Peds: Cardiology Flashcards
1
Q
Abnormal S2 Sounds: Widely Split S2
A
electrical delay (RBBB) VSD repair (TOF) pulmonic stenosis
prolonged RV emptying
2
Q
Abnormal S2 Sounds: Fixed Split S2
A
volume overload (ASD)
L–> R shunt/flow
excess flow from L heart to pulmonary bed
3
Q
Abnormal S2 Sounds: Narrowed Split S2
A
pulmonary HTN (loud S2)
4
Q
Abnormal S2 Sounds: Paradoxical Split S2
A
electrical delay (LBBB) aortic stenosis
prolonged LV emptying
split eliminated on inspiration
5
Q
Abnormal S2 Sounds: Single S2
A
complex heart defect (TGA)
single ventricle defect
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
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
8
Q
Other Sounds: Click
A
pulmonary stenosis (LUSB, changes w/ expiration)
aortic stenosis (apex, no change w/ respiration)
9
Q
Other Sounds: friction rub
A
pericarditis (EKG: diffuse ST elevation)
10
Q
Pulses: PDA
A
bounding
11
Q
Pulses: aortic stensosis, HLHS
A
weak, thready
12
Q
Pulses: coarcation
A
LE: poor, absent, delay
13
Q
Innocent Heart Murmurs
A
still’s murmur (systolic)
venous hum murmur (continuous)
peripheral pulmonary stenosis (systolic)
14
Q
Pathological Heart Murmurs
A
systolic
diastolic
continuous
15
Q
Murmur Radiation:
- neck
- back
- axilla
A
- neck: aortic stenosis
- back: pulmonary valve stenosis
- axilla: peripheral pulmonary murmur
16
Q
Systolice Murmur: ejection
A
aortic/pulmonary stenosis HCM ASD Still's COA
17
Q
Systolic Murmur: holocystolic
A
VSD
mitral/tricuspid regurgitation
18
Q
Diastolic Murmur
A
early: semilunar valves
- aortic/pulmonic regurgitation
- mitral stenosis
19
Q
Continuous Murmur
A
PDA
venous hum murmur
coronary fistula
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
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)
22
Q
Murmur: Supine Position
A
inc innocent
dec HCM
23
Q
Murmur: Sitting Position
A
inc venous hum
dec innocent
24
Q
Murmur: Standing Position
A
inc HCM, mitral valve prolapse
dec aortic stenosis
25
Murmur: Valsalva
dec innocent
| inc HCM
26
What is the MC innocent heart murmur?
Still's murmur
27
Still's Murmur:
- age group
- EKG
- evaluation
3-6yo - outgrow in adolescence
normal EKG
```
low frequency
musical/vibratory
LMSB, LLSB, apex
loudest w/ supine, stress
dec w/ sitting
```
28
Venous Hum Murmur:
- aka
- age group
- etiology
- evaluation
cervical hum murmur
3-6yo
turbulence due to jugular venous drainage
continuous (R>L)
base
loudest: upright
dec w/ supine/turning neck
29
Peripheral Cyanosis
aka: acrocyanosis
normal saturation and PaO2
normal transitional newborn physiology
due to vasospasm of sm arterioles
30
Central Cyanosis
blue lips, tongue
low saturations and PaO2
CHD
31
Patent Ductus Arteriosus:
- functional closure
- anatomic closure
functional closure: 12-90hrs
anatomic closure: 2-3wks
32
Pink Baby
normal baby
normal physiology
normal heart
PDA closed
33
Blue Baby
clue to CHD
| PDA closing
34
Grey Baby
intracardiac shunt closed
need PGE to open PDA
no mixing of blood
35
Blue or Purple Baby
PDA patency open
palliation to provide PBF or systemic blood flow
saturation 75-90%
mixing of blood
36
CHD Symptoms: tachypnea
L to R shunt
CXR: pulmonary edema, cardiomegaly
37
CHD Symptoms: cyanosis
R to L shunt, obstruction to lungs
blue baby
low saturations
CXR: dec PBF
38
CHD Symptoms: grey baby
dec/no systemic blood flow
poor perfusion
lactic acidosis
39
CHD Physiology: volume overload
L to R shunt (ASD, VSD, PDA)
dilation of heart chambers
CXR: cardiomegaly, inc PBF
40
CHD Physiology: pressure overload
outflow obstruction (aortic, pulmonary)
hypertrophy of heart chambers
EKG: LVH, RVH
41
CHD Physiology: cyanotic lesion
R to L shunt
no PBF
poor mixing of blood
low saturations
42
Acyanotic Defects
(volume issue)
ASD
VSD
PDA
43
Cyanotic Defects
TOF
TGA
truncus arteriosus
tricuspid atresia
44
Obstructive Defects
PS
| COA
45
Complex Heart Defect/Single Ventricle
HLHS
46
What type of shunt is usually associated with ACYANOTIC defects?
L to R shunt
47
ASD
R ventricular volume load
48
VSD, PDA, AV canal defects
L ventricular volume load
49
What is the effect of volume loading on the heart?
dilation of the ventricles (and atria)
50
Which CHD does NOT require PGE to treat?
acyanotic defects
51
Symptoms of L to R Shunting (+ exception)
tachypnea
poor feeding
exercise intolerance
poor growth
**EXCEPTION: large ASDs: asymptomatic
52
Atrial Septal Defect:
- physical exam
- auscultation
- EKG
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
Atrial Septal Defect: treatment
may close spontaneously
| surgery vs percutaneous closure
54
What is the MC congenital heart defect?
ventricular septal defect
55
What is the MC defect of a ventricular septum?
muscular
56
Ventricular Septal Defect: consequences of mod-large defect
CHF (FTT, hepatomegaly, diaphoresis w/ feeding)
57
Ventricular Septal Defect: complication
if untreated: pulmonary vascular disease (irreversible)
58
Ventricular Septal Defect: small defects
Normal growth and development
Holosystolic murmur, grade 2-3/6
High-pitched, short duration
Normal S2
59
Ventricular Septal Defect: large defects
```
Failure to thrive
Holosystolic murmur, grade 2-3/6
Lower-pitched
Loud S2
May hear apical diastolic “rumble”
Diastolic murmur of aortic regurgitation
```
60
Ventricular Septal Defect:
- EKG
- CXR
LVH, RVH
cardiomegaly
61
Patent Ductus Arteriosus: seen with...
MC: premature newborn, newborn w/ primary pulmonary HTN
hypoplastic L heart syndrome
pulmonary atresia
asymptomatic w/ continuous murmur
62
Patent Ductus Arteriosus: presentation:
- preemies
- small PDA
- large PDA
preemies: failure to wean from vent, FTT
small: asymptomatic
large: similar to VSD (CHF, diaphoresis w/ feeding)
63
In a newborn with cyanosis and lower ext sats < upper ext sats what is the cause (until proven otherwise)?
R to L shunt of PDA?
64
Patent Ductus Arteriosus: physical exam (pulse, murmur):
- large shunt
- small shunt
```
large:
bounding pulses
wide pulse pressure
CONTINUOUS MACHINERY LIKE MURMUR AT LUSB/AXILLA
diastolic rumble
```
small:
no findings
65
Patent Ductus Arteriosus: differential cyanosis
```
hands PURPLE (94%)
feet BLUE (85-90%)
```
BLUE BLOOD MIXING WITH RED BLOOD
elevated pulmonary pressures or inc PVR
66
Patent Ductus Arteriosus: treatment
- preemies
- small audible PDA in older child
- nonaudible incidental finding
preemie: NSAIDs, ductal ligation
sm audible: coil/device occlusion, ductal ligation
incidental: no tx
67
Cyanotic Heart Defects
tetralogy of fallot
transposition of the great arteries
truncus arteriosus
68
Which CHD require prostaglandins to treat?
cyanotic heart defects
severe obstructive heart defects
severe coarcation of aorta
severe aortic stenosis
69
Indications to start prostaglandin therapy
```
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
Tetralogy of Fallot: comprised of 4 abnormalities
VSD
PS/RVOT obstruction
overriding aorta
RVH
71
Tetralogy of Fallot: degree of cyanosis depends on...
size of pulmonary annulus relative to aorta
pulmonary vascular resistance
size of VSD
72
Tetralogy of Fallot: other associated abnormalities
DiGeorge syndrome
| Down Syndrome
73
Tetralogy of Fallot: physical exam
- murmur
- types
- CXR
harsh systolic LUSB
cyanosis
TET:
- blue: severe
- pink: less severe
CXR: boot shaped
74
TET Spell:
- what is it
- presentation
spasm of RVOT muscle
fussy
cyanotic
loss of systolic heart murmur
75
TET Spell: intervention
```
keep calm
oxygen
volume (NS bolus)
knee to chest maneuver
morphine
propanolol
```
early vs delayed repair
76
Transposition of the Great Arteries: what is it
oxygenated blood recirulates through lungs --> cycle of hypoxemia, acidosis
state of parallel circulation
77
Transposition of the Great Arteries:
| what defects can allow for mixing, ensuring survival?
concomitant PFO, VSD, PDA
78
Transposition of the Great Arteries: treatment
arterial switch operation
79
Truncus Arteriosus:
- comprised of
- associated disorder
aortic arch abnormalities
VSD
coronary artery conductive system abnormalities
DiGeorge syndrome
80
Truncus Arteriosus:
- diagnosis
- treatment
echocardiography
surgical repair
81
Obstructive Heart Defects:
- obstruction to pulmonary blood flow
- obstruction to systemic blood flow
PBF:
-pulmonary stenosis
SBF:
- coarcation of aorta
- aortic stenosis
**both: treat w/ PGE in sev cases
82
Pulmonary Stenosis:
- murmur
- EKG
harsh systolic ejection murmur at LUSB w/ click
RVH
83
Pulmonary Stenosis: treatment
<40mmHg: follow conservatively w/ echo
TOC: balloon valvuloplasty
84
Coarcation of the Aorta:
- what is it
- murmur
- pulse
- BP
- severe cases
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
Coarcation of the Aorta: associated disorders
bicuspid aortic valve
| TURNER SYNDROME
86
Aortic Stenosis:
- murmur
- associated disorders
- EKG
- Echo
systolic ejection murmur at RUSB
click
associated w/:
- bicuspid aortic valve
- COA
EKG: LVH (strain)
Echo: concentric LVH
87
Aortic Stenosis: treatment
mild: monitor clinically
balloon valvuloplasty
surgical
88
Complex Heart Defect/Single Ventricle: conditions
- hypoplastic left heart syndrome (HLHS)
| - true single ventricle
89
Hypoplastic Left Heart Syndrome: what is it
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
Hypoplastic Left Heart Syndrome: treatment
staged procedures (neonatal, 2-4yrs)
91
Why do we do cardiac sport screenings?
to prevent sudden cardiac death
92
What is the MCC of sudden cardiac death?
HCM
93
What are the highest risk sports for sudden cardiac death?
track
| basketball
94
Hypertrophic Cardiomyopathy
disarray of hypertrophic myocardial cells
concentric hypertrophy
- LV stiffness
- impaired diastolic filling
- normal systolic function
inc ventricular arrythmias
95
Marfan Syndrome: cardiac abnormalities
aortic root dilation
aortic root rupture
mitral valve prolapse
96
Reasons to Consider EKG Screening
```
Premature ventricular contractions (PVCs)
LVH and LV strain patterns
Wolff Parkinson White syndrome
Long QT syndrome (QTc > 460)
Brugada syndrome
Heart block
```
97
Commotio Cordis
blunt force trauma to chest wall over heart during upstroke of T wave
inc risk for ventricular arrhythmias
98
Pediatric Dyslipidemia:
| -universal screening
all children 9-11yo (lipid panel - fasting)
99
Pediatric Dyslipidemia:
- risk factors
- risk conditions
```
Overweight
Obesity
Family history CAD
Acanthosis
Hypertension
```
Kawasaki
Diabetes
Transplant
100
Pediatric Dyslipidemia: treatment
diet
exercise
weight loss
statin (10+yo)
101
Kawasaki Disease: presentation
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
Kawasaki Disease: treatment
IVIG
| high dose ASA
103
Kawasaki Disease: other considerations
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
Kawasaki Disease: complication
high risk of coronary aneurysms
