Pediatric Cardiology Flashcards
What does heart failure look like in a neonate?
- Respiratory distress, especially with feeding
- Poor feeding
- Poor growth
- Hepatomegaly and rales
What is the anatomic location of the foramen ovale?
Right atrium to left atrium
Where is the ductus arteriousus located anatomically?
pulmonary artery to aorta
What physiologically occurs with the infants first breath?
High surge in pressure that causes lungs to expand to clear fluid and surge of surfactant release
What circulatory changes occur once the neonate takes their first breath?
- Pressure changes help to close bypass tracts
- Decreased levels of prostoglandin E2 leads to closure of ductus arteriosus
What are the three types of critical congenital heart disease (CCHD)?
- Acyanotic heart disease (left to right shunt)
- Obstructive lesions
- Cyanotic heart disease (right to left shunt)
What are the risk factors for congenital heart disorders?
- ** Prematurity
- Family history
- Genetic syndromes
- Maternal factors: DM, HTN, obesity, PKU, thyroid disorders, smoking, and alcohol use
- TORCH infections
What are the TORCH infections?
- Rubella
- Flu-like illnesses
- CMV
- HHV6
- HSV
- Parvovirus
- Toxoplasmosis
What are signs and symptoms concerning for CHD in the outpatient setting?
- Cyanosis
- Respiratory symptoms
- Difficulty feeding
- Sweating with feeds
- Poor weight gain
What is acyanotic heart disease and what are common causes?
L > R shunts
- PDA
- VSD
- ASD
PDA’s are more common in whom?
Babies with a birth GA < 30 weeks
What are the common osculatory sounds of a PDA?
Continuous machine-like murmurs LUSB or left infra-clavicular area
Can you give prostaglandin inhibitors to older and term infants?
No
What prostaglandin inhibitors can be given to preterm infants with a symptomatic PDA?
- Indomethacin
- Ibuprofen
Once medical treatment fails, how should a moderate-severe PDA be treated?
Surgical or percutaneous closure
What percentage of all congenital heart disease have a VSD as a component?
50%
What is the number one sign of a VSD?
Failure to thrive, not regaining to birthweight
What are the symptoms of a VSD?
- Diaphoresis, particularly with feeds
- Difficulty feeding
- Failure to thrive
- CHF
- Irreversible pulmonary vascular changes within 6-12 months
How is a VSD murmur characterized?
Holosystolic murmur heard best at the mid to LLSB
How is a VSD diagnosis confirmed?
ECHO
What is the treatment for a small VSD (< 4mm)?
- 75% will close spontaneously by age 2, most by age 6 months
- Benign if they persist into adulthood
- Regular evaluation for clinics signs of PHN, CHF with ECHO
What is the treatment for moderate (4-6 mm) or large (> 6 mm) VSDs?
- Asymptomatic: regular f/u x 1 year, then q2 years
- Symptomatic: mild to moderate treated with oral diuretics and nutritional support. Severe need to stabalize with IV diuretics and nutrition in anticipation for surgical repair
What are the classic findings on auscultation in an ASD?
- Wide, fixed split S2
- Mid-systolic ejection murmur
What genetic disorder has a high association with coarctation of aorta?
Turnor’s Syndrome
What are common obstructive heart defects?
Coarctation of the aorta (COA)
Aortic Stenosis (AS)
Pulmonary Stenosis (PS)
What are the classic findings of COA?
- Hypertension in UEs, low/unobtainable BPs in LE
- Decreased/delayed femoral pulses
- Possible murmur caused by collateral blood flow
How is a COA diagnosed?
ECHO
*often not found prenatally due to low cardiac output via aorta
What is the initial treatment of a COA?
Prostaglandin E to keep the PDA open
What murmur is heard in aortic stenosis?
- Harsh systolic ejection murmur with systolic ejection click
What are the cyanotic heart diseases?
5 T’s (1-5)
- Truncus arteriosus (1 great vessel)
- Transposition of great vessel ( 2 great vessels)
- Tricuspid atresia ( 3 - Tri)
- Tetralogy of Fallot (4 defects)
- Total anomalous pulmonary venous return (5 letters, TAPVR)
Are cyanotic heart diseases typically found prenatally?
Yes, on prenatal ECHO
Truncus Arteriosus always has an associated
VSD
What are the symptoms associated with Truncus Arteriosus?
- Cyanosis (mild)
- Respiratory distress/signs of CHF
- +/- murmur: systolic ejection murmur with click
- loud S2
Survival of Tricuspid Atresia is dependent on what two structures until surgery?
Survival is dependent on R > L flow (ASD/PFO and PDA)
What is the pathophysiology of Tetralogy of Fallot?
Results from abnormal septation of the truncus arteriosus into the aorta and pulmonary artery that occurs early in gestation (3-4 weeks)
What are the 4 components of Tetralogy of Fallot?
- VSD
- Pulmonary valve stenosis
- Overriding aorta
- Right ventricular hypertrophy
What are Tet Spells?
- Intermittent, sudden increase in cyanosis
- Restless, agitated, inconsolable
- Prolonged spells can lead to syncope, convulsion, stroke, cardiac arrest/death
What is seen on CXR with TOF?
Boot-shaped heart
What is the characteristic murmur heard in TOF?
- Crescendo-decrescendo systolic murmur heard best in the left mid to upper sternal border
- Single S2
*Usually due to pulmonary stenosis, not the VSD
When do you start screening for cholesterol in kids?
Around age 13
Is sudden cardiac death more common in males or females?
Males > Females (2:1)
What are warning signs of sudden cardiovascular death?
- Chest pain
- Fatigue/stamina issues
- Syncope or near syncope
- Dizziness
- Palpatations
- Dyspnea
- Activity limitations
What is the first line treatment in HCM?
Beta blockers
What is the conservative medication therapy in patients with Marfan’s Syndrome?
What surgical interventions maybe indicated?
Beta-blockers (first line) or angiotensin receptor blockers to halt the progression of aortic root dilation
Aortic aneurysm repair or cardiac valve repair if indicated
Which congenital heart defect is characterized by a ventricular septal defect, overriding aorta, right ventricular hypertrophy, and pulmonary stenosis?
How is it diagnosed?
Tetralogy of Fallot
ECHO
Which condition is characterized by the “boot-shaped” heart on chest X-ray and cyanosis during crying or feeding?
Tetralogy of Fallot
