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RC: Specialties Woo Hoo > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Pulsus Paradoxus

A

decrease BP > 8-10mmHg in inspiration

DDX: tamponade, asthma, constrictive pericarditis, pericardial effusion

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2
Q

Pulsus Bigeminus

A

= two heartbeats close together followed by pause

DDX: HOCM, dig toxicity, low thyroid

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3
Q

Atrial Fibrillation DDX

A 
PIRATES
PE
Ischemia
MR
Anemia
Thyrotoxicosis
Toxins
Electrolytes
Sepsis, Stimulants
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4
Q

Name 3 Cyanotic CHD + Low pul blood flow

A 
"To-Tri"
TOF
Tricuspid Atresia
TR
Ebstein Anomaly
TAVPR w/ obstruction
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5
Q

IDM Hypertrophic Cardiomyopathy Tx

A

Spontaneous resolution.

If symptomatic (Resp, CO, HF) then support (i.e. propranolol).

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6
Q

Fetal pO2

A

25-30 mmHg

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7
Q

% Asymptomatic PFO in Adults

A

15-25

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8
Q

LVH Findings on ECG

A 
LAD
V1= S Deep Big + wide
V6= (R'R= R big)
V5-V7= Deep Q waves
V5-V7= ST depression, T wave inversion
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9
Q

RVH Findings on ECG

A

RAD
V1= rSR’ (big R’)
V1-V3= abnormal T orientation (upright)
V6= S wave Deep + Big

Remember R big first (V1) given ‘R’ in RVH.

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10
Q

T21 with previous CHD repair. 2 considerations for diff Sx:

A

R/O pul HTN
R/O undx/residual heart dx
R/O other T21: cervical spine instability, upper airway obstruction, heme imbalance, CBC (Fe) etc.

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11
Q

Familial Hypercholesterolemia Mngmt

A
  1. HMG-CoA reductase inhibitors (Statins)
  2. Ezetimibe (block cholesterol absorption from gut)
  3. LDL aphaeresis from blood
  4. Liver transplant
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12
Q

Indomethacin/Indocid AE

A
  1. Low plt function (GI bleed, IVH)
  2. NEC
  3. Transient renal insufficiency
  4. Spontaneous GI perforation
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13
Q

First line med for HF

A

Diuretics; Furosemide most commonly used.

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14
Q

Cyanotic Heart Disease: Murmur or not?

A

NOT. Most have murmur and no distress.

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15
Q

Name 3 Cyanotic with increased pulmonary volume

A

“The Great-Trunk”

TGA
Truncus Arteriosus
Single Ventricle
TAPVR w/o obstruction

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16
Q

Name cyanotic heart lesions

A
  1. Truncus arteriosus
  2. Tricuspid Atresia
  3. Total anomalous pulmonary venous return
  4. TOF
  5. TGA

Other: 2 A’s
- Pulmonary Atresia
- Ebstein Anomaly
Other: Critical PS/ AS, Critical Coarc., Hypoplastic L Heart Syn

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17
Q

CXR: Egg on String

A

TGA

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18
Q

to-and-fro murmur (systole + diastole)

A

Truncus Arteriosus

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19
Q

CXR: Boot Shaped

A

TOF

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20
Q

CXR: small heart with pulmonary venous congestion (snowman)

A

TAPVR

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21
Q

4 Parts of TOF

A

PROV

  1. Pulmonary atresia/RV outflow tract obstruction
  2. RVH
  3. Overriding Aorta
  4. Large VSD
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22
Q

What is a truncus arteriosus

A

dilated aorta overriding a large VSD

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23
Q

CXR for TAPVR

A

Snowman

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24
Q

How does Hypoplastic Left Heart Syn (HLHS) present?

A

Cardiogenic shock (i.e. 3 d old when PDA closed)

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25
Q

Cardiac Assoc. W/ Williams Syn

A

Supravalvular AS

Williams: elfin, friendly, DD, high Ca2+

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26
Q

Cardiac Assoc. W/ Marfan

A

Mitral Valve Proplapse

Aortic Root Dilation

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27
Q

Tricuspid atresia has normal CXR.

A

Sorta true +/- decreased pulmonary vasculature (dependent on if associated PS)

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28
Q

Prolonged RV Ejection in ASD Causes…

A

Fixed split S2.

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29
Q

TGA vs. Trun Arter. P/E difference.

A

“The Great Trunk”
Both single S2
TGA: no murmur
Trunc Art: (+) murmur

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30
Q

4 Complications PGE1

A
  1. Fever
  2. Apnea
  3. Hypotension
  4. Tachycardia
  5. Flushing
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31
Q

Vibratory Murmur =

A

Still’s Murmur

  • 2-6 yr commonly
  • vibratory
  • LLSB to apex; NO back
  • loud supine, quiet standing
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32
Q

Peripheral Pul Stenosis Murmur =

A

high pitched grade 1-2, base of heart and radiate to axillae and back

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33
Q

Supraclavicular Bruit=

A

low pitch brief SEM at clavicle and radiate to neck. Gone with hyperextending shoulders. No click (which is why not AS)

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34
Q

Venous Hum

A

3-8 y.o.
Roaring Continuous murmur
By clavicles
Loud when sitting

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35
Q

Pt with ASD have fixed split S2 due to:

A

prolonged RV ejection

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36
Q

For Fun: Split S2 DDX

A

ASD
Severe PS
TAPVR
RBBB

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37
Q

Still vs. Venous Hum

A

Still: LLSB, vibratory
Venous: Clavicular, Continuous, gone supine

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38
Q

4 Flags for Cardiac Syncope

A
  1. No prodrome
  2. Mid-exertion
  3. prolonged LOC (>5 min)
  4. Fright/startle induced
  5. Associated CP, palpitation
  6. (+) Hx heart dx
  7. New med with potential cardiotoxicity
  8. Fhx sudden death, long QT
  9. AbN cardiac P/E
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39
Q

Viral, Disproportionate Tachy, HF symptoms +/- Rash =

A

Viral myocarditis

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40
Q

Friction Rub=

A

Pericardial Effusion (i.e. Think Pericarditis)

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41
Q

Gallop=

A

Myocarditis

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42
Q

Cardiac Tamponade Beck Triad

A
  1. JVP distension
  2. Muffled Heart Sounds
  3. HYPOtn for age
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43
Q

Diffuse ST elevation

A

Pericarditis

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44
Q

Myocarditis ECG

A

non specific

  • sinus tachy
  • ventricular hypertrophy
  • low QRS voltage
  • inverted T waves
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45
Q

Abx Prophylaxis for Infective Endocarditis (IE)

A
  1. Previous IE
  2. Unprepared cyanotic congenital heart dx (including palliative shunt and conduit)
  3. Prosthetic valve
  4. Within 6 mo. of completely repaired congenital heart defect w/ prosthetic material or device
  5. Repaired congenital heart dx w/ residual defect at or adjacent to site of prosthetic patch
  6. Cardiac transplant w/ valvulopathy
  7. Rhematic heart dx (if prosthetic material used in repair)
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46
Q

What Abx Prophylaxis for IE to Give

A

Amox single dose 1h before (to 2h after) procedure

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47
Q

Dental prophylaxis needed for what dental procedures

A
  1. Gingival tissue manipulation

2. Oral mucosa perforation

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48
Q

True or False: You do not need GI/GU IE ABX prophylaxis

A

TRUE

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49
Q

Common Bacterial IE (list w/e you know)

A
  1. Strep viridians
  2. Staph aureus
  3. Enterococcus (Strep bovis or faecalis)
  4. HACEK= Haemophilus influenzae, Acetinobacillus, Cardiobacterium hominis, Eikenella corrodens, Kingella species
  5. IVDU= pseudomonas aeurginosa, Serratia marcescens
  6. Immunosuppressed, Neo= fungal
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50
Q

Infect. Endo. Pathological Dx

A

Microorganism (Cx or Histology)

OR pathologic lesion via histology showing active IE

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51
Q

Name of Clinical Diagnosis Criteria for Infect. Endo

A

Duke Criteria.

2 major
OR 1 major + 3 minor
OR 5 minor

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52
Q

Name the Duke Criteria. What Does it Dx.

A

Dx: Infective Endocarditis

Major:

  1. (+) BCX for typical bug in 2 sep. Cx.
  2. (+) Endocardial involvement on echo.

Minor:

  • predisposing PMHX (i.e. cardiac dx, IVDU)
  • fever
  • vascular: conjunctival hemm, intracranial hemm, arterial emboli, septic pul infarct, janeway lesion
  • immunologic: Roth spots, Osler nodes, GN, (+) RF
  • bugs (single Cx)
  • echo (not major criteria)
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53
Q

List four clinical signs of Endocarditis

A
  1. Fever
  2. New or change in murmur
  3. Conjunctival hemorrhage
  4. Janeway Lesion (painless on finger + soles)
  5. Roth spot (hemm w/ pale centre)
  6. Osler nodes (painful + pad on finger or soles)
  7. Splinter hemorrhages
  8. Petechiae
  9. Signs of HF (rales, edema)
  10. Hematuria
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54
Q

Most common IE complication

A

Congestive Heart Failure

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55
Q

List diagnostic criteria for KD

A

“Crash and Burn”

Fever for min. 5 d
+ 4 of 5
1. Conjunctiva
- b/l non purulent injection
2. Rash (NOT vesicle, bullae, petechial)
3. Adenopathy
- cervical; min. 1.5cm diameter; mostly unilateral
4. Strawberry Tongue
/red crack lips, +/- red oral & pharynx mucosa
5. Hands (Palms + Soles)
- red & edema; periungal desquamation in subacute

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56
Q

Incomplete KD Def’n

A

Fever 5 d + 2 or 3 criteria OR infant with fever min. 7d without explanation

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57
Q

2 B/W if Incomplete KD

A

CRP (min. 3 suggestive)

ESR (min. 40 suggestive)

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58
Q

KD BW findings.. list any.

A
  1. high CRP, ESR
  2. WBC > 15
  3. Anemia
  4. Plt > if after 7th day of fever
  5. Hypoalbumin
  6. ++ ALT
  7. Urine sterile pyuria
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59
Q

Describe Pompe Disease.

A
  • glycogen storage dx
  • AR
  • CC: in first 5 mon
  • big tongue
  • CHF
  • hepatomegaly
  • hypotonia
  • ECG: huge QRS + short PR
  • die before 2nd y.o. unless enzyme replacement (Myozyme)
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60
Q

4 week old with CHF. Huge voltage on ECG, short PR. Hypotonic, weak, HSM and large tongue.

A

Pompe Disease.

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61
Q

List meds w/ long QT.

A
  1. Abx- clarithro/ erythro/ azithro, TMP/Sulfa, fluroquinolone
  2. Antidepressant- TCA (imipramine), amitriptyline (Elavil)
  3. Antipsychotic (haldol, risperidone)
  4. Ondansetron
  5. Antifungal
  6. Diuretics (Lasix= low K)
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62
Q

Pulseless Electrical Activity. Which drug?

A
  1. 1 mL/kg

1: 10 000 IV/IO Epi

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63
Q

CPR qualities

A
  1. hard + fast= push min. 1/3 anterior-posterior diameter; min. 100 bpm
  2. rotate every 2 min.
  3. If no advanced airway 15:2; advanced airway then continuous with breath 8-10 per minute
  4. avoid interruption
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64
Q

VF/VT arrest.

A 
= Shockable Rhythm
CPR immediately
1. Shock= 2J/kg
2. IV access
3. R/A
4. Same Shockable Rhythm
5. Shock= 4 J/kg
6. Epi= 1:10K 0.1mL/kg
Consider advanced airway
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65
Q

Cardiac Arrest: Asystole/PEA

A 
= Unshockable Rhythm
CPR immediately
1. IV access
2. Epi 1:10K 0.1mL/kg
Consider advanced airway
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66
Q

How do you know if asynchronous or not?

A

No palpable pulse= Asynchronous.

Pulse= Synchronous.

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67
Q

Signs of SVT and Tx

A
  1. Hx (nonspecific; abrupt change)
  2. Invariable HR (infant usually 220+; kids 180+)
  3. P wave absent/abN

Tx: Adenosine 0.1mg/kg rapid bolus (max 6mg)

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68
Q

Neonatal Goitre. What anti-arrhythmic is mom on?

A

Amiodarone.

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69
Q

Bradycardia PALS Drug options

A
  1. Epinephrine

2. Adenosine

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70
Q

V TACH w/ a pulse. PALS drug options.

A

Monomorphic= Amiodarone.

If ever w/out pulse = Epi -> Amiodarone or Lidocaine

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71
Q

Two things for SVT in stable child.

A
  1. Vagal maneuver (ice, valsalva, breath holding, bear down)

2. Adenosine (keep code blue cart nearby as can initiate afib)

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72
Q

SVT + unstable. What do you do?

A

Synchronized DC conversion (1J/kg first; then 2J/kg)

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73
Q

Hyperkalemia ECG Findings.

A
  1. Tall peaked T waves.
  2. Prolonged PR
  3. Disappearing P waves
  4. Wide QRS
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74
Q

Treatment of Hyperkalemia

A
  1. Calcium gluconate
  2. Sodium bicarb (if acidosis)
  3. Insulin + Glucose
  4. Inhaled salbutamol
  5. Ion exchange resin (Kayexelate)
  6. Furosemide
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75
Q

Neonate with complete heart block. List causes.

A
  1. Maternal SLE
  2. Maternal Sjogren Syn
  3. Structural: ASD, Post VSD closure, Myocardial Tumour
  4. Myocarditis
  5. Genetic Association (i.e. Long QT Syn).
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76
Q

Single S2 Association. Name Two.

A
  1. TGA
  2. Pulmonary Atresia
  3. Aortic Atresia.

Single S2= aorta more anterior.

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77
Q

Congenital Cyanotic Dx
Pan systolic Murmur
ECG: RAD

A

TOF

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78
Q

HF in Teenager

A

Acquired likely.

  1. Myocarditis
  2. Cardiomyopathy.
  3. Infective Endocarditis (acquired valvular dx)
  4. Other Non-Structural
    - HTN, KD, Anemia, Hypothyroidism, Muscular Dystrophy
  5. Structural
    - R side pressure: severe PS
    - L side pressure: severe AS, coarc
    - Vol L-R: VSD
    - Vol from valve: AR, PR
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79
Q

DOL 2. Hydrocephalus + CHF.

A

Vein of Galen Aneurysm.

Neo w/ AV malformation ppt with HF + progressive hydrocephalus or sz. Dx: Murmur over cranium + Head imaging.

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80
Q

What is the Vein of Galen Aneurysm?

A

NICU + CHF + Hydrocephalus.

Murmur over cranium.

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81
Q

Which virus associated with increased risk of nec fasciitis?

A

Varicella

82
Q

When to discontinue PALS resus?

A
  1. Usually within 30 min. should see spontaneous circulation efforts as unlikely to survive after 2 doses of epi.

UNLESS recurrent VT, VF, toxic exposure, hypothermia.

83
Q

Hypothermia and when to d/c resus.

A

When core temp < 30= CPR continues.

  1. Rewarm until 32-34C
  2. If no effective rhythm then may D/C. Don’t have to complete rewarm to stop.
84
Q

RF for Atherosclerosis. List 4.

A
  1. HTN
  2. Obesity (abdo fat pad esp)
  3. DM
  4. FHX premature coronary artery dx (hyperlipidemia familial dx)
  5. Smoking
  6. Other: Physical inactivity, homocysteine dx, lipoprotein dx.

Risk Factors for Coronary Artery Dx:

  1. Male
  2. Low BW
  3. LGA
  4. Hyperlipidemia
  5. HTN
  6. DM (1 or 2)
  7. Smoking
  8. Obesity
  9. FHX (CAD, premature MI/stroke, PVD)
85
Q

% of population with congenital heart disease

A

1-2%

86
Q

List CHD with maternal DM:

A

HOCM
PDA
VSD

87
Q

List CHD with maternal lupus:

A

heart block
cardiomyopathy
myocarditis

88
Q

List CHD with FASD:

A

VSD
ASD
PDA

89
Q

List CHD with T21:

A

AVSD (most classic)
VSD (most common)
ASD
TOF

90
Q

List CHD with Turner Syndrome:

A

Coarctation

Bicuspid Ao. Valve

91
Q

Noonan CHD:

A

Pul Stenosis

Hypertrophic cardiomyopathy

92
Q

What are pathologic murmurs?

A
  1. Diastolic
  2. Grade 3-6
  3. Click, thrill, gallop
  4. No change with position
    (usually benign if louder w/ inspiration or supine)
93
Q

What causes diastolic murmurs?

A
  1. Aortic or pul insufficiency (descrendo)

2. Mitral/tricuspid stenosis (mid-diastolic rumble)

94
Q

When is a Holter useful?

A
  1. correlate symptoms w/ ECG changes
  2. follow response to med
  3. follow pacemaker f’n
95
Q

When is exercise testing helpful?

A

Heart functional assessment

96
Q

T or F: cardiothoracic ratio > 0.5 is normal

A

False.

NORMAL= Cardio/Entire thoracic diameter < 0.5 (0.6 if newborn)

97
Q

How do you interpret an ECG?

A
  1. Rate: 300-150-100-75-60-50
  2. Rhythm
    - p for every QRS
    - QRS for every P
    - P wave axis normal (upright I, II, AvF)
  3. Axis
    - I and AVF point twd= R
    - I and AVF opposite= Left
  4. P wave
    - Tall (>3)= RA big
    - Wdie (>3)= LA big
  5. PR
    - PR> 3= 1st
    - 2nd - type 1= progression w/ dropped beat and sinus beat return w/ shorter PR
    - 2nd- type 2= drop
    - 3rd= no relation btwn P + QRS
  6. Delta wave= WPW
  7. QRS
    < 3 box
    RBBB= RAD, (V1) MoRRoW (V6)
    LBBB= LAD, (V1) WiLLiaM(V6)
  8. QTc= QT/square root (RR)
  9. ST
    - normal up to 1mm
    - diffuse up= pericarditis, myocarditis, pericardial effusion
    - local ST= coronary ischemia
  10. T wave
    - 0-7 DOL= T up V1
    - 7d-7 y.o.= T inverted V1
    - teen= T upright in V1
  11. U wave
98
Q

Describe WPW ECG findings:

A
  1. Delta wave
  2. Short PR followed by wide QRS

WPW= Wolf-Parkinson-White
- cut through conduction pathway (bundle of Kent)

99
Q

What type of axis does AVSD have?

A

Left or northwest

100
Q

ASD commonly has what ECG finding?

A

RBBB pattern in V1

101
Q

Hypokalemia ECG findng

A

Flat T wave (or U wave)

102
Q

First questions if QRS wide on ECG?

A

QRS: Narrow or Wide

  • Wide= V-Tach
  • also consider WPW
  • Narrow= Look at P/QRS ratio
    1:1= SVT or AVNRT
    p>QRS Reg= Flutter
    p>QRS chaotic= Fib
    p>QRS variable= Ectopic tachy
103
Q

Which supra ventricular tachycardia has slow to start and slow to cool down tachycardia?

A

Atrial ectopic tachy

vs. sudden= AVNRT, AVRT

104
Q

In which patients do you see a-flutter or a-fib?

A

Post-op CHD

105
Q

First line long-term treatment for supra ventricular tachycardia?

A

Beta blocker.

If resistant can try others or radio ablation.

106
Q

Why do we worry about WPW?

A

You have 1:1 with atrial fibrillation= high rate= syncope and risk of sudden death

107
Q

If you see atrial fibrillation what associated condition do you always look for on ECG?

A

WPW

= Delta Waves!

108
Q

List causes of ventricular tachycardia?

A

“CHILL KLM”

  • CHD
  • Idiopathic VT
  • Long QT
  • Lytes= ++ K, low Mg
  • Myocarditis
  • Arrhythmogenic RV dysplasia
109
Q

How do you manage ventricular tachycardia?

A

ABC- PALS
Etiology
Acute: *amiodarone, lidocaine
Chronic: amiodarone, defibrillator, ablation

110
Q

List two reasons for PAC and PVC:

A

PAC: stimulant, caffeine, hypoxia, hyperthyroid

PVC: *hypoxia, cardiomyopathy, lytes, cardiac tumours

111
Q

When do I care about PVC’s?

A
  • underlying CHD
  • polymorphic
  • > 100 in 24 hour
  • pmhx or fhx of sudden death or syncope
112
Q

What causes CHF:

A

L-R shunt: VSD, AVSD, ASD, PDA

Cardiomyopathy (dilated, hypertrophic, restrictive)

Obstructive:

  • coarc
  • interrupted Ao. arch
  • hypoplastic L heart
  • Ao. stenosis
113
Q

CHF Management

A
  • Rest as needed
  • Diet: more calories (120% nutritional intake)
  • Low Na not recommended routinely
  • Tx any specific cause (i.e. SVT, anemia, low thyroid)
  • Med Tx: Lasix q6h
  • If structural- grow until big enough for Sx
114
Q

CHF: 2’s of what

A 
2 tachy + megaly
= tachy HR
= tachy RR
= cardiomegaly
= hepatomegaly
115
Q

Name causes of CHF per pop’n:

  • Fetus
  • Neonate
  • Infant/Toddler
  • Child
  • Teen
A

Fetus:

  • severe anemia (hemolysis, fetal-materal transfusion)
  • SVT

Prem: PDA, fluid ++

1st week: HLH (d3-5), severe AS, Coarc (d7-10), SVT > 24h

week 2-6:

  • L-R: VSD, AVSD
  • L obstructive: Coarc, AS
  • KD

Kid: PUMP

  • Viral myocarditis (RF, Endocarditis, Arrhythmia)
  • Cardiomyopathy (acute HTN, cor pulmonate)
116
Q

When does the PDA functionally versus anatomically close?

A 
Functional= 24-48h
Anatomy= 4-6 wk
117
Q

Most common type of ASD?

A

Secundum (50-70%) (around PFO)

> Primum (inferior part)

> Sinus Venous (superior)

118
Q

ECG of ASD?

A

Right ++

= RAD, RA enlargement, RVH, incomplete RBBB

119
Q

Close ASD if:

A
  1. symptomatic
  2. CHF
  3. +++ pul pressure
  4. volume load RV
  5. big (>8mm)
  6. sinus venosus ASD (superior location)
120
Q

List 3 complications of ASD:

A
  1. pul HTN (in 30s-40s)
  2. arrhythmia (Afib, flutter- in 40-50s)
  3. stroke (rare)
  4. CHF (rare)
121
Q

Most common CHD?

A

VSD

122
Q

When does CHF with VSD present

A

3-4 weeks of age

  • CHF
  • FTT
  • high RR
  • 3/6 pan systolic murmur at LLSB
123
Q

Child with large VSD get better at 6-9 mon. and quieter. Why is there no murmur anymore?

A
  • PUL HTN

- Not because it closed, large do not close on own (vs. 80% small muscular do)

124
Q

What is an unrestricted VSD?

A

When RV pressure= LV pressure b/c VSD very large

125
Q

Optimal time for VSD Sx

A

4-6 mo. old

Sx patch

126
Q

Contraindication for VSD Sx?

A

Pulmonary HTN

127
Q

Baby presents with shock at 2 wks of age. List three categories to think of:

A
  1. Sepsis
  2. Cardiac- critical coarc, AS, hypo plastic LH
  3. Metabolic-
128
Q

All F babies with coarctation must be screened for:

A

Turner’s syndrome.

129
Q

Most common congenital cardiac anomaly associated with Coarc:

A 
Hypoplastic arch 
OR
Bicuspid Aortic Valve
OR 
VSD
130
Q

Older child with HTN. Which Cardiac lesion must you R/O and how?

A

Coarc.

  • HTN
  • Arm/leg BP gradient (worry if > 20)
  • femoral pulses
  • ECG: LVH
131
Q

List two CXR findings of coarc in newborn and older kids.

A

Newborns= CHF:

  • cardiomegaly
  • pul edema

Older=

  1. Rib notching
  2. 3 sign
132
Q

List complications of coarc Sx:

A
  1. Rebound HTN
  2. Aortic Aneurysm
  3. Re-coarc
  4. Aortic dissection
133
Q

Hypo plastic Left Heart usually presents how?

A

Cardiogenic shock
@4-7d due to PDA closure.

Acyanotic

134
Q

HLH Sx?

A

Norwood-Fontan

135
Q

Most common cyanotic lesion of childhood

A

TOF

136
Q

Which syndrome do you think of w/ TOF

A

DiGeorge

CATCH-22
C: cardiac (aortic arch, TOF)
A: abN facies (small jaw, funky ears)
T: thymic aplasia (T cell related)
C: cleft palate
H: hypoCa (no PTH= low Ca, high phosphate, low PTH)
137
Q

Tell me the difference btwn Pink vs. Blue TET

A

RVOT obstruction

little RVOT= PINK
- balanced shunt across VSD, more signs of CHF

++ RVOT= BLUE
- pul Q depend on PDA but as close you have severe cyanosis and R-L shunt

138
Q

What is a tet spell?

A 
R-L shunt +++
- crying, agitated
= more RVOTO
= more R-L shunt across vSD
= less Pul Q
= systemic hypoxemia + acidosis
= further aggravate RVOTO
= if profound cyanosis  =sycnope
139
Q

How do you treat a txt spell?

A
  1. ABC
    - O2 (lower PVR)
    - +/- Bolus
  2. Knee to chest to squat (increase BP to reduce R-L shunt)
  3. Reduce HR/ obstruction
    - morphine (Sedate)
    - cool
    - beta blocker
    - phenylepinephrine
140
Q

TOF ECG findings

A

RAD

RVH

141
Q

Untreated TOF at risk for:

A
  1. cerebral thrombosis (if < 2 and why avoiding dehydration and Hct ++ key)
  2. bacterial endocarditis
  3. brain abscess (if > 2)
142
Q

Primary repair for TOF

A

4-6 month

Early Sx w/ PGE if severe

143
Q

Most common TOF complications post-op

A
  1. Residual RVOTO/ VSD

2. Pul Valve Regurg

144
Q

Most common cyanotic lesion in newborns?

A

TGA

  • RF: gDM, M sex
145
Q

Single S2 + no murmur + cyanosis at birth

A

TGA

146
Q

Why do you want to do TGA Sx repair within 2 week of life?

A
  • LV mass reduce over 1st week of life as pulmonary pressure decrease
  • if try Sx later LV mass and pressure reduced = LV can’t generate enough pressure to pump blood through high pressure systemic circulation
  • so if present > 4 week do PA band to re-condition LV and then arterial switch
147
Q

What is acute Rhematic fever? (lay terms)

A

systemic immune dx that develop after infection w/ streptococcus bacteria (usually GAS)

148
Q

What types of infections does Group A streptococcus infection produce?

A

Suppurative

  • Pharyngitis
  • Tonsillitis
  • Impetigo
  • Cellulitis
  • Pneumonia etc.

Non-Suppurative

  • ARF
  • Acute PSGN
  • Meningitis
  • TSS
  • Nec Fas
149
Q

What is usually the first symptom of ARF?

A
  • arthritis (large joint, migratory)
150
Q

List symptoms of ARF:

A
  • large joint migratory arthritis
  • pericardial rub or murmur
  • jerky movements (chorea)
  • small nodule or bump under skin (subcut nodules)
  • rash (erythema marginatum)
  • fever
151
Q

What is the name of ARF Criteria:

A

Jones Criteria.

2 major or 1 major + 2 minor

152
Q

How do you meet criteria for ARF:

A

Jones Criteria

Evidence of GAS infection+

2 major
OR 1 major + 2 minor

153
Q

What are the Jones Criteria?

A

Recent strep (Cx, rapid, ASOT)

Major:
J= Joints= polyarthritis
O= other= pancarditis (affect valves first)
N= Nodules subcut
E= Erythema Marginatum
S= Sydenham chorea
Minor: ABC FPR
Arthralgia
B= BW (WBC, ESR, CRP)
F= Fever
Previous ARF
PR prolonged
154
Q

How do you treat ARF?

A
  1. Arthritis: pred or ibuprofen
  2. CHF
    - diuretics, nutrition
    - +/ Sx if severe
    - carditis= pred until BW normal
  3. Nodules + Rash self resolve
  4. Chorea
    - haldol
    - Na valproate
  5. Infection
    = Pen G
  6. Prophylaxis
    to avoid recurrent cardiac dx
    - pen V daily
    - generally ~x 5 year or until 21 y.o. (which ever longer)
155
Q

Which pt do you check BP on in appointments?

A
  1. min. 3 y.o.
  2. < 3 IF
    - prem
    - CHD
    - renal dx
    - solid organ transplant
    - CA
    - tx w/ drug that raises BP
    - other assoc. illness (NF, TS)
    - ICP signs
156
Q

How do you check BP

A
  • auscultation
  • sit x 5 min
  • cuff cover 2/3 of arm
  • cuff cover 80-100% of circumference
157
Q

How many measurements do you need to dx BP?

A

3

158
Q

Defined HTN stages:

A

** old definition**

preHTN: 90-94% tile for ht, wt, gender
Stage 1: 95th to 99%+5
Stage2: > 99% +5 (usually assoc. w/ secondary causes)

159
Q

What is a HTN crisis/emergency?

A

symptomatic elevated BP + evidence of end-organ damage (brain/encephalitis, eye, kidney/AKI, HF)

vs. urgency= acute severe but no target organ damage

160
Q

Common cause of secondary HTN in prem

A
  • umbilical a. catherization

- renal a. thrombosis

161
Q

Common causes of secondary HTN in pre-teen

A
  • renal dx (GN, congenital anomaly, reflux)
  • coarc
  • pheo, cushing
162
Q

List conditions associated w/ chronic HTN in kids:

A
  • Renal: chronic pyelo, GN, congenital dysplastic kidney, multi cystic kidney etc.
  • Vascular: coarc, renal artery lesion (stenosis, fibromuscular dysplasia, thrombosis), umbilical a. cath, NF
  • Endo: pheochromocytoma, hyperaldosteronism (Conn= low K), Cushing (+++ steroid), hyperthyroid, hyperparathyroid, CAH
  • CNS: mass, hemorrhage, following brain injury, OSA
  • Drugs:
    OCP, nasal decongestant, immunosuppressant, steroid use
163
Q

T or F: primary HTN more common than secondary in adolescence

A

True

164
Q

When do you start drugs in HTN?

A
  • symptomatic (H/a, vomiting, vision, encephalopathy)
  • end-organ damage
  • stage 2
  • secondary HTN cause
  • stage 1 w/ DM (T1, T2)
  • stage 1 + failed 4-6 wks lifestyle change
165
Q

General HTN drug to consider

A

ACEI (enalapril, captopril)
- good for DM, cautious for RF (watch K, Cr)

*Contraindicated in renal artery stenosis.

166
Q

List 2 Primary and secondary causes of hyperlipidemia:

A

Primary= inherited

  • Familial Hypercholesterolemia
  • Familial Combined Hypercholesterolemia

Secondary

  • up cholesterol= *hypothyroid, *nephrotic, cholestasis, *cyclosporine
  • up TG= obesity, *T2DM, *cushing, hepatitis, steroids
  • reduce HDL= smoking, *obesity, T2 DM
167
Q

What’s the most common gene mutation associated with CAD in adults?

A

Heterozygous Familial Hypercholesterolemia

  • very high cholesterol in kids should prompt screen
168
Q

Who gets screened for hyperlipidemia?

A

Fasting lipid panel between 2-10 y.o. if meet 1 of:

  • FHX (premature dx)
  • missing fhx but RF (obesity, HTN, smoking, DM)
  • DM>5 or 12 y.o.
  • high cholesterol
169
Q

First line treatment for dyslipidemia?

A

6 month of lifestyle modification.

  • Diet: fruit, veg, whole grain, low fat dairy
  • Activity: 60 min. mod-big play daily

If fail= drug= statin 1st line. Contraindicated if pregnant.

  1. Bile acid sequestration (cholestyramine)
  2. Niacin
170
Q

Two AE to look Statin (why we do BW)

A
  1. Myositis (CK)

2. Hepatitis (AST, ALT)

171
Q

How is Marfan syndrome inherited?

A

AD (fibrillin mutation)

172
Q

List some features of Marfans

A
  • ectopia lentis (superior subluxation)
  • pneumothorax
  • aortic root dilation
  • mitral valve prolapse
  • pectus excavatum
  • scoliosis
  • arm/ht ratio > 1
  • long finger
  • joint laxity (thumb sign, wrist sign)
  • pes plenus
  • lax skin
173
Q

Two cardiac conditions associated with Marfan Syndrome.

A
  1. Mitral valve prolapse.

2. Aortic root dilatation

174
Q

low pitch SEM + fixed S2

A

ASD

175
Q

SEM radiate to neck

A

AS

176
Q

SEM radiate to back

A

PS, PDA, coarc

177
Q

high pitch short systolic murmur at LLSB

A

small VSD

MR

178
Q

When are you at risk of Torsades de Pointes?

A
  1. Long QT syn
  2. Hypomagnesia

Torsade de Pointes= Polymorphic VT

179
Q

What is the difference between Jervell and Lange Nielsen Syndrome and Romano-Ward Syn for Long-QT?

A

J and L-N:

  • AR
  • sensorineural hearing loss

Romano-Ward

  • AD
  • more common
  • cardiac only
180
Q

List Lytes that cause Issues

A

Long-QT= LOW

  • low K
  • low Ca
  • low Mg
181
Q

Classic ppt of long-QT syndrome?

A

Syncope w/ exercise, fright, startle

182
Q

Normal QTC

A

Boy: < 0.45
Girl: < 0.47

183
Q

First line med for long-QT syndrome?

A

Beta blocker

*always make sure not acquired (meds, lytes)

184
Q

T or F: length of QTC predict sudden cardiac death.

A

TRUE

185
Q

WPW at risk of:

A
  1. SVT
  2. Syncope
  3. Sudden death
186
Q

ECG: LAD.
Association:

A
  1. AVSD
  2. Small RV (tricuspid atresia)
  3. Noonan
187
Q

When do you given Plaivizumab ( monoclonal IgG antibody against RSV) to kids with CHD?

A

< 1 y.o.
w/ cyanotic CHD
or hemodynamically significant CHD (requiring med)

  • 5 doses throughout season; can give any time after OR too
  • don’t forget about flu (if > 6 mo.) + regular immunization
188
Q

List two complications to be aware of if prompt says Fontan procedure:

A
  1. Protein losing enteropathy.
  2. Plastic Bronchitis (productive cough)

Note: Fontan part of single functional ventricle as 2nd Sx (2-4 yr).

189
Q

Broad System based DDX for cyanotic newborn

A
  1. Heart
    - cyanotic CHD
    - severe CHF
  2. Lung (parenchymal like RDS, pul hem; non parenchymal like pleural effusion, CDH)
  3. Neuro (hypovent)
  4. Blood (polycythemia, methemglobinemia)
190
Q

Initial Management of Cyanotic BB

A

!!! ABC + IV!!!

  • Transillumination, CXR
  • CBC, Ca, Mg, glucose, gas, BCX
  • Correct issue, Temp

!!! - ABX if sepsis

!!!!- If no change w/ O2 think PGE (prostaglandin 0.05 mcg/k/gmin.)
- Cardio call

191
Q

Most common cause of myocarditis

A

Viral.

  • Other: Bacterial, Fungal, Protozoal
  • Non-infectious: AI KD, SLE, ARF, IBD, Drugs (chemo, cocaine)
192
Q

Common VS change on myocarditis presentation?

A

+++ tachy HR out of proportion to degree of fever

193
Q 
Prodromal Illness
\+ Fever
\+ Disproportionate Tachy
\+ HF symptom
=
A

Myocarditis

194
Q

Common categorical of pericarditis aetiologies?

A

Infectious: viral, bacterial, protozoal, fungal

AI: SLE, ARF, Sarcoidosis

Metabolic: uremia, thyroid

Other: CA, trauma, FMF

195
Q

Stabbing pleuritic CP that is worse laying flat=

A

Pericarditis

196
Q

Friction Rub
+ Muffled Heart Sounds
+ HF/JVP up

A

Pericarditis

197
Q

ECG stages of Pericarditis (1-4)

A 
1= ST elevation
2= T wave flat
3= Inverted T
4= Normal
198
Q

First line treatment for stable pericarditis

A

Ibuprofen or prednisone.

Unstable = ABC + Pericardiocentesis.

199
Q

Do ASD’s typically cause CHF

A

NO!

  • unless something blocking mitral valve!
200
Q

Janeway lesion versus Osler Node

A

Janeway= palms + soles; flat; hemm
* NON-TENDER

Osler= tips of fingers + toes; immunologic
*VERY PAINFUL; “O it hurts!!”

201
Q

Aschoff bodies on pathology=

A

Rheumatic Fever

RC: Specialties Woo Hoo (31 decks)

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