cardioped Flashcards
receives the largest amount of combined ventricular output(55%) and has the lowest resistance in the fetal circulation
placenta
why is the fetal heart unable to increase stroke volume when the HR falls
it has a low compliance
why does is there functional closure of the foramen ovale
due to increased pressure in the left atrium
why does the ductus venosus closes
it is the result of lack of blood flow leading to faill in pulmonary artery pressure
trigger for closure of PDA(within 10-15hrs)
increased arterial Oxygen saturation
why is the ductus arteriosus more likely to remain open in preterms
because the preterm’s ductal smooth muscle does not have a fully developed constrictor response to oxygen
congenital acyanotic heart dses
ASD VSD PDA
most common type of ASD
ostium secundum (at the site of fossa ovalis)
chamber enlargement in ASD
right sided of the heart (RA RV PA)
murmur in ASD
systolic ejection murmur at the 2nd left ICS due to relative stenosis of pulmonary valve; wide-split S2 resulting from RBBB which delays both electrical depolarization of the RV and the ventricular contraction resulting in DELAYED closure of PV
most common congenital heart diease
VSD
irreversible changes occur in the pulmonary arterioles leading to pulmonary vascular obstructive dse (from L-R shunt to R-L shunt)
Eisenmenger syndrome
pertinent PE findings in VSD
Gr 2-5/6 systolic regurgitant murmur at the LLSB; loud S2; P2 intensity is increased in large shunt
site of enlargement in VSD
LA LA main PA
site of enlargement in PDA
LA LV Aorta
auscultatory finding in PDA
continuous machinery-like murmur
manifestations in PDA
tachycardia; exertional dyspnea due to volume overload; hyperactive precordium; bounding peripheral pulses with widened pulse pressure
complications of PDA
CHF; recurrent pneumonia
contraindication to surgical of PDA
PVOD
most common cause of cyanotic congenital heart disease in the newbords
TOGA
egg-shaped cardiac silhouette with a narrow superior mediastinum
TOGA
balloon atrial septostomy (creating interatrial communication in TOGA)
Rashkind procedure
atrial septostomy (creating interatrial communication in TOGA)
Blalock-Hanlon procedure
Definitive repair of TOGA
switch right and left-sided blood at 3 levels atrial(SENNING or MUSTARD); ventricular(RASTELLI); great artery level(JATENE)
manifestations of TOF
cyanosis; tachypnea; clubbing; RV tap on the left sternal border; Gr 3-5/6 systolic ejection murmur at the mid and ULSB(PS) with radiation to the back; single S2(esp with pulmonary HTN)
small heart size; decreased pulmonary markings; concave main PA with an unruptured apex
Boot-shaped heart seen in CXR of those with TOF
natural history of TOF
polycythemia develops; growth retardation if cyanosis is severe; brain abscess and CVA rarely occur; coagulopathy is a late complication
paroxysm of hyperpnea; irritability; prolonged crying; increasing cyanosis; decreasing intensity of murmur
hypoxic spell
management of hypoxic spell
put the child in knee-chest position to decrease systemic venous return; morphine to suppress the respiratory center and hyperpnea; O2 to improve O2sat; Phenylephrin to raise SVR; Propranolol may stabilize vascular reactivity of the systemic arteries preventing decrease in SVR; Ketamine to increase SVR
pathogenesis of truncus arteriosus(both ventricles eject blood to a common vessel; VSD always present)
caused by a failure of development of SPIRAL septum
mechanism of TAPVR
all 4 pulmonary veins drain to the RA causing RV volume overload
snowman sign on xray
TAPVR
what chromosomal abnormality is associated with coarctation of the aorta
Turner syndrome
how does coarctation of the aorta seen in xray of children around 7yo
rib notching
manifestations of coarctation of the aorta
asymptomatic but can have CHF if severe; weak or delayed femoral pulses; BP higher in arms than legs; LVH in CXR or ECG
which part of the aorta is typically affected in coarctation of the aorta
descending aorta distal to the origin of the left subclavian artery
what obstructive condition is associated with congenital Rubella; Noonan and William syndrome
Pulmonic stenosis
auscultatory finding in pulmonic stenosis
systolic ejection murmur at the LUSB with radiation to the back; soft P2
ECG finding in pulmonic stenosis
right axis deviation; RBBB if mild; RVH (pure R and upright T in V1)
surgical tx for Pulmonic stenosis
valvotomy(Brock’s procedure)
auscultatory finding in aortic stenosis
harsh systolic ejection murmur at the RUSB; systolic thrill (suprasternal notch)
surgical tx for aortic stenosis that remove patient’s own pulmonary valve and using it to replace the abnormal aortic valve and a homograft is placed in the pulmonary position
Ross procedure
inflammatory lesions with swelling fragmentation of the collagen fibers with altered staining characteristics of connective tissue found in the atrial myocardium seen in Rheumatic fever
Aschoff bodies
Jones Criteria
Arthritis; Carditis; Erythema marginatum; subcutaneous nodules; Sydenham’s chorea(associated with increased antineuronal antibodies); ACESS; minor:arthralgia(not considered if arthritis is present); fever(at least 38.8); elveated ESR/CRP; prolonged PR interval in ECG
most reliable lab evidence in Rheumatif fever
ASO (titers usually become elevated 2 weeks after strep infection; peaks at 4-6wks; and decreases after another 2wks; a 4-fold rise in titer in samples taken 10days apart)
Diagnosis of rheumatic fever
highly probable when either 2 major + ASO positive OR 1major and 2 minor +ASO
Antibiotics to eradicate Strep in Rheumatic fever
Penicillin VK 200-500mg QID x10days; Benzathine PCN 0.6 to 1.2MU IM; Eryhromycin 250mgTID x10days
anti-inflammatory tx for Rheumatic Fever
ASA 100mkd and prednisone 2mkd for 6-8wks
secondary prophylaxis (prevent recurrences of RF and RHD)
Pen VK 250mg BID; or Benzathine Penicillin 0.6-1.2MU q21days IM Duration: Arthritis: at least 5 years; Carditis: at least 10years
most common valvular involvement in adults
mitral stenosis
auscultatory finding in mitral stenosis
OPENING snap followed by mitral diastolic rumble
CXR finding in mitral stenosis
LA and RV enlargement; prominent MPA
why does hemoptysis develop in mitral stenosis
due to rupture of small vessels in the bronchi as a result of long-standing pulmonary venous hypertension
most common valvular involvement in children with RHD
mitral regurgitation
hallmark auscultatory finding in mitral regurgitation
systolic regurgitant murmur Gr2-4/6 at the apex with transmission to the left axilla
semilunar cusps are deformed and shortened; dilated valve ring so that the cusps fail to appose lightly
aortic regurgitation
manifestations in aortic regurgitation
widened pulse pressure; bounding WATER-HAMMER pulse in severe cases; high-pitched diastolic murmur at the 3rd-4th LICS (hallmark and more easily audible when sitting and leaning forward)
CXR finding in aortic regurgitation
Left ventricular enlargement; dilated ascending aorta and prominent aortic knob
most common valvular heart disease
MVP
most common complaint of patients with MVP
palpitations
major complications of MVP
infective endocarditis; sudden cardiac death; severe MV regurgitation; cerebrovascular ischemic events
auscultatory finding in MVP
MIDSYSTOLIC CLICK due to tensing of the MV as the leaflets prolapses into the LA during systole
subacute infective endorcarditis in SLE px
Libman-Sacks endocarditis or sterile endocarditis
etiology of infective endocarditis
Strep viridans and Staph aureus
manifestations in IE
prolonged fever; new murmur or a changing heart murmur; fatigue; myalgia; arthralgia; splenomegaly; petechiae; meningismus
tender pea sized intradermal nodules in pads of fingers and toes in IE
Osler nodes
painless small erythematous or hemorrhagic lesions on the palms and soles in px with IE
Janeway lesions
linear lesions beneath the nails in px with IE
splinter hemorrhages
duke major criteria in IE
(+) 2 blood cultures; evidence of endocarditis in echocradiography a.intracardiac mass on valve or other site; b.regurgitant flow near a prosthesis; c.abscess; d.partial dehiscence of prosthetic valves; e.new valve regurgitant flow
Tx of IE caused by Staph
Oxacillin with optional addition of Gentamicin; if resistant:Vancomycin
Tx of IE caused by Strep
Pen G Na or Ceftriaxone plus Gentamicin
Tx of prosthetic valve endocarditis due to Staph
Oxacillin + Rifampicin + Gentamicin
when to repeat 2d-echo in Kawasaki dse after performing 2d echo at diagnosis
repeat after 2-3wks of illness