Peds cardio 2 Flashcards
What are the obstructive heart defects
Obstruction to pulmonary flow: PS, Pulm atresia
Obstruction to systemic flow: AS, coarcation of aorta
-If either are severe, give PGE to keep PDA open
Characteristics of obstructive flow are
Systolic ejection murmur
Pressure overload
LVH/RVH/Concentric hypertrophy
Strain pattern on ECG
What is pulmonary stenosis
Pressure overload on RV 2/2 thick, dysfunctional valve
Systolic, harsh ejection murmur at LUSB (click! loud on inspo)
ECG: RVH
Severe or critical hypoxia= give PGE
How do you treat pulm stenosis
cath lab for balloon valvuloplasty
What us Aortic stenosis
Bicuspid aortic valve Systolic ejection murmur at RUSB W/ diastolic murmur at apex Click (no resp change) LVH on ECG concentric hypertrophy to LV Severe/critical: give PGE
How do you treat aortic stenosis
mild: clinically monitor
balloon valvuloplasty
surgical
What is coarcation of aorta
Narrowing of aortic isthmus causing pressure overload on LV
Systolic murmur at precordium
Decreased LE pulses
BP difference >20 mmHg between arm (higher) and leg (lower)
If severe, need PGE
Coarcation of aorta is associated with
Turner syndrome
MCC of sudden cardiac death is
HCM
Most high risk sports for sudden cardiac death
Basketball!
Then track
What is the US vs Euro approach to pre-health screenings
US: Focused H&P, no ECG
Euro: H&P, ECG
Per AHA, what should a pre-participation physical comprise
PMHx: Exertional chest pain, unexplained syncope, excessive exertional and unexplained dyspnea and fatigue, heart murmur, high SBP
FHx: premature death (sudden, before 50), disability from heart disease in close relative, Knowledge of HCM, DCM, marfans, arrhythmias
PE: Abn murmur, femoral pulses (exclude coarcation), marfan syndrome, brachial artery BP (sitting)
*Not recommended: ECG, Echo
If a pre-participation physical is abnormal
restrict from playing
refer for further evaluation
What can be detected by a provider
HCM, marfans, myocarditis, LVOT obstruction, MVP, CAD, WPW, Brugada, short QT, drugs, pulmonary HTN
What is HCM
Autosomal dominant disarray and build up of hypertrophic myocardial cells
bnormal stiffness of LV, impaired Diastolic filling
Systolic function is OK!
Increase in ventricular arrhythmias
NO SPORTS
What heart defects are present in Marfan syndrome
Aortic root dilation
Aortic root rupture
MVP
What should you do if you find PVC on ECG
Refer to cardiology
Get an echo
24 hour holter and tredmill stress test; If PVC are depressed with higher HR, this is good!
<5-7% PVC in 24 hrs is considered normal
What is long QT syndrome
QTc >460
Leads to syncope, deafness, seizures, and SIDS
What is Brugada syndrome
Ventricular arrhythmia that can cause sudden cardiac death
ECG: pseudo-RBBB and ST elevation in V1-V2
Risks to an anomalous coronary artery are
coronary origin off wrong sinus
LMCA off right sinus
coronary artery pulsing between aorta and pulmonart artery
What is commotio cordis
Lethal disruption of heart rhythm 2/2 direct blunt trauma over the heart
What are RF for pediatric dyslipidemia
overweight or obese FHx of CAD Acanthosis HTN Has Kawasaki, diabetes, or a transplant
What are normal fasting lipid levels vs. when you should refer
Total chol: <200 Tg: <150 LDL: <130 HDL: >40 nonHDL: <145 Refer if: TC >200, LDL >130, TG >200
How do you treat pediatric dyslipidemia
diet exercise weight loss Statins (yes, even at 10 years old!) *Kids are universally screened at 9-11 y/o*
