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Pediatrics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Describe murmur of venous hum

A

Continuous, soft blowing, in right and left infraclavicular areas. Increased by sitting, standing, decreased by supine or turning head. Produced by flow in jugular veins

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2
Q

Describe pulmonary flow murmur

A

midsystolic, soft blowing best heard at 2nd LICS, 2/2 to flow in RVOT, increased when supine, expiration. heard at age 7-10 and persists into adulthood

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3
Q

Which congenital heart lesions typically present with heart failure in first 6 weeks of life

A

Obstructive lesions of the left side of the heart - aortic stenosis, coartation of the aorta, hypoplastic left heart. Also large shunt lesions cause pulmonary overcirculation and symptoms of heart failure.

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4
Q

Most common form of congenital heart disease?

A

Bicuspid Ao valve, then VSD

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5
Q

When is surgery for VSD performed?

A

3-6 months

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6
Q

Why do u get a fixed second heart sound in ASD?

A

Usually right ventricle empties slightly later than the left therefore get P2. The split is increased in inspiration because of more venous return. In an ASD, the right ventricle is always volume overloaded in expiration and inspiration this fixed second heart sounds.

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7
Q

What is EKG sign of right ventricle volume overload

A

RSR’ in V1

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8
Q

Signs of PDA in newborns

A

continuous machinery-like murmur at left infraclavicular area, wide pulse pressure, bounding pulses,

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9
Q

4 features of TOF

A
  1. Overriding aorta, 2. VSD, 3. Pulm stenosis or RVOF 4. RV hypertrophy
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10
Q

tet spell

A

Murmur is actually softer because less blood across RV OFT. . Treatment - assume knee-chest position, fluids, oxygen.

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11
Q

Egg on a string heart

A

Transposition of great arteries, directanterior posterior relationship of the arteries

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12
Q

Treatment of transposition of the great arteries

A

atrial septostomy, then arterial switch in first couple weeks of life

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13
Q

TAPVR

A

Pulmonary veins drain into the systemic venous system. Can get supracardiac - svc or innominate vein, cardiac - drainage into coronary sinus, infracardiac - into IVC.

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14
Q

Obstructed TAPVR

A

Not getting enough blood back to heart, pulmonary congestion and need emergent surgical repair

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15
Q

Who needs prophy antibiotics?

A

Prostetic cardiac heart valve, previous infective endocarditis, Unrepaired cyanotic CHD, including shunts and conduits, Completely repaired CHD with prostetic material or device within 6 months or with residual defects.

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16
Q

Jones Criteria

A

MAJOR: Carditis, Polyarthritis, Chorea, subq nodules, erythema marginatum MINOR: fever, prolonged PR interval, elevated Acure phase reactants, arthralgia, previour acute rheumatic fever. Need 2 major, 1 major and 2 minor PLUS evidence of recent strep test.

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17
Q

Kawasaki Disease Criteria

A

Fever for 5 days PLUS 4 of: Rash, conjunctivitis, mucosal changes, Lymphadenopathy, extremity erythema, edema

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18
Q

Treatment of acute rheumatic fever

A

ASA and pcn. Steroid only for severe carditis or symptoms not improved with asa

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19
Q

Why do you not want to use oxygen in pulmonary over circulation congenital heart syndrome?

A

Bc oxygen is a pulmonary vasodilator and systemic vasoconstrictor

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20
Q

Signs and symptoms of PDA

A

Wide pulse pressure bc have systolic and diastolic shunt and runoff in diastole. Bounding pulses. Machinery like murmur

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21
Q

What is the snowman sign on chest X-ray?

A

Total anomalous pulmonary venous return

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22
Q

What is the effect on oxygen on pulmonary and systemic circulation?

A

pulmonary vasodilator (therefore dont want to use in VSD or anything with increase pulm flow) systemic vasoconstrictor.

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23
Q

When do you start a statin in a kid with high cholesterol?

A

When they are over the age of 8 and have one of the following: 1.) LDL >190, 2.) LDL>160 and family member with premature CAD or 2 CAD risk factors. 3.) LDL>130 and diabetes

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24
Q

What does cyanosis of preductal structures suggest?

A

transposition of the great vessels.

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25
Q

Describe the murmur of physiologic peripheral pulmonic stenosis

A

due to fetal anatomy - pulmonary arteries come off very acutely and are small. Creates turbulence. Causes soft, harsh, SEM heard in the axilla. disappears by 12 months

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26
Q

What drug should never be used in Aflutter for patients < 1 and why?

A

verapamil bc it can cause heart failure or hypotension

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27
Q

Which drugs can worsen torsades de pointes?

A

quinidine or procainamide can worsen

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28
Q

What conditions should you avoid verapamil?

A

young infants, afib with WPW, a flutter, wide complex tachycardias, beta blockers

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29
Q

What class is quinidine and what are major side effects?

A

Ia, prolongs QT segment -> torsades, diarrhea, hearing loss and tinnitis

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30
Q

What class is procainamide and what are major side effects?

A

prolongs QT and QRS. Can cause blood dyscrasias, drug induced lupus, caution in HF patients

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31
Q

What class is lidocaine and what are major side effects?

A

class Ib. Seizures

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32
Q

What class is amio and what are major side effects?

A

class III; very long half life. Corneal deposits, pulm fibrosis, sun sensitivity. No hematologic changes

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33
Q

which conditions worsen dig toxicity?

A

hypokalemia or hypercalcemia

34
Q

What cardiac lesion is noonan syndrome associated with?

A

pulmonic stenosis or HCOM

35
Q

What cardiac lesion is apert syndrome associated

A

VSD or coarct

36
Q

What cardiac lesion is holt-oram syndrome associated

A

ASD, VSD

37
Q

What cardiac lesion is alagille syndrome associated

A

pulmonic stenosis

38
Q

What cardiac lesion is cri-du-chat syndrome associated

A

ASD

39
Q

What cardiac lesion is trisomy 13 syndrome associated

A

VSD

40
Q

What cardiac lesion is trisomy 18 syndrome associated

A

VSD

41
Q

Where are VSDS most likely in kids <1

A

muscular septum

42
Q

Where are VSDs most likely in kids >1

A

membranous septum

43
Q

Most common form of ASD

A

ostrium secundum

44
Q

How do you distinguish ASDs in ostium secundum from primum on EKG?

A

primum have left axis deviation and RVH (secundum only have RVH, no LAD)

45
Q

In what lesion does paradoxic splitting occur?

A

aortic stenosis because increased LV load takes longer to get out.

46
Q

Which congenital lesion can cause increased bp of 15mmHg in right arm?

A

supravalvular aortic stenosis

47
Q

What are the congenital heart defects with left axis deviation

A

ostium primum ASD, complete AV canal, tricuspid atresia

48
Q

snowman or figure 8 shaped heart

A

TAPVR without obstruction

49
Q

Egg shaped heart

A

transposition of the great arteries

50
Q

boot shaped heart

A

TOF

51
Q

What is right atrial isomerism?

A

bilateral right-sidedness with bilateral 3 lobed lungs, a horizontal liver, no spleen. bilateral RA with 2 sinus nodes, common bowel malrotations and other congenital heart disease

52
Q

Left atrial isomerism

A

bialteral left sidedness - 2 lobed lungs, polysplenia, increased risk of bowel malrotation and congenital heart disease

53
Q

Which syndromes is right aortic arch common?

A

TOF and truncus arteriosus

54
Q

what syndrome is aortic arch abnormalities associated with?

A

Digeorge syndrome

55
Q

what is anomalous origin of the left coronary artery

A

left coronary artery comes off of the pulmonary artery

56
Q

Kussmaul sign

A

Increased JVP with inspiration because right heart cannot accomodate increased venous return and it backs up, usually JVP decreased with inspiration. Seen in tamponade and constrictive pericarditis

57
Q

Pulsus paradoxus

A

normally with inspiration, bp falls 4-10mmHg. With tamponade, the aortic pressure will fall 10-15mmHg

58
Q

Becks triad

A

Increased JVP, dropping systolic bps, muffled heart sounds = tamponade physiology

59
Q

What happens to chamber pressures in tamponade and constrictive pericarditis?

A

end diastolic pressure equalize

60
Q

Dobutamine effects

A

B1 adrenergic effects - increases contractility without increasing HR or BP

61
Q

Epinephrine effects

A

stimulates both alpha and beta adrenergic receptors

62
Q

Dopamine effects

A

increases myocardial contractility by stimulating NE release. dilates peripheral beds at low dose, alpha adrenergic at higher doses

63
Q

Milrinone

A

noncatecholamine - inotropic and vasodilator by inhibitis phosphodiesterase

64
Q

what meds increase digoxin levels

A

quinidine, verapamil, amiodarone, beta blockers, tetracycline, erythromycin

65
Q

Describe digoxin toxicity

A

arrythmias, color vision changes, confusion, vertigo, n/v/d. ignore dig levels

66
Q

What are criteria for acute rheumatic fever?

A

Proof of group A strep infection. 2 Major, or 1Major and 2 minor.
Major Jones criteria for ARF are polyarthritis, carditis, Sydenham chorea, subcutaneous nodules, and erythema marginatum.

Minor Jones criteria for ARF are fever, arthralgia, prolonged PR interval on electrocardiograph, and elevated acute-phase reactants.
67
Q

first and second most common causes of SCD in young athletes

A

HCOM and anomalous coronary artery

68
Q

side effects of spironolactone

A

gynecomastia, hyperkalemia

69
Q

Which infection can put you at risk for pneumothorax

A

pcp pneumonia

70
Q

Who needs SBE prophylaxis

A

prosthetic heart valve, previous endocarditis, unrepaired cyanotic heart disease, repair congenital diz with prosthetic material <6 mos post op, heart transplant pts with valvulopathy

71
Q

What is used for SBE prophy is pcn allergic?

A

clindamycin or keflex or azithro

72
Q

Most common age for kawasakis

A

6 months to 5 years

73
Q

How long after IVIG for kawasakis do you need to postpone vaccines?

A

live attenuated for 11 months. Can give other routine vaccines. Important to give killed flu vaccine to decrease risk of Reyes while on ASA

74
Q

What do you need to think about before giving O2 to baby with possible cyanotic disease?

A

O2 will close PDA faster, decrease vascular resistance in lungs causing increased pulmonary blood flow to the lungs. Also O2 is a systemic vasoconstrictor, forcing more blood to the pulmonary circulation

75
Q

Snowman heart

A

TAPVR

76
Q

supravalvular aortic stenosis is associated with what genetic syndrome

A

Williams syndrome

77
Q

Holt-Oran syndrome heart defect

A

ASD, VSD

78
Q

should lasix be given fast or slow IV?

A

slow - fast associated with otoxocity

79
Q

Which heart arrhythmia is associated with drownings?

A

Long Qtc syndrome

80
Q

What is the incidence of CHD in patients with Downs?

A

50%

81
Q

Jervell and Lange-Neilsen syndrome

A

long Qt syndrome and SNHL

Pediatrics (25 decks)

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