Cardiology #5 (Pediatric Cardiology) Flashcards
What is the MC innocent (physiologic) murmur?
Still Murmur
What is the pathophysiology of a still murmur?
Thought to be due to vibration of the valve leaflets
Explain a still murmur
Musical, vibratory noisy, twanging, low-pitched early to mid-systolic ejection murmur that is best heart in the inferior aspect of the left lower sternal border and apex
When does a still murmur present?
MC heard from 2 months to preadolescence
What is a patent foramen ovale?
Covered but not sealed open communication between the right and left atria
Even though most patients with a patent foramen ovale are asymptomatic, what are some symptoms they MAY have?
Strokes from paradoxical embolism (stroke with no other underlying cause AKA cryptogenic stroke)
Best test to diagnose patent foramen ovale
Echocardiogram
What should be done for a patent foramen ovale?
- Percutaneous device closure surgically
- If the patient has cryptogenic strokes, give antiplatelet or anticoagulants
What is an atrial septal defect?
Abnormal opening in the atrial septum between the right and left atrium
MC type of atrial septal defect
Ostium secundum
What are some symptoms in infants and young adults with an ASD?
- Recurrent respiratory infection
- Failure to thrive
- Exertional dyspnea
- Easy fatiguability
- Syncope
- Heart Failure
However, in young adults, like patent Foramen ovale, patients with an ASD may have?
Paradoxical emboli (stroke from venous clots) later in life
Explain the murmur of a patient with ASD
- Systolic ejection crescendo-decrescendo flow murmur at the pulmonic area (LUSB)
- Wide, fixed split S2 that does not vary with inspiration
Best test to make diagnosis of ASD
Echo
However, what diagnostic is the gold standard/definitive for ASD?
Cardiac catheterization
Management for an ASD
Small (< 5mm): may be observed. Most close spontaneously in first year of life
If > 1 cm or symptomatic, percutaneous trans catheter closure between 2-4 years old
What is a patent ductus arteriosus?
Persistent communication between the descending thoracic aorta and the main pulmonary artery after birth
What are some risk factors for PDA?
Prematurity
Females
Fetal hypoxia
Explain the pathophysiology of a PDA
-Continued prostaglandin E1 production and low arterial oxygen content promotes patency
Symptoms of a patient with a PDA
-Most asymptomatic
-Poor feeding
-Wide pulse pressures (bounding peripheral pulses)
-loud S2
Frequent lower respiratory tract infections
Explain the murmur of PDA
Continuous machine-like murmur loudest at pulmonic area (LUSB)
Best initial test for PDA
Echocardiogram
Definitive diagnostic for PDA
-Cardiac catheterization
First line medical treatment for PDA
NSAIDs (IV Indomethacin, Ibuprofen)
How do NSAIDs work in regards to prostaglandins
They inhibit prostaglandin synthesis
What should be done if there is no closure with Indomethacin?
Surgical correction before 1-3 years of age
Coarctation of the aorta is congenital narrowing of the aortic lumen at what site?
Descending aorta
Coarctation of the aorta is more common in
Males
Symptoms of coarctation of the aorta
- Bilateral claudication
- Dyspnea on Exertion
- Syncope
- Failure to thrive in infants, poor feeding 1-2 weeks after birth
- Upper extremity systolic hypertension with lower extremity hypotension
- Diminished or delayed lower extremity pulses
What kind of murmur is present with coarctation of the aorta?
Systolic murmur radiating to the back, scapula, or chest
What is the confirmatory test for coarctation of the aorta?
Echocardiogram
Gold standard diagnostic for coarctation of the aorta
Angiography
What does a CXR show in coarctation of the aorta?
Posterior rib notching 3 sign (narrowed aorta looks like the number 3)
What is the treatment for coarctation of the aorta
- Corrective surgery or trans catheter based intervention (balloon angioplasty with or without stent placement) in early childhood
- Prostaglandin E1 (Alprostadil) preoperatively to maintain PDA to reduce symptoms and improve lower extremity blood flow
What are the 4 components of Tetralogy of Fallot?
- Pulmonary stenosis
- Right ventricular hypertrophy (RVH)
- Overriding aorta
- VSD
PROVe
What is the MC cyanotic congenital heart disease?
Tetralogy of Fallot
What chromosome deletion is associated with tetralogy of Fallot?
Chromosome 22 deletion
Symptoms of Tetralogy of Fallot
- Cyanosis (MC Presentation in infants)
- Tet Spells: paroxysms of cyanosis relieved with squatting (in infants, knees to chest helps)
- Digital clubbing, cyanosis
What kind of murmur is heard with Tetralogy of Fallot?
harsh systolic murmur at left mid to upper sternal border (VSD), right ventricular heave (RVH)
Test of choice for Tetralogy of Fallot
Echocardiogram
What does a CXR for Tetralogy of Fallot show?
Boot-shaped heart (prominent right ventricle)
Treatment for Tetralogy of Fallot
- Surgical repair in first 4-12 months of life
- Prostaglandin infusion prior to surgery to maintain PDA
True or False: If a patient has Tetralogy of Fallot, he or she should receive prophylaxis for bacterial endocarditis?
True
What is the pathophysiology of transposition of the great arteries?
Discordance between the aorta and pulmonary trunk (aorta arises from right ventricle and the pulmonary trunk arises from left ventricle)
What is the MC type of ToGA?
Dextro-TGA: this leads to two parallel circuits. Deoxygenated blood gets sent back into circulation and oxygenated blood gets sent back up to the lungs.
Prior to surgical correction of TGA, what is survival dependent on?
Shunts between right and left circulations (PDA, ASD, VSD)
Symptoms of TGA
-Severe cyanosis and tachypnea within the first 30 days of life (not affected by exertion)
Although cardiac catheterization is the gold standard diagnostic for TGA, what is the primary means of diagnosis? What does a CXR show?
Echocardiogram
CXR: egg on string appearance. Heart appears as egg on side with the narrowed superior mediastinum appearing as the string.
Treatment for TGA
Arterial switch operation
Prostaglandin E1 to maintain PDA
MC type of congenital heart disease in childhood
VSD
MC type of VSD
Perimembranous (Hole in the LV near tricuspid valve)
Symptoms of a VSD
- Excessive sweating or fatigue
- Lack of adequate growth
- Frequent respiratory infections
What kind of murmur is associated with a VSD?
High-pitched harsh holosystolic murmur best heard at LLSB
What is the BEST diagnostic for a VSD?
Echocardiogram usually preferred over catheterization
Treatment for VSD is defined by size. Explain
Small: Observation. Most close within 12 months
Symptomatic or Large: Patch closure by 2 years of age
What is Eisenmenger Syndrome?
Right-to-left shunt occurring with VSD
- -This occurs when a left-to-right shunt switches and becomes a right-to-left shunt. Cyanosis occurs.
- -Pulmonary hypertension and cyanotic heart disease occur simultaneously
