Cardiology Flashcards
1
Q
Definition of CHF
A
inadequate oxygen delivery
2
Q
What is the most common cause of CHF in older children and adolescents
A
Viral myocarditis
3
Q
What is a miscellaneous cause of CHF
A
severe anemia, causes high-output CHF
4
Q
Common symptom in newborn for CHF
A
poor feeding
5
Q
common symptom in older children and adolescents for CHF
A
exercise intolerance
6
Q
last clinical manifestations for CHF
A
cyanosis and shock
7
Q
Evidence of systemic venous congestions for CHF
A
hepatomegaly and peripheral edema
8
Q
Medical management of CHF
A
- cardiac glycosides (digoxin)
- loop diuretics (furosemide, ethacrynic acid)
- inotropic medications ( dobutamine, dopamine)
9
Q
define innocent cardiac heart murmurs
A
turbulent blood flow not caused by structural heart defect
10
Q
What confirms anatomic lesions in acyanotic congenital heart disease
A
echocardiogram
11
Q
Classifications for atrial septal defect
A
- Ostium primum
- Ostium secundum
- Sinus venosus
12
Q
Ostium primum ASD is a common congenital heart lesion in what
A
Down Syndrome
13
Q
What is the most common type of ASD
A
Ostium Secundum
14
Q
What type of shunt is an ASD
A
left-to-right shunt
15
Q
3 PE for ASD
A
- increased right ventricular impulse
- Systolic ejection murmur ( heard mid and upper left sternal borders)
- Fixed-split second heart sound
16
Q
Treatment for ASD
A
closure by open heart surgery
17
Q
What are 3 innocent heart murmurs
A
- Still’s murmur
- Pulmonic systolic murmur
- Venous hum
18
Q
when is Still’s murmur loud
A
- loudest supine
- louder with exercise
19
Q
when is pulmonic systolic murmur loud
A
- loudest supine
- louder with exercise
20
Q
when is venous hum heard
A
- heard only when sitting or standing
- disappears if supine
21
Q
where does right pulmonary veins drain in sinus venosus
A
into right atrium or SVC instead of into left atrium
22
Q
patients with ostium primum might develop what
A
mitral regurgitation
23
Q
The amount of blood shunted in a VSD depends on what 2 things
A
- size of VSD
2. pulmonary vascular resistance
24
Q
as the size of the VSD decreases, the intensity of the murmur
A
increases
25
besides a holosystolic murmur being heard on a moderate and large VSD, what else can be heard and where
diastolic murmur of mitral turbulence
| - apex
26
if PVR remains elevated, pulmonary hypertension reversible
no
27
shunting changes from left-to-right to right-to-left
Eisenmenger syndrome
28
what does the PDA connect
pulmonary artery to aorta
29
what is used un premature infants to close PDA medically
Indomethacin
30
if the left-to-right shunt is large enough in PDA, what is heard
- diastolic rumble across mitral valve
- widened pulses
- brisk pulses
31
Neonates or infants with severe coarctation may depend on what
PDA (right-to-left)
32
symptoms of coarctation of the heart in older children in adolescents
- hypertension in right arm
| - blood pressure reduced in lower extremities
33
what happens to femoral pulse in coarctation of the heart
dampened and delayed after radial pulse ( radiofemoral delay)
34
what valve problem is associated with coarctation of the heart
biscupid aortic valve
35
what initial medications are given to coarctation of the heart
- intravenous prostaglandin E
| - Inotropic medications
36
therapy of choice for recurrent coarctation
balloon angioplasty
37
other children symptoms of aortic stenosis
- no symptoms
| - exercise intolerance, chest pain, syncope, sudden death
38
intervention for aortic stenosis
- surgery with insufficiency and 5-10 years after palliative balloon valvuloplasty
- Ross procedure: valve replaced
39
severe pulmonary stenosis in neonate may show up as
right-to-left shunting
40
clinical features of pulmonary stenosis in older children
symptoms are absent
41
Management for pulmonary stenosis
balloon vavluloplasty
42
Xray shows rib notching
coarctation of the heart
43
most common cardiac causes of central cyanosis
```
Tetralogy of Fallot
Transposition of great arteries
Tricuspid atresia
Truncus arteriosus
Total anomalous pulmonary venous connection
```
44
Most common cause of central cyanosis
Tetralogy of Fallot
45
Define Tetralogy of Fallot
1. VSD
2. overriding aorta
3. pulmonary stenosis
4. right ventricular hypertrophy
46
which cyanotic congenital heart disease increases pulmonary flow
- Transposition of great arteries
- Total anomalous pulmonary venous connection
- Truncus arteriosus
- single ventricle
47
which cyanotic congenital heart disease decreases pulmonary flow
Tetralogy of Fallot
Tricuspid atresia
pulmonary atresia
48
what increases right-to-left shunting in tetralogy of fallot
exercise, vasodilation, volume depletion
49
what reduces right-to-left shunting in tetralogy of fallot
systemic hypertension, Valsalva maneuver
50
neonates with tetralogy of fallot depend of what
PDA
51
what is a tet spell
sudden cyanosis and decreased murmur intensity
52
what procedure can be done for tetralogy of fallot
Blalock-Taussig shunt or balloon valvuloplasty
53
Transposition of the Great arteries
aorta arises from right ventricle and main pulmonary artery from left ventricle
54
what must a neonate depend on for Transposition of the Great arteries
PDA, ASD, VSD
55
PE for Transposition of the Great arteries
central cyanosis
single S2
no murmur
56
Initial management for Transposition of the Great arteries
- PGE
| - emergent atrial septostomy (Rashkind procedure)
57
Definitive repair for Transposition of the Great arteries
arterial switch operation
58
What is always present in tricuspid atresia
ASD or PFO
59
If no VSD is present in tricuspid atresia, what is present
ventricular septum is intact
| pulmonary atresia
60
clinical sign of tricuspid atresia with intact ventricular septum and pulmonary atresia
no murmur
| single S 2
61
what does ECG show for tricuspid atresia
- Left axis deviation
| - left ventricular hypertrophy
62
Management of tricuspid atresia
1. Glenn shunt: superior vena cava is anastomosed to the right pulmonary artery
then
2. Fonton
63
Truncus arteriosus, what is always present
VSD
64
PE findings for truncus arteriosus
- systolic ejection murmur
- diastolic murmur
- high-pitched systmolic murmur
- single S2
65
Total Anomalous Pulmonary Venous Connection
pulmonary veins drain into systemic venous side rather than into left atrium
66
CXR: uptruned cardiac apex
Decreased pulmonary vascular markings
Right aortic arch
Tetralogy of Fallot
67
CXR: Small heart with narrow mediastinum
| Increased pulmonary vascular markings
Transposition of the great arteries
68
CXR: Small heart
| Decreased pulmonary vascular markings
tricuspid atresia
69
CXR: Enlarged heart
Increased pulmonary vascular markings
right aortic arch
Truncus arteriosus
70
CXR: Increased pulmonary vascular markings
| enlarged heart in older unrepaired children
total anomalous pulmonary venous connection
71
Boot shaped
Tetralogy of Fallot
72
"egg-on-a-string" apperance
Transposition of the great arteries
73
"snowman appearance"
total anomalous pulmonary venous connection
74
Most common cause of acquired heart disease in children in the United States
Kawasaki
75
Most common cause of acquired heart disease worldwide
acute rheumatic fever
76
Location of infective endocarditis
internal surface of heart
77
who usually gets infective endocarditis
- structural abnormalities of heart
| - after cardiac surgery
78
what causes infective endocarditis
- Gram positive cocci, alpha-hemolytic streptococcus
Staph species
- gram negative rarely cause it
79
what is pathophysiology for infective endocarditis after surgery
1. bacteria introduced into blood
| 2. fibrin and platelets adhere: vegetation
80
single most important laboratory test for infective endocarditis
Blood culture
81
Labs ordered for infective carditis
1. ESR elevated
2. rheumatoid factor
3. transesophageal echocardiography
82
management of infective endocarditis
1. intravenous antimicrobial therapy
83
who qualifies for infective endocarditis antibiotic prophylaxis
1. all patients with structural heart disease except secundum ASD
84
Pericarditis
inflammation of pericardial space
85
most common cause of pericarditis in children
viral infection
86
most common cause of purulent pericarditis
1. staph. aureus
| 2. strep. pneumonia
87
patients with purulent pericarditis have an high incidence of what
constrictive pericarditis
88
splinter hemorrhages
linear hemorrhages beneath the nails
89
osler nodes
small, raised pink, red, or blue swollen tender lesions on palms, soles or pads of toes and fingers
90
Janeway lesion
small, erythematous hemorrhagic lesions on palms or soles
91
Roth's spots
round or oval white spots seen in retina
92
when are symptoms intense for pericarditis
intense while supine
| relieved when sitting upright
93
pulses paradoxus
greater than 10mm Hg reduction in systolic blood pressure on deep inspiration
94
what is ESR for pericarditis
elevated
95
myocarditis
inflammation of myocardium
96
common cause of sudden death in young athletes
myocarditis
97
Myocarditis usually occurs after what
viral or flu like illness
98
Common lab findings for myocarditis
1. elevated ESR
2. creatinine kinase MB fraction
3. CRP
99
what will echocardiogram show for myocarditis
global ventricular dysfunction
100
what deficiency can cause dilated cardiomyopathy
carnitine deficiency
| Selenium and thiamine
101
most typical anatomic finding for hypertrophic cardiomyopathy
asymmetric septal hypertrophy
102
Most common cause of sudden death in atheletes
hypertrophic cardiomyopathy
103
PE for hypertrophic cardiomyopathy
harsh, systolic ejection murmur at the apex
104
Management for hypertrophic cardiomyopathy
1. beta blockers, calcium channel blockers
2. surgical myomectomy
3. antiarrhythmic medications
4. dual-chamber pacing
105
define restrictive cardiomyopathy
- rigid ventricular walls that impair normal diastolic filling
106
2 causes of restrictive cardiomyopathy
1. amyloidosis
| 2. inherited infiltrative disorders
107
Most common dysrhythmia in childhood
supraventricular tachycardia SVT
108
EKG for Wolff-Parkinson-White syndrome
delta wave
109
what maneuvers can help manage SVT
Vagal maneuvers
- valsalva
- ice pack to face
110
medication use for SVT
intravenous adenosine
111
first degree AV heart block
prolongation of PR interval
112
second-degree AV heart block: type I
Wenchkeback
| - progressive prolongation of PR interval leading to fail AV conduction
113
second-degree AV heart block: type II
abrupt failure of AV conduction without progressive prolongation of PR interval
114
third degree AV block
complete block, no conduction
115
congenital third-degree AV block is associated with children born to mother with
SLE
116
Long QT syndrome increases the risk of what
torsades de pointes
117
management of long QT syndrome
beta-blocker
118
Jervell-Lange-Nielson
austomal recessive: prolong QT
| congenital deafness
119
Romano-ward syndrome
autosomal dominant: prolong QT
120
Previous surgery 2 weeks ago, with chest pain while laying down? diagnosis
Pericarditis
121
what heart abnormality structure can cause CHF
Large VSD
122
where is venous hum heard
neck and below clavicle
