Peds Cardio Flashcards
1
Q
What are the 3 “innocent” murmors?
A
Systolic, musical
- Stills murmur (systolic)
- Venous hum (continuous)
- Peripheral pulmonary stenosis (systolic)
2
Q
What are the 3 pathological heart murmurs?
A
- Systolic
- Diastolic
- Continuous
3
Q
Eval murmur by radiation…
Neck > _____
Back > _____
Axilla > ______
A
Neck > Aortic Stenosis
Back > Pulm valve stenosis
Axilla > Peripheral Pulmonary Murmur
4
Q
Does the following describe an innocent or pathological murmur?
- Systolic
- Musical
- Not assoc. w/ adventitious sounds (S3 or S4)
- No assoc. sxs/findings
- Louder with stress
A
Innocent
5
Q
Does the following describe an innocent or pathological murmur?
- Diastolic or continuous
- Harsh
- Clicks or S3/S4
- h/o syncope
A
Pathologic
6
Q
Does the intensity of a HCM murmur increase or decrease during standing/valsalva?
A
Increase
7
Q
Does the intensity of an innocent heart murmur increase or decrease during valsalva?
A
decrease
8
Q
Does the intensity of a mitral valve prolapse murmur increase or decrease during standing?
A
Increase
9
Q
Does the intensity of an Aortic Stenosis murmur increase or decrease during standing?
A
Decrease
10
Q
What is the most common innocent heart murmur?
A
Still’s Murmur
11
Q
Which murmur?
- 3-6 y/o
- Normal EKG
- low freq, vibratory, musical sound
-
Loudest in supine and stress (fevers)
*
A
Still’s murmur
12
Q
When is the Still’s Murmur loudest? when does it change intensity?
A
- Loudest in supine and stress (fevers)
- Changes intensity w/ sitting position
13
Q
Do you need an echo for a Still’s Murmur? Why?
A
No. They outgrow it in adolescent years
14
Q
Which murmur?
- 3-6y/o
- Turubulence due to jugular venous drainage
- Continuous (R>L), base of heart, Diastolic louder than systolic
A
Venous Hum Murmur
15
Q
When is a venous hum murmur loudest? Whe is it decreased (2)?
A
- Loudest- upright position
- Decreased w/ supine or turning neck
16
Q
Is an echo needed for a Venous Hum Murmur?
A
No
17
Q
What is the MC congenital abnormality causing morbidity and mortality in the 1st year of life in the US?
A
Congenital Heart Defects
18
Q
A
19
Q
Peripheral or central cyanosis?
- Low saturations and PaO2?
A
Central cyanosis
(these would be normal in peripheral cyanosis)
20
Q
T/F: Peripheral cyanosis is normal transitional newborn physiology
A
True
21
Q
Does acrocyanosis have normal or abnormal pulses?
A
normal pulses
(blue baby would NOT have normal pulses)
22
Q
What are 3 sxs of CHD?
A
- Tachypnea
- Cyanosis
- “Grey Baby”
23
Q
CHD sxs: what does tachypnea indicate?
A
L-R shunt
24
Q
What is the difference b/w “blue baby” and “grey baby”
A
blue baby= cyanosis
grey baby= decreased or no systemic blood flow
25
Does the following describe a grey or blue baby?
* No pulse or capillary refill
* lactic acidosis
Grey baby
26
Cardiac physiology: 3 components?
1. **Volume overload** (L-R shunt- ASD, VSD, PDA, etc)
2. **Pressure overload** (Outflow obstruction, etc)
3. **Cyanotic lesion** (R-L shunt, etc)
27
Types of CHD:
What are the 3 ****_A_**cyanotic** defects?
Volume issue!
1. ASD
2. VSD
3. PDA
28
Types of CHD:
What are the 3 **Cyanotic** defects?
1. TOF (Tetralogy of Fallot)
2. TGA (Transposition of the Great Arteries)
3. TA (Truncus Arteriosus)
29
Are **prostaglandins** required to treat **Acyanotic** defects?
NO
30
What are teh 4 sxs of L-R shunting?
* Tachypnea
* **Poor feeding**
* **exercise intolerace**
* **Poor growth**
(Large ASDs= asymptomatic)
31
RA, RV and PA can become ______ as a result of ASD
enlarged
32
Physical Exam findings of what?
* **Precordial bulge**
* Hyperdynamic precordium
ASD
33
If you hear the following on auscultation, which CHD is it?
* Normal S1
* Fixed split of S2
* 2-3/6 systolic ejection murmur at LUSB
* +/- diastolic "rumble" at RLSB
* _DOESN'T change w/ position_
ASD
34
Which CHD might have right axis deviation and right vent conduction delay seen on EKG?
ASD
35
How do you tx ASD?
* May close spontaneously in first few yrs of life
* +/- closure depending on RA/RV dilation--\> **Sx vs percutaneous closure**
* No medical therapy
36
The goal of treatment for ASD is to prevent which 3 long term complications
1. Pulmonary vascular disease
2. Arrhythmias
3. Embolic events
37
What's the MC congenital heart defect?
VSD
38
What 3 things are seen with a mod-large VSD? What does this cause?
* Failure to Thrive
* Hepatomegaly
* Diaphoresis w/ feeding
mod-lrg VSD causes CHF
39
Small or large VSD?
* Holosystolic murmur
* **High-pitched**
* **normal S2**
Small
40
Small or large VSD?
* Failure to thrive
* Holosystolic murmur
* **Lower pitched**
* **Loud S2**
* +/- diastolic "rumble"
* Diastolic murmur of aortic regurg
Large VSD
41
What might been seen on EKG and CXR in a patient with a large VSD?
EKG: LVH and RVH
CXR: Cardiomegaly
42
Who is PDA most commonly seen in? (2)
* MC in:
1. **Premature** newborns
2. Newborns w/ primary **pulmonary HTN**
43
What 2 conditions is PDA seen with?
1. hypoplastic left heart syndrome
2. pulmonary atresia
44
What does the ductus arteriosus do? When does it normally close?
Ductus shunts blood away from the lungs in the fetus (R-L)
Normally closes w/in 72 hrs of birth
45
What causes cyanosis in newborn with lower extremity \< upper extremity sats?
What screening is mandatory?
* This is a R-L shunt of **_PDA_** until proven otherwise!
* Mandatory pulse-ox screening in US in RUE and LLE
46
What causes a continuous **_"machinery-like"_** murmur at **_LUSB_**/axilla and a diastolic rumble?
Large PDA
47
What is normal pulse oximetry in the hands and feet? What is differential cyanosis in the hands and feet?
_Normal:_
* Hands RED: sats \>95%
* Feet RED: sats \>95%
_Differential Cyanosis:_
* Hands PURPLE: sat ~94%
* Feet BLUE: Sat ~85-90%
48
How do you tx PDA in preemies?
NSAIDs and ductal ligation
49
How do you treat a **small PDA** in an **older child** that is **audible**?
Coil/device occlusion
Ductal ligation
(both to reduce risk of endocarditis)
50
How do you tx a **PDA** that is **incidentally** found and **non-audible**?
No treatment
51
T/F: **Cyanotic** heart defects (TOF, TGA, TA) do **NOT** need **prostaglandins**
FALSE
Cyanotic heart defects REQUIRE prostaglandins to treat!!
52
The following are indications to start what?
* **Blue or Grey baby**
* 5 cyanotic heart defects (TOF, TGA, TA, etc)
* Obstruction to lungs or systemic blood flow
* **_Failed pulse oximetry testing_**
* abnl CXR, EKG, ABG (acidosis, low pao2)
Start Prostaglandins
53
What 4 abnormalities complise Tetralogy of Fallot?
1. VSD
2. PS/RVOT obstruction
3. Overriding aorta
4. RVH
54
What is the MC Cyanotic defect?
Tetralogy of Fallot
55
Tetralogy of Fallot arises from what one embryologic malformation?
anterior malalignment of coronal septum
56
What murmur is heard with TOF?
Harsh systolic LUSB
57
What is seen on CXR in TOF??
| (POPCORN)
Boot shaped
58
What syndrome is TOF associated with?
DiGeorge syndrome
59
What are TET spells and what CHD is this seen in?
* TET= cyanotic spells during feeding or crying (due to RVOT spasm)
* Seen in TOF
60
How do you tx a TET spell in a baby with TOF? (6)
* Keep calm
* O2
* NS bolus
* Knee to chest
* Morphine (sedation)
* Propanolol
61
How do you tx TOF?
* Depends- complex management
* Early repair vs. delayed/staged repair
62
The following describes which CHD?
* State of parallel circulation
* **Oxygenated blood is recirculated through the lungs**
* Result= vicious cycle of hypoxemia and acidosis (sat 40-60%)
* Death imminent unless also have PFO, VSD or PDA
Transposition of the Great Arteries (TGA)
(A type of cyanotic heart defect)
63
How do you tx Transposition of the Great arteries?
Arterial switch operation
64
What is Truncus Arteriosus?
Aortic arch abnormalities, VSD, Coronary artery conduction system abnormalities
65
Truncus Arteriosus is associated with what syndrome?
KNOW!!
DiGeorge syndrome
66
T/F: in a patient with **Truncus Arteriosus**, **heart failure sxs** don't develop until the patient is older
FALSE
HF sxs develop in the **first several weeks of life**
67
How do you dx and tx Truncus Arteriosus?
Dx: Echo
Tx: Surgical Repair
68
What murmur is heard with Pulmonary stenosis?
**Harsh** **systolic** ejection murmur at **LUSB**, w/ a **click**
69
What does EKG show in pulmonary stenosis?
RVH
70
How do you tx Pulm stenosis?
* Valve gradient \<40= follow conservatively
* TOC= Balloon valvuloplasty
71
**Which CHD?**
* Systolic murmur at the precordium
* Decreased LE pulses
* **Increased UE BP**
* **Decreased LE BP**
*
COA
72
What is the murmur heard in COA?
Systolic murmur at the precordium
73
What syndrome is COA associated with?
| (POPCORN)
Turner Syndrome
74
Aortic stenosis is associated with what type of valve?
Bicuspid aortic valve
75
How is severe COA treated
PGE
76
Which condition?
* Systolic ejection murmur at RUSB
* Click (w/o resp variation)
Aortic Stenosis
77
What is seen on EKG for Aortic stenosis
LVH
78
What is seen on echo for Aortic Stenosis
Concentric LV hypertrophy
79
How do you tx a patient who has severe/critical aortic stenosis (presents in shock)
PGE (maintains systemic BF)
80
How do you treat aortic stenosis? If mild?
* Mild- clinically monitor
* Balloon valvuloplasty
* Surgical
81
What is hypoplastic left heart syndrome?
Complete mixing of systemic and pulmonary venous return blood w/in the atria
82
How do you tx Hypoplastic left heart syndrome?
Staged procedures
83
What type of arrhythmias are people with HCM at higher risk for?
ventricular arrhythmias
84
85
Marfan Syndrome is associated w/ what 3 cardiac complications?
1. Aortic root dilation
2. Aortic root rupture
3. Mitral valve prolapse
86
What is Commotio Cordis? what does this increase risk for?
* Blunt force trauma to CW over heart
* Increase risk for ventricular arrhythmias
87
Pediatric dyslipidemia- All children universally should be screened between what ages?
9 and 11 y/o
88
The following are risk factors for what?
* **Obesity**
* FHx CAD
* **Acanthosis migrans**
* HTN
Pediatric dyslipidemia
89
What 3 conditions put someone at increased risk for pediatric dyslipidemia?
**_1. Kawasaki_**
2. DM
3. Transplant
90
How do you tx pediatric dyslipidemia?
* Diet, exercise, weight loss
* Statin (10y/o)
91
**What disease?**
* High fevers \>5d
* Polymorphous exanthema (bad diaper rash)
* Bi conjunctival injection
* Strawberry tongue
Kawasaki Disease
92
People with Kawasaki Disease are at high risk for developing what?
Coronary aneurysms
93
How do you tx Kawasaki Disease?
IVIG
High dose ASA
94
When should you give vaccines in a patient with Kawasaki Disease?
Delay live vaccines (~11 mo)
