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Cardiac Flashcards

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0
Q

What is the importance of prostaglandins?

A

keeps the ductus arteriosus open

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1
Q

What is the importance of ductus arteriosus?

A

connects the blood from the pulmonary artery and aorta to mix to provide O2 to the trunk and lower extremities of the body

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2
Q

When does prostaglandins start to drop?

A

FUNCTIONAL closure of the ductus arteriosus

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3
Q

When does the functional closure of the ductus arteriousus occur?

A

12-15hrs after birth

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4
Q

What happens during the functional closure of the ductus arteriousus?

A
  • smooth muscle constricts

- drop of prostaglandins

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5
Q

When does the anatomic closure of the ductus arteriousus occur?

A

2-3 wks

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6
Q

How does the foramen ovale close after birth?

A

the pressure in the lungs increase causing a shunt from L to R; there is an increased pressure on the L atrium

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7
Q

What to check for in newborns - cardiac?

A 
CAPIG
Color
Auscultation
Pulse/palpitation 
Inspection
General appearance
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8
Q

What is more concerning regarding cyanosis?

A

central is more alarming than peripheral cyanosis

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9
Q

What is acrocyanosis?

A

peripheral cyanosis

benign

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10
Q

What murmur will have a thrill?

A

4+/6

loud HARSH murmur

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11
Q

How do you take peripheral pulses?

A

take 2 from different areas
ie) femoral + femoral OR femoral + brachial
check the two pulses and if they is a delay –> suspect cardiac stenosis

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12
Q

How do you check for perfusion and what is normal?

A

press firmly for 5 sec

normal: <2 sec

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13
Q

How do you grade murmurs?

A

1-3: NO thrill
4: 3 PLUS thrill
5-6: no need stethoscope

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14
Q

Which is more concerning: systolic or diastolic murmur?

A

DIASTOLIC

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15
Q

What to check for BP?

A

1) RECHECK ANY ABNORMAL BP
2) always compare upper and lower BP
3) keep in mind of baby’s: ht, wt, and age

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16
Q

What can cx false low O2 readings?

A 
severe anemia
carbon monoxide
hypotension
hypothermia
nail polish
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17
Q

What is normal pulse grade?

A

2+
1+: diminished
3+: hyperactive

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18
Q

What is the hyperoxia test?

A

1) give pt O2
if there is improvement –> respiratory defect
if there is NO improvement –> cardiac defect
*USED TO DIFFERENTIATE IF PROB IS FROM THE LUNGS OR THE CARDIAC

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19
Q

What should you check for re: CXR?

A 
LVSSR (l-o-v-rs)
Location
Vasculature (lungs)
Shape
Size
Ribs
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20
Q

CT ratio: neonates vs infant/child?

A

neonates: <45%

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21
Q

What does rib notching suggest?

A

masses

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22
Q

What is S1 and S2?

A

S1: mitral and tricuspid
S2: aorta and pulmonary

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23
Q

What do you hear in ASD?

A

FIXED SPLIT: valve is not working

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24
What can you hear upon inspiration?
splitting | BUT FIXED SPLITTING = ASD
25
What is a murmur?
the turbulence that is heard from the chambers and valve | abnormal in adults but normal in kids
26
At what age are murmurs concerning (abnormal)?
usually all benign murmurs heard in newborns and infants | after 8yo- NOT normal
27
Whats the steps when you hear a murmur?
1) murmur heard 2) refer 3) cardio does an echo
28
What is a functional murmur?
when the murmur that is heard is BENIGN and normal and NOT pathologic
29
What are the common benign murmurs?
Peripheral pulmonary stenosis Stills Venous humm
30
At what age can you typical hear the peripheral pulmonary stenosis murmur?
newborn to 2yo
31
At what age can you hear the Stills murmur?
2-8yo
32
At what age can you hear the venous hum murmur?
3-6yo
33
Which murmur sounds like a musical/vibration?
Stills | b/c the chordae tendinae are vibrating
34
Which benign murmur is heard the loudest in SUPINE?
Stills
35
Which benign murmur is heard the loudest in SITTING position?
Venous Hum murmur | b/c gravity is pulling the blood down from the brain --> internal jugular --> subclavian vein = MORE TURBULENCE
36
What is the Venous Hum murmur?
the turbulence of the internal jugular vein AND subclavian vein that goes into the superior
37
What is concerning murmur?
``` over 8yo murmur does NOT change w/ position (supine/siting, etc) grade is 4 (b/c there is a thrill involved) murmur is heard with: -growth failure -click -cyanosis -has other congenital anomalies ```
38
What are the categories of congenital heart dz?
cyanotic: right -> left, parallel, and mixed acyanotic: left -> right, obstructive
39
What are the right to left congential heart dz?
tetralogy of fallot | tricuspid
40
What is parallel congenital heart dz?
transposition of great vessels | total anomalous pulmonary return
41
What is mixed congenital heart dz?
Truncus arteriousus
42
What is tertalogy of fallot?
``` POVER Pulmonary stenosis Override aorta VSD RVH ```
43
Tetralogy of Fallot - sx?
pink- mild stenosis and able to send blood back | blue- severe stenosis and blood is shunted to systemic
44
Tetralogy Fallot - labs?
CXR: boot shpaed/egg on side
45
What is tet spell?
peripheral cyanosis | crying on the side in fetal position
46
Tetralogy Fallot - tx?
morphine to calm down | Phenlephrine to increase systemic vascular resistance and pulmonary circulation
47
What is transposition of the great vessel?
COMPLETELY TWO DIFFERENT CIRCUITS R atria and ventricle pumps to the systemic L atria and ventricle pumps to the lungs NEVER crosses
48
What is tricuspid atresia?
missing the tricuspid valve so there is no connection between the right atria and ventricle it is important to keep the foreman ovale and the ductus arteriosus open because it is the only way that the blood is able to flow between the right and left chambers of the heart (give them PROSTAGLANDINS!)
49
What is total anamlous pulmonary return?
all the blood from the pulmonary veins drain into the systemic veins or right atrium and does NOT into the venous circulation
50
What is truncus arteriosus?
the aorta and the pulmonary artery are ONE
51
Which cyanotic congenital heart dz has VSD?
Truncus arteriosus Tricuspid Atresia Tetralogy of Fallot
52
What are the cyanotic congenital heart dz?
``` Truncus Transitional Tricuspid Tetra Total Anamous Hypoplastic ```
53
What is hypoplastic left heart syndrome?
cyanotic mitral valve is closed and the left ventricle is small relies on the ductus arteriosus --> if closed --> bad news bear
54
What are the acyanotic congenital heart dz?
L to right | obstructive
55
What are the left to right congenital heart dz?
ASD VSD PDA
56
What is ASD?
atrial septal defect | right atria has blood from the left atria
57
What is VSD?
acyanotic | right ventricle has mixing of the blood from the left ventricle
58
What is PDA?
acyanotic patent ductus arteriosus aorta blood is mixing in with the pulmonary artery
59
What are the obstructive congenital heart dz?
coarctation of aorta aortic stenosis pulmonary stenosis
60
What is coarctation of the heart?
obstructive acyanotic there is a obstruction/squeeze of the aorta AFTER brachio, left common, and left subclavian --> upper extremities are perfused BUT lower extremities are NOT
61
Coarctation of the aorta - sx?
UE pulses stronger than LE | RIGHT radial/brachial is STRONG
62
Aortic stenosis and pulmonary stenosis?
narrowing of the aorta and pulmonary artery acyanotic obstructive
63
When do you need to administer prophylaxis bacterial endocartitis?
prosthetic valve hx of infective endocarditis congenital heart dz
64
What is the most common cause for HTN in kids?
renal dz (secondary HTN)
65
HTN in kids - sx?
HA | nosebleeds
66
What is the normal BP %?
below 90%
67
What is preHTN %?
90-95%
68
What is HTN %?
greater than 95%
69
When do you start checking for BP in kids?
3 yo
70
What if kid is OVERWT but under BP 95%?
HTN
71
What if kid is skinny with BP 95%?
HTN
72
If kid is 95% what labs would you order?
``` you're trying to find the cause of the HTN: 1) compare the BP UE and LE 2) UA 3) CBC 4) BMP (BUN, Cr) 5) Lipid 6) Renal ANYTHING TO CLUE IN OR R/O RENAL FAILURE ```
73
HTN - tx?
LIFESTYLE MODIFICATIONS | but if cause of HTN is secondary - start drugs (ACE, etc)
74
What are the causes of sudden cardiac death in children?
``` MAAHT Myocarditis Arrhthmias Aberrant coronary artery Hypertrophic cardiomyopathy Trauma to chest ```
75
What is hypertrophic cardiomyopathy?
most common cause of sudden cardiac death in children autosomal dominant murmur is LOUD sitting > supine
76
Hypertrophic cardiomyopathy - sx?
on exertion: chest pain palpitation sycnope
77
What are the arrhythmias that cause sudden cardiac death?
long QT | WPW
78
What strucutral or fxnal heart dz can cause sudden cardiac death?
myocarditis marfan aortic stenosis ARDS
79
What can cx long QT?
abx - quinolones
80
What should be asked when doing a PRE sports physical to prevent sudden cardiac death?
family hx of early death deafness chest pain w/ syncope med hx of ADHD
81
What is commotio cordis?
when kid is hit in the chest during a sport
82
What is Marfan sx?
genetic dz
83
Marfan - sx?
``` long fingers - arachnodactyly ectopia lentis - lens are subluxed early scoliosis AA dral extasia pneumothorax ```
84
Marfan sx - PE?
steinberg sign | walker sign

Pediatrics (12 decks)

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