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Pedia SB Review > Part 19. Cardio > Flashcards

Part 19. Cardio Flashcards

1
Q

Differential cyanosis is seen with?

A

Differential cyanosis, manifested as blue lower extremities and pink upper extremities (usually the right arm), is seen with right-to-left shunting across a ductus arteriosus in the presence of coarctation or an interrupted aortic arch.

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2
Q

In the normal neonate

Foramen ovale is usually functionally closed by?

A

3rd month of life

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3
Q

In the normal neonate, functional closure of the ductus arteriosus is usually complete by?

A

10-15h postnatal age

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4
Q

True or False

Normally, the femoral pulse should be appreciated immediately before the radial pulse.

A

True

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5
Q

On Cardiac PE

What finding on inspection indicates the presence of RV enlargement?

A

Substernal thrust

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6
Q

On Cardiac PE

What finding on inspection is noted with LV enlargement?

A

Apical heave

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7
Q

The first heart sound (S1) is best heard ____, whereas the second heart sound (S2) should be evaluated at ____.

A

at the apex;
the upper left and right sternal borders.

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8
Q

S1 is caused by closure of the ____. S2 is caused by closure of the ____.

A

atrioventricular valves (mitral and tricuspid);
semilunar valves (aortic and pulmonary)
Splitting of the second heart sound increases during inspiration and decreases during expiration.

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9
Q

ECG reading

Tall (>2.5 mm), narrow, and spiked P waves are indicative of?

A

Right atrial enlargement. These are seen in congenital pulmonary stenosis, Ebstein anomaly of the tricuspid valve, tricuspid atresia, and some- times cor pulmonale. These abnormal waves are most obvious in leads II, V3R, and V1.

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10
Q

ECG reading

Broad P waves, commonly bifid and sometimes biphasic, are indicative of?

A

Left atrial enlargement. Seen in pts with large left-to-right shunts (ventricular septal defect [VSD], patent ductus arteriosus) and with severe mitral stenosis or mitral regurgitation.

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11
Q

ECG reading

A long PR interval is diagnostic of?

A

first degree heart block

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12
Q

ECG reading

Normal QTc interval?

A

< 0.45 sec. It is often lengthened with hypokalemia and hypocalcemia.

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13
Q

The most frequently used index of cardiac function in children is?

A

percent fractional shortening (%FS), which contrasts to adults, where ejection fraction is the most common functional measurement.
Normal fractional shortening is approximately 28–42%.

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14
Q

Major components of DiGeorge syndrome.

A

aka Shprintzen (velocardiofacial) syndrome. With deletion of a large region of chromosome 22q11.2
The acronym CATCH 22 has been used to summarize the major components of these syndromes: cardiac defects,
abnormal facies,
thymic aplasia,
cleft palate, and
hypocalcemia.

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15
Q

Specific cardiac anomalies associated with DiGeorge syndrome.

A

conotruncal defects (tetralogy of Fallot, truncus arteriosus, double-outlet right ventricle, subarterial VSD)

and

branchial arch defects (coarctation of the aorta, interrupted aortic arch, right aortic arch)

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16
Q

Common cardiac defects assoc with…

Trisomy 21

A

AVSD

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17
Q

Common cardiac defects assoc with…

Alagille syndrome

A

Peripheral pulmonary hypoplasia, PS, TOF

(bile duct hypoplasia, right-sided cardiac lesions)

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18
Q

Common cardiac defects assoc with…

Holt-Oram syndrome

A

ASD, VSD, PDA

(limb defects, ASD)

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19
Q

Common cardiac defects assoc with…

Noonan syndrome

A

PS, ASD, VSD, PDA, cardiomyopathy

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20
Q

Common cardiac defects assoc with…

Marfan Syndrome

A

Aortic aneurysm, mitral valve disease

(connective tissue weakness, aortic root dilation)

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21
Q

Common cardiac defects assoc with…

Turner Syndrome

A

Coarctation of the aorta, aortic stenosis

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22
Q

Common cardiac defects assoc with…

CHARGE syndrome

A

ASD, VSD, TOF

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23
Q

Critical cyanotic CHD lesions

A
  • hypoplastic left heart syndrome,
  • pulmonary atresia,
  • tetralogy of Fallot,
  • total anomalous pulmonary venous return,
  • transposition of the great arteries,
  • tricuspid atresia,
  • truncus arteriosus,
  • neonatal coarctation of the aorta, and
  • aortic arch hypoplasia/atresia
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24
Q

This is due to the chronic exposure of the pulmonary circulation to high pressure and blood flow resulting in a gradual increase in PVR.

A

Eisenmenger physiology

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25
Q

Most common form of Atrial septal defect.

A

An ostium secundum defect in the region of the fossa ovalis

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26
Q

Cardiac PE

In most patients with an ASD, the characteristic finding is?

A

The second heart sound (S2) is widely split and fixed in its splitting during all phases of respiration.
A systolic ejection murmur is heard; it is usually no greater than a grade 3/6, medium pitched, without harsh qualities, seldom accompanied by a thrill, and best heard at the left middle and upper sternal border. It is produced by the increased flow across the RV outflow tract into the pulmonary artery.

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27
Q

Most common cardiac malformation?

A

Ventricular septal defect. Most common are of the membranous type.

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28
Q

Management goals for large VSDs?

2

A
  1. Control the symptoms of heart failure
  2. Prevent the development of pulmonary vascular disease
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29
Q

What is a contraindication to closure of a VSD?

A

Severe pulmonary vascular disease nonresponsive to pulmonary vasodilators

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30
Q
A
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31
Q

Why is PDA is common problem in premature infants?

A

Because the smooth muscle in the wall of the preterm ductus is less responsive to high PO2 and therefore less likely to constrict after birth. In these infants the shunt through a PDA can cause severe hemodynamic derangements and several major sequelae

32
Q

Why does a PDA persisting beyond the 1st few wk of life in a term infant rarely close spontaneously or with pharmacologic intervention?

A

When a term infant is found to have a PDA, the wall of the ductus is deficient in both the mucoid endothelial layer and the muscular media, whereas in the premature infant the PDA usually has a normal structure.

33
Q

Initial treatment of choice for moderate to severe pulmonic stenosis

A

Balloon valvuloplasty

33
Q

This CHD is caused by muscular or fibrous obstruction in the outflow tract of the right ventricle.

A

Infundibular pulmonary stenosis

33
Q

Name some conditions associated with peripheral pulmonary stenosis

A
  • Congenital rubella syndrome
  • Williams syndrome (combination of supravalvular aortic stenosis with pulmonary arterial branch stenosis, idiopathic hypercalcemia of infancy, elfin facies, and mental retardation)
  • Alagille syndrome
34
Q

Prominent physical sign of pulmonary insufficiency?

A

The prominent physical sign is a decrescendo diastolic murmur at the upper and mid-left sternal border, which has a lower pitch than the murmur of aortic insufficiency because of the lower pressure involved.

35
Q

When this group of left-sided obstructive lesions (CoA, mitral valve abnormalities, subaortic stenosis) occurs together, they are referred to as the?

A

Shone complex

36
Q

This is a post surgical correction of CoA complication associated with acute hyperten- sion and abdominal pain in the immediate postoperative period.

A

Postoperative mesenteric arteritis
The pain varies in severity and may occur in conjunction with anorexia, nausea, vomiting, leukocytosis, intestinal hemorrhage, bowel necrosis, and small bowel obstruction. Relief is usually obtained with antihyper- tensive drugs (e.g., nitroprusside, esmolol, captopril) and intestinal decompression.

37
Q

Should recoarctation occur after surgery, what is the procedure of choice?

A

BAlloon angioplasty.
In these patients, scar tissue from previous surgery may make reoperation more difficult yet makes balloon angioplasty safer because of the lower incidence of aneurysm formation.

38
Q

What is the most common aortopulmonary shunt procedure?

A

Blalock-Taussig shunt

39
Q

Name a method to distinguish cyanotic CHD from pulmonary disease.

A

Hyperoxia test.
Neonates with cyanotic CHD usually are unable to significantly raise their arterial blood partial pressure of oxygen (PaO2) during administration of 100% oxygen. This test is usually performed using a hood rather than nasal cannula or face mask, to best guarantee delivery of almost 100% oxygen to the patient.

40
Q

Tetralogy of Fallot

What determines the timing of the onset of symptoms, the severity of cyanosis, and the degree of right ventricular hypertrophy (RVH)?

A

The degree of RV outflow tract obstruction

41
Q

TOF

What should you do when confronted by a child having a Tet spell?

A

Tet spells aka Paroxysmal hypercyanotic attacks.
One or more of the following procedures should be instituted in sequence:
1. placement of the infant on the abdomen in the knee-chest position while making certain that the infant’s clothing is not constrictive,
2. administration of oxygen (although increasing inspired oxygen will not reverse cyanosis caused by intracardiac shunting), and
3. injection of morphine subcutaneously in a dose not in excess of 0.2 mg/kg.

42
Q

CHDs

The combination of cyanosis and left axis deviation on the ECG is highly suggestive of?

A

Tricuspid atresia

43
Q

CHD

This consists of downward displacement of an abnormal tricuspid valve into the right ventricle.

A

Ebstein anomaly

44
Q

CHD

Chest radiographs may show mild cardiomegaly, a narrow mediastinum (the classic “egg-shaped heart”), and normal to increased pulmonary blood flow.

A

d-Transposition of the Great arteries. Though in the early newborn period, the chest radiograph is generally normal.

45
Q

CHDs

What is the surgical treatment of choice for neonates with d-TGA and an intact ventricular septum and is usually performed within the first 2 weeks of life?

A

The arterial switch (Jatene) procedure

46
Q

In this CHD, the atrioventricular relationships are dis- cordant: the right atrium is connected to a left ventricle and the left atrium to a right ventricle (also known as ventricular inversion).

A

L-TGA

47
Q

CHD

Snowman appearance on CXR.

A

Total anomalous pulmonary vascular return

48
Q

CHD

This 2D-ECho with Doppler finding is pathognomonic of TAPVR.

A

The demonstration of any vein with Doppler flow away from the heart is pathognomonic of TAPVR, because normal venous flow is usually toward the heart

49
Q

CHD

What is an example of a pediatric cardiac surgical emergency because prostaglandin therapy is usually not effective?

A

Obstructed TAPVR

50
Q

Surgical procedure for HLHS?

A

Norwood or Sano procedure.
The 1st-stage repair is designed to construct a reliable source of systemic blood flow arising from the single right ventricle using a combination of aortic and pulmonary arterial tissue, and to limit pulmonary blood flow to avoid heart failure and prevent the develop- ment of pulmonary vascular disease.

51
Q

Features of the syndrome include: recurrent epistaxis and GI tract bleeding. Transitory dizziness, diplopia, aphasia, motor weakness, or convulsions may result from cerebral thrombosis, abscess, or paradoxical emboli. Soft systolic or continuous murmurs may be audible over the site of the fistula. The ECG is normal.

A

Osler-Weber-Rendu syndrome
Fistula is a pulmonary arteriovenous fistula.

52
Q

Pentalogy of Cantrell consists of?

A
  1. ectopia cordis,
  2. midline supraumbilical abdominal defect,
  3. deficiency of the anterior diaphragm,
  4. defect of the lower sternum, and
  5. an intracardiac defect (ventricular septal defect, tetralogy of Fallot, or diverticulum of left ventricle)
53
Q

This term refers to patients with an intracardiac defect or aortopulmonary connection through which blood is shunted partially or totally from right to left as a result of the development of pulmonary vascular disease.

A

Eisenmenger syndrome

54
Q

What is the 1st line therapy for malignant PVCs?

A

An intravenous lidocaine bolus and drip is the first line of therapy, with more effective drugs such as amiodarone reserved for refractory cases or for patients with underlying ventricular dysfunction or hemodynamic compromise.

55
Q

Typical electrocardiographic features of the WPW syndrome.

A

These features include a short P-R interval and slow upstroke of the QRS (delta wave).

56
Q

What are treatments for SVTs?

A
  • Vagal stimulation by placing of the face in ice water (in older children) or by placing an ice bag over the face (in infants) may abort the attack. To terminate the attack, older children may be taught vagal maneuvers such as the Valsalva maneuver, straining, breath holding, or standing on their head.

When above measures fail, pharmacologic alternatives are:
* adenosine by rapid intravenous push is the treatment of choice (0.1 mg/kg, maximum dose 6 mg) because of its rapid onset of action and minimal effects on cardiac contractility. Because of the potential for adenosine to initiate atrial fibrillation, it should never be administered without a means for direct current (DC) cardioversion near at hand.
* Ca-channel blockers (eg verapamil) in older children as it may reduce cardiac output and produce hypotension and cardiac arrest in infants younger than 1 yr and therefore is contraindicated in this age-group.
* synchronized DC cardioversion (0.5-2 J/kg) is recommended as the initial management when symptoms of severe heart failure have occured

57
Q

What is the most common mechanism of SVT in infants? in adolescents?

A
  • Atrioventricular reciprocating tachycardia (AVRT) involves an accessory pathway and is the most common mechanism of SVT in infants.
  • Atrioventricular node reentry tachycardia (AVNRT) is rare in infancy, but there is an increasing incidence of AVNRT in childhood and into adolescence. AVNRT involves the use of 2 functional pathways within the AV node, the slow and fast AV node pathways. It is one of the few forms of SVT that is occasionally associated with syncope. This arrhythmia is often seen in association with exercise.
58
Q

Drug of choice for management of SVT caused by AVNRT?

A

Beta blockers.
Acutely, AVNRT responds to adenosine

59
Q

The congenital defect most often associated with sudden death in children

A

Valvar aortic stenosis

60
Q

The most common cause of sudden death in the athletic adolescent.

A

Hypertrophic cardiomyopathy (HCM)

61
Q

Drugs that are contraindicated in WPW syndrome.

A

As digoxin and verapamil can augment conduction down accessory pathways, these drugs are contraindicated in WPW syndrome.

62
Q

A typical ECG finding in Brugada syndrome

A

Coved ST segment elevations in V1-V3.

63
Q

This is an almost universally fatal condition that follows blunt nonpenetrating trauma to the chest (e.g., from a baseball or hockey puck)

A

Commotio cordis

64
Q

Leading causative agents for endocarditis in pediatric patients.

A

Viridans-type streptococci (α-hemolytic streptococci groups such as Streptococcus mitis, S. anginosus, S. mutans, S. salivarius, and S. bovis) and Staphylococcus aureus

65
Q

Infective endocarditis causative agent

more common in patients with no underlying heart disease

A

Staphylococcus

66
Q

Infective endocarditis causative agent

more common after dental procedures

A

Viridans streptococci

67
Q

Infective endocarditis causative agent

seen more often after lower bowel or genitourinary manipulation.

A

group D enterococci

68
Q

Infective endocarditis causative agent

more frequently in intravenous drug users

A

Pseudomonas aeruginosa or Serratia marcescens

69
Q

True or False

Infective endocarditis can also occur in children without any abnormal valves or cardiac malformations.

A

True

70
Q

This set of criteria helps in the diagnosis of infective endocarditis

A

**Duke’s criteria. **
Two major criteria, 1 major and 3 minor, or 5 minor criteria suggest definite endocarditis.

71
Q

Drugs of choice for fungal endocarditis

A

amphotericin B (liposomal or standard preparation) and 5-fluorocytosine

72
Q

Empirical therapy for suspected IE in patients without a prosthetic valve and when there is a high risk of S. aureus, enterococcus, or viridans streptococci.

A

Vancomycin + gentamicin

73
Q

Cardiac Conditions Associated with Highest Risk of Adverse Outcome from Infective Endocarditis for Which Prophylaxis with Dental Procedures Is Reasonable (2007 AHA Statement)

A

*Prosthetic cardiac valve or prosthetic material used for cardiac valve repair
*Previous infective endocarditis

CONGENITAL HEART DISEASE (CHD)
* Unrepaired cyanotic CHD, including palliative shunts and conduits
* Completely repaired CHD with prosthetic material or device, whether placed by surgery or catheter intervention, during the 1st 6 mo after the procedure
* Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch, or prosthetic device (which inhibit endothelialization)

*Cardiac transplantation recipients who develop cardiac valvulopathy

Except for the conditions listed here, antibiotic prophylaxis is no longer recommended by the AHA for any other form of CHD

74
Q

Most commonly affected valve in rheumatic heard disease

A

Mitral valve, followed by aortic valve

75
Q
A

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