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Pediatrics > Pediatric Cardiology > Flashcards

Pediatric Cardiology Flashcards

1
Q

What does heart failure look like in a neonate?

A
  • Respiratory distress, especially with feeding
  • Poor feeding
  • Poor growth
  • Hepatomegaly and rales
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2
Q

What is the anatomic location of the foramen ovale?

A

Right atrium to left atrium

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3
Q

Where is the ductus arteriousus located anatomically?

A

pulmonary artery to aorta

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4
Q

What physiologically occurs with the infants first breath?

A

High surge in pressure that causes lungs to expand to clear fluid and surge of surfactant release

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5
Q

What circulatory changes occur once the neonate takes their first breath?

A
  • Pressure changes help to close bypass tracts
  • Decreased levels of prostoglandin E2 leads to closure of ductus arteriosus
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6
Q

What are the three types of critical congenital heart disease (CCHD)?

A
  • Acyanotic heart disease (left to right shunt)
  • Obstructive lesions
  • Cyanotic heart disease (right to left shunt)
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7
Q

What are the risk factors for congenital heart disorders?

A
  • ** Prematurity
  • Family history
  • Genetic syndromes
  • Maternal factors: DM, HTN, obesity, PKU, thyroid disorders, smoking, and alcohol use
  • TORCH infections
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8
Q

What are the TORCH infections?

A
  • Rubella
  • Flu-like illnesses
  • CMV
  • HHV6
  • HSV
  • Parvovirus
  • Toxoplasmosis
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9
Q

What are signs and symptoms concerning for CHD in the outpatient setting?

A
  • Cyanosis
  • Respiratory symptoms
  • Difficulty feeding
  • Sweating with feeds
  • Poor weight gain
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10
Q

What is acyanotic heart disease and what are common causes?

A

L > R shunts

  • PDA
  • VSD
  • ASD
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11
Q

PDA’s are more common in whom?

A

Babies with a birth GA < 30 weeks

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12
Q

What are the common osculatory sounds of a PDA?

A

Continuous machine-like murmurs LUSB or left infra-clavicular area

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13
Q

Can you give prostaglandin inhibitors to older and term infants?

A

No

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14
Q

What prostaglandin inhibitors can be given to preterm infants with a symptomatic PDA?

A
  • Indomethacin
  • Ibuprofen
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15
Q

Once medical treatment fails, how should a moderate-severe PDA be treated?

A

Surgical or percutaneous closure

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16
Q

What percentage of all congenital heart disease have a VSD as a component?

A

50%

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17
Q

What is the number one sign of a VSD?

A

Failure to thrive, not regaining to birthweight

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18
Q

What are the symptoms of a 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

How is a VSD murmur characterized?

A

Holosystolic murmur heard best at the mid to LLSB

20
Q

How is a VSD diagnosis confirmed?

A

ECHO

21
Q

What is the treatment for a small VSD (< 4mm)?

A
  • 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
22
Q

What is the treatment for moderate (4-6 mm) or large (> 6 mm) VSDs?

A
  • 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
23
Q

What are the classic findings on auscultation in an ASD?

A
  • Wide, fixed split S2
  • Mid-systolic ejection murmur
24
Q

What genetic disorder has a high association with coarctation of aorta?

A

Turnor’s Syndrome

25
Q

What are common obstructive heart defects?

A

Coarctation of the aorta (COA)
Aortic Stenosis (AS)
Pulmonary Stenosis (PS)

26
Q

What are the classic findings of COA?

A
  • Hypertension in UEs, low/unobtainable BPs in LE
  • Decreased/delayed femoral pulses
  • Possible murmur caused by collateral blood flow
27
Q

How is a COA diagnosed?

A

ECHO

*often not found prenatally due to low cardiac output via aorta

28
Q

What is the initial treatment of a COA?

A

Prostaglandin E to keep the PDA open

29
Q

What murmur is heard in aortic stenosis?

A
  • Harsh systolic ejection murmur with systolic ejection click
30
Q

What are the cyanotic heart diseases?

A

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)
31
Q

Are cyanotic heart diseases typically found prenatally?

A

Yes, on prenatal ECHO

32
Q

Truncus Arteriosus always has an associated

A

VSD

33
Q

What are the symptoms associated with Truncus Arteriosus?

A
  • Cyanosis (mild)
  • Respiratory distress/signs of CHF
  • +/- murmur: systolic ejection murmur with click
  • loud S2
34
Q

Survival of Tricuspid Atresia is dependent on what two structures until surgery?

A

Survival is dependent on R > L flow (ASD/PFO and PDA)

35
Q

What is the pathophysiology of Tetralogy of Fallot?

A

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

36
Q

What are the 4 components of Tetralogy of Fallot?

A
  • VSD
  • Pulmonary valve stenosis
  • Overriding aorta
  • Right ventricular hypertrophy
37
Q

What are Tet Spells?

A
  • Intermittent, sudden increase in cyanosis
  • Restless, agitated, inconsolable
  • Prolonged spells can lead to syncope, convulsion, stroke, cardiac arrest/death
38
Q

What is seen on CXR with TOF?

A

Boot-shaped heart

39
Q

What is the characteristic murmur heard in TOF?

A
  • Crescendo-decrescendo systolic murmur heard best in the left mid to upper sternal border
  • Single S2

*Usually due to pulmonary stenosis, not the VSD

40
Q

When do you start screening for cholesterol in kids?

A

Around age 13

41
Q

Is sudden cardiac death more common in males or females?

A

Males > Females (2:1)

42
Q

What are warning signs of sudden cardiovascular death?

A
  • Chest pain
  • Fatigue/stamina issues
  • Syncope or near syncope
  • Dizziness
  • Palpatations
  • Dyspnea
  • Activity limitations
43
Q

What is the first line treatment in HCM?

A

Beta blockers

44
Q

What is the conservative medication therapy in patients with Marfan’s Syndrome?

What surgical interventions maybe indicated?

A

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

45
Q

Which congenital heart defect is characterized by a ventricular septal defect, overriding aorta, right ventricular hypertrophy, and pulmonary stenosis?

How is it diagnosed?

A

Tetralogy of Fallot

ECHO

46
Q

Which condition is characterized by the “boot-shaped” heart on chest X-ray and cyanosis during crying or feeding?

A

Tetralogy of Fallot

Pediatrics (16 decks)

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