Cardiovascular (Alice) (10%) Flashcards
leading cause of mitral valve stenosis and valve replacement in adults in the US
rheumatic fever
rheumatic fever develops in peds following what infxn
pharyngitis w. group A beta-hemolytic strep
most important virulence factor for GAS in humans
M protein
_ abs against the streptococcal infection may cross react with heart tissue
anti M abs
age group mc affected by rheumatic fever
5-15
major jones criteria
jones
joint pain (polyarthritis)
(o) carditis
nodules (subcutaneous)
erythema marginatum
sydenham’s chorea
minor jones criteria (5)
arthralgia
elevated ESR or CRP
fever
prolonged PR
leukocytosis
pt w. rheumatic fever may develop what arrhythmia
afib
tx for rheumatic fever
pcn
asa
7 pediatric heart defects to know
ASD
coarctation of the aorta
HOCM
kawasaki dz
PDA
TOF
VSD
-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
ASD is caused by a patent
foramen ovale
what diagnosis makes you think ASD in a kiddo
failure to thrive
is ASD cyanotic
no!
gs dx for ASD
passing a catheter thru the defect
tx for ASD (4)
diuretics
ACEI
digoxin
surgical closure
wide, fixed, split S2
systolic ejection murmur at 2nd ICS
early to mid systolic rumble
ASD
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
what is this showing
figure of 3 sign -> coarctation of the aorta
t/f: coarctation of the aorta is NON cyanotic
t!
what pt pop makes you think of coarctation of the aorta
teens/twenties w. HTN
hallmark finding of coarctation of the aorta
elevated BPin arms
low BP in legs
ejection murmur in aortic area and LSB that radiates to the left axilla and left back
coarctation of the aorta
what malformation is seen in 50% of coarctation pt’s
bicuspid valve
coarctation increases the risk for
berry aneurysm
dx for coarctation of the aorta
- echo
- EKG
- 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
S4
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
f!
t/f: small-med VSD’s may self resolve
t!
most close by 6 yo
