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Cardiology > Pediatric cardiology > Flashcards

Pediatric cardiology Flashcards

1
Q

What is the foramen ovale?

A

Connection between right and left atria (fetal)

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2
Q

What is the ductus venosus?

A

Umbilical vein connection with IVC-shunts oxygenated blood

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3
Q

What are the 5 T lesions of cyanotic heart disease?

A 
Truncus arteriosis
Total anamalous pulmonary venous drainage
Tricuspid atresia
Tetralogy of Fallot
Transposition of great arteries
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4
Q

What is the most common cyanosis heart disease in neonates?

A

Transposition of the great arteries

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5
Q

What is the oxygen saturation cutoff for cyanosis?

A

75%

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6
Q

What is the classic history for tetralogy of fallot?

A

Hypoxic spells during exertion like crying

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7
Q

What signs make a murmur unlikely to be benign?

A
  1. Murmur greater than 4/6 (thrill)
  2. Diastolic murmurs
  3. Regurgitant systolic murmurs
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8
Q

Still’s Murmur

A
  1. Grade 1-2/6
  2. Musical systolic ejection murmur
  3. Best heard between apex and LLSB, little radiation
  4. Increases with exercise, fever, supine
  5. Decreases sitting, standing, or Valsalva
  6. Age 2-7
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9
Q

Pulmonary flow murmur

A
  1. Grade 1/2 SEM
  2. Vibratory/soft
  3. Best heard @ left base
  4. Increases with exercise/supine
  5. Ages 8-16
  6. S2 is normal*** differentiate from ASD
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10
Q

Venous hum

A
  1. Grade 1/2
  2. Soft/blowing, continuous into diastole
  3. Supra/sub clavicular regions, radiates to neck and base of heart
  4. Decreases with supine position or gentle pressure of jugular veins
  5. Age 3-8 years.
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11
Q

Carotid/brachiocephalic bruits

A
  1. Grade 1/2
  2. Harsh systolic ejection murmur
  3. Supraclavicular neck region, radiates below clavicles
  4. Age 2-10
  5. Increase with fever/exercise, decrease with hyperextension of the neck
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12
Q

Who should get IE prophylaxis?

A
  1. Prosthetic valve
  2. Previous endocarditis
  3. Congenital heart defect: unrepaired cyanotic, 6mo or less post repair
  4. Heart transplant patients with valvulopathy
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13
Q

What are the three fetal shunts?

A
  1. Ductus venosus- bypasses liver with oxygen rich blood (IVC)
  2. Foramen ovale- allows blood to go RA-LA and bypass the lungs
  3. Ductus arterious- allows blood exiting RV via pulmonary artery to bypass lungs and join aorta
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14
Q

What is unique about fetal circulation?

A
  1. Arterial PaO2 is generally low (hb properties)
  2. Pulmonary= high resistance to flow until birth
  3. RV is dominant (until birth)
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15
Q

What changes with fetal circulation at birth?

A
  1. Fluid in airways is cleared, breathing begins= decrease in pulmonary resistance, increase in pulmonary blood flow
  2. Systemic circulation becomes high resistance (no more placenta)
  3. Increased blood return to LA closes foramen ovale
  4. LV becomes dominant over 4-6 weeks
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16
Q

Transposition of the Great Arteries

A
  1. Aorta comes from RV, pulm art from LV= two parallel circulations, only mix via ASD or VSD
  2. Rapidly progressive severe hypoxemia in neonates, oxygen unresponsive. Loud S2. May get CHF in first weeks
  3. CXR= Egg on a string”
  4. Tx= Prostaglandin- keeps ductus arteriosus open-MIXING, Balloon atrial septostomy- create ASD for mixing
    Repair when stable
17
Q

Tetralogy of Fallot

A
  1. VSD+RVH+RV outflow tract obstruction+ overriding aorta
  2. Progressive cyanosis, hypoxic ‘tet’ spells with crying or feeding
  3. CXR=boot shaped heart
  4. Surgical repair, manage tet spells in interim
18
Q

Truncus arteriosus

A
  1. Single great vessel gives off aorta, pulmonary artery, coronaries- allows MIXING
  2. Tachypnea, cardiomegaly, poor growth
  3. Tx= surgical repair in first six weeks
19
Q

Hyperoxic test

A

Give 100% oxygen and see response

20
Q

Valvular aortic stenosis

A
  1. Severity varies
  2. Hx= asymptomatic—> chest pain—> cardiogenic shock
    Starts around time of duct closure (12 h to 1 week ish)
  3. Px= SEM @ RUSB, palpable thrill
  4. ECG=LVH (sometimes)
    CXR=Cardiomegaly + pulmonary edema (depends)
  5. Tx= Emergent or elective valvuloplasty. Prostaglandin
21
Q

Coarctation of the aorta

A
  1. Hx= association with bicuspid aortic valve, turner sydrome. Poor feeding, resp distress,
  2. Px= Often CHF from LV failure, weak femoral pulses, S3 gallop, no murmur,
    BP gradient between upper and lower limbs
  3. Ix= ECG- RVH +strain (in infancy), LVH later
    CXR= cardiomegaly + pulmonary edema
  4. Tx= prostaglandin, tx for CHF, surgical reapair
22
Q

Pulmonary atresia

A
  1. Hx= associated with other congenital heart lesions, syndromes
  2. Px= Wide split S2 on expiration, SEM @ LUSB, pulmonary ejection click, hepatomegaly
  3. Ix- ECG= RVH
    CXR= dilation of main pulmonary artery
  4. Tx= surgical repair
23
Q

What are the Jones criteria?

A
  1. Major: carditis, chorea, polyarthritis, erythema marginatum, subcutaneous nodules
  2. Minor: fever, arthralgia, increased acute phase reactants, increased PR interval
24
Q

Atrial septal defect

A
  1. Abnormal persistent opening in the inter atrial septum
  2. Blood shunted from left atrium to right atrium,
  3. RA enlarges, eventually RV
  4. Px= RV heave, fixed split S2, LUSB systolic murmur.
  5. Ix= CXR= cardiomegaly, increase in pulmonary vasculature
25
Q

Ventricular septal defect

A
  1. Abnormal opening in interventricular septum. Usually present around 4-6weeks
  2. Blood shunted left ventricle to right ventricle, causes increased return to left heart.
  3. Left atrial enlargement, leads to LA/LV dilation. Eventually RV hyper trophy due to increased resistance.
  4. Hx: failure to thrive, feeding difficulties,
  5. Px= displaced apex, RV heave, thrill over VSD! Harsh pan systolic murmur.
  6. Sx= signs of CHF= increased work of respiration, crackles, signs of systemic congestion (eyelids, scrotum), disphoresis during feeding, fever, decreased cardiac output.
  7. Tx= small will close on their own, large surgical repair
26
Q

Patent ductus arteriosus

A
  1. Persistent connection between the great vessels
  2. Blood shunted from aorta to pulmonary artery in systole or diastole. Left atrium enlarges first. Over time RV enlarge.
  3. Hx: premature baby, children. See breathlessness
  4. Px: continuous machine murmur
    Bounding pulses, enlarged heart. Thrill LUSB.
  5. Tx: surgical ligation. In premature, can use ibuprofen
27
Q

What left to right shunts increase left heart size?

A

VSD, patent ductus arteriosus

28
Q

Atrioventricular septal defect

A
  1. Common AV valve
  2. Left to right shunt on both levels. Enlarges both sides of heart
  3. Presents in first month of life
  4. Hx= failure to thrive
29
Q

Eisenmenger syndrome

A
  1. Change of shunt from left to right to cyanotic lesion.
  2. Erythrocytosis, pulmonary HTN, cyanosis.
  3. Leads to early death
30
Q

What is the most worrisome feature of Kawasaki disease?

A
  1. Causes aneurysms of coronary arteries
31
Q

How do we treat Kawasaki disease?

A
  1. IVIG, antiinflammatories
32
Q

General care for cyanotic baby?

A
  1. Administer oxygen
  2. Correct underlying things- metabolic acidosis, hypoglycemia etc
  3. Prostaglandin if think it would help
  4. Echo once stable enough
33
Q

Signs of pediatric CHF?

A
  1. Pulmonary congestion: Increased resp rate, signs of increased work of resp
  2. Signs of systemic congestion: hepatomegaly, edema of eyelids, labia/scrotum, hands and feet (NOT JVP NO NECK)
  3. Increased sympathetic drive: increased heart rate, resp rate, diaphoresis, fever
  4. Decreased cardiac output: pallor, cool extremities

Cardiology (20 decks)

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