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PEDS > Cardiology-Notes > Flashcards

Cardiology-Notes Flashcards

1
Q

What might a normal newborn EKG show?

A

physiologic R axis deviation

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2
Q

What is acrocyanosis? When is it normal?

A

peripheral cyanosis
from peripheral vasoconstriction
can be normal in newborns, but should resolve
if it persists–think about central cause-heart defect.

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3
Q

Cyanosis w/o respiratory distress–what should you think of?

A

congenital heart defect

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4
Q

How do congenital cyanotic heart disease patients react to 100% oxygen?

A

no improvement

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5
Q

How might polycythemia in a patient with congenital heart dx contribute to acrocyanosis?

A

increased RBCs (as a reaction to cyanosis) can cause sluggish blood flow & prompt peripheral cyanosis

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6
Q

What are some symptoms associated with a pathologic murmur in an infant?

A

diaphoresis
tiring with feeds
poor weight gain

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7
Q

What are some symptoms associated with a pathologic murmur in children?

A 
chest pain
dizziness
syncope
SOB
fatigue
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8
Q

What are some concerning physical exam findings of a murmur?

A 
holosystolic
diastolic
>=3/6
INCREASES with standing or Valsalva (decreased blood return)
Loud, fixed split, or single S2
decreased or absent femoral pulses
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9
Q

What is the work up for a concerning murmur in a child?

A

CXR (cardiomegaly)
EKG (hypertrophY)
ECHO
cardio referral

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10
Q

Holosystolic harsh @ LLSB. Do you need an ECHO?

A

Yes, possibly a VSD.

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11
Q

What are the heart defects of R–>L shunts? Blue babies?

A

1-5

  1. Truncus Arteriosus (1 vessel)
  2. Transposition of the Great Vessels (2 vessels)
  3. Tricuspid Atresia (tri-3)
  4. Tetrology of Fallot (4-tetra)
  5. TAPVR (5 letters)
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12
Q

What are the heart defects of L–>R shunts? Blue kids?

A

1-3
1 VSD
2. ASD
3. PDA

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13
Q

Which congenital heart defects are associated with Digeorge 22q11?

A

the Ts
Truncus Arteriosus
Tetrology of Fallot

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14
Q

Which heart defect is associated with congenital rubella?

A

PDA

Ruby is the color of love. public displays of affection.

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15
Q

Which heart defects are associated with Turner’s syndrome?

A

coarctation of the aorta

bicuspid aortic valve

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16
Q

Which cardiac conditions are associated with marfan’s? & ehlers danlos?

A

aortic root dilation aka ascending thoracic aortic aneurysm
increased risk for aortic dissection
MVP
aortic insufficiency (regurg)

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17
Q

Diabetic moms have increased risk of children with what?

A

transposition of the great vessels.

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18
Q

Friedrich’s ataxia is associated with what?

A

hypertrophic cardiomyopathy

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19
Q

What are the features that are shared by Marfan syndrome and homocystinuria?

A 
pectus deformity
tall stature with high arm/height ratio
larger lower segment than upper segment
arachnodactyly
joint hyperlaxity
skin hyperelasticity
scoliosis
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20
Q

What are the features of Marfan syndrome that distinguish it from homocystinuria?

A

autosomal dominant
normal intellect
lens dislocation
aortic root dilation

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21
Q

What are the features of homocystinuria that distinguish it from Marfan’s syndrome?

A 
autosomal recessive
intellectual disability
thrombosis
megaloblastic anemia
fair complexion
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22
Q

When can PDA be beneficial? What is it associated with? What does the murmur sound like?

A

beneficial in R–>L shunts blue babies
associated w/ congenital rubella
sounds like a continuous machine like murmur

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23
Q

What is the presentation of PDA?

A 
may be asymptomatic
accentuated increased pulses
if large-can get CHF
tachypnea, tachycardia, poor feeding, FTT
can lead to Eisenmenger
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24
Q

WHat is the workup and treatment of a PDA?

A

dx: via ECHO
treatment: usu closes in a few weeks
can ligate surgically if it doesn’t close or use indomethacin
keep it if they have R–>L shunt.

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25
Q

what is an ASD? Which types are most common? associations?

A

endocardial cushion defect
ostium secundum is most common-90%
ostium primum is second most common-seen in down syndrome

26
Q

What is the murmur and presentation of ASD?

A

split S2-delayed closure of the pulmonary valve b/c of increased blood in the R heart
fixed splitting of S2
presentation-fixed split S2, paradoxical emboli

27
Q

What is the most common congenital heart defect and what is it associated with?

A

VSD

associated with FAS, vascular rings

28
Q

What can improve vascular rings stridor?

A

extension of the neck and racemic epi

29
Q

What is the VSD murmur?

A

2/6 harsh, holosystolic LLSB (T)

diastolic rumble over cardiac apex

30
Q

What is the presentation of VSD?

A 
asymptomatic at birth
pulmonary resistance drops...
can get CHF 
tachypnea, tachycardia, poor feeding, FTT
Eisenmenger
Need ECHO
may need repair surgically
31
Q

What is Still’s murmur?

A

benign murmur that is 2/6 low frequency midsystolic murmur at LLSB
just reassure
if harsher, holosystolic, 3/6 then think VSD.

32
Q

What are the features of Tetrology of Fallot?

A

Overriding aorta
Pulmonic stenosis
RVH
VSD

33
Q

Which conditions is tetrology of fallot associated with ?

A 
22q11
down syndrome
alagille syndrome (aut dom)
34
Q

What is the murmur and presentation of tetrology of fallot?

A

VSD murmur T spot 3/6 harsh holosytolic murmur
Pulmonic stenosis murmur: harsh systolic ejection murmur at LUSB (P)
boot shaped heart on CXR
kids squat during a cyanotic spell

35
Q

What is the appropriate treatment for tetrology of fallot?

A

surgery before 6 months

36
Q

Who gets transposition of the great vessels? Murmur?

A

maternal diabetes
22q11
Murmur: Single S2, VSD murmur

37
Q

Presentation and treatment of transposition of the great vessels?

A

cyanosis with RVH
egg on a string Xray
PGE2
then surgical correction-make a VSD or ASD. Mix the blood.

38
Q

What’s the deal with tricuspid atresia?

A

need both an ASD and VSD to survive
hypoplastic RV, tricuspid valve fails to develop, L axis deviation
decreased pulmonary artery development–see fewer markings on CXR
PGE2 until surgery

39
Q

What’s the deal with TAPVR?

A

all 4 pulmonary veins return to the right atrium
get RA and RV enlargement–>RVH and R axis deviation
CXR: cardiomegaly, increased pulmonary markings
diastolic and systolic murmur–b/c increased flow across tricuspid and pulmonary valves.

40
Q

What is the presentation of coarctation of the aorta?

A

lower extremity hypoperfusion (cyanosis) and acidosis
won’t have equal palpable femoral pulses
adults-rib notching HTN in upper extremities
get RAAS activation HTN b/c of decreased renal perfusion
keep ductus arteriosus open with PGE2.

41
Q

Central cyanosis w/o murmur?

A

hypoplastic left heart

42
Q

benign condition that presents with soft systolic murmur heard best at LUSB (P) w/ radiation to both axilla?

A

peripheral pulmonary stenosis

due to acute angle of R & L pulmonary arteries.

43
Q

What is the murmur of a bicuspid aortic valve? what can it lead to?

A

S2 click

aortic stenosis, aortic regurg, aortic root dilation

44
Q

What is Ebstein’s anomalY?

A

due to maternal lithium usage
malformed tricuspid valve is in the RV
get tricuspid regurg and RA enlargement

45
Q

What would an EKG of ebstein’s anomaly show?

A

R axis deviation

tall p waves from RA enlargement

46
Q

What is the murmur of MVP? Which conditions may cause this?

A 
mid systolic click. More severe with earlier click.
Marfarns,
Ehlers Danlos,
OI
ADPKD
47
Q

What is the treatment for MVP?

A

beta blockers if there is chest pain

but really nothing helps.

48
Q

Which conditions are associated with mitral regurg?

A

infective endocarditis
acute rheumatic heart dx
tuberous sclerosis

49
Q

What is the presentation, complications, and treatment of mitral regurgitation?

A

holosystolic blowing murmur
this increases with squatting and expiration (like most murmurs)
can get volume overload and L-sided heart failure
need valve replacement

50
Q

Which condition can cause a rhabdomyoma in children?

A

benign hamartoma of cardiac muscle

associated with tuberous sclerosis

51
Q

What are the features of tuberous sclerosis?

A

HAMARTOMAS
ash leaf spots (white leaf patches over body)
renal angiomyolipoma
mitral regurgitation
rhabdomyoma
seizures
subependymal astrocytoma
angiofibromas in butterfly pattern on face
shagreen patches-orange dimply leathery spots on the face.
AUTOSOMAL DOMINANT

52
Q

Where can HOCM murmurs be heard?

A

apex

LLSB

53
Q

What does valsalva do to preload? Which murmur increases with it?

A

increases intrathoracic pressure
decreases preload
increases HOCM murmur

54
Q

Which murmurs increase with inspiration? expiration?

A

increases with inspiration-R sided murmur

increases with expiration–L sided murmur

55
Q

ASD V. VSD?

A

ASD-fixed split S2.

56
Q

Other disorders that can cause tetrology of fallot and transposition of the great vessels?

A

cru di chat

trisomy 13/18

57
Q

bounding peripheral pulses?

A

truncus arteriosus, pda

58
Q

What are some arrhythmias associated with ebstein’s anomaly?

A

SVT

WPW

59
Q

Causes of aortic stenosis?

A
  1. calcific
  2. congenital
  3. rheumatic fever
  4. infective endocarditis
    5 tertiary syphilis
60
Q

pulvus parvus et tardus?

A

weak pulses with delayed peak

aortic stenosis

61
Q

Wide pulse pressure

water hammer pulse

A 
aortic regurgitation
water hammer (corrigan's)
Austin flint: low pitched diastolic rumble
62
Q

Causes of mitral regurgitation?

A 
endocarditis (s. aureus)
papillary muscle rupture
ischemia
chordae tendinae rupture
myxomatous degeneration
rheumatic fever
marfan's 
cardiomyopathy
tuberous sclerosis

PEDS (14 decks)

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