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CMN574 > Module 2 - Pediatric Cardiac Disorders > Flashcards

Module 2 - Pediatric Cardiac Disorders Flashcards

1
Q

Cardiac abnormalities: trisomy 21

A

40% structural cardiac lesion

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2
Q

Cardiac abnormalities: Marfans

A

mitral/aortic valve regurgitation

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3
Q

Cardiac abnormalities: Turners

A

Coarctation of aorta

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4
Q

Cardiac abnormalities: Noonan

A

pulmonary stenosis
ASD
Cardiomyopathy

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5
Q

Cardiac abnormalities: Fetal ETOH Syndrome

A

VSD

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6
Q

Cues of the physical exam: (blood pressure) coarctation of aorta

A

discrepancy between upper and lower extremities

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7
Q

Cues of the physical exam: (blood pressure) supraventricular aortic stenosis

A

higher BP in right upper limb than left upper limb

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8
Q

Cues of the physical exam: (blood pressure) aortic valve stenosis

A

narrow pulse pressure

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9
Q

Cues of the physical exam: (blood pressure) aortic regurgitation of aortic insufficiency

A

wide pulse pressure

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10
Q

Gold standard for diagnosing congenital heart defect

A

ECHO

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11
Q

Innocent heart murmurs

A

Newborn
Still murmur
Pulmonary ejection
Venous hum
Carotid bruits
Cranial bruits

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12
Q

Innocent heart murmurs: newborn
-age
-type of murmur
-where is it heard
-position changes

A

-first few days of life
-short systolic grade I-II/VI
-lower left sternal border
-X

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13
Q

Innocent heart murmurs: Still murmur
-age
-type of murmur
-where is it heard
-position changes

A

-2-7 years
-Short, high-pitched, early systolic murmur (musical, vibratory)
-Midway between apex and left sternal border
-Loudest when patient is supine

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14
Q

Innocent heart murmurs: Pulmonary ejection
-age
-type of murmur
-where is it heard
-position changes

A

-3 years and over
-Soft systolic ejection murmur grade I-II/VI
-Left upper sternal border
-X

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15
Q

Innocent heart murmurs: Venous hum
-age
-type of murmur
-where is it heard
-position changes

A

-after 2 years of age
-Continuous musical hum, grade I-III/IV; diastolic murmur
-Right infraclavicular area
-best heard in sitting position (tends to go away in supine)

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16
Q

Innocent heart murmurs: carotid bruit
-age
-type of murmur
-where is it heard
-position changes

A

-older children (adolescent)
-Long systolic ejection, grade II-III/VI
-supraclavicular area
-X

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17
Q

Innocent heart murmurs: cranial bruit
-age
-type of murmur
-where is it heard
-position changes

A

-older children (adolescent)
-Long systolic ejection, grade II-III/VI
-supraclavicular area
-X

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18
Q

Innocent heart murmurs: newborn
-at what age is this murmur heard?

A

first few days of life

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19
Q

Innocent heart murmurs: stills murmur
-at what age is this murmur heard?

A

2-7 years

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20
Q

Innocent heart murmurs: pulmonary ejection
-at what age is this murmur heard?

A

3 years and over

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21
Q

Innocent heart murmurs: venous hum
-at what age is this murmur heard?

A

heard after 2 years

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22
Q

Innocent heart murmurs: carotid bruit
-at what age is this murmur heard?

A

older children - adolescent

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23
Q

Innocent heart murmurs: cranial bruit
-at what age is this murmur heard?

A

older children - adolescent

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24
Q

Innocent heart murmurs: newborn
-what type of murmur is heard?

A

short systolic

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25
Q

Innocent heart murmurs: stills murmur
-what type of murmur is heard?

A

musical/vibratory
short high-pitched
early systolic murmur

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26
Q

Innocent heart murmurs: pulmonary ejection
-what type of murmur is heard?

A

soft systolic ejection

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27
Q

Innocent heart murmurs: venous hum
-what type of murmur is heard?

A

continuous musical hum
diastolic murmur

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28
Q

Innocent heart murmurs: Carotid bruit
-what type of murmur is heard?

A

long systolic ejection

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29
Q

Innocent heart murmurs: cranial bruit
-what type of murmur is heard?

A

long systolic ejection

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30
Q

Innocent heart murmurs: newborn
-where is this murmur heard?

A

lower left sternal border

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31
Q

Innocent heart murmurs: stills murmur
-where is this murmur heard?

A

midway between apex and left sternal border

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32
Q

Innocent heart murmurs: pulmonary ejection
-where is this murmur heard?

A

left upper sternal border

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33
Q

Innocent heart murmurs: venous hum
-where is this murmur heard?

A

right infraclavicular area

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34
Q

Innocent heart murmurs: carotid bruit
-where is this murmur heard?

A

supraclavicular area

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35
Q

Innocent heart murmurs: cranial bruit
-where is this murmur heard?

A

supraclavicular area

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36
Q

Innocent heart murmurs: newborn
-position changes to help hear murmur

A

X

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37
Q

Innocent heart murmurs: stills murmur
-position changes to help hear murmur

A

supine

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38
Q

Innocent heart murmurs: pulmonary ejection
-position changes to help hear murmur

A

supine or increased cardiac output

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39
Q

Innocent heart murmurs: venous hum
-position changes to help hear murmur

A

sitting (goes away when supine)

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40
Q

Innocent heart murmurs: carotid bruit
-position changes to help hear murmur

A

X

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41
Q

Innocent heart murmurs: cranial bruit
-position changes to help hear murmur

A

X

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42
Q

What is the most common murmur heard in older children and adults?

A

Pulmonary ejection

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43
Q

What is the most common innocent murmur of childhood?

A

Stills murmur

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44
Q

What are the causes of KAWASAKI DISEASE?

A

Bacterial, viral, genetic, environmental

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45
Q

Symptoms of KAWASAKI DISEASE?

A

FEVER +
conjunctivitis
erythema of lips and oral mucosa
peripheral erythema/edema
rash and peeling skin
cervical adenopathy

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46
Q

How is KAWASAKI DISEASE diagnosed?

A

Echo
Fever for 5days and 4/5 of symptoms (conjunctivitis, erythema of lips/oral mucosa, peripheral erythema/edema, rash and peeling skin, cervical adenopathy)

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47
Q

Treatment for KAWASAKI DISEASE?

A

Immunoglobulin, high dose aspirin

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48
Q

Who is at risk for rheumatic heart disease?

A

African Americans, children, adolescents, women

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49
Q

What is rheumatic heart disease usually preceded by?

A

Group A Beta hemolytic streptococcal infection of upper respiratory tract

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50
Q

What is the most serious consequence of rheumatic heart disease?

A

Carditis

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51
Q

Valves impacted in rheumatic heart disease?

A

Mitral valve
Aortic valve

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52
Q

What are the clinical features criteria called to diagnose rheumatic heart disease?

A

Jones Criteria

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53
Q

rheumatic heart disease - Jones Criteria
-major manifestations (5)

A

-carditis
-polyarthritis
-sydenham chorea
-erythema marginatum
-subcutaneous nodules

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54
Q

rheumatic heart disease - Jones Criteria
-minor manifestations - clinical (3)

A

-previous rheumatic fever/rheumatic heart disease
-polyarthralgia
-fever

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55
Q

rheumatic heart disease - Jones Criteria
-laboratory - acute phase reaction lab work

A

-ESR
-C-reactive protein
-leukocytosis (elevated WBC count)

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56
Q

rheumatic heart disease - Jones Criteria
-laboratory - what EKG interval possibly prolongs?

A

PR interval

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57
Q

rheumatic heart disease - Jones Criteria
-what infection can occur prior to rheumatic heart disease?

A

preceding streptococcal infection i.e. increased titers of antistreptolysin O or other streptococcal antibodies, positive throat culture for group A streptococcus

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58
Q

rheumatic heart disease - treatment

A

long-acting benzathine penicillin
-ASA (naproxen), corticosteroids (carditis may be used)

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59
Q

Children with what disease are effected by endocarditis?

A

Congenital heart disease

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60
Q

What type of infection/Where is the infection in endocarditis?

A

Bacterial or fungal
endocardium and valves

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61
Q

What are the clinical features of endocarditis?

A

Prolonged fever
Vasculitis
Clubbing of fingers
Positive blood cultures

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62
Q

Treatment of endocarditis?

A

Antibiotics/antifungal therapy immediately –> amoxicillin
***prophylaxis for high risk patients

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63
Q

Endocarditis: vasculitis symptoms (5)

A

Petechiae
Splinter hemorrhages of nails
Conjunctival hemorrhages
Janeway lesions
Osler nodules

64
Q

Endocarditis: vasculitis symptom - Janeway lesions
-what are they?
-how big? how long do they last?
-associated with what?
-believed to be caused by what?

A

-small, non-tender, irregular lesions that appear on palms and or soles of feet (can be erythematous, hemorrhagic, violaceous in color, can be macular, papular, nodular in shape
-few millimeters in diameter; last for few days or weeks
-associated with infective endocarditis (bacterial infection)
-septic microemboli from valvular lesions that deposited bacteria and led to formation of microabscesses in dermis

65
Q

Endocarditis: vasculitis symptom - Janeway lesions
-where do these appear?

A

palms or soles of feet

66
Q

Endocarditis: vasculitis symptoms - Osler nodules
-what are they?
-what precedes development of lesion?
-what kind of manifestation is an Osler nodule?
-what is it a result of/what causes it?

A

-red/purple, slightly raised, tender lumps, often with pale center
-pain often precedes development of visible lesion by up to 24 hours
-cutaneous manifestation of endocarditis
-results from deposition of immune complexes –> the resulting inflammatory response leads to swelling, redness, pain that characterizes these lesions

67
Q

Arrhythmias in children: are they always associated with syndrome?

A

No

68
Q

Arrhythmias in children: can they occur in healthy children?

A

Yes

69
Q

Arrhythmias in children: sinus arrhythmias
-when does rate increase?
-when does rate decrease
-are P-QRS-T intervals stable?
-require treatment?

A

-inspiration
-expiration
-yes
-never

70
Q

What arrhythmia is a major cause of sudden cardiac death in athletes?

A

Prolonged QT
LQT1

71
Q

Arrhythmias in children: prolonged QT
-what causes prolonged QT?

A

congenital (more common) or acquired (meds) causes

72
Q

Arrhythmias in children: prolonged QT
-what length of time is considered a prolonged QT?

A

> 460milliseconds

73
Q

Arrhythmias in children: prolonged QT
-how is prolonged QT diagnosed?

A

-ECG
-possible exercise test
-genetic testing

74
Q

Arrhythmias in children: prolonged QT
-types of prolonged QT and their implications

A

-LQT1: exercise
-LQT2: auditory/emotional stimuli
-LQT3: sleep; most common

75
Q

Arrhythmias in children: prolonged QT
-treatment

A

exercise restriction, treat with beta blockage, possible placement of internal cardioverter/defibrillator

76
Q

Arrhythmias in children: PAC
-does this require treatment?
-are we worried about these?

A

-no treatment (if benign)
-benign in absence of underling cardiac disease

77
Q

Arrhythmias in children: Wandering atrial pacemaker
-definition
-what is the morphology of P wave?

A

-Rare type of arrhythmia/heart beat problem that occurs when heart’s pacemaking activity originates from different areas of the atria instead of SA node = generates consecutive action potentials that are all conducted to the ventricles
-P waves will all have different morphology

78
Q

Arrhythmias in children: SVT
-how to differentiate SVT from sinus tachycardia

A

-when HR goes too fast, P wave becomes lost in T wave
-must slow rate down to evaluate
1. facial ice water immersion
2. adenosine
-12 lead EKG
**allows you to look for WPW syndrome

79
Q

What can sinus rate be in children <1 year (when stressed, etc.)?

A

220-250bpm

80
Q

Arrhythmias in children: SVT
-what two methods are used to slow tachycardia down in infants/young children?

A

-facial ice water immersion
-adenosine

81
Q

Wolff-Parkinson-White Syndrome
-type of arrhythmia it is associated with
-characterized by?
-how often does it occur with this arrhythmia?

A

-SVT
-short P-R interval, delta wave, prolongation of QRS complex
**Not evident when tachycardia present
-25% of patients with SVT

82
Q

what is the most common arrhythmia requiring tx in pediatrics?

A

SVT

83
Q

What age is SVT presentation most common for pediatric patients?

A

First 3MO of life

84
Q

Arrhythmias in children: SVT
-characterized by?

A

-narrow QRS
-rates vary with patient’s age
-P waves are difficult to define; if present 1:1 w/ QRS complex

85
Q

Arrhythmias in children: SVT
-average pediatric SVT HR
-<=9MO SVT HR
-Older kids SVT HR

A

-235bpm
-270bpm
-210bpm

86
Q

Syncope
-what do you obtain with new onset syncope or new-onset seizure that is atypical for classic vasovagal rxn?
-what are you looking for?
-differential dx?

A

-EKG
-Look for “footprints” of possible arrhythmia causes
-WPW syndrome, prolonged QT, AV block

87
Q

Pediatric Structural Cardiac Defects (6)

A

-patent ductus arteriosus
-patent foramen ovale
-atrial septal defect
-ventricular septal defect
-atrial ventricular septal defect
-coarctation of aorta

88
Q

Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA)
-when does the ductus arteriosus normally spontaneously close?

A

after 1-5 days

89
Q

Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA)
-where is this located?

A

persistence of normal fetal vessel joining pulmonary artery to the aorta

90
Q

Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA)
-what type of shunt is this?

A

Left to right

91
Q

Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA)
-clinical symptoms: anatomical

A

-continuous rough machinery type murmur
-if large defect, bounding peripheral pulses

92
Q

Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA)
-where is this murmur best auscultated?

A

2nd left intercostal space

93
Q

Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA)
-clinical symptoms: sx of patient

A

failure to thrive
tachypnea
diaphoresis with feeding

94
Q

Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA)
-how is this diagnosed? (what imaging is used?)

A

ECHO

95
Q

Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA)
-treatment

A

-surgical closure
-indomethacin in premature infants (80-90% success rate w/ birth weight >1200g)

96
Q

Pediatric Structural Cardiac Defect: patent foramen ovale
-is this normal in fetal circulation?

A

Yes

97
Q

Pediatric Structural Cardiac Defect: patent foramen ovale
-what occurs during this defect?

A

failure of foramen ovale to close at birth

98
Q

Pediatric Structural Cardiac Defect: patent foramen ovale
-what is this a variant of?

A

Atrial Septal Defect

99
Q

Pediatric Structural Cardiac Defect: patent foramen ovale
-Clinical symptoms

A

-systolic ejection murmur

100
Q

Pediatric Structural Cardiac Defect: patent foramen ovale
-Dx

A

imaging, ECHO

101
Q

Pediatric Structural Cardiac Defect: patent foramen ovale
-Tx

A

-surgeries
-anticoagulants

102
Q

What are PFO’s and PDA’s associated with?

A

stroke

103
Q

What is the difference between PFO and ASD?

A

-PFO is a normal occurrence in fetal circulation but closes at birth
-ASD is a congenital defect; abnormally exists r/t failure of septum between right and left atrium to develop properly

104
Q

What are both PDA and PFO associated with?

A

migraines and can cause microthromboses and strokes

105
Q

Pediatric Structural Cardiac Defect: atrial septal defect
-definition

A

opening in the septum and shunting of blood between atria

106
Q

Pediatric Structural Cardiac Defect: atrial septal defect
-clinical features

A

-fixed widely split S2 right ventricle, heave
-systolic ejection murmur
-diastolic flow murmur at left lower sternal border in larger shunts
-frequently asymptomatic and often goes unnoticed until adulthood

107
Q

Which pediatric structural cardiac defect frequently goes unnoticed until adulthood?

A

atrial septal defect

108
Q

Pediatric Structural Cardiac Defect: atrial septal defect
-DX

A

ECHO

109
Q

Pediatric Structural Cardiac Defect: atrial septal defect
-TX

A

surgical or catheterization closure for symptomatic children with LARGER defect and associated right heart dilation

110
Q

Pediatric Structural Cardiac Defect: atrial septal defect
-what kind of murmur?

A

-systolic ejection murmur
-diastolic flow murmur at left lower sternal border in larger shunts

111
Q

Pediatric Structural Cardiac Defect: atrial septal defect
-what kind of S2 occurs?

A

fixed widely split S2 right ventricle, heave

112
Q

Pediatric Structural Cardiac Defect: atrial septal defect
-what kind of problems can this defect have if untreated?

A

lung problems
-when blood passes through ASD, larger volume of blood must be handled by the right side of the heart
-extra blood passes through pulmonary artery into the lungs, causing increased amounts of blood flow in vessels of the lungs

113
Q
A
114
Q

What two structural cardiac defects have a clinical feature of heave?

A

ASD
VSD

115
Q

Pediatric Structural Cardiac Defect: ventricular septal defect
-anatomy
-type of shunt

A

-septal defect between ventricles
-left to right shunt with normal pulmonary vascular resistance

116
Q

Pediatric Structural Cardiac Defect: ventricular septal defect
-Clinical symptoms

A

-usually appears in infancy
-holosystic murmur at left lower sternal border with right ventricular heave
-failure to thrive, tachypnea, diaphoresis when feeding

117
Q

Pediatric Structural Cardiac Defect: ventricular septal defect
-at what age do clinical features appear?

A

Infancy

118
Q

Pediatric Structural Cardiac Defect: ventricular septal defect
-what type of murmur is auscultated with this murmur?
-where is this murmur auscultated?

A

-holosystic murmur
-left lower sternal border with right ventricular heave

119
Q

Pediatric Structural Cardiac Defect: ventricular septal defect
-DX

A

ECHO

120
Q

Pediatric Structural Cardiac Defect: ventricular septal defect
-TX

A

-Manage HF
-Surgery

121
Q

Pediatric Structural Cardiac Defect: atrial ventricular septal defect (AVSD)
-What disorder is common with this defect?

A

Down’s syndrome

122
Q

Pediatric Structural Cardiac Defect: atrial ventricular septal defect (AVSD)
-anatomy/physiology

A

incomplete fusion of embryonic endocardial cushions
-varying degrees of AV valves abnormalities

123
Q

Pediatric Structural Cardiac Defect: atrial ventricular septal defect (AVSD)
-Clinical sx

A

-murmur often inaudible in neonates
-loud pulmonary components of S2

124
Q

Pediatric Structural Cardiac Defect: atrial ventricular septal defect (AVSD)
-Dx

A

-cardiac echo is diagnostic showing cardiac enlargement
-ECG shows extreme left axis deviation

125
Q

Pediatric Structural Cardiac Defect: atrial ventricular septal defect (AVSD)
-Tx

A

-surgery required
-urgency depends upon significance of defect and sx (arrhythmias, heart failure, pulmonary HTN)

126
Q

Pediatric Structural Cardiac Defect: coarctation of aorta
-in what disease does this impact women?

A

Turner’s syndrome

127
Q

What is the leading cause of HF among pediatric patients within the first month of life?

A

Coarctation of aorta

128
Q

Pediatric Structural Cardiac Defect: coarctation of aorta
-is this more prevalent in males or females?

A

Males (3x)

129
Q

Pediatric Structural Cardiac Defect: coarctation of aorta
-anatomy

A

narrowing of aortic arch

130
Q

Pediatric Structural Cardiac Defect: coarctation of aorta
-cardinal sign

A

absence of femoral pulses

131
Q

Pediatric Structural Cardiac Defect: coarctation of aorta
-clinical features

A

-cardinal sign: absent femoral pulses
-upper to lower extremity systolic pressure gradient greater than 20mmHg
-blowing systolic murmur in the back of left axilla

132
Q

Pediatric Structural Cardiac Defect: coarctation of aorta
-where is this best auscultated?

A

back of left axilla

133
Q

Pediatric Structural Cardiac Defect: coarctation of aorta
-what type of murmur is auscultated?

A

-blowing systolic murmur

134
Q

Pediatric Structural Cardiac Defect: coarctation of aorta
-Dx

A

radiographs, ECG, ECHO

135
Q

Pediatric Structural Cardiac Defect: coarctation of aorta
-Tx

A

PGE2 infusion until stabilized then surgical correction is warranted

136
Q

Pediatric Structural Cardiac Defect: tetralogy of fallot
-anatomy

A

anterior deviation of infundibular septum causes narrowing of the right ventricular outflow tract –> leads to VSD, aorta overrides crest of ventricular septum; RV hypertrophies.
= right side arch of aorta in 1/4 of patients

137
Q

Pediatric Structural Cardiac Defect: tetralogy of fallot
-what type of shunt is this?

A

right to left

138
Q

Pediatric Structural Cardiac Defect: tetralogy of fallot
-what type of murmur occurs?

A

systolic ejection murmur (at left sternal border)

139
Q

Pediatric Structural Cardiac Defect: tetralogy of fallot
-where is this murmur heard best?

A

left sternal border

140
Q

Pediatric Structural Cardiac Defect: tetralogy of fallot
-what is common (25%) with the aorta arch?

A

right side aorta arch

141
Q

Pediatric Structural Cardiac Defect: tetralogy of fallot
-clinical sx (5)

A

-hypoxemia in infancy
-fatigue
-dyspnea on exertion
-clubbing of fingers and toes
-chronic arterial desaturation causes elevated RBCs and H&H

142
Q

Pediatric Structural Cardiac Defect: tetralogy of fallot
-Dx

A

2 dimensional imaging is diagnostic

143
Q

Pediatric Structural Cardiac Defect: tetralogy of fallot
-Tx

A

Surgical repair early

144
Q

Pediatric Structural Cardiac Defect: tetralogy of fallot
-what combination of four congenital abnormalities?

A
  1. VSD
  2. Pulmonary valve stenosis
  3. misplaced aorta
  4. thickened ventricular wall (right ventricular hypertrophy)
145
Q

Heart Failure
-what is the most important thing to determine?

A

the cause!

146
Q

Heart Failure
-what causes HF?

A

-right and left HF caused by volume or pressure overload
-occurs when heart fails to meet circulatory and metabolic demands of the body

147
Q

Heart Failure
-clinical features (5)

A

children may present with irritability, diaphoresis with feedings, fatigue, exercise intolerance or evidence of pulmonary congestion

148
Q

Heart Failure
-DX

A

-based on sx
-radiographs (x-ray), EKG, ECHO

149
Q

Heart Failure
-TX

A

therapy should focus on improving cardiac fx
-ACEI and diuretics are first line therapy in children with HF requiring long-term therapy

150
Q

Syndromes and trisomies with associated cardiovascular abnormalities:
-DiGeorge

A

aortic arch abnormalities interrupted arch, right aortic arch

151
Q

Syndromes and trisomies with associated cardiovascular abnormalities: fetal alcohol

A

VSD

152
Q

Syndromes and trisomies with associated cardiovascular abnormalities:
-marfan

A

dilation of ascending aorta/aortic sinus, aortic and mitral insufficiency

153
Q

Syndromes and trisomies with associated cardiovascular abnormalities: Noonan

A

dysplastic pulmonic valve, atrial septal defect

154
Q

Syndromes and trisomies with associated cardiovascular abnormalities: turner

A

coarctation of the aorta, bicuspid aortic valve

155
Q

Syndromes and trisomies with associated cardiovascular abnormalities: trisomy 13

A

PDA, septal defects, pulmonic and aortic stenosis (atresia)

156
Q
A

CMN574 (6 decks)

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