Cardiology Flashcards
1
Q
Hypertension
A
- BP consistently above 95% of age, gender, height on 3 separate occasions
- essential: multifactorial -> diuretics, vasodilators, beta blockers, ace inhibitors never first line**
- secondary: usually renal vascular
- hypertensive emergencies: IV calcium channel blockers
2
Q
Murmurs
A
- described by: intensity (grading I-VI), timing (systolic vs diastolic), location, radiation/transmission, quality
- innocent murmurs accentuated by high output states (fever, illness, anemia)
- *Still’s murmur: low frequency, LLSB when supine, quiet or gone when upright**, louder with illness/anemia/excitement, common ages 3-6yr
- pulmonary ejection murmur: LUSB, mid systolic, grating sound without radiation
- peripheral pulmonic stenosis: LUSB, common in newborns (caused by turbulent flow through hypoplastic PA branch after ductus closes), usually gone by 3-6mo
- venous hum: turbulent jugular venous flow, continuous murmur, heard only when upright
3
Q
Rheumatic fever
A
- collagen vascular disease of connective tissue –> vasculitis 2-4wks after a Strep A pharyngitis**
- arthritis, carditis, chorea, erythema marginatum, sub cutaneous nodules, progressive valve damage
- diagnosis based on Jones Criteria** 2 major or 1 major and 2 minor (arthralgia, fever, elevated ESR & CRP, prolonged PR)
- mgmnt: penicillin, aspirin, bedrest –> prevention with penicillin prophylaxis
4
Q
Long QT syndrome
A
- usually not diagnosed until child has cardiac event or family history
- treatment with beta blockers and possibly ICD/ defribillator
5
Q
Valvular stenosis
A
- mitral stenosis: commonly caused by rheumatic fever, LA enlargement, a-fib, pulmonary edema —>frequent pulm infections and apical murmurs
- aortic stenosis: sub-valvar, moderate LVH –> CHF, harsh loud mid-systolic murmur that radiates to neck
6
Q
Myocarditis
A
- acute infection/inflammation of myocardium from viral infection –> sudden cardiac failure with murmur, gallop or arrhythmia, tachycardia, elevated troponin and BNP
- supportive care: digoxin, ace inhibitors, diuretics, IVIG
7
Q
Pericarditis
A
- inflammation of pericardium –> fever, tachycardia, friction rub, tamponade symptoms, cardiomegaly, ST elevation, PR depression
- management with pericardiocentesis and ABX for 3-4 weeks for presumed staph and hflu
8
Q
Endocarditis
A
- acutely septic presentation –> fever, murmur, emboli phenomenon, petichiae, vasculitis, Osler nodes
- *strep: PCN, rocephin, vanco
- *enterococci: ampicillin
- *staph aureus: nafcillin
- 6 months of ABX
9
Q
Cardiomyopathies
A
- 3 types: dilated (most common), hypertrophic, restrictive
- dilated: systolic dysfunction, LA/LV affected, decreased contractility, poor function –> beta blockers
- restricted: atrial diastolic dysfunction, walls of ventricle stiff, preload dependent *** (avoid diuretics and beta blockers)
- hypertrophic obstructive cardiomyopathy: autosomal dominant –> ace inhibitors, beta blockers, intropes, vasodilators, diuretics, **preload dependant volume restriction - treatment of arrhythmia with cardiomyopathy is amiodarone –> can cause hyper/hypothyroidism, thyroid crisis, liver dysfunction
- SOB, CHF, fatigue, lethargy, decreased appetite, exercise intolerance –> echo with decreased CO and global function, EKG with sinus tach, prolonged PR, ST wave changes, hypertrophy
10
Q
Atrial septal defect
A
- acyanotic (flow left to right), often asymptomatic and close spontaneously, widely split fixed** S2 grade 2-3/6
- can have device closure (at risk for migration)
11
Q
Ventricular septal defect
A
- acyanotic (flow left to right), most common**
- regurgitant harsh holosystolic murmur
- enlarged LA, CHF, pulmonary hypertension with lg defects
12
Q
AV canal
A
- acyanotic (flow left to right), associated with t21
- ASD, inlet VSD, abnormal AV valve formation** –> FTT, CHF, tachypnea –> surgery around 6 months of age
13
Q
PDA
A
- acyanotic (flow left to right), common in preterm infants
- continuous machinery like murmur, CHF, tachycardia, tachypnea, bounding pulses, widened pulse pressure –> surgically ligated
14
Q
CHF management
A
-diuretics, digoxin, afterload reducers (enalapril), anticoagulants, maximize nutrition
15
Q
Transposition of the great vessels
A
- cyanotic defect (right to left shunting)
- aorta rises from RV/ PA arises from LV–> desaturated blood returns from lungs to RA and out to body, oxygenated blood returns from LA to PA –> parallel circulation** not compatible with life, need ASD or VSD (may need to create), PFO not large enough - balloon septostomy and prostaglandins , presents with cyanosis without respiratory distress
- treatment is arterial switch (moving coronary arteries***) –> need LV support post op
