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MJ- Peds Block 1 > Peds Cardio > Flashcards

Peds Cardio Flashcards

1
Q

What are the 3 “innocent” murmors?

A

Systolic, musical

  1. Stills murmur (systolic)
  2. Venous hum (continuous)
  3. Peripheral pulmonary stenosis (systolic)
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2
Q

What are the 3 pathological heart murmurs?

A
  1. Systolic
  2. Diastolic
  3. Continuous
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3
Q

Eval murmur by radiation…

Neck > _____

Back > _____

Axilla > ______

A

Neck > Aortic Stenosis

Back > Pulm valve stenosis

Axilla > Peripheral Pulmonary Murmur

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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

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5
Q

Does the following describe an innocent or pathological murmur?

  • Diastolic or continuous
  • Harsh
  • Clicks or S3/S4
  • h/o syncope
A

Pathologic

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6
Q

Does the intensity of a HCM murmur increase or decrease during standing/valsalva?

A

Increase

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7
Q

Does the intensity of an innocent heart murmur increase or decrease during valsalva?

A

decrease

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8
Q

Does the intensity of a mitral valve prolapse murmur increase or decrease during standing?

A

Increase

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9
Q

Does the intensity of an Aortic Stenosis murmur increase or decrease during standing?

A

Decrease

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10
Q

What is the most common innocent heart murmur?

A

Still’s Murmur

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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

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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
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13
Q

Do you need an echo for a Still’s Murmur? Why?

A

No. They outgrow it in adolescent years

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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

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15
Q

When is a venous hum murmur loudest? Whe is it decreased (2)?

A
  • Loudest- upright position
  • Decreased w/ supine or turning neck
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16
Q

Is an echo needed for a Venous Hum Murmur?

A

No

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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

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18
Q
A
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19
Q

Peripheral or central cyanosis?

  • Low saturations and PaO2?
A

Central cyanosis

(these would be normal in peripheral cyanosis)

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20
Q

T/F: Peripheral cyanosis is normal transitional newborn physiology

A

True

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21
Q

Does acrocyanosis have normal or abnormal pulses?

A

normal pulses

(blue baby would NOT have normal pulses)

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22
Q

What are 3 sxs of CHD?

A
  1. Tachypnea
  2. Cyanosis
  3. “Grey Baby”
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23
Q

CHD sxs: what does tachypnea indicate?

A

L-R shunt

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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

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25
Q

Does the following describe a grey or blue baby?

  • No pulse or capillary refill
  • lactic acidosis
A

Grey baby

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26
Q

Cardiac physiology: 3 components?

A
  1. Volume overload (L-R shunt- ASD, VSD, PDA, etc)
  2. Pressure overload (Outflow obstruction, etc)
  3. Cyanotic lesion (R-L shunt, etc)
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27
Q

Types of CHD:

What are the 3 Acyanotic defects?

A

Volume issue!

  1. ASD
  2. VSD
  3. PDA
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28
Q

Types of CHD:

What are the 3 Cyanotic defects?

A
  1. TOF (Tetralogy of Fallot)
  2. TGA (Transposition of the Great Arteries)
  3. TA (Truncus Arteriosus)
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29
Q

Are prostaglandins required to treat Acyanotic defects?

A

NO

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30
Q

What are teh 4 sxs of L-R shunting?

A
  • Tachypnea
  • Poor feeding
  • exercise intolerace
  • Poor growth

(Large ASDs= asymptomatic)

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31
Q

RA, RV and PA can become ______ as a result of ASD

A

enlarged

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32
Q

Physical Exam findings of what?

  • Precordial bulge
  • Hyperdynamic precordium
A

ASD

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33
Q

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
A

ASD

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34
Q

Which CHD might have right axis deviation and right vent conduction delay seen on EKG?

A

ASD

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35
Q

How do you tx ASD?

A
  • May close spontaneously in first few yrs of life
  • +/- closure depending on RA/RV dilation–> Sx vs percutaneous closure
  • No medical therapy
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36
Q

The goal of treatment for ASD is to prevent which 3 long term complications

A
  1. Pulmonary vascular disease
  2. Arrhythmias
  3. Embolic events
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37
Q

What’s the MC congenital heart defect?

A

VSD

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38
Q

What 3 things are seen with a mod-large VSD? What does this cause?

A
  • Failure to Thrive
  • Hepatomegaly
  • Diaphoresis w/ feeding

mod-lrg VSD causes CHF

39
Q

Small or large VSD?

  • Holosystolic murmur
  • High-pitched
  • normal S2
40
Q

Small or large VSD?

  • Failure to thrive
  • Holosystolic murmur
  • Lower pitched
  • Loud S2
  • +/- diastolic “rumble”
  • Diastolic murmur of aortic regurg
41
Q

What might been seen on EKG and CXR in a patient with a large VSD?

A

EKG: LVH and RVH

CXR: Cardiomegaly

42
Q

Who is PDA most commonly seen in? (2)

A
  • MC in:
    1. Premature newborns
    2. Newborns w/ primary pulmonary HTN
43
Q

What 2 conditions is PDA seen with?

A
  1. hypoplastic left heart syndrome
  2. pulmonary atresia
44
Q

What does the ductus arteriosus do? When does it normally close?

A

Ductus shunts blood away from the lungs in the fetus (R-L)

Normally closes w/in 72 hrs of birth

45
Q

What causes cyanosis in newborn with lower extremity < upper extremity sats?

What screening is mandatory?

A
  • This is a R-L shunt of PDA until proven otherwise!
  • Mandatory pulse-ox screening in US in RUE and LLE
46
Q

What causes a continuous “machinery-like” murmur at LUSB/axilla and a diastolic rumble?

47
Q

What is normal pulse oximetry in the hands and feet? What is differential cyanosis in the hands and feet?

A

Normal:

  • Hands RED: sats >95%
  • Feet RED: sats >95%

Differential Cyanosis:

  • Hands PURPLE: sat ~94%
  • Feet BLUE: Sat ~85-90%
48
Q

How do you tx PDA in preemies?

A

NSAIDs and ductal ligation

49
Q

How do you treat a small PDA in an older child that is audible?

A

Coil/device occlusion

Ductal ligation

(both to reduce risk of endocarditis)

50
Q

How do you tx a PDA that is incidentally found and non-audible?

A

No treatment

51
Q

T/F: Cyanotic heart defects (TOF, TGA, TA) do NOT need prostaglandins

A

FALSE

Cyanotic heart defects REQUIRE prostaglandins to treat!!

52
Q

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)
A

Start Prostaglandins

53
Q

What 4 abnormalities complise Tetralogy of Fallot?

A
  1. VSD
  2. PS/RVOT obstruction
  3. Overriding aorta
  4. RVH
54
Q

What is the MC Cyanotic defect?

A

Tetralogy of Fallot

55
Q

Tetralogy of Fallot arises from what one embryologic malformation?

A

anterior malalignment of coronal septum

56
Q

What murmur is heard with TOF?

A

Harsh systolic LUSB

57
Q

What is seen on CXR in TOF??

(POPCORN)

A

Boot shaped

58
Q

What syndrome is TOF associated with?

A

DiGeorge syndrome

59
Q

What are TET spells and what CHD is this seen in?

A
  • TET= cyanotic spells during feeding or crying (due to RVOT spasm)
  • Seen in TOF
60
Q

How do you tx a TET spell in a baby with TOF? (6)

A
  • Keep calm
  • O2
  • NS bolus
  • Knee to chest
  • Morphine (sedation)
  • Propanolol
61
Q

How do you tx TOF?

A
  • Depends- complex management
  • Early repair vs. delayed/staged repair
62
Q

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
A

Transposition of the Great Arteries (TGA)

(A type of cyanotic heart defect)

63
Q

How do you tx Transposition of the Great arteries?

A

Arterial switch operation

64
Q

What is Truncus Arteriosus?

A

Aortic arch abnormalities, VSD, Coronary artery conduction system abnormalities

65
Q

Truncus Arteriosus is associated with what syndrome?

KNOW!!

A

DiGeorge syndrome

66
Q

T/F: in a patient with Truncus Arteriosus, heart failure sxs don’t develop until the patient is older

A

FALSE
HF sxs develop in the first several weeks of life

67
Q

How do you dx and tx Truncus Arteriosus?

A

Dx: Echo

Tx: Surgical Repair

68
Q

What murmur is heard with Pulmonary stenosis?

A

Harsh systolic ejection murmur at LUSB, w/ a click

69
Q

What does EKG show in pulmonary stenosis?

70
Q

How do you tx Pulm stenosis?

A
  • Valve gradient <40= follow conservatively
  • TOC= Balloon valvuloplasty
71
Q

Which CHD?

  • Systolic murmur at the precordium
  • Decreased LE pulses
  • Increased UE BP
  • Decreased LE BP
    *
72
Q

What is the murmur heard in COA?

A

Systolic murmur at the precordium

73
Q

What syndrome is COA associated with?

(POPCORN)

A

Turner Syndrome

74
Q

Aortic stenosis is associated with what type of valve?

A

Bicuspid aortic valve

75
Q

How is severe COA treated

76
Q

Which condition?

  • Systolic ejection murmur at RUSB
  • Click (w/o resp variation)
A

Aortic Stenosis

77
Q

What is seen on EKG for Aortic stenosis

78
Q

What is seen on echo for Aortic Stenosis

A

Concentric LV hypertrophy

79
Q

How do you tx a patient who has severe/critical aortic stenosis (presents in shock)

A

PGE (maintains systemic BF)

80
Q

How do you treat aortic stenosis? If mild?

A
  • Mild- clinically monitor
  • Balloon valvuloplasty
  • Surgical
81
Q

What is hypoplastic left heart syndrome?

A

Complete mixing of systemic and pulmonary venous return blood w/in the atria

82
Q

How do you tx Hypoplastic left heart syndrome?

A

Staged procedures

83
Q

What type of arrhythmias are people with HCM at higher risk for?

A

ventricular arrhythmias

85
Q

Marfan Syndrome is associated w/ what 3 cardiac complications?

A
  1. Aortic root dilation
  2. Aortic root rupture
  3. Mitral valve prolapse
86
Q

What is Commotio Cordis? what does this increase risk for?

A
  • Blunt force trauma to CW over heart
  • Increase risk for ventricular arrhythmias
87
Q

Pediatric dyslipidemia- All children universally should be screened between what ages?

A

9 and 11 y/o

88
Q

The following are risk factors for what?

  • Obesity
  • FHx CAD
  • Acanthosis migrans
  • HTN
A

Pediatric dyslipidemia

89
Q

What 3 conditions put someone at increased risk for pediatric dyslipidemia?

A

1. Kawasaki

  1. DM
  2. Transplant
90
Q

How do you tx pediatric dyslipidemia?

A
  • Diet, exercise, weight loss
  • Statin (10y/o)
91
Q

What disease?

  • High fevers >5d
  • Polymorphous exanthema (bad diaper rash)
  • Bi conjunctival injection
  • Strawberry tongue
A

Kawasaki Disease

92
Q

People with Kawasaki Disease are at high risk for developing what?

A

Coronary aneurysms

93
Q

How do you tx Kawasaki Disease?

A

IVIG

High dose ASA

94
Q

When should you give vaccines in a patient with Kawasaki Disease?

A

Delay live vaccines (~11 mo)

MJ- Peds Block 1 (7 decks)

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