Cardiovascular

Question 1

Congenital heart disease:

ductal dependent lesions present in what 2 ways

how to dx

Answer 1

Neonate:

1. (cyanotic–blue baby) hypoxic. pulm blood flow dependent on ductus arteriosus, not responsive to O2
2. (acyanotic–grey baby) shocky/acidotic. systemic flow dpendent on ductus arteriosus, not responsive to fluids
   - dx with hyperoxia test, ABG for acidosis, CXR, 4 extremity BP

Question 2

congenital heart disease

hyperoxia test?

Answer 2

10-15 min of 100% fio2

If ABG pao2 <150, indicative of cyanotic CHD

Question 3

congenital heart disease: CHF

• what age presents
• signs/sxs

Answer 3

think month 2-6

FTT, sweating with feeds, difficult to feed, hepatomegaly

Question 4

pediatric acquired heart disease, think what 2 main things

Answer 4

myocarditis

kawasaki’s

Question 5

child with persistent tachycardia, no obvious cause

-what uncommon thing to consider

Answer 5

myocarditis

can be insidious onset

Question 6

SVT vagal maneuvers in peds:

Answer 6

neonate: bag of ice
toddler: hold by feet
child: syringe blow through

Question 7

SVT

Adenosine dose peds

Cardioversion dose peds

Answer 7

0. 1 mg/kg adenosine
1. 5-1 J/kg

Question 8

pediatric chest pain

general approach

Answer 8

Make sure in Hx to see if syncope/exertion is component

EKG, CXR

if both normal and well appearing, then reassurance and pain control

most CP is not cardiac in peds

Question 9

Peds EKG

what 3 things to know that are very different from adults

Answer 9

1. Juvenile TWI–v1-3 from birth to age 7
2. R heart dominant at birth, may even have incomplete RBBB
3. Q wave in inferior/left precordial leads

Question 10

congenital long QT

• what QT value to be concerned
• what types of syndromes

Answer 10

• 0.5 is concerning, like adults
• congenital: romano-ward (not deaf), jervell lange nielson (deaf)

Question 11

peds ekg axis:

what to know

Answer 11

R axis deviation normal at birth

if you see L axis deviation <30degrees after infancy (“superior axis”), then think something congenital and wierd (eg VSD in down’s, or tricuspid/pulm atresia)

Question 12

peds EKG:

ventricular hypertrophy, how to tell

Answer 12

use chart to look at criteria

combine heights of V1 and V6

V1 positive, V6 neg: RVH, opposite is LVH

Question 13

PACs and PVCs in peds

Answer 13

PACs: very common, esp in infancy. rarely assoc with dz

PVCs: common, if structually normal heart than usu benign. . worry if multifocal and >3 in a row