Peds Cardiology Flashcards
1
Q
babies PMI is normal…
A
displaced b/c they are msmaller
2
Q
RV heave = ?
A
RV HTN
3
Q
what is the MOST SENSITIVE finding for anatomic abnormality on a baby?
A
thrills -> suggests anatomic abnormality
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
5
Q
what can large liver size in babies indicate?
A
CHF
6
Q
when looking at extremities of baby on PE, what do you look for?
A
perfusion (color), edema, clubbing
7
Q
babies should be what color?
A
pink (NOT BLUE -> MEANS CYANOSIS)
8
Q
what do differential pulses (weak LE pulses) represent on a baby?
A
coarctation
9
Q
what do bounding pulses on a baby represent?
A
L->R PDA shunt, aortic insufficiency
10
Q
what do weak pulses on a baby represent?
A
cariogenic shock or coarctation
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
12
Q
what does pulses alternans mean and indicate in babies?
A
altering pulse strength
-LV mechanical dysfunction
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
14
Q
when do you hear a mid-systolic click?
A
MVP
15
Q
when is S2 loud in baby?
A
pulmonary HTN
16
Q
when do you hear fixed, split S2?
A
ASD, PS
17
Q
when do you hear gallop (S3)?
A
may be d/t cardiac dysfunction/volume overload
18
Q
when do you hear muffled heart sounds and/or a rub?
A
pericardial effusion +/- tamponade
19
Q
what are 3 types of murmurs?
A
systolic ejection murmur, holosystolic murmur, continuous murmur
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
21
Q
what does holosystolic murmur sound like and what 2 conditions is it in?
A
turbulence gins with systole (VSD, MR)
22
Q
what do you usually feel in a holosystolic murmur?
A
thrills
23
Q
what is a continuous murmur and what condition is it seen in?
A
pressure difference in systole and diastole (PDA)
24
Q
what provides oxygen to the fetus in the womb?
A
the placenta
25
what 3 shunts are normal in baby in womb and what do they allow for?
ductus venosus (bypasses liver)
foramen ovale (R -> L atrial shunt)
ductus arteriosus (R -> L arterial shunt)
SHUNTS ALLOW OXYGENATION TO OCCUR
26
what do shunt allow for as the baby is in the womb?
SHUNTS ALLOW OXYGENATION TO OCCUR
27
how many arteries and veins does the umbilical cord have? what veins carry oxygenated blood to the baby?
2 umbilical arteries and 1 umbilical vein
pulmonary vein and umbilical vein carry oxygenated blood to the baby
28
when do the shunts in the baby begin to shut down?
after the body is born
29
what do the umbilical arteries do when the placenta is removed from the fetal circulation?
the umbilical arteries constrict to help prevent loss of the babies blood
30
when is the umbilical cord tied off? why wait this long?
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
31
when the umbilical cord is clamped, what is increased?
systemic vascular resistance is increased when the umbilical cord is clamped
32
what is the ductus venosus shunt? what type of blood does it carry? how does it close?
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
33
what promotes lung expansion at babies birth?
the first breaths that the baby takes which causes the lungs/alveoli to fill with air and not fluid
34
aeration of the lungs at birth causes what?
decreased pulmonary vein resistance
increased pulmonary blood flow
35
what is the foramen ovale shunt? how does it close at birth?
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
36
what does the ductus arteriosus shunt protect the baby from prior to birth?
protects the lungs against circulatory overload
37
what does the ductus arteriosus become after birth?
becomes ligamentous arteriosum which tacts the heart down
38
where is the ductus arteriosus shunting blood from and to?
from pulmonary artery directly to the aorta (bypassing the lungs)
39
when does the ductus arteriosus close after birth in mature infants?
functionally closes 24-48 hrs and structurally w/in a few weeks (in mature infants)
40
what causes the ductus arteriosus to close after birth?
increased O2 sat, decreased pulmonary resistance, and decreased prostaglandin E2 levels
41
in what pathology of the heart would you want to keep the ductus arteriosus open and how do you keep it open?
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
42
in what babies may the ductus arteriosus remain open for much longer?
in premature infants and in those with persistent hypoxia (may be d/t prostaglandins)
43
at birth, which ventricle becomes dominant d/t pulmonary resistance dropping? what is the pressure like in the RV and LV in utero?
LV becomes dominant d/t pulmonary resistance dropping
in utero, pulmonary vein resistance is high so initially RB pressure and LV pressure are similar
44
what does the foramane ovale become?
fossa ovalis
45
what does the umbilical vein become?
ligamentum teres
46
what does the ductus venosus become?
ligamentum venosus
47
who are innocent murmurs most common in?
pre-school age child
48
innocent murmurs change with...
position
49
what will accentuate murmurs?
high output state
50
what imaging to find out the nature of a murmur?
ECHO
51
what do you look at to figure out if the murmur is good or bad in children?
growth chart - good growth pattern is NOT pathologic murmur
52
what does the still's murmur sound like and where is it best heard?
vibratory, twangy, systolic murmur best head at left sternal border and apex
53
still's murmur is loudest in what position? in what position does it disappear? changes with...
loudest in supine position
disappears upright
CHANGES WITH POSITION
54
still's murmur thought to represent what?
vibration of the great vessels and/or LVOT
55
still's murmur will NEVER have what?
a thrill (thrill heard starting at 4/6 murmur)
56
what children is pulmonary flow murmur heard in?
older children, adolescents
57
what does the pulmonary flow murmur sound like?
systolic ejection murmur over the pulmonary area
58
what is the grade of the pulmonary flow murmur?
grade 1-2/6
59
pulmonary flow murmur increase with ___ position and decreases with ___ position
increases with supine position and decreases with upright position
60
what does the venous hum sound like? what area is it best heard in?
low pitched continuous murmur often heard best in infraclavicular area, normal heart sounds
61
venous hum murmur is loudest in what position? diminishes/disappears in what position?
loudest upright and diminishes/disappears when pt is supine or compression of jugular veins
62
venous hum is continuous but may be louder during what phase?
systole
63
what are the 4 red flags of murmurs?
(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
at what time frame should PDA be gone by?
by 48 hours
65
what is the most sensitive indication of baby with heart problem?
baby that feeds poorly or sweats when they feed
66
congenital heart disease is classified by what 3 things?
acyanotic (L -> R shunts)
cyanotic (R -> L shunts)
obstructive lesions
67
what type of sx's are seen with L->R acyanotic shunts?
pulmonary edema sx's -> edema, swelling, rest issues
68
what type of sx's are seen with R->L cyanotic shunts?
cyanosis, weakness, baby not feeding well, not growing well
69
if babies don't turn pink, what type of shunt do they have?
R->L shunt b/c deoxygenated blood is mixing with the oxygenated blood
70
what are the 3 primary defects of L->R acyanotic shunts?
VSD, PDA, ASD
71
what is VSD?
type of L->R acyanotic shunt
blood flows from high pressure left ventricle to the lower pressure right ventricle
72
what is PDA?
type of L->R acyanotic shunt
blood flows from high pressure aorta to the lower pressure pulmonary artery
73
what is ASD?
type of L->R acynatoic shunt
blood flow from higher pressure left atrium to the lower pressure right atrium
74
VSD and PDA present when and with what?
presents in infancy with HF, murmur, and poor growth/poor feeding
75
what part of the heart is enlarged in VSD and PDA?
left heart enlargement
76
what are the sx's of ASD?
asx
77
when does ASD present and with what?
presents in childhood with murmur or exercise intolerance
78
what part of the heart is enlarged in ASD if severe?
right heart enlargement
79
what is the most common of all congenital heart malformations?
VSD
80
what type of murmur does VSD have, where is it heard and what does it have?
holosystolic murmur at lower left sternal border with heave
81
what are clinical features of VSD?
FTT, tachypnea, and diaphoresis with feeding
82
what type of murmur is ASD and heard where?
Grade 1-3 systolic ejection murmur at the pulmonary area
83
large ASD causes what type of murmur and where?
large ASD shunts cause a diastolic flow murmur at the lower left sternal border (increased flow across the tricuspid valve)
84
what are the s/s of PDA?
FTT and diaphoresis with feeds
BOUNDING PULSE
85
PDA can be treated with what?
indomethacin
86
in R->L cyanotic shunts, deoxygenated blood is bypassing what?
the lungs
87
R->L shunts are classified based on what?
pulmonary blood flow
88
what is the most common R->L shunt with decreased pulmonary blood flow?
Tetralogy of Fallot
89
what is the MOST IMPORTANT feature of Tetraology of Fallot?
Right ventricular outflow tract obstruction d/t pulmonary stenosis
90
what are the 4 features of Tetralogy of Fallot?
(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
Tetralogy of Fallot heart is what shape on X-ray?
Boot-shaped
92
what is the murmur from in Tetralogy of Fallot?
Pulmonary stenosis
93
what is key to Kawasaki disease and why?
early dx b/c can develop neurological deficits
94
etiology of Kawasaki?
unknown, thought to be infectious in nature
95
what sign MUST kid have for it to be Kawasaki's Disease?
Fever (102.2F, 39C) for 5 days or longer
96
what other symptoms should kid with Kawasaki's Disease have at least 4 of for dx?
(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
mnemonic for Kawasaki's symptoms?
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
what is rheumatic fever?
a post-infectious connective tissue disease that follows GAS pharyngitis by several weeks
99
what is the earliest and most common feature of rheumatic fever? what is affected?
painful migratory arthritis
| -large joints like knees, ankles, elbows or shoulders are affected
100
symptoms of acute rheumatic fever?
chorea
erythema marginatum (skin rash) with clear margination and ring-shaped
subcutaneous nodules (painless)
101
who is low risk and high risk for rheumatic fever?
people from US = low risk
people from anywhere else but US = high risk
102
what 2 symptoms are good enough to make dx of rheumatic fever?
poly arthritis and chorea
103
what is HOCM?
autosomal dominant abnormality that results in hypertrophy of the ventricular myocardium
result is left ventricular outflow obstruction
104
what is a common cause of cardiac arrest in young athletes?
HOCM
105
is HOCM familial? what is it important to ask about?
yes - important to ask about hx of excise problems related to the heart in the family
106
most common symptom of HOCM? what are you looking for work-up of HOCM?
syncope = M/C sx
looking for arrhythmias on work-up of HOCM
107
what kinda of murmur is HOCM? heard where?
systolic ejection murmur heard at the left sternal border and apex
108
what does HOCM increase with?
valsalva or with standing
109
what is the only murmur that changes with position and is NOT innocent?
HOCM
110
HOCM evaluation?
12-lead ECG
24hr ambulatory ECG monitoring
Echo with Doppler for participation clearance
