Pediatric Cardiology

Question 1

What is normal adult circulation starting from the right side

Answer 1

S and L vena cava drop blood to RA -> RV -> Pulmonary arteries -> Lungs -> pulmonary veins -> LA -> LV -> aorta -> body

Question 2

What are structural differences for normal fetal circulation

Answer 2

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

Question 3

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

Answer 3

True

Question 4

How is pulmonary vascular resistance diffrent in the fetus, what happens when it is born

Answer 4

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

Question 5

What causes the foramen ovale to close, closure of ductus arteriosus

Answer 5

Decrease in right atrial pressure, increase in pO2 and decrease in circulating prostaglandins (PGE2)

Question 6

What is the usual heart rate of neonates, blood pressure

Answer 6

140-160, 70/50

Question 7

What are genetic factors that can lead to congenital heart defects, envornmental factors

Answer 7

Complex syndromes/ viruses, fetal exposure to drugs and substances, maternal disease states

Question 8

What are the classifications of congenital heart defects

Answer 8

Left to right shunts, right to left shunts, Obstructive lesions, regurgitant lesions

Question 9

What occurs in a left to right shunt

Answer 9

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

Question 10

What are consequences of a left to right shunt

Answer 10

Decreased renal fucntion, decreased systemic perfusion, pulmonary edema, right heart failure

Question 11

T/F: Patent ductus arteriousus is a type of left to right shunt because blood leaves aorta and enters the pulmonary vein

Answer 11

True

Question 12

What are clinical features for ductus arteriosus, how is it confirmed

Answer 12

Cardiac murmur, tachycardia, tachypnea/ echocardiogram

Question 13

What contributes to the closure of the ductus arteriosus

Answer 13

Reduction in circulating prostaglandin

Question 14

How should patent ducuts arteriosus symptoms be managed, actual closure

Answer 14

Fluid restricution, diuretics/ prostaglandin inhibitors, surgical closure through ligation

Question 15

What prostaglandin inhibitors would be used to close a ductus arteriosus

Answer 15

Indomethacin 3 doses every 12-24 hours or ibuprofen 3 doses every 24 hours

Question 16

What are side effects of the prostaglandin inhibitors

Answer 16

Renal dysfunction, increased Scr, increased risk of bleeding

Question 17

What are the contraindications of use for prostaglandin inhibitors

Answer 17

active bleeding, thrombocytopenia, renal impairment, ductal-dependent congenital heart defect

Question 18

What are right to left shunts

Answer 18

Blood shunts from systemic venous circulation to systemic arterial circulation therefore not becoming oxygenated due to abnormal connections

Question 19

T/F: In right to left shunts the ducuts arterious should be closed immediately just like in left to right shunts

Answer 19

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

Question 20

What drug should be given to keep the ducuts arteriosus open, side effect

Answer 20

Prostaglandin E1 (Alprostadil)/ apnea, fever, flushing, hypotension

Question 21

What is the most common cause of primary hypertension in kids

Answer 21

Obesity

Question 22

What is the cutoff for children to be considered in the correct ranges for BP

Answer 22

13

Question 23

T/F: Children can be considered to have hypertension after one reading

Answer 23

False: Diagnosis for hypertension is confirmed by 3 separate readings taken at least 1 week apart

Question 24

How are kids categorized with regards to their blood pressure

Answer 24

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

Question 25

What are drugs that kids could take that could cause elevated blood pressure

Answer 25

Stimulants, corticosteriods, tricyclic antidepressants, decongestants, caffeine, cocaine, amphetamines

Question 26

T/F: Kids usually need at least five minutes of minimal movement before taking their blood pressure

Answer 26

True

Question 27

What are the steps for assessing a child’s BP

Answer 27

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

Question 28

What is the treatment algorithm if a child is considered to have elevated BP

Answer 28

Recommende lifestyle changes -> recheck in 6 months -> if NO target organ damage routine rechecks OR target organ damage initiate therapeutic therapy

Question 29

What is the treatment algorithm if a child is considered to have HTN 1

Answer 29

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

Question 30

What is the treatment algorithm if a child is considered to have HTN 2

Answer 30

Refer to nephrology/hypertension clinic

Question 31

What are the goals of therapy

Answer 31

Reduce the BP to less than the 90th percentile for age, gender, and height/ prevent target organ damage

Question 32

What are indications for pharmacologic management

Answer 32

Failed at least 6 months of lifestyle modifications, stage 2 HTN or symptomatic, presence of other comorbidities

Question 33

What are the comorbidities present that would cause pharmacologic treatment to be given immediately if BP is elevated

Answer 33

Hyperlipidemia, diabetes, renal disease

Question 34

What are thre drug classes that are acceptable options for a child with hypertension, when can they be considered

Answer 34

ACE/ARB ( diabetic or proteinuric renal diseae), CCBs (concurrent migraines), Thiazide diuretics, Beta-blockers (concurrent migraines)

Question 35

T/F: Just like in adults beta-blockers should not be first line and ACE/ARBs do not work as well in blacks

Answer 35

True

Question 36

Why should a child with diabetes not be given beta-blockers

Answer 36

BB could mask the symptoms of diabetes