Peds: Cardiology

Question 1

Which heart defect is a through & through communication between the atria at the septal level?

Answer 1

atrial septal defect (ASD)

Question 2

What is the pathophysiology of atrial septal defect?

Answer 2

large enough defect to allow free communication between the atria

Question 3

What do most ASDs occur & why?

Answer 3

mid septum due to lack of tissue for overlap

Question 4

What are some symptoms for ASD?

Answer 4

most are asymptomatic (defect often missed in childhood)

fatigue

dyspnea

decreased stamina

paradoxical emboli can result in stroke

Question 5

What is the murmur like for ASD?

Answer 5

Grade II-III midsystolic crescendo-descresendo murmur

heard at upper LSB

Question 6

What will the EKG show with someone with ASD?

Answer 6

RSR’ in right precordial leads w/ mostly widened QRS (RBBB)

Question 7

What is the diagnostic test used to identify ASD?

Answer 7

Echo-Doppler

Question 8

What is the treatment for ASD?

Answer 8

once sxs are present- surgical/catheter closure

Question 9

What is coarctation of the aorta?

Answer 9

discreet narrowing of the distal segment of the aortic arch, just distal to the origin of the subclavian artery

causes obstruction to outflow to the lower half of the body

Question 10

What is the principle CV abnormality associated with coarctation of aorta?

Answer 10

LVH due to pressure overload

arterial hypertension

Question 11

What are some S/S for coarctation of the aorta?

Answer 11

50% present as infants with HF due to pressure overload

older kids-fatigue, dyspnea, fatigue in legs while running

HTN in childhood

upper body well-developed; legs very thing

Question 12

What will be some findings on a Chest Xray of someone with coarctation of the aorta?

Answer 12

LV prominent

HF-infants

motching of inferior margins of ribs in adolescence

Question 13

What will the EKG show in someone with coarctation of the aorta?

Answer 13

LVH

Question 14

What is the treatment for coarctation of the aorta?

Answer 14

surgery-direct resection/repair if possible

stenting via catheters is an option if feasible

Question 15

What is the persistant patency of the vessel that normally connects the pulmonary arterial system & the aorta in the fetus?

Answer 15

patent ductus arteriosus (PDA)

Question 16

Ductus often remains open in _______ deliveries

Answer 16

pre-term

Question 17

Moderate ductus

Answer 17

elevated PAP

significant shunting

Question 18

Large ductus

Question 19

equal pressures w/ marked L -> R shunting

Question 20

What are some S/S of PDA?

Answer 20

maternal hx of exposure to rubella

premature deliveries

large-HF develops first few weeks of life

systolic thrill over PA in suprasternal notch & LSB

Question 21

What is the murmur like in PDA?

Answer 21

murmur is continuous (through systole & diastole)

machinery murmur (Gr IV or louder)

Question 22

What is the diagnostic tool of choice for PDA?

Answer 22

Echo-doppler

Question 23

What is the ultimate goal of treatment for PDA & how is it accomplished?

Answer 23

goal-closure of the ductus

premature infants-Indomethacin

surgical/catheter closures

Question 24

What is the pathophysiology of pulmonic stenosis?

Answer 24

‘dome shaped’ stenosis of the PV

RV develops concentric hypertrophy & reflects degree of obstrution at the valvular level

Question 25

What is the major hemodynamic burden of pulmonic stenosis?

Answer 25

**right ventricular pressure overload**

Question 26

What are some S/S of pulmonic stenosis?

Answer 26

most asymptomatic unless obstruction is severe-DOE, fatigue ## Footnote **early systolic click in the upper LSB**

Question 27

What is the murmur like for pulmonic stenosis?

Answer 27

**loud** **harsh** **crescendo-decrescendo at upper LSB radiation towards the clavicle & louder w/ inspiration**

Question 28

What is the diagnostic tool that identifies pulmonic stenosis and estimates its severity?

Answer 28

**echo-doppler**

Question 29

What is the treatment of pulmonic stenosis?

Answer 29

valvuloplasty balloon valvuloplasty has replaced surgery as first approach

Question 30

What is tetralogy of fallot?

Answer 30

biventricular origin of the aorta

Question 31

What defect is an opening in the part of the ventricular septum that separates the two ventricles?

Answer 31

ventricular septal defect

Question 32

80% of ventricular septal defect involved what?

Answer 32

**the ​thin membranous septum**

Question 33

What are some S/S of VSD?

Answer 33

varies depending on size small-no sxs, murmur appears within 36 hrs of birth larger-**HF early in life**

Question 34

What is the murmur like in VSD?

Answer 34

**holosystolic murmur along LSB**

Question 35

What is the diagnostic tool used for VSD?

Answer 35

**echo-doppler**

Question 36

What is the treatment for VSD?

Answer 36

**majority of VSDs are small-close spontaneously** moderate/large-**surgical repair** **closure in early childhoo years if PAP is elevated**

Question 37

What is the most common cause of sudden cardiac death is athletes \< 35 yrs?

Answer 37

**hypertrophic cardiomyopathy**

Question 38

What is the leading cause of acquired heart disease in the US?

Answer 38

Kawasaki Diseas

Question 39

What are the S/S for Kawasaki Disease?

Answer 39

conjunctivitis lip or oral cavity changes cervical lympadenopathy polymorphous exanthema (rash) extremity changes (redness swelling of hands/feet)

Question 40

What is the treatment Kawasaki Disease?

Answer 40

IVIG (recudes aneurysm formation)