Chest problems Flashcards
Kids with Respiratory distress, prenatal polyhydramnios, 70/40, 176bpm, 70RR, pulse ox,82%, absent breaths on left and fair aeration of right lung, right heart sounds, abd appears scaphoid;
DX?
Congenital diaphragmatic hernia (CDH)
CDH causes
abdomincal viscera to herniate into chest:
pulmonary hypoplasia and pulmonary HTN
Why is there polyhydramnios in CDH?
esophageal compression
Stat protocol in CDH?
C/I maneuvers?
- endotracheal intubation
- bag-mask ventilation can pump air into GI and exacerbate problem
After airway secure: NG tube and suction
1 day old Kid with respiratory problems, 80% sat, mask with 100% air doesnt help, Machine like murmur heard; administer what?
PGE1
Many congenital heart defects can be associated with a PDA and need to be ruled out first
PDA usually closes by day 3
1 month old kid, harsh III/VI holosystolic murmur over LL sternal border, everything else normal, Dx?
VSD
Do echo
mcc of congenital heart disease
Electrolyte derangements of QT prolongation?
Hypocalcemia
Hypokalemia
Hypomagnesemia
Med induce long QT syndrome
Macrolide Flouroquinolone Antipsychotics TCA SSRI Methadone Oxycodone Ondansetrone/gransetron Class 1a: Quinidine, procainamide Flecainide Class 3: except amiodarone
Inherited long qt syndrome
Jervel and lange nielsen sydnrome (AR)
Romano- Ward syndrome (AD)
Rx long QT syndrome
Class II antiarrhythims
B-Blockers: Propranolol
possibly pacemaker placement
Hypertrophic Cardiomyopathy EKG findings
LVH: Tall R wase in aVL + Deep S wave in V3
Repolarization change in anterolaterl leads (I, aVL, V4-V6)
Trisomy 21 Cardiac problems
ECD: complete ACSD
VSD
PDA,ASD
MVP
Trisomy 18 and 13 cardiac issues
VSD > ASD, PDA
cyanotic lesions
Williams syndrome cardiac porblems
Supravalvular AS
Turner syndrome cardiac issue
Bicuspid AV
Coarctaion of aorta
AS,MVP,
HTN common
Neonatal lupus cardiac problem
congenital heart block
Marfan syndrome cardiac problem
Ascending aortic dilation->dissecting aorts
2ndry AR or MVP
Ehler Danlos syndrome cardiac problems
MVP, TVP
Aortic dilation-> dissecting aneurysm
ASD
Fetal alcohol syndrome cardiac issue
VSD>ASD
TOF
Rubella assoc cardiac problem
PDA
Kawasaki disease cardiac issue
Coronary artery aneursyms
Transient tachypnea of newborn xray findings
increased pulmonary vascular markings or fluid in the fissures
(bilateral perihilar linear streaking)
Rheumatic fever rx:
penicillin G IM every 4 wks
RF w/out carditis duration of antibiotic
5 yrs or until 21
whichever longer
RF with carditis but no residual hear or valvular disease; AB rx duration
10 yrs or until 21
whichever longer
RF w/ carditis and persistent heart or valvular disease;
AB Rx duration
10 yrs or until 40 years olf
whichever longer
MS symptomatic rx
preload reduction: diuretics or nitrates
Auscultation and xray of Transposition of great vessels
Cyanosis w/in 24 hrs of life
Exam: Single S2; +/- VSD
Xray: egg on string
Auscultation and xray of TOF
Exam: Harsh PS murmur or single S2, VSD
Xray: Boot shaped heart
Auscultation and xray of Tricuspid atresis
Exam: Single S2, VSD murmur
Xray: minimal pulm BF
Auscultation and xray of Truncus arteriosus
Exam: SIngle S2, systolic ejection murmur (increased flow through truncal valve)
Xray: increase pulmonary BF, Edema
Auscultation and xray of TAPVR with obstruction
Exam: severe cyanosis, respiratory distress
Xray: pulmonary edema, snowman sign (enlarged supracardiac veins & SVC)
Pediatric viral myocarditis etiology
Coxsackie B virus
Adenovirus
Myocarditis Clinical presentation
Viral prodrome
HF: dyspnea, syncope, tachycardia, N/V, hepatomegaly
Xray of myocarditis
Cardiomegaly
Pulmonary edema
ECG and ECHO of mycarditis
EKG: sinus tachy
ECHO: decreased EF
Diffuse hypokinesis
auscultaion of myocarditis
holosystolic murmur may be identified secondary to dilated cardiomyopathy and the resulting functional MR
Rx of myocarditis
diuretics and inotrope
Rx in ICU due to risk of shock and fatal arrhythmias
Fredrich ataxia cardiac problems
assoc w/ necrosis and degeneration of cardia muscle fibers leading to myocarditis, myocardial fibrosis and cardiomyopathy
EKG: T Wave inversion due to myocarditis
VSD auscultation and if uncorrected
holosystolic murmur at left lower sternal border,
uncorrected apical diastolic rumble( increased BF across MV)
VSD is not corrected what happens
L-R shunt produces permanant pulmonary htn and RVH leading to Eisenmenger syndrome which causes R-L shunting
In a TOF what are the 4 defects
RV outflow tract obstruction (PS or atresia)
RVH
Overriding aorta
VSD
Patient with a RVOT obstruction develope profound cyanosis and hypoxemia why?
they develop a infundibular spasm precipitated by agitation or exertion (feeding, crying, hyperventilation)
results in complete occlusion
shunts blood R->L via VSD
Respiratory distress syndrome x-ray
diffuse reticulogranular (ground glass) appearance, air bronchograms, low lung volumes
High pulmonary vascular resistance results in R->L shunting and hypoxia; causes what?
Persistent pulmonary HTN
Tachypnea and severe cyanosis
Chest xray in Pulmonary htn
clear lungs w/ decreased pulmonary vascularity
inadequate alveolar fluid clearance at birth results in mild pulm edema; Dx?
Transient tachypnea of newborn
Croup: laryngotracheobronchitis C/f..
MC 6-6 yrs old
assoc w/ barky cough,
fever,
rhinorrhea and Congestion
Laryngomalacia c/f
Stridor most severe at 4-8 months
persistent stridor that worsens in supine positions + improve in prone position
Vascular Ring C/F
Present before age 1
Persistent stridor that improves w/ neck extension
Assoc. w/ cardiac abnormalities
Dx/Rx laryngomalacia
Dx: Flexible laryngoscopy
Rx: reassurance (fixes by 18 months)
Supraglottopasty is severe symptoms
Tricuspid Valve atresia EKG/xray
Left axis deviation
Tall peaked P waves
LVH
Xray: decreased pulmonary BF
Ebsteins anomaly EKG
TR + R atrial enlargement=
Tall P waves
Right axis deviation
Respiratory Distress Syndrome R/F
Maternal DM
Male sex
perinatal asphyxia
C-section w/out labor
How Maternal DM cause RDS
Maternal hyperglycemia leads to fetal hyperglycemia which trigger fetal hyperinsulinism
High insulin antagonize cortisol and block maturation of sphingomyelin
Decrease risk of RDS in newborn
Intrauterine stress stimulates early fetal lung maturity:
IUGR
Maternal HTN
PROM
Postpericardiotomy syndrome
pleuropericardial disease that occurs days or months after cardiac surgery or injury
