Cardiovascular (Alice) (10%) Flashcards by Seth Northway

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

rheumatic fever

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rheumatic fever develops in peds following what infxn

pharyngitis w. group A beta-hemolytic strep

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most important virulence factor for GAS in humans

M protein

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_ abs against the streptococcal infection may cross react with heart tissue

anti M abs

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age group mc affected by rheumatic fever

5-15

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major jones criteria

jones
joint pain (polyarthritis)
(o) carditis
nodules (subcutaneous)
erythema marginatum
sydenham’s chorea

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minor jones criteria (5)

arthralgia
elevated ESR or CRP
fever
prolonged PR
leukocytosis

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pt w. rheumatic fever may develop what arrhythmia

afib

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tx for rheumatic fever

pcn
asa

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7 pediatric heart defects to know

ASD
coarctation of the aorta
HOCM
kawasaki dz
PDA
TOF
VSD

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-hyperdynamic precordium w. prominent right ventricular heave
-grade III/IV systolic ejection murmur in 2nd left ICS w. early to mid systolic rumble and split S2

ASD

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ASD is caused by a patent

foramen ovale

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what diagnosis makes you think ASD in a kiddo

failure to thrive

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is ASD cyanotic

no!

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gs dx for ASD

passing a catheter thru the defect

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tx for ASD (4)

diuretics
ACEI
digoxin
surgical closure

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wide, fixed, split S2
systolic ejection murmur at 2nd ICS
early to mid systolic rumble

ASD

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8 yo M who tires easily and c/o leg weakness - PE is mostly normal but LE are slightly atrophic and mottled - he also has weak/delayed femoral pulses - he has a late systolic ejection murmur

coarctation of the aorta

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what is this showing

figure of 3 sign -> coarctation of the aorta

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t/f: coarctation of the aorta is NON cyanotic

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what pt pop makes you think of coarctation of the aorta

teens/twenties w. HTN

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hallmark finding of coarctation of the aorta

elevated BPin arms
low BP in legs

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ejection murmur in aortic area and LSB that radiates to the left axilla and left back

coarctation of the aorta

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what malformation is seen in 50% of coarctation pt’s

bicuspid valve

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coarctation increases the risk for

berry aneurysm

dx for coarctation of the aorta

1. echo 2. EKG 3. CXR

what is this showing

figure of 3 sign -> **rib notching -> coarctation of the aorta**

EKG finding of coarctation of the aorta

LVH

tx for coarctation of the aorta

prostaglandins E1 **surgical repair w. balloon dilation**

HOCM is a _ genetic condition

autosomal dominant

25 yo F presents w. syncopal episode and loss of consciousness x 3 over the past year, each occurring just after PA - normal vitals - systolic ejection murmur heard best at LSB

HOCM

the HOCM murmur increases w. _ (2) and decreases w. _

increaes: standing, valsalva decreases: squatting

EKG finding of HOCM (2)

diffused increased QRS voltage LVH

3 sx of HOCM

SOB CP syncope after exertion

what heart sound is associated w. HOCM

the HOCM murmur increases in intensity w. any maneuver that

decreases preload

tx for HOCM

bb + disopyramide CCB

_ should be avoided in HOCM tx

diuretics (decrease preload)

5 yo presents to ED w. 5 days of fevers, morbilliform rash, bilat conjunctivitis, bright red tongue, and swollen hands/feet

kawasaki dz

4 lab elevations associated w. kawasaki dz

ESR CRP WBC PLT +/- LFTs

kawasaki is autoimmune destruction of the

arteries -> vasculitis

hallmark first sign of kawasaki

persistent fever in kids < 5 yo

what does crash and burn fever make you think of

**kawasaki dz:** conjunctival injxn (spares limbus, non purulent) rash (all body, desquamating) adenopathy (cervical, assymetric, nontender) strawberry tongue/red cracked lips hand/foot rash burn: fever >/= 5 days unresponsive to antipyretics

25% of kawasaki dz pt's have what sequelae (3)

coronary artery aneurysm myocarditis MI

dx criteria for kawasaki dz

4/5 of CRASH PLUS high fever >/= 5 days

definitive dx for kawasaki dz

vasculitis in coronary arteries

all pt's w. suspected kawasaki should get

echo: at time of dx 2-6 weeks later

tx for kawasaki

IVIG asa *to reduce risk of cardiac complications* self limited in 6-8 weeks regardless of tx

2 week old infant w. PMH prematurity presents w. pink torso and UE plus blue LE

PDA

murmur associated w. PDA

rough, continuous machinery heard over LSB at 2nd ICS

sx of PDA

tachypnea diaphoresis poor feeding no weight gain **in 3-6 mo old**

2 PE findings of PDA

bounding pulses widened pulse pressure

what substance keeps ductus arteriosus patent

prostaglandin e2 (alprostadil)

tx for PDA

NSAIDs/indomethacin (blocks PG e2 -> closes PDA)

transient loss of consciousness/postural tone 2/2 to acute decrease in cerebral blood low w. rapid recovery

syncope

2 mcc of syncope

**vasovagal** idiopathic

6 red flags w. syncope

during exertion multiple recurrences in short time murmur/structural heart dz old age significant injury during event fam hx undexpected death

5 types of syncope

vasovagal cardiac orthostatic cerebral vascular dz noncardiogenic

cardiac syncope is associated w.

arrhythmia

defect in vasomotor reflexes

orthostatic hypotn

orthostatic hypotn is common in what pt pops (3)

elderly diabetics taking diuretics/vasodilating meds

workup for syncope (5)

ECG glucose pulse ox echo tilt table

2 week old infant w. sudden loss of consciousness during feeding - lips are cyanotic - hypotensive

TOF

grade 3/6, holosystolic, harsh, decrescendo/crescendo ejection murmur heard best at left left USD

TOF

what is this showing

small, boot shaped heart -> **TOF**

hallmark symptom of TOF

**tet spell**: cyanosis and loss of consciousness w. crying

what does PROV stand for

4 features of TOF: pulmonary stenosis right ventricular hypertrophy overriding aorta ventricular septal defect

TOF murmur radiates to the

back

4 yo M who is easily fatigued - has loud, harsh, holosystolic murmur at left lower sternal border w. NO radiation to the axillae

ventricular septal defect

mc pathologic murmur in peds

ventricular septal defect

complication of VSD

pulmonary HTN

t/f: VSD is cyanotic

t/f: small-med VSD's may self resolve

t! *most close by 6 yo*