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Pediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

How do pediatric cardiac d/o typically present

A

cyanosis and distress in first few days of life: duct dependent lesions

CHF in first few days of life: Atrioventricular septal defects

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2
Q

Describe flow of oxygenated blood in fetus

A
  1. Placenta
  2. Umbilical vein
  3. Ductus venosus (bypass fetal liver)
  4. Inferior vena cava
  5. Right atrium
  6. Foramen ovale (preferentially shunted)
  7. Left atrium
  8. Left ventricle
  9. Aorta
  10. Fetal coronary and cerebral circulation (preferentially directed)
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3
Q

Describe flow of deoxygenated blood in fetus

A
  1. Superior vena cava
  2. Right atrium
  3. Right ventricle
  4. Pulmonary artery
  5. Patent ductus arteriosus (due to high PVR and relatively low SVR)
  6. Aorta (mixes with oxygenated blood)
  7. Umbilical arteries
  8. Placenta
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4
Q

When is anatomic closure of the foramen ovale usually complete?

A

3 months

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5
Q

When is the ductus arteriosus functionally and anatomically closed (normally)?

A
  • Functionally: 10 – 15 hours

- Anatomically: 2 – 3 weeks

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6
Q

What are the two fundamental and clinically useful formulas for cardiac output and blood pressure?

A
  1. Cardiac Output = Stoke volume x HR

2. Blood Pressure = Cardiac output x SVR

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7
Q

List causes of decreased stroke volume in infants and children

A
  1. hypovolemia
  2. myocarditis
  3. Hypertrophic cardiomyopathy with decreased diastolic filling
  4. dilated cardiomyopathy with decreased diastolic filling
  5. pericarditis or pericardial effusion with tamponade
    tachydysrhythmias with decreased diastolic filling
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8
Q

When do children achieve the adult ability to increase their stroke volume in order to augment their cardiac output?

A

8-10yrs

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9
Q

What, after increasing HR, can a child do to compensate for decreased stroke volume and what are clinical correlates?

A 
- Increased SVR manifested as
	o Increased diastolic BP à narrowed pulse pressure
	o Paleness
	o Mottling
	o Coolness
	o Delayed capillary refill
Weak or thready distal pulses
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10
Q

What maternal illnesses are associated with congenital heart block.

A

SLE

collagen vascular d/o

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11
Q

List 8 common causes of pediatric chest pain.

A
  1. MSK/chest wall pain
  2. pleurisy
  3. asthma
  4. pneumonia
  5. costochondritis
  6. gastritis
  7. GERD
  8. Precordial catch syndrome (texidor’s twinge)
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12
Q

Describe the hyperoxia test.

A
  • Administer 100% O2 for10 minutes, get an ABG before and after
    o Oyxgen saturation
    § Pulmonary: increase > 10%
    § Cardiac: No increases
    o PaO2
    § Pulmonary: GT 250 (or increase PaO2 LT 20 – 30%)
    § Cyanotic CHD with reduced pulmonary blood flow or R—L Shunt: LT100
    § Cyanotic CHD with intracardiac mixing: 100-250
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13
Q

What are the three congenital heart lesions with “classic” characteristic findings on CXR

A
  • Tetralogy of Fallot: Boot shaped heart
  • Transposition of the Great Vessels: Egg on a string
  • TAPVR: Snowman or figure of eight heart
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14
Q

Describe the T wave changes in the pediatric ECG:

A
  • Week 1: upright – if persists can be a sign of RVH
  • Juvenile pattern: newborn – age 8; twi V1-V3. May persist into adulthood.
  • Teenage: tw upright, adult pattern
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15
Q

What CHD presents with shock

A

coarctation

aortic stenosis

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16
Q

What CHD presents with CHF

A

VSD

PDA

17
Q

What CHD present in the first 2 wks

A
  1. TGA
  2. TAPVR
  3. tricuspid atresia
  4. ebstein anomaly of TV
  5. truncus arteriosus
  6. pulmonary atresia
  7. hypoplastic L heart
  8. hypoplastic R heart
18
Q

What CHD presents up to 12 wks

A

tetralogy of fallot

19
Q

List duct dependent CHD lesions that present with cyanosis

A

PDA needed for blood flow from Ao to lungs

  1. tetralogy
  2. TGA
  3. tricuspid atresia
  4. pulmonary atresia
  5. hypoplastic R heart
20
Q

List duct dependent CHD lesions that present with shock

A

PDA needed for blood flow from pulmonary artery to systemic circulation
coarctation
severe Ao stenosis
hypoplastic L heart

21
Q

List adverse effects of PGE1.

A
  1. apnea
  2. hypotension
  3. fever
  4. seizures
  5. bradycardia
  6. flushing
  7. decreased plt aggregation
22
Q

What is the most common congenital cardiac defect?

A

VSD

23
Q

List specific treatments for a tet spell (Box 171-9)

A
  • Place in knees to chest or squat position
  • Supplemental O2
  • Calm child: fentanyl 1mcg/kg/dose or ketamine 1-2mg/kg IV or 2-4mg/kg IM
  • NaHCO3 1mEq/kg IV
  • If not working consider:
    o Propanolol 0.01mg/kg IV : thought to reduce RVOT spasm
    o Phenylephrine 0.01mg/kg IV (same dosing as epi)
24
Q

List causes of CHF in infants.

A
  • CHD
  • Anomlaous left coronary artery
  • Myocarditis
  • Endocarditis
  • Rheumatic heart disease
  • Pericardial effusions
  • Cardiomyopathies
  • Anemia
  • Systemic hypertension
  • Hypothyroidism
  • Electrolyte imbalance
  • Cardiac toxins
  • Dysrythmias
25
Q

How is myocarditis treated?

A

· Maintiain CO and control dysrhythmias
· Digoxin and pressors can be arrhythmogenic so be careful with them
· B-blockers are contraindicated

26
Q

List causes of pericarditis.

A 
- Bacterial
	o Pneumococcus
	o Staph aureus
	o Menigococcus
	o H Influenzae
- Viral
	o Coxsackie
	o ECHO viruses
	o Adenovirus
	o EBV
	o Influenzae virus
- TB
- Noninfectious
	o Acute rheumatic fever
	o SLE
	o Uremia
	o Post pericardiotomy syndrome
27
Q

List classic ECG findings of pericarditis.

A

First phase (2d-2wk)

  • Diffuse ST elevation
  • +/- PR depression

Second phase (weeks)

  • Isoelectric ST segments
  • Decreased T wave amplitude and flattening of T waves
Third phase (weeks)
- Inverted T waves
Fourth phase (up to 3 months)
- Resolution
28
Q

List the diagnostic criteria of Kawasaki Disease (KD).

A
  • Fever >5 days
  • At least 5 of the five findings:
    o Bilateral conjunctivitis (non-purulent, perilimbic sparing)
    o Oropharyngeal mucous membrane changes
    o Cervical lymphadenopathy
    o Rash
    Extremity changes (swelling, erythema à scaling later stages
29
Q

What is incomplete Kawasaki disease?

A
  • Febrile for 5 days, with >2 criteria.

- If CRP >3 or ESR > 40, should get further laboratory investigations and ECHO

30
Q

What are 6 laboratory findings suggestive of Kawasaki’s Dz

A
  • normocytic/normochromic anemia
  • abN LFTs
  • Sterile Pyuria
  • elevated ESR >40/CRP>3
  • ↑ WBC
  • ↓Albumin
  • Thrombocytopenia
  • CSF pleiocytosis
31
Q

What are RFs for coronary aneurysms?

A
  • Male
  • Prolonged febrile period
  • WBC >30
  • Elevated CRP or ESR
  • Other aneurysms (renal, axillary, iliac)
  • Giant (>8mm) coronary aneurysms
32
Q

What are the Jones criteria for the diagnosis of Acute Rheumatic Fever (ARF) (Box 171-19)

A
  • Antecedant step infection (ASO, antigen, swab) PLUS 2 major or 1 major + 2 minor
  • Major:
    o Subcutaneous nodules
    o Pancarditis
    o Arthritis
    o Chorea
    o Erythema marginatum
  • Minor:
    o Clinical: fever, arthralgia
    o Lab: elevated CRP or ESR, prolonged PR
    o Supporting evidence for strep infection with: positive ASOT, swab, or antigen test
33
Q

what are the 6 acyanotic CHD

A
  1. VSD
  2. ASD
  3. PDA
  4. Coarctation of Ao
  5. Ao stenosis
  6. Pulmonic stenosis
34
Q

What are the 9 cyanotic CHD

A
  1. Tetrallogy of fallot
  2. TAPVR
  3. Truncus arteriosus
  4. tricuspid atresia
    t5. transposition of great arteries
  5. pulmonary atresia
  6. ebstein’s anomaly
  7. hypoplastic R heart
  8. hypoplastic L heart
35
Q

What is a tet spell

A
  1. An event suddenly lowers SVR i.e. crying or defecating (hypovolemia and tachycardia can also precipitate tet spells)
  2. A large R – L shunt is produced, bypassing the lungs
  3. Decrease in PaO2 and increase in PaCO2 and a fall in arterial pH
  4. Stimulation of respiratory centre produces hyperpnea (deep, rapid resps), which:
  5. Increases negative intrathoracic pressure
  6. Increases systemic venous return to right heart
  7. Increased shunt through VSD
  8. Further decreases in PaO2
    Perpetuation of tet spell

Pediatrics (10 decks)

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