focal pain usually located in the left peri-

transposition of the great arteries VSD with pulmonary stenosis

165. Ped Cardiac Flashcards by Tegan Turner

How does circulation work in a fetus to get ox blood? 1. oxy blood to fetus through umb vein 2. bypasses liver through ductus venosus 3. return to heart through IVC

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How does circulation work in a fetus once blood gets to heart? 1. IVC to RA 2. then shunted to LA through patent foramen ovale 3. PVR > SVR so most blood bypasses lungs 4. LA to LV and aorta 5. then preferentially to fetal coronary and cerebral circulations

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How does deoxygenated blood get back to mum from fetus? 1. SVC to RA

then RV 2. RV to PA 3. PA to aorta through patent ductus arterosus 4. mixes with ox blood in desc aorta 5. then to placenta for o2 through 2 umb arteries

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Once the infant is delivered and umbilical cord is cut

how does blood flow change/circulation change? 1. expansion and aeration of lungs = decr PVR 2. o2 incr then causes closure umb art

vein

ductus venosus and arteriosus 3. incr pulmonary blood flow to infant LA promotes closure of Foramen ovale

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At what age does foramen ovale close? 3mo

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When does ductus arteriosus functionally close vs anatomic closure? 10-15h 2-3 weeks of life

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How do kids increase their CO? by incr heart rate - str of myo contraction not that good

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When to children develip adult capacity to increase heart contractility? 8-10yoa

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Common general signs of cardiac disorders in infants? fussy

lethargy

poor feed +/- diaphoresis

poor growth

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Common CV signs of cardiac disorders in infants? tachycardia shock pale mottled cyanosis palpitations cp syncope dysrythmias

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Common resp signs of cardiac disorders in infants? resp distress wheeze apnea

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“<img src=”“Screen Shot 2024-07-18 at 3.15.45 PM.png””>”

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Causes of decreased SV in infants/kids? hypovolemia HF myocarditis HOCM dilated cardiomyopathy pericarditis tachydysrhytmias

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If tachycardia doesn’t help kids pump their heart

what goes up next? incr diastolic blood pressure = narrow pulse pressure also see incr SVR - mottle

cold

deplayed cap refill >2s

weak and thready distal pulses

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What is cyanosis caused by? preponderance of deoxyg blood in cap beds

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Where are the best places to see cyanosis? mucous membranes conjuntiva nail beds skin

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To see cyanosis: normal child vs anemic child hbg? 90-85% sats anemia may be even lower because they don’t have enough hemoglobin to meet criteria

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DDX central cyanosis pulmonary ventil and o2 decr decr pulmonary pefusion shunting deox blood directly into syst circulation abnormal hbg

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Cyanosis in neonate: ddx 4 main categories cardiac pulmonary hematologic toxic

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Cardiac ex of cyanosis in kids R-toL shunt cardiac lesion with decr or incr pulmonary flow

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Pulmonary causes of cyanosis is kids bronchiolitis pneumonia pulmonary edema

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What is a hematologic cause of cyanosis? methemoglobinemia

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Central vs peripheral cyanosis signs/places in body central - lip/tongue/mm periph: hands

feet

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What are two signs to help differentiate pulmonary vs cardiac central cyanosis cause? “cardiac: ““comfortably”” blue

worsens with crying

minimal improvement suppl o2”

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Early signs of HF diaphoresis during feeds
poor weight gain

Precordial catch sundrome/Texidor's twinge: what is this? "

presents as a sharp

focal pain ## Footnote usually located in the left peri-

apical area of the chest wall. It occurs suddenly

is often worsened by

inspiration

and is not associated with dyspnea. The child may report

that the pain “took my breath away” or that “I was afraid to move”; the

pain typically resolves within a few minutes and is not associated with

dysrhythmias or other sequelae.

CP in kids - r/o ? (4) ao dissxn
PE
drug abuse + subseq injury
hereditary (HOCM)

Infants with patent ductus arteriosus have what kind of pulse? bounding

Kids with coarctation have what kind of pulse? strong or unequal pulses UE

weak in lower

Pathologic murmur in kids: ANY of the following: TYPE
diastolic murmur
systolic >3/6

continuous or have thrill
murmurs with abn heart sound (click ## Footnote rub gallop)
OTHER VITALS:
cyanosis or resp distress
bounding or weak pulse
IMAGE:
abnormal ecg
abnormal cardiac silouette/vasculature or cardiomegaly on cxr

Does presence of femoral pulses rule out coarctation? no

BP in thigh may often be normally __ than upper

so if low... higher due to lack of well designed for legs
so if low ## Footnote bad check it out

S3 in children - possibly normal? yes - rapid filling of ventricles

early diastole
BUT can also indicate dilation so careful

wo of the most common innocent murmurs encoun- tered in the pediatric population are the:

" "

(peripheral pulmonic stenosis murmur) and Still’s murmur.

Peripheral pulmonary stenosis mumur - normal in neonate. what does this sound like? "

systolic murmur is best heard at the left upper sternal border with radi-

ation throughout the entire chest

axilla ## Footnote and back

gone by 3-6mo

persistence = concern AS

Still's murmur - what age

what does it sound like? 2-6y
systolic midsternal border
vibratory/musocal twang
intesnity incr supine or sick/anemia

What is a hyperoxia test? cardiac vs pulmonary central cyanosis
100% o2 - measure abg
pao2 >250 means cannot be CHD
<100 - R-L shunt
100-250 = mixing

When is hyperoxia testing a bad idea? kids with possible L heart obstruction (closure ductus arteriosus) or pulmonary vasodilation

Lab findings in kids with HF resp acidosis
with low pao2 due to resp fatigue

Compensated cyanotic CHD labs N pH despite chr low pao2
polycythemia - hbg and hct helpful
lytes for dyrsh

CXR: The normal cardiothoracic ratio in children is _ -- __ 50% to 55%.

What might falsely increase the cardiac size in infants on CXR? thymus - wavy/sail sign along superior R border heart

Boot shaped heart XR ToF

Egg on a string silouette on xr transposition great arteries

snowman shaped or figure 8 heart on xr TAPVR

Increased pulmonary vasculature on CXR - incr pulmonary arteries in lateral third of lung fields or apices
-PA view of R PA wider than diameter of trachea

DDX cyanotic infant with decreased vascular markings: -tof
-pulmonary atresia
-tricuspid atresia

DDX cyanotic infant with increased pulmonary vascular markings transposition of Great arteries
TAPVR
truncus arteriosus

Increased vascular markings in an acyanotic infant ddx endocardial cushion defect
VSD
ASD
Patent ductus arteriosus

Undiagnosed coarctation - findings on CXR?
Why? rib notching
Secondary to increased collateral blood flow along intercostal vessels between 4-8 ribs

R sided aortic arch on CXR found in up to 25% of children with which heart abnormality? ToF

Neonatal ECG: normal axis deviation is __ward R

When does LV assume dominance (ie what age?) 1mo

By 6mo LV to RV mass ratio?
Adults = 2.5:1 2:1

What QRS findings may be consisten with an endocardial cushion defect or tricuspid atresia? "

“superior” QRS axis (0 to −180 degrees

with an S wave in aVF greater than the R wave)

Anomalous origin of L CA from pulmonary artery (ALCAPA): shows what on ECG? ischemic change

Volume load ECG signs: "1. RAE - ASD

atrioventricular [AV] canal defects ## Footnote tricuspid atre-

sia

Ebstein anomaly ## Footnote and severe pulmonary stenosis);
2. RVH - ulmonary stenosis Tetralogy of

Fallot

transposition of the great arteries ## Footnote VSD with pulmonary stenosis

or pulmonary hypertension

coarctation of aorta [CoA] in the newborn

pulmonary valve atresia

and hypoplastic left heart syndrome)"

3 reasons to get a trop in kids "

suspected

cardiac ischemia (of any etiology)

myocarditis ## Footnote and myocardial dys-

function in sepsis syndrome

Many CHD dx prior to birth but what is a cheap

standard screening? pulse ox pre d/c

For example, the presence of cyanosis, a grade 3/6 systolic ejection murmur best heard at the mid left sternal border, a boot-shaped heart, and a decreased pulmonary blood flow on the chest radiograph with evidence of right ventricular hypertrophy on the ECG suggest ? disease

" ToF

Suspected CHD - how is resuscitation different for shock/vol depletion? 10ml/kg instead of 20

CHD that is manifested within the first 2 to 3 weeks of life with a sudden onset of cyanosis or cardiovascular collapse is typically due to __-dependent cardiac lesions

" ductal

How to maintain a patent ductus arteriosus - management in ED 1. PG E1 alprostadil 0.05-0.1 microgram/kg/min **causes apnea

watch for this

Recommended induction and paralytic agent for kids with CHD ketamine + roc

Adverse reactions of PGE1 if needs to be given to maintain PDA? 1. APNEA
2. fever
3. seizure
4. brady
5. hypoT
6. flushing
7. decreased plt aggregation

Acyanotic congenital heart defects: divsion into which 2 categories? 1. obstructive
2. L to R shunt with incr in pulmonary blood flow

Obstructive acyanotic heart defect ex pulmonic stenosis
aortic stenosis
coarctation

L to R shunt acyanotic heart disease ex vsd
asd
patent ductus arteriosus
endocardial cushion defect

MC cardiac defect? VSD

When might a VSD become clinically apparent? (age in WEEKS) 6-8 - PVR DECREASES

Sx of VSD in children (not sp to age) yo - poor feed and growth
older - decr ex tolerance

recurrent pulmonary infection

Eisenmonger syndrome - what is this? sign VSD not corrected leads to high PVR --> pulmonary hypertension --> RA and RV incr pressure
then changes R to L shunt
poor ox blood to systemic circulation --> cyanosis

CXR possible findings VSD - N
-cardiomegaly with incr pulmonary vascular markings

ECG VSD findings N if smol
LVH
can also get biventricular hypertrophy if large enough L to R shunt

VSD are at risk of what disease? Why? bact endocarditis due to high turbulent flow --> repair them!

ASD - large or comorbid conditions (bronchopulm dysplasia) can show what sx? HF
pulmonary overcirculation - dyspnea with feeds

poor w gain ## Footnote freq LRTI
widely split and fixed s2

Is ASD assoc with bacterial endocarditis like VSD? no - not as turbulent flow

Eisenmonger syndrome - sx cyanosis
chest pain
sob on exertion
hemoptysis

Coarctation: what kind of valve do they have? 50% have bicuspid aortic

Coarctation: proximal vs distal to ? - which is mc? ductus arteriosus
mc postductal

Coarctation: signs? if proximal coarc: cyanosis lower half body

circulatory shock when closes
brachial fem delay - hold both simultaneously
-----
post: mc systolic murmur or HTN; but can be shock

Cyanotic CHDs - typical 2 physiologies 1. decreased pulmonary blood flow to lungs
2. R to L shunt of desat blood into systemic circulation

Classic cyanotic CHDS - 5 Ts? truncus arteriosus
ToF
TAPV
TGA
tricuspid atresia

ToF: what 4 abnromalities? 1. RV outflow obstruction
2. VSD (large

misaligned)
3. overriding aorta that gets blood both vents
4. RV hypertrophy (secondary to 1)

ToF: sx cyanosis cry or feed
systolic ejection murmur L sternal border

Tet spell defn hypercyanotic or hypoxic spell in ToF kiddo

common 2-4mo

Tet spell pathophysiology sudden lowers SVR/hypovolemia or tachycardia
- increases large R to L shunt across VSD
then bypasses lungs to decr pao2

incr pxo2 and fall pH
then increase rapid resps ## Footnote increasing negative intrathroacic pressure
causing incr in SVR to right heart
Blood to RV through VSD further decreasing SVR

How to tx tet spell o2
knee to chest
alagesia - fent and midaz
if ph <7.4m 1meq/kg IV na bicarb
if no go then give pheylephrine
if still no propranolol 0.1-0.2mg/kg IB

MC post op CHD - thrombosis of shunt conduit
-incr shunt conduit flow with resultant CHF
-atri/ventr dystrh
-heart block
-MI
- endocarditis

Post pericardiotomy syndrome: defn 1-6wk post surg
fever

cp ## Footnote pericardial effusion
**echo for dx
rare to need to do pericardiocentesis

MC tx for post pericardiotomy syndrome bed rest
NSAID

Which kiddos are increased risk of RSV fatality? cyanotic/complex CHD
pulmonary HTN
premature - bronchopulm dysplasia

CLD
Immunodefic

Primary cause of HF in infants and children? CHD

HF infants/children ddx "

anomalous left coronary artery in

infants

myocarditis ## Footnote endocarditis rheumatic heart disease pericardial

effusions

anemia ## Footnote cardiomyopathies systemic hypertension hypothy-

roidism

hyperthyroidism ## Footnote electrolyte imbalances endocrine disorders

cardiac toxins

and dysrhythmias that compromise cardiac output.

CHD

HF result from derangement in which 4 primary cardiac function 1. excess preload
2. decr cardiac contractility (myocarditis)
3. excess afterload
4. rhythm abn

Manageemnt of kid in HF: 1. suppl o2
2. pulm congestion = cpap/bipap pre intub
3. furos

Management HF diff kiddo vs adult? NO nitro kids as too sens --> hypot

cardiogenic shock in kids - prefered vasopressor? ne
then dob if RQ for cardiac ino
epi for ino and chronotropy to incr svr
then milrinone

SE milrinone kids hypot
dysr
hypersens rxn
fever
hepatotox
low plt

MC peds cardiac arrest from? resp failure or shock

Peds mc arrest rhythms? asystole or brady as secondary to resp failure

MC dysrh in kids? SVT - can happen N

"**Kids: Although some medications can be used to treat only atrial tachy- cardia (e.g., adenosine for supraventricular tachycardia) or ventricular tachycardia (e.g., lidocaine for ventricular tachycardia), amiodarone and procainamide can be used for an array of both atrial and ventricular dysrhythmias, including supraventricular and ventricular tachycardia."

MC cause syptomatic brady in infants and children? hypoxia

How to tx symptomatic brady in kids? 1. o2 and ventil
2. epi 0.01mg/kg
3. atropine for vagally induced brady or tx primary AV block

Causes of bradycardia in children hypoxia
hypothermia
incr ICP
heart blocks
dennerv after cardiac surg
hypothyroid
sick sinus
meds/toxins

SVT in kids: what is cause in 50%? nothing

healthy

SVT in kids: what is cause in 10-20%? wpw

orthodromic svt avnrt pathway orthodromic: N rhyth down atria to v through av node

retrogr is accessroy pathway back up

orthodromic vs antidromic avrnt pathway QRS? narrow
wide

SVT vs sinus tachy
sinusv tach if __ <HR in yo children + infants
beat to beat var?
p waves? 180
220
yes
see ps

Management SVT in kids with sx poor perfusion - ams

delayed cap refill ## Footnote pallor cyanosis hypot 1j/kg up to 5 shock
if no then repeat 2

SVT tx if hemodynamically stable vagal meanuevers - ice to face

bend knees
adenosine

Adenosine in kids dose for svt 0.1mg/kg up to 6mg
if no go 0.2mg/kg

Adenosine induced wide complex tachycardia: uncommon complication

how to tx? amiodarone loading dose 5mg/kg over 20-60 mins
then cont 5mcg/kg/min

Aflutter and afib in children - concern for what in kids? underlying heart condition

what 4 meds to avoid in pt with wpw? a2bcd
amiodarone

adenosine
beta blocker
ccb
dig
* block av node leaving accessory pathway open

pt with wpw - safe options for cardioversion? (3) amiodarone
procainamide
cardioversion

VTach causes in kids post cardiac surgery
myocarditis
prolonged qt synd
drug/toxin exposure (tca)
electrolyte abnormality

Torsades tx alternating polarity and amplitude of qrs
IV mag 25-50mg/kg up to 2g over 2 mins

Contraindicated medications in torsades? class ia like procainamide
class III amiodarone
as these can incr qtc --> lethal

When to use heparin - which types of CHD physiology? systemic to pulm artery shunt
RV to pulm artery shunt

1) systemic to pulm artery shunt
2) RV to pulm artery shunt
preferred spo2? 80%

Pulmonary htn kiddos - how to optimize? preload saline bolus
inhaled NO in ICU for reduced PVR
early contact with cardio

What cardiac lesions are higher risk for bact endocarditis? - VSD
- aortic valvular stenosis
- tof
- sv states
- bicuspid aortic valves
- postop systemic to pulmonary shunt

Symptoms and signs bacterial endocarditis in kids (particularly helpful): nonsp tbh:
- fever

tachycardia
- new heart murmur <50% cases
- petechiae
- denntal caries
- hepatosplenomegaly
- HF
-splinter hemorrhages
-roth spot
-osler nodes

Initial diagnostic studies for bact endocarditis in kids - cbc
-crp and or esr
- blood cultures x3
-cxr
- ecg

What are 2 mc bugs in kids in bact endocarditis? streptococcus viridans
staph aureus

Tx for bact endocarditis in kids in emerg - aminoglycoside + penicillinase R penicllin
- if mrsa suspected --> vanco

What are the cardiac conditions for which endocarditis prophylaxis is required? - prosthetic cardiac valve or material for valvue
-previous IE
- CHD:
a. repaired CHD with prosthetic mat or device during first 6mo post prcoedure
b. Repaired CHD with residual defects at site or adj to site
c. Cardiac transplant ind with cardiac valvulopathy

Procedures for which endocarditis prophylaxis is recommended: - all dental manipulating gingival tissue or peripapical region of teth or perforation of oral mucosa
- consider for incisional proceduires on resp tract

infected skin or MSK for hih risk pts

Pericarditis defn inflamm of pericardial sac +/- pericardial effusion

Pericarditis: ddx causes - bact/viral infection
-TB!!
- kidney: ARF

uremia
- autoimmune: lupus
-neoplasms: leukemia ## Footnote lymphoma

MC bacterial causes of pericarditis pneumococcus
s aureus
meningococcus
h influ

MC viral causes of pericarditis coxsackie
echovirus
adenovirus
EBV
influ

Classic ecg with pericarditis diffuse ST segm elevation

diffuse T wave inversion
+/- PR segment depression

Pericarditis: phase 1 diffuse st segm elevation

Pericarditis: ph 2 ST segm back to isoelectric but decr T wave amp

Pericarditis: ph 3 t wave inversion

Pericarditis: ph 4 normal/resolved

When to perform an echo immediately in kids with pericarditis? - fever
-resp distress
-HF signs

what to send aspirated pericardial effusion fluid for? -routine cell counts
-gram stain and culture

MC causes of myocarditis "- viral: adenovirus

enterovirus (others: echoviruses ## Footnote influenza coxsackie adenovirus

varicella-zoster

Epstein-Barr ## Footnote cytomegalovirus and hepatitis B virus) "

MC bacteria causing myocarditis: corynebacterium diptheriae
GAS
s aureus
mycoplasma pneumoniae
borrelia burgdorferi
meningococcus

Noninfectious causes of myocarditis - kawasaki
-ARF
-vascular disease like SLE
- toxins - cocaine

doxorubicin
- hyperthyroidism ## Footnote drug induced hypersens (penicillin sulfonamides phenytoin carbamazepine)

Clinicians should consider myocardi- tis in infants and children with symptoms .... to the typical course of a benign cause, such as a viral syndrome

" out of proportion

Myocarditis in kids: HR findings? disproportionate to fever = concern for myo

Myocarditis in kids: diagnostic eval depends on suspected cause

presenting signs and symptoms: bl and viral titres if infectious
ecg may or may not be helpful
trop
bedside echo - effusion/tamponade/global function

Myocarditis in kids: management if have HF and poor perfusion: inotropic support
ppv
diuretics
ivig unclear

Myocarditis in kids: what tx is contraindicated? beta blockers

What is Kawasaki disease? febrile

exanthematous multisystem vasculitis

Kawasaki disease symptoms - classic? 1. fever for 5 days or more
2. at least four of five:
- bilat nonexudative bulbar conjunctival injection (scleral injection with perilimbic sparing)
- oropharyngeal mm changes - pharyngeal erythema

red and cracked lips ## Footnote strawberry tongue
- cervical LN > 1.5cm diameter
- peripheral extremity changes: diffuse erythema and swelling or hands and feet during acute ph periungal desquamation in convalescent *diffuse palmar erythemat NOT maculopapular*
-polymorphous generalized rash (nonvesicular/bullous)

Incomplete Kawaski disease: what is this? mc infants <6mo - does not meet complete criteria

Incomplete Kawaski disease: recommendations for testing? fever 5d or more:
presence of 2 or 3 of complete kawasaki dx should do crp/esr. If crp >3 or esr >40

more investigations
if less ## Footnote observe daly and r/a

What is the major feared complication of kawasaki disease? coronary aneurysm

Kawasaki disease: who is most at risk for giant coronary artery aneurysm formation? children </= 6mo of age - mc present with incomplete kawasaki

Kawasaki disease: for infants 6mo or younger

fever greater than or equal to 7d: what to do next? undergo investigation and echo if inflamm markers abnormal as can present mc with incomplete kawasaki

Kawasaki disease: why does this happen? - infx agent to resp tract causing oligoconcal IGA response --> lymphocytes/CK/proteinases activated that weaken vessel walls and can cause aneurysm

What is the ddx of Kawasaki disease: measles
GAS disease
surgical abdomen causes
Rocky mountain
leptospirosis
SJS
JRA

Measles rash vs kawasaki head and face

progressing caudally. palmar rash is discrete macular

K: trunk then face and extremities ## Footnote potentially polymorphous. palmar rash is diffuse erythema

Kawasaki disease: management 1. supportive care in acute febrile ph
2. IVIG (2g/kg over 10-12 hours) within 10d + aspirin (80-100mg/kg/DAY) of onset to decr risk progress to coronary a dilation

aneurysm formation

IVIG side effects hypot
nausea/emesis
headache
seizure

Kawasaki disease: aspirin: when to stop? until child afebrile 48-72 hours

Acute rheumatic fever: what is this? delayed immune reaction to GAS infection

Acute rheumatic fever: mc age 5-15yoa

Acute rheumatic fever: most serious complication? carditis

Acute rheumatic fever: how to document an antecedant infection? + throat culture
+ rapid
elevated ASO titre - rises 1-3 weeks post infxn

peaks 3-5 weeks ## Footnote falls to BL after 6mo

Acute rheumatic fever: mc major criterion symptom migratory polyarthritis - larger joints of extremities + smaller tarsal joints of foot

smaller carpal joints in hand

"Disease?" kawasaki

Supplemental lab criteria for kawasaki: 4 categories (6 results total) 1. CBC: WBC: >15

hbg - anemic for age ## Footnote plt >/=450 000
2. Albumin: </=3g/dL
3. elevated ALT
4. Sterile pyruria >/= 6 wbc per high power field

Acute rheumatic fever: carditis presentation mitral or ao insuff (mc effects these valves)
--> holosystolic murmur with rads to axilla OR diastolic murmur best heard over heart base

Acute rheumatic fever: other cardiac manifestations than mitra or ao insufficiency? - HF
- pericarditis
- heart block

Key to Acute rheumatic fever: "

If arthritis

is used as a major component

arthralgia cannot be used as a minor

component to make the diagnosis. Likewise

if carditis is used as a

major component

a prolonged PR interval cannot be used as a minor

component

128 ## Footnote 172);"">

DDX acute rheumatic fever myocarditis
bact endocarditis
lyme disease
SLE
JRA
serum sickness
septic arthritis

Diagnostic testing for acute rheumatic fever: ecg
crp/esr
documentation of antecedent strep infection

+ needs cxr

echo

acute rheumatic fever: management - stabilize any cardiac disease
- tx for strpe infection
- bed rest
- antiinflamm for arthritis
adm

Prophylaxis for recurrent attacks of acute rheumatic fever 1. benzathine pen G
2. alt oral ID
3. allergic to pen: oral erythro BID

until 18yo or maybe life (cardiac dep)

Cardiovascular causes of sudden death in yo athletes: categories to consider 1. Genetic/congenital
2. Dysrhythmia
3. Trauma
4. Idiopathic
5. Vasculitis
6. Structural heart disease
7. Viral cause

Cardiovascular causes of sudden death in yo athletes: ddx diseases HOCM
congenital coronary a anomalies
marfan's
prolonged qtc

wpw
commotio cordis
idiopathic dilated cardiomyopathy
kawasaki disease causing cor a disease
ao stenosis ## Footnote mvp

Marfan disease: common sx tall and slender
striae atrophiace
disprop long extrem compared to trunk
scoliosis
pectus excavatum or carinatum
lens dislocation

Marfan's: common cardiac issues MVP
aortic dilation (bad as can rupture) --> NO contact sports/really any sports per

HOCM RF family hx
mod sev exercise causing cp/pre/palpitations syncope in yo person

HOCM: how does valsalva incr the murmur? "

During the Valsalva maneuver

the

venous blood return to the heart is decreased

which in turn tran-

siently reduces the left ventricular size. The transient reduction in the

size of the left ventricle will increase the degree of obstruction and

thus an increase in the intensity of the systolic murmur he

Pre sports screening importance fam and personal hx re heart idsease
PE
ECG

HOCM ecg LVH
q waves in inferolatreal leads
diffuse t wave inversions

hocm: helpful meds? beta blocker to improve diastolic filling

hocm CI meds? dig

2 ex prolonged qtc syndrome in kids jervell-langue neilsen
romano ward

DDX prolonged qtc children congenital syndrome (JVN

RW)
lytes - hypok/mg
meds - procainamide ## Footnote erythromycin phenothiazine organophosphate quinidine
myocarditis

Safe med for pt with prolonged qtc induced v tach or v fib? lidocaine

Commotio cordis - defn for peds and what to do about it high impact trauma to chest during repol cycle of heart causing vfib
mc child 5-15y
RAPID AED required and if not - chest thump

1. Which of the following increases the systemic vascular resistance (SVR), thus producing a left-to-right shunt through the ventricular septal defect (VSD) associated with Tetralogy of Fallot?
a. Acutehypovolemia

b. Crying
c. Defecation d. Squatting

" d

2. A 14-year-old girl presents to the emergency department (ED) with altered level of consciousness and trouble breathing. Her vital signs are blood pressure (BP), 72/39 mm Hg; heart rate, 240 beats/min; temperature, 99.6° F; respiratory rate, 60 breaths per minute; and oxygen saturation, 80%. An electrocardiogram (ECG) is performed, which shows supraventricular tachycardia. The patient weights 50 kg. Which of the following is the most appropriate initial treatment? a. Adenosine 5 mg IV

b. Cardioversion with 50 J
c. Cardioversion with 200 J
d. Diltiazem 12.5 mg IV

" b

3. What is the most common cause of bradycardia in infants?

a. Complete heart block b. Hypothermia
c. Hypothyroidism
d. Hypoxia

" d

4. A 16-year-old boy presents with complaints of syncope during a

basketball game. His mother reports a family history of sudden death in young adults, and you are concerned that the patient may have hypertrophic cardiomyopathy. Which of the following increases the murmur associated with this condition?

a hand grip

b. Methoxamine c. Squatting
d. Valsalva

Answer: D. During the Valsalva maneuver, the venous blood return to the heart is decreased, which in turn transiently reduces the left ventricular size. This transient reduction will increase the degree of obstruction and thus cause an increase in the intensity of the murmur. Hand grip, methox- amine, and squatting will increase return of blood to the heart and there- fore decrease the murmur associated with hypertrophic cardiomyopathy.

" d

5. A 5-month-old girl presents with fever for a week, rash, and fussi-

ness; reportedly yesterday her rash was faint throughout her body and has since resolved. On examination, she is febrile with other- wise reassuring vital signs; she is fussy and has conjunctival injec- tion in both eyes. Her parents think she got sick from their other children. Which of the following statements regarding this patient’s most likely disease is true?

a. If present, other systemic signs (such as, nausea, vomiting, and diarrhea) suggest an alternative diagnosis (such as, acute gastro- enteritis).

b. Laboratory investigation in the emergency department (ED) will assist in her risk stratification.

d. Older children are at the highest risk for aneurysm formation.

" b

165. Ped Cardiac Flashcards

(293 cards)