PowerPoint Chapter 16 Flashcards
What are the differences between kids and adults in the cardiovascular system (6)?
Kids have:
Higher: Resting HR
Submax HR
Max HR
Peripheral resistance
Max ventilation
Lower : Stroke Volume and BP
____ starts the changes into adulthood and more mature Cardiovascular system?
Puberty starts the changes into adulthood and more mature Cardiovascular system.
What do healthy pediatric resting ECGs show?
Higher Resting HR
LV hypertrophy
Nonspecific ST changes
(In pediatrics) Abnormalities are more likely seen during ____ ____ to show ____ ____?
(In pediatrics) Abnormalities are more likely seen during exercise testing to show physiological demands
5 reasons to give kids an exercise test?
-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
What are three testing protocols for pediatrics?
Ramp protocol
Manual loading
Single stage exercise
What is single stage exercise used for?
Exercise-induced Asthma
Growth hormone deficiency
Exercise induced hypoglycemia (type 1 diabetes)
When should a pediatric exercise test be terminated (6)?
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
(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?
(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?
What are three common ECG findings in pediatrics (bad)?
-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
What is an athletes heart?
Sinus Bradycardia
LV hypertrophy
Early Repolarization
Two symptoms for pediatric heart issues?
Chest pain
Syncope
What to investigate if a pediatric has chest pain?
Chest pain
-Rule out heart disease
-Eval ischemic changes
-Look for Arrhythmias
-ID BP abnormalities
What to investigate/causes if a pediatric has syncope?
Syncope
-Rule out cardiac disease
-Vasovagal triggers
-Positional orthostatic tachycardia syndrome
What three pathophysiologic groups does pediatric heart disease fall into?
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)
What defects occur with a L –> R shunt?
Atrial Septal Defect, Ventral Septal defect, Patent ductus arteriosus
What defects can occur from a R –> L shunt?
Tetralogy of Fallot, Transposition of Great vessels, Single Ventricle
What defects occur in obstruction of the heart in pediatrics?
Coarctation of the aorta, Aortic stenosis
What can exercise tests be used to evaluate in pediatrics (5)?
Use Exercise testing to evaluate function, arrhythmias, ischemia, need for intervention, tolerance
What is another name for Andersen-Tawil Syndrome?
Type 7 long QT syndrome
When is Andersen-Tawil Syndrome diagnosed?
Diagnosed after syncopal episode
How does Andersen-Tawil Syndrome appear at rest?
At rest – sinus with frequent PVC’s and non-sustained VT w/ LBBB morphology
How does Andersen-Tawil Syndrome appear with exercise?
Exercising – VT slows to single PVC’s that then terminate with HR at 180bpm
How does Andersen-Tawil Syndrome appear in recovery?
Recovery – VT returns as HR slows. 20 min post recovery
How will an ECG of a teenager with post-tetralogy of fallout appear?
Note Characteristic RBBB and periods of junctional rhythm with sinus capture beats
What is mitral valve prolapse?
Condition where the heart’s valves are “floppy”
Mitral valve prolapse is generally ____ and ____?
Mitral valve prolapse is generally benign and asymptomatic
What is mitral valve prolapse associated with?
Most commonly associated with Marfan’s syndrome
What are four types of non-congenital heart disease in pediatrics?
Mitral valve prolapse
Kawasaki disease
Hypertrophic cardiomyopathy
Long QT syndrome
What Kawasaki disease + tests?
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)
Describe long QT syndrome?
(What predisposes you)
(Put you at risk for)
(What test should be performed)
(Management strategies)
-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.
Long QT syndrome is estimated to affect ____ in ____ people?
Long QT syndrome is estimated to affect 1 in 7,000 people.
What population is affected by long QT syndrome?
Females are affected more often than males.
Most people with long QT syndrome develop symptoms before they are ____ ____ ____?
Most people with long QT syndrome develop symptoms before they are 40 years old
Long QT syndrome is a relatively common cause of sudden death along with____ ____and____ ____ ____ ____?
Long QT syndrome is a relatively common cause of sudden death along with Brugada syndrome and arrhythmogenic right ventricular dysplasia?
Long QT syndrome has ____ deaths a year in the US and was first clearly described in ____?
Long QT syndrome has 3,500 deaths a year in the US and was first clearly described in 1957
What are the subcategories of long QT syndrome
Average QTc= .40-.44sec
Borderline QTc= .44-.49sec
Long QTc= >.49sec
