Depend on size - Palpitations - Dyspnea - A Fib

Cardio Flashcards by Deborah Karp

What is the most common cyanotic congenital heart defect after infancy?

Tetralogy of Fallot

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What are the four characteristics of Tetralogy of Fallot?

Pulmonary stenosis
RV hypertrophy
VSD
Overriding aorta

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PE of Tetralogy of Fallot

Pulmonary stenosis
RV impulse at LLSB
Single S2
Tet spells

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What is a tet spell?

Child turns blue when crying or feeding

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EKG of Tetralogy of Fallot

Right axis deviation

Right ventricular hypertrophy

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CXR of Tetralogy of Fallot

Boot shaped heart

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Tx of Tetralogy of Fallot

Surgical repair

Subacute bacterial endocarditis prophylaxis for life

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What is the most common congenital heart disorder?

VSD

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What are the four types of VSD?

Infundibular
Perimembranous
Inlet
Muscular

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What is the most common VSD?

Perimembranous

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What is also associated with VSD?

Myocardial infarction

Down syndrome

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Characteristics of VSD

Pansystolic murmur at LLSB
+/- LA and LV enlargement
Most spontaneously close

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Tx of VSD

Diuretics
ACE inhibitors
Cardiac glycosides
Transcatheter closure
Surgery

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What is the most common ASD?

Secundum

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Sx of ASD

Depend on size

Palpitations
Dyspnea
A Fib

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PE of ASD

Fixed split S2

Systolic ejection murmur

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EKG of ASD

RVH and RAD

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CXR of ASD

Cardiomegaly
RAE
Large pulmonary artery

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S/sx of PDA

Continuous machine-like murmur
Bounding pulses
Widened pulse pressure

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Tx of PDA

Preterm-indomethacin
Term- closure device or coil embolization
-Surgical ligation

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PE of coarctation of aorta

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Decreased femoral pulses
Systolic murmur
-Blowing
-Left axilla
-Left back
Low BP to anything distal, high BP to anything proximal

Infant ECG/CXR of coarctation of aorta

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Cardiomegaly
RVH
Pulmonary edema

Older children ECG/CXR of coarctation of aorta

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Mild cardiomegaly

LVH

General ECG/CXR of coarctation of aorta

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Rib notching

3 sign- dimpling of artery on angiography

Tx of coarctation of aorta

Prostaglandin E1 +/- Emergency Balloon Angioplasty Surgical repair

Sx of HCM

``` Asymptomatic Dyspnea Fatigue Atypical chest pain Syncope Palpitations Sudden cardiac death ```

EKG of HCM

T-wave inversion can happen with LVH

What decreases the HCM murmur?

Squatting

Tx of HCM

``` Beta blockers Calcium channel blockers Left ventricular mymectomy Catheter septal ablation ICD ```

How is a definitive dx of acute rheumatic fever made?

Presence of 2 major Jones criteria or one major and two minor, along with evidence of an antecedent streptococcal infection

What are the major Jones criteria?

``` Polyarthritis Carditis Chorea Erythema marginatum Subcutaneous nodules ```

What is the most common major manifestation of acute rheumatic fever?

Arthritis

What are minor Jones criteria for acute rheumatic fever?

``` Fever Arthalgias Previous rheumatic fever Leukocytosis Elevate ESR/CRP Prolonged PR interval ```

What is considered carditis for acute rheumatic fever?

``` Tachycardia New murmur Pericarditis Cardiomegaly Signs of heart failure ```

Erythema marginatum

A serpiginous, non-pruritc, evanescent rash Uncommon On the trunk Brought out by warmth

Tx of acute rheumatic fever

Benzathine PCN Salicylates Bed rest Long-term PCN prophylaxis, preferably with IM benzathine PCN G, 1.2 million U every 28 days.

Possible causes of syncope

``` Neurocardiogenic Micturition Hair grooming Cough Carotid sinus Cardiac syncope Left ventricular outflow tract obstruction Pulm HTN Myocarditis Tumor or mass Coronary artery disease Dysrhythmia ```

Definition of syncope

The transient loss of consciousness and muscle tone that, by history, does not suggest other altered states of consciousness

Definition of pre-syncope or near-syncope

Has many or all of the prodromal sx without loss of consciousness

Syncopal prodrome

Consists of: - Dizziness - Lightheadedness - Nausea - Diaphoresis - Visual changes (blacking out) - Palpitations

What is the second most common vasculitis of childhood?

Kawasaki disease

When does Kawasaki disease most commonly occur?

Children younger than 5 years of age

What are the three phases of Kawasaki disease?

Acute Subacute Convalescent

What happens during the acute phase of Kawasaki disease?

``` Sudden onset of high, hectic fever Conjunctival erythema Dry cracked lips Strawberry tongue Cervical LAD Swelling of the hands and feet ```

How long does the acute phase of Kawasaki disease last?

1-2 wks

Criteria for cervical LAD in Kawasaki disease

>1.5 cm in diameter

Description of conjunctivitis in Kawasaki disease

Bilateral Bulbar Nonsuppurative

How long does the subacute phase of Kawasaki disease last?

Until the fourth wk

Characteristics of the subacute phase of Kawasaki disease

Gradual resolution of fever and other acute phase sx Desquamation of the skin Increased platelet count Coronary artery aneurysms

Labs and rads for Kawasaki disease

Blood and urine cultures CXR Inflammatory parameters (WBC, CRP, ESR) are elevated during acute phase Platelet count elevated during subacute phase Hepatobiliary function tests Echo for coronary artery aneurysms

How to diagnose Kawasaki disease

Fever for >5 days without identifiable source and presence of four of five other clinical criteria

Tx of Kawasaki disease

IVIG | Aspirin in anti-inflammatory doses then in antithrombotic doses once fever is resolved

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