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PNCB2 > Cardiovascular Issues and Disorders > Flashcards

Cardiovascular Issues and Disorders Flashcards

1
Q

S1 heart sound

A

mitral/tricuspid (AV) valves closure

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2
Q

S2 heart sound

A

aortic/pulmonic (semilunar) valves closure

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3
Q

Systole heart sound

A

period between S1 and S2

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4
Q

Diastole heart sound

A

period between S2 and S1

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5
Q

S3 heart sound

A

ken-tuck-y, increased fluid states

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6
Q

S4 heart sound

A

ten-ne-ssee, stiff ventricular wall

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7
Q

APE TO MAN, auscultatory areas

A

A: aortic–right upper sternal border (2nd ICS)
P: pulmonic– left upper sternal border(2nd ICS)
E: erb’s point– 3rd ICS on left sternal border
T: tricuspid– lower left sternal border (4th ICS) **VSD
M: mitral–5th ICS on midclavicular line (apex)

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8
Q

Kawasaki Disease

A

Acute febrile syndrome causing vasculitis
leading cause of artery disease in children of an infectious etiology
most commonly noted in children under age of 2 and f Asian ethnicity

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9
Q

Diagnostic criteria for Kawasaki Disease

A
  • Pt must have a fever–and at least 4 of the following:
  • fever for >5 days
  • bil conjuctival injection without exudate
  • polymorphous rash (urticarial or pruritic)
  • inflammatory changes of lips and oral cavity
  • changes in extremities (erythema, edema)
  • cervical lymphadenopathy

**if the pt has more than 4 of the criteria, coronary vessel involvement is most likely

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10
Q

Fiery CRASH in relation to Kawasaki Disease

A 
Fiery: fever for more than 4 days
C: conjunctival injection
R: rash
A: adenopathy 
S: strawberry tongue/lips
H: hands
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11
Q

Laboratory and diagnostics with Kawasaki Disease

A

CBC
elevated ESR
Positive CRP
ECG changes: prolonged PR and QT interval

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12
Q

Management of Kawasaki disease

A

admit to hospital
immediate referral to a cardiovascular specialist
HIGH DOSE aspirin therapy:
80-100 mg/kg/day until afebrile for 48 hours (and sometimes IGG)
Then lower ASA dose (3-5 mg/kg/day) for anti platelet response
Discontinue ASA therapy in collaboration with cardiologist

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13
Q

Rheumatic Fever

A

a post-infectious disease that can affect the heart, joints, and CNS
it follows a group A strep infection of the upper respiratory tract and is the most common in ages 6-15 years

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14
Q

Which valve is most commonly affected in rheumatic fever?

A

mitral valve

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15
Q

What is the diagnostic criteria of rheumatic fever?

A

diagnosis of an initial attack of rheumatic fever plus 2 major OR 1 major and 2 minor criteria

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16
Q

What are the major manifestations of rheumatic fever?

A 
carditis
polyarthritis
chorea (abnormal, involuntary movement)
erythema marginatum (pink rings on trunk and inner surfaces of limbs) 
subcutaneous nodules
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17
Q

What are the minor criteria for rheumatic fever?

A

arthralgia without objective inflammation
fever >102.2
elevated ESR and CRP
prolonged interval on ECG with evidence of a group A b-hemolytic streptococcus infection

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18
Q

What are the laboratory and diagnostic tools for rheumatic fever?

A 
postive throat culture
postive rapid strep assay
increased or rising strep antibody titer
ECG
echocardiogram
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19
Q

What is the management of rheumatic fever?

A

refer to a pediatric cardiology
aggressive strep infection treatment
bed rest if acute carditis is present
prophylactic antibiotics for invasive procedures, as indicated

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20
Q

What is hypertension?

A

a persistent elevation of average systolic/diastolic blood pressure >95th% with measurements obtained on at least 3 separate occasions per published tables for age and sex

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21
Q

What is secondary hypertension?

A

A symptom of other organ dysfunction–this is very common in children

22
Q

Signs and symptoms of hypertension?

A 
headaches
vision problems
dizziness 
respiratory distress
irritability 
nosebleed
23
Q

What are some differential diagnoses of hypertension in children?

A

kidney dysfunction
heart condition
pulmonary hypertension

24
Q

What lab/diagnostic tests would you do in someone with hypertension?

A

chest xray (PA and lateral)
plasma aldosterone level to rule out aldosteronism
morning and evening cortisol levels to rule out cushion’s syndrome
UA, BMP, CBC, cholesterol, and triglycerides
ECG for dysrhythmias, bundle branch block, or LVH

25
Q

Venous Hum

A

innocent, continous humming murmur
heard at the right upper sternal border
heard best in the sitting position, and disappears in the supine position
obliterated by turning head and/or compressing neck on same side of body

26
Q

Still’s murmur

A

most common innocent murmur
musical systolic ejection murmur
heard best between LLSB and apex
due to narrowing of the left ventricular outflow tract

27
Q

What is an innocent murmur?

A 
no associated symptoms, failure to thrive or cyanosis 
occurs in >50% of children :
       thin chest wall
       more angulated great vessels
       more dynamic circulation 
low intensity systolic murmur (grade I-III/VI)
may vary with position (sit>standing)
no radiation to neck/back
28
Q

Common genetic syndromes and associated cardiac defects?

A

diGeorge syndrome: aortic arch anomalies
trisomy 18
trisomy 21: ASD, VSD
marfan syndrome: aortic regurgitation, mitral valve prolapse
turner syndrome: coarctation of the aorta, bicuspid arctic valve

29
Q

Presenting signs and symptoms of a potential cardiac defect in a child

A 
frequent resp infections
exercise intolerance
color changes, cyanosis
tachypnea during sleep
feeding problems
diaphoresis
abnormal heart sounds
edema 
clubbing 
congestive heart failure
30
Q

Acyanotic defects

A

left to right shunting–pink child:

ASD
VSD
PDA

31
Q

Cyanotic defects

A

right to left shunting–blue baby:
TGA
Tetralogy of fallot

32
Q

Obstructive lesions

A

aortic stenosis
pulmonic stenosis
coarctation of the aorta

33
Q

What type of murmur would you hear for an ASD and where would you hear it?

A

systolic ejection, heard best at left upper sternal border

34
Q

What type of murmur would you hear for an VSD and where would you hear it?

A

systolic ejection murmur
holosystolic thrill may be felt at the LLSB

thrill=VSD

35
Q

What type of murmur would you hear for an PDA and where would you hear it?

A

Left upper sternal border, machinery sound

36
Q

What would an X-ray show for a child with TGA?

A

egg on string

37
Q

What type of murmur would you hear for a TGA and where would you hear it?

A

very similar to VSD—systolic ejection murmur

38
Q

What are the 4 defects of tetralogy of ballot?

A

large VSD
pulm stenosis
overriding aorta
Right ventricular hypertrophy

**Vikings suck at running
V: VSD large
S: stenosis pulmonary
A: aorta overriding
R: right ventricular hypertrophy
39
Q

What type of murmur would you hear for a tet and where would you hear it?

A

loud systolic ejection click at the middle and upper left sternal border

40
Q

What would an X-ray show of a tet?

A

boot shaped heart

41
Q

What is a tet spell?

A

hypercyantoic episode

stay in knee to chest position
stopping and squatting

42
Q

What type of murmur would you hear for aortic stenosis and where would you hear it?

A

systolic thrill at the right upper sternal border

43
Q

What type of murmur would you hear for an pulmonic stenosis and where would you hear it?

A

systolic loudest at the LUSB
click decreases with inspiration and increases with expiration
thrill at LUSB radiating to back and sides

44
Q

What type of murmur would you hear for coarctation of the aorta and where would you hear it?

A

systolic ejection murmur

ejection click at the apex and RUSB if the bicuspid valve is involved

45
Q

What will the BP be like in someone with a coarc?

A

BP in lower extremities will be lower than in upper extremities

46
Q

What is one X-ray finding of someone with a coarc?

A

rib notching due to collateral circulation

47
Q

What heart condition comprises up to 30% of all congenital heart defects?

A

VSD

48
Q

What is characteristic of obstructive defects when auscultating?

A

ejection clicks heard due to turbulence

referred or radiated sound noted

49
Q

Name the valves in the heart

A 
To pay more attention
T: tricuspid
P: pulmonic
M: mitral 
A: aortic
50
Q

Explain the blood flow through the heart

A 
SVC ->
R atrium ->
Tricuspid valve ->
Right ventricle ->
Pulmonic valve ->
Pulmonary artery ->
Lungs ->
Pulmonic veins ->
Left atrium->
Mitral valve->
Left ventricle->
Aortic valve ->
Aorta ->
Body->
SVC
  • left side: oxygenated blood to body
  • right side: no oxygenated blood to lungs to get oxygen
51
Q

Fetal resistance and flow

A

increased pulmonary vascular resistance and decreased systemic vascular resistance

52
Q

Neonatal resistance and flow

A

decreased pulmonary vascular resistance and increased systemic vascular resistance

PNCB2 (18 decks)

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