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Peds EOR > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is the leading cause of mitral valve stenosis and valve replacement in adults in the US?

A

acute rheumatic fever

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2
Q

What are the valves that get replaced with acute rheumatic fever?

A

1st mitral valve, 2nd aortic valve, 3rd tricuspid alve

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3
Q

When does rheumatic fever develop?

A

in children and adolescents following pharyngitis with group A beta-hemolytic streptococcus

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4
Q

The presence of what protein is seen with acute rheumatic fever?

A

the presence of the M protein is the most important virulence factor for group A streptococcal infection in humans and anti-M antibodies against the streptococcal infection may cross-react with heart tissue

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5
Q

When is the peak incidence of acute rheumatic fever?

A

ages 5-15 years

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6
Q

What is the jones criteria (major)?

A 
carditis
chorea
erythema marginatum 
polyarthritis 
subcutaneous nodules
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7
Q

What is the jones criteria (minor)?

A 
arthralgia 
elevated ESR or C-reactive protein 
fever
prolonged PR interval (on ECG)
leukocytosis
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8
Q

What is cardiac rhythm may patients with rheumatic heart develop?

A

atrial fibrillation

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9
Q

What is the tx of acute rheumatic fever?

A

pcn and asa

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10
Q

What is an atrial septal defect?

A

noncyantoic foramen ovale fails to close

Ostium secundum is most common

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11
Q

What are the physical exam findings of an atrial septal defect?

A
  • wide fixed, split, second heart sound (S2)
  • systolic ejection murmur at second left inutersotals space with an early to mid-systolic rumble
  • failure to thrive
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12
Q

How is an atrial septal defect dx?

A

best diagnosed by passing a catheter through defect

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13
Q

What is the tx for an atrial septal defect?

A

symptomatic: diuretics, ACE inhibitors, digoxin
definitive: surgical closure

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14
Q

When is a coarctation of the aorta found?

A

noncyantoic - typically found just after the vessels are given off to the left arm

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15
Q

What does coarctation of the aorta cause?

A

high blood pressure, as the kidney do not “see” as high of blood pressure as they would like

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16
Q

What does coarctation of the aorta lead to?

A

release substances to raise the pressure/renine

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17
Q

How old is a person with coarctation of the aorta?

A

in their teens, twenties need to r/o in a young adult with HTN

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18
Q

What are the key findings of coarctation of the aorta?

A

elevated blood pressure in the arms with a low blood pressure in the legs
-pulses in the leg may be decreased in intensity or delayed compared with their occurrence in the arm

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19
Q

What is heard on physical exam with coarctation of the aorta?

A

ejection murmur is heard at the aortic area and the left sternal border that radiated into the left axilla and left back

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20
Q

What is seen in 50% of cases with coarctation of the aorta?

A

a bicuspid valve - also increase incidence of cerebral berry aneurysm

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21
Q

How is coarctation of the aorta dx?

A
  • 1st echocardiogram
  • EKG = LVH
  • CXR = rib notching “figure of 3 sign”
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22
Q

What is the tx of coarctation of the aorta?

A
  • prostaglandins E1

- generally, require surgical repair with dilating the segment with balloons

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23
Q

What is hypertrophic cardiomyopathy?

A
  • genetic condition autosomal dominant
  • the most common cause of sudden death in young athletes
  • 2.8 times more common in young athletes vs non-athletes
  • Marfan’s syndrom
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24
Q

What is seen on EKG with hypertrophic cardiomyopathy?

A

12 lead EKG practice test

-LVH on EKG

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25
Q

What occurs in the heart in a person who has hypertrophic cardiomyopathy?

A

LV myocardium becomes hypertrophied leading to outflow obstruction sxs

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26
Q

What are the symptoms of hypertrophic cardiomyopathy?

A

SOB, chest pain, syncopal episode after exertion

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27
Q

What is are the physical exam findings of a hypertrophic cardiomyopathy?

A

systolic murmur left sternal border/loud S4 (outflow obstruction)

  • the cardiac murmur will sound similar to the murmur of aortic stenosis
  • however, a murmur due to HCM will increase in intensity with any maneuver that decreased the volume of blood in the left ventricle
  • increase with standing increase with Valsalva
  • decreased with squatting
  • in contrast, standing up results in decreased venous return and thus decreased preload
  • with less preload there is less blood to separate the anterior leaflet from the hypertrophied septum, resulting in more obstruction and hence increased intensity of the murmur
28
Q

How is hypertrophic cardiomyopathy dx?

A

echocardiogram, MRI

29
Q

What is the tx of hypertrophic cardiomyopathy?

A
  • beta-blockers + disopyramide (nor pace)
  • calcium channel blockers
  • diuretics should be avoided
30
Q

What is Kawasaki disease?

A

a vasculitis mostly affecting children where the immune system attacks arteries, taming endothelial cells of blood vessels

31
Q

What is the first sign of Kawasaki disease?

A

lasting fever

32
Q

Who does Kawasaki disease most often affect?

A

kids younger than 5 years old and boys

33
Q

What is Kawasaki disease characterized by?

A

CRASH and burn (fever)

  • Conjunctival injection (spares limbus)
  • Rash (all body parts, flakes)
  • Adenopathy (enlarged lymph nodes, cervical)
  • Strawberry tongue
  • Hand and foot rash
  • fever (5 or more days that doesn’t resolve with antipyretics)

25% of patients have cardiac sequelae

  • coronary artery aneurysm in 25% of patients and may lead to death
  • myocarditis
  • myocardial infarction
34
Q

What is the presentation of Kawasaki disease?

A
  • 5 days or more of high fever, arthritis may be reported
  • bilateral non-purulent conjunctival injection
  • erythematous morbilliform rash with desquamation on the trunk that may spread
  • may also be urticarial or erythema multiform-like
  • non-vesicular
  • erythema and swelling of the hands and feet with desquamation
  • oral mucositis
  • red cracked lips
  • strawberry tongue
  • asymmetric cervical adenopathy
  • firm, unilateral, and nontender
35
Q

What is the dx of Kawasaki disease?

A

diagnostic criteria = four of five CRASH symptoms + high fever lasting five days

  • vasculitis in coronary arteries is a definitive sign
  • it is possible to have cases that do not meet all clinical diagnostic requirements
36
Q

What are the lab findings of Kawasaki disease?

A
  • increased inflammatory markers
  • increased C-reactive protein
  • increased erythrocyte sedimentation rate
  • increased platelet count (often at weeks 2-3)
  • increased white blood cells with a shift to left
  • increased liver transaminases
  • echocardiography for all patients with Kawasaki disease to assess for cardiac abnormalities
  • obtained at time of diagnosis and again at 2 and 6-8 weeks after diagnosis
37
Q

What is the tx of Kawasaki disease?

A

include both intravenous immunoglobulin (IVIG) and aspirin

-self limited and resolves in 6-8 weeks or without treatment but 25% risk of heart complications if left untreated

38
Q

What is a patent ductus arteriosus?

A

ductus arteriosus is a normal fetal structure

-if it remains open it’s called a patent ductus arteriosus

39
Q

How do patients with a patent ductus arteriosus present?

A

3-6 week infants can present with tachypnea, diaphoresis, inability or difficulty with feeding, and no weight gain
-low birth weight premature infant adults with PDA may present with signs and symptoms of heart failure

40
Q

What is heard on physical exam in a person with patent ductus arteriosus?

A

rough “machinery” murmur late in systole at the time of S2 making it loud
-murmur is best heard at the pulmonic area 2nd ICS left sternal border and inferior to the clavicle bounding pulses and a widened pulse pressure

41
Q

What will close a patent ductus arteriosus?

A

because prostaglandin E-2 is responsible for keeping the ductus patent - inhibitors of prostaglandin will close it
-this is why NSAIDS are the treatment and are contraindicated in pregnancy

42
Q

How is a patent ductus arteriosus diagnosed?

A

echocardiogram

43
Q

What is the tx of patent ductus arteriosus?

A

indomethacin has been used to help close a PDA?

44
Q

What is syncope refer to?

A

a transient loss of consciousness/postural tone secondary to an acute decrease in cerebral blood flow

45
Q

What is syncope characterized by?

A

a rapid recovery of consciousness without restriction

46
Q

What is the most common cause of syncope?

A

vasovagal, idiopathic

47
Q

What are the red flags of syncope?

A

syncope during exertion, multiple recurrences in short time, heart murmur/structural heart disease, old age, significant injury during syncope, family hx of unexpected death/extertional/unexplained recurrent syncope

48
Q

What is syncope usually from?

A

insufficient cerebral blood flow/from benign causes

49
Q

What is the less common cause of syncope?

A

cardiac arrhythmia

50
Q

What is vasovagal syncope?

A

(neurocardiogenic) most common cause

51
Q

What is cardiac syncope?

A

arrhythmias (AV block, sick sinus syndrome), obstruction of blood flow (aortic stenosis, hypertrophic cardiomyopathy), massive MI

52
Q

What is orthostatic hypertension?

A

defect in vasomotor reflexes, common in elderly, diabetics, patients taking certain medications (diuretics, vasodilators)

53
Q

What is a rare cause of syncope?

A

cerebral vascular disease

54
Q

What are some other noncardiogenic causes of syncope?

A

metabolic causes (hypoglycemia, hyperventilation), hypovolemia (hemorrhage), hypersensitivity (syncope precipitated by wearing a tight collar or turning the head), mechanical reduction of venous return (valsalva maneuver, postmicturition), and various medications (Beta-blockers, nitrates, antiarrhythmic agents)

55
Q

How is syncope dx?

A

ECG, glucose, pulse ox, echo, tilt table, CNS imaging = rare

56
Q

What is the tx for syncope?

A

fix the underlying cause

57
Q

What is the presentation of tetralogy of fallot?

A

difficult feeding, failure to thrive, “tet spells” = a baby with cyanosis and loss of consciousness with crying

58
Q

What are the features of tetralogy of fallot?

A

PROVe

  • pulmonary stenosis
  • right ventricular hypertrophy
  • overriding aorta
  • ventricular septal defect
59
Q

What are the physical exam findings of tetralogy of fallot?

A

crescendo-decrescendo, holosystolic at LSB radiating to the back

60
Q

What is chest radiography of tetralogy of fallot?

A

boot shaped heart

61
Q

What is the most common pathologic murmur in childhood?

A

ventricular septal defect

62
Q

Where is the hole or “defect” in the heart muscle with a ventral septal defect?

A

between the ventricles (the intraventricular “septum”)

63
Q

What can be a complication of ventral septal defect?

A

the heart can dilate, the muscle can become weak, and the pressures in the pulmonary arteries can increase (pulmonary hypertension) due to the increase in blood flow

64
Q

What are the physical exam findings of ventral septal defect?

A

loud, harsh, holosysoltic murmur, left to right - heard best at the lower left sternal border

65
Q

What are some characteristics of ventral septal defect?

A
  • like ASD’s, the size and therefore the clinical course of these defects is quite variable
  • some remain large, while others become smaller over time
  • it is not unusual for small-to-medium-sized VSD’s to eventually close spontaneously
66
Q

How are ventral septal defects dx?

A

echocardiogram

67
Q

What is the treatment of ventral septal defects?

A

most close by age 6, surgery if large

Peds EOR (12 decks)

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