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Peds Boards > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Down Syndrome associated with

A

AV canal defects

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2
Q

Turner Syndrome associated with

A

Bicuspid Ao Valve
CoArc

Turners: nonpitting edema of LE, Webbed neck, widely spaced nipples

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3
Q

Williams Syndrome associated with

A

Supravalvular Aortic Stenosis

Can sound like pulm stenosis on exam - systolic ejection murmur along L sternal border

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4
Q

Rheumatic Fever Criteria

A

Recent GAS infection +

“JONES CAFE PAL”

  • Joints - polyarthritis
  • Carditis (valvular disease +/- myo or pericarditis)
  • subcutaneous Nodules
  • Erythema marginatum
  • sydenham’s chorea (later, 2wk-2yrs)

C – CRP Increased
A – Arthralgia
F – Fever
E – Elevated ESR

P – Prolonged PR Interval
A – Anamesis of Rheumatism (hx of rheumatic fever)
L – Leukocytosis

2 MAJOR OR 1 Major and 2 Minor
With GAS infection or Antistreptolysin O Ab

Secondary prevention, after a first episode of rheumatic fever, is essential to prevent RHD or to stabilize the disease process in patients already affected. This requires continuous daily oral penicillin or penicillin injections every 3 or 4 weeks.

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5
Q

Digitalis toxicity symptoms

A

Digoxin: increases the force of contraction of the muscle of the heart by inhibiting the activity of an enzyme (ATPase) that controls movement of calcium, sodium, and potassium into heart muscle

Abd pain, nausea, vomiting
PVCs, inverted T waves, AV block
HyperK
Alteration in color vision

Tx: Digoxin specific Fab Ab

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6
Q

Postpericardiotomy Syndrome

A

Pericarditis/Pericardial Effusion days to weeks after open cardiac surgery. Inflammatory or immune mediated.

chest pain, cough, SOB, tachycardia, hypotension, muffled heart sounds, enlarged heart on CXR, EKG shows low voltages or electrical altercans

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7
Q

Endocarditis Prophylaxis: Indications and Tx

A

Indications:

  • prosthetic valve
  • unrepaired cyanotic CHD
  • repaired cyanotic CHD within 6 months OR with residual defects
  • previous hx endocarditis
  • cardiac transplant who develop valvulopathy

NOT for like VSD, AS, or non-cyanotic lesions.

Dental, Oral, or Resp procedures that put you at risk for transient bacteremia.
NOT for GI or GU procedures.

Amox 2g 1 hour prior to procedure
(Keflex, Azithro, Clinda alternatives)

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8
Q

Truncus Arteriosus Murmur

A

Ejection click (opening of the single valve)
Single S2
+ VSD (Systolic ejection murmur)

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9
Q

What 2 conditions cause EXTREME left axis deviation on EKG?

A

Tricuspid atresia
AV canal defect

LAD without LV hypertrophy in these two conditions due to their effects on the conduction system’s orientation

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10
Q

SVC Syndrome Signs

A

Signs: facial and upper extremity swelling, jugular venous distention, and inability to increase cardiac output on demand due to decreased venous return (air hunger, dizziness, syncope)

Associated with anterior mediastinal masses: lymphoma, teratoma, thyroid carcinoma, and enlargement of the thymus. Or just enlarged lymph nodes.

Extreme caution should be taken prior to sedating, anesthetizing, or initiating positive- pressure ventilation as they cannot ventilate well

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11
Q

How to treat a hypercyanotic TET spell

A

TOF: Overriding Ao, VSD, Pulm Stenosis, RVH

Hypercyanotic spell - fever, crying - something causing vasodilation that reduces SVR.

Decreased SVR means that the shunt shifts from R->L across VSD and less pulmonary flow so you’re delivering cyanotic blood to the body

Tx:

  1. knee chest to increase SVR
  2. 100% O2
  3. IV fluid bolus
  4. morphine to calm baby and decrease hyperventilation
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12
Q

Presentation and Tx of a VSD

A

Presents ~4 wks of age when pulm vascular resistance falls and you have L->R shunting, which leads to volume overload, pulm edema, and CHF

Tx: diuresis to treat pulm edema (Furosemide)

O2 is BAD. May increase shunting L->R worsening pulmonary edema

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13
Q

How does pulmonary stenosis cause cyanosis?

A

As stenosis worsens, RV pressure then RA pressure increases. If you have PFO, then shunts from RA -> LA, causing systemic desaturation. That responds to O2.

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14
Q

Infective Endocarditis Symptoms

A

Presentation:
- subacute (over several weeks) or acute (rapidly progressive)
- fever, malaise, anorexia
- new murmur (new or changing)
- splenomegaly, embolic phenomenon
- petechiae
children only rarely have
- Roth spots (small retinal hemorrhages)
- Janeway lesions (small painless hemorrhagic lesions on the palms and soles)
- Osler nodes (small tender intradermal nodules on the fingers and toes)
- splinter hemorrhages (linear streaks beneath the nail beds)

Occurs in:

  • children with underlying congenital heart disease, but it can occur in children with normal hearts.
  • Central venous catheters also pose an increased risk for infective endocarditis.

Patho:
transient bacteremia from the oropharynx, gastrointestinal tract, or genitourinary tract. The bacteremia interacts with damaged cardiac endothelium, platelets, and fibrin resulting in an infected thrombus on the surface of the endothelium

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15
Q

Endocarditis Organisms

A

Viridans streptococci (strep mitis) = abnormal cardiac valves (congenital heart disease, rheumatic heart disease, postoperative changes)

Staphylococcus aureus = an otherwise structurally normal heart.

The AACEK organisms (Aggregatibacter parainfluenzae, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) are gram-negative organisms that cause infective endocarditis, although less commonly than the Streptococcus and Staphylococcus species.

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16
Q

Chart of Murmurs

A

file:///Users/vicky/Downloads/C59.pdf

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17
Q

Acrocyanosis vs Central cyanosis

A

Acrocyanosis

  • normal finding in newborns
  • due to slow flow of blood across an area with a large arteriovenous difference (hands, feet)

Central cyanosis
- lips, mucous membranes
> 5 /dL of deoxygenated blood; easier to see in higher hemoglobin concentrations (newborns)

Other normal newborn findings

  • liver 1 cm below costal margin
  • 2/6 low-pitched, MUSICAL, midsystolic ejection murmur at the lower left sternal border
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18
Q

Cardiac manifestations of hyperthyroidism

A
  • tachycardia
  • HTN with a wide pulse pressure (dec peripheral vascular resistance)
  • palpitations
  • rarely arrhythmias

Tx: Propranolol. Started at diagnosis and continued until methimazole takes effect

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19
Q

First line therapy for Graves disease

A
  • methimazole as the first-line treatment. some may go into remission with drugs alone, so it’s first line.
  • radioactive iodine therapy, and thyroidectomy.
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20
Q

How does cyanotic congenital heart disease increase your risk of stroke?

A

Polycythemia in the setting of chronic cyanosis increases the risk of a thromboembolic event.

Many patients with cyanotic congenital heart disease are treated prophylactically with aspirin, warfarin, or other anticoagulants to help prevent thromboembolic events

Other manifestations of congenital heart disease: Heart failure, arrhythmias, pulmonary hypertension, and neurologic, hepatic, and renal dysfunction are complications of cyanotic congenital heart disease.

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21
Q

To pass CCHD screening you need

A

Oxygen saturations should be greater than 95%, with no more than a 3% difference between preductal and postductal oxygen saturations (R hand and R foot).

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22
Q

Cardiomegaly and “wall to wall” heart on CXR

A

Ebstein Anomaly
- displacement of tricuspid valve to RV leading to atrialization of the RV -> massive RA enlargement and “wall to wall” or “box shaped” heart

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23
Q

“egg on a string” CXR

A

d-TGA due to anterior-posterior relationship of the great arteries

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24
Q

“boot shaped heart’ and decreased vascular markings

A

TOF

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25
Q

normal sized heart with decreased vascular markings

A

conditions that obstruct pulm blood flow
pulm stenosis
tricuspid atresia

26
Q

snowman sign

A

supracardiac total anomalous pulm venous return

27
Q

tx for prolonged QT

A

propranolol

28
Q

Pneumomediastinum on auscultation

A

Harsh systolic crunching sound due to subQ air

Sx: chest pain (radiating to neck, back, shoulders), dyspnea, subq emphysema

29
Q

Anorexics can develop what valvulopathy

A

mitral valve prolapse

30
Q

What drugs cause drug induced SLE?

A

Procainamide and Hydralazine

Sx: fever, myalgia, arthralgia, pericarditis, pleuritis, hepatomegaly, splenomegaly
+ ANA

31
Q

Rib Notching is associated with

A

CoArc

Rib notching: due to erosion of inferior part of rib due to dilated intercostal collateral vessels. usually doesn’t appear until child is school aged.

3 sign on CXR: L paramedistinal area shows prestenotic and poststenotic dilation

32
Q

Rhabdomyolysis can do what to the heart?

A

Causes Hyperkalemia, leading to prolonged PR, bradycardia and heart block!! Need to give Ca gluconate

33
Q

Adolescent abusing IV drugs leads to what valvulopathy

A

Endocarditis and Tricuspid Regurg
(systolic murmur at LLSB that radiate to the R)

Likely due to staph aureus

34
Q

Tricuspid Regurg associated with what physical findings

A

systolic murmur at LLSB that radiate to the R
jugular venous distension
hepatomegaly and LE edema (RHF)

35
Q

Marfans is associated with what cardiac abnormality

A

Aortic root dilation (which may lead to aneurysm or dissection)

MVP

Marfans - tall, increased U:L body segment ratio, scoliosis, lens dislocation, myopia

36
Q

Vascular Ring Etiologies and appearance on barium enema

A 
Anterior Filling Defect of Esophagus: 
Pulmonary Sling (LPA coming off of RPA instead of PA trunk)

Posterior Filling Defect:
Double Aortic Arch
R Aortic Arch with Abberrant L subclavian artery

37
Q

How does venous return relate to MVP?

A

Inversely.

Decreasing venous return (standing) -> decreased LV preload -> more laxity of the chordae tendinae -> will prolapse earlier so the murmur is longer and click is earlier.

Increasing venous return (squatting), will decrease the prolapse aka murmur is shorter and click is later

38
Q

HyperCa on EKG

A

shortened QTc and abrupt upstroke of T wave

39
Q

PDA closure in a preterm neonate depends on…

A

Usually conservative management! Do not pharmacologically close the PDA if the patient is stable and resp status not worsening because it will likely close on its own.

The “normal” course for a PDA in a term neonate is closure within 72 hours of birth. In preterm neonates, this course is delayed, and the PDA remains open in 10% of neonates born at 30 to 37 weeks’ gestation, 80% born at 25 to 28 weeks’ gestation, and 90% born at 24 weeks’ gestation.

By 7 days after birth, these rates decline to 2%, 65%, and 87%, respectively. Data from controlled studies indicate that spontaneous closure of PDAs frequently occurs.

While individual studies and meta-analyses have demonstrated the ability to close a PDA, both medically and surgically, no study has shown that closing a PDA improves long-term outcomes.

40
Q

When does CHD with L->R shunting present

A

Congenital heart disease with left to right shunting, such as ventricular septal defects, atrioventricular canal defects, and anomalous pulmonary venous return often manifest with heart failure at approximately 1-2 months of age.

41
Q

What cardiac effect of fetal alcohol syndrome

A

VSD

Dysmorphic features of fetal alcohol syndrome: microcephaly, short palpebral fissures, long smooth philtrum, thin vermillion border, midface hypoplasia, ptosis, epicanthal folds, micrognathia

42
Q

What is Tietze syndrome?

A

Differs from costochondritis in that it is associated with visible swelling, erythema, and warmth - and is usually the 2nd costochondral cartilage

43
Q

Most common cyanotic heart defect manifesting in first few days of life

A

Transposition of the Great Arteries

44
Q

For what condition is an atrial septostomy helpful?

A

Transposition of the Great Arteries - to facilitate mixing of blood

45
Q

When do ASDs become symptomatic?

A

2nd decade of life - usually with exercise intolerance

46
Q

S3 vs S4

A

Both in diastole

S3: can be normal, increased filling of dilated LV (passive filling phase of diastole)

S4: never normal, blood entering poorly compliant stiff LV during atrial contraction

47
Q

PDA is associated with what maternal risk factor?

A

Rubella

48
Q

Unrepaired TET is associated with what?

A

Brain abscess, cerebral thrombosis, endocarditis.

There is R->L shunt across VSD.

49
Q

Noonan is associated with

A

Pulmonary Stenosis

Male with phenotypic features of Turner’s (45X girl) but normal karyotype

50
Q

T wave morphology in children

A

Newborns have upright T waves for up to 7 days after birth.

T waves in the right precordial leads (V4R and V1) then become inverted.

T waves then generally return to upright in early adolescence. But they may remain inverted after this time, and it does not necessarily indicate heart disease.

51
Q

What does an ASD do to the heart?

A

RVH

There is a clear rsR’ in V1
Tall R waves and virtually no S waves in the special right precordial leads, V3R and V4R.
The S waves in V5 and V6 are more prominent than normal.

52
Q

VSD, PDA, CoArc result in left or right hypertrophy?

A

LVH

And tricuspid atresia = left axis deviation and left ventricular hypertrophy (since it must pump blood to both the pulmonary and systemic systems)

53
Q

Treatment of long QT

A

Beta-blockers

54
Q

Rhabdomyosarcoma is associated with

A 
Tuberous Sclerosis 
(Ash leaf spots, shagreen patches, seizures, intellectual disability, intracranial calfications, tumors in various organs including heart)
55
Q

Kawasaki is associated with what in the abdomen

A

Gallbladder hydrops

Mucocele (hydrops) of the gallbladder is a term denoting an overdistended gallbladder filled with mucoid or clear and watery content

56
Q

Brugada syndrome

A

right bundle-branch block pattern and ST-segment elevation in leads V1–V3.

57
Q

Peripheral pulmonic stenosis vs stills murmur

A

PPS

  • grade 2/6 systolic murmur heard best at the left upper sternal border, radiating to the right upper sternal border and into the posterior lung fields and axillae. The murmur is caused by turbulent flow at the acute angular origin of the relatively small-branch pulmonary arteries as they exit from the larger main pulmonary artery.
  • usually resolves by 6 months

Stills
- musical-like” grade 2/6 midsystolic murmur heard best at the left lower sternal border and apex and is believed to be caused by blood flow in the left ventricle leading to vibrations in the left ventricular outflow tract and aorta.

It is most common among toddlers and young school-age children.

58
Q

Neurocardiogenic (Vasovagal syncope) tx

A

Fludrocortisone - increases blood volume.

Can be diagnosed with tilt table test if history is unclear

59
Q

ASD vs pulm stenosis

A

Both will have RVH but ASD = rSR pattern (volume overload) and PS = QR pattern.

ASD also has wide fixed split S2 and slightly prolonged QRS

60
Q

Causes of sudden cardiac death/arrest:

A

HOCM

  • most common cause of sudden death on athletic field
  • AD inheritance, family hx of sudden death
  • feels sx of decreased cardiac output prior to event like SOB/chest pain

Anomalous coronary artery

  • 2nd most common cause
  • also have preceding sx of SOB, chest pain, may also have syncope episodes
  • no family hx

Prolonged QT

  • not as common. does cause syncope with exercise
  • AD inheritance
  • seizure like events with ventr arrhythmias
  • congenital deafness
61
Q

Endocarditis: DUKE criteria

A

2 major
1 major and 3 minor
5 minor

Major:

  • two positive BCx for orgs likely to cause IE (viridans, staph), or persistently positive BCx with less common orgs
  • echo findings
  • new murmur on exam

Minor:

  • fever
  • blood cultures not meeting major crtieria
  • underlying heart disease
  • IVDU
  • vasculitis or immune effects like glomerulonephritis
62
Q

HOCM vs AS

A

HOCM
- increases with valsalva (decreased preload)

AS:
- decreases with valsalva

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