Pediatric Cardiology Flashcards
What is normal adult circulation starting from the right side
S and L vena cava drop blood to RA -> RV -> Pulmonary arteries -> Lungs -> pulmonary veins -> LA -> LV -> aorta -> body
What are structural differences for normal fetal circulation
Placenta provides oxygen,ductus venosus brings blood to the inferior vena cava, foramen ovale moves blood from right atrium to left atrium, ductus arteriosous connects pulmonary artery to the aorta
T/F: Cardiac output in a fetus is strongly tied to HR BUT raising the cardiac output is much more difficult than decreasing the cardiac output
True
How is pulmonary vascular resistance diffrent in the fetus, what happens when it is born
It is much higher causing little to no pulmonary circulation as a fetus, PVR drops dramatically allowing pulmonary blood flow and the fetus to get its own oxygen
What causes the foramen ovale to close, closure of ductus arteriosus
Decrease in right atrial pressure, increase in pO2 and decrease in circulating prostaglandins (PGE2)
What is the usual heart rate of neonates, blood pressure
140-160, 70/50
What are genetic factors that can lead to congenital heart defects, envornmental factors
Complex syndromes/ viruses, fetal exposure to drugs and substances, maternal disease states
What are the classifications of congenital heart defects
Left to right shunts, right to left shunts, Obstructive lesions, regurgitant lesions
What occurs in a left to right shunt
Blood shunts from systemic circulation (left) to pulmonary circulation (right) through abnormal connection causing already oxygenated blood to recirculate through the lungs, low cardiac output
What are consequences of a left to right shunt
Decreased renal fucntion, decreased systemic perfusion, pulmonary edema, right heart failure
T/F: Patent ductus arteriousus is a type of left to right shunt because blood leaves aorta and enters the pulmonary vein
True
What are clinical features for ductus arteriosus, how is it confirmed
Cardiac murmur, tachycardia, tachypnea/ echocardiogram
What contributes to the closure of the ductus arteriosus
Reduction in circulating prostaglandin
How should patent ducuts arteriosus symptoms be managed, actual closure
Fluid restricution, diuretics/ prostaglandin inhibitors, surgical closure through ligation
What prostaglandin inhibitors would be used to close a ductus arteriosus
Indomethacin 3 doses every 12-24 hours or ibuprofen 3 doses every 24 hours
What are side effects of the prostaglandin inhibitors
Renal dysfunction, increased Scr, increased risk of bleeding
What are the contraindications of use for prostaglandin inhibitors
active bleeding, thrombocytopenia, renal impairment, ductal-dependent congenital heart defect
What are right to left shunts
Blood shunts from systemic venous circulation to systemic arterial circulation therefore not becoming oxygenated due to abnormal connections
T/F: In right to left shunts the ducuts arterious should be closed immediately just like in left to right shunts
False: In right to left shunts the ducutus arterious is the only reason the body gets oxygenated blood. It should stay open until corrections are made
What drug should be given to keep the ducuts arteriosus open, side effect
Prostaglandin E1 (Alprostadil)/ apnea, fever, flushing, hypotension
What is the most common cause of primary hypertension in kids
Obesity
What is the cutoff for children to be considered in the correct ranges for BP
13
T/F: Children can be considered to have hypertension after one reading
False: Diagnosis for hypertension is confirmed by 3 separate readings taken at least 1 week apart
How are kids categorized with regards to their blood pressure
Normal: less than the 90th percentile, Elevated BP: Greater than or equal to the 90th percentile but less than the 95th percentile, HTN 1: greater than the 95th percent + 12 mmHg, HTN 2: greater than the 95th percentile + 12 mmHg
What are drugs that kids could take that could cause elevated blood pressure
Stimulants, corticosteriods, tricyclic antidepressants, decongestants, caffeine, cocaine, amphetamines
T/F: Kids usually need at least five minutes of minimal movement before taking their blood pressure
True
What are the steps for assessing a child’s BP
Step 1: Obtain patient information/ Step 2: Use BP tablets to find the 50th, 90th, 95th percentile for patient’s age, gender, and height/ Step 3: Compare the patient’s BP to percentile BPs to determine the category
What is the treatment algorithm if a child is considered to have elevated BP
Recommende lifestyle changes -> recheck in 6 months -> if NO target organ damage routine rechecks OR target organ damage initiate therapeutic therapy
What is the treatment algorithm if a child is considered to have HTN 1
Recommend lifestyle changes-> recheck in 1-2 weeks or sooner if symptomatic -> if normal BP routine rechecks OR if BP persistently elevated on 2 additional checks refer to hypertension/nephrology clinic
What is the treatment algorithm if a child is considered to have HTN 2
Refer to nephrology/hypertension clinic
What are the goals of therapy
Reduce the BP to less than the 90th percentile for age, gender, and height/ prevent target organ damage
What are indications for pharmacologic management
Failed at least 6 months of lifestyle modifications, stage 2 HTN or symptomatic, presence of other comorbidities
What are the comorbidities present that would cause pharmacologic treatment to be given immediately if BP is elevated
Hyperlipidemia, diabetes, renal disease
What are thre drug classes that are acceptable options for a child with hypertension, when can they be considered
ACE/ARB ( diabetic or proteinuric renal diseae), CCBs (concurrent migraines), Thiazide diuretics, Beta-blockers (concurrent migraines)
T/F: Just like in adults beta-blockers should not be first line and ACE/ARBs do not work as well in blacks
True
Why should a child with diabetes not be given beta-blockers
BB could mask the symptoms of diabetes
