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Peds Cards Boards > Heart Failure and Transplant > Flashcards

Heart Failure and Transplant Flashcards

1
Q

Echo findings for HCM over athletes heart

A
  • Irregular hypertrophy
  • Normal sized LV diastolic dimensions
  • Left atrial enlargement
  • Abnormal ECG
  • Abnormal LV diastolic function
  • Female gender
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2
Q

Infectious cause of DCM from Latin America

A

Chaga’s disease
- Higher risk of stroke d/t apical aneurysms

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3
Q

Echo findings for restrictive cardiomyopathy

A

Enlarged atria (Mickey mouse ears) - won’t have this in constrictive pericarditis

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4
Q

EKG, echo and CXR findings for myocarditis

A
  • Low voltage QRS and sinus tachycardia
  • CXR with no cardiomegaly (acute process)
  • Echo with thick myocardium (not thinned out like DCM)
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5
Q

Gold standard for diagnosis of myocarditis

A

Biopsy but not typically done (and low yield with patchy disease)

Biopsy will show lymphocytes and edema

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6
Q

Two peas

A

:)

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7
Q

MRI findings for myocarditis

A

Focal subepicardial delayed enhancement

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8
Q

Treatment for lyme myocarditis

A

IV ceftriaxone x 3 weeks

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9
Q

Treatment and biopsy findings for giant cell myocarditis

A
  • Tx with steroids (only actual indication)
  • Biopsy with multinucleated giant cell
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10
Q

EKG, echo and CXR findings for dilated CM

A
  • EKG with increased LV forces, sometimes can see atrial enlargement
  • Echo with thinned out myocardium
  • CXR with cardiomegaly
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11
Q

Genetic mutations in DCM

A
  • Dystrophin (X-linked)
  • Sarcomere (TTN, MYH7)
  • LAMIN (conduction problems)
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12
Q

MRI findings for DCM

A

Mid wall LGE

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13
Q

Outpatient treatment for DCM

A
  • Asymptomatic: ACE, B-blocker
  • Symptomatic: lasix, aldactone, digoxin
    Aspirin
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14
Q

DCM and low ANC

A

Barth syndrome

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15
Q

Barth syndrome genetic mutation and enzyme problem

A
  • Elevated 3-methylglutaconic acid
  • TAZ gene mutation, X-linked (also linked to LVNC)
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16
Q

Arrhythmogenic RV cardiomyopathy has what type of mutations

A

Desmosome mutations

ITALIAN descent

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17
Q

ALCAPA ECG findings

A

Q waves in leads I and aVL

18
Q

Exam findings for HCM murmur

A
  • Crescendo decrescendo murmur that increases with standing or Valsalva and decreases with squatting and hand grip
19
Q

Type of genetic mutations for HCM

A

Sarcomere mutations (MYBPC1, MYH7)
Autosomal dominant

20
Q

MRI findings for HCM

A

LGE at LV and RV junctions

21
Q

Pathology for DCM vs HCM

A
  • DCM has fibrosis between cells
  • HCM has chaotic/disarrayhypertrophy
22
Q

Treatment for HCM

A
  • B-blockers (DO NOT DECREASE RISK OF SUDDEN DEATH)
  • CCB
  • Exercise restriction
  • ICD if 2 or more risk factors
23
Q

HCM, hypotonia, big tongue, short PR disease and enzyme

A

Pompe disease
Alpha glucosidase deficiency

If alpha glucosidase is normal then it’s Dannon disease

24
Q

HCM, coarse facial features, corneal clouding, HSM genetic disease and enzyme

A
  • Alpha-L-iduronidase deficiency (Hurler syndrome)

If presents later without eye involvement then hunter syndrome

25
Q

Survival of RCM

A

2 year is 50% - very poor
Often transplant early but need to monitor PVR closely pre-transplant as at high risk of developing irreversible PH

26
Q

Contra-indications to transplant

A
  • PVR > 8 and not reactive
  • Irreversible end organ damage
  • PA/PV severely hypoplastic
  • Re-transplant within 6 months of prior transplant
27
Q

Survival of transplant in infants vs adolescents

A

Infants: 1 yr 75%, 5 yr 68%
Adolescents: 1 yr 88%, 5 yr 68%

28
Q

Why is ABO incompatible transplant acceptable in infants

A
  • Organ transplant across blood types typically leads to hyper-acute rejection
  • Infants don’t have blood group antibodies so it’s safe to do
29
Q

What is induction immunosuppression post transplant

A
  • 5-7 days post transplant
  • Give ATG/thymoglobulin which eradicates T cells
  • Goal is to delay starting calcineurin inhibitors (d/t renal toxicity)
  • Anti-CD3 rabbit monoclonal antibody
30
Q

Mechanism of action of calcineurin inhibitors

A

Block T cell activation and IL2 production

31
Q

Side effects of calcineurin inhibitors

A
  • Tacro: nephrotoxic, diabetes
  • Cyclosporine: HTN, gingival hyperplasia, hirsutism
32
Q

Mycophenolate (cellcept) mechanism of action

A

Adjunct to calcineurin inhibitors
Prevents both T and B cell proliferation

33
Q

What is sirolimus used for in post transplant

A

Used to prevent renal dysfunction and coronary artery disease (less potent rejection med)

Inhibits mTOR and T cell proliferation

34
Q

Side effects of sirolimus

A

Wound healing (switch off if having surgery)
Mouth ulcers

35
Q

Treatment for acute cellular rejection vs. antibody mediated rejection

A
  • Cellular treat with pulse steroids
  • AMR treat with IVIG or PLEX
36
Q

Symptoms of CMV infection in transplant patient

A

Fever
Pneumonitis or colitis

Tx: ganciclovir
Really high risk for CAV with CMV

37
Q

Most common form of PTLD

A

Abdominal
Most are EBV driven
Need tissue for diagnosis

38
Q

Treatment for PTLD

A

Decrease immunosuppresion
Rarely need surgery or chemo

39
Q

Leading cause of late graft loss or re-transplant

A

CAV – neo-intimal proliferation

40
Q

Treatment for CAV

A
  • Change from calcineurin inhibitor to sirolimus
  • Statin
  • ASA
  • Re-transplant
41
Q

Stage and class of heart failure

A

Stage is LV dysfunction
- A: at risk, B: mild/mod and asymptomatic, C: severe/symptomatic, D: refractory

Class is symptoms
- 1: asymptomatic, 2: symptoms with moderate exertion, 3: symptoms with mild exertion, 4: symptoms at rest

42
Q

What heart failure meds do you have to dose adjust if you start amio

A
  • Dig
  • Warfarin

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