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Pediatrics Rotation > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Definition of CHF

A

inadequate oxygen delivery

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2
Q

What is the most common cause of CHF in older children and adolescents

A

Viral myocarditis

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3
Q

What is a miscellaneous cause of CHF

A

severe anemia, causes high-output CHF

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4
Q

Common symptom in newborn for CHF

A

poor feeding

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5
Q

common symptom in older children and adolescents for CHF

A

exercise intolerance

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6
Q

last clinical manifestations for CHF

A

cyanosis and shock

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7
Q

Evidence of systemic venous congestions for CHF

A

hepatomegaly and peripheral edema

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8
Q

Medical management of CHF

A
  • cardiac glycosides (digoxin)
  • loop diuretics (furosemide, ethacrynic acid)
  • inotropic medications ( dobutamine, dopamine)
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9
Q

define innocent cardiac heart murmurs

A

turbulent blood flow not caused by structural heart defect

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10
Q

What confirms anatomic lesions in acyanotic congenital heart disease

A

echocardiogram

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11
Q

Classifications for atrial septal defect

A
  1. Ostium primum
  2. Ostium secundum
  3. Sinus venosus
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12
Q

Ostium primum ASD is a common congenital heart lesion in what

A

Down Syndrome

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13
Q

What is the most common type of ASD

A

Ostium Secundum

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14
Q

What type of shunt is an ASD

A

left-to-right shunt

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15
Q

3 PE for ASD

A
  1. increased right ventricular impulse
  2. Systolic ejection murmur ( heard mid and upper left sternal borders)
  3. Fixed-split second heart sound
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16
Q

Treatment for ASD

A

closure by open heart surgery

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17
Q

What are 3 innocent heart murmurs

A
  1. Still’s murmur
  2. Pulmonic systolic murmur
  3. Venous hum
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18
Q

when is Still’s murmur loud

A
  • loudest supine

- louder with exercise

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19
Q

when is pulmonic systolic murmur loud

A
  • loudest supine

- louder with exercise

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20
Q

when is venous hum heard

A
  • heard only when sitting or standing

- disappears if supine

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21
Q

where does right pulmonary veins drain in sinus venosus

A

into right atrium or SVC instead of into left atrium

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22
Q

patients with ostium primum might develop what

A

mitral regurgitation

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23
Q

The amount of blood shunted in a VSD depends on what 2 things

A
  1. size of VSD

2. pulmonary vascular resistance

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24
Q

as the size of the VSD decreases, the intensity of the murmur

A

increases

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25
Q

besides a holosystolic murmur being heard on a moderate and large VSD, what else can be heard and where

A

diastolic murmur of mitral turbulence

- apex

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26
Q

if PVR remains elevated, pulmonary hypertension reversible

A

no

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27
Q

shunting changes from left-to-right to right-to-left

A

Eisenmenger syndrome

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28
Q

what does the PDA connect

A

pulmonary artery to aorta

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29
Q

what is used un premature infants to close PDA medically

A

Indomethacin

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30
Q

if the left-to-right shunt is large enough in PDA, what is heard

A
  • diastolic rumble across mitral valve
  • widened pulses
  • brisk pulses
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31
Q

Neonates or infants with severe coarctation may depend on what

A

PDA (right-to-left)

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32
Q

symptoms of coarctation of the heart in older children in adolescents

A
  • hypertension in right arm

- blood pressure reduced in lower extremities

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33
Q

what happens to femoral pulse in coarctation of the heart

A

dampened and delayed after radial pulse ( radiofemoral delay)

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34
Q

what valve problem is associated with coarctation of the heart

A

biscupid aortic valve

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35
Q

what initial medications are given to coarctation of the heart

A
  • intravenous prostaglandin E

- Inotropic medications

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36
Q

therapy of choice for recurrent coarctation

A

balloon angioplasty

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37
Q

other children symptoms of aortic stenosis

A
  • no symptoms

- exercise intolerance, chest pain, syncope, sudden death

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38
Q

intervention for aortic stenosis

A
  • surgery with insufficiency and 5-10 years after palliative balloon valvuloplasty
  • Ross procedure: valve replaced
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39
Q

severe pulmonary stenosis in neonate may show up as

A

right-to-left shunting

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40
Q

clinical features of pulmonary stenosis in older children

A

symptoms are absent

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41
Q

Management for pulmonary stenosis

A

balloon vavluloplasty

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42
Q

Xray shows rib notching

A

coarctation of the heart

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43
Q

most common cardiac causes of central cyanosis

A 
Tetralogy of Fallot
Transposition of great arteries
Tricuspid atresia
Truncus arteriosus 
Total anomalous pulmonary venous connection
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44
Q

Most common cause of central cyanosis

A

Tetralogy of Fallot

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45
Q

Define Tetralogy of Fallot

A
  1. VSD
  2. overriding aorta
  3. pulmonary stenosis
  4. right ventricular hypertrophy
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46
Q

which cyanotic congenital heart disease increases pulmonary flow

A
  • Transposition of great arteries
  • Total anomalous pulmonary venous connection
  • Truncus arteriosus
  • single ventricle
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47
Q

which cyanotic congenital heart disease decreases pulmonary flow

A

Tetralogy of Fallot
Tricuspid atresia
pulmonary atresia

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48
Q

what increases right-to-left shunting in tetralogy of fallot

A

exercise, vasodilation, volume depletion

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49
Q

what reduces right-to-left shunting in tetralogy of fallot

A

systemic hypertension, Valsalva maneuver

50
Q

neonates with tetralogy of fallot depend of what

A

PDA

51
Q

what is a tet spell

A

sudden cyanosis and decreased murmur intensity

52
Q

what procedure can be done for tetralogy of fallot

A

Blalock-Taussig shunt or balloon valvuloplasty

53
Q

Transposition of the Great arteries

A

aorta arises from right ventricle and main pulmonary artery from left ventricle

54
Q

what must a neonate depend on for Transposition of the Great arteries

A

PDA, ASD, VSD

55
Q

PE for Transposition of the Great arteries

A

central cyanosis
single S2
no murmur

56
Q

Initial management for Transposition of the Great arteries

A
  • PGE

- emergent atrial septostomy (Rashkind procedure)

57
Q

Definitive repair for Transposition of the Great arteries

A

arterial switch operation

58
Q

What is always present in tricuspid atresia

A

ASD or PFO

59
Q

If no VSD is present in tricuspid atresia, what is present

A

ventricular septum is intact

pulmonary atresia

60
Q

clinical sign of tricuspid atresia with intact ventricular septum and pulmonary atresia

A

no murmur

single S 2

61
Q

what does ECG show for tricuspid atresia

A
  • Left axis deviation

- left ventricular hypertrophy

62
Q

Management of tricuspid atresia

A
  1. Glenn shunt: superior vena cava is anastomosed to the right pulmonary artery
    then
  2. Fonton
63
Q

Truncus arteriosus, what is always present

A

VSD

64
Q

PE findings for truncus arteriosus

A
  • systolic ejection murmur
  • diastolic murmur
  • high-pitched systmolic murmur
  • single S2
65
Q

Total Anomalous Pulmonary Venous Connection

A

pulmonary veins drain into systemic venous side rather than into left atrium

66
Q

CXR: uptruned cardiac apex
Decreased pulmonary vascular markings
Right aortic arch

A

Tetralogy of Fallot

67
Q

CXR: Small heart with narrow mediastinum

Increased pulmonary vascular markings

A

Transposition of the great arteries

68
Q

CXR: Small heart

Decreased pulmonary vascular markings

A

tricuspid atresia

69
Q

CXR: Enlarged heart
Increased pulmonary vascular markings
right aortic arch

A

Truncus arteriosus

70
Q

CXR: Increased pulmonary vascular markings

enlarged heart in older unrepaired children

A

total anomalous pulmonary venous connection

71
Q

Boot shaped

A

Tetralogy of Fallot

72
Q

“egg-on-a-string” apperance

A

Transposition of the great arteries

73
Q

“snowman appearance”

A

total anomalous pulmonary venous connection

74
Q

Most common cause of acquired heart disease in children in the United States

A

Kawasaki

75
Q

Most common cause of acquired heart disease worldwide

A

acute rheumatic fever

76
Q

Location of infective endocarditis

A

internal surface of heart

77
Q

who usually gets infective endocarditis

A
  • structural abnormalities of heart

- after cardiac surgery

78
Q

what causes infective endocarditis

A
  • Gram positive cocci, alpha-hemolytic streptococcus
    Staph species
  • gram negative rarely cause it
79
Q

what is pathophysiology for infective endocarditis after surgery

A
  1. bacteria introduced into blood

2. fibrin and platelets adhere: vegetation

80
Q

single most important laboratory test for infective endocarditis

A

Blood culture

81
Q

Labs ordered for infective carditis

A
  1. ESR elevated
  2. rheumatoid factor
  3. transesophageal echocardiography
82
Q

management of infective endocarditis

A
  1. intravenous antimicrobial therapy
83
Q

who qualifies for infective endocarditis antibiotic prophylaxis

A
  1. all patients with structural heart disease except secundum ASD
84
Q

Pericarditis

A

inflammation of pericardial space

85
Q

most common cause of pericarditis in children

A

viral infection

86
Q

most common cause of purulent pericarditis

A
  1. staph. aureus

2. strep. pneumonia

87
Q

patients with purulent pericarditis have an high incidence of what

A

constrictive pericarditis

88
Q

splinter hemorrhages

A

linear hemorrhages beneath the nails

89
Q

osler nodes

A

small, raised pink, red, or blue swollen tender lesions on palms, soles or pads of toes and fingers

90
Q

Janeway lesion

A

small, erythematous hemorrhagic lesions on palms or soles

91
Q

Roth’s spots

A

round or oval white spots seen in retina

92
Q

when are symptoms intense for pericarditis

A

intense while supine

relieved when sitting upright

93
Q

pulses paradoxus

A

greater than 10mm Hg reduction in systolic blood pressure on deep inspiration

94
Q

what is ESR for pericarditis

A

elevated

95
Q

myocarditis

A

inflammation of myocardium

96
Q

common cause of sudden death in young athletes

A

myocarditis

97
Q

Myocarditis usually occurs after what

A

viral or flu like illness

98
Q

Common lab findings for myocarditis

A
  1. elevated ESR
  2. creatinine kinase MB fraction
  3. CRP
99
Q

what will echocardiogram show for myocarditis

A

global ventricular dysfunction

100
Q

what deficiency can cause dilated cardiomyopathy

A

carnitine deficiency

Selenium and thiamine

101
Q

most typical anatomic finding for hypertrophic cardiomyopathy

A

asymmetric septal hypertrophy

102
Q

Most common cause of sudden death in atheletes

A

hypertrophic cardiomyopathy

103
Q

PE for hypertrophic cardiomyopathy

A

harsh, systolic ejection murmur at the apex

104
Q

Management for hypertrophic cardiomyopathy

A
  1. beta blockers, calcium channel blockers
  2. surgical myomectomy
  3. antiarrhythmic medications
  4. dual-chamber pacing
105
Q

define restrictive cardiomyopathy

A
  • rigid ventricular walls that impair normal diastolic filling
106
Q

2 causes of restrictive cardiomyopathy

A
  1. amyloidosis

2. inherited infiltrative disorders

107
Q

Most common dysrhythmia in childhood

A

supraventricular tachycardia SVT

108
Q

EKG for Wolff-Parkinson-White syndrome

A

delta wave

109
Q

what maneuvers can help manage SVT

A

Vagal maneuvers

  • valsalva
  • ice pack to face
110
Q

medication use for SVT

A

intravenous adenosine

111
Q

first degree AV heart block

A

prolongation of PR interval

112
Q

second-degree AV heart block: type I

A

Wenchkeback

- progressive prolongation of PR interval leading to fail AV conduction

113
Q

second-degree AV heart block: type II

A

abrupt failure of AV conduction without progressive prolongation of PR interval

114
Q

third degree AV block

A

complete block, no conduction

115
Q

congenital third-degree AV block is associated with children born to mother with

A

SLE

116
Q

Long QT syndrome increases the risk of what

A

torsades de pointes

117
Q

management of long QT syndrome

A

beta-blocker

118
Q

Jervell-Lange-Nielson

A

austomal recessive: prolong QT

congenital deafness

119
Q

Romano-ward syndrome

A

autosomal dominant: prolong QT

120
Q

Previous surgery 2 weeks ago, with chest pain while laying down? diagnosis

A

Pericarditis

121
Q

what heart abnormality structure can cause CHF

A

Large VSD

122
Q

where is venous hum heard

A

neck and below clavicle

Pediatrics Rotation (19 decks)

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