Pediatric Cardiology Flashcards
Which vessel carries oxygenated blood to the fetus?
THE Umbilical vein (carries blood back to the heart)
What is an Ebstein anomaly?
tricuspid leaflets displaced inferiorly
RV hypoplasia
tricuspid regurgitation or stenosis
+/- patent foramen ovale
80% have PFO with Right-to-left shunt
dilated right atrium leads to increaesd risk of SVT and WPW
physical exam characteristics:
widely split S2
tricuspid regurgitation
Treatment: PGE digoxin diuresis propanolol for SVT
Tetralogy of Fallot
RV outflow tract obstruction
right ventricular hypertrophy
VSD
overriding aorta
risk factors:
Down syndrome, Cri-du-chat, Trisomy 13 and 18
Early cyanosis, dyspnea, fatigue
squatting during tet spells
(forcing L to R to become R to L shunt)
Systolic ejection murmur at left sternal border
Tx: PGE to maintain PDA
O2, propanolol, fluids, morphine can help older kids
surgery indicated if symptomatic
Single canal
severe endocardial cushion defect, may be seen in Down syndrome
presents with heart failure and pneumonitis
EKG may show left axis deviation.
Echo is diagnostic
Treatment is surgical correction
presentation of mild endocardial cushion defects resembles…
ASD
What heart defects are Down patients at higher risk of having?
endocardial cushion defects
tetralogy of fallot
transposition of the great vessels
Croup
Parainfluenza virus (75%) 6% incidence annually in children under 6yo
less commonly, RSV influenza adenovirus mycoplasma
H and P: 12-72 hours mild fever and coryza (nasal congestion)–> hoarseness and barking cough (nondescript- barky/harsh/seal- like) –> peak resp distress at 24-48 hrs –> resolution in 1 week
dyspnea, stridor (inspiratory and upper airway NOT wheezing), retractions with increased breathing and inspiratory stridor, symptoms are worse at night
this is a clinical diagnosis
dark vertical stripe at trachea shows steeple sign
ER treatment: change ambient temperature, humidified oxygen mask, dexamethasone (IM or IV) or prednisolone for several days, racemic epinephrine if there is stridor at rest
Indications for admission: progressive stridor stridor at rest no improvement after steroids hypoxia/cyanosis respiratory distress unclear diagnosis
Epiglottitis
rare due to H. influenzae B
life-threatening
also strep species, staph, nontypable H flu
inflammation at epiglottis in child 2-7yo, unimmunized
presents with high fever, poor oral intake, drooling, respiratory distress, STRIDOR, hypoxia, muffled voice/crying
toxic- appearing
tripoding, sniffing position
cyanosis
“hot potato” voice- not moving soft palate
CBC: leukocytosis with bandemia
CXR: thumbprint sign
note- do not agitate child, and sending the child to xray is unsafe, only if prepared to intubate
direct or indirect laryngoscopy may be needed in older children to confirm the diagnosis: cherry red, swollen epiglottis
Treatment:
- minimize child anxiety during the interview
- intubation or tracheostomy as soon as possible upon making the diagnosis
- culture and sensitivity from blood and epiglottis surface
- EMPIRIC IV ABX: oxacillin, nafcillin, cefazolin, clindamyin or vancomycin+ceftriaxone, or cefotaxime
Bronchiolitis
Bronchioles are like the leaves of a the tree
Primarily 2/2 RSV, also influenza, parainfluenza type 3, adenovirus, metapneumovirus
RF: winter, spring,
RDS of the newborn
24-37 weeks gestation
pathophysiology: surfactant (dipalmotyl phosphotidyl choline) deficiency
tachypnea (>60 breaths/min) nasal flaring expiratory grunting intercostal retractions hypoxia crackles decreased breath sounds diffuse hazy interstitial infiltrates with ground glass appearance
Treatment:
1. prevention
If L:S1500g) or if active, breathing spontaneously and not in respiratory failure
lecithin: sphingomyelin ratio as an indicator of fetal lung maturity
as the lungs mature at 35 weeks, the amount of lecithin produced increases while sphingomyelin remains constant
L:S ratio >2 obtained by amniocentesis, indicates fetal lung maturity
If L:S ratio is 1.5-1.9, 50% chance of developing RDS
If L:S
RDS vs TTN on CXR
RDS: low lung volume, diffuse ground glass appearance with air bronchograms
TTN: increased lung volumes with flattening of the diaphragm, prominent vascular markings from the hilum (sunburst pattern), fluid streaking in interlobular fissures +/- pleural effusions
Meconium aspiration syndromw
Big babies, difficult deliveries, meconium stained fluid? ask the OB
meconium staining of skin
respiratory distress signs immediately
CXR- atalectasis, hyperinflation
Treatment: prevention (suction naso/oropharynx)
debris should be suctioned from airway before it can be inhaled
supplemental O2, intubation, surfactant administration, consider empiric antibiotics if concerned about PNA or sepsis
Short-term complications include PTX, pulm HTN, reactive airway disease is increased
Cystic fibrosis
Most common fatal AR disorder in the US.
Meconium ileus at birth
Recurrent pulmonary infections including pseudomonas, staphylococcus aureus
Chronic productive cough, dyspnea, hemoptysis, chronic sinusitis, cyanosis, finger clubbing
FTT, pancreatic insufficiency, steatorrhea (fatty, greasy stools)
Diagnosis:
Sweat chloride concentration >60mEq/L on 2 or more occasions
Genetic testing for CFTR gene mutations
Nasal transepithelial chloride secretion measures abnormalities in ion transport across the nasal epithelium
What are the general strategies for treating pulmonary CF?
Beta2 agonist (albuterol, salmeterol, formoterol)
DNAse I (donrase alfa) to decrease sputum viscosity
Aerosolized hypertonic saline for chronic cough
Physiotherapy (aerobic exercise) for increased mucus clearance
Azithromycin used liberally, PRN, when lung function decreases in order to slow the decline in lung function and treat any pseudomonas aeruginosa
