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Peds Shelf > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the 5 types of cyanotic heart defects?

A

Truncus

Transposition of the Great Vessels

Tricuspid Atresia

Tetrology of Fallot

Total Anomalous Pulmonary Venous Return (Obstructive)

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2
Q

What 4 anomalies constitute Tetralogy of Fallot? What prenatal factors are associated with it?

A

Aortic Override

VSD

RVH

Right Ventricular outflow obstruction

Maternal rubella or viral illness

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3
Q

Kids with TOF will often squat after exercise - why?

A

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
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4
Q

Tet Spell

A

Kids with TOF suddenly develop cyanosis

Inc. CO w/ fixed RV outflow - Increased R to L shunt

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5
Q

What are 3 things on CXR that can help diagnose Tetrology of Fallot?

A

Boot shaped heart

Decreased pulmonary vascular markings

Right aortic arch (25%)

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6
Q

What is the most common cyanotic congenital heart defect presenting in the neonatal period?

A

Transposition of the Great Vessels

*Must have ASD &/or VSD for mixing*

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7
Q

What does this patient have? How do you treat it?

A

Transposition of the Great Arteries w/ Intact Ventricular septum

*Need PGE1 for patent PDA & Early Balloon Atrial Septostomy

**Arterial Switch is definitive**

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8
Q

Subendocardial cushion defects are associated with what genetic syndrome? What defects are typically seen?

A

Trisomy 21

*Ostium primum ASD

*VSD

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9
Q

What are signs/symptoms of ASDs? (2)

A

Wide, fixed split S2

CHF & pulmonary HTN in 20s-30s

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10
Q

What size ASD are likely close on their own? Which are unlikely?

A

90% close spontaneously

< 3mm = 100%

> 8mm = unlikely

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11
Q

What is the most common congenital heart disorder?

A

VSD (membranous)

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12
Q

What percent of VSDs spontaneously close? When is intervention indicated? How do you treat?

A

30-50%

CHF, pulmonary HTN, growth failure

Diuretics and digitalis

Surgery

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13
Q

What is the main cause of PDA closure?

A

Ductal PO2 > 50 mmHg

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14
Q

Eisenmenger’s Syndrome

A

An unrepaired left-to-right shunt turns into a cyanotic right-to-left shunt

Increased pressure leads to pulmonary HTN

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15
Q

An opening snap wth a presystolic murmur is indicative of what?

A

Mitral Stenosis

Sequela of acute rhematic fever

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16
Q

Supravalvular aortic stenosis is associated with __________.

A

Idiopathic Hypercalcemia

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17
Q

Midsystolic click and late systolic murmur

A

Mitral Valve Prolapse

*nearly all Marfan’s pts have it*

Symptomatic treatment: β-blocker for chest pain

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18
Q

Coarctation of the Aorta is seen in 1/3 of patients with ____________.

A

Turner’s Syndrome

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19
Q

Pulmonary flow murmurs, physiologic pulmonary branch stenosis and Still’s murmurs can all be heard best when the patient is _______.

A

Supine

All are innocent

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20
Q

Common to all innocent murmurs (5)

A

Absence of structural defects

Normal S1/S2

Normal peripheral pulses

Normal CXR and ECG

Asymptomatic

**Usually systolic and < Grade III

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21
Q

Causes of tachycardia

A

Fever, anxiety, hypovolemia, sepsis

CHF

SVT, v-tach, atrial flutter & fibrillation

Meds: Theophylline

22
Q

Causes of prolonged QT

A

Long QT Syndrome

Hypo K, Mg, Ca

Neurologic Injury

23
Q

PVC may be normal if they are ________ and ___________.

A

Uniform

Decrease with exercise

24
Q

V TAch

A

Series of 3++ PVCs + HR 120-200

Wide QRS

T waves opposite QRS

**Usually suggests significant pathology**

25
Q

QRS Axis

I+ & aVF+ =

1+ & aVF- =

1- & aVF+ =

A

Normal

LAD

RAD

26
Q

What causes peaked pointed T waves? (3)

A

Hyperkalemia

LVH

Head Injury

27
Q

Wide P wave

A

LAE

VSD, PDA, mitral stenosis

28
Q

What is the boat or sail-shaped opacity that can obscure the heart in newborn and small infant CXR?

A

Thymus

Involutes after puberty

Not seen in premature newborns

29
Q

Increased pulmonary vascular markings

A

Acyanotic: ASD, VSD, PDA, endocardial cushion defect, partial APVR

Cyanotic: Total APVR, transposition, hypoplastic L heart, truncus, or single ventricle

30
Q

Decresaed pulmonary vascular markings i.e. dark lung fields with small vessels

A

Pulmonary/Tricuspid stenosis and atresia

Tetralogy of Fallot

31
Q

Snowman Shape Heart

A

Total Anomalous Pulmonary Venous Return

32
Q

How long after a Group A Strep infection of the pharynx can one develop Rheumatic Fever?

A

Average 3 weeks (1-5w)

33
Q

How do you diagnose Rheumatic Fever?

A

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

34
Q

What does this person have?

A

Erythema Marginatum - non-pruritic, disappears when cold

Rheumatic Fever!

35
Q

What do you use to treat a patient with Rheumatic Fever’s arthritis? What if it doesn’t improve within 48 hours?

A

Aspirin

Probably not rheumatic fever

36
Q

How do you treat Rheumatic Fever?

A

Benzathine Penicillin G 1.2 mil units IM + Prednisone/ASA to prevent carditis

PPX throughout adolescence/indefinitely

37
Q

What is the most common cause of endocarditis?

A

α-hemolytic strep i.e. Strep viridins 67%

Most is left-sided

38
Q

What are signs/symptoms of endocarditis

A

Fever

New/changing murmur

Chest pain, dyspnea, arthralgia, myalgia, headache

Hematuria + red cell casts

TIA

Roth spots, splinter hemorrhages, Osler nodes, Janeway lesions

39
Q

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.

A

Think Bacterial Endocarditis

40
Q

Myocarditis is most often cause by _______. (4)

A

Viruses: Coxsackie and echo

Immune-mediated: Acute rheumatic fever, Kawasaki

Collagen Vascular Disease

Toxic Ingestions

41
Q

How does myocarditis present?

A

Asymptomatic - Fulminant CHF

Usually symptomatic/supportive treatment

42
Q

What causes pericarditis?

A

Viral (most common)

Bacterial: Rheumatic Fever, S. Aureus, Neisseria, H. Flu

Complications from heart surgery

Uremia

Collagen Vasc. Disease

Meds: Dantrolene, Onc. Agents

43
Q

Pericardial friction rub and chest pain relieved by standing

Pulsus Paradoxus

Diffuse ST Elevation

A

Pericarditis

44
Q

Henoch-Schonlein Purpura

A

Immune vasculitis: IgA vasculitis

GN

Colicky abdominal pain - intuss., N/V

Palpable purpura and joint pain

Supportive treatment, recover in 4-6 weeks

45
Q

What drugs do you use to treat CHF in kids?

A

Digitalis

Diuretics

Afterload reducing: ACE/CCB/Nitro

46
Q

What is the danger in using diuretics and digitalis together?

A

Loop diuretics can cause hypokalemia which can precipitate digitalis toxicity.

47
Q

Kawasaki’s Disease

A

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

48
Q

What are the most dangerous sequelae of Kawasaki Disease? How do you treat the disease?

A

Coronary Aneurysm, Pericardial Effusion, CHF, MI

IVIG and High dose ASA

49
Q

Polyarteritis Nodosa

A

Prolonged fever/weight loss, malaise, subcutaneous nodules on extremities, rashes, gangreneof distal extremities,HTN + abdominal pain

Abnormal cell counts, p-ANCA

Treat with steroids

50
Q

Takayasu’s Arteritis

A

Chronic inflammatory disease involving aorta and branches

Aneurysmal/saccular dilation of aorta

Polyarthralgias, loss of radial pulse, LV dysfunction, HTN

Treat with Steroids

51
Q

Wegener’s Granulomatosis

A

Necrotizing granulomas

Rhinorrhea, nasal ulcers

Hematuria

Cough, hemoptysis, pleuritis

Arrhythmias (granulomas in heart)

c-ANCA, ESR

Steroids +/- cyclophosphamide or azathioprine

52
Q

Children with cyanotic heart disease are at increased risk for what 2 things?

A

Strokes and scoliosis

Peds Shelf (11 decks)

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