Cardiology Flashcards
What are the 5 types of cyanotic heart defects?
Truncus
Transposition of the Great Vessels
Tricuspid Atresia
Tetrology of Fallot
Total Anomalous Pulmonary Venous Return (Obstructive)
What 4 anomalies constitute Tetralogy of Fallot? What prenatal factors are associated with it?
Aortic Override
VSD
RVH
Right Ventricular outflow obstruction
Maternal rubella or viral illness
Kids with TOF will often squat after exercise - why?
Causes trapping of desaturated blood in the LE and Increaces SVR while the RV outflow is fixed
- Dec, R to L shunt
- Inc. pulmonary blood flow
- Inc arterial saturation
Tet Spell
Kids with TOF suddenly develop cyanosis
Inc. CO w/ fixed RV outflow - Increased R to L shunt
What are 3 things on CXR that can help diagnose Tetrology of Fallot?
Boot shaped heart
Decreased pulmonary vascular markings
Right aortic arch (25%)
What is the most common cyanotic congenital heart defect presenting in the neonatal period?
Transposition of the Great Vessels
*Must have ASD &/or VSD for mixing*
What does this patient have? How do you treat it?
Transposition of the Great Arteries w/ Intact Ventricular septum
*Need PGE1 for patent PDA & Early Balloon Atrial Septostomy
**Arterial Switch is definitive**
Subendocardial cushion defects are associated with what genetic syndrome? What defects are typically seen?
Trisomy 21
*Ostium primum ASD
*VSD
What are signs/symptoms of ASDs? (2)
Wide, fixed split S2
CHF & pulmonary HTN in 20s-30s
What size ASD are likely close on their own? Which are unlikely?
90% close spontaneously
< 3mm = 100%
> 8mm = unlikely
What is the most common congenital heart disorder?
VSD (membranous)
What percent of VSDs spontaneously close? When is intervention indicated? How do you treat?
30-50%
CHF, pulmonary HTN, growth failure
Diuretics and digitalis
Surgery
What is the main cause of PDA closure?
Ductal PO2 > 50 mmHg
Eisenmenger’s Syndrome
An unrepaired left-to-right shunt turns into a cyanotic right-to-left shunt
Increased pressure leads to pulmonary HTN
An opening snap wth a presystolic murmur is indicative of what?
Mitral Stenosis
Sequela of acute rhematic fever
Supravalvular aortic stenosis is associated with __________.
Idiopathic Hypercalcemia
Midsystolic click and late systolic murmur
Mitral Valve Prolapse
*nearly all Marfan’s pts have it*
Symptomatic treatment: β-blocker for chest pain
Coarctation of the Aorta is seen in 1/3 of patients with ____________.
Turner’s Syndrome
Pulmonary flow murmurs, physiologic pulmonary branch stenosis and Still’s murmurs can all be heard best when the patient is _______.
Supine
All are innocent
Common to all innocent murmurs (5)
Absence of structural defects
Normal S1/S2
Normal peripheral pulses
Normal CXR and ECG
Asymptomatic
**Usually systolic and < Grade III
Causes of tachycardia
Fever, anxiety, hypovolemia, sepsis
CHF
SVT, v-tach, atrial flutter & fibrillation
Meds: Theophylline
Causes of prolonged QT
Long QT Syndrome
Hypo K, Mg, Ca
Neurologic Injury
PVC may be normal if they are ________ and ___________.
Uniform
Decrease with exercise
V TAch
Series of 3++ PVCs + HR 120-200
Wide QRS
T waves opposite QRS
**Usually suggests significant pathology**
QRS Axis
I+ & aVF+ =
1+ & aVF- =
1- & aVF+ =
Normal
LAD
RAD
What causes peaked pointed T waves? (3)
Hyperkalemia
LVH
Head Injury
Wide P wave
LAE
VSD, PDA, mitral stenosis
What is the boat or sail-shaped opacity that can obscure the heart in newborn and small infant CXR?
Thymus
Involutes after puberty
Not seen in premature newborns
Increased pulmonary vascular markings
Acyanotic: ASD, VSD, PDA, endocardial cushion defect, partial APVR
Cyanotic: Total APVR, transposition, hypoplastic L heart, truncus, or single ventricle
Decresaed pulmonary vascular markings i.e. dark lung fields with small vessels
Pulmonary/Tricuspid stenosis and atresia
Tetralogy of Fallot
Snowman Shape Heart
Total Anomalous Pulmonary Venous Return
How long after a Group A Strep infection of the pharynx can one develop Rheumatic Fever?
Average 3 weeks (1-5w)
How do you diagnose Rheumatic Fever?
Jones Criteria (2 major or 1 major + 2 minor)
Joints - polyarthritis
<3 - carditis
Nodules
Erythema marginatum
S ydenham’s Chorea
Minor = Joint pain, fever, inc. ESR or CRP, prolonged PR interval + ASO titer
What does this person have?
Erythema Marginatum - non-pruritic, disappears when cold
Rheumatic Fever!
What do you use to treat a patient with Rheumatic Fever’s arthritis? What if it doesn’t improve within 48 hours?
Aspirin
Probably not rheumatic fever
How do you treat Rheumatic Fever?
Benzathine Penicillin G 1.2 mil units IM + Prednisone/ASA to prevent carditis
PPX throughout adolescence/indefinitely
What is the most common cause of endocarditis?
α-hemolytic strep i.e. Strep viridins 67%
Most is left-sided
What are signs/symptoms of endocarditis
Fever
New/changing murmur
Chest pain, dyspnea, arthralgia, myalgia, headache
Hematuria + red cell casts
TIA
Roth spots, splinter hemorrhages, Osler nodes, Janeway lesions
A 6 yo girl with PDA develops fever and anorexia. Hgb is 9, she has hematuria, increased ESR, positive rheumatoid factor, and immune complexes are present.
Think Bacterial Endocarditis
Myocarditis is most often cause by _______. (4)
Viruses: Coxsackie and echo
Immune-mediated: Acute rheumatic fever, Kawasaki
Collagen Vascular Disease
Toxic Ingestions
How does myocarditis present?
Asymptomatic - Fulminant CHF
Usually symptomatic/supportive treatment
What causes pericarditis?
Viral (most common)
Bacterial: Rheumatic Fever, S. Aureus, Neisseria, H. Flu
Complications from heart surgery
Uremia
Collagen Vasc. Disease
Meds: Dantrolene, Onc. Agents
Pericardial friction rub and chest pain relieved by standing
Pulsus Paradoxus
Diffuse ST Elevation
Pericarditis
Henoch-Schonlein Purpura
Immune vasculitis: IgA vasculitis
GN
Colicky abdominal pain - intuss., N/V
Palpable purpura and joint pain
Supportive treatment, recover in 4-6 weeks
What drugs do you use to treat CHF in kids?
Digitalis
Diuretics
Afterload reducing: ACE/CCB/Nitro
What is the danger in using diuretics and digitalis together?
Loop diuretics can cause hypokalemia which can precipitate digitalis toxicity.
Kawasaki’s Disease
Sterile pyuria, aseptic meningitis
DX Criteria - need 5+
Fever > 104 for 5 days
Bilateral conjunctivitis
Strawbery tongue/dry cracked lips
Erythema/Edema in UE and LE
Polymorphic rash
Cervical LAD
What are the most dangerous sequelae of Kawasaki Disease? How do you treat the disease?
Coronary Aneurysm, Pericardial Effusion, CHF, MI
IVIG and High dose ASA
Polyarteritis Nodosa
Prolonged fever/weight loss, malaise, subcutaneous nodules on extremities, rashes, gangreneof distal extremities,HTN + abdominal pain
Abnormal cell counts, p-ANCA
Treat with steroids
Takayasu’s Arteritis
Chronic inflammatory disease involving aorta and branches
Aneurysmal/saccular dilation of aorta
Polyarthralgias, loss of radial pulse, LV dysfunction, HTN
Treat with Steroids
Wegener’s Granulomatosis
Necrotizing granulomas
Rhinorrhea, nasal ulcers
Hematuria
Cough, hemoptysis, pleuritis
Arrhythmias (granulomas in heart)
c-ANCA, ESR
Steroids +/- cyclophosphamide or azathioprine
Children with cyanotic heart disease are at increased risk for what 2 things?
Strokes and scoliosis
