Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BRS Pediatrics > Ch. 8 Cardiology > Flashcards

Ch. 8 Cardiology Flashcards

1
Q

Etiology of CHF

A
  1. Congenital
    1. Increased pulm. blood flow
      1. Large VSD
      2. Large PDA
      3. Transposition of great arteries
      4. Truncus arteriosus
      5. Total anamalous pulmonary venous return
    2. Obstructive lesions
      1. Severe aortic, pulmonary, mitral valve stenosis
      2. Coarctation of aorta
      3. Hypoplastic L heart syndrome
    3. Other causes
      1. AVM
      2. Mitral or tricuspid regurgitation
  2. Acquired
    1. Viral myocarditis
    2. Other cardiac infections (e.g., endocarditis, pericarditis), metabolic diseases (e.g., hyperthyroidism), medications (e.g., doxorubicin), cardiomyopathies, ischemic diseases
    3. Dysrhythmias (tachycardia and bradycardia)
  3. Miscellaneous
    1. Severe anemia –> high output CHF
    2. Rapid infusion of IV fluids, especially in premature infants
    3. Obstructive processes of the airway (enlarged tonsils or adenoids), cystic fibrosis (causes chronic hypoxemia that results in R-sided heart failure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical Features of CHF

A
  1. Pulmonary congestion:
    1. Tachypnea, cough, wheezing, rales (on exam)
    2. Pulmonary edema (on CXR)
  2. Impaired myocardial performance
    1. Tachycardia, sweating, pale or ashen skin color, diminished urine output
    2. Enlarged cardiac silhouette (on CXR)
  3. Systemic venous congestion
    1. Hepatomegaly
    2. Peripheral edema
  4. FTT, poor feeding (common symptom in newborns) / exercise intolerance (common symptom in older children)
  5. Cyanosis and shock = late manifestations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CHF mgmt

A

Goals:

  1. Improve myocardial fxn
  2. Relieve pulmonary/systemic congestion

Drugs:

  1. Cardiac glycosides (e.g., digoxin) - inc. efficiency of myocardial contractions and relieve tachycardia
  2. Loop diuretics (e.g., furosemide) - reduce intravascular volume by maximizing sodium loss –> diminished ventricular dilation and improved fxn
  3. Inotropic meds administered IV (e.g., dobutamine, dopamine)
  4. Phosphodiesterase inhibitors (e.g., milrinone) - improve contractility and reduce afterload

Interventional cath procedures: may address some of the underlying causes of CHF (e.g., balloon valvuloplasty for critical aortic and pulmonary valve stenosis)

Surgical repair: often definitive tx of CHF 2/2 CHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes innocent murmurs?

What are the most common examples?

A

Turbulent blood flow NOT structural heart disease; have no hemodynamic significance

Clinical Features of Innocent Heart Murmurs

  1. Still’s murmur (ages 2-7)
    1. Grade II-III, mid-systolic vibratory murmur heard best near L lower sternal border/apex
    2. Source: Vibrations in ventricular or mitral structures caused by flow in L ventricle
  2. Pulmonic systolic murmur (any age)
    1. Systolic ejection murmur best heard at L upper sternal border
    2. Source: Turbulence of flow where the main pulmonary artery connects to the RV (across the pulmonary valve)
  3. Venous hum (any age)
    1. Continuous, soft humming murmur heard at neck or R upper chest that disappears in supine position
    2. Source: Turbulent flow in the jugular venous/SVC systems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Acyanotic Congenital Heart Disease: Types

A

ASD

VSD

PDA

Coarctation of the aorta (older child)

Aortic stenosis

Pulmonary stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

ASD

Classification, Clinical Findings, Mgmt

A
  1. Ostium primum
    1. Defect in lower portion of atrial septum
    2. A cleft, or division, in the anterior mitral valve leaflet may also be present and may cause MR** (watch out for CHF)
    3. Ostium primum ASD = common congenital heart lesion in Down Syndrome
  2. Ostium secundum
    1. Defect in middle portion of atrial septum
    2. Most common type of ASD
  3. Sinus venosus
    1. Defect high in septum near junction of RA and SVC
    2. R pulmonary veins usually drain anomalously into RA or SVC instead of into LA

Clinical findings:

  • Increased RV impulse (as a result of RV overload)
  • Systolic ejection murmur (from excessive pulmonary blood flow) best heard at mid and upper L sternal borders
  • Fixed-split S2 (because of excessive pulmonary blood flow)

Mgmt:

  • Closure by open heart surgery to prevent R-sided HF, pulmonary HTN, atrial dysrhythmias, paradoxical embolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the pathologic concern of this condition?

A

PVR elevated in response to chronically high pulmonary flow

When PVR becomes elevated, the RV impulse is noticeably increased and the second heart sound may be single and loud. Mitral filling rumble disappears b/c of diminished pulmonary blood flow as a result of decreased L-R shunting. Symptoms of CHF also dec. as PVR inc. b/c of decrease in pulmonary blood flow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the blood flow?

A

Through ductus from aorta to pulmonary artery (L to R shunt) –> inc. pulmonary blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Eisenmenger syndrome

A

In extreme situation where PVR exceeds SVR, shunting changes from L-R to R-L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PDA

Physical Exam Findings

A
  1. “Machinery-like” continuous murmur at upper L sternal border
  2. If L-R shunt is large, diastolic rumble of blood flow across mitral valve at apex b/c of high flow rate
  3. Widened pulse pressure (>30 mm Hg) - shunting of blood will lower diastolic
  4. Brisk pulses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Neonates or infants with severe coarctation may depend on ____________ for perfusion of the lower thoracic and descending aorta.

A

R-L shunt through PDA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Initial mgmt in the symptomatic neonate for coarctation of the aorta

A
  1. IV prostaglandin E (to open ducutus arteriosus)
  2. Inotropic meds (to overcome myocardial depression)
  3. Low-dose dopamine to maximize renal perfusion and fxn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is always present with a tricuspid atresia?

A

ASD or PFO

An atrial septal defect (ASD) and a ventricular septal defect (VSD) must both be present to maintain blood flow-from the right atrium, the blood must flow through the ASD to the left atrium to the left ventricle and through the VSD to the right ventricle to allow access to the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the most common cause of acquired heart disease in children in the U.S.? Worldwide?

A

Kawasaki disease / ARF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Mgmt of Bacterial Endocarditis

A

IV antimicrobial therapy 4-6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Most common cause of pericarditis in children

A

Viral infection (coxsackievirus, echovirus, adenovirus, influenza, parainfluenza, EBV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Most common dysrhythmias of childhood (3)

A

SVT, heart block, long QT syndrome

18
Q

SVT?

A

Abnormally accelerated heart rhythm that originates proximal to bifurcation of bundle of His

Two types:

  1. AV re-entrant tachy (AVRT)
    1. Retrograde conduction through accessory pathway leads to SVT
  2. AV node re-entrant tachy (AVNRT)
    1. Conduction abnormality occurs in different pathways within the AV node itself

When anterograde conduction occurs through bypass tract between atria and ventricles, WPW syndrome is present. –> associated with SCD

19
Q

Differential diagnosis of chest pain in children and adolescents

A
20
Q

Failure of septum primum and septum secundum to fuse after birth

A

PFO

21
Q

Complication of PFO

A

Paradoxical emboli (venous thromboemobli that enter systemic arterial circulation)… similar to those resulting from ASD

22
Q

Alcohol exposure in utero (fetal alcohol syndrome)

Defect?

A

VSD, PDA, ASD, ToF

23
Q

Congenital rubella

Defect?

A

PDA, Pulmonary artery stenosis, septal defects

24
Q

Infant of diabetic mother

Defect?

A

TGA

25
Q

Down Syndrome

Defect?

A

AV septal defect (endocardial cushion defect), VSD, ASD

26
Q

Marfan Syndrome

Defect?

A

MVP, thoracic aortic aneurysm and dissection, AR

27
Q

Prenatal lithium exposure

Defect?

A

Ebstein anomaly

28
Q

Turner syndrome

Defect?

A

Bicuspid aortic valve

Coarctation of aorta

29
Q

Williams syndrome

Defect?

A

Supravalvular aortic stenosis

30
Q

22q11 syndromes

Defect?

A

Truncus arteriosus

ToF

31
Q

How to achieve adequate saturation in TGA?

A

Shunting blood from one circulation to the other through PFO, ASD, VSD, or PDA

32
Q
A
33
Q
A
34
Q
A
35
Q

Differential diagnosis of stridor (4)

A

Acute:

  • Croup
    • Most common in infants/toddlers
    • “Barky” cough, inspiratory stridoe, fever, rhinorrhea, congestion
  • Foreign body aspiration
    • Most common in infants/toddlers
    • Acute onset of inspiratory stridor &/or wheeze without inefctious sx

Chronic:

  • Laryngomalacia
    • Inspiratory stridor most prominent in infants
    • Stridor worse when supine, improves when prone
  • Vascular ring
    • Present in infants
    • Biphasic stridor that improves with neck extension
36
Q

Treatment for HOCM

A

Beta blockers or CCB

37
Q

What does a classic VSD murmur sound like?

A

Harsh, holosystolic murmur best heard at L lower sternal border

38
Q

How does knee-chest position improve ToF pts’ condition?

A

Increases SVR

Kinks femoral arteries increasing SVR and consequently reducing degree of R-L shunting

39
Q

LAD on ECG and decreased pulmonary vascular markings due to hypoplasia of RV and pulmonary outflow tract

A

Tricuspid atresia

40
Q

What type of defect would you see widely split and fixed S2 and systolic ejection murmur in left upper sternal border due to increased flow across pulmonary valve?

A

ASD

41
Q

Abx prophylaxis for rheumatic fever

A

IM penicillin G every 4 weeks

BRS Pediatrics (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions