Cardiology Flashcards
Aortic stenosis murmur
Right upper sternal border
Midststolic ejection
Radiating to neck
Pulmonic stenosis murmur
Left upper sternal border
Softer P2
Atrial septal defect murmur
Wide, fixed, split S2
LUSB systolic ejection murmur
Short mid-diastolic murmur at LLSB
Williams syndrome heart
Supravalvular aortic stenosis
+/- branch PA stenosis
Murmur that increases with standing
Increase with standing or valsalva: HOCM or MVP
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Long-term complications of an unrepaired ASD
Pulmonary hypertension
Atrial dysrhythmias
Tricuspid or mitral insufficiency
Heart failure
Abx prophylaxis indicated for endocarditis… (7)
- Prosthetic cardiac valves
- Previous infective endocarditis
- Unrepaired cyanotic congenital heart disease, incluing palliative shutns and cnoduits
- Completely repaired CHD with prosthetic material/device within first SIX MONTHS
- Repaired CHD with RESIDUAL defects at the site ora djance to the site of prosthetic patch or prosthetic device (which inhibit endothelialization
- Cardiac transplant recipients with cardiac valvulopathy
- Rheumatic heart disease if prosthetic valves/material used in valve repair
CHD with increased pulmonary blood flow (6)
Transposition of the great arteries Total anomalous pulmonary venous return Truncus arteriosus Hypoplastic left heart syndrome Single ventricle physiology DORV (without PS)
Cyanotic heart disease with decreased pulmonary blood flow (5)
Tetralogy of Fallot Pulmonary atresia Tricuspid atresia Ebstein anomaly Single ventricle with pulmonary stenosis
Marfan
- gene, genetics and features
- fibrillin gene
- AD inheritance
signs: positive thumb, pectus excavatum, scoliosis, long arms, dilation of ascending aorta, mitral valve prolapse
Suprasternal notch thrill
aortic stenosis
SEM radiating to back
PS, PDA, coarctation
Cardiac syncope features
- little or no prodrome
- prolonged LOC (> 5min)
- exericse or startle induced
- associated chest pain or palpitations
- hx of cardiac disease
- positive fam hx
+/- abN exam
fright/startle induced syncope
think long QT
1st line therapy for long QT syndrome
and normal QTc values
- beta blockers
- avoid QT prolonging drugs
boys < 0.45, girls < 0.47
Features of WPW on ECG
- short PR interval
- delta wave
Risks of WPW
- SVT
- sudden cardiac death
Torsades de pointes causes
- long QT syndrome
- hypomagnesemia
- hypokalemia
ECG shows left axis
- think AVSD
- small RV (e.g. tricuspid atresia)
- Noonan syndrome
Normal saturations based on operations:
- Sano or BT shunt (Norwood)
- arterial switch
- Glenn
- Fontan
Sano/BT shunt/Norwood: 75-85%
Art switch: 100% sats
Glenn: 75-85%
Fontan: >90 (usually)
Fontans-specific complications
- protein losing enteropathy
- plastic bronchitis
Coronary artery involvement in KD (%)
- ~20% untreated
- 5% with treatment
5Ts and 3As of cyanotic congenital heart disease
- truncus
- transposition
- tricuspid atresia
- tetralogy
- total anomalous pulmonary venous connections
- Atresia pulmonary
- Anomaly Ebsteins
- A single ventricle
Pericarditis ECG findings
- depressed PR interval
- elevated ST
Causes of CHF by age
- 1st week of life
- weeks 2-6
- older children
1st week: obstructions e.g. HLHS, severe AS, coarctation, asphyxia, severe MR or TR, uncontrolled tachy e.g. SVT>24hr
Week 2-6: VSD, AVSD, PDA (not ASD)
Older children = pump failure: dilated CM, myocarditis, tachycardias
3 cardinal signs of CHF in infants
- tachycardia
- tachypnea
- hepatomegaly
Rheumatic fever diagnosis
- 2 major
or 1 major and 2 minor - AND evidence of recent GAS infection
(different in low vs moderate/high-risk population)
Rheumatic fever criteria major and minor
Major: carditis, polyarthritis, chorea, subcutaneous nodules, erythema marginatum
Minor: fever, polyarthalgia, prolonged PR, elevated CRP or ESR
Cor pulmonale
symptoms
= right heart dysfunction secondary to pulmonary disease
features: SOBOE, decreased activity tolerance, CP, syncope on exertion, edema, decreased appetite/energy
Pulmonary hypertension and cor pulmonale physical findings
- precordial bulge
- RV heave
- single S2
- TR, PR murmurs
- pulsatile liver (TR)
- hepatomegaly
- edema
ARF prophylaxis
ARF without carditis - 5 yrs or until 21 yrs
ARF with carditis (no valvular disease) - 10 yrs or until 21 yrs
ARF with carditis and persistent valvular disease - 10 yrs or until 40 yrs of age (sometimes lifelong)
Treatment ARF
- bed rest and monitor for carditis (ambulate when inflam has subsided)
- 10 days of oral penicillin or a single IM pen (then long term prophylaxis)
- ASA
- steroids if carditis and significant heart involvement
Long QT syndrome treatment
- beta blockers
TOF 4 features
- stenosis of pulmonary artery
- intraventricular communication
- over-riding aorta
- right ventricular hypertrophy
Management of tet spells
- knee chest position
- oxygen
- IV fluid bolus
- IV morphine
- IV beta blocker
- IV phenylephrine
- emergency repair
Prostaglandin side effects
apnea/hypoventilation
others: hypotension, flushing, hyperthermia
HoCM screening
- ECG and echo q3-5 yr for children < 12yo
- annually for 12+ yrs
