Cardiology Flashcards
1
Q
Congenital disorders that can result in CHF
A
- Increased pulmonary blood flow
- Obstructive lesions
- AV malformations
- Mitral or tricuspid regurgitation
2
Q
Acquired heart disorders that can result in CHF
A
- Viral myocarditis
- Endocarditis
- Pericarditis
- Metabolic disease (eg hypothyroidism)
- Medications (eg doxorubicin)
- Cardiomyopathies
- Ischemic diseases
- Dysrhythmias (tachycardia and bradycardia)
3
Q
Miscellaneous causes of CHF
A
- Severe anemia (high-output CHF)
- Rapid infusion of IV fluids, esp in premature infants
- Obstructive processes of the airways (enlarged tonsils or adenoids, laryngomalacia, CF - may cause CHF as a result of chronic hypoxemia that results in right sided heart failure)
4
Q
Clinical features of CHF
A
- Tachypnea
- Cough
- Wheezing
- Rales
- Pulmonary edema on CXR
- Tachycardia
- Sweating
- Pale or ashen skin color
- Diminished urine output
- Enlarged cardiac silhouette
- Hepatomegaly
- Peripheral edema
- Failure to thrive
- POOR FEEDING (common in newborns)
- Exercise intolerance
- Cyanosis and shock (late manifestations)
5
Q
Innocent cardiac murmurs
A
- Result from turbulent blood flow and are NOT caused by structural heart disease and have no hemodynamic significance
- Up to 50% of children
- INCLUDE: Still’s murmur, pulmonic systolic murmur/ systolic ejection murmur, venous hum
6
Q
Still’s murmur
A
- Ages 2-7
- Mid-left sternal border
- Grade 1-3
- Systolic
- Vibratory, twanging, or buzzing
- Loudest supine
- Louder with exercise
7
Q
Pulmonic systolic murmur/ systolic ejection murmur
A
- Any age
- Upper left sternal border
- Grade 1-2
- Peaks early in systole
- Blowing, high-pitched
- Loudest supine
- Louder with exercise
8
Q
Venous hum
A
- Any age
- Neck and below clavicles
- Continuous murmur
- Heard only sitting or standing
- Disappears if supine; changes with compression of the jugular vein or with neck flexion or extension
9
Q
Classifications of ASDs
A
- Ostium primum
- Ostium secundum
- Sinus venosus
10
Q
Ostium primum
A
- Defect in the lower portion of the atrial septum
- A cleft, or divison, in the anterior mitral valve leaflet may also be present and may cause mitral regurgitation
- Common in Trisomy 21
11
Q
Ostium secundum
A
- Defect in middle portion of the atrial septum
- Most common type of ASD
12
Q
Sinus venosus
A
- Defect high in the septum near the junction of the right atrium and SVC
- Right pulmonary veins usually drain anomalously into the right atrium or SVC instead of into the left atrium
13
Q
Physical exam findings of ASD
A
- Increased right ventricular impulse as a result of right ventricular overload
- Systolic ejection murmur (from excessive pulmonary blood flow) best heard at mid and upper left sternal borders (a mid-diastolic filling rumble representing excessive blood flow through the tricuspid valve may also be heard)
- Fixed split second heart sound because of the excessive pulmonary blood flow, the normal physiologic variation in timing of the aortic and pulmonic valve closure with respiration is absent
14
Q
VSD classification
A
By location - inlet, trabecular (muscular), membranous, and outlet (supercristal)
15
Q
Clinical features and course of small VSDs
A
- Little to no shunt across the VSD
- May close spontaneously
- Thrill at the lower left sternal border and a grade 4 high pitched holosystolic murmur
16
Q
Clinical features and course of moderate VSDs
A
- May have a large shunt across the VSD that may result in signs and symptoms of CHF
- Holosystolic murmur
- If 2:1 pulmonary to systemic flow, then a diastolic murmur of mitral turbulence (mitral filling rumble representing the excess blood from the lungs now passing through the mitral valve) may be heard at apex
17
Q
Clinical features and course of large VSDs
A
- Often cause signs and symptoms of CHF
- Less turbulence across the VSD so systolic murmur is shorter and lower in pitch
- Mitral filling rumble may be heard at the apex
18
Q
Large VSDs are associated with a high incidence of
A
Pulmonary infections from excessive blood flow
19
Q
Indications for surgical closure of VSDs
A
- Heart failure refractory to medical management
- Large VSDs with pulmonary hypertension are usually surgically closed at 3-6 mo of age
- Small to moderate VSDs are usually surgically closed between 2 and 6 years of age
20
Q
Symptoms of small PDAs
A
Usually produce no symptoms
21
Q
Symptoms of moderate and large PDAs
A
Generally result in signs and symptoms of VHF due to increased pulmonary blood flow
22
Q
Clinical features of neonates or infants with severe coarctation
A
- Depend on a right to left shunt through the PDA for perfusion of the lower thoracic and descending aorta
- May be minimally symptomatic initially, but symptoms of CHF develop and progress as PDA closes
- BP may be elevated in the upper extremities and low in the lower extremities before the onset of CHF
- Once CHF develops, pulses in all 4 extremities are poor, any murmur is absent and hypotension may develop
23
Q
Clinical features of older children or adolescents with coarctation
A
- May have no symptoms and may have only hypertension or a heart murmur
- HTN is typically noted in the right arm and BP is reduced in the lower extremities
- Femoral pulse, which normally precedes the radial pulse is dampened and delayed until after the radial pulse (radio-femoral delay)
- BP and pulse findings may be less prominent if collateral vessels (intercostal arteries) develop that allow the ascending aortic pressure and flow to circumvent the coarctation
- Bicuspid aortic valve or aortic stenosis is present in 50% of patients
- Bruit of turbulence through the coarctation may be audible at the left upper back near the scapula
24
Q
Initial management of coarctation
A
- Directed at improving circulation to the lower body
- IV prostaglandin E (PGE) is given urgently to open the ductus arterioles
- Inotropic medications are given to overcome myocardial depression and low dose dopamine is used to maximize renal perfusion and function
25
In the neonate, severe aortic stenosis may be associated with
Hypoplasia of the left ventricle as a result of impaired fetal left ventricular development
26
Clinical features of neonates with severe aortic stenosis
- Critical aortic stenosis
| - Normal at birth, but develop signs and symptoms of CHF at 12-24 hours of age
27
Clinical features of older children with aortic stenosis
- Generally, no symptoms
| - Once severe, symptoms include exercise intolerance, chest pain, syncope, and even sudden death
28
Peripheral cyanosis
Caused by vasomotor instability or vasoconstriction as a result of cold temperature
29
Central cyanosis
Attributable in both cardiac and non cardiac causes, it is esp apparent in the tongue and inner mucous membranes:
- Non-cardiac: pulmonary disease, sepsis, hypoglycemia, polycythemia, and neuromuscular diseases that impair chest wall movement
- Cardiac: Tetralogy of Fallot, transposition of the great arteries, tricuspid atresia, truncus arterioles and total anomalous pulmonary venous connection
30
Most common cause of central cyanosis presenting beyond the newborn period
Tetralogy of Fallot
31
Physical exam findings of transposition of great vessels
- Central cyanosis
- Quiet precordium
- Single S2 (because the aortic valve is anterior and the pulmonary valve is posterior in TGA, the closure of the pulmonary valve is difficult to hear)
- No murmur
32
What is always present in tricuspid atresia
An ASD or PFO
