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X Pediatrics Final > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Congenital vs acquired heart disease

A

Congenital-cardiac abnormalities due to abnormal fetal heart development
Acquired-cardiac abnormalities due to disease processes

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2
Q

How do you diagnose all cardiac diseases?

A

Echocardiography

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3
Q

Causes of acquired heart disease

A

Sequelae from infection (rheumatic disease or kawasaki)
Genetic predisposition (hypertrophic cardiomyopathy)
Idiopathic
Like in adults

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4
Q

Signs/sxs of heart disease in infants vs older children

A

Infants: poor weight gain/FTT, tachypnea with feeding/activity
Older children: palpitations/chest pain, dizziness/syncope, exercise intolerance/dyspnea on exertion, unexplained HTN

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5
Q

What can cause a wide vs narrow split of S2?

A

Can be a normal split
Wide: atrial septal defect, pulmonary stenosis
Narrow: pulmonary HTN

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6
Q

When is a murmur usually innocent?

A 
Short systolic
Soft, grade <2/6 and softer upright
Musical or vibratory quality
Remainder of PE normal
No family hx or syndromic hx
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7
Q

When is a murmur pathologic?

A 
Holosystolic or diastolic
Loud, grade >3/60 which means a thrill
Harsh or blowing quality
Abnormal pulses/vitals, hepatomegaly, MSK abnormalities
Possible family hx or syndromic hx
Increased intensity upright
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8
Q

What do you think of with bounding pulses?

A

Patent ductus arteriosus

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9
Q

What do you think of with delayed/weak/absent femoral pulses?

A

Coarctation of aorta (COA)

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10
Q

What is a cardinal sign of right heart failure?

A

Hepatomegaly

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11
Q

What do you see in chronic right heart failure?

A

Ascites

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12
Q

What is clubbing of the fingers/toes associated with?

A

Cyanotic congenital heart disease (after age 1)

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13
Q

Most common Echo

A

Transthoracic

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14
Q

What does an echo evaluate?

A

Cardiac anatomy, direction of BF, intracardiac pressures, ventricular function

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15
Q

Examples of innocent murmurs

A

Stills murmur, pulmonary flow murmur, venous hum

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16
Q

What is the most common innocent murmur of early childhood?

A

Still’s murmur (2-7)

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17
Q

Characteristics of Still’s murmur

A

Musical or vibratory quality, short, high-pitched grades I-III
Heard loudest supine and at LLSB!
Louder when pt is under stress (fever, anemia etc)

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18
Q

What is the most common innocent murmur in older children and adults?

A

Pulmonary flow murmur (3 and up)

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19
Q

Characteristics of pulmonary flow murmur

A

Soft and usually grade 2

Louder supine at ULSB

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20
Q

Characteristics of venous hum

A

2 and up
Continuous musical hum, grades 1-3
R/LUSB
Louder in diastole and in sitting position with head extended

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21
Q

How do you differentiate venous hum from PDA?

A

Alterations of intensity with position changes

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22
Q

What are the acyanotic congenital heart diseases?

A

VSD, ASD, patent ductus arteriosus and COA

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23
Q

What are the cyanotic congenital heart diseases?

A 
5 Ts:
Tetralogy of Fallot
Transposition of great arteries
Tricuspid atresia
Truncus arteriosus
Total anomolous pulmonary venous return (TAPVR)
and Hypoplastic left heart syndrome
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24
Q

5 adaptations in fetal circulation

A 
Umbilical vein
Ductus venosus
Foramen ovale
Ductus arteriosus
Umbilical arteries
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25
Q

When does the ductus arteriosus close?

A

7-14 days

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26
Q

What is the most common of all congenital heart defects?

A

Ventricular septal defect

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27
Q

What is VSD associated with?

A

Trisomy 21 and Tetralogy of Fallot

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28
Q

Presentation of VSD

A

If small, may be asymptomatic
Large: FTT, poor growth, dyspnea, frequent respiratory infections
Tachycardia, tachypnea, hepatomegaly
Blowing harsh holosystolic murmur at LLSB

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29
Q

What innocent murmur can VSD sound like?

A

Stills

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30
Q

Management of VSD

A

If asymptomatic it might just close on own
Treat CHF (diuretics, ACE inhibitor)
If failing med management then septal occlusion wtih cardiac catheterization or surgical closure via median sternotomy (preferred)

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31
Q

How do you classify atrial septal defects?

A

By anatomic location:
Ostium secundum (most common)
Ostium primum (associated with other anomalies)
Sinus venosus

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32
Q

Presentation of ASD

A

If large, CHF, recurrent respiratory infections, FTT (worse with age if don’t correct)
Tachypnea, hepatomegaly, rales, respiratory retractions
Midsystolic pulmonary flow/ejection murmur at ULSB

33
Q

What can you see on a CXR for ASD?

A

Enlarged heart due to right side dilation, increased pulmonary vascularity

34
Q

Management of ASD

A

None because spontaneous closure in kids when less than 6 mm

Can do surgery (percutaneous transcatheter closure, surgical patch closure)

35
Q

When is patent ductus arterious more common?

A

Premature, in females and in maternal rubella

36
Q

What happens when the L to R shunt is reversed in PDA?

A

Due to high pulmonary pressures so causes cyanosis (Eisenmenger syndrome)- medical emergency

37
Q

What kind of murmur is seen in PDA?

A

Continuous machinery murmur

Also see wide pulse pressure and bounding pulses

38
Q

Management for PDA

A

Keep it open with IV prostaglandin E1

Close it with IV indomethacin (prostaglandin inhibitor)

39
Q

What is coarctation of the aorta?

A

Narrowing in the aortic arch, usually in the proximal descending aorta near the takeoff of the left subclavian artery and ductus arteriosus

40
Q

What can increase the incidence of COA?

A

Males over females
Seen with Turner syndrome (45 X-female)
Seen in kids with unexplained UE HTN

41
Q

What is seen on the PE in COA?

A

Absent or decreased femoral pulses
UE SBP >20 mmh higher than LE
Blowing systolic murmur in back or left axilla

42
Q

What do you see on a CXR for COA?

A

Figure 3 sign or rib notching

43
Q

Tx of COA

A

Surgical repair or balloon angioplasty

44
Q

What makes up tetralogy of fallot?

A

Right ventricular hypertrophy
VSD
Overriding aortia
RV outflow obstruction (pulm stenosis)

45
Q

What is the most common cyanotic cardiac lesion?

A

Tetralogy of fallot

46
Q

What are Tet spells?

A

Hypercyanotic episodes with sudden onset or worsening of cyanosis, dyspnea, alterations in consciousness and decrease/disappearance of systolic murmur (as RV becomes totally obstructed)
Start at 4-6 mos

47
Q

What do kids do to relieve dyspnea?

A

Squat

48
Q

What kind of murmur is associated with TOF?

A

Harsh systolic ejection crescendo-decrescendo at ULSB

49
Q

What do you see on CXR for TOF?

A

Boot-shaped heart with upturned apex (might be pathognomic)

50
Q

Tx of TOF

A

Need endocarditis abx prophylaxis until after repair
Meds: acutely for a spell need o2, fetal position, morphine and IVF bolus etc
Surgery: intracardiac repair usually by 1 YO

51
Q

What is transposition of the great arteries?

A

Malformation where aorta comes off RV and pulmonary artery off LV

52
Q

Presentation of TGA

A

Profoundly cyanotic neonate without respiratory distress or significiant murmur (blue baby)

53
Q

What is pathognomonic on a CXR for TGA?

A

Egg on a string: globular heart and narrow superior mediastinum due to degradation and dysplasia of the thymus

54
Q

Tx for TGA

A

Cardiac cath
Prostaglandin E1 to keep ductus arteriosus open
Surgery usually donea t 4-7 days (arterial switch operation)

55
Q

What is tricuspid atresia?

A

Congenital absence of a tricuspid valve so no communication between RA and RV
Usually associated with other things (like ASD or VSD)

56
Q

Presentation of tricuspid atresia

A

Central cyanosis at birth and 1 heart sound (s2)

Holosystolic murmur at LLSB (if have VSD too)

57
Q

Tx for tricuspid atresia

A

Initial prostaglandin E1 to maintain PDA

Definitive: surgery (need 3 from birth to age 3)

58
Q

What is truncus arteriosus?

A

Aorta and PA fail to separate so only 1 artery and VSD is always present

59
Q

Presentation of truncus arteriosus

A

Cyanosis, CHF, pulmonary congestion
Loud single S2, prominent ejection click, systolic ejection murmur at LLSB
Narrow split

60
Q

What might you see on an xray in truncus arteriosus?

A

Boot shaped heart (absence of PA and large aorta)

61
Q

What is total anomalous pulmonary venous return (TAPVR)?

A

Rare
Abnormal pulmonary venous configuration leading to cyanosis (PVs drain into venous system like SVC)
Right to left shunt must occur

62
Q

Tx of TAPVR

A

Surgery

63
Q

What is hypoplastic left heart syndrome?

A

Hypoplasic (underdevelopment) of LV and stenosis or atresia of mitral and aortic valves
PDA dependent because sxs develop when it closes

64
Q

Presentation of HLHS

A

Stable at birth when ductus is still open and rapid deterioration (shock, acidosis) when ductus closes

65
Q

Tx of HLHS

A

Prostaglandin E1 is essential and life saving

Staged surgeries but even so 1 yr survival as low as 70%

66
Q

What are some acquired heart diseases?

A

Acute rheumatic fever, kawasaki disease and hypertrophic cardiomyopathy

67
Q

When does acute rheumatic fever occur?

A

2-4 wks after group A strep pharyngitis

68
Q

What are the major jones criteria for rheumatic fever?

A

Pancarditis (pericarditis, endocarditis, myocarditis)

2 major or 1 major and 2 minor to diagnose

69
Q

What happens when acute rheumatic fever involves the endocardium?

A

Presents as valvulitis especially of mitral (more common) and aortic valves

70
Q

Presentation of Kawasaki Disease

A

Fever over 5 days and CRASH (conjunctivits, rash, adenopathy cervical, strawberry tongue, hands swollen)

71
Q

Tx of Kawasaki

A

High dose aspirin or IVIG

72
Q

What is the major cardiac complication of kawasaki disease?

A

Coronary artery aneurysms

73
Q

What is the leading cause of cardiac death in young persons?

A

Hypertrophic cardiomyopathy

74
Q

What is the most common cause of hypertrophic cardiomyopathy?

A

Familial hypertrophic cardiomyopathy

75
Q

What may be noted on the PE for hypertrophic cardiomyopathy?

A

S4 gallop

76
Q

Tx of hypertrophic cardiomyopathy

A

Sports restriction, meds (BB or verapamil), reduce septal size, consider defibrillator

77
Q

When do you refer to cardio?

A

Weak femoral pulse or 10mmhg change in SBP between UE and LE
Generalized decreased pulses
Pathologic murmur
Abnormal ecg and pulse ox
Abnormal fetal echo
Anything associated with increased likelihood of CHD

78
Q

What is associated with trisomy 21?

A

AVSD, TOF, PDA

79
Q

What is associated with fetal alcohol syndrome?

A

ASD or VSD

X Pediatrics Final (3 decks)

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