Peds cardio 2

Question 1

What are the obstructive heart defects

Answer 1

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

Question 2

Characteristics of obstructive flow are

Answer 2

Systolic ejection murmur
Pressure overload
LVH/RVH/Concentric hypertrophy
Strain pattern on ECG

Question 3

What is pulmonary stenosis

Answer 3

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

Question 4

How do you treat pulm stenosis

Answer 4

cath lab for balloon valvuloplasty

Question 5

What us Aortic stenosis

Answer 5

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

Question 6

How do you treat aortic stenosis

Answer 6

mild: clinically monitor
balloon valvuloplasty
surgical

Question 7

What is coarcation of aorta

Answer 7

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

Question 8

Coarcation of aorta is associated with

Answer 8

Turner syndrome

Question 9

MCC of sudden cardiac death is

Answer 9

HCM

Question 10

Most high risk sports for sudden cardiac death

Answer 10

Basketball!

Then track

Question 11

What is the US vs Euro approach to pre-health screenings

Answer 11

US: Focused H&P, no ECG
Euro: H&P, ECG

Question 12

Per AHA, what should a pre-participation physical comprise

Answer 12

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

Question 13

If a pre-participation physical is abnormal

Answer 13

restrict from playing

refer for further evaluation

Question 14

What can be detected by a provider

Answer 14

HCM, marfans, myocarditis, LVOT obstruction, MVP, CAD, WPW, Brugada, short QT, drugs, pulmonary HTN

Question 15

What is HCM

Answer 15

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

Question 16

What heart defects are present in Marfan syndrome

Answer 16

Aortic root dilation
Aortic root rupture
MVP

Question 17

What should you do if you find PVC on ECG

Answer 17

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

Question 18

What is long QT syndrome

Answer 18

QTc >460

Leads to syncope, deafness, seizures, and SIDS

Question 19

What is Brugada syndrome

Answer 19

Ventricular arrhythmia that can cause sudden cardiac death

ECG: pseudo-RBBB and ST elevation in V1-V2

Question 20

Risks to an anomalous coronary artery are

Answer 20

coronary origin off wrong sinus
LMCA off right sinus
coronary artery pulsing between aorta and pulmonart artery

Question 21

What is commotio cordis

Answer 21

Lethal disruption of heart rhythm 2/2 direct blunt trauma over the heart

Question 22

What are RF for pediatric dyslipidemia

Answer 22

overweight or obese 
FHx of CAD 
Acanthosis 
HTN 
Has Kawasaki, diabetes, or a transplant

Question 23

What are normal fasting lipid levels vs. when you should refer

Answer 23

Total chol: <200 
Tg: <150 
LDL: <130 
HDL: >40 
nonHDL: <145 
Refer if: TC >200, LDL >130, TG >200

Question 24

How do you treat pediatric dyslipidemia

Answer 24

diet 
exercise 
weight loss 
Statins (yes, even at 10 years old!) 
*Kids are universally screened at 9-11 y/o*

Question 25

What are findings in Kawasaki disease

Answer 25

High spiking fever (>102) for 5+ days 
Cojunctivitis (non-exudative) 
Rash (polymorphous) 
Edema (hands and feet) 
Adenopathy (cervical) 
Mucositis (cracked lips, strawberry tongue) 
*Thrombocytosis, sterile pyuria, high LFT
-Echo: coronary dilation or aneurysms

Question 26

How do you treat Kawasaki disease

Answer 26

IVIG + high dose ASA
outpt: No live vaccines for 11 months, continue ASA for 6-8 weeks, restrict activity
May need to place on statin 2/2 premature atherosclerosis