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CORE--Peds > Pediatric Cardiac > Flashcards

Pediatric Cardiac Flashcards

1
Q

Most important clinical history in evaluating pediatric cardiac disease

A

Cyanosis vs acyanotic

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2
Q

CXR cardiac imaging features

A
  1. pulmonary vascularity in outer 1/3 lungs
  2. cardiac size
  3. contour of aorta/cardiac chambers, orientation of arch, side of stomach bubble
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3
Q

3 types of pulmonary vascularity that can be seen on CXR

A
  1. increased pulmonary venous flow (pulmonary edema); indistinct vessel/septal markings
  2. increased pulmonary arterial flow (shunt vascularity)
  3. decreased pulmonary arterial flow (right ventricular outflow tract insufficiency)
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4
Q

What is increased pulmonary venous flow (pulmonary edema) and imaging appearance

A

L heart insufficiency, obstructive left heart lesion, CHF, aortic coarctation, neonatal sepsis
indistinct lung periphery lesions

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5
Q

What is increased pulmonary arterial flow, imaging appearance, age of presentation

A

Shunt vascularity; increased arterial flow with Lā€“> R; increased right heart flow going into pulmonary arteries/lungs

Distinct large caliber vessels in 1/3 of lungs

presents in childhood, not infancy

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6
Q

What is decreased pulmonary arterial flow and imaging appearance

A

R ventricle outflow tract insufficiency; cyanotic, not enough blood going into lungs

Decreased vasculature in 1/3 of lungs

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7
Q

CXR enlarged heart and abnormal pulmonary vasculature ddx

A

Congenital heart disease, intracardiac tumor (rhabdomyoma), CHF ue to peripheral shunt (vein of Galen, hepatic hemangioendothelioma), mediastinal mass, congenital diaphgragmatic hernia with unaerated bowel; bronchiolitis in kids with CHD

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8
Q

Causes for increased neonatal pulmonary venous flow (acyanotic)

A

hypoplastic left heart, aortic coarctation (left ventricular outflow tract), CHF, neonatal sepsis

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9
Q

Causes for increased neonatal pulmonary arterial flow (shunt vascularity); acyanotic

A

ASD, VSD, PDA, endocardial cushion defect

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10
Q

Causes of cyanotic congenital heart disease

A

Ebstein anomaly, Tetralogy of Falot, Transposition of great arteries, tricuspid atresia, TAPVR, Single ventricle (double outlet left ventricle, double outlet right ventricle)

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11
Q

Cyanotic heart disease; decreased pulmonary vascularity with cardiomegatly

A

Ebstein anomaly

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12
Q

Cyanotic heart disease; decreased pulmonary vascularity without cardiomegatly

A

Teralogy of Fallot

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13
Q

Cyanotic heart disease; increased pulmonary vascularity

A

transposition of great arteries, tricuspid atresia, TAPVR, Single ventricle (double outlet left ventricle, double outlet right ventricle)

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14
Q

Presentation for hypoplastic left heart syndrome

A

acyanosis, increased pulmonary venous flow/pulmonary edema that worsens once the patent ductus closes and pulmonary arterial resistance falls (cardiogenic shock)

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15
Q

Treatment for HLHS

A

Transplantation or staged surgeries

  1. Norwood
  2. BTS replaced with bidirectional Glenn shunt
  3. Modified Fontan
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16
Q

Describe stage 1 surgery for HLHS

A

Goal: created unobstructed systemic flow and provide pulmonary blood flow (previously RV and ductus dependent)

Norwood procedure:

  • atrial septectomy
  • construct neoaorta from anastamosis of the proximal pulmonary artery o aorta with homograft augmentationtof the aortic arch
  • BT shunt: aortopulmonary shunt (Blalock Taussig shunt)
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17
Q

Describe stage 2 of HLHS

A

Goal: reduce volume overload on RV and redirect systemic venous return from upper body to PA

  • remove BTS
  • replace with bidirectional Glenn shunt (SVC to right PA anastamosis)

Separates systemic and pulmonary circulationā€¦.the RV pumps to the body only

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18
Q

Describe stage 3 of HLHS surgery

A

Goal: redirect systemic venous return to lungs

Fontan: redirect systemic venous return to lungs; IVC to pulmonary artery extracardiac shunt and through right atrium

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19
Q

Extracardiac causes for CHF

A

vein of Galen malformation (high output cardiac failure) and hepatic hemangioendothelioma

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20
Q

Aortic coarctation pathophysiology findings

A

left ventricular obstruction, cardiomegaly, increased pulmonary venous flow

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21
Q

Acyanotic congenital heart disorders with shunt vasculairty

A

ASD, VSD, PDA, Endocardial cushion defect

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22
Q

When do ASD present?

A

late childhood/early adulthood; 2x females

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23
Q

Associated syndrome with ASD

A

Holt Oram and upper extremity bone deformities (lack of thumb)

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24
Q

Most common type of ASD

A

ostium secundum (75%) > ostium primum (15%), sinus venosus ASD 10%

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25
Q

Describe ostium secundum ASD

A

incomplete covering by septum secundum

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26
Q

Describe ostium primum ASD

A

incomplete fusion of septum primum to endocardial cushion

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27
Q

Association with ostium primum ASD

A

fetal alcohol syndrome, down syndrome

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28
Q

Physical exam finding with ASD

A

right heart volume overload; secondary left atrial enlargement; splitting of S2 due to delayed pulmonic valve closure

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29
Q

ASD treatment

A

ASD closure with an Amplatzer or similar device

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30
Q

Complication of ASD

A

paradoxical emboli

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31
Q

Which is diagnosed sooner? ASD vs VSD

A

ASD

32
Q

Describe sinus venosis ASD and its important association

A

occurs near SVC or IVC; associated iwth anomalous pulmonary venous drainage

33
Q

VSD causes dilation of ? ASD causes dilation of?

A

VSD: left heart dilation, left atria may also splay the main stem bronchi at carina
ASD: right atrial enlargement

34
Q

Eisenmenger syndrome

A

pulmonary hypertension and reversal of Lā€“> R shunting

35
Q

persistent postnatal patency of normal fetal connection between pulmonary artery to proximal descending aorta

A

patent ductus arteriosus

36
Q

imaging findings of PDA

A

cardiomegaly (left sided), increased pulmonary vascularity, enlarged proximal aortic arch

37
Q

Treatment for PDA

A

indomethacin or surgical clip

38
Q

endocardial cushion defect

A

AV canal defects; spectrum of abnormalities involving ostium primum ASD, VSD, AV valves (mitral/tricuspid) anomalies

39
Q

Associations with endocardial cushion defect

A

trisomy 21

40
Q

Ebstein anomaly

A

apical displacement of septal/posterior tricuspid valves (R AV) by 1-2 mm lower than mitral valves ā€“> atrialization of right ventricle

41
Q

Imaging appearance of ebstein anomaly

A

cardiomegaly from R atrial enlargement; ā€˜wall to wallā€™ or ā€˜box shapedā€™ heart

42
Q

Ebstein anomaly: cyanotic vs acyanotic

A

cyanotic; decreased pulmonary vascular resistance with cardiomegaly; less blood flow from RV

43
Q

Ebstein anomaly appears identical on CXR to?

A

pulmonary atresia with intact ventricular septum

44
Q

Ebstein anomaly associations

A

Trisomy 21, 18

45
Q

Pulmonary atresia with intact ventricular septum appears identical to?

A

ebstein anomaly

46
Q

Four components of Tetralogy of Fallot

A
  1. right ventricular outflow tract
  2. right ventricular hypertrophy
  3. VSD
  4. overriding VSD
47
Q

Most common cyanotic heart disease in adults/children

A

Tetralogy of Fallot

48
Q

TOF associations

A

DiGeorge (absent thymus/parathyroids, hypocalcemia), VACTERL, Trisomy 21

49
Q

XR findings of TOF

A

boot shape hearted (apex uplifted by RV hypertropy), decreased pulmonary vascularity, concave main PA

50
Q

Repair of TOF?

A

closure of VSD, opening of RVOT obstruction

51
Q

Cyanotic lesions

A

TOF, Transposition of Great Arteries, Tricuspid atresia, Trucus arteriosus, Total anomalous pulmonary venous return, Tingle ventricle

52
Q

Cyanotic lesion with decreased pulmonary vascuarity and no cardiomegaly

A

TOF

53
Q

Atrioventricular concordance and ventriculoarterial discordance

A

TGA

54
Q

Egg on a string appearance

A

TGA

55
Q

Arterial switch (Jatene) procedure

A

swap aorta and pulmonary artery; relocates coronary artery to neoaorta for TGA

56
Q

Tricuspid atresia apperance

A

absent tricuspid valve; variable appearance based on associated VSD

small VSD: normal heart size, decreased pulmonary vasculature
large VSD: cardiomegaly, increased pulmonary flow

57
Q

Trucus arteriosus

A

single great artery from base of heart; usually overrides a VSD

58
Q

Truncus arteriosus CXR

A

cardiomegaly, narrow mediastinum, pulmonary edema

59
Q

TAPVR

A

all pulmonayr veins connect to systemic venous circulation instead of draining into left atrium; failure of pulmonary vein to connect to left atrium

60
Q

Classification of TAPVR based on venous drainage of heart

A

Supracardiac: 50% anomalous venous return at/above level of SVC

Cardiac: drainage at coronary sinus/right atrium

INfracardiac: anomalous drainage through diaphgragm via esophageal hiatus to IVC

Mixed: anomalous venous drainage

61
Q

Single ventricle

A

monoventricle; AV admixture at the level of the monoventricle; double outlet right ventricle

62
Q

Cyanotic heart diseases

A

Ts: TGA, Tricuspid atresia, truncus arteriosus, TAPVR, single ventricle

Decreased pulmonary vacularity: TOF, Ebstein, Pulmonary atresia and intact septum

63
Q

Acyanotic CHD

A

Pulmonary edema: hypoplastic left heart, extracardiac shunt causing CHF, aortic coarctation

Shunt vascularity: ASD, VSD, PDC, endocardial cushion defect

64
Q

Types of aortic coarctation

A

preducta, periductal, postductal ; longer segment stenosis caleld tubular hypoplasia

65
Q

Associations with aortic coarctation

A

Turner syndrome (XO), bicuspid aortic valve

66
Q

What type of CHF does aortic coarctation cause? acyanotic vs cyanotic

A

Acyanotic

67
Q

Classic XR findings with coarctation

A

3 sign of the aorta in the left upper mediastinum, rib notching (Roseler sign)

68
Q

Young patient with hypertension?

A

watch out for coarctation

69
Q

Most common cardiac tumor

A

Rhabdomyoma

70
Q

Pts that get rhabdomyoma

A

babies under 1 with tuberous sclerosis; often earliest sign of TS

71
Q

CXR for rhabdomyoma

A

cardiomegaly; varied pulmonary vascularity

72
Q

Cardiac teratoma common location

A

root of pulmonary artery and aorta

73
Q

Cardiac fibroma tissue and common location?

A

fibroblast and myofibroblasts; interventricular septum

74
Q

Presentation of fibroma

A

arrhytmias and outflow obstruction; similar to rhabdomyoma

75
Q

What types of cardiac masses can causes pericardial effusions?

A

hemangioma, teratoma

CORE--Peds (7 decks)

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