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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
Describe ostium secundum ASD
incomplete covering by septum secundum
26
Describe ostium primum ASD
incomplete fusion of septum primum to endocardial cushion
27
Association with ostium primum ASD
fetal alcohol syndrome, down syndrome
28
Physical exam finding with ASD
right heart volume overload; secondary left atrial enlargement; splitting of S2 due to delayed pulmonic valve closure
29
ASD treatment
ASD closure with an Amplatzer or similar device
30
Complication of ASD
paradoxical emboli
31
Which is diagnosed sooner? ASD vs VSD
ASD
32
Describe sinus venosis ASD and its important association
occurs near SVC or IVC; associated iwth anomalous pulmonary venous drainage
33
VSD causes dilation of ? ASD causes dilation of?
VSD: left heart dilation, left atria may also splay the main stem bronchi at carina ASD: right atrial enlargement
34
Eisenmenger syndrome
pulmonary hypertension and reversal of L--> R shunting
35
persistent postnatal patency of normal fetal connection between pulmonary artery to proximal descending aorta
patent ductus arteriosus
36
imaging findings of PDA
cardiomegaly (left sided), increased pulmonary vascularity, enlarged proximal aortic arch
37
Treatment for PDA
indomethacin or surgical clip
38
endocardial cushion defect
AV canal defects; spectrum of abnormalities involving ostium primum ASD, VSD, AV valves (mitral/tricuspid) anomalies
39
Associations with endocardial cushion defect
trisomy 21
40
Ebstein anomaly
apical displacement of septal/posterior tricuspid valves (R AV) by 1-2 mm lower than mitral valves --> atrialization of right ventricle
41
Imaging appearance of ebstein anomaly
cardiomegaly from R atrial enlargement; 'wall to wall' or 'box shaped' heart
42
Ebstein anomaly: cyanotic vs acyanotic
cyanotic; decreased pulmonary vascular resistance with cardiomegaly; less blood flow from RV
43
Ebstein anomaly appears identical on CXR to?
pulmonary atresia with intact ventricular septum
44
Ebstein anomaly associations
Trisomy 21, 18
45
Pulmonary atresia with intact ventricular septum appears identical to?
ebstein anomaly
46
Four components of Tetralogy of Fallot
1. right ventricular outflow tract 2. right ventricular hypertrophy 3. VSD 4. overriding VSD
47
Most common cyanotic heart disease in adults/children
Tetralogy of Fallot
48
TOF associations
DiGeorge (absent thymus/parathyroids, hypocalcemia), VACTERL, Trisomy 21
49
XR findings of TOF
boot shape hearted (apex uplifted by RV hypertropy), decreased pulmonary vascularity, concave main PA
50
Repair of TOF?
closure of VSD, opening of RVOT obstruction
51
Cyanotic lesions
TOF, Transposition of Great Arteries, Tricuspid atresia, Trucus arteriosus, Total anomalous pulmonary venous return, Tingle ventricle
52
Cyanotic lesion with decreased pulmonary vascuarity and no cardiomegaly
TOF
53
Atrioventricular concordance and ventriculoarterial discordance
TGA
54
Egg on a string appearance
TGA
55
Arterial switch (Jatene) procedure
swap aorta and pulmonary artery; relocates coronary artery to neoaorta for TGA
56
Tricuspid atresia apperance
absent tricuspid valve; variable appearance based on associated VSD small VSD: normal heart size, decreased pulmonary vasculature large VSD: cardiomegaly, increased pulmonary flow
57
Trucus arteriosus
single great artery from base of heart; usually overrides a VSD
58
Truncus arteriosus CXR
cardiomegaly, narrow mediastinum, pulmonary edema
59
TAPVR
all pulmonayr veins connect to systemic venous circulation instead of draining into left atrium; failure of pulmonary vein to connect to left atrium
60
Classification of TAPVR based on venous drainage of heart
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
Single ventricle
monoventricle; AV admixture at the level of the monoventricle; double outlet right ventricle
62
Cyanotic heart diseases
Ts: TGA, Tricuspid atresia, truncus arteriosus, TAPVR, single ventricle Decreased pulmonary vacularity: TOF, Ebstein, Pulmonary atresia and intact septum
63
Acyanotic CHD
Pulmonary edema: hypoplastic left heart, extracardiac shunt causing CHF, aortic coarctation Shunt vascularity: ASD, VSD, PDC, endocardial cushion defect
64
Types of aortic coarctation
preducta, periductal, postductal ; longer segment stenosis caleld tubular hypoplasia
65
Associations with aortic coarctation
Turner syndrome (XO), bicuspid aortic valve
66
What type of CHF does aortic coarctation cause? acyanotic vs cyanotic
Acyanotic
67
Classic XR findings with coarctation
3 sign of the aorta in the left upper mediastinum, rib notching (Roseler sign)
68
Young patient with hypertension?
watch out for coarctation
69
Most common cardiac tumor
Rhabdomyoma
70
Pts that get rhabdomyoma
babies under 1 with tuberous sclerosis; often earliest sign of TS
71
CXR for rhabdomyoma
cardiomegaly; varied pulmonary vascularity
72
Cardiac teratoma common location
root of pulmonary artery and aorta
73
Cardiac fibroma tissue and common location?
fibroblast and myofibroblasts; interventricular septum
74
Presentation of fibroma
arrhytmias and outflow obstruction; similar to rhabdomyoma
75
What types of cardiac masses can causes pericardial effusions?
hemangioma, teratoma

CORE--Peds (7 decks)

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