Cardiology Flashcards
1
Q
What skin finding for hyperlipidemia?
A
Tendon xanthoma
2
Q
What fmhx would prompt lipid testing?
A
Early coronary artery disease 240 total chol
3
Q
What test to screen if family Hx has hi chol?
A
Total cholesterol random
4
Q
What test to screen if early CAD?
A
Lipid profile fasting
5
Q
Official recommendation for screening every kid.
A
Random chol at 8 to 9 and again at 15yr
6
Q
What is considered Hi chol?
A
Total >200, LDL >130
7
Q
What is considered borderline chol?
A
Total 170-199
LDL 110-129
8
Q
Indication for statins?
A
1) Diet II tried for 6-12mo
2) LDL still >190
3) LDL >160 + FMHX CAD or 2+ risk factors* *HDL
9
Q
What are secondary causes of high chol?
A
Drugs: AED, Accutane, thiazides, beta-blockers, steroid
DM, HypoTH, chronic liver/renal
10
Q
Sx of Kawasaki
A
Fever, conjunctivitis, swollen lips, strawberry tongue, lymphadenopathy, desquamation of fingers, truncal rash, CAA, sterile pyuria
11
Q
Rx for Kawasaki
A
1x IVIg 2g/kg
Hi dose aspirin 80-100mg/kg/day Q6h w/IVIg.
2-3 days after fever reduced, ASA 3-5mg/kg/day.
8 wks -> ECHO -> stop ASA -> ECHO 6-12mo
12
Q
If Kawasaki patient is untreated, what percentage get Kawasaki?
A
25%
13
Q
Pattern: sinus tachy, gallop rhythm, LV enlargement
A
CHF/myocarditis
14
Q
Pattern: muffled heart sound, reduced QRS voltages
A
pericardial effusion
15
Q
Pattern: prolonged PR interval
A
arrhythmias
16
Q
Pattern: fever, high ESR, arthralgias, chest pain, arm HTN, poor pulses in legs and long systolic murmur heard over the back and abdomen
A
Takayasu arteritis
coarct with fever, high ESR
17
Q
What is cause of rheumatic fever?
A
delayed immune response to group A beta hemolytic strep pharyngitis (GAS)
18
Q
How soon after pharyngitis can you see rheumatic fever?
A
2 to 4 wks
19
Q
What are the major Jones criteria?
A
Polyarthritis, carditis, subQnodules, erythema marginatum, chorea
20
Q
What are the minor Jones criteria?
A
fever, arthralgia, previous rheumatic fever, ESR/CRP, leukocytosis, prolonged PR
21
Q
Rheumatic fever involve which valve disease?
A
aortic and mitral valves
22
Q
What antibiotics for carditis?
A
Penicillin
23
Q
What antibiotics for secondary prevention after rheumatic fever?
A
Benzathine penicillin G IM 9 month, penicillin V 250mg BID
24
Q
Rx with CHF from rheumatic fever?
A
bed rest, digoxin and diuretics
25
What are causes of pericarditis?
viral, bacteria, TB, collagen vascular JRA/SLE, majority POST-PERICARDIOTOMY (1-2 WKS)
26
Pattern: fever, chest pain, respiratory distress, leans forward
Pericarditis
27
What EKG finding for pericarditis?
ST segment elevation
28
What complication of pericarditis should be treated?
Effusions
Small - anti-inflammatory meds
Large - pericardiocentesis
29
What is the most common cause of myocarditis?
Coxsackie A/B
30
Pattern: tachypnea, poor feeding, preceding illness, lethary, S3 gallop, increased HR, RR, decreased BP, cool, clammy, mottled
Myocarditis
31
Pattern: Diffuse low voltage, arrhythmias on EKG
Myocarditis
32
What lab results are associated with myocarditis?
Increased WBC, ESR, CK, troponin, dilated heart and poor function on ECHO, cardiomegaly on CXR
33
Rx for severe CHF from myocarditis.
Dobutamine, DA, milrinone
34
Rx for mild CHF from myocarditis
Digoxin, Lasix, captopril
35
Prognostic counseling for recovery of CHF
1/3 recover, 1/3 chronic, 1/3 death/transplant
36
What are causes of infective endocarditis?
CHD, central line, immune deficiency, IVDA, strep viridins, staph aureus
37
Pattern: flu-like, fever, wt loss, fatigue, myalgia, joint pain
subacute infective endocarditis
38
Pattern: fever, malaise, new changing murmur, Janeway lesion, Osler's nodes, Roth spots, splinter hemorrhage (all from embolic)
acute infective endocarditis
39
Which genetic disorder often associated with valvular disease?
William - supravalvar aortic stenosis and coronary osteal stenosis
40
Who should get ppx antibiotics for infective endocarditis?
1. Previous endocarditis
2. Transplant pt
3. Unrepaired cyanotic disease, including palliative shunt and conduit
4. Repaired with residual defects or no endothelization
5. Device, shunt, valve replacement in last 6 months
6. Valve with prosthetic material
41
What Rx for ppx for infective endocarditis?
amoxicillin 30-60 min prior to procedure
42
Pattern: tachycardic, decreased CO --> decreased BP, presentation to hypovolemic shock
CHF
43
Rx high preload in CHF
diuretics
44
Rx for decrease in contractility
Digoxin, beta-agonists, phosphodiesterase, dobutamine, milrinone, epinephrine
45
Rx for high afterload in CHF
vasodilators, ACE inhibitors, milrinone
46
What are symptoms of digoxin toxicity?
heart block, SVT, VT, nausea, vomiting, lethargy, hypoKalemia
47
Rx for digoxin toxicity
charcoal, lavage, Digibind (Fab)
48
Rx for heart block with CHF
atropine
49
Rx for SVT with CHF
phenytoin or beta-block
50
Rx for VT with CHF
lidocaine or phenytoin
51
What don't you want to do to treat SVT/VT with CHF?
Cardiovert, worsens it
52
Pattern: sudden death, S3 murmur softer lying down, chest pain, exertional syncope, ventricular gallop
HOCM
53
What is pathophysiology of HOCM?
AD familial in 1/2 cases causing abnormal thickening of ventricle, decreasing diastolic function, limitation of systolic function
54
What do you see in HOCM EKG?
LAD, LVH, ST-T wave changes
55
Rx for HOCM
B-blocker, Ca channel blocker, AICD, surgery
56
What is the sequelae of HOCM?
endocarditis - so ppx antibiotics (but only moderate risk - so not absolutely required)
57
What is considered acceptable chol?
LDL
58
Describe AHA diet I
1) Sat fat
59
Describe AHA diet II
1) Sat fat
60
What cardiac condition is associated with Down?
AV canal
61
What cardiac condition is associated with Turner?
bicupsid aortic valve, coart
62
What cardiac condition is associated with DiGeorge?
TOF, truncus arteriosus
63
What cardiac condition is associated with Williams
supravalvular AS
64
What cardiac condition is associated with Marfan
dilated aorta, MVP
65
What cardiac condition is associated with Holt-Oram (limb/thumb)
ASD, VSD
66
What cardiac condition is associated with Frederick's ataxia
Cardiomyopathy
67
What cardiac condition is associated with Noonan
pulmonary stenosis
68
Which of the 5 T's in CHD?
| Most common cyanotic at birth, seen in large 1st born male
Transposition of the great vessels
69
Which of the 5 T's in CHD? Loud, 2nd heart sound
TGA
70
Which of the 5 T's in CHD? CXR, egg on string, narrow mediastinum
TGA
71
What is EKG like in TGA?
Normal
72
What saves kids of TGA?
oxygenation dependent on mixing of blood via PFO and PDA
73
How do you improve mixing in kids with TGA?
prostaglandin, balloon septostomy, surgical correction
74
What is most common sequelae of TGA correctional operation?
Pulmonary stenosis, aortic insufficiency from stretching during surgery
Coronary artery stenosis from kinking
75
4 features of Tetrology of Fallot
1) VSD
2) Pulm stenosis
3) Overriding aorta
4) RVH
76
With TOF, presentation is dependent on what two features?
degree of pulmonary stenosis and timing of ductal closure
77
Rx for TOF
PGE1 and surgical correction as newborn
78
What additional features are seen in truncus arteriosus?
VSD, abnormal truncal valve - stenotic +/- regurgitant
79
What does CXR look like for truncus arteriosus?
cardiomegaly and increased pulmonary flow
80
Pattern: 2 week to 2 month old with CHF, systolic murmur LUSB, single S2
Truncus arteriosus
81
Pattern: cardiomegaly and increased pulmonary blood flow
Tricuspid atresia
82
With tricuspid atresia and small VSD, what symptom?
cyanosis
83
With tricuspid atresia and large VSD, what symptom?
CHF
84
Pattern: cyanosis shortly after birth, respiratory distress, no mumur, CXR normal heart, severe pulmonary edema, ground glass, snowman
total anomalous pulmonary venous return
85
Pattern: fixed split S2, systolic murmur, EKG could show WPW, RBBB, RAE, CXR wall to wall heart
Ebstein's anomaly of tricuspid valuve
86
Pattern: opening click and systolic murmur, RVH CXR shows decreased pulmonary blood flow
Pulmonary stenosis
87
What do you do for pulmonary stenosis?
PGE1 if cyanotic newborn period, balloon valvuloplasty or surgical valvotomy
88
Rx for PDA
Indomethacin or catheter intervention
89
Contraindication for indomethacin
renal, platelet dysfunction
90
Pattern: Harsh, holosystolic murmur in left sternal border, PMI is displaced, diastolic rumble, precordium is hyperdynamic
VSD
91
What is sequelae of VSD and if not repaired in first year?
1) CHF
| 2) Pulm HTN
92
Pattern: fixed split S1 on respiration
ASD
93
Sequelae of unrepaired ASD
1) atrial arrhythmias, sick sinus (can occur despite)
2) PHTN
3) 50% mortality by 37yrs from stroke and heart failure
94
Pattern: LUSB crescendo/decrescendo murmur radiating to midscapular
Coarctation
95
Pattern: higher blood pressure in R arm than leg
Coarctation
96
Rx for coarctation
PGE1 in infants with shock, beta blockers in older children
97
Pattern: shock or cyanosis, sudden death in young
Aortic stenosis
98
Rx for aortic stenosis
balloon valvuplasty, surgical valvotomy, valve replacement
99
Pattern: opening click or split first heart sound, most common valvular disease
bicupsid aortic valve
100
Rx for bicuspid aortic valve
anti-hypertensive and valve replacement
101
Pain with touch of chest
costochondritis
102
Stabbing chest pain, sudden in onset, lasting a few second to minutes, worsened by inspiration
precordial catch syndrome (pinched nerve, pleuritic pain)
103
Pain w/ palpitations
SVT
104
Pain relieved with tripod
Pericarditis
105
Constant pain
myocarditis
106
Pain and nausea with exercise
anomalous right coronary artery
107
What are red flags for cardiac cause of syncope?
1) No preceding symptoms
2) Injury from LOC
3) During exertion or emotional stress
4) While sitting or supine, during activity
108
Pattern: murmur radiates to carotids, associated with opening click (split 1st)
Bicuspid aortic valve
109
Pattern: flow murmur across R (ventricular outflow tract, split 2nd)
Atrial septal defect
110
Pattern: grade 2-3/6 high pitch, one frequency, higher with fever or exercise
Stills' murmur
111
Pattern: Murmur louder in axilla than centrally
Peripheral pulmonic stenosis
112
Pattern: venous hum, changes with repositioning
Continuous murmur that is benign
113
How fast is heart rate in sinus tachycardia?
114
What does EKG look like in sinus tachycardia?
Normal QRS, P wave normal, but may be hidden
115
What test should you do if sinus tach is diagnosed?
HyperTH
116
How fast is HR in SVT?
180-300
117
Describe EKG of SVT
QRS narrow, LBBB, p waves abnormal and multiple for each QRS
118
Rx for SVT
Start with adenosine 50-100mcg/kg then double with each injection, verapamil, DC cardioversion for low cardiac output, antiarrhythmic if refractory
119
What EKG pattern for WPW?
short PR interval, widened QRS, slurred upstroke
120
What is atrial and ventricular rate with atrial flutter?
>300 atrial, 150-250 ventricular
121
In an older child with atrial flutter, what do you worry about?
atrial conduction problem (sick sinus syndrome/myocarditis)
122
Rx for atrial flutter
Amiodarone, sotalol, class I (procainamide, flecanide), DC convert
123
What should be given first before class I anti-arrhythimic?
Digoxin, because they will incrase conduction via AV node, so block first with dig
124
Pattern: wide abnormal QRS, T waves in opposite direction from QRS, steady rate
Ventricular tachycardia
125
Rx for ventricular tachycardia
Amiodarone, procainamide, cardioversion
126
What are causes of sinus brady?
athletes, sedation, Cushing's Triad, hypoxemia
127
What are causes of SA node dysfunction?
S/p atrial surgery for ASD, Mustard, Fontan
128
What else is typically seen with SA node dysfunction?
tachy/brady syndrome, junctional or ventricular escape rhythm
129
Pattern: prolonged PR interval, narrow QRS
Primary heart block
130
Pattern: PR interval lengthens and then drops
Secondary heart block - Mobitz I benign seen in athletes or in sleep
131
Pattern: PR drops without any changes to interval
Mobitz II - not benign
132
Pattern: no correlation between P and QRS
3rd degree heart block
133
What diseases are typically associated with congenital heart block?
any heart disease, SLE, connective tissue (Sjogren's)
134
Pattern: variation in P-P and R-R interval due to changes in cardiac filling during respiration
Sinus arrhythmia
135
What other abnormality is typically associated with sick sinus syndrome?
secundum ASDs
136
Pattern: delta wave in sinus rhythm, narrow QRS
WPW
137
Pattern: early/abnormal P wave with normal QRS
PACs
138
Rx for PACs
digoxin
139
Pattern: early, wide QRS without preceding P wave
PVC's
140
Pattern: Wide QRS, P wave present, V1 QRS up, V6 QRS down
RBBB
141
Pattern: Wide QRS, + P wave, V1 QRS down, V6 QRS up
LBBB
142
EKG HypoK
U wave
143
EKG 6-7.5 K+
elevated T
144
EKG 7.5-9 K+
increase dip of RS and elevated T
145
EKG >9 K+
sinusoidal
146
Pattern: shortened PR interval, large tongue
glycogen storage disease
147
EKG hypoCa
shortened ST seg
148
EKG hyperCa
lengthened ST seg
149
What fmhx should make you concern for long QT syndrome?
FmHx of syncope, seizure, sudden death, with emotional stress or exercise
150
How to calc QTc
QT/RR interval (seconds)
151
How do you roughly estimate if QT is normal?
if HR 70-100bpm, if QT interval is
152
What is the AD genetic disorder associated with prolonged QT?
Romano-Ward
153
What is the AR genetic disorder for prolonged QT? What is the associated symptom?
Jervell-Lange-Neilsen; congenital deafness
154
Pattern: absent p wave, pause is 2x P-P interval
sinus exit block
155
Describe criteria for results of hyperoxia test
pO2 150 cardiac unlikely
156
How do you workup cynosis?
1) Hyperoxia test
| 2) pCO2 - normal in cyanotic heart disease and hemoglobinopathy; hi in pulmonary and neurologic disorders
157
Describe triggering situations and physiology of TET spell
Agitation, anger, dehydration, sickness --> inc HR --> incr RVOT obstruction and decr SVR
158
What are Rx (3 categories for TET spell)
Decr RVOT Morphine, propanolol, sedation, IV/IM ketamine
Incr SVR knee to chest, phenylephrine
Incr O2 delivery volume, pRBC, oxygen, bicarb
159
What is body's response to CHF?
Decr CO = incr HR x decr SV (due to incr preload, decr contractility, inc afterload)
160
When do PDA, ductus venosus, PFO close?
PDA - hrs to days
DV - min to days
PFO - min to months
161
What are parameters of correct pressure cuff?
Width of cuff >40% of arm circumference
| Bladder length should cover 80-100% of arm
162
When should bp be measured?
Starting at 3 yo right arm
163
If bp is at >90% what do you do?
Repeat
164
If confirmed bp is 90-95% what do you do?
Recheck in 6 months, begin weight management
165
If confirmed bp is 95-99% what do you do?
recheck in 1 wk, treatment and weight management
166
If confirmed bp is >99th% what do you do?
eval/treat in 1 wk
167
Workup for HTN
ECHO, renal US, UA, creatinine, K+
168
Pulse ox screening in >24hr baby -
ECHO
169
Pulse ox screening in R hand/foot >24hr baby or >3% change in R hand/foot - 90-95%
Repeat 3x
170
Pulse ox screening in >24hr baby >95% in R hand/foot or
normal
