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Pediatrics Board review > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are some indications for an EKG?

A
  • Chest pain
  • Syncope
  • Cyanotic episodes
  • Drug ingestion
  • CHD evaluation
  • Palpitations
  • Pericarditis
  • Kawasaki disease
  • myocarditis
  • Rheumatic heart fever
  • Family history of sudden death
  • electrolyte abnormalities
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2
Q

What is the criteria for RVH on EKG?

A
  • Pure R wave in V1 > 10mm
  • Upright T wave in V1
  • RSR’ pattern in V1, where R’ > 15mm ( 10mm (>1yo)
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3
Q

What can prolong PR interval?

A
  • Increased vagal tone
  • Heart block
  • Endocarditis with abscess
  • Hyperkalemia
  • Digoxin toxicity
  • Wolf-Parkinson-White
  • Glycogen storage disease
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4
Q

What can prolong QRS? (>0.08msec if 0.10msec if >8yo)

A
  • Bundle branch block

- Junctional or ventricular rhythm (not through His-Purkinje)

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5
Q

How do you correct QT for heart rate?

A

Bazett formula:

From start of Q to end of T

QTc=QT/(RR)^1/2

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6
Q

What is a normal QTc?

A

upper limit of normal: 450msec

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7
Q

Normal axis on EKG?

A

0 to 90: +I, +II and +aVF

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8
Q

Left axis deviation on EKG?

A

0 to -90: +I, +aVL and -aVF

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9
Q

Right axis deviation on EKG?

A

90 to 180: -I, +III and +aVF

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10
Q

Extreme right axis deviation on EKG?

A

-90 to -180: -I, -aVF and +aVR

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11
Q

What is Congestive Heart Failure?

A

Clinical syndrome defined as the inadequate oxygen delivery by the myocardium to meet the metabolic demands of the body

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12
Q

What’s the pathophysiology of CHF?

A

*Hypoperfusion of end organs:

-It stimulates the heart to maximize contractility and
heart rate in an attempt to increase cardiac output

  • It also signals the kidneys to retain salt and water through the reninangiotensin system in an attempt to increase blood volume
  • Catecholamines
  • Released by the sympathetic nervous system also increase heart rate and myocardial contractility
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13
Q

What congenital lesions may cause increased pulmonary blood flow leading to CHF?

A
  • A large ventricular septal defect (VSD)
  • A large patent ductus arteriosus (PDA)
  • Transposition of the great arteries (TGA)
  • Truncus arteriosus
  • Total anomalous pulmonary venous connection (TAPVC)
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14
Q

What obstructive congenital lesions can lead to CHF?

A
  • Severe aortic, pulmonary, and mitral valve stenosis
  • Coarctation of the aorta
  • Interrupted aortic arch
  • Hypoplastic left heart syndrome
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15
Q

What are other congenital causes of CHF?

A
  • Arteriovenous malformations

- Mitral or tricuspid regurgitation, which overload portions of the heart

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16
Q

What are some acquired heart diseases that can cause CHF?

A
  • Viral myocarditis (common cause of CHF in older children and adolescents)
  • Other cardiac infections (endocarditis, pericarditis)
  • Metabolic diseases (hyperthyroidism)
  • Medications (doxorubicin, a chemotherapeutic agent)
  • Cardiomyopathies
  • Ischemic diseases
  • Dysrhythmias (including tachycardia and bradycardia)
17
Q

What are some miscellaneous causes of CHF?

A

-Severe anemia (which may cause high-output CHF)
-Rapid infusion of intravenous fluids (especially in premature infants)
-Obstructive processes of the airway (such as enlarged tonsils or adenoids, laryngomalacia, and cystic fibrosis), which may cause CHF as a result of chronic
hypoxemia that results in right-sided heart failure

18
Q

What’s evidence of pulmonary congestion in CHF?

A
  • Tachypnea
  • Cough
  • Wheezing
  • Rales
  • Pulmonary edema on chest radiograph
19
Q

What’s evidence of impaired myocardial performance in CHF?

A
  • Tachycardia
  • Sweating
  • Pale or ashen skin color
  • Diminished urine output
  • Enlarged cardiac silhouette on CXR
20
Q

What’s evidence of systemic venous congestion in CHF?

A

-Hepatomegaly and peripheral edema

21
Q

What are other signs and symptoms of CHF?

A
  • Failure to thrive
  • Poor feeding (common symptom in newborns)
  • Exercise intolerance (common symptom in older children and adolescents)
22
Q

What are late manifestations of CHF?

A

-Cyanosis and shock

23
Q

What are the goals of management of CHF?

A

To improve myocardial function and relieve

pulmonary and systemic congestion

24
Q

What is the role of cardiac glycosides (digoxin) in the treatment of CHF?

A

Increase the efficiency of myocardial contractions and relieve tachycardia

25
Q

What is the role of loop diuretics (furosemide, ethacrynic acid) in the treatment of CHF?

A

Reduce intravascular volume by maximizing sodium loss, which in turn leads to diminished ventricular dilation and
improved function

26
Q

What is the role of loop inotropic medications (dobutamine, dopamine) in the treatment of CHF?

A

They are administered intravenously and may be used to treat severe CHF

Pediatrics Board review (5 decks)

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