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Clin Med IV: Pediatrics > Pediatric Cardiology > Flashcards

Pediatric Cardiology Flashcards

1
Q

What does heart failure look like in an infant

A

Respiratory distress, especially with feeding
poor feeding
poor growth
hepatomegaly and rales

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2
Q

What is the foramen ovale

A

Right atrium to left atrium hole

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3
Q

what is ductus arteriosus

A

pulmonary artery to aorta

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4
Q

What is ductus venosis

A

umbilical verin to IVC (bypasses liver)

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5
Q

what happens to lead to the closure of ductus arteriosus

A

decreased level of prostaglandin E2

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6
Q

What is the leading cause of birth-defect related perinatal and infant death and disease

A

Congenital heart disease

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7
Q

What are the types of congenital heart disease

A

Acyanotic heart disease
obstructive lesions
cyanotic heart disease

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8
Q

What is the most common heart defect

A

Bicuspid aortic valve
often unknown until adulthood

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9
Q

What are risk factors for CHD

A

prematurity: 2-3x higher
family history: 3 fold increase if first degree relative
genetic syndrome
maternal factors: diabetes, HTN, obesity, PKU, thyroid, smoking, alcohol use
in utero infection: TORCH

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10
Q

What are TORCH infections

A

in utero infection
rubella, flu-like illness, CMV, HHV6, HSV, parvovirus, toxoplasmosis

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11
Q

What is Acyanotic heart disease

A

L>R shunts
Patent ductus arteriosus (PDA)
Ventricular septal defect (VSD)
Atrial septal defect (ASD)

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12
Q

What is the classic murmur description of PDA

A

continuous machine-like murmur LUSB or left infra-clavicular area

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13
Q

What is a PDA

A

failure of DA to close
more common in babies born < 30 weeks

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14
Q

how are PDA’s diagnosed

A

clinical findings (murmur)
ECHO

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15
Q

What is the management of a PDA

A

mod-severe or signs of CHF/PHN: surgical or percutaneous (preferred) closure

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16
Q

what is the management of premature infants with PDA

A

prostaglandin inhibitors tried first
-indomethacin, ibuprofen
(does not work in term neonates and older infants)

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17
Q

What is a VSD

A

ventricular septal defect
common congenital heart disease - 50% of all congenital heart disease have VSD as a component

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18
Q

what are symptoms of VSD

A

diaphoresis, particularly with feeds
difficulty feeding
failure to thrive
CHF
irreversible pulmonary vascular changes within 6-12 months

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19
Q

What is the classic sign of VSD

A

holosystolic murmur heard best a the mid to LLSB

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20
Q

what confirms the diagnosis of a VSD

A

ECHO - size and location confirmation

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21
Q

What is the management of VSD

A

35% will close spontaneously
small defects - will close by age 2
moderate or large: asymptomatic: regular follow ups, symptomatic depends

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22
Q

what is the treatment for moderate or severe symptomatic VSD

A

mild: oral diuretics (lasix), neutritional support
Moderate: lasiz +/- aldactone; maximize caloric intake
Severe: inpatient, IV diuretics, max nutritional suppport, stabilize condition for surgery

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23
Q

What are the types of ASD

A

Primum
Secundum
Sinus venosus

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24
Q

What is primum ASD

A

septrum primum doesnt fuse with the endocardial cushions
usually associated iwth other abnormalities

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25
What is secundum ASD
hole near the foramen ovale females> males usu. isolated; can be associated with genetic disorders
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what is sinus venosus ASD
malposition of insertion of vena cava
28
What is the clinical presentation of ASD
usu no symptomatic early, normally come to attention on PE impact depends on size/location infants with larger ASD can present with CHF, FTT
29
What is the classic findings with ASD
wide, fixed split S2 (vs only on inspiration) mid-systolic ejection murmur
30
how is ASD diagnosed
clinical suspicion with murmur EKG may show RBBB ECHO confirms diagnosis MRI can be helpful
31
what is the managment of ASD
many spontaneously close in infancy/early childhood untreated, with persistent shunt: R sided heart failure afe 30-40 repair if R heart enlargement surgical
32
What are Acyanotic Obstructive defects
Coarctation of the Aorta (COA) Aortic Stenosis (AS) Pulmonary stenosis (PS)
33
What is Coarctation of the Aorta
narrowin of descending oarta, distal to LSCA symptoms depend on degree of obstruction
34
what are the classic findings with COA
hypertension in UEs, low-unobtainable BPs in LE decreased/delayed femoral pulses possible murmur caused by collateral blood flow
35
how is COA diagnosed
prenatal difficulties due to low CO via aorta ECHO
36
what is the management of COA
imperative to identify critical COA in neonates: rapid initiation of prostaglandin E > once stable, surgery balloon angioplasty preferred
37
What are signs of Critical aortic stenosis (AS)
severe heart failure, central cyanosis and shcok -ductal dependent
38
what is the murmur with AS
harsh systolic ejection murmur systloic ejection click
39
what is the diagnosis of AS
PE and ECHO; cardiac catheterization
40
What is the treatment of AS
prostaglandin if critical baloon valvuloplasty may need surgical management (valve replacement rare)
41
What are the signs of of severe/critical PS
right-to-left shunting; survival dependent on maintaining a PDA and a PFO
42
What is the murmur heard with PS
normal 1st heart sound followed by click systolic ejection murmur at 2nd LICS
43
how is PS diagnosed
PE and ECHO
44
what is the treatment of PS
if severe: balloon valvuloplasty
45
What are the Cyanotic heart diseases
5 T's: 1-5 * Truncus arteriosus * transposition of great vessel * tricuspid atresia * tetralogy of fallot * total anomalous pulmonary venous return 6th T: tons of other things, i.e. hypoplastic left heart (HLH)
46
how are cyanotic heart diseases diagnosed
cofirmed by ECHO most diagnosed by fetal echo
47
What is the treatment of Cyanoic heart diseases
ALL require surgical repair at a pediatric cardiac surgery-capable center - not always emergently or urgently - stabilization first!
48
What is Truncus arteriosus
single great cessel (common arterial trunk) ALWAYS has associated VSD
49
what are the symptoms of Truncus arteriosis
cyanosis (~mild) respiratory distress / signs of CHF +/- murmur: systolic ejection murmur with click S2 is loud and single develop heart failure over days to weeks
50
What is transpotition of the Great vessels
arota and pulmonary artery are switched presents with cyanosis: mild to severe
51
52
what happens if transposion of great vessels is untreated
most die within first year of life
53
how do we treat/manage transposition of great vessels
prostaglandin E to keep PDA intact balloon atrial spetostomy surgical repaire: arterial switch
54
What is Tricuspid atresia
3rd most common cyanotic heart condition abscent tricsupid valve no communication between R atrium and ventricle survival is dependent on Right>left flow
55
what is the presentation of Tricuspid atresia
severly cyanotic plus murmur failed oximetry screen
56
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what is the treatment of tricuspid atresia
if diagnosed prenatally - transfer for delivery to heart center immediate initiation of prostaglandin complex, staged surgery
58
How quickly does tetralogy of fallot require correction
wihtin first year of life
59
60
what is tetralogy of fallot
results from septation of truncus arteriosus into the aorta and pulmonary artery that occurs early in gestation (3-4 weeks)
61
what are the components of tetrology of fallot | 4
* ventricular septal defect * pulmonary valve stenosis * overriding arota * right ventricular hypertrophy
62
what is a tet spell
intermittent sudden increase in cyanosis restless, agitated, inconsolable prolonged spells can lead to syncope, convulsions, stroke, cardiac arrest/death
63
what is the murmur heard with tetralogy of fallot
usually due to pulmonary stenosis not the VSD crescendo-decrescendo systolic murmur heard best in the left mid to upper sternal corder Single S2
64
what is seen on XR with tetralogy of fallot
boot-shaped heart
65
what is the treatment of TOF
surger (maybe temporary shunt)
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What is a Total Anomalous Pulmonary Venous Return (TAPVR)
none of the pulonary veins connect to the left atrium; all return via sysetmic venous circulation port of the blood shunts across ASD or PDA
68
What murmus is heart with TAPVR
systolic ejection murmur widely split S2
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What is the treatment of TAPVR
prostaglandin, other medical stabilization may require ECMO and palliative septostomy prior to surgery
71
What is Hypoplastic left heart syndrome (HLHS)
underdeveloped left heart, normal great vessels, varying degress of valvular abnormalities R ventricle supports both pulmonary AND systemic circulation
72
what is the presentation of HLHS
often detected by prenatal US if baby does NOT have an ASD: severe respiratory distress, cyanosis, cardiogenic shock at birth CYANOSIS(sometimes described as grey)
73
what is the initial management of HLHS
prostaglandin E2 to keep patient ductus open if no ASD or a restrictive ASD: atrial septostomy
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what is the definitive management of HLHS
complex, staged surgical rare
75
when are murmurs always pathologyic
Grade IV or more Diastolic
76
at what grade murmur do we refer / evaluate murmurs
Grade III : no palpable thrill yet
77
What are the 7 S's
key features of innocent murmurs * sensitive * short duration * single * small * soft * sweet * systolic
78
what are 4 criteria for innocent murmurs
normal PE except for murmur negative ROS no hx that includes risk factors for structural heart disease murmur has the characteristic features of a specific benign murmur
79
What is Still's murmur, vibratory murmur
systolic ejection murmur best heard at LLSB vibratory - musical quality grade 1 or 2 intensity decreases in upright position
80
What are red flags with murmurs
loud murmur, grade III or higher harsh murmur holo/pansystolic murmur diastolic murmur lound or single second heart sound gallop rhythm friction rub Failure to thrive
81
What are asymptomatic arrhythmias
sinus arrhythmias PVCs PACs
82
What are the types of symptomatic arrhythmias
Atrial: m/c seen in children with CHD who have had cardiac surgery SVT Ventricular (uncommon without underlying heart disease) sinus node dysfunction heart block
83
What are warning signs of SCA/SCD
chest pain fatigue/stamina issues syncope or near-syncope dizziness palpitations dyspnea activity limitations
84
what is an autosomal dominant inherited cardiomyopathy
hypertrophic cardiomyopathy (HCM)
85
how is HCM diagnosed
EKG is abnormal LVH, T-wave abnormalities ECHO
86
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what are presenting symptoms of HCM
chest pain syncope/presyncope palpitations heart failure sudden cardiac arrest/death
88
What is the first line for HCM management
Beta-blockers
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what is second line for HCM management
calcium channel blockers

Clin Med IV: Pediatrics (16 decks)

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