Peds Cardio X3

Question 1

Cardiac disease in infants SX

Answer 1

FTT

Tachypnea with feeding/activity

Question 2

Cadiac disease in older children sx

Answer 2

palpitations, chest pain
dizzines/syncope
exercise intolerance,
unexplained hypertension

Question 3

what will hepatomegaly and Ascities indiicate

Answer 3

R sided heart failure

Question 4

Clubbing of fingers/toes associated with?

Answer 4

appears after age 1

with cyanotic congenital heart disease

Question 5

Echocardiogram

Answer 5

Gold standard
Ultrasound of the heart
1. Transthorasic echo (more common)
2. Transesophageal echo

Question 6

EKG

Answer 6

evaluates electrical activity and cardiac postition

-evolves with age

Question 7

CXR

Answer 7

exaluates

• position of heart/size/shape
• position of abdominal viscera
• pulmonary vasculature

Question 8

Cardiac Catherization

Answer 8

fluroscopy when a wire is threaded up to the heart

• radioopaque dye injecednto evaluate anatomy
• samples and measure pressure

Question 9

Innocent Murmurs characteristics

Answer 9

• no FH
• -<= 2grade 2
• short systolic duration
• minimal radiation
• soft intensity
• musical or vibratory quality
• normal pulse
• normal pulse ox,CXR, EKG

Question 10

Still murmur

Answer 10

-most common innocent murmur
musical/vibratory
-short high pitched
- loudest supine, dimishes/disappears with inspiration or sitting

Question 11

Pulmonary flow murmur

Answer 11

most common in older children and alsults >3

• sof SEM
• louder supine

Question 12

venoud hum

Answer 12

2 and up 
continuous musical hum 
-hear at R/L USB 
*louder in diastole**
-disappears with turning head or placing shild in supine

Question 13

Acyanotic congenital heart disease

Answer 13

Vesntral septal defect
atrial septal defect
patent ductus arteriosis
coartication of aorta

Question 14

Cyanotic conegital heart disease

Answer 14

• tetrlogy of Fallot
• transposition of the great arteries
• tricuspid ateriosus
• total anomalous pulmonry venoud return

-hypoplastic left heart syndrome

Question 15

when should the ductus arteriosus close?

Answer 15

14 days

Question 16

Vesntricular septal defect (VSD)

Answer 16

• most common congenital heart defet

- associated trisomy 21 and tetralogy of fallot

Question 17

VSD presentation

Answer 17

Small VSD may be aymptomatic
Larger: FTT, poor growth, dyspnea, frequent respiratory infections
PE: tachycardia, tachypnea, hepatomegaly
**blowing harsh holosystolic murmur LLSB

Question 18

VSD dx

Answer 18

Echo: locates
EKG: LVH
CXR: cardiomegaly, increased pulmonary vascular markings

Question 19

VSD Managment

Answer 19

wait and see> esp with asymptomatic
Med: tx CHF (diuretic Ace inhibitor
Surgical: septal occlusion via caterization
* prefereec surgical closure via median sternotomy

Question 20

Atrial Septal defect ASD classifies

Answer 20

Ostium secundum (most common)> oftenisolated 
Ostium primum> often associaye with other anomolies

Question 21

ASD presentation

Answer 21

CHF, recurrent resp infections FTT
-fixed widely split s2 at pulmonary area
@ULSB
-surgical patch if larger than 6mm

Question 22

Eisenmenger syndrome

Answer 22

if you have a PDA for a log time and the shunt can reverse at high pulomary pressures casuing cyanosis

Question 23

Tx of PDA

Answer 23

Monitor
Keep open : IV prostagladin E1
Close it up : IV indomethacin (prostagandin inhibit)
Surgery if nonresponders

Question 24

Coarctation of the Aorta

Answer 24

Narrowing of the aortic arch in the proximaldecending aorta near takeoff of the left subclavian artery

Question 25

What is female coarctation of the aorta associated with

Answer 25

Turner syndrome

Question 26

Coarctation of the aorta

Answer 26

Echo  
CXR
-figure 3 sign 
-inferior rib notching 
Tx: surgery

Question 27

Teralogy of fallot

Answer 27

Righ ventricular hypertrophy 
ventricular septal defect 
overiding aorta
RV outflow obstruction 
**most common cyanotic CHD

Question 28

Tetralogy of fallot presentation

Answer 28

“Test spells”

• begins 4-6 mo
• sunden onset or worsening of cyanosis
• alterations of consciousness (irratable to syncope )
• often occuring with crying or feeding or exercise
• toddlers may squat to relieve dyspnea

Question 29

tetralogy of fallot

Answer 29

Pe: harsh systolic ejection ULSB 
echo-DX
CXR: boot shaped heart > upturned apex 
Tx: oxygen knees to chest 
surgery by age 1

Question 30

Tranpostion of the great arteries

Answer 30

second most common
-no murmur becuase no holes in heart
Presentation: profoundly cyanotic neonate “ blue baby

Question 31

What do you need to keep open in transposition of great arteries

Answer 31

keep ASD open or PFO!!

so you can get some mixing of blood

Question 32

Tx: of transposition of vessels

Answer 32

-balloon atrial septostomy to improve intraatrial communication
-prostaglandin E1 administration -keep ductus art open
-Surgery 4-7 days
arterial switch operation

Question 33

Tricuspid Atresia

Answer 33

absence of a tricuspid valve - must occur with other defects at the sme time becuase we need to keep blood goign

Question 34

Tricuspid atresia pres

Answer 34

centra cyanosis at birth, single heart sound
FTT tachpnea axhaustion during feeding
Tx: prostaglandin E1 to maintain PDA > surgery

Question 35

Truncus Arteriorsis

Answer 35

aorta and PA fail to separate
**VSD is always present
Sx: poor feeding lethary respiratory distress. narrow s2 spil at LLSB

Question 36

Total ANomalous Pulmonary venoud return

Answer 36

pulmonary veins drain into venoud system
*need some kind of R to Left shunt for oxygenation
Sx: varies depedning on location of venous connection
Tx: surgery