart
99
when is tetralogy of Fallot repaired?
surgically repaired in infancy- often allowed to grow for a few months before repair
100
major criteria for rheumatic fever
JCNES criteria
2 signify dz
```
JOINTS-
CARDITIS
NODULES
ERYTHEMA marginatum
SYDENHAM'S chorea
```
101
Joints
migratory polyarthritis
| typically large joints
102
carditis
myocarditis
pericarditis
valvular dz
indolent carditis can be a single criterion defining dz
103
nodules
subcutaneous
| extensor surfaces of extremities
104
erythema marginatum
can be locally exacerbated by heat
| pink-red macules grow, then coalesce into serpiginious long patches
105
Sydenham's chorea
w/ or w/o psychiatric dz
| may define dz as a single criterion
106
minor criteria for rheumatic fever
```
1 major + 2 minor---> signifies dz
polyarthralgia
fever
previous rheumatic fever
elevated ESR, CRP, WBC
prolonged PR interval
supportive serology of previous infxn
```
107
what is the best test for looking for previous rheumatic fever infxn
anti-streptolysin O is the best test
anti-DNAase B & streptozyme also used
108
rheumatic fever tx
Abx- short term to tx indolent infxn, long term to prevent recurrence (often every 3-4 wks for life)
aspirin for anti-inflammatory effects (sometimes corticosteroids necessary)
supportive (cardiac meds- digoxin, diuretics; endocarditis prophylaxis for procedures
109
infective endocarditis
greatest risk is to those w/ preexisting heart dz or cardiac foreign material
may be acute/subacute
110
causes of infective endocarditis
viridans streptococci
S. aureus
less common- enterococci, HACEK organisms (fastidious gram negative rods)
111
S&S of infective endocarditis
```
fever
CP
heart failure sx's- fatigue, tachypnea, DOE
changing murmur
petechiae & embolic phenomena
splenomegaly +/- hepatomegaly
arthritis
wt loss ( subacute/ chronic)
bacteremia
hematuria
markedly elevated inflammatory markers
```
112
tx for infective endocarditis
long term Abx- directed therapy based on cultures
surgical excision or valve repair sometimes warranted
supportive care for sequelae- CHF
113
preventing endocarditis
cardiac risk factors that are often indications for prophylaxis- prior hx of infective endocarditis, any valvulopathy, prosthetic heart valves, unrepaired cyanotic CHD, repaired CHD w/ prosthetic material, device or venous pacer wires
114
endocarditis prevention dependent on type of procedure
dental/oral or upper respiratory tract- amoxicillin
GU/GI procedures- amoxicillin for enterococcal coverage, aminoglycoside for gram neg. coverage
procedures that involved infected tissues- clindamycin or vancomycin to cover MRSA
