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FALL15 N833 Adv Pedi Probs > Pedi Cardiology > Flashcards

Pedi Cardiology Flashcards

1
Q

What is neurocardiogenic syncope?

A

“Vasovagal syncope” a hypersensitive autonomic response
heart rate slows, and the blood vessels in legs dilate, blood pools in LEs > BP drops. Lower HR and BP > diminished blood flow to your brain > syncope

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2
Q

Prodrome to syncope

A

nausea, palpitations, diaphoresis, tinnitus, pallor, dizziness, lightheadedness, blurred vision, weakness

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3
Q

Tx for near syncope

A

Lie down, elevate legs

increases blood return to brain

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4
Q

Classifications of syncope

A

Neurally mediated (vasovagal), Cardiovascular, Other (metabolic, neurologic, psychologic)

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5
Q

Causes of CV syncope

A

congenital HD (impaired CO), CAD, arrhythmia

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6
Q

Bezold-Jarisch reflex

A

paradoxical response of bradycardia, vasodilation, hypotension in vasovagal syncope

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7
Q

Syncope: when to worry

A

family Hx sudden death or seizure do (misdiagnosed long QT)
Myocardial dz
occurs w/exercise
associated palpations or CP

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8
Q

Work up for syncope

A

EKG to evaluate for: long QT, WPW, Complete Heart Block, Ventricular hypertrophy, myocardial ischemia

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9
Q

When to consult cardiology regarding syncope?

A

recurrent w/o identifiable cause
arrhythmia suspected or identified
occurs during exercise

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10
Q

Tx for vasovagal syncope

A

Volume & solute replacement
Mineralcorticoids (problematic & recurrent syncope)
BBs

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11
Q

Who is at risk for myocardial ischemia (as a cause of CP)?

A

Kawasaki dz, Transposition of the great arteries w/coronary switch operation, Ross operation
anomalies in coronary arteries (single coronary, ALCAPA, pulmonary atresia)

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12
Q

Sx of myocardial ischemia

A

pressure sensation +/- burning
radiation to neck, shoulder, arm
during or following exercise
improves w/rest

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13
Q

Sx pericarditis

A 
severe substernal CP
squeezing or tightening
worse w/movement, breathing
Lean forward, may refuse to lie down
reproducible by sternal pressure
Friction rub if small or no effusion
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14
Q

Tx pericarditis

A

NSAIDs 2-6weeks (always w/GI prophylaxis!), steroids if severe/recurrent

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15
Q

When to consult cardiology regarding CP

A 
w/or after exercise
w/syncope or near syncope
known cardiac dz
acute sudden onset w/marfan 
abnormal PE findings
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16
Q

Sx of hypertrophic cardiomyopathy

A

> 50% have murmurs r/t LVOT obstruction
exertional dyspnea, palpitations, syncope, CP
95% have EKG abnormalities

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17
Q

When to consult cardiology regarding palpitations

A

PACs and single monomorphic PVCs
Associated w/exercise, syncope, symptoms
asymptomatic generally no referral

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18
Q

How much of AP width does cardiac silhouette occupy on CXR?

A

50-55%

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19
Q

What are you looking for on CXR when assessing CV system?

A

size of heart (small, normal, large)
contours of heart (enlarged, absent, displaced)
pulmonary vascularity (diminished, normal, increased)

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20
Q

ASD on CXR

A

Prominent pulmonary vasculature and enlarged right heart

increased compliance LV, L-> R shunting

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21
Q

VSD on CXR

A

Enlarged pulmonary vasculature, left heart dilation

L-> R shunt, increased P blood flow & return to LA and LV

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22
Q

PDA on CXR

A

Left heart dilation and cardiomegaly

L–>R shunt at arterial level, inc P blood flow and return to LA and LV

23
Q

AV canal defect on CXR

A

Prominent pulmonary vasculature, dilation all 4 chambers

often w/ASD & VSD, L–>R shunting, inc Pulm blood flow, regurgitation AV valves

24
Q

AS on CXR

A

Dilated ascending aorta, LV dilated & hypertrophic, displaced downward and lateral
(increased velocity across narrowed LVOT, LV works harder)

25
Q

ToF on CXR

A 
small, hypo plastic or atretic Pas
Mediastinum appears narrowed
RVH d/t PS
Uplifting of cardiac apes
BOOT SHAPED HEART
Diminished pulmonary vascular markings (PA restricts PBF)
26
Q

TAPVR on CXR

A

Snowman appearance, pulmonary vasculature prominent

TAPVR–> vertical vein –> innominate vein –> SVC

27
Q

Pathogenesis of IE

A

formation of small thrombus on abnormal endothelial surface > secondary infection w/bacteria transiently circulating > proliferation of bacteria > vegetations on endothelial surface

28
Q

2007 changes in prophylaxis for IE?

A

More likely to get it w/daily activities than procedures. Good oral hygiene more important.

29
Q

Who gets IE prophylaxis?

A

prosthetic cardiac valve / material for valve repair
Hx IE
cardiac transplant w/abnormal valves
CHD (unrepaired cyanotic HD, 1st mth after complete repair, repaired but w/residual defect, 1st 6mo after transcatheter device placement)

30
Q

What procedures merit IE prophylaxis?

A

Dental procedures involving manipulation of gingival tissues, including routine cleaning
Respiratory/airway procedures: T&A, airway biopsy, bronchoscopy w/biopsy
NOT for GI, GU, orthodontic, vaginal procedures, c-section

31
Q

What is given for IE prophylaxis

A

amox or ampicillin 1st line

32
Q

ADHD meds: initial workup

A

patient & FH
PE for murmurs, HTN, irregular HR, stigmata of marfan
ECG baseline

33
Q

What is kawasaki Dz?

A

idiopathic multisystem dz characterized by vasculitis of small and medium blood vessels including coronary arteries

34
Q

Predisposing factors to KD?

A

age around 2.3 yrs, asian american, winter or spring

35
Q

Diagnostic criteria for KD

A

R/o other origin
Fever 5+ days (high w/reduced response to antipyretics)
At least for of following: 1) changes in extremities (edema, erythema, desquamation, 2) polymorphous exanthem (typically truncal), 3) conjunctival injection (non purulent), 4) erythema +/- fissuring of lips and oral cavity, 5) cervical LSD

36
Q

Lab finding supporting KD

A 
Leukocytosis w/left shift
mild normocytic, normochromic anemia
thrombocytosis >450
Elevated ESR & CRP
hypoalbuminemia
elevated transaminases
sterile pyuria
mild hyponatremia
37
Q

Phases of KD

A

ACUTE: 1-2w from onset (febrile, toxic appearing; oral changes, rash, erythema)
SUBACUTE: 2-8w from onset (desquamation, gradual improvement even w/o Tx)
CONVALESCENT: months to years (remaining sx resolve, lab criteria normalize)

38
Q

Signs and Symptoms of KD

A

Respiratory (rhinorrhea, cough, pulmonary infiltrate)
GI (V/D, abd pain, gallbladder hydrops)
Neurologic (irritability, aseptic meningitis (IVIG))
MS (myositis, arthralgias, arthritis)

39
Q

KD cardiac changes on EKG

A

EKG: arrhythmias, abnormal Q waves, prolonged PR and or QTc, low voltages, ST-T wave changes

40
Q

KD cardiac changes on CXR

A

cardiomegaly

41
Q

KD cardiac changes on PE

A

suggestive of myocarditis (tachy, m/g, CHF), pericarditis (distant heart sounds friction rub, tamponade), valvulitis (murmur, tachy)

42
Q

When are aneurysms of KD more likely to occur?

A 
8yrs
Fever >14 days
Male
Thrombocytosis
Evidence of cardiac involvement on exam (Mitral regurg or pericardial effusion)
43
Q

Principle cause of death in KD?

A

MI, most often in 1st year, majority while at rest/sleeping

about 1/3 asymptomatic

44
Q

Tx KD

A

IVIG 2g/kg as one time dose
Aspirin: high dose (80-100mg/kg/day div q6h) until afebrile + 48h; Low dose (3-5mg/kg/day) x 6wks or until normalization of acute phase reactants (CRP, ESR, PLT)
*repeat IVIG if failure to respond or recurrent fever after 24h after 1st dose

45
Q

F/U for KD

A

lifelong. 6mo-5y depending on risk

46
Q

What is WPW?

A

Wolff Parkinson White

abnormal accessory conduction pathways between atria and ventricles - risk for SVT

47
Q

ECG changes associated w/WPW?

A

Delta wave, short PR interval, widened QRS complex

48
Q

WPW associated w/structural HD?

A

Not usually, but Ebstein anomaly and HCM in some

49
Q

Risks associated w/WPW

A

SVT, afib, SCD

50
Q

Tx for WPW

A

transcatheter ablation

51
Q

High risk for SCD w WPW

A 
Male, less than 30
Hx afib
Hx syncope
Familial WPW
CHD
52
Q

Atypical KD

A

Less than 4 of 5 Dx criteria
Compatible labs
Coronary aneurysm risk

53
Q

When is atypical KD more common

A

Less than 6mo

Older than 10 years

FALL15 N833 Adv Pedi Probs (10 decks)

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