Cardiovascular (10%) Flashcards by Laura Gardner

What are two examples of very serious complications of Kawasaki dz?

Coronary artery aneurysm

Myocardial Infarction

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What is the recommended managment of tetralogy of fallot?

Surgical correction

Prostaglandin E1 prior to surgery to maintain patency of the ductus arteriorsis

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What are some clinical manifestations a pt with hypertrophic cardiomyopathy may present with?

Often asymptomatic, 1st sx may be sudden cardiac death

Dyspnea MC initial complaint (90%)

Fatigue

Angina pectoris (75%)

Syncope (pre syncope, dizziness)

Arrhythmias (A fib, V Tach/V Fib)

Sudden cardiac death: adolescent/preadolescent children, esp. during times of extreme exertion –> usually d/t V Fib

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What is the mainstay of tx for a pt with Kawasaki dz?

IV Immunoglobulin + High dose ASA

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What diagnostic test should be ordered if a pt is suspected to have hypertrophic cardiomyopathy?

Echocardiogram: asymmetrical wall thickness (especially septal) and systolic anterior motion of the mitral valve

CXR: cardiomegaly

ECG: LVH

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T/F: Restrictive VSD (left > right-sided pressure) is associated with a poor prognosis

False, it has a GOOD prognosis :)

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A patient with ASD may develop a stroke due to _______ _______

Paradoxical emboli

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Until what age are ASDs usually asymptomatic?

30 y/o

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What kind of murmur is associated with hypertrophic cardiomyopathy?

What does it decrease with?

Increase with?

Harsh systolic ejection murmur

Decrease: Hand grip, squatting, laying supine (increased venous return)

Increase: valsalva and standing (decreased venous return)

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A pt with PDA usually has what kind of pulses?

Bounding

wide pulse pressure

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Describe the murmur that is associated with VSD

Loud high-pitched harsh, holosystolic murmur at the lower left sternal border (LLSB)

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What heart sound, other than a murmur, may be heard in a pt with ASD?

Widely fixed, split S2 that does NOT vary with respirations

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What are the three types of Atrial Septal Defects?

Where are they located?

Ostium Primum

Ostium Secundum

Sinus venosus

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What kind of murmur is usually associated with ASD?

Where is it best auscultated?

Systolic ejection murmur

Pulmonic area

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What does a pt (infant vs older children) with tetralogy of fallot present with?

Cyanosis in infants

Tet spells in older children (periodic episodes of cyanosis relieved with squatting or putting an infant’s knees to chest)

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What are the two types of coarctation of the aorta?

Preductal and postductal

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What will be seen on CXR in a pt with tetralogy of fallot?

Boot shaped heart

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What are the components of tetralogy of fallot?

RV outflow obstruction
RV hypertrophy
VSD (large and unrestrictive)
Overriding aorta

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Hypertrophic cardiomyopathy is a disorder of inappropriate ____ and/or ____ hypertrophy (especially _____)

Left ventricular

Right ventricular

septal

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With hypertrophic cardiomyopathy, what is obstructed?

Subaortic outflow obstruction

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What is the most common type of VSD?

What are the other three types?

Supacristal (outlet): 5%, beneath the pulmonic valve. ± aortic valve insufficiency
Perimembranous: MC type (80%), hole in LV outflow tract near the tricuspid valve
Inlet (posterior): 10%, located posterior to the septal leaflet of the tricuspid valve
Muscular: 5-20%, usually multiple holes in a “swiss cheese” pattern

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Kawasaki disease causes necrotizing vasculitis in what blood vessels?

Medium and small vessels

Cornoary arteries

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What is the most common cyanotic heart disease?

Tetralogy of Fallot

What are the major and minor Jones criteria for diagnosing rheumatic fever?

How many of each are required for diagnosis?

MAJOR

Joint (migratory polyarthritis, lower to upper)
Oh my heart! (active carditis)
Nodules (subcutaneous)
Erythema marginatum
Sydenham’s chorea

MINOR

Clinical: Fever, arthralgia

Laboratory: increased ESR, CRP, leukocytosis

ECG: prolonged PR interval

Describe the strength of femoral pulses in a pt with coarctation of the aorta

Delayed or weak

You should suspect coarctation of the aorta in a child who has ________ and \_\_\_\_\_\_\_\_\_

Secondary HTN and bilateral LE claudication

What is the recommended management for rheumatic fever?

**Anti inflammatory** (ASA) **_PCN G_** abx of choice, *or erythromycin if PCN allergic*

Kawasaki syndrome is most common in kids who are in what age group? More common in boys or girls? What ethnicity is at greated risk?

\<5 y/o boys Asians

Large VSDs should be surgically repaired by 2 y/o to prevent \_\_\_\_\_\_\_

pulmonary HTN

\_\_\_\_\_\_\_\_\_\_ is usually performed in patients with hypertrophic cardiomyopathy with severe, refractory sx despite medical management

Myomectomy

What lab tests will be elevated in a pt with Kawasaki dz? What is peculiar about their urine?

ESR, CRP, platelets= elevated Sterile pyuria

Most small VSDs close spontaneously within ___ years

10 years

Is hypertrophic cardiomyopathy inherited?

Yes

Rheumatic fever is an acute _________ inflammatory multi-systemic illness mainly affecting children \_\_\_\_-\_\_\_\_ y/o

autoimmune 5-15 y/o

In a pt with coarctation of the aorta, the systolic BP in the upper extremities will be (lower/higher) than in the lower extremities

Higher

What is the most common type of congenital heart disease?

Ventricular septal defect

What medications are 1st line for management of hypertrophic cardiomyopathy?

Beta blockers

What are potential complications of rheumatic fever?

***_Rheumatic valvular disease_***: **mitral** (75-80%), aortic (30%); tricuspid & pulmonic (5%)

What murmur is associated with PDA? Where is it best auscultated?

Continuous machine like murmur heard best at the pulmonic area

What is a patent ductus arteriosis

A heart defect caused by problems in the heart's development ^{Before a baby is born, the fetus's blood does not need to go to the lungs to get oxygenated. The ductus arteriosus is a hole that allows the blood to skip the circulation to the lungs. However, when the baby is born, the blood must receive oxygen in the lungs and this hole is supposed to close. If the ductus arteriosus is still open (or patent) the blood may skip this necessary step of circulation. The open hole is called the patent ductus arteriosus.}

T/F: If the patient has a large VSD, they may present with signs of CHF

True

\_\_\_\_\_\_\_\_\_\_ is an alternative to surgical management of hypertrophic cardiomyopathy with good outcomes

Alcohol Septal Ablation ## Footnote *Ethanol destroys the extra myocardial tissue*

What is Eisenmenger's syndrome?

Non-restrictive, the blood takes the path of least resistance (flows to the right side) Over time, when the pulmonary pressure becomes \> systemic pressure, this creates a RIGHT TO LEFT SHUNT Asymptomatic at rest but ± **cyanosis**, exertional dyspnea, CP, and syncope

Rheumatic fever is caused by what infectious organism?

GABHS

Describe the murmur often heard in a child with coarctation of the aorta

Systolic murmur that radiates to the back, scapula, or chest

What will be seen on CXR of a pt with coarctation of the aorta?

Rib notching (due to dilation of the intercostal arteries) "3" sign (shape of the coartation)

What is 1st line tx for PDA in infants?

**IV Indomethacin** *prostglandin inhibitor*

What is coarctation of the aorta?

A narrowing of the large blood vessel (aorta) that leads from the heart to carry blood to the rest of the body

70% of pts with coarctation of the aorta also have a _________ aortic valve

Bicuspid

In pts with hypertrophic cardiomyopathy, tx should focus on early detection, medical management, surgical and/or ______ placement Counseling to avoid ________ and extreme \_\_\_\_\_\_\_/\_\_\_\_\_\_\_ is very important

Implantable Cardioverter Defibrillator dehydration exertion/exercise

What will be seen on the following imaging studies if a pt has a VSD? CXR Echo ECG MRI Cardiac Catheterization

**CXR**: varies. May be normal or show left atrial enlargement, RV hypertrophy **Echocardiogram**: determines size and location of VSD (Echo preferred over catheterization) **ECG**: LVH with mild to moderate VSD, normal with small VSD, + combined RVH/LVH (large equiphasic waves \>50% in precordial leads - Katz-Wachtel phenomenon), LAE/RAE **MRI**: only used if echo is non-diagnostic, MRI gives the same dx info as catheterization **Cardiac Catheterization**: done if other tests are non-diagnostic or pulmonary HTN

Describe the phrase/acronym "Warm CREAM" in regards to Kawasaki syndrome's clinical manifestations.

Warm = Fever, + 4 out of the following 5: ## Footnote 1. ****_C_**onjunctivitis**: bilateral and nonexudative (± photophobia), spares the limbus 2. ****_R_**ash**: polymorphous (erythematous or morbiliform or macular). 3. ****_E_**xtremity** (*peripheral*) **changes**: desquamation (especially perineum), edema, erythema of the palms & soles, induration of the hands & feet, Beau's lines (transverse nail grooves), arthritis. 4. ****_A_**denopathy**: cervical lymphadenopathy (erythematous, nonsuppurative, induration, unilateral) 5. ****_M_**ucous membrane**: pharyngeal erythema, lip swelling & fissures, "strawberry tongue"

In a pt with a moderate VSD, what sx may they experience?

Excessive sweating or fatigue, especially during feeds

Does VSD result in a (left/right) to (left/right) shunt

Left to right ## Footnote *blood flows from the left ventricle (higher pressure) to the right ventricle (lower pressure)*

In a small, restrictive VSD, are pressures between ventricles (low/normal/high)? Are pts usually asymptomatic or symptomatic?

Normal Asymptomatic