Cardiac Flashcards
(152 cards)
1
Q
what’s an easy screen to look closer for heart disease.
A
fall off the growth curve
2
Q
when will you see prominence of pulmonary vasculature.
A
Pulmonary overcirculation
3
Q
What does an “egg on a string” indicate on an x-ray?
A
Transposition of the great arteries
4
Q
What does a boot shaped heart indicate?
A
Tetrology of Fallot
5
Q
what does an active precordium indicate?
A
cardiomegaly or large right side of the heart
6
Q
what can differential pulses indicate?
A
Coarctation of the aorta
7
Q
what can bounding pulses indicate?
A
Run off lesions
Left to right PDA shunt, AI
8
Q
what can weak pulses indicate?
A
cardiogenic shock or coarctation of the aorta
9
Q
is an exaggerated SBP drop with inspiration → tamponade or bad asthma
A
Pulsus paradoxus
10
Q
altering pulse strength → LV mechanical dysfunction
A
Pulsus alternans
11
Q
closing of mitral and tricuspid valves, LLSB or apex
A
S1
12
Q
closing of aortic (A2)and pulmonic (P2) valves
A
S2
13
Q
heard in diastole ,related to rapid ventricular filling , can be normal, or abnormal -accentuated with dilated ventricles
A
S3
14
Q
late in diastole just before S1 – always bad.
Decreased vent compliance / heart failure
A
S4
15
Q
Heart murmurs which occur in the absence of anatomic or physiologic abnormalities of the heart or circulation
A
Innocent Heart Murmurs
16
Q
a louder murmur is going through what type space?
A
a smaller space
17
Q
signs for concern with a murmur
A
Easy fatigability, including difficulty with feeding in infants
Claudication
Symptoms that worsen with exertion
Growth failure
18
Q
Common functional murmur in a newborn
A
first days of life LLSB
1-2/6, gone by 2-3 weeks of life
19
Q
Functional murmur that is often in the newborn period from branching PA. Heard in axillae and back short, high pitched 1-2/6
A
Peripheral pulmonary artery stenosis
20
Q
when will the murmur be the loudset?
A
When the blood is coming toward the stethoscope from where the blood is coming.
21
Q
most common murmur of early childhood. Heard ages 2-7yrs. Musical, vibratory, mid to lower LLSB, 1-3/6. loudest when patient supine.
A
Still murmur
22
Q
most common innocent murmur in older children, ages 3 yrs and up. ULSB, soft ejection murmur , 1-2/6.
A
Pulmonary ejection murmur
23
Q
heard after age 2, infraclavicular R>L, Continuous musical hum. Best heard sitting. Comes from turbulence at confluence of subclavian and jugular vein.
A
Venous Hum
24
Q
older child and adolescent. Rt supraclavicular area, harsh, 2-3/6.
A
innomiate or carotid bruit
25
do you have to "work up" a murmur is hx and PE are UNL?
No
26
if syncope is heart related, what will the problem be?
arrhythmia or CHD
27
is chest pain common in children?
No, usually MSK
28
most common arrhythmia in kids?
PACs
29
Some conducted, some non-conducted. Slight not-quite compensatory pause before next beat. Benign
PACs
30
wide QRS, no compensatory pause, typically benign unless they come several in a row
PVCs
31
3 PVC’s in a row
V tach
32
how do you treat Vtach?
cardioverting
33
280-300 bpm, well tolerated in kids (unless underlying heart dz)
Supraventricular tachycardia (SVT)
34
Wolff-Parkinson-White Syndrome
Re-enterant tachycardia
35
how do you manage SVTs?
beta blockers
36
how do you stop supraventricular tachycaria?
adenosine
37
what's another symptoms that can put someone in SVT?
prolonged QTC syndrome
38
heart block with prolonged PR
first degree
39
what normally causes heart block in kids?
maternal lupus (3rd degree)
40
Block where not all P waves are conducted.
second degree block
41
types of second degress block where there are progressively longer PR intervals until a QRS is dropped.
Type 1 second degree block
42
what is a second degree heart block where PR intervals are equal but there is an occasional QRS dropped
Type 2 second degree heart block
43
block with complete dissociation of SA with AV
third degree heart block
44
Children’s heart disease , particularly congenital heart disease is due to _______________________
structural abnormalities
45
causes of congenital heart dz.
multifactorial
46
What viruses can lead to mycoarditis?
coxsackie B, Parvovirus
47
what can ibuprofen taken by the mother cause in the baby?
Pulmonary HTN
48
what can lupus in mom cause?
congenital heart block
49
what can diabetes in mom cause in baby
TGA
VSD
ventricular hypertrophy
50
what Trisomy 21 lead to in the heart?
AV septal defect
51
what can turner's syndrome have to the heart?
CoA, biscupsid aortic valve
52
what can marfan syndrome cause in the heart?
MVP, dilated aortic root, MR
53
what is the most common CHD that presents in the first week of life?
Transposition of the great arteries
54
what is the second most common presenting heart condition in the first week of life?
hypoplastic left heart dz
55
what is the most common CHD presenting beyond infancy?
tetraology of fallot
56
differences b/w fetal heart and normal heart?
```
open ducuts arteriosus
open foramen ovale
increased pulmonary pressure
most blood routed around lungs
oxygenation in placenta, not lungs
```
57
how does oxygen help the PDA close
mild vasoconstrictor
58
if a baby is acyanotic, what type shunt must there be?
Left to right
59
If a baby is cyanotic what must the shunt be?
Right to left shunt
60
If pulmonary flow is increased, what type shunt is it?
left to right shunt
61
if there is decreased pulmonary flow what type shunt will you have?
right to left shunt
62
what is the most common noncyanotic CHD?
VSD
63
list the nonxyanotic CHD problems
ASD, VSD, PDA
| pulmonary stenosis, aortic stenosis, aortic coarctation
64
Presents in childhood w/ murmur or exercise intolerance. RA and RV volume overload (enlargement). Physical findings of RV lift, persistently split S2, diastolic flow over tricuspid valve
ASD
65
ASDs that persistent after how many years will not close?
2 years
66
what finding goes with a persistently split S2?
ASD
67
will present with poor growth, SOB, easy fatigue, may have recurrent respiratory infections. Can has a "boudning" precordial activity, holosystolic mumur.
VSD
68
tx for VSD
observation
anti-congestive HF meds (diuretics)
fortified diet
surgery
69
can kids increase rate and stroke volume?
No, only can increase rate
70
tx for PDA
indocin/ ibuprofen or sx
71
how can you keep PDAs open?
prostaglandins
72
is pulmonic stenosis progressive?
no
73
what is the first sign of aortic stenosis?
Murmur (ejection click, basilar ejection murmur, precordial or suprasteneral thrill)
74
Will present with chest pain, dizziness, syncope (especially with exertion)
Aortic stenosis
75
tx for aortic stenosis
most are progressive, can need a valve replacement
76
blowing systolic in left axilla. Neonates will have severe congestive cardiac failure. older children will have HTN, absent or weak femoral pulses.
CoA
77
what are cyanotic CHD problems? (5 T's)
```
Tetraology of Fallot
Triscupsid atresia
total anamalous pulmonary venous return (RAPVR)
truncut arteriosus
transposition of the great vessels
hypoplastmic left heart syndrome (HLH)
pulmonary atresia (PA)
double outlet right ventricle (DORV)
```
78
if a one week up sepsis in the ER what should you have on your ddx
sepsis
inborn error
cOA
79
does truncus arteriosis increase or decrease pulmonary blood flow?
increase pulmonary blood flow
80
does tetraology of fallot increase or decrease blood flow?
decrease pulmonary blood flow.
81
what can worsen with the closure of a PDA and can have "tet spells"
tetraology of fallot
82
4 things with tetraology of fallot
1. narrowing of pulmonary valve
2. thickening of wall of right ventricle
3. displacement of aorta over VSD
4. VSD
83
what is the most common cyanotic lesion
tetraology of fallot
84
what will kids with tetraology of fallot do?
squat
85
when are most patietns with TOF cyanotic by?
4 months
86
tx for TOF
surgical correction, fix VSD
| can get prostaglandins
87
tx for TGA
form a ASD, give prostaglandins, tx
88
will you hear a murmur with TGA?
no
89
bacteria pneumonia tends to look like what on a x-ray?
lobar, consolidated
90
what are responsible for atypical pneumonias?
Chlamydia and mycoplasm
91
how will atypical pneumoniae present?
x-rays will be normal, or interstitial (perihilar streakiness, etc)
92
from ages 1-5 what type of causes of pneumoniae are common?
Viruses
93
Over 5 what are the most common causes of pneumonia?
strep pneumo and mycoplasma
94
Acyanotic heart lesions
3 Ds (VSD, ASD, PDA)
95
cyanotic heart lesions
```
12345
1 trunk
2 (vessel switch)
3 (tricupsid insufficiency)
4- tetraology of fallot
5 (TAPVR) total anomalous pulmonary venous return
```
96
what does a hypoplastic left heart need to get blood to the body?
PDA with an ASD
97
How do you treat hypoplastic left heart?
prostaglandins
98
what will happen with a hypoplastic left heart without tx?
Death at 5-7 days untreated
| Shock and acidosis
99
what are some non-ductal dependent conditions?
mild-moderate AS, CoA or PS
100
Presents in infants with dyspnea, fatigue, poor feeding, FTT, tachycardia, gallop rhythm, hepatomegaly
heart failure
101
In an older kid due exercise intolerance, somnolence, anorexia, (cough, wheeze, crackles in late failure)
heart failure
102
how is a chest x-ray helpful in heart failure?
if it is negative, but not helpful with fluid in lungs (could be pneumonia or heart failure)
103
heart sound associated with heart failure?
S4
104
what is the best study for heart failure?
Echo
105
what is the most common type of cardiomyopathy?
dilated then
| hypertrophic
106
Increased ventricle size with decreased contractility
| no evidence of coronary,valvular or pericardial disease
Dilated cardiomyopathy
107
what will happen with dilated cardiomyopathy?
leaky valvues (mitral insufficiency)
108
tx for cariomyopathy
```
Diuretics
inotropic meds (help squeeze)
afterload reducers (vasodilation)
```
109
what is hypertrophic cardiomyopathy associated with?
prolonged QT interval
110
what does a narrow pulse pressure indicate?
systolic is very close to diastolic
111
what is a case of widened pulse pressure?
PDA
112
what is a cause of a narrow pulse pressure?
dilated cardiomyopathy
113
what will the pulses be like with dilated cardiomyopathy?
weak
114
what can cause viral myocarditis?
echovirus
| coxsackie B
115
are EKGs helpful with cardiomyopathies?
yes, will be abnormal but will be nonsprcific
116
if pericarditis is bacterial what can cause it?
Staph A
| Strep Pneumo
116
if pericarditis is bacterial what can cause it?
Staph A
| Strep Pneumo
117
What is the best test for pericarditis?
echo
117
What is the best test for pericarditis?
echo
118
what is the most often cause of pericarditis?
Viral
118
what is the most often cause of pericarditis?
Viral
119
what labs can do you for pericarditis?
viral titers, antistreptolysin O titers ASO (blood)
119
what labs can do you for pericarditis?
viral titers, antistreptolysin O titers ASO (blood)
120
what do vegetations on valves in endocarditis do?
create clots
120
how do you treat pericarditis
anti inflammatories (viral)
121
infection on endothelial surface of heart- make vegetations. Typically a complication of CHD and surgery. Present with nonspecific symptoms- fever, malaise, weight loss, tachycardia, new or changed murmur
endocarditis
121
tx for infective endocarditis?
high dose penicillin + aminoglycoside
122
patient presents with polyarthritis, syndenham's chorea, erythema marginatum, subq nodules. had a previous hx of strep.
Acute rheumatic fever
123
what are some systemic symptoms of endocarditis?
```
Anemia
pallor
splinter hemorrhage in nailbeds
clubbing
retinal infarcts
```
124
what do vegetations on valves in endocarditis do?
create clots
125
most common organisms for endocarditis?
strep viridans
| staph aureus
126
Labs for endocarditis?
CBC- luekocytosis, anemia
blood culture
ESR and CRP often elevated
127
tx for infective endocarditis?
high dose penicillin + aminoglycoside
128
patient presents with polyarthritis, syndenham's chorea, erythema marginatum, subq nodules. had a previous hx of strep.
Acute rheumatic fever
129
when after strep does acute rheumatic fever present?
1-3 weeks following group A beta-hemolytic strep
130
what is prophylaxis for ARF?
Pen V BID or PEN G IM q 4 wekks until low risk
131
what is the criteria used to decide if it is rheumatic fever or not?
Modified jones criteria
132
what are major criteria for the JOhnes criteria?
```
migratory polyarthritis
carditis
Sydenham's chorea
erythema marginatum
SubQ nodules
```
133
treatment for Kawasaki's
IVIG at high dose
| high dose ASA
134
tx for ARF
Penicillin
antistrep prophylaxis and bacterial endocarditis prophylaxis
aspirin for pain and dever
135
how do you tx severe carditis
corticosteroids for severe carditis
136
3 stages of kawasaki's?
acute- fever, mucocutaneous symptoms (up to 2 weeks)
subacute- thrombocytosis, coronary artery changes (2-4 weeks)
chronic- slow resolution (2 months) `
137
what are the 5 stymptoms of kawasaki's dz?
1. fever (min 5 days)
2. conjunctivitis (no exudate, painless)
3. rash
4. changes in hand and feet- ersythema and desquamation
4. mucous membrane involvement (strawberry tongue, pharyngitis)
5. Cervical adenopathy- often unilateral
Plus coronary aneurysms
138
what type shunts are always cyanotic?
right to left
139
joint pain + fever + murmur indicates what?
rheumatic fever
140
9 year old with "fluttering" in chest after soccer game- what do you suspect?
Supraventricular Tachycardia
asthmatic
anemia
141
another name of kawasaki disease?
mucocutaneous lymph node syndrome
142
3 stages of kawasaki's?
acute- fever, mucocutaneous symptoms
subacute- thrombocytosis, coronary artery changes
chronic- slow resolution
144
what type shunts are always cyanotic?
right to left
145
joint pain + fever + murmur indicates what?
rheumatic fever
146
9 year old with "fluttering" in chest after soccer game- what do you suspect?
Supraventricular Tachycardia
| asthmatic
149
what are the 5 symptoms of kawasaki's dz?
1. fever (min 5 days)
2. conjunctivitis (no exudate, painless)
3. rash
4. changes in hand and feet- ersythema and desquamation
4. mucous membrane involvement (strawberry tongue, pharyngitis)
5. Cervical adenopathy- often unilateral
Plus coronary aneurysms
