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Pediatrics Module > Peds Cardio > Flashcards

Peds Cardio Flashcards

1
Q

fetal circulation pathway of mothers oxygenated blood to fetal heart.

A

oxygenated blood to placenta via umbilical vein -> inferior vena cava -> right atrium -> foramen ovale to left atrium -> left ventricle -> aorta

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2
Q

Placenta accepts deoxygenated blood from the fetus through _________.

A

two umbilical arteries

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3
Q

Mother oxygenates the blood and returns it to the placenta to the fetus via _________.

A

one umbilical vein

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4
Q

What type of cyanosis most concerning?

A

central > peripheral

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5
Q

If you hear thrill what grade murmur?

A

4/6 or more

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6
Q

Define thrill

A

vibratory sensation associated with loud murmur

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7
Q

How does fetal blood bypass lungs and get oxygenated in placenta?

A

ductus arteriosus connects pulmonary artery to aorta and shunts blood

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8
Q

When and how does ductus arteriosus functionally close?

A

within 12 hrs of life

due to drop in prostaglandin levels and smooth muscle constriction

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9
Q

Progression from newborns first breaths to closure of foramen ovale and ductus arteriolus

A

Birth  First breath  decreased pulmonary resistance  increased blood through lungs  Increased PO2 tension  closure of ductus arteriosus and more flow through the lung

Increased flow to lungs leads to increased flow to L atrium  mechanical closure of the foramen ovale

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10
Q

What to do for congenital cyanotic heart disease?

A

Keep ductus arteriosus patent
Prostaglandins
Lower O2 sats (80-90%)
Trying to maintain high O2 saturations will increase pulmonary perfusion, but kill your baby!!

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11
Q

Define acrocyanosis

A

Peripheral cyanosis
Central trunk-pink
Benign

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12
Q

central cyanosis

A

Tongue, mouth, lips-(perioral)

Pathological

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13
Q

pectus excavatum indicates _____.

A

Marfan Syndrome

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14
Q

splinter hemorrhages, Janeway lesions, Osler Nodes indicate ________.

A

endocarditis

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15
Q

What may cause thrill? Where?

A

URSB/suprasternal notch: aortic stenosis

LLSB: VSD

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16
Q

How is normal pulse reported?

A

2+

1+ diminished, 3+ bounding and hyperactive

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17
Q

How to check perfusion of infant?

A

press firmly on skin for 5 seconds then release; should refill in < 2 sec

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18
Q

What is grade 6/6 murmur?

A

murmur heard with stethoscope off chest

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19
Q

What is grade 2/6 murmur?

A

murmur can be heard by trained ear

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20
Q

types of systolic and diastolic murmurs

A

systolic: ejection murmurs
diastolic: aortic regurg., Tricuspid or mitral stenosis

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21
Q

What causes artificially lower pulse ox readings?

A

severe anemia, hypotension, hypothermia, artificial nails or nail polish

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22
Q

How is the hyperoxia test done? Why is it done?

A

done for cyanotic/low O2 sat infants to determine if the problem is cardiac or pulmonary

breath 100% oxygen for 10 min
improved paO2 and pulse ox -> respiratory defect
no improvement in paO2 or pulse ox -> cardiac defect

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23
Q

Any time you don’t hear an S2 split it is a _______ until proven otherwise.

A

ASD

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24
Q

How to determine cardiomegaly on chest XR?

A

CT ratio > 60% in neonate and > 45% in infant or child

CT ratio = cardio/thoracic

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25
Q

EKG most effective for what heart conditions?

A

dysrhythmias

WPW

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26
Q

What normal kids can appear like LVH?

A

very thin athletic kids

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27
Q

What is S1 sound?

A

closure of mitral and tricuspid valves

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28
Q

What is S2 sound?

A

closure of aortic and pulmonary valves

normal physiological S2 splitting, increases with inspiration

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29
Q

Most common cardiology referral in pediatric patients?

A

murmurs; 60% not pathologic

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30
Q

mid-systolic vibratory, musical murmur

A

Stills murmur

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31
Q

When does systolic and diastolic murmurs occur?

A

systolic btwn S1 and S2

diastolic after S2

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32
Q

Abnormal S2 sounds

A

fixed: ASD

Single/no split: absence of aorta or pulmonary valve (ex. transposition, truncus, HLHS)

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33
Q

Most common benign pediatric murmurs in each age group: infants, child, adolescence?

A

newborn: peripheral pulmonary stenosis murmur (PPS)

Infant/child: Stills, Venous Hum

Adolescent: innocent pulmonary ejection murmur

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34
Q

When is murmur pathologic?

A

Grade 4 or more
Description: systolic-harsh, holosystolic, continuous, diastolic
Fixed sound (no changes with position)

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35
Q

When is murmur benign?

A

Grade 3 or less
Description: vibratory, twanging, musical
Intensity changes with position

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36
Q

When are congenital heart diseases dx’d?

A

within first 4 weeks of life

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37
Q

Two broad categories of congenital heart diseases:

A

acyanotic and cyanotic

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38
Q

Left- to-right diseases

A

ASD, VSD, PDA

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39
Q

Right-to-left heart diseases

A

Tetralogy of Fallot

Tricuspid atresia

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40
Q

Eisenmenger syndrome

A

low pulmonary resistance -> pulls blood to lungs -> pulm HTN -> increase pulm resistance/edema

41
Q

left-to-right pathophysiology

A

low pulmonary resistance with higher systemic resistance

42
Q

Complete congenital obstructions present in infancy/newborn as ______ and need to treat with ________.

A

shock

prostaglandins

43
Q

Pearl: memorize 5 T’s and H of cyanotic heart disease using hand

A

1) Truncus Arteriosus
2) Transposition of great arteries
3) Tricuspid atresia
4) Tetralogy of Fallot
5) Total Anomalous Pulmonary Return

Hypoplastic Left Heart Syndrome

44
Q

Prophylaxis for bacterial endocarditis required for patients with:

A

Prosthetic heart valves
H/O infective endocarditis
Dental procedures w/ gums
Congenital heart disease

45
Q

Bacterial endocarditis prophylaxis treatment for children

A

amoxicillin 50mg/kg

46
Q

Major cause of HTN 1-6 yo vs 12-18 yo

A

1-6 yo: renal and renal vascular disease

12-18 yo: essential HTN

47
Q

percentile BP of normal, pre-HTN, HTN

A

Normal < 90
Pre-HTN > or = 90
HTN > 95 (stage 1 95-99 and stage 2 +99)

48
Q

Most common cause of elevated BP in children

A

faulty measurement (wrong cuff size)

49
Q

Red flags of HTN

Think secondary HTN!

A
  • Prepubertal child
  • Thin child with negative fhx
  • Acute rise in BP above a previously stable baseline
  • Severe HTN (Stage 2)
  • Diastolic and/or nocturnal HTN
  • Abnormal sx’s (chest pain, vision changes, urinary complaints, snoring, weight changes, cold/heat intolerance)
  • Abnormal Exam findings (tachycardia, flushing, edema, goiter, rashes, joint effusions, masses, or murmurs)
50
Q

Reasons for labs/dx testing in child with HTN

A

all < 12 yo, all with normal BMI

51
Q

Labs/Dx testing for HTN child that isn’t obese and older than 12yo

A

UA, CBC, BMP (lytes, BUN/Cr, glucose), Lipid panel, renal u/s with flow dopplers

52
Q

HTN treatment in child

A

lifestyle modifications first line: diet, exercise, stop tobacco exposure, family-based intervention

Pharm: ACEs, diuretics, beta blockers

  • for stage I (>95%) if unresponsive to 4-6 mon of lifestyle changes
  • for most stage II (>99%)
53
Q

Most common causes of sudden cardiac death

A

1) HCM = hypertrophic cardiomyopathy (formerly called IHSS)

2) Arrhythmias: Long QT, WPW

54
Q

How to differentiate athletic heart vs HCM?

A

HCM autosomal dominant, so get fhx!

HCM: +/- systolic ejection murmur (louder when upright), LVH, Q wave, ST strain

55
Q

Characteristics of HCM murmur?

A

systolic ejection murmur

louder when upright

56
Q

EKG findings of Wolff Parkinson White?

A
  1. Short PR interval
  2. Delta wave
  3. Widen QRS
57
Q

Meds that cause long QT

A

quinolones, macrolides, antipsychotics, TCAs

58
Q

commotio cordis

A

direct blow to chest at upstroke of T wave; leads to cardiac arrest

associated with ALCAPA - only true situation where child can have heart attack

59
Q

How is sudden cardiac death prevented?

A

Most important is H&P
Trainers & school officials competent in basic CRP
AED devices at schools
Pre-Sports Physicals

60
Q

AHA guidelines for sports participation

A

12 ELEMENT H&P

  1. Exertional chest pain or discomfort
  2. Presyncope/Syncope
  3. Unexplained exertional dyspnea or fatigue
  4. Prior recognition of heart murmur
  5. Elevated systemic blood pressure

Family history

  1. Unexpected/Sudden cardiac death
  2. Disability or early cardiovascular death in relative (< 50 yo)
  3. Known h/o cardiac anomaly in family member (HCM, Marfan, prolonged QT, etc.)

Physical Exam

  1. Heart Murmur
  2. Femoral pulses
  3. Physical stigmata of Marfan syndrome
  4. Elevated brachial artery BP when sitting
  • Any YES to these, child does NOT play, until seen by cardiology or ECHO
61
Q

Most common innocent murmur in childhood

A

Still’s murmur

62
Q

Describe Still’s murmur

A

loudest in apex and LSB
musical or vibratory
systolic
diminishes with sitting/standing

63
Q

Venous hum diminished with what?

A

turning of head, jugular compression, supine

64
Q

Describe peripheral pulm stenosis murmur

A

soft, systolic ejection murmur

well localized to ULSB

65
Q

When do innocent murmurs Still’s, venous hum, and peripheral pulm stenosis appear?

A

PPS: newborn
Still’s: 2-8 yo
Venous hum: 3-6 yo

66
Q

Innocent murmurs are what grade?

A

Grade I-III

67
Q

What does squatting from standing do to venous pressure?

A

squatting from standing -> increase venous return from lower body -> increase SVR -> increase LV filling

68
Q

Why not increase O2 in cyanotic newborn with non-respiratory cause?

A

O2 sat will get worse and PDA will close up

69
Q

PGE1 indication

A

cyanotic infant that is cardio-related; keep ductus arteriosus open for shunting

70
Q

Indomethacin indication

A

close off PDA

71
Q

Standing decreases intensity of all murmurs except _________ and ________.

A

HCM and mitral valve prolapse

72
Q

Continuous murmur in 3 yo that is loudest when sitting. Normal exam.

A

venous hum murmur

73
Q

fixed split S2 with increased pulmonary blood flow and pulmonary ejection murmur

A

ASD

74
Q

continuous machine-like murmur, wide pulse pressure, tachypnea

A

PDA

75
Q

How to treat PDA?

A

indomethacin

76
Q

congenital obstruction in heart that’s seen in Turner syndrome.

A

Aortic coarctation

77
Q

Congenital condition where femoral pulses are weaker than RIGHT radial and brachial pulses. Also find differential cyanosis with lower pulse ox in lower extremities.

A

Aortic coarctation

78
Q

Describe pulses of aortic coarctation in upper and lower extremities

A

UE: normal or bounding 3+
LE: diminished 1+

79
Q

How is aortic coarctation treated in newborns? Why?

A

prostaglandins to keep ductus arteriosus open

80
Q

Newborn with SOB, cyanosis, and systolic ejection murmur. EKG shows RVH.

A

pulmonary stenosis

81
Q

Most congenital cyanotic heart diseases treated with what med? Which you should NOT be treated this way?

A

prostaglandins to keep DA open

EXCEPT truncus arteriosus (no DA dependence)

82
Q

Heart defect with single arterial trunk making loud single S2

A

truncus arteriosus

83
Q

Heart defect that creates parallel circuits where there is tachypnea with no pulmonary findings

A

transposition of Great Vessels

84
Q

Heart defect where there is no flow from RA to RV

A

tricuspid atresia

85
Q

4 features of Tetralogy of Fallot

A

overriding aorta
pulmonary stenosis
VSD
RVH

86
Q

CXR of Tetralogy of Fallot

A

boot-shaped (uplifted apex or egg on side)

decreased pulm blood flow

87
Q

“Tet spell” management

A 
squatting or knee to chest position
high flow O2
morphine
beta blockers (relax RV)
phenylephrine (increase pulm circulation)
88
Q

pink vs blue tetralogy

A

pink: mild pulm stenosis; some blood still goes to lungs for oxygenation
blue: severe pulm stenosis; all blood shunted to systemic circulation

89
Q

How does “Tet spell” occur?

A

stress (i.e. heat, infection, exercise, acidosis) -> decreased systemic vascular resistance (SVR) -> increased shunting to systemic circulation -> decreased pulm perfusion -> increased cyanosis

90
Q

Heart abnormality where all 4 pulmonary veins drain into right atria, so oxygenated blood never reaches LA

A

Total Anomalous Pulmonary Return

91
Q

Marked hypoplasia of left ventricle and ascending aorta, leading to rapid cariogenic shock

A

HLHS (hypoplastic left heart syndrome)

92
Q

How to treat HCM?

A

pacemaker

avoid isometric activities

93
Q

genetic syndrome that presents with widened down-slanting eyes, pulmonary stenosis, short stature, and webbed neck.

A

Noonan syndrome

94
Q

Fibrillin defect in Marfan syndrome causes what symptoms?

A

Hypermobile joints, arachnodactyly, pectus deformity, wingspan > height, ectopic lentis

95
Q

Inheritance of Marfan syndrome

A

autosomal dominant

96
Q

What should be monitored in Marfan patient? Why?

A

ophthalmology (watch for ectopic lentis)
Annual ECHO
Strict BP control
No isometric sports

High risk of aortic aneurysm!!!

97
Q

Which murmur is loudest in supine position?

A

Stills

98
Q

Benign murmur in ped patient that is loudest upright and disappears supine.

A

Venous hum

99
Q

Harsh, crescendo murmur that is loudest squatting and softer standing

A

aortic stenosis

Pediatrics Module (15 decks)

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