Pediatric Cardiology

Question 1

What are the 3 major closures that occur?

Answer 1

Foramen ovale, ductus arteriosus and ductus venosus close after birth

Question 2

What is the purpose of the foramen ovale?

Answer 2

Allows oxygen rich blood from the placenta to cross directly into the LA therefore bypassing the lungs; after birth its closure allows all blood from the IVC to flow into the RA -> RV -> pulmonary arteries -> lungs

Question 3

What is the purpose of the ductus arteriosus?

Answer 3

Allows deoxygenated blood to flow from the pulmonary trunk to the aorta (bypassing the lungs); Low oxygen blood returns to the heart via SVC and IVC -> RA -> RV -> pulmonary trunk -> aorta -> out to body; the closed ductus arteriosus forms the ligamentum arteriosum

Question 4

What is the purpose of the ductus venosus?

Answer 4

Allows oxygen rich blood from the ublilcal vein to flow into the IVC (placenta -> umbilical vein -> ductus venosus -> IVC -> RA); the closed ductus venosus forms the ligamentum venosum

Question 5

What is the purpose of the newborn pulse oximetry screening test?

Answer 5

ID babies who may be at risk for sudden death from critical congenital heart disease (CCHD); the idea is to check the room air oxygen sat in what would be pre- and post-ductal extremities; if a baby fails it means that further work up for the cause of hypoxemia needs to occur

Question 6

What are the criteria for failing the pulse oximetry screening?

Answer 6

Oxygen sats anywhere are <90%; saturation in the R hand is 90-95% or difference between right hand and foot is >3% (times 3 with 1 hour between each screening)

Question 7

What are the sx of hemodynamically significant cardiac dz in newborns/infants?

Answer 7

Tachypnea, cyanosis, diaphoresis, feeding intolerance (can’t finish a bottle), developmental delay, cough, failure to gain weight

Question 8

What are the PE findings for hemodynamically significant cardiac dz in newborns/infants?

Answer 8

Tachycardia, tachypnea, hypoxia, wheezes/crackles, murmur, poor perfusion, cyanosis, edema, abnormal pulses

Question 9

What are the sx of hemodynamically significant cardiac dz in older children/adolescents?

Answer 9

Dizziness, near syncope or syncope, palpitations, CP, diaphoresis, easy fatigue/exercise intolerance, poor growth, asthma like sx, cough, DOE

Question 10

What are the PE findings for hemodynamically significant cardiac dz in older children/adolescents?

Answer 10

Same as for newborns/infants

Question 11

What is a sign of congenital heart dz?

Answer 11

silent tachypnea (RR >60 breaths/min) in a baby

Question 12

What are some Ddx for a baby with tachypnea and some element of distress?

Answer 12

Transient tachypnea of the newborn (basically excessive lung fluid, usually resolves spontaneously), respiratory distress syndrome (premature babies due to lack of surfactant), meconium aspiration (the baby defecates in utero), infection (pneumonia, sepsis), congenital heart defect, pneumothorax

Question 13

What should be asked during history in older kids?

Answer 13

If any relatives have died suddenly at a young age and if so what were the circumstances, ask about palpitations, dizziness/fainting, CP, cough, exercise/activity intolerance, sleep position, cyanosis

Question 14

What should be asked about during a history in a neonates/infants?

Answer 14

Ask about head bobbing while eating, diaphoresis, ability to gain weight, feeding tolerance, cyanosis, cough

Question 15

What are the 6 components included when describing and documenting a cardiac murmur?

Answer 15

Grade 1-6, timing (early, mid, late, holosystolic, diastolic), character (harsh, machinery, whooping, honking, blowing, musical, vibratory, sing-song), location (best heard at..), radiation (listen in axilla and back), changes with position of pt

Question 16

What are the key features of innocent murmurs in children?

Answer 16

Sensitive (changes with position), shorter duration (not holosystolic), single (the murmur is the only abnormal sound aka no rubs, gallops, clicks), small (limited to a small area, non-radiating), soft (low amplitude, no more than grade 3), sweet (not harsh), systolic (venous hums are innocent and continuous and have a diastolic component)

Question 17

What is the exception to the sensitive rule of murmurs?

Answer 17

The pathologic murmur of idiopathic hypertrophic sub aortic stenosis (IHSS) which gets louder when a pt goes from a supine to an upright position

Question 18

What is the criteria for referring a pediatric pt with a heart murmur?

Answer 18

Grade 4 or above (thrill palpable), diastolic, increased intensity when pt stands (IHSS), any murmur that is symptomatic, S1 and/or S2 obscured, fixed split S2 (ASD?), weak femoral pulses (aortic stenosis? coarctation of the aorta?), clicks, hyperactive precordium at rest, Fhx of the sudden death of an individual at a young age, abnormal or extra heart sounds (except S3 in children or young adults), conditions (chromosomal or prenatal) predisposing a pt to congenital heart lesions, anytime you get “that feeling”

Question 19

What are the 5 T’s of cyanotic congenital heart dz?

Answer 19

Tetralogy of Fallot (VSD, over riding aorta, RVH, RV outflow obstruction), transposition of the great arteries, truncus arteriosus, total anomalous pulmonary venous return, tricuspid valve abnormalities and hypoplastic right heart syndrome

Question 20

How does a small BP cuff change the BP reading?

Answer 20

BP will be artificially high

Question 21

How does a large BP cuff change the BP reading?

Answer 21

BP will be artificially low