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SD- Pediatrics > Cardiac lecture > Flashcards

Cardiac lecture Flashcards

1
Q

Difficulty feeding
Increased RR
Sweating
Cyanosis
Syncope

A

Cardiac symptoms in newborns

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2
Q

Mainstay imaging?

A

Echocardiography

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3
Q

Defects that cause right to left shunting can cause…

A

Cyanosis

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4
Q

Will hypoxemia from HF respond to oxygen?

Will hypoexmia from R to L shunting respond to oxygen?

A

HF will respond to O2

R to L shunting will not repsond to O2

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5
Q

Hematocrit over 60 is common with R to L shunting and associated chronic hypoxemia

A

Polycythemia

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6
Q

Polycythemia from R-L shunting can lead to direct intracranial thrombosis.

Paradoxical embolus as noted

this can cause..?

A

Stroke

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7
Q

Retardation of growth can be a complication of…

A

congenital heart disease (CHD)

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8
Q

Pulmonary arterial hypertensions (PAH)

Pulmonary vascular obstructive disease (PVOD)

A

Major complications of congenital heart disease

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9
Q

Destruction of pulmonary vascular (arteriolar) bed in pressure of continous pressure overload (much less common with volume overload alone)

results in marked increase in PuVR and further elevation of PAP

A

Pulmonary vascular obstructive disease

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10
Q

An opening in part of the ventricular septum that separates the 2 ventricles

80% involve the thin membranous septum
20% involve the muscular septum

A

Ventricular septal defect

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11
Q

Associated with:
Coarctation of the aorta
ASD
PDA
sub-aortic/pulmonic stenosis

A

Ventricular septal defect

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12
Q

large resistance to flow through small hole
normal RVP and PAP
small L to R shunt
well tolerated.

*will often close on own. must monitor

A

Small “restrictive” ventricular septal defect (VSD)

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13
Q

allow varying transmission of LVP into the RV→PA.
PAH common and PVOD develops over time.

Large defects result in LV dilation and failure.

A

Moderate to large ventricular septal defects (VSDs)

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14
Q

When severe, CXR will show cardiomegaly, dialted pulmonary artery and HF

A

Ventricular septal defects (VSD)

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15
Q

Which image is diagnostic for ventral septal defect (VSD)

identifies the size and location of the defect and presence of shunting;
RV and pulmonary artery pressures can be estimated .

A

Echo-doppler

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16
Q

clinical manifestations:

no symptoms

harsh holosytolic murmur (best heard at LSB) appears within 36 hrs of birth

intensity may change with age.

A

Small VSD

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17
Q

HF signs and symptoms early in life; surgical repair indicated.

A

Large VSD

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18
Q

Possible systolic thrill at LLSB
nl S2
harsh holosystolic murmur along LSB.

A

Ventricular septal defect (VSD)

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19
Q

Are most of the ventricular septal defects small or large?

A

SMALL!

24% close spontaneously by 18 mos
50% by 4 years
even more by 10 years

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20
Q

HF occurs in ___% of infants with large VSD

A

80%

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21
Q

Risk of PVOD is high in….

A

moderate to large ventricular septal defects (VSD)

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22
Q

If the ventricular septal defect remains about, what is the pt at risk for?

A

Endocarditis

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23
Q

Do we still give antibiotics for prophylactic endocarditis?

A

NO

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24
Q

Timing of surgery is dependent on….

A

severity of shunt
LV function
Pulmonary artery pressure

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25
Q

if ______ continues overtime…. progressive, irreversible PVOD develops and surgery carries high mortality with little benefit

A

Pulmonary artery HTN

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26
Q

In presence of significant __________
PuVR and PAP rise dramatically.
This can lead to shunt reversal→R to L shunting→ hypoxemia and Rt sided heart failure (Eisenmenger’s physiology/complex).

A

Pulmonary vascular obstructive disease (PVOD)

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27
Q

A through and through communication between the atria at the septal level.

Pathology: Large enough defect to allow free communication between the atria.

Most common form (previously undetected) of CHD in adults;
female to male ratio is 2:1.

A

Atrial septal defect (ASD)

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28
Q

Atrial septum formed by fusion* of 2 overlapping planes of tissue during fetal development.
Most ASD’s occur in _____ septum due to lack of tissue for overlap.

A

Mid septum!

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29
Q

*Lack of atrial septal fusion occurs in up to ___% of adults leaving a “patent foramen ovale”,

a potential space/opening between the two atria.

A

25%

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30
Q

With this defect, it is possible for a clot to form between the flaps, causing a paradoxical embolus

A

Atrial septal defect (ASD)

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31
Q

defect in mid septum at the fossa ovalis (80%) from incomplete development

A

Ostium secundum

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32
Q

defect in lower atrial septum;
usually associated with additional defects.

A

Ostium primum

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33
Q

Which of the following is a defect in mid atrial septum? which one is a defect in lower atrial septum?:

Ostrium primum
Ostium secundum

A

Ostium primum= defect in lower septum

Ostium secundum= defect in mid septum

34
Q

RA, RV and PA enlarge - volume overload

Pulmonary HTN usually occurs late (3rd or 4th decade) if lesion goes undetected up to that time in life
result of chronic volume overload x years.

A

Atrial septal defects

35
Q

L to R shunting at atrial level due to:

Rt atrium more distensible than left
RV more compliant than LV
PuVR greater than SVR
LA pressure greater than RA pressure

A

Atrial septal defect (ASD)

36
Q

RV volume overload and increased pulmonary blood flow;
well tolerated for many years.

A

Atrial septal defect

37
Q

Majority of children are asymptomatic

Symptoms when present include fatigue, dyspnea, decreased stamina and usually begin in early 20’s.

Most adults become increasingly symptomatic by 3rd or 4th decade: fatigue, dyspnea and atrial arrhythmia’s (Afib).

paradoxical emboli can result in stroke!

A

Atrial septal defect

38
Q

*Patent foramen ovale: incomplete fusion of atrial septum (tiny defect) allows
clot to pass from ______ to _______

A

right atrium –> left atrium

39
Q

Hyperdynamic RV (lift): RV volume increase leads to ↑contraction via Starling mechanism.

S1 accentuated at LLSB

S2 widely split through inspiration/expiration: RV ejection is delayed from volume overload.

A

Atrial septal defect

40
Q

Grade II-III midsystolic crescendo-decrescendo mumur, at upper LSB reflects increased blood flow across pulmonic valve.

Present during childhood.

A

Atrial septal defect

41
Q

ECG shows:
rsR’ pattern in Rt precordial leads with mildly widened QRS (incomplete RBBB)

arrhythmias common in adults-Afib, Aflutter.

A

Atrial septal defect

42
Q

Echo-Doppler shows: RV volume overload
enlarged RV, RA
2D echo and doppler identify the defect and semi quantitate the shunt.

A

Atrial septal defect

43
Q

Cardiac cath shows:
Measurement of RV/PA pressures
quantification of shunting
identification of anomalous pulmonary veins if present.

Closure of ____ often performed percutaneously using catheters/devices.

A

atrial septal defects (ASD)

44
Q

Is PVOD seen more with ventricular septal defect (VSD) or atrial septal defect (ASD)

A

VSD

(PVOD is uncommon ins ASD)

45
Q

Harsh, holosytolic murmur at LSB

VSD or ASD?

A

large VSD

46
Q

Grade II-III mid systolic crescendo-decrescendo murmur at upper LSB

VSD or ASD?

A

ASD

(reflects increased blood flow across pulmonic valve)

47
Q

Undetected ASD can later lead to (right or left) sided HF?

A

Right

48
Q

Once symptoms present (including paradoxical emboli), what do you do for ASD?

A

Surgical/catheter closure

49
Q

For ASD, if there are NO SYMPTOMS but…

QP:QS ratio is greater than 1.5:1.0

OR

PAH is present

…what do you do?

A

Surgical/catheter closure

50
Q

MC form of pulmonary stenosis= “dome shaped” stenosis of pulmonic valve

in pulmonic stenosis, the right ventricle develops _________ hypertrophy, and reflects the degree of obstruction at the valvular level

A

concentric!

51
Q

Pulmonic valve must be obstructed by ___% or more to be hemodynamically significant

A

60%

52
Q

Peak systolic gradient (pressure between RV and pulmonary artery) is
>40 mmHg

A

Moderate pulmonary stenosis

53
Q

Peak systolic gradient (pressure gradient between RV and pulmonary artery) is
>75 mmHg

A

Severe pulmonic stenosis

54
Q

RV failure occurs with severe obstruction due to pulmonic stenosis

this results in a decreased…

A

cardiac output

(and associated signs/symptoms)

55
Q

Most infants/children are asymptomatic, unless severe
Sx include: DOE, fatigue

PE shows:
systolic thrill at suprasternal notch
early systolic click at upper LSB
murmur is LOUD! (grade 3-4)
harsh crescendo-decrescendo at upper LSB radiating towards clavicle and LOUDER WITH INSPIRATION

A

Pulmonic stenosis

56
Q

Harsh crescendo-decrescendo murmur at upper LSB, radiating towards clavicle and louder with inspiration!!!

(usually grade 3-4)

A

Pulmonic stenosis

57
Q

Image of choice for pulmonic stenosis

Identifies obstruction and estimates severity

A

Echo/doppler

58
Q

Tx for pulmonic stenosis

A

Balloon valvuloplasty opens stenotic valve

59
Q

Is intervention for pulmonic stenosis required if the gradient is <25 mmHg

A

NO!

but intervention is always required if gradient >75 mmHg

60
Q

Persistent patency of the vessel that normally connects the pulmonary arterial system and the aorta in the fetus

A

Patent Ductus Arteriosus (PDA)

61
Q

Normally, the patent ductus arteriosus (PDA) closes within _____ days after birth

A

2-3 days

62
Q

Risk factors:

Maternal exposure to rubella
Pre-term deliveries

A

PDA

63
Q

High resistance to flow
Well tolerated
Small L to R shunt

…small, moderate or large PDA?

A

Small

64
Q

Aorta and pulmonary artery are in free communication, equal pressures
Marked L to R shunting
Pulmonary congestion
LV dysfunction and failure
PVOD

..small, moderate or large PDA?

A

Large

65
Q

Elevated pulmonary artery pressure
Significant shunting

…small, moderate or large PDA?

A

Moderate

66
Q

If there is a large PDA, what type of symptoms can you see within the first weeks of life?

A

CHF type symptoms

67
Q

Systolic thrill over pulmonary artery in suprasternal notch and LSB
Apical and RV impulse increased

Murmur is continuous (thru systole and disatole)
“machinery murmur”
Grade 4 or louder at LSB and beow clavicle
Peaks near S2

A

PDA murmur

68
Q

First line tx for PDA in premature infants

A

Indomethacin

..if ductus remains open, surgical or catheter closure!

(constriction of ductus)

69
Q

8-9% of all infants presenting with CHD

discrete narrowing of distal segment of the aortic arch, just distal to the origin of the subclavian artery

A

Coarctation of the aorta

70
Q

Systolic and diastolic pressures above coarctation are….

A

elevated!

(systolic and diastolic pressures below coarctation are reduced)

71
Q

What 2 other cardiac abnormalities are often seen with coarctation of the aorta?

A

Ventricular Septal Defect

Bicuspid Aortic Valve

72
Q

Prominent collateral circulation to lower body develops via internal mammary and subcostal arteries, causing what to be seen on CXR in coarcation?

A

Rib notching

73
Q

Fatigue
Dyspnea
Fatigue in legs with exertion
Frank claudication

signs/symptoms of?

A

Coarctation of aorta

74
Q

If a child has HTN, what 2 things should you consider?

A

Coarctation of aorta
Renal artery stenosis

(HTN secondary cause in kids)

75
Q

In coarctation of the aorta, what does the BP look like in the legs compared to the arms?

A

>10 mmHg drop in leg BP compared to arms

(arm BP >10 mmHg higher than leg BP)

76
Q

Mechanical obstruction of the coarct
PLUS
High renin HTN due to decreased perfusion of kidneys

…leads to what in coarctation pts?

A

Marked HTN in uper body

77
Q

How does a pt with coarctation of the aorta appear?

A

Well developed upper body

Very thin legs

78
Q

What will an ECG look like in a pt with coarctation of aorta?

A

LVH

79
Q

With coarctation of aorta…

progressive HTN develops with age and often persists if surgical correction is performed after age…?

A

6

80
Q

Biventricular origin of the aorta
Large VSD
Obstruction to pulmonary blood flow
RVH

A

Tetralogy of Fallot

81
Q

MC cause of SCD in pts under 35 yo

A

HCM

SD- Pediatrics (11 decks)

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