Cardio Tx

Question 1

ASD

Answer 1

Closure of defect

• age 1-3 years
• symptomatic child with a large defect
• asymptomatic kid with hemodynamic significance- cardiac cath or surgery

Question 2

Patent Ductus Arteriosus

Answer 2

Preterm- prostaglandin inhibitor- indomethacin PO

Term infant- small to moderate just monitor, larger do a surgical closure by age 1y

Question 3

VSD

Answer 3

monitor- small 90% close by 6y, moderate- serial echo monitoring
surgery- pts with cardiomegaly, poor growth, exercise intolerance, shunt >2:1
- repair at 3-6 mo, risk of eisenminger syndrome, synthetic or pericardial patch

Question 4

Coarctation of the aora

Answer 4

Goal- reduce the risk of cardiac failure, correction >5yrold cat increased risk of HTN and myocardial dysfunction
surgical repair, balloon angioplasty, trans catheter stent in older patients

Question 5

tetralogy of fallot

Answer 5

complete repair during the neonatal or infancy perior
open hear surgery
- VSD closed
- trans annular patch until pulmonary valve replacement necessary (about 10-15 yrs posted)

Question 6

Transposition of the Great Arteries

Answer 6

early corrective surgery, before 14days old(usually at 4-7d) Arterial Switch- transect the arteries above the level of the valves and switch, separately reimplant coronary arteries, close ASD or VSD

Question 7

Dialated cardiomyopathy

Answer 7

manage heart failure- control lipids, DM, BP, weight control, cease alcohol and smoking
all patients, regardless of etiology- Beta Blocker and ACE inhibitor
ACS+reduced LVEH- Ace or ARB and BetaBlocker, Statin

Question 8

Taka Tsubo cardiomyopathy

Answer 8

Short term- ASA, beta blocker, ACE1 until LV recovers

long term- ACE1

Question 9

Hypertrophic cardiomyopathy

Answer 9

slow HR to increase diastolic filling- beta blocker, maybe CCB
lower LV diastolic and LA pressure- diuretics
treat Afib, dual chamber pacing, non surgical septal ablation, implantable defib

Question 10

restrictive cardiomyopathy

Answer 10

acute- diuretics, beta blockers
amyloidosis- difluisal or tafamidis
sarcoidosis- corticosteroids

Question 11

Aortic Aneyrusm

Answer 11

abdominal- elective repair 5.5cm or over o.5cm growth in 6 months, impending rupture or rupture
thoracic- surgery when over 6 cm, descending- endovascular graft, aortic arch repaired by skilled team

Question 12

Aortic Dissection

Answer 12

A- surgical intervention urgently for all
B- bypass, medical management, stent/ graft
long term- BP 120/80, serial MRI or CT at 3, 6, 12mo, annually thereafter

Question 13

Giant cell/temporal areteritis

Answer 13

Urgent- Prednisone 60mg PO daily for a month, if vision loss on presentation start IC methylprednisone

Question 14

Peripheral arterial disease

Answer 14

stop smoking, statins, wound care, exercise and weight loss, aspirin, surgical- angioplasty and stent, bypass graft, revascularization, amputation

Question 15

Superficial thrombophlebitis

Answer 15

montior IV site daily, remove if sx develop, localized- NSAID and heat
anticoag prophylaxis if >5cm affected
Septic- urgent heparin treatment and Vanc + Ceftriaxone

Question 16

Chronic venous insufficiancy

Answer 16

Compression stockings- 20-30 or higher, foot to knee
avoidance of prolonged standing, elevate LE at night
Ulceration- compression and wound care, percutaneous thermal ablation if recurrent

Question 17

Venous thrombosis

Answer 17

LMWH, Warfarin, or oral anticoagulant

Question 18

bacterial endocarditis

Answer 18

MRSA- Naf or Ocacillin IV or Cefazolin prosthetic valve- Nad or Oxacillin with rifampin and gentamicin, or Vanc
Viridians- penecillin G or ceftriaxone IV, can add gentamicin
enterococci- ampicillin or penecillin G IV plus gentamycin
HACEK- ceftriaxone
surgery- valve replacement if unresponsive to abs
dicontinue anticoagulant if prosthetic valve

Question 19

Acute inflammatory pericarditis

Answer 19

activity restriction until symptom resolution, Cholchincine plus NSAID

Question 20

Pericardial effusion

Answer 20

small- observe JVP and serial echocardiogram

Tamponade- urgent pericardiocentesis, cardiac surgery if needed