PowerPoint Chapter 16

Question 1

What are the differences between kids and adults in the cardiovascular system (6)?

Answer 1

Kids have:
Higher: Resting HR
Submax HR
Max HR
Peripheral resistance
Max ventilation
Lower : Stroke Volume and BP

Question 2

____ starts the changes into adulthood and more mature Cardiovascular system?

Answer 2

Puberty starts the changes into adulthood and more mature Cardiovascular system.

Question 3

What do healthy pediatric resting ECGs show?

Answer 3

Higher Resting HR
LV hypertrophy
Nonspecific ST changes

Question 4

(In pediatrics) Abnormalities are more likely seen during ____ ____ to show ____ ____?

Answer 4

(In pediatrics) Abnormalities are more likely seen during exercise testing to show physiological demands

Question 5

5 reasons to give kids an exercise test?

Answer 5

-Tolerance to PA
-Data for other procedures – surgery, therapy, testing.
-Eval how well a surgery went, or treatment/therapy
-Baseline data
-Parent peace of mind

Question 6

What are three testing protocols for pediatrics?

Answer 6

Ramp protocol
Manual loading
Single stage exercise

Question 7

What is single stage exercise used for?

Answer 7

Exercise-induced Asthma
Growth hormone deficiency
Exercise induced hypoglycemia (type 1 diabetes)

Question 8

When should a pediatric exercise test be terminated (6)?

Answer 8

Predetermined with procedure and purpose of test
ST seg depression or elevation >3mm
Progressive drop in BP
Aggravation of arrhythmia by exercise
Uninterpretable ECG
Signs or symptoms of potential hazard to patient

Question 9

(In pediatrics) Most ____ ____ ____ are benign if no evidence of underlying cardiac/metabolic disease, no symptoms can be reproduced to link to ____ or ____ (syncope, seizures, etc), and/or ____ stop during exercise test?

Answer 9

(In pediatrics) Most irregular HR rhythms are benign if no evidence of underlying cardiac/metabolic disease, no symptoms can be reproduced to link to VTach or VFib (syncope, seizures, etc), and/or PVC’s stop during exercise test?

Question 10

What are three common ECG findings in pediatrics (bad)?

Answer 10

-Exaggerated sinus arrhythmia’s in sync with respirations
-PAC’s and PVC’s – if PVC increase w/ Exercise or are in runs of 3 or more = Electrophysiology study or Cardiac Cath. Frequency of PVC’s does not matter if isolated (unifocal)
-Multifocal PVC’s – Require a follow up to rule out heart disease

Question 11

What is an athletes heart?

Answer 11

Sinus Bradycardia
LV hypertrophy
Early Repolarization

Question 12

Two symptoms for pediatric heart issues?

Answer 12

Chest pain
Syncope

Question 13

What to investigate if a pediatric has chest pain?

Answer 13

Chest pain
-Rule out heart disease
-Eval ischemic changes
-Look for Arrhythmias
-ID BP abnormalities

Question 14

What to investigate/causes if a pediatric has syncope?

Answer 14

Syncope
-Rule out cardiac disease
-Vasovagal triggers
-Positional orthostatic tachycardia syndrome

Question 15

What three pathophysiologic groups does pediatric heart disease fall into?

Answer 15

L –> R Shunt
(Atrial Septal Defect, Ventral Septal defect, Patent ductus arteriosus)
R –> L Shunt
(Tetralogy of Fallot, Transposition of Great vessels, Single Ventricle)
Obstruction
(Coarctation of the aorta, Aortic stenosis)

Question 16

What defects occur with a L –> R shunt?

Answer 16

Atrial Septal Defect, Ventral Septal defect, Patent ductus arteriosus

Question 17

What defects can occur from a R –> L shunt?

Answer 17

Tetralogy of Fallot, Transposition of Great vessels, Single Ventricle

Question 18

What defects occur in obstruction of the heart in pediatrics?

Answer 18

Coarctation of the aorta, Aortic stenosis

Question 19

What can exercise tests be used to evaluate in pediatrics (5)?

Answer 19

Use Exercise testing to evaluate function, arrhythmias, ischemia, need for intervention, tolerance

Question 20

What is another name for Andersen-Tawil Syndrome?

Answer 20

Type 7 long QT syndrome

Question 21

When is Andersen-Tawil Syndrome diagnosed?

Answer 21

Diagnosed after syncopal episode

Question 22

How does Andersen-Tawil Syndrome appear at rest?

Answer 22

At rest – sinus with frequent PVC’s and non-sustained VT w/ LBBB morphology

Question 23

How does Andersen-Tawil Syndrome appear with exercise?

Answer 23

Exercising – VT slows to single PVC’s that then terminate with HR at 180bpm

Question 24

How does Andersen-Tawil Syndrome appear in recovery?

Answer 24

Recovery – VT returns as HR slows. 20 min post recovery

Question 25

How will an ECG of a teenager with post-tetralogy of fallout appear?

Answer 25

Note Characteristic RBBB and periods of junctional rhythm with sinus capture beats

Question 26

What is mitral valve prolapse?

Answer 26

Condition where the heart’s valves are “floppy”

Question 27

Mitral valve prolapse is generally ____ and ____?

Answer 27

Mitral valve prolapse is generally benign and asymptomatic

Question 28

What is mitral valve prolapse associated with?

Answer 28

Most commonly associated with Marfan’s syndrome

Question 29

What are four types of non-congenital heart disease in pediatrics?

Answer 29

Mitral valve prolapse
Kawasaki disease
Hypertrophic cardiomyopathy
Long QT syndrome

Question 30

What Kawasaki disease + tests?

Answer 30

Acute, general inflammation of vascular system
Coronary aneurysm develops in 2-4wks
1% chance of Artery stenosis, MI, or sudden death
(Exercise test for eval coronary perfusion, risk assessment for activity)

Question 31

Describe long QT syndrome?
(What predisposes you)
(Put you at risk for)
(What test should be performed)
(Management strategies)

Answer 31

-Genetic
-Risk of V-tach and sudden death during exercise or high emotions
-Exercise test to rule out or rule in borderline cases
-Risk stratification and management strategies.

Question 32

Long QT syndrome is estimated to affect ____ in ____ people?

Answer 32

Long QT syndrome is estimated to affect 1 in 7,000 people.

Question 33

What population is affected by long QT syndrome?

Answer 33

Females are affected more often than males.

Question 34

Most people with long QT syndrome develop symptoms before they are ____ ____ ____?

Answer 34

Most people with long QT syndrome develop symptoms before they are 40 years old

Question 35

Long QT syndrome is a relatively common cause of sudden death along with____ ____and____ ____ ____ ____?

Answer 35

Long QT syndrome is a relatively common cause of sudden death along with Brugada syndrome and arrhythmogenic right ventricular dysplasia?

Question 36

Long QT syndrome has ____ deaths a year in the US and was first clearly described in ____?

Answer 36

Long QT syndrome has 3,500 deaths a year in the US and was first clearly described in 1957

Question 37

What are the subcategories of long QT syndrome

Answer 37

Average QTc= .40-.44sec
Borderline QTc= .44-.49sec
Long QTc= >.49sec