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pediatrics > cardiology > Flashcards

cardiology Flashcards

1
Q

Right-to-Left shunts diseases

A
  1. Truncus arteriosus
  2. D-Transposition of great vessels
  3. Tricuspid atresia
  4. Tetralogy of Fallot
  5. Total anomalous pulmonary venous return
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2
Q

Persistent truncus arteriosus pathophysiology (due to)

A

Truncus arteriosus fails to divide into pulmonary trunk and aorta –> LARGE VESSEL ARISING FROM BOTH VENTRICLES
- lack of aorticopulm septum formation

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3
Q

Truncus arteriosus - clinical examination

A
  • single S2 (only 1 semilunar valve) and a systolic ejection
  • peripheral pulses are bounding
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4
Q

Truncus arteriosus - Diagnostic tests

A

chest x-ray: cardiomegaly with increased pulm marking

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5
Q

Truncus arteriosus - treatment

A

the most severe sequela is pulmonary hypertension, which will develop within 4 weeks –> surgery must be completed early to prevent pulm hypertension

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6
Q

D-transposition of great vessels - definition

A

Aorta leaves RV (anterior) and pulmonary trunk leaves LV posterior –> seperation of systemic and pulmonary circulations
- failure of the aorticopulmonary septum to spiral

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7
Q

transposition of great vessels - S2

A

single, because aorta is anterior to pulm artery *absent of pulm sound)

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8
Q

transposition of great vessels - x-ray

A

egg on a string heart

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9
Q

Tricuspid atresia - mechanism

A

absence of tricuspid valve and hypoplastic RV

requires ASD and VSD

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10
Q

Tricuspid valve atresia - ECG / xray

A

left deviation and small or absent R

x-ray: decreased pulm markers

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11
Q

MCC of ealry childhood cyanosis

A

Tetralogy of Fallot

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12
Q

Tetralogy of Fallot is caused by

A

anteriosuperior displacement of the infundibular septum

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13
Q

Tetralogy of Fallot is consists from

A
  1. Pulmonary infundibular stenosis
  2. RV hypertrophy (boot shaped heart on CXR)
  3. Overriding aortra
  4. VSD
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14
Q

tetralogy of fallot - diagnostic tests

A

chest x-ray: boot shaped heart

decreased pulmonary vascular marking

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15
Q

tetralogy of fallot - treatment

A

surgical intervention is the only definitive treatment

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16
Q

Total anomalous pulmonary venous return?

A

pulmonary veins drain into right heart circulation (SVC, coronary sinus etc)

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17
Q

Total anomalous pulmonary venous return - forms

A

with or without obstruction of the venous return (obstruction refers to the angle at which the veins enter the sinus)

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18
Q

Total anomalous pulmonary venous return - with vs without regarding treatment

A

with: surgery (definitive)
without: surgery to restore proper blood flow)

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19
Q

Total anomalous pulmonary venous return - with obstruction - signs/symptoms

A

early in life with resp distress and cyannosis

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20
Q

Total anomalous pulmonary venous return - without obstruction - signs/symptoms

A

age 1-2 with RHF and tachypnea

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21
Q

Hypoplastic left heart syndrome - definition

A
  1. LV hypoplasia
  2. mitral malve atresia
  3. aortic valve lesion
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22
Q

Hypoplastic left heart syndrome - presentation

A
  1. absent pulse with single s2
  2. increased RV impulse
  3. Gray (rather than) bluish cyanosis
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23
Q

Hypoplastic left heart syndrome - diagnostic tests

A

chest x-ray: globular shaped heart with pulm edema

ECHO IS THE MOST ACCURATE

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24
Q

Hypoplastic left heart syndrome - treatment

A

2 separate surgeries or heart transplantation (extremely high mortality)

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25
Q

transoposition of Great vessels - definitive treatment

A

2 seperate surgeries are necessary –> each carries a 50% moratlity (only 1/4 will survive)

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26
Q

Ebstein anomaly?

A

characterised by displacement of tricuspid valve leaflets downward into RV, artificially atrializing the ventricle
(lithium in utero)

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27
Q

Ebstein anomaly is associated with (complications)

A
  1. tricuspid regurgitation

2. right HF

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28
Q

The most common cyanotic condition in children after neonatal period

A

Fallot

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29
Q

most common cyanotic lesion during the neonatal period

A

transoposition of Great vessels

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30
Q

which of them are PDA depended

  1. Truncus arteriosus:
  2. D-Transposition of great vessels
  3. Hypoplastic left heart syndrome
  4. Tetralogy of Fallot
  5. Total anomalous pulmonary venous return
A
  • trasnp of great vessels

- Hypoplastic left heart syndrome

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31
Q

which of them are VSD depended

  1. Truncus arteriosus:
  2. D-Transposition of great vessels
  3. Hypoplastic left heart syndrome
  4. Tetralogy of Fallot
  5. Total anomalous pulmonary venous return
A

FALLOT

Truncus arteriosus

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32
Q

total anomalous pulm venous return with obstruction - x-ray

A

pulm edema, snowman sign

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33
Q

Left-to-right diseases by frequency

A

VSD>ASD>PDA

34
Q

MC congenital cardiac defect

A

VSD

35
Q

VSD - presentation

A

asymptomatic at birth
may manifest weeks later or remain asymptomatic throughout life
- LV overload / HF / endocarditis

36
Q

VSDs are common in

A
  1. down (21)
  2. Edwards (18)
  3. Patau (13)
37
Q

VSD - diagnostic tests

A

chest x-ray: increased vascular marking

Echo is diagnostic and cardiac catheterization is definitive

38
Q

VSD - treatment

A
  • smaller lesions usually close in the first 1-2 years
  • larger or more symptomatic require surgery
  • Diuretics and digoxin for conservative therapy
39
Q

ASD - S sounds

A

loud S1

wided fixed S2

40
Q

ASD - type of defect in interatrial septum

A
  1. ostium secundum defects (MC and usually as isolated findings)
  2. ostium primum defects (rare, usually occur with other cardiac anomalies)
41
Q

ASD - diagnosis

A

most definitive: cardiac catheterization
echo is less invasive and can be just as effective
CXR: increased vascular markings and cardiomegaly

42
Q

ASD - treatment

A
  • Vast majority close spontaneously

- surgery or transcatheter closure is indicated for all symptomatic patients

43
Q

coarctation of the aorta - PDA

A
  • infantile coarctation of the aorta is associated with PDA

- adults coarctation of the aorta in not associated with PDA

44
Q

PDA - most accurate and best initial test

A

best initial: ECHO

most accurate cardiac catheterization

45
Q

PDA - MC complciation later in the child’s life

A

resp infections and infective endocarditis

46
Q

coartraction - diagnostic tests

A
  • rib notching and a “3” sign are seen on chest x-ray

- cardiac catheterization is the most accurate test

47
Q

coartraction - treatment

A

resection of the narrowed segment and then balloon dilation if recurrent stenosis occurs

48
Q

coarctation of the aorta - complications

A
  1. HF
  2. high risk of cerebral hemorrhage (berry)
  3. aortic rupture
  4. endocarditis
49
Q

coarctation of the aorta is associated with

A
  1. bicuspid aortic valve
  2. other heart defects
  3. Turner syndrome
50
Q

patent ductus arteriosus is often due to

A
  1. congenital rubella
  2. prematurity
  3. birth at high altitudes
  4. fetal alcohol syndrome
51
Q

congenital cardiac defect associations - fetal alcohol syndrome

A
  1. VSD 2. ASD 3. PDA

4. tetrallogy of fallot

52
Q

congenital cardiac defect associations - congenital rubella

A
  1. septal defects
  2. PDA
  3. Pulmonary stenosis
53
Q

congenital cardiac defect associations - down syndrome

A
  1. AV septal defect (endocardial cushion defect)
  2. VSD 3. ASD
    MC is COMPLETE AV septal defect
54
Q

congenital cardiac defect associations - diabetic mother

A

transposition of great vessels

55
Q

congenital cardiac defect associations - Marfan

A
  1. MVP
  2. Thoracic aortic aneurysm
  3. Thoracic aortic dissection
  4. Aortic regurgitation
56
Q

congenital cardiac defect associations - Turner syndrome

A
  1. bicuspid aortic valve

2. coarctation of aorta

57
Q

congenital cardiac defect associations - Williams syndrome

A

supravalvular aortic stenosis

58
Q

congenital cardiac defect associations - Williams syndrome

A

supravalvular aortic stenosis

59
Q

congenital cardiac defect associations - 22q11 syndrome

A
  1. Truncus arteriosus

2. Tetralogy of Fallot

60
Q

bicuspid aortic valve complications

A
  1. AR
  2. AS
  3. AORTIC DISSECTION
  4. THORACIC AORTIC ANEURYSM
  5. coarctation of the aota
61
Q

Cardaic X-ray - pear shaped

A

pericardial effusion

62
Q

patients with history of rheumatic fever have increased risk of recurrent episodes and progression of rheumatic heart disease with repeated infection. prophylaxis

A

continuous antibiotc prophyllaxis: IM benzathine penicillin G every 4 wks (the duration depends on associated conditions:

  1. no carditis: 5 years or until 21 years old (whichever is longer)
  2. carditis but no residual heart or valvular disease by clinical or echo criteria: 10 years or until 21
  3. with carditis + persistent heart or valvular disease: 10 years or until 40 years old
63
Q

congenital QT prolongation - management

A

avoid electrolyte derangments and medications that block + channels
- beta blockers with pacemaker can prevent arrest

64
Q

Kawsaki is characterised by

A 
5 or more days of fever and 4 or more of the following 
(CRASH)
Conjuctival injection (non purulent)
Rash
Adenopathy (cervical)
Strawberry tongue (oral mucositis)
Hand-foot changes (edema, eruthema)
65
Q

Benign vs pathologic murmurs - history

A

BENIGN: normal apperite, energy, activities + growth
no family history
PATHOLOGIC: diaphoresis, fatique with feeding or exercise, poor weight gain, family history

66
Q

benign murmur featires

A

early or mid SYSTOLIC, grade I or II that decreases with valsava or stunding

67
Q

patholical mumrur features

A
  • harsh holosystolic or diastolic
  • Grade 3 or higher
  • increases with standing + valsava
68
Q

DDX of stridor

A

acute: croup, foreign body
chronic: laryngomalacia, vascular ring

69
Q

vascular rings?

A

rings that encircle the trachea and/or esophagus + present with resp (biphasic stridor, wheezing, coughing) + esophageal (dysphagia, vomiting) symptoms
stridor typically improves with neck extension

70
Q

vascular ring vs laryngomalacia - prone position

A

only laryngomalacia’s stridor improves

71
Q

normal ECG in neonates

A

R deviation and R in V1-V3

72
Q

pediatric viral myocarditis - clinica presentation / etiology

A
  • viral prodrome
  • heart failure
  • etiology: Cox B, adenov
73
Q

pediatric viral myocarditis - diagnostic studies

A

x-ray: caardiomegaly, pulm edema
ECG: tachycardia
echo: decreased EG, diffuse hypokinesis
biopsy (gold standard): infiltration

74
Q

coartraction - pathology

A

thickening of tunica media

75
Q

transposition of great vessels - examination and x-ray

A

Single S2 +/- VSD murmur

- egg on a strinng heart (narrow mediastinum)

76
Q

tricuspid atresia - examination and x-ray

A

single S2 and VSD murmur

- minimal pulm blood flow

77
Q

Truncus arteriosus - examination + x-ray

A

single S2, systolic ejection murmur

- increaed pulm flow + edema

78
Q

knee chest position improves Fallot due to

A

increasing in systemic vascular resistance

79
Q

adolescents with a family history of sudden death in young relatives should refrain sports until

A

ECG and ECHO performed

80
Q

peripheral pulse in PDA

A

mildly accentuated

81
Q

viral myocarditis - prognosis

A
  • mortality: gretar in newborns

- outcome of survivors: full recovery in 66%, CHF in 33%

pediatrics (16 decks)

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