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PHA 581 > Peds: Cardiology > Flashcards

Peds: Cardiology Flashcards

1
Q

Abnormal S2 Sounds: Widely Split S2

A 
electrical delay (RBBB)
VSD repair (TOF)
pulmonic stenosis

prolonged RV emptying

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2
Q

Abnormal S2 Sounds: Fixed Split S2

A

volume overload (ASD)

L–> R shunt/flow
excess flow from L heart to pulmonary bed

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3
Q

Abnormal S2 Sounds: Narrowed Split S2

A

pulmonary HTN (loud S2)

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4
Q

Abnormal S2 Sounds: Paradoxical Split S2

A 
electrical delay (LBBB)
aortic stenosis

prolonged LV emptying
split eliminated on inspiration

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5
Q

Abnormal S2 Sounds: Single S2

A

complex heart defect (TGA)

single ventricle defect

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6
Q

Adventitious Heart Sounds: S3 sound

A

low pitch
early diastole
best heard at apex
rapid ventricular filling/vol overload (pregnancy, MR/TR)

can be normal variant in children

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7
Q

Adventitious Heart Sounds: S4 sound

A 
low pitch
late diastole
best heard at apex
obstruction, dec ventricular compliance 
pathologic: HTN, CM, pulmonary stenosis
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8
Q

Other Sounds: Click

A

pulmonary stenosis (LUSB, changes w/ expiration)

aortic stenosis (apex, no change w/ respiration)

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9
Q

Other Sounds: friction rub

A

pericarditis (EKG: diffuse ST elevation)

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10
Q

Pulses: PDA

A

bounding

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11
Q

Pulses: aortic stensosis, HLHS

A

weak, thready

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12
Q

Pulses: coarcation

A

LE: poor, absent, delay

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13
Q

Innocent Heart Murmurs

A

still’s murmur (systolic)
venous hum murmur (continuous)
peripheral pulmonary stenosis (systolic)

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14
Q

Pathological Heart Murmurs

A

systolic
diastolic
continuous

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15
Q

Murmur Radiation:

  • neck
  • back
  • axilla
A
  • neck: aortic stenosis
  • back: pulmonary valve stenosis
  • axilla: peripheral pulmonary murmur
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16
Q

Systolice Murmur: ejection

A 
aortic/pulmonary stenosis
HCM
ASD
Still's
COA
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17
Q

Systolic Murmur: holocystolic

A

VSD

mitral/tricuspid regurgitation

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18
Q

Diastolic Murmur

A

early: semilunar valves
- aortic/pulmonic regurgitation
- mitral stenosis

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19
Q

Continuous Murmur

A

PDA
venous hum murmur
coronary fistula

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20
Q

Innocent Heart Murmurs: qualities

A 
Systolic
Soft intensity (Grade <4) 
Musical/vibratory 
Altered with positions or respirations  
NOT associated with adventitious heart sounds 
NO associated symptoms 
NO associated findings 
Louder with stress
Fever, pain, anxiety
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21
Q

Pathological Heart Murmurs: qualities

A 
Diastolic or continuous 
Increase intensity
Grade > 4 (with thrill) 
Harsh
No changes with position or respiration
Louder with standing 
Clicks or S4
Gallop rhythm 
Abnormal physical exam
Poor pulses
Unequal UE/LE blood pressures 
Abnormal EKG
Hypertrophy, arrhythmias
Abnormal CXR:
Cardiomegaly 
Cardiac symptoms 
Syncope  
Syndromes
Trisomy 21 (Down syndrome)
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22
Q

Murmur: Supine Position

A

inc innocent

dec HCM

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23
Q

Murmur: Sitting Position

A

inc venous hum

dec innocent

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24
Q

Murmur: Standing Position

A

inc HCM, mitral valve prolapse

dec aortic stenosis

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25
Q

Murmur: Valsalva

A

dec innocent

inc HCM

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26
Q

What is the MC innocent heart murmur?

A

Still’s murmur

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27
Q

Still’s Murmur:

  • age group
  • EKG
  • evaluation
A

3-6yo - outgrow in adolescence
normal EKG

low frequency
musical/vibratory
LMSB, LLSB, apex
loudest w/ supine, stress 
dec w/ sitting
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28
Q

Venous Hum Murmur:

  • aka
  • age group
  • etiology
  • evaluation
A

cervical hum murmur
3-6yo

turbulence due to jugular venous drainage

continuous (R>L)
base
loudest: upright
dec w/ supine/turning neck

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29
Q

Peripheral Cyanosis

A

aka: acrocyanosis
normal saturation and PaO2
normal transitional newborn physiology
due to vasospasm of sm arterioles

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30
Q

Central Cyanosis

A

blue lips, tongue
low saturations and PaO2
CHD

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31
Q

Patent Ductus Arteriosus:

  • functional closure
  • anatomic closure
A

functional closure: 12-90hrs

anatomic closure: 2-3wks

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32
Q

Pink Baby

A

normal baby
normal physiology
normal heart
PDA closed

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33
Q

Blue Baby

A

clue to CHD

PDA closing

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34
Q

Grey Baby

A

intracardiac shunt closed
need PGE to open PDA
no mixing of blood

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35
Q

Blue or Purple Baby

A

PDA patency open
palliation to provide PBF or systemic blood flow
saturation 75-90%
mixing of blood

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36
Q

CHD Symptoms: tachypnea

A

L to R shunt

CXR: pulmonary edema, cardiomegaly

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37
Q

CHD Symptoms: cyanosis

A

R to L shunt, obstruction to lungs

blue baby
low saturations
CXR: dec PBF

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38
Q

CHD Symptoms: grey baby

A

dec/no systemic blood flow

poor perfusion
lactic acidosis

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39
Q

CHD Physiology: volume overload

A

L to R shunt (ASD, VSD, PDA)

dilation of heart chambers

CXR: cardiomegaly, inc PBF

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40
Q

CHD Physiology: pressure overload

A

outflow obstruction (aortic, pulmonary)

hypertrophy of heart chambers

EKG: LVH, RVH

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41
Q

CHD Physiology: cyanotic lesion

A

R to L shunt
no PBF
poor mixing of blood

low saturations

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42
Q

Acyanotic Defects

A

(volume issue)

ASD
VSD
PDA

43
Q

Cyanotic Defects

A

TOF
TGA
truncus arteriosus
tricuspid atresia

44
Q

Obstructive Defects

A

PS

COA

45
Q

Complex Heart Defect/Single Ventricle

A

HLHS

46
Q

What type of shunt is usually associated with ACYANOTIC defects?

A

L to R shunt

47
Q

ASD

A

R ventricular volume load

48
Q

VSD, PDA, AV canal defects

A

L ventricular volume load

49
Q

What is the effect of volume loading on the heart?

A

dilation of the ventricles (and atria)

50
Q

Which CHD does NOT require PGE to treat?

A

acyanotic defects

51
Q

Symptoms of L to R Shunting (+ exception)

A

tachypnea
poor feeding
exercise intolerance
poor growth

**EXCEPTION: large ASDs: asymptomatic

52
Q

Atrial Septal Defect:

  • physical exam
  • auscultation
  • EKG
A

precordial bulge
hyperdynamic precordium

fixed split S2
grade 2-3/6 systolic ejection murmur at LUSB
diastolic rumble at RLSB
does NOT change w/ position

R axis dev
RV conduction delay

53
Q

Atrial Septal Defect: treatment

A

may close spontaneously

surgery vs percutaneous closure

54
Q

What is the MC congenital heart defect?

A

ventricular septal defect

55
Q

What is the MC defect of a ventricular septum?

A

muscular

56
Q

Ventricular Septal Defect: consequences of mod-large defect

A

CHF (FTT, hepatomegaly, diaphoresis w/ feeding)

57
Q

Ventricular Septal Defect: complication

A

if untreated: pulmonary vascular disease (irreversible)

58
Q

Ventricular Septal Defect: small defects

A

Normal growth and development
Holosystolic murmur, grade 2-3/6
High-pitched, short duration
Normal S2

59
Q

Ventricular Septal Defect: large defects

A 
Failure to thrive
Holosystolic murmur, grade 2-3/6
Lower-pitched
Loud S2
May hear apical diastolic “rumble”
Diastolic murmur of aortic regurgitation
60
Q

Ventricular Septal Defect:

  • EKG
  • CXR
A

LVH, RVH

cardiomegaly

61
Q

Patent Ductus Arteriosus: seen with…

A

MC: premature newborn, newborn w/ primary pulmonary HTN

hypoplastic L heart syndrome
pulmonary atresia
asymptomatic w/ continuous murmur

62
Q

Patent Ductus Arteriosus: presentation:

  • preemies
  • small PDA
  • large PDA
A

preemies: failure to wean from vent, FTT
small: asymptomatic
large: similar to VSD (CHF, diaphoresis w/ feeding)

63
Q

In a newborn with cyanosis and lower ext sats < upper ext sats what is the cause (until proven otherwise)?

A

R to L shunt of PDA?

64
Q

Patent Ductus Arteriosus: physical exam (pulse, murmur):

  • large shunt
  • small shunt
A 
large:
bounding pulses
wide pulse pressure
CONTINUOUS MACHINERY LIKE MURMUR AT LUSB/AXILLA
diastolic rumble

small:
no findings

65
Q

Patent Ductus Arteriosus: differential cyanosis

A 
hands PURPLE (94%)
feet BLUE (85-90%)

BLUE BLOOD MIXING WITH RED BLOOD

elevated pulmonary pressures or inc PVR

66
Q

Patent Ductus Arteriosus: treatment

  • preemies
  • small audible PDA in older child
  • nonaudible incidental finding
A

preemie: NSAIDs, ductal ligation

sm audible: coil/device occlusion, ductal ligation

incidental: no tx

67
Q

Cyanotic Heart Defects

A

tetralogy of fallot
transposition of the great arteries
truncus arteriosus

68
Q

Which CHD require prostaglandins to treat?

A

cyanotic heart defects
severe obstructive heart defects
severe coarcation of aorta
severe aortic stenosis

69
Q

Indications to start prostaglandin therapy

A 
blue/grey baby 
cyanotic heart defect
obstruction to lungs or systemic blood flow
abnormal CXR, EKG, ABG
failure to improve w/ oxygen
FAILED PULSE OX TESTING
70
Q

Tetralogy of Fallot: comprised of 4 abnormalities

A

VSD
PS/RVOT obstruction
overriding aorta
RVH

71
Q

Tetralogy of Fallot: degree of cyanosis depends on…

A

size of pulmonary annulus relative to aorta
pulmonary vascular resistance
size of VSD

72
Q

Tetralogy of Fallot: other associated abnormalities

A

DiGeorge syndrome

Down Syndrome

73
Q

Tetralogy of Fallot: physical exam

  • murmur
  • types
  • CXR
A

harsh systolic LUSB
cyanosis

TET:

  • blue: severe
  • pink: less severe

CXR: boot shaped

74
Q

TET Spell:

  • what is it
  • presentation
A

spasm of RVOT muscle

fussy
cyanotic
loss of systolic heart murmur

75
Q

TET Spell: intervention

A 
keep calm
oxygen
volume (NS bolus)
knee to chest maneuver
morphine
propanolol

early vs delayed repair

76
Q

Transposition of the Great Arteries: what is it

A

oxygenated blood recirulates through lungs –> cycle of hypoxemia, acidosis

state of parallel circulation

77
Q

Transposition of the Great Arteries:

what defects can allow for mixing, ensuring survival?

A

concomitant PFO, VSD, PDA

78
Q

Transposition of the Great Arteries: treatment

A

arterial switch operation

79
Q

Truncus Arteriosus:

  • comprised of
  • associated disorder
A

aortic arch abnormalities
VSD
coronary artery conductive system abnormalities

DiGeorge syndrome

80
Q

Truncus Arteriosus:

  • diagnosis
  • treatment
A

echocardiography

surgical repair

81
Q

Obstructive Heart Defects:

  • obstruction to pulmonary blood flow
  • obstruction to systemic blood flow
A

PBF:
-pulmonary stenosis

SBF:

  • coarcation of aorta
  • aortic stenosis

**both: treat w/ PGE in sev cases

82
Q

Pulmonary Stenosis:

  • murmur
  • EKG
A

harsh systolic ejection murmur at LUSB w/ click

RVH

83
Q

Pulmonary Stenosis: treatment

A

<40mmHg: follow conservatively w/ echo

TOC: balloon valvuloplasty

84
Q

Coarcation of the Aorta:

  • what is it
  • murmur
  • pulse
  • BP
  • severe cases
A

narrowing of aortic isthmus
pressure load on LV

systolic murmur at precordium
dec LE pulses
BP >20mmHg (inc UE, dec LE)

shock, dec renal perfusion (tx w/ PGE)

85
Q

Coarcation of the Aorta: associated disorders

A

bicuspid aortic valve

TURNER SYNDROME

86
Q

Aortic Stenosis:

  • murmur
  • associated disorders
  • EKG
  • Echo
A

systolic ejection murmur at RUSB
click

associated w/:

  • bicuspid aortic valve
  • COA

EKG: LVH (strain)
Echo: concentric LVH

87
Q

Aortic Stenosis: treatment

A

mild: monitor clinically
balloon valvuloplasty
surgical

88
Q

Complex Heart Defect/Single Ventricle: conditions

A
  • hypoplastic left heart syndrome (HLHS)

- true single ventricle

89
Q

Hypoplastic Left Heart Syndrome: what is it

A

complete mixing of systemic and pulmonary venous return blood w/in atria

underdeveloped L ventricle
PFO
ASD

usually obstruction of pulmonary blood flow OR systemic blood flow

90
Q

Hypoplastic Left Heart Syndrome: treatment

A

staged procedures (neonatal, 2-4yrs)

91
Q

Why do we do cardiac sport screenings?

A

to prevent sudden cardiac death

92
Q

What is the MCC of sudden cardiac death?

A

HCM

93
Q

What are the highest risk sports for sudden cardiac death?

A

track

basketball

94
Q

Hypertrophic Cardiomyopathy

A

disarray of hypertrophic myocardial cells

concentric hypertrophy

  • LV stiffness
  • impaired diastolic filling
  • normal systolic function

inc ventricular arrythmias

95
Q

Marfan Syndrome: cardiac abnormalities

A

aortic root dilation
aortic root rupture
mitral valve prolapse

96
Q

Reasons to Consider EKG Screening

A 
Premature ventricular contractions (PVCs)
LVH and LV strain patterns
Wolff Parkinson White syndrome
Long QT syndrome (QTc > 460)
Brugada syndrome
Heart block
97
Q

Commotio Cordis

A

blunt force trauma to chest wall over heart during upstroke of T wave

inc risk for ventricular arrhythmias

98
Q

Pediatric Dyslipidemia:

-universal screening

A

all children 9-11yo (lipid panel - fasting)

99
Q

Pediatric Dyslipidemia:

  • risk factors
  • risk conditions
A 
Overweight 
Obesity 
Family history CAD 
Acanthosis
Hypertension

Kawasaki
Diabetes
Transplant

100
Q

Pediatric Dyslipidemia: treatment

A

diet
exercise
weight loss
statin (10+yo)

101
Q

Kawasaki Disease: presentation

A

High spiking fevers > 5 days
Swelling extremities
Peeling of fingers or toes
Polymorphous exanthema (bad diaper rash)
Bilateral conjunctival injection (no exudate)
Changes lips & mouth (lips cracking, strawberry tongue, red mouth)
Unilateral cervical lymphadenopathy
Thrombocytosis
Sterile pyuria
↑ LFTs

102
Q

Kawasaki Disease: treatment

A

IVIG

high dose ASA

103
Q

Kawasaki Disease: other considerations

A

Delay live vaccines (~11 months)
ASA discontinued after 6-8 weeks (no previous history of dilated coronaries)
Activity restriction
↑ risk of premature atherosclerosis (statin)

104
Q

Kawasaki Disease: complication

A

high risk of coronary aneurysms

PHA 581 (6 decks)

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