Peds Cardio X3 Flashcards
Cardiac disease in infants SX
FTT
Tachypnea with feeding/activity
Cadiac disease in older children sx
palpitations, chest pain
dizzines/syncope
exercise intolerance,
unexplained hypertension
what will hepatomegaly and Ascities indiicate
R sided heart failure
Clubbing of fingers/toes associated with?
appears after age 1
with cyanotic congenital heart disease
Echocardiogram
Gold standard
Ultrasound of the heart
1. Transthorasic echo (more common)
2. Transesophageal echo
EKG
evaluates electrical activity and cardiac postition
-evolves with age
CXR
exaluates
- position of heart/size/shape
- position of abdominal viscera
- pulmonary vasculature
Cardiac Catherization
fluroscopy when a wire is threaded up to the heart
- radioopaque dye injecednto evaluate anatomy
- samples and measure pressure
Innocent Murmurs characteristics
- no FH
- -<= 2grade 2
- short systolic duration
- minimal radiation
- soft intensity
- musical or vibratory quality
- normal pulse
- normal pulse ox,CXR, EKG
Still murmur
-most common innocent murmur
musical/vibratory
-short high pitched
- loudest supine, dimishes/disappears with inspiration or sitting
Pulmonary flow murmur
most common in older children and alsults >3
- sof SEM
- louder supine
venoud hum
2 and up continuous musical hum -hear at R/L USB *louder in diastole** -disappears with turning head or placing shild in supine
Acyanotic congenital heart disease
Vesntral septal defect
atrial septal defect
patent ductus arteriosis
coartication of aorta
Cyanotic conegital heart disease
- tetrlogy of Fallot
- transposition of the great arteries
- tricuspid ateriosus
- total anomalous pulmonry venoud return
-hypoplastic left heart syndrome
when should the ductus arteriosus close?
14 days
Vesntricular septal defect (VSD)
- most common congenital heart defet
- associated trisomy 21 and tetralogy of fallot
VSD presentation
Small VSD may be aymptomatic
Larger: FTT, poor growth, dyspnea, frequent respiratory infections
PE: tachycardia, tachypnea, hepatomegaly
**blowing harsh holosystolic murmur LLSB
VSD dx
Echo: locates
EKG: LVH
CXR: cardiomegaly, increased pulmonary vascular markings
VSD Managment
wait and see> esp with asymptomatic
Med: tx CHF (diuretic Ace inhibitor
Surgical: septal occlusion via caterization
* prefereec surgical closure via median sternotomy
Atrial Septal defect ASD classifies
Ostium secundum (most common)> oftenisolated Ostium primum> often associaye with other anomolies
ASD presentation
CHF, recurrent resp infections FTT
-fixed widely split s2 at pulmonary area
@ULSB
-surgical patch if larger than 6mm
Eisenmenger syndrome
if you have a PDA for a log time and the shunt can reverse at high pulomary pressures casuing cyanosis
Tx of PDA
Monitor
Keep open : IV prostagladin E1
Close it up : IV indomethacin (prostagandin inhibit)
Surgery if nonresponders
Coarctation of the Aorta
Narrowing of the aortic arch in the proximaldecending aorta near takeoff of the left subclavian artery
What is female coarctation of the aorta associated with
Turner syndrome
Coarctation of the aorta
Echo CXR -figure 3 sign -inferior rib notching Tx: surgery
Teralogy of fallot
Righ ventricular hypertrophy ventricular septal defect overiding aorta RV outflow obstruction **most common cyanotic CHD
Tetralogy of fallot presentation
“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
tetralogy of fallot
Pe: harsh systolic ejection ULSB echo-DX CXR: boot shaped heart > upturned apex Tx: oxygen knees to chest surgery by age 1
Tranpostion of the great arteries
second most common
-no murmur becuase no holes in heart
Presentation: profoundly cyanotic neonate “ blue baby
What do you need to keep open in transposition of great arteries
keep ASD open or PFO!!
so you can get some mixing of blood
Tx: of transposition of vessels
-balloon atrial septostomy to improve intraatrial communication
-prostaglandin E1 administration -keep ductus art open
-Surgery 4-7 days
arterial switch operation
Tricuspid Atresia
absence of a tricuspid valve - must occur with other defects at the sme time becuase we need to keep blood goign
Tricuspid atresia pres
centra cyanosis at birth, single heart sound
FTT tachpnea axhaustion during feeding
Tx: prostaglandin E1 to maintain PDA > surgery
Truncus Arteriorsis
aorta and PA fail to separate
**VSD is always present
Sx: poor feeding lethary respiratory distress. narrow s2 spil at LLSB
Total ANomalous Pulmonary venoud return
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
