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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
Q

What is secundum ASD

A

hole near the foramen ovale
females> males
usu. isolated; can be associated with genetic disorders

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26
Q
A
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27
Q

what is sinus venosus ASD

A

malposition of insertion of vena cava

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28
Q

What is the clinical presentation of ASD

A

usu no symptomatic early, normally come to attention on PE
impact depends on size/location
infants with larger ASD can present with CHF, FTT

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29
Q

What is the classic findings with ASD

A

wide, fixed split S2 (vs only on inspiration)
mid-systolic ejection murmur

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30
Q

how is ASD diagnosed

A

clinical suspicion with murmur
EKG may show RBBB
ECHO confirms diagnosis
MRI can be helpful

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31
Q

what is the managment of ASD

A

many spontaneously close in infancy/early childhood
untreated, with persistent shunt: R sided heart failure afe 30-40
repair if R heart enlargement
surgical

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32
Q

What are Acyanotic Obstructive defects

A

Coarctation of the Aorta (COA)
Aortic Stenosis (AS)
Pulmonary stenosis (PS)

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33
Q

What is Coarctation of the Aorta

A

narrowin of descending oarta, distal to LSCA
symptoms depend on degree of obstruction

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34
Q

what are the classic findings with COA

A

hypertension in UEs, low-unobtainable BPs in LE
decreased/delayed femoral pulses
possible murmur caused by collateral blood flow

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35
Q

how is COA diagnosed

A

prenatal difficulties due to low CO via aorta
ECHO

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36
Q

what is the management of COA

A

imperative to identify critical COA in neonates: rapid initiation of prostaglandin E > once stable, surgery
balloon angioplasty preferred

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37
Q

What are signs of Critical aortic stenosis (AS)

A

severe heart failure, central cyanosis and shcok
-ductal dependent

38
Q

what is the murmur with AS

A

harsh systolic ejection murmur
systloic ejection click

39
Q

what is the diagnosis of AS

A

PE and ECHO; cardiac catheterization

40
Q

What is the treatment of AS

A

prostaglandin if critical
baloon valvuloplasty
may need surgical management (valve replacement rare)

41
Q

What are the signs of of severe/critical PS

A

right-to-left shunting; survival dependent on maintaining a PDA and a PFO

42
Q

What is the murmur heard with PS

A

normal 1st heart sound followed by click
systolic ejection murmur at 2nd LICS

43
Q

how is PS diagnosed

A

PE and ECHO

44
Q

what is the treatment of PS

A

if severe: balloon valvuloplasty

45
Q

What are the Cyanotic heart diseases

A

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
Q

how are cyanotic heart diseases diagnosed

A

cofirmed by ECHO
most diagnosed by fetal echo

47
Q

What is the treatment of Cyanoic heart diseases

A

ALL require surgical repair at a pediatric cardiac surgery-capable center
- not always emergently or urgently
- stabilization first!

48
Q

What is Truncus arteriosus

A

single great cessel (common arterial trunk)
ALWAYS has associated VSD

49
Q

what are the symptoms of Truncus arteriosis

A

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
Q

What is transpotition of the Great vessels

A

arota and pulmonary artery are switched
presents with cyanosis: mild to severe

51
Q
A
52
Q

what happens if transposion of great vessels is untreated

A

most die within first year of life

53
Q

how do we treat/manage transposition of great vessels

A

prostaglandin E to keep PDA intact
balloon atrial spetostomy
surgical repaire: arterial switch

54
Q

What is Tricuspid atresia

A

3rd most common cyanotic heart condition
abscent tricsupid valve
no communication between R atrium and ventricle
survival is dependent on Right>left flow

55
Q

what is the presentation of Tricuspid atresia

A

severly cyanotic plus murmur
failed oximetry screen

56
Q
A
57
Q

what is the treatment of tricuspid atresia

A

if diagnosed prenatally - transfer for delivery to heart center
immediate initiation of prostaglandin
complex, staged surgery

58
Q

How quickly does tetralogy of fallot require correction

A

wihtin first year of life

59
Q
A
60
Q

what is tetralogy of fallot

A

results from septation of truncus arteriosus into the aorta and pulmonary artery that occurs early in gestation (3-4 weeks)

61
Q

what are the components of tetrology of fallot

4

A
  • ventricular septal defect
  • pulmonary valve stenosis
  • overriding arota
  • right ventricular hypertrophy
62
Q

what is a tet spell

A

intermittent
sudden increase in cyanosis
restless, agitated, inconsolable
prolonged spells can lead to syncope, convulsions, stroke, cardiac arrest/death

63
Q

what is the murmur heard with tetralogy of fallot

A

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
Q

what is seen on XR with tetralogy of fallot

A

boot-shaped heart

65
Q

what is the treatment of TOF

A

surger (maybe temporary shunt)

66
Q
A
67
Q

What is a Total Anomalous Pulmonary Venous Return (TAPVR)

A

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
Q

What murmus is heart with TAPVR

A

systolic ejection murmur
widely split S2

69
Q
A
70
Q

What is the treatment of TAPVR

A

prostaglandin, other medical stabilization
may require ECMO and palliative septostomy prior to surgery

71
Q

What is Hypoplastic left heart syndrome (HLHS)

A

underdeveloped left heart, normal great vessels, varying degress of valvular abnormalities
R ventricle supports both pulmonary AND systemic circulation

72
Q

what is the presentation of HLHS

A

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
Q

what is the initial management of HLHS

A

prostaglandin E2 to keep patient ductus open
if no ASD or a restrictive ASD: atrial septostomy

74
Q
A
74
Q

what is the definitive management of HLHS

A

complex, staged surgical rare

75
Q

when are murmurs always pathologyic

A

Grade IV or more
Diastolic

76
Q

at what grade murmur do we refer / evaluate murmurs

A

Grade III : no palpable thrill yet

77
Q

What are the 7 S’s

A

key features of innocent murmurs
* sensitive
* short duration
* single
* small
* soft
* sweet
* systolic

78
Q

what are 4 criteria for innocent murmurs

A

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
Q

What is Still’s murmur, vibratory murmur

A

systolic ejection murmur
best heard at LLSB
vibratory - musical quality
grade 1 or 2
intensity decreases in upright position

80
Q

What are red flags with murmurs

A

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
Q

What are asymptomatic arrhythmias

A

sinus arrhythmias
PVCs
PACs

82
Q

What are the types of symptomatic arrhythmias

A

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
Q

What are warning signs of SCA/SCD

A

chest pain
fatigue/stamina issues
syncope or near-syncope
dizziness
palpitations
dyspnea
activity limitations

84
Q

what is an autosomal dominant inherited cardiomyopathy

A

hypertrophic cardiomyopathy (HCM)

85
Q

how is HCM diagnosed

A

EKG is abnormal
LVH, T-wave abnormalities
ECHO

86
Q
A
87
Q

what are presenting symptoms of HCM

A

chest pain
syncope/presyncope
palpitations
heart failure
sudden cardiac arrest/death

88
Q

What is the first line for HCM management

A

Beta-blockers

88
Q
A
89
Q

what is second line for HCM management

A

calcium channel blockers

Clin Med IV: Pediatrics (16 decks)

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