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Flashcards in Cardio Deck (24)
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1

Acute rheumatic fever presentation

Jones criteria: 2 major and 1 minor

Major → carditi, erythema marginatum, subcutanoues nodules, chorea, polyarthritis

Minor → fever, polyarthralgias, reversible prolongation of PR interval, rapid erythrocyte sedimentation rate or CRP

2

Acute rheumatic fever etiology

Systemic immune resp 2-3 wks following β-hemolytic strep pharyngitis

MC 5-15 yo

3

Acute rheumatic fever tx

Strict bed rest until stable

IM penicillin and erythromycin

Salicylates to ↓ fever and relieve joint pain, corticosteroids can also help w/ joint pain

Prevent w/ early tx of strep

4

Atrial Septal Defect presentation

Systolic ejection murmur at 2nd LICS; early to middle systolic rumble

Failure to thrive, fatigability, RV heave, wide fixed split S2

5

Atrial Septal Defect definition

Opening between the right and left atria

MC = ostium
secundum

Acyanotic

6

Atrial Septal Defect tx

Refer to pediatric cards for echo

Surgical repair at age 2-3 for most

Small defects in boys don’t need closure if RV size is normal

7

Coarctation of the Aorta presentation

Systolic, LUSB and L interscapular area, may be continuous

Infants may present
with CHF

Older chil- dren may have systolic hypertension or murmur or underdeveloped lower extremities

Diff betwn arterial pulses and BP in UE and LE pathognomonic

8

Coarctation of the Aorta tx

Refer for echo

Reopen truncus arteriosus within 4 d of birth w/ prostaglandins

9

Coarctation of the Aorta definition

Obstructive

Narrowing in the proximal thoracic aorta

10

Hypertrophic Cardiomyopathy definition

autosomal dom

Massive hypertrophy (particularly of the septum), small left ventricle,
systolic anterior mitral motion, and diastolic dysfunction

11

Hypertrophic Cardiomyopathy presentation

L ventricular hypertrophy

LV outflow obstruction, diastolic dysfunction, MR, MI

LVOT murmur = harsh crescendo-decrescendo systolic murmur that begins slightly after S1 and is heard best at the apex and lower left sternal border

MR murmur = mid-late systolic murmur at the apex

HF, chest pain, or arrhythmias, fatigue, dyspnea, chest pain, palpitations, syncope/presyncope

12

Hypertrophic Cardiomyopathy tx

Initial tx → β-blockes or CCB
Disopyramide is used for its neg
inotropic effects

Surgical or nonsurgical ablation of the hypertrophic septum may be required

Dual-chamber pacing, implantable defibrillators, or mitral valve replacement may be indicated

Cardiac transplantation may be indicated for severe disease

13

Kawasaki disease presentation

< 5 yo

Fever > 5 days + at least 4 of the following: conjunctivi-
tis, lip cracking and fissuring, strawberry tongue, or inflammation of the oral mucosa, cervical lymphade- nopathy, (usually unilateral), polymorphous exanthem, or redness and swelling of the hands and feet w/ subsequent desquamation

14

Kawasaki disease tx

IV immunoglobulin and high-dose aspirin

Early tx will ↓ chance of cardiac events

Pts with cardiac disease should receive LT aspirin therapy and annual follow-up

Monitor through serial electrocardio, chest radiography and echocardio until recoverd

15

Patent Ductus Arteriosus definition

Acyanotic

Failed or delayed closure of the channel bypassing the lungs, which allows placental gas exchange during the fetal state

16

Patent Ductus Arteriosus presentation

Harsh continuous machine murmur

Usually asymptomatic

May have exertional dyspnea or heart failure

Wide pulse pressure

17

Patent Ductus Arteriosus tx

Refer to pediatric cards for echo and for meds to make ductal tissue regress or surgical repair

IV indomethacin

18

Syncope

A sudden, transient LOC not resulting from trauma

19

Common causes of syncope

Common causes include arrhythmias, aortic stenosis, carotid sinus hypersensitivity, myocardial infarction, hypoglycemia, orthostatic hypotension, postprandial hypotension, psychogenic disorders, pulmonary embolus, and vagal faint

20

Tetralogy of Fallot definition

Pulmonary stenosi → RV hypertroph, VSD, overriding aorta

VSD may be R to R or L to R

21

Tetralogy of Fallot presentation

Progressive

May appear healthy and pink at birth

Cyanotic “tet spells” where child turns blue, squats to valsalva

Crescendo–decrescendo holosystolic at LSB, radiating to back

Cyanosis, clubbing, increased RV impulse at LLSB, loud S2

22

Tetralogy of Fallot tx

Surgical correction in early infancy

23

Ventricular Septal Defect presentation

Holosystolic murmur at LLSB

May have thrill or diastolic rumble

Heart failure

(MC dx congenital heart defect)

24

Ventricular Septal Defect tx

Most will get smaller and disappear on their own

Surgical repair indicated for intractable CHF, failure to thrive