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Peds-Final > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Chest pain is a frequent pediatric complaint & is most often related to what?

A

musculoskeletal in origin

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2
Q

CP & older children are most likely to have what type of reason for it?

A

psychogenic

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3
Q

younger CH are more likely to have CP d/t what?

A

respiratory dz: cough, asthma, pneumonia

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4
Q

etiologies of CP

A 
MS
idiopathic
psychogenic/psychiatric
respiratory d/o's
GI
cardiac
breast
pulmonary vascular d/o's
toxic exposure
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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
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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

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7
Q

chest tenderness is very reassuring against what?

A

cardiac source

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8
Q

initial workup for CP usually starts w/ what?

A

EKG

chest plain film

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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
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10
Q

direct trauma & CP

A

rib fracture

contusion of chest wall

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11
Q

slipping rib syndrome

A

involves 8th, 9th, 10th ribs slipping & impinging on intercostal n.

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12
Q

precordial catch (Texidor’s twinge)

A

sharp pain at the left sternal border, lasts < 3 mins

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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

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14
Q

pleurisy

A

involves pleuritic CP

infectious

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15
Q

respiratory source of CP

A 
illnesses w/ persistent/forceful cough
pneumonia +/- pleural effusion
asthma +/- pneumomediastinum
spontaneous pneumothorax
pleurisy
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16
Q

some causes of spontaneous pneumothorax

A

asthma
cystic fibrosis
Marfan’s syndrome

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17
Q

pulmonary vascular d/o’s as sources of CP

A

pulmonary embolism
pulmonary HTN
acute chest syndrome

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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

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19
Q

risk factors for pulmonary embolism in CH

A

oral contraceptives
termination of pregnancy
trauma, particularly of lower extremities

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20
Q

pulmonary HTN

A

pain typically related to underlying heart or lung dz

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21
Q

acute chest syndrome

A

chest source crisis in pts w/ sickle cell dz

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22
Q

psychogenic source of CP

A

anxiety d/o or conversion d/o

hyperventilation

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23
Q

anxiety d/o or conversion d/o

A

relative or friend w/ cardiac dz
FH of depression, somatization
triggered by stress

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24
Q

GI source of CP

A

reflux esophagitis
intrathoracic FB
pill esophagitis

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25
Q

reflux esophagitis sx’s

A

burning, substernal pain- worse w/ reclining or certain pain
may be assoc. w/ esophageal spasm (mimicks angina)
severe cases complicated by esophageal candidiasis

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26
Q

mammary source of CP

A

females: mastitis, thelarche, pregnancy, fibrocystic dz
males: gynecomastia

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27
Q

cardiac source of CP

A

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)

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28
Q

what are some co-morbid risk factors that raise the likelihood of cardiac-source CP

A

DM
Kawasaki’s dz
chronic anemia
stimulant use- cocaine, amphetamines

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29
Q

cardiac ischemia may result from

A

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

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30
Q

myocardial infarction

A

rare in CH

herald sign- pain w/ exertion

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31
Q

what is a herald sign

A

pain w/ exertion

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32
Q

hypertrophic obstructive cardiomyopathy (HOCM)

A

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

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33
Q

pericarditis

A 
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
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34
Q

what are you looking for in pre-sports physicals?

A

hypertrophic obstructive cardiomyopathy (HOCM)

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35
Q

if a murmur worsens with reduced preload, most likely d/t what?

A

hypertrophic obstructive cardiomyopathy (HOCM)

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36
Q

myocarditis

A 
pain develops over a few days
fever
systemic symptoms (vomiting, lightheadedness, etc.)
gallop rhythm (S3, S4 sounds)
tachycardia
orthostatic HoTN
CXR- cardiomegaly
abnormal EKG
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37
Q

what is the MC pediatric dysrhythmia?

A

supraventricular tachycardia

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38
Q

pediatric arrhythmias

A

sinus arrhythmia can be very pronounced in CH- HR slows w/ expiration

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39
Q

mechanisms of pediatric arrhythmias include

A

intra-atrial reentry
AV nodal reentrant tachycardia
AV accessory conduction- Wolff-Parkinson-White syndrome, slurred upstroke of the QRS (delta wave)

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40
Q

murmur description

A

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

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41
Q

intensity

A 
how loud it is
I- can barely hear it w/ stethoscope
II
III
IV
V
VI- can hear w/o stethoscope
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42
Q

quality

A

harsh & soft

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43
Q

timing

A

holosystolic- you don’t hear S2

midsystolic/earlysystolic- you hear the heart beat in between

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44
Q

location

A

will localize to specific valves

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45
Q

all murmurs that come from the heart that are normal are?

A

systolic murmurs

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46
Q

SEM

A

systolic ejection murmur

47
Q

systolic murmurs

A

SEM

Pansystolic

48
Q

SEM fall into 2 categories

A

normal & abnormal

49
Q

normal SEM

A

Still’s
Pulm eject
carotid bruit

50
Q

abnormal SEM

A 
aortic stenosis
pulmonic stenosis
coarctaion
ASD
HOCM
51
Q

pansystolic murmurs

A

VSD
MR
TR

52
Q

diastolic murmurs are always

A

abnormal (except venous hum)

53
Q

continuous murmurs

A

abnormal &

PDA, AP window, AVM

54
Q

innocent is synonymous w/ what terms?

A

functional
benign
flow

55
Q

innocent murmurs

A 
newborn murmur
peripheral pulmonic stenosis
Still's (vibratory) murmur
adolescent ejection murmur
venous hum
carotid bruit
56
Q

all innocent murmurs are what?

A

systolic ejection murmurs

57
Q

all vibratory murmurs are?

A

innocent

58
Q

newborn murmur

A

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
Q

peripheral pulmonic stenosis (PPS)

A 
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
Q

murmur best heard in LLSB

A

newborn murmur

61
Q

which murmur is loudest over LUSB?

A

peripheral pulmonic stenosis

62
Q

Still’s (vibratory) murmur

A 
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
Q

adolescent ejection murmur

A 
heard from age 8+
grade I-II in intensity
soft
well localized to the LUSB
louder when pt is supine
64
Q

venous hum

A

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
Q

carotid bruit

A 
any age-more common in older child & adolescent
grade II-III
long, systolic ejection murmur
heard in right supraclavicular area
radiates to neck
66
Q

systemic (left) & pulmonary (right) circuits generally operate in ?

A

series

67
Q

a shunt implies…

A

a connection that allows communication bet. the 2 systems

68
Q

shunting proceeds down__________in pressure

A

gradient

69
Q

how long do newborns have high pulmonary pressure (high pulmonary resistance) for

A

until 2-8 wks of life

left-to-right shunts commonly become evident in this period

70
Q

right to left shunts cause?

A

cyanosis

71
Q

mixing lesions my have either (or both) directions of______present

A

shunt

72
Q

acyanotic congenital heart dz

A

ASD, VSD (25% of all CHD), PDA
semilunar valvular defects
coarctation of the aorta

73
Q

ASD or PFO (patent foramen ovale) places pts at risk for what?

A

systemic embolism & altitude sickness

74
Q

aortic stenosis & pulmonic stenosis are

A

uncommon

AS 5% of all CHD, PS 10% of all CHD

75
Q

AS & PS at risk for

A

endocarditis

76
Q

small VSD

A

80-85% of VSDs
asymptomatic
generally close on own w/o surgery

77
Q

moderate VSD

A

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
Q

large VSD w/ nml pulmonary vascular resistance

A

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
Q

Eisenmenger’s Syndrome

A

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
Q

prolonged cyanosis can lead to

A

organ & vascular damage
platelet dysfunction
treatable only w/ heart transplant

81
Q

coarctation of the aorta is d/t

A

main artery to body is stenotic or interrupted

82
Q

coarctation of the aorta causes what

A

upper extremity HTN & reduced flow to abdominal organs & lower extremities

83
Q

newborns screened for femoral pulses to check for

A

coarctation of the aorta

suspicion prompts 4 extremity BP & O2 saturation measurements

84
Q

mild cases of coarctation of the aorta may have long term growth problems such as

A

aortic valve abnormalities audible on exam

may have chronic leg discomfort or lower extremity wasting

85
Q

in non-mild cases_________needs to be kept open to ensure survival

A

PDA

if PDA closes, shock & acidosis ensue rapidly

86
Q

cyanotic congenital heart dz

A

tetralogy of Fallot

not presented: tricuspid atresia, truncus arteriosus, TGA, TAPVR, hypoplastic left heart

87
Q

cyanotic CHD is separated into

A

lesions w/ obstructive lesions leading to nml pulmonary blood flow
lesions w/ increased pulmonary blood flow

88
Q

prolonged cyanosis leads to polycythemia assoc. w/ cyanotic CHD

A

enables easier visual recognition of cyanosis

89
Q

five MC cyanotic CHD

A 
tetralogy of Fallot
tricuspid atresia
transposition of the great arteries
truncus arteriosus
total anomalous pulmonary venous return
90
Q

tetralogy of Fallot caused by what?

A

misplaced migration of neural crest to form the supracristal septum

91
Q

rheumatic fever follows a previous infection w/

A

S. pyogenes (GAbetaHS)

rate in untreated is approx. 3%

92
Q

rheumatic fever typically occurs between ages?

A

5-15yo

93
Q

pathophys of rheumatic fever

A

sensitization of B lymphocytes
formation of anti-streptococcal Ab’s
formation of immune complexes
myocardial & valvular inflammatory response

94
Q

four components to defect of tetralogy of Fallot

A

ventricular septal defect
pulmonary stenosis
right ventricular hypertrophy
overriding aorta- sometimes w/ dextroposition of aorta

95
Q

child may be pink with tetralogy of Fallot if?

A

pulmonic stenoisis mild & VSD shunts left to right

96
Q

what is a “tet spell”

A

pt grows cyanotic, progressively worse w/ age- infants become agitated, tachypneic & have difficulty feeding, toddlers may squat to resolve Tet spell

97
Q

what type of murmur will you hear in tetralogy of Fallot

A

long systolic ejection murmur (from PS)

98
Q

classic CXR appearance of tetralogy of Fallot

A

boot shaped heart

99
Q

when is tetralogy of Fallot repaired?

A

surgically repaired in infancy- often allowed to grow for a few months before repair

100
Q

major criteria for rheumatic fever
JCNES criteria
2 signify dz

A 
JOINTS-
CARDITIS
NODULES 
ERYTHEMA marginatum
SYDENHAM'S chorea
101
Q

Joints

A

migratory polyarthritis

typically large joints

102
Q

carditis

A

myocarditis
pericarditis
valvular dz
indolent carditis can be a single criterion defining dz

103
Q

nodules

A

subcutaneous

extensor surfaces of extremities

104
Q

erythema marginatum

A

can be locally exacerbated by heat

pink-red macules grow, then coalesce into serpiginious long patches

105
Q

Sydenham’s chorea

A

w/ or w/o psychiatric dz

may define dz as a single criterion

106
Q

minor criteria for rheumatic fever

A 
1 major + 2 minor---> signifies dz
polyarthralgia
fever
previous rheumatic fever
elevated ESR, CRP, WBC
prolonged PR interval
supportive serology of previous infxn
107
Q

what is the best test for looking for previous rheumatic fever infxn

A

anti-streptolysin O is the best test

anti-DNAase B & streptozyme also used

108
Q

rheumatic fever tx

A

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
Q

infective endocarditis

A

greatest risk is to those w/ preexisting heart dz or cardiac foreign material
may be acute/subacute

110
Q

causes of infective endocarditis

A

viridans streptococci
S. aureus
less common- enterococci, HACEK organisms (fastidious gram negative rods)

111
Q

S&S of infective endocarditis

A 
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
Q

tx for infective endocarditis

A

long term Abx- directed therapy based on cultures
surgical excision or valve repair sometimes warranted
supportive care for sequelae- CHF

113
Q

preventing endocarditis

A

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
Q

endocarditis prevention dependent on type of procedure

A

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

Peds-Final (10 decks)

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