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Clin Med Peds > Peds Cardiology > Flashcards

Peds Cardiology Flashcards

1
Q

babies PMI is normal…

A

displaced b/c they are msmaller

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2
Q

RV heave = ?

A

RV HTN

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3
Q

what is the MOST SENSITIVE finding for anatomic abnormality on a baby?

A

thrills -> suggests anatomic abnormality

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4
Q

what is the MOST SENSITIVE finding for a respiratory issue in a baby? what could it indicate?

A

intercostal retractions -> could indicate a cardiac problem

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5
Q

what can large liver size in babies indicate?

A

CHF

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6
Q

when looking at extremities of baby on PE, what do you look for?

A

perfusion (color), edema, clubbing

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7
Q

babies should be what color?

A

pink (NOT BLUE -> MEANS CYANOSIS)

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8
Q

what do differential pulses (weak LE pulses) represent on a baby?

A

coarctation

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9
Q

what do bounding pulses on a baby represent?

A

L->R PDA shunt, aortic insufficiency

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10
Q

what do weak pulses on a baby represent?

A

cariogenic shock or coarctation

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11
Q

what is pulses paradoxes? what conditions does it indicate in babies?

A

exaggerated SBP drop (>10mmHg) with inspiration

indicates tamponade or severe asthma

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12
Q

what does pulses alternans mean and indicate in babies?

A

altering pulse strength

-LV mechanical dysfunction

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13
Q

what heart sounds MUST be identified on a baby? why?

A

S1 and S2 - b/c of murmurs being different in diastolic and systolic

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14
Q

when do you hear a mid-systolic click?

A

MVP

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15
Q

when is S2 loud in baby?

A

pulmonary HTN

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16
Q

when do you hear fixed, split S2?

A

ASD, PS

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17
Q

when do you hear gallop (S3)?

A

may be d/t cardiac dysfunction/volume overload

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18
Q

when do you hear muffled heart sounds and/or a rub?

A

pericardial effusion +/- tamponade

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19
Q

what are 3 types of murmurs?

A

systolic ejection murmur, holosystolic murmur, continuous murmur

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20
Q

what does a systolic ejection murmur sound like? what 2 heart sounds does it come in b/w?

A

turbulence across a valve

comes b/w S1 and S2

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21
Q

what does holosystolic murmur sound like and what 2 conditions is it in?

A

turbulence gins with systole (VSD, MR)

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22
Q

what do you usually feel in a holosystolic murmur?

A

thrills

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23
Q

what is a continuous murmur and what condition is it seen in?

A

pressure difference in systole and diastole (PDA)

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24
Q

what provides oxygen to the fetus in the womb?

A

the placenta

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25
Q

what 3 shunts are normal in baby in womb and what do they allow for?

A

ductus venosus (bypasses liver)

foramen ovale (R -> L atrial shunt)

ductus arteriosus (R -> L arterial shunt)

SHUNTS ALLOW OXYGENATION TO OCCUR

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26
Q

what do shunt allow for as the baby is in the womb?

A

SHUNTS ALLOW OXYGENATION TO OCCUR

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27
Q

how many arteries and veins does the umbilical cord have? what veins carry oxygenated blood to the baby?

A

2 umbilical arteries and 1 umbilical vein

pulmonary vein and umbilical vein carry oxygenated blood to the baby

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28
Q

when do the shunts in the baby begin to shut down?

A

after the body is born

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29
Q

what do the umbilical arteries do when the placenta is removed from the fetal circulation?

A

the umbilical arteries constrict to help prevent loss of the babies blood

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30
Q

when is the umbilical cord tied off? why wait this long?

A

umbilical cord is not tied for 30-60 seconds so that blood flow thru umbilical vein continues to transfer fetal blood from placenta to the infant

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31
Q

when the umbilical cord is clamped, what is increased?

A

systemic vascular resistance is increased when the umbilical cord is clamped

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32
Q

what is the ductus venosus shunt? what type of blood does it carry? how does it close?

A

fetal blood vessel that connects the umbilical vein to the IVC causing blood to bypass babies liver

carries oxygenated blood

closes when umbilical vein pressure falls

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33
Q

what promotes lung expansion at babies birth?

A

the first breaths that the baby takes which causes the lungs/alveoli to fill with air and not fluid

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34
Q

aeration of the lungs at birth causes what?

A

decreased pulmonary vein resistance

increased pulmonary blood flow

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35
Q

what is the foramen ovale shunt? how does it close at birth?

A

shunt b/w the right and left atrium

closes at birth b/c the pressure becomes decreased in the right atrium and increased in the left atrium -> left atrium pressure causes the septum push up against and to close the foramen ovale

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36
Q

what does the ductus arteriosus shunt protect the baby from prior to birth?

A

protects the lungs against circulatory overload

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37
Q

what does the ductus arteriosus become after birth?

A

becomes ligamentous arteriosum which tacts the heart down

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38
Q

where is the ductus arteriosus shunting blood from and to?

A

from pulmonary artery directly to the aorta (bypassing the lungs)

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39
Q

when does the ductus arteriosus close after birth in mature infants?

A

functionally closes 24-48 hrs and structurally w/in a few weeks (in mature infants)

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40
Q

what causes the ductus arteriosus to close after birth?

A

increased O2 sat, decreased pulmonary resistance, and decreased prostaglandin E2 levels

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41
Q

in what pathology of the heart would you want to keep the ductus arteriosus open and how do you keep it open?

A

for tetralogy of fallout want to keep ductus arteriosus open at times and the only way to do this is by regulating prostaglandins by using NSAIDs

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42
Q

in what babies may the ductus arteriosus remain open for much longer?

A

in premature infants and in those with persistent hypoxia (may be d/t prostaglandins)

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43
Q

at birth, which ventricle becomes dominant d/t pulmonary resistance dropping? what is the pressure like in the RV and LV in utero?

A

LV becomes dominant d/t pulmonary resistance dropping

in utero, pulmonary vein resistance is high so initially RB pressure and LV pressure are similar

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44
Q

what does the foramane ovale become?

A

fossa ovalis

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45
Q

what does the umbilical vein become?

A

ligamentum teres

46
Q

what does the ductus venosus become?

A

ligamentum venosus

47
Q

who are innocent murmurs most common in?

A

pre-school age child

48
Q

innocent murmurs change with…

A

position

49
Q

what will accentuate murmurs?

A

high output state

50
Q

what imaging to find out the nature of a murmur?

A

ECHO

51
Q

what do you look at to figure out if the murmur is good or bad in children?

A

growth chart - good growth pattern is NOT pathologic murmur

52
Q

what does the still’s murmur sound like and where is it best heard?

A

vibratory, twangy, systolic murmur best head at left sternal border and apex

53
Q

still’s murmur is loudest in what position? in what position does it disappear? changes with…

A

loudest in supine position

disappears upright

CHANGES WITH POSITION

54
Q

still’s murmur thought to represent what?

A

vibration of the great vessels and/or LVOT

55
Q

still’s murmur will NEVER have what?

A

a thrill (thrill heard starting at 4/6 murmur)

56
Q

what children is pulmonary flow murmur heard in?

A

older children, adolescents

57
Q

what does the pulmonary flow murmur sound like?

A

systolic ejection murmur over the pulmonary area

58
Q

what is the grade of the pulmonary flow murmur?

A

grade 1-2/6

59
Q

pulmonary flow murmur increase with ___ position and decreases with ___ position

A

increases with supine position and decreases with upright position

60
Q

what does the venous hum sound like? what area is it best heard in?

A

low pitched continuous murmur often heard best in infraclavicular area, normal heart sounds

61
Q

venous hum murmur is loudest in what position? diminishes/disappears in what position?

A

loudest upright and diminishes/disappears when pt is supine or compression of jugular veins

62
Q

venous hum is continuous but may be louder during what phase?

A

systole

63
Q

what are the 4 red flags of murmurs?

A

(1) diastolic murmurs (only venous hum is ok) - continuous murmurs
(2) loud murmurs, especially with thrills
(3) little or no effect with change in position
(4) SYMPTOMS, especially cyanosis

64
Q

at what time frame should PDA be gone by?

A

by 48 hours

65
Q

what is the most sensitive indication of baby with heart problem?

A

baby that feeds poorly or sweats when they feed

66
Q

congenital heart disease is classified by what 3 things?

A

acyanotic (L -> R shunts)

cyanotic (R -> L shunts)

obstructive lesions

67
Q

what type of sx’s are seen with L->R acyanotic shunts?

A

pulmonary edema sx’s -> edema, swelling, rest issues

68
Q

what type of sx’s are seen with R->L cyanotic shunts?

A

cyanosis, weakness, baby not feeding well, not growing well

69
Q

if babies don’t turn pink, what type of shunt do they have?

A

R->L shunt b/c deoxygenated blood is mixing with the oxygenated blood

70
Q

what are the 3 primary defects of L->R acyanotic shunts?

A

VSD, PDA, ASD

71
Q

what is VSD?

A

type of L->R acyanotic shunt

blood flows from high pressure left ventricle to the lower pressure right ventricle

72
Q

what is PDA?

A

type of L->R acyanotic shunt

blood flows from high pressure aorta to the lower pressure pulmonary artery

73
Q

what is ASD?

A

type of L->R acynatoic shunt

blood flow from higher pressure left atrium to the lower pressure right atrium

74
Q

VSD and PDA present when and with what?

A

presents in infancy with HF, murmur, and poor growth/poor feeding

75
Q

what part of the heart is enlarged in VSD and PDA?

A

left heart enlargement

76
Q

what are the sx’s of ASD?

A

asx

77
Q

when does ASD present and with what?

A

presents in childhood with murmur or exercise intolerance

78
Q

what part of the heart is enlarged in ASD if severe?

A

right heart enlargement

79
Q

what is the most common of all congenital heart malformations?

A

VSD

80
Q

what type of murmur does VSD have, where is it heard and what does it have?

A

holosystolic murmur at lower left sternal border with heave

81
Q

what are clinical features of VSD?

A

FTT, tachypnea, and diaphoresis with feeding

82
Q

what type of murmur is ASD and heard where?

A

Grade 1-3 systolic ejection murmur at the pulmonary area

83
Q

large ASD causes what type of murmur and where?

A

large ASD shunts cause a diastolic flow murmur at the lower left sternal border (increased flow across the tricuspid valve)

84
Q

what are the s/s of PDA?

A

FTT and diaphoresis with feeds

BOUNDING PULSE

85
Q

PDA can be treated with what?

A

indomethacin

86
Q

in R->L cyanotic shunts, deoxygenated blood is bypassing what?

A

the lungs

87
Q

R->L shunts are classified based on what?

A

pulmonary blood flow

88
Q

what is the most common R->L shunt with decreased pulmonary blood flow?

A

Tetralogy of Fallot

89
Q

what is the MOST IMPORTANT feature of Tetraology of Fallot?

A

Right ventricular outflow tract obstruction d/t pulmonary stenosis

90
Q

what are the 4 features of Tetralogy of Fallot?

A

(1) Right ventricular outflow tract obstruction
(2) VSD
(3) Overriding aorta (aortic dextroposition) - aorta pushed to both sides of heart
(4) Right ventricular hypertrophy (d/t the stenosis)

91
Q

Tetralogy of Fallot heart is what shape on X-ray?

A

Boot-shaped

92
Q

what is the murmur from in Tetralogy of Fallot?

A

Pulmonary stenosis

93
Q

what is key to Kawasaki disease and why?

A

early dx b/c can develop neurological deficits

94
Q

etiology of Kawasaki?

A

unknown, thought to be infectious in nature

95
Q

what sign MUST kid have for it to be Kawasaki’s Disease?

A

Fever (102.2F, 39C) for 5 days or longer

96
Q

what other symptoms should kid with Kawasaki’s Disease have at least 4 of for dx?

A

(1) Non-purulent bulbar conjunctivitis
(2) skin rash
(3) extremity change (erythema, induration, desquamation, edema)
(4) Lymphadenopathy (>1.5 cm)

(5) Oropharyngeal
changes (strawberry tongue, cracked red lips)

97
Q

mnemonic for Kawasaki’s symptoms?

A

CREAM + fever >5 days

C = bulbar non-exudative conjunctivitis
R = rash (polymorphous non-vesicular)
E = edema (or erythema of hands or feet)
A = adenopathy (cervical, unilateral)
M = mucosal involvement (erythema or fissures or crusting)
98
Q

what is rheumatic fever?

A

a post-infectious connective tissue disease that follows GAS pharyngitis by several weeks

99
Q

what is the earliest and most common feature of rheumatic fever? what is affected?

A

painful migratory arthritis

-large joints like knees, ankles, elbows or shoulders are affected

100
Q

symptoms of acute rheumatic fever?

A

chorea

erythema marginatum (skin rash) with clear margination and ring-shaped

subcutaneous nodules (painless)

101
Q

who is low risk and high risk for rheumatic fever?

A

people from US = low risk

people from anywhere else but US = high risk

102
Q

what 2 symptoms are good enough to make dx of rheumatic fever?

A

poly arthritis and chorea

103
Q

what is HOCM?

A

autosomal dominant abnormality that results in hypertrophy of the ventricular myocardium

result is left ventricular outflow obstruction

104
Q

what is a common cause of cardiac arrest in young athletes?

A

HOCM

105
Q

is HOCM familial? what is it important to ask about?

A

yes - important to ask about hx of excise problems related to the heart in the family

106
Q

most common symptom of HOCM? what are you looking for work-up of HOCM?

A

syncope = M/C sx

looking for arrhythmias on work-up of HOCM

107
Q

what kinda of murmur is HOCM? heard where?

A

systolic ejection murmur heard at the left sternal border and apex

108
Q

what does HOCM increase with?

A

valsalva or with standing

109
Q

what is the only murmur that changes with position and is NOT innocent?

A

HOCM

110
Q

HOCM evaluation?

A

12-lead ECG

24hr ambulatory ECG monitoring

Echo with Doppler for participation clearance

Clin Med Peds (10 decks)

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