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Peds > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What % of kids will have a murmur at some point in their lives?

A

90%

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2
Q

What % of murmurs in children actually represent pathology?

A

<5%

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3
Q

What are some buzz words for describing an innocent murmur?

A

V’s: Very Good
Vibratory
Venous hum
Vascular (Carotid bruit)

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4
Q

What in the history should make you think of a pathological murmur?

A

Any associated physiological problem

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5
Q

Name some findings on history that would point away from an innocent murmur

A
  1. Tachypnea
  2. Exercise intolerance
  3. Feeding difficulties
  4. Dyspnea
  5. Cyanosis
  6. Syncope
  7. Wheezing/Cough
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6
Q

What are some descriptions of a murmur that should make you think pathological?

A
  1. Harsh sounding
  2. Intensity >3/6
  3. Pansystolic or late systolic
  4. Diastolic
  5. 4th heart sound or S4 gallop
  6. Ejection and/or mid-systolic clicks
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7
Q

What is the first thing to do if they describe a 3rd heart sound?

A

Check the position of the child

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8
Q

If you hear a 3rd heart sound in what position is it normal versus not?

A

If laying down, can be normal- Should disappear when sitting- if not, could be abnormal

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9
Q

Fixed split S2?

A

ASD

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10
Q

Patient with decreased exercise tolerance and a fixed split S2?

A

ASD

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11
Q

Where is the VSD murmur best heard?

A

Left lower sternal border

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12
Q

Blowing/Holosystolic murmur?

A

VSD

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13
Q

True or False: Infants with VSDs typically do not have a murmur in the immediate newborn period?

A

True

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14
Q

Why doesn’t an infant with a VSD have an audible murmur?

A

Right/left ventricular pressures are roughly equal in newborn period so no interventricular flow to create a murmur

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15
Q

When is a VSD murmur louder- with a smaller opening or larger one?

A

Smaller (more turbulance)

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16
Q

Baby with tachypnea, sweating with feeds, hyperdynamic precordium…?

A

Watch out for VSD (may not have murmur)

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17
Q

Systolic click and normal splitting of S2?

A

Pulmonary stenosis

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18
Q

What changes to the heart happen with pulmonary stenosis?

A

RVH

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19
Q

Systolic (ejection) click, regardless of position?

A

Aortic stenosis

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20
Q

Murmur best heard at the upper right sternal border and radiating into the neck?

A

Aortic stenosis

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21
Q

What changes to the heart happen with aortic stenosis?

A

LVH

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22
Q

To-and-fro machinery-type murmur?

A

PDA

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23
Q

What condition should you think of with an AV canal defect?

A

Down Syndrome

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24
Q

What axis is seen in an AV canal defect?

A

Superior QRS axis (30-90degrees)

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25
Q

Why does an AV canal defect have a superior QRS axis?

A

Conduction system has to go around the large defect in the middle of the heart

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26
Q

What axis deviation is seen in AV canal defect?

A

LAD

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27
Q

What should a right-sided aortic arch make you think of?

A

22q11 deletion

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28
Q

What axis deviation on EKG does LVH lead to?

A

LAD

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29
Q

Does hypertrophic cardiomyopathy that results in LVH lead to left axis deviation on EKG?

A

No

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30
Q

What are 2 scenarios where you can see left axis deviation without left ventricular hypertrophy?

A
  1. Tricuspid atresia
  2. AV canal defects

Due to effect on conducting system’s orientation

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31
Q

True or False: CHF presents the same in infants and older children

A

False

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32
Q

How does CHF in infancy present?

A

Difficulty feeding, weight loss or failure to gain weight, tachypnea, tachycardia, hepatomegaly

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33
Q

What should you think with an infant that is small, sweaty, surly, and sick?

A

CHF

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34
Q

How does CHF present in older children?

A

Fatigue (especially with exertion or exercise), poor appetite, coughing, shortness of breath, diaphoresis

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35
Q

What are clinical scenarios where you would see systemic arteriovenous shunting of blood?

A

AV malformation in brain or liver

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36
Q

What does systemic arteriovenous shunting of blood result in?

A

Left to right extracardiac shunting which leads to right sided congestion

  • Blood goes from high pressure (arterial) to low pressure (venous)
  • Causes volume overload on right side of heart leading to jugular vein distension and hepatomegaly
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37
Q

What are some physical exam findings of CHF?

A
  1. Gallop rhythm
  2. Distended jugular veins
  3. Peripheral edema
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38
Q

What treatments are preferred for CHF?

A

Ones that rest the heart:

  1. Diuretics
  2. Vasodilators
  3. Beta-blockers

Over inotropes (Dignoxin) that overexert the heart

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39
Q

What is the murmur with coarctation?

A

Systolic murmur with radiation to the back and an early diastolic component

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40
Q

Name 3 classic findings of coarctation

A
  1. Murmur (systolic, radiates to back, early diastolic)
  2. Systolic HTN
  3. Decreased perfusion/pulses in lower extremities
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41
Q

What is the classic description for BP with coarctation?

A

> 10mmHg difference in BP between arms and leg (brachial/femoral pulse delay)

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42
Q

What are some findings you might be presented with for coarctation?

A
  1. Classic signs of CHF
  2. Shock
  3. Acidosis
  4. Lethargic infant not feeding well
  5. Non-specific gallop
  6. Nasal flaring
  7. Sweating while feeding
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43
Q

What is the main goal of treatment of coarctation?

A

Maintain PDA with a prostaglandin drip (increases blood flow to descending aorta)

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44
Q

How is coarctation ultimately treated?

A

Surgery

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45
Q

True or False: After coarctation correction, re-occurance and HTN can occur

A

True

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46
Q

Does coarctation in newborns present with right or left ventricular hpertropy?

A

Right (RV is dominant pumping chamber in fetus)

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47
Q

When do infants with hypoplastic left heart present?

A

When PDA closes

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48
Q

How does hypoplastic left heart present?

A

Severe CHF (after PDA closes), cardiomegaly, precordial hyperactivity, loud S2

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49
Q

10 day old newborn, tachypneic, thready pulses, enlarged liver, ABG with metabolic acidosis…. what medication do you start?

A

Prostaglandin E1 (hypoplastic left heart)

-Presents with picture of cardiogenic shock

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50
Q

Describe the murmur with hypoplastic left heart

A

There isn’t one- PDA is open, but pulmonary and aortic pressures are equal so no turbulance across the patent ductus

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51
Q

What are 2 important tests to get in a child with cardiogenic shock?

A

EKG and ECHO

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52
Q

What should you think with a newborn with hypoxemia whose O2 sat doesn’t improve with 100% O2?

A

Cardiac disease (vs. pulmonary)

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53
Q

What are infants with cyanotic heart disease and polycythemia at risk for?

A

CVA

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54
Q

What are the 3 causes of severe cyanosis in the immediate newborn period?

A
  1. Transposition
  2. Pulmonary atresia
  3. Ebstein malformation
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55
Q

Which 3 conditions will presents with central cyanosis, no respiratory distress, no significant murmur, and fail to correct with 100% O2?

A
  1. Transposition
  2. Pulmonary atresia
  3. Ebstein malformation
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56
Q

What is the first thing to do for an infant with transposition, pulmonary atresia, or Ebstein malformation?

A

PGE1 (maintain PDA)

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57
Q

What can present similarly to transposition/pulmonary atresia/Ebstein, but will improve with O2 administration?

A

Persistent pulmonary HTN of the newborn

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58
Q

True or False: If an infant is anemic, they may not show signs of cyanosis on PE?

A

True (even with O2 sats around 88%)

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59
Q

Why might you not see cyanosis in an infant until O2 sats are quite low?

A

Because infants have high fetal Hbg levels

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60
Q

5 T’s of cyanotic congenital heart disease?

A
  1. Truncus Arteriosus
  2. Transposition of the Great Arteries
  3. Tricuspid Atresia
  4. Tetrology of Fallot
  5. Total Anomalous Pulmonary Venous Return
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61
Q

Of the 5 T’ which presents with severe cyanosis in the first few hours of life?

A

Transposition (the others turn blue after PDA closes

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62
Q

Infant with good APGARs, pink/well-perfused initially. Day 1-2 of life becomes cyanotic, tachypneic. CXR has no increased vascular markings?

A

Ductal Dependent Lesions

  • Cyanotic with closing PDA (decreased mixing at level of PDA)
  • Lack of increased vascular markings rules out pulmonary disease
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63
Q

How are ductal dependent lesions treated?

A

Prostaglanding- Maintain PDA

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64
Q

None of the 4 pulmonary veins is attached to the left atrium?

A

TAPVR

-Oxygenated blood leaving lungs returns to RA and then back to lungs

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65
Q

What must be presents for TAPVR to be compatible with life?

A

Connection from R heart to L (ASD/VSD/PDA)

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66
Q

How does TAPVR present?

A

Full term infant

  1. Increased right ventricular activity
  2. Cyanosis
  3. Hypoxia
  4. Hypercarbia
  5. Pulmonary edema
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67
Q

What are findings on CXR consistent with TAPVR?

A
  • Pulmonary congestion (increased venous return)

- Normal to small heart

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68
Q

What is seen on ABG with TAPVR?

A

Increase PCO2

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69
Q

What pulmonary problem can TAPVR present similarly to?

A

RDS- With a full term baby, consider TAPVR first (even though RDS can occur in full term infants)

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70
Q

What is the valve between RA and RV?

A

Tricuspid

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71
Q

What is Ebsteins’ anomaly?

A

Abnormality of the Tricuspid valve leaflets

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72
Q

What 2 drugs can cause Ebsteins’ anomaly?

A

Lithium or Benzos

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73
Q

4 components of TOF?

A
  1. Pulmonary stenosis
  2. Overriding aorta
  3. VSD
  4. RVH with RAD on EKG
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74
Q

What is the overall most common cyanotic heart condition?

A

TOF

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75
Q

What is the most common cyanotic heart condition in newborns?

A

Transposition of the great arteries

TOF most common overall, but not usually present in the newborn period

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76
Q

How do kids with TOF present?

A

Palpable right ventricular impulse

Single 2nd heart sound (pulmonary component absent)

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77
Q

What does EKG demonstrate in TOF?

A

RVH

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78
Q

What is seen on CXR for TOF?

A

“Boot-Shaped” heart with decreased pulmonary vascularity

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79
Q

When does TOF typically present?

A

Infant 3-5 months

Often asymptomatic in early infancy

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80
Q

What 2 things are kids at risk for after surgery for TOF?

A
  1. Arrhythmias

2. Episodes of syncope

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81
Q

What happens during a tet spell?

A

Increased right to left shunting causes hypercyanosis and hypoxia

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82
Q

What are common triggers for tet spells?

A

Anemia and dehydration

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83
Q

Describe what the child does during a tet spell?

A

Turn blue, deep rapid respiratory pattern (hyperpnea)

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84
Q

What is found on cardiac exam during a tet spell?

A

Murmur disappears… Usually they have a systolic murmur

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85
Q

What are 4 factors that worsen cognitive prognosis in children with cyanotic heart disease?

A
  1. Decreased neurological baseline before surgery
  2. Seizures occurring after surgery (especially early)
  3. Coexistent problems (chromosomal abnormality)
  4. Duration of intraoperative circulatory arrest (>75 min makes for worse prognosis)
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86
Q

What is a clue you will see when describing a classic tet spell?

A

Acute onset

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87
Q

What is treatment for a tet spell?

A
  1. Squatting position or knee to chest (increase peripheral vascular resistance)
  2. Morphine
  3. Phenylephrine
  4. IV propranolol
  5. Volume expansion
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88
Q

When should elective repair of TOF be completed?

A

In the first postnatal year

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89
Q

What is transposition?

A

Aorta connected to right ventricle and pulmonary artery to the left ventricle

Two circulations in parallel

90
Q

What is the most common congenital heart defect presenting with severe cyanosis in the first week of life?

A

Transposition of the great arteries

91
Q

Where does blood have to mix in transposition to be compatible with life?

A

Either at the foramen ovale (atrial level) or PDA

“Ductal Dependent”

92
Q

What should you think with a cyanotic newborn?

A

Transposition

93
Q

How do infants with transposition present?

A

Cyanosis, tachypnea, single 2nd heart sound

94
Q

What is seen on CXR with transposition?

A
  • Egg-shaped heart (this can be absent in 1st week of life)

- Increased pulmonary vascularity

95
Q

What does S2 represent on heart exam?

A

Closure of the aortic and pulmonic valve

96
Q

Can you have a normal split S2 with cyanotic heart disease?

A

Not really- this essentially rules this out

97
Q

What do you think if they mention a single S2?

A

Concern for cyanotic heart disease

Need prostaglandin

98
Q

When do you see a fixed split S2?

A

ASD

99
Q

True or False: TOF and transposition both present with a single 2nd heart sound?

A

True

100
Q

Which presents with increased pulmonary vascularity, TOF or transposition?

A

Transposition

101
Q

How is transposition treated?

A
  1. IV prostaglandin E1- Maintain PDA
  2. Balloon septostomy (to maintain ASD- if above doesn’t work)
  3. Ultimately surgical correction
102
Q

When is a differential O2 saturation seen between arms and legs?

A

Transposition

103
Q

Which saturation is higher in transposition, legs or arms?

A

Legs

  • Upper extremities dependent on RV
  • Lower extremities dependent on LV (via duct)
104
Q

What cardiac findings are seen in DiGeorge?

A

Aortic arch defects

105
Q

What cardiac findings are seen in Downs?

A

AV canal defects

106
Q

What cardiac findings are seen in Marfans?

A

Aortic root dissection

MVP

107
Q

What cardiac findings are seen in Williams?

A

Supravalvular aortic stenosis

108
Q

What cardiac findings are seen in Noonans?

A

Supravalvular pulmonic stenosis

109
Q

What cardiac findings are seen in Turners?

A

Coarctation of the aorta

110
Q

Anxious patient with tachycardia which has occurred on more than one occasion?

A

Sinus tachycardia

111
Q

When can sinus tachycardia be appropriate?

A

When it is secondary in cases of infection and dehydration

112
Q

What are 2 examples of when sinus tachycardia is pathologic?

A
  1. Hyperthyroidism

2. Pheochromoytoma

113
Q

True or False: A cardiac echo is routinely done in infants with atypical physical features even with a normal initial cardiac exam.

A

True

114
Q

True or False: Most of the time, PACs are benign?

A

True

115
Q

What are 3 things that can cause PACs?

A
  1. Caffeine
  2. Drug use
  3. Electrolyte imbalances
116
Q

What 2 situations should you worry about PACs progressing to Atrial Flutter?

A
  1. Digoxin

2. Children under 1

117
Q

Saw tooth waves

A

Atrial flutter or Atrial fibrillation

118
Q

What is a sinus arrhythmia?

A

Normal variation in the heart rhythm caused by breathing

Common in healthy, normal children

119
Q

Shortened PR interval and/or delta wave (distorts QRS upstroke)?

A

WPW

120
Q

What arrhythmia are kids with WPW at risk for?

A

SVT

SVT can be a presenting sign of WPW on exam

121
Q

What does the QT interval represent?

A

The time it takes the heart muscle to recover between beats

122
Q

Why is a prolonged QT so dangerous?

A

When a new beat starts before the old beat as had time to end can lead to serious arrhythmias

123
Q

What should family history of sudden death make you think of?

A

Prolonged QT syndrome

124
Q

Previously healthy person who has unexplained syncope?

A

Prolonged QT syndrome

125
Q

Syncope associated with emotions (sudden fright) or surprise (alarm clock going off)?

Vs. Exercise

A

Prolonged QT syndrome

126
Q

Syncope that is followed by a seizure (syncope happens first then the seizure)?

A

Prolonged QT syndrome

127
Q

Child collapses/is resuscitated after passing out in a pool. Family member with history of epilepsy and sudden death. What test do you do?

A

EKG- Long QT

Congenital long QT syndrome is caused by a variant of V-tach and can result in brief generalized seizures

128
Q

Recurrent episodes of syncope usually with standing for prolonged periods of time. No family history of sudden death in anyone under 50 or other premature cardiac disease. Diagnosis?

A

Neurocardiogenic syncope

Not prolonged QT- no family history

129
Q

Athletic teenage boy, 2 episodes syncope during practice. Not dehydrated, drug screen negative, no known family history of cardiac arrhythmia, no known history of sudden death in anyone under 50. Management?

A

Cardiology consult, no sports until cleared by cards, get more family history (no “known” history)

Could be congenital long QT syndrome.. key is history of syncope during exercise (as opposed to occurring with prolonged standing)

130
Q

What is the most common symptomatic arrhythmia in children?

A

SVT

131
Q

How might infants present with SVT?

A

Fussy and tachypneic

132
Q

What might an older child with SVT complain of?

A

Chest pain

133
Q

What is considered SVT?

A

Narrow complex tachycardia over 200-220

134
Q

What is the first thing you do in a stable patient with SVT (HR over 220)?

A

Get a 12 lead EKG

135
Q

What can be done to correct SVT in a stable patient?

A

Vasovagal maneuvers: Brief facial stimulation (cold, wet cloth, ice bag), want to induce the diving reflex that normally slows down the heart

136
Q

What is the drug to use for SVT?

A

Adenosine

137
Q

What type of pacing can be used in SVT?

A

Atrial overdrive pacing

138
Q

If you give adenosine for SVT and it works, but the SVT returns right after adenosine is given, what do you use?

A

IV diltiazem

139
Q

What do you do for an unstable patient with SVT?

A

Adenosine immediately… if IV adenosine isn’t available, use cardioversion

140
Q

When medication is sometimes used in the long term management of children with SVT?

A

Digoxin

141
Q

What syndrome is the use of Digoxin contradicted in?

A

WPW

142
Q

What drug is not indicated for SVT in children (especially younger than 1) because it can cause cardiac arrest?

A

Verapamil

143
Q

What is it called when the P waves and the QRS complexes are working independently of each other?

A

AV block

144
Q

In AV block which is more concerning… a widened QRS complex or narrow one?

A

Widened… blood flow to brain can be compromised resulting in risk for seizure and syncope

145
Q

What is often seen in Mom’s of kids with a 3rd degree heart block?

A

SLE

146
Q

What can AV block be associated with?

A

Viral myocarditis

147
Q

What is 3 or more continuous wide QRS complexes with abnormal or absent P waves?

A

Ventricular tachycardia

148
Q

What is the rate in V-tach?

A

120-150 bpm

149
Q

What are 3 symptoms of V-tach?

A
  1. Pallor
  2. Fatigue
  3. Palpitation
150
Q

True or False: Majority of patients with VT have underlying heart disease?

A

True

151
Q

What is the most likely cause of VT with loss of consciousness?

A

Torsades de pointes VT

152
Q

What is the treatment of choice for sustained VT longer than 30 seconds?

A

Synchronized cardioversion

153
Q

What is seen in history for rheumatic fever?

A
  1. Pharyngitis

2. URI

154
Q

What labs are seen with rheumatic fever?

A
  1. Elevated ESR
  2. Elevated CRP
  3. Elevated ASO titer
155
Q

What is found on physical exam for rheumatic fever?

A

Migratory arthritis of large joints, emotional lability, purposeless rapid movements of extremities, muscle weakness (Syndenham’s chorea)

-Joint pain and a new heart murmur

156
Q

What are 2 two most common murmurs in rheumatic fever?

A
  1. Mitral insufficiency

2. Aortic insufficiency

157
Q

What are the requirements to meet Jones criteria for Rheumatic fever?

A
  1. Proof of recent group A strep infection

2. 2 major symptoms or 1 major/2 minor symptoms

158
Q

New murmur with mild congestive heart failure?

A

Aortic regurgitation (think rheumatic fever)

159
Q

What is the most common murmur in rheumatic fever?

A

Mitral valve regurgitation

160
Q

What is the description of a mitral valve regurgitation murmur?

A

Murmur heard best at the apex

161
Q

True or False: A positive throat culture distinguishes chronic carrier state from a recent infection?

A

False

162
Q

True or False: A negative rapid strep doesn’t rule out a recent infection?

A

True

163
Q

What test can provide definitive documentation of a recent strep infection when trying to diagnose rheumatic fever?

A

ASO titers and positive streptozyme (these correlate very well with a recent strep infection)

164
Q

What are the major Jones criteria?

A
  1. Joints: Polyarthritis
  2. Heart: Carditis (CHF, new murmur, cardiomegaly)
  3. Nodules (subcutaneous)
  4. Erythema marginatum
  5. Sydenham chorea
165
Q

What % of cases of rheumatic fever have polyarthritis?

A

75%

166
Q

Describe the nodules seen in rheumatic fever.

A

Firm, painless, extensor surfaces of wrists, elbows, and knees

167
Q

What is sydenham chorea?

A

Rapid, purposeless movements of the face and upper extremities

168
Q

What are minor Jones criteria?

A
  1. Fever
  2. Arthralgia
  3. Elevated acute phase reactants (ESR, CRP)
  4. Prolonged PR interval

Help- Hot (fever), Elevated (CRP/ESR), arthraLgia, Prolonged (PR)

169
Q

True or False: Asthralgia is a major Jones critera?

A

False: Arthritis is major, arthralgia is minor

170
Q

Describe the arthritis seen in rheumatic fever.

A

Migratory

171
Q

Which joints are involved in arthritis seen in rheumatic fever?

A

Larger joints: Knee, ankle, elbow, wrist

172
Q

How long do episodes of arthritis with rheumatic fever typically last?

A

From a week up to a month

173
Q

What is the rash seen in rheumatic fever?

A

Erythema marginatum

Don’t mix up with erythema migrans (Lyme)

174
Q

What are the 3 treatment goals for rheumatic fever?

A
  1. Eliminate Group A strep infection
  2. Alleviate symptoms
  3. Prophylaxis to prevent recurrence
175
Q

What do you use to eliminate strep infection in rheumatic fever?

A

Penicillin

This does alter disease course, this is empiric

176
Q

What is used for prophylaxis for rheumatic fever?

A

Penicillin

177
Q

What is used to treat migratory arthritis and somewhat fevers seen in rheumatic fever?

A

ASA

178
Q

What treats carditis seen in rheumatic fever?

A

Steroids (controversial for mild carditis)

179
Q

What is used to help with chorea in rheumatic fever?

A

Haldol

180
Q

What is used to treat heart failure seen with rheumatic fever?

A

Digoxin

181
Q

What is an infection of the endocardial surface of the heart, usually involving the valves called?

A

Infective endocarditis

182
Q

What are 2 major risk factors for infective endocarditis?

A
  1. Congenital heart disease (repaired or not)

2. Dental work

183
Q

What are some factors in the history that you would see with infective endocarditis?

A
  1. Unexplained fever
  2. Hepatosplenomegaly
  3. Petechiae
  4. New or changing murmur
  5. Myalgias
  6. Arthalgias
  7. Headaches
  8. Generalized malaise
184
Q

What are Osler nodes?

A

Tender nodules on the pads of fingers and toes

185
Q

What are non-tender red nodules on the palms or soles?

A

Janeway lesions

186
Q

What is the best study to confirm diagnosis of infective endocarditis?

A

Blood culture (have to isolate pathogen in blood)

187
Q

What are the 2 most common causes of acute bacterial endocarditis in children?

A
  1. Viridans strep

2. S. Aureus

188
Q

What is the initial IV antibiotic regimen for infectious endocarditis?

A

Vancomycin plus gentamicin for minimum 4-6 weeks

189
Q

Who is routine antibiotic prophylaxis for dental work to prevent infectious endocarditis indicated for?

A

Patients with congenital heart disease and…

  1. Incompletely repaired cyanotic heart disease (especially shunts and other hardware)
  2. Heart disease surgically corrected with hardware and other devices within previous 6 months
  3. Any residual defect near a prosthetic cardiac device
190
Q

What antibiotics are used for dental prophylaxis with concern for infectious endocarditis?

A

Oral amoxicillin 50mg/kg 30-60 minutes prior to procedure

191
Q

What is given for dental prophylaxis with concern for infectious endocarditis in a child with a penicillin allergy?

A

Clindamycin or azithromycin

192
Q

What is typically seen in the recent history of myocarditis?

A

Viral illness (like a recent URI)

193
Q

What is often described on exam for myocarditis?

A

A new murmur

194
Q

Name some symptoms of myocarditis.

A
  1. Fatigue
  2. Lethargy
  3. Tachypnea
  4. Tachycardia
  5. Chest pain
  6. Shock
  7. CHF
  8. Pulmonary edema
  9. Arrhythmias
  10. Death
195
Q

What is the most common cause of myocarditis?

A

Coxsackie group B virus

196
Q

What is the treatment for myocarditis?

A

Supportive

Steroids are controversial

197
Q

What is inflammation of the pericardial sac, typically involving the epicardium and pericardium?

A

Pericarditis

198
Q

What are some causes of pericarditis?

A

Viral (URI) or collagen vascular disease (JIA) are more common. Can also be due to bacteria.

199
Q

When pericarditis is caused by bacteria, what is it usually due to?

A

Preceding or concurrent bacterial infection somewhere else (like a pneumonia)

200
Q

What is the most common bacterial cause of pericarditis?

A

S. Aureus

201
Q

How can a definitive cause of pericarditis be obtained?

A

Cardiocentesis to get a sample for serology and cultures

202
Q

What position do children with pericarditis prefer?

A

Leaning forward

203
Q

What is heard on auscultation in pericarditis?

A

Friction rub

204
Q

What is seen on EKG in pericarditis?

A

ST segment elevation

205
Q

What are some other symptoms of pericarditis?

A

Non-specific chest pain or epigastric pain

206
Q

What are 2 exam findings besides the friction rub that can be seen in pericarditis?

A

Low grade fever, jugular venous distention

207
Q

What is an important part of the history to get when concerned for pericarditis?

A

If there is an underlying rheumatological disorder

208
Q

Chest pain worse when lying down, ST segment elevation, muffled heart sounds?

A

Pericarditis

209
Q

What is the most important study to order when pericarditis or effusion is suspected?

A

CXR

210
Q

What is pulsus paradoxus?

A

Drop of systolic BP more than 10mmHg seen with inspiration

211
Q

What condition is pulsus paradoxus seen in?

A

Pericardial effusion, tamponade, pericarditis, some cardiomyopathies, severe asthma

212
Q

How might a child with a pericardial effusion present?

A

Chest pain and general malaise

213
Q

What is the finding on CXR in pericardial effusion?

A

Enlarged heart

214
Q

Does a child with a pericardial effusion have clinical heart failure?

A

No… even though they have an enlarged heart on CXR

215
Q

What is seen on ECHO in pericardial effusion?

A

Pericardial fluid

216
Q

What is called when a pericardial effusion builds up enough pressure to compromise cardiac output?

A

Cardiac temponade

217
Q

What are signs of cardiac tamponade?

A
  1. Tachypnea
  2. Rales
  3. Pulsus paradoxus
  4. Muffled heart sounds
  5. JVD
  6. Hepatomegaly
  7. Peripheral edema
  8. Hypotension
218
Q

What % of chest pain is cardiac in origin?

A

Less than 1

219
Q

What is chest pain that is cardiac in origin often described as?

A

Pain that radiates to the neck, back, shoulders, or left arm. Pain that is constant/frequent, dull, pressure-like, associated with exercise.

220
Q

What is the likely cause of chest pain that is infrequent and brief or sharp that increases with a deep breath?

A

Musculoskeletal or pleuritic pain

221
Q

Name 7 cardiac causes of chest pain in children.

A
  1. Pericarditis/Myocarditis
  2. Aortic stenosis and severe pulmonic stenosis
  3. Anomalous origin of coronary arteries
  4. Mitral valve prolapse
  5. Kawasaki disease
  6. Arrhythmias (SVT and VT)
  7. IHSS

Peds (35 decks)

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