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Cardiology Flashcards

(52 cards)

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1
Q

What are the 5 types of cyanotic heart defects?

A

Truncus

Transposition of the Great Vessels

Tricuspid Atresia

Tetrology of Fallot

Total Anomalous Pulmonary Venous Return (Obstructive)

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2
Q

What 4 anomalies constitute Tetralogy of Fallot? What prenatal factors are associated with it?

A

Aortic Override

VSD

RVH

Right Ventricular outflow obstruction

Maternal rubella or viral illness

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3
Q

Kids with TOF will often squat after exercise - why?

A

Causes trapping of desaturated blood in the LE and Increaces SVR while the RV outflow is fixed

  • Dec, R to L shunt
  • Inc. pulmonary blood flow
  • Inc arterial saturation
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4
Q

Tet Spell

A

Kids with TOF suddenly develop cyanosis

Inc. CO w/ fixed RV outflow - Increased R to L shunt

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5
Q

What are 3 things on CXR that can help diagnose Tetrology of Fallot?

A

Boot shaped heart

Decreased pulmonary vascular markings

Right aortic arch (25%)

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6
Q

What is the most common cyanotic congenital heart defect presenting in the neonatal period?

A

Transposition of the Great Vessels

*Must have ASD &/or VSD for mixing*

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7
Q

What does this patient have? How do you treat it?

A

Transposition of the Great Arteries w/ Intact Ventricular septum

*Need PGE1 for patent PDA & Early Balloon Atrial Septostomy

**Arterial Switch is definitive**

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8
Q

Subendocardial cushion defects are associated with what genetic syndrome? What defects are typically seen?

A

Trisomy 21

*Ostium primum ASD

*VSD

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9
Q

What are signs/symptoms of ASDs? (2)

A

Wide, fixed split S2

CHF & pulmonary HTN in 20s-30s

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10
Q

What size ASD are likely close on their own? Which are unlikely?

A

90% close spontaneously

< 3mm = 100%

> 8mm = unlikely

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11
Q

What is the most common congenital heart disorder?

A

VSD (membranous)

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12
Q

What percent of VSDs spontaneously close? When is intervention indicated? How do you treat?

A

30-50%

CHF, pulmonary HTN, growth failure

Diuretics and digitalis

Surgery

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13
Q

What is the main cause of PDA closure?

A

Ductal PO2 > 50 mmHg

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14
Q

Eisenmenger’s Syndrome

A

An unrepaired left-to-right shunt turns into a cyanotic right-to-left shunt

Increased pressure leads to pulmonary HTN

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15
Q

An opening snap wth a presystolic murmur is indicative of what?

A

Mitral Stenosis

Sequela of acute rhematic fever

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16
Q

Supravalvular aortic stenosis is associated with __________.

A

Idiopathic Hypercalcemia

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17
Q

Midsystolic click and late systolic murmur

A

Mitral Valve Prolapse

*nearly all Marfan’s pts have it*

Symptomatic treatment: β-blocker for chest pain

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18
Q

Coarctation of the Aorta is seen in 1/3 of patients with ____________.

A

Turner’s Syndrome

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19
Q

Pulmonary flow murmurs, physiologic pulmonary branch stenosis and Still’s murmurs can all be heard best when the patient is _______.

A

Supine

All are innocent

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20
Q

Common to all innocent murmurs (5)

A

Absence of structural defects

Normal S1/S2

Normal peripheral pulses

Normal CXR and ECG

Asymptomatic

**Usually systolic and < Grade III

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21
Q

Causes of tachycardia

Study These Flashcards
A

Fever, anxiety, hypovolemia, sepsis

CHF

SVT, v-tach, atrial flutter & fibrillation

Meds: Theophylline

22
Q

Causes of prolonged QT

Study These Flashcards
A

Long QT Syndrome

Hypo K, Mg, Ca

Neurologic Injury

23
Q

PVC may be normal if they are ________ and ___________.

Study These Flashcards
A

Uniform

Decrease with exercise

24
Q

V TAch

Study These Flashcards
A

Series of 3++ PVCs + HR 120-200

Wide QRS

T waves opposite QRS

**Usually suggests significant pathology**

25
**QRS Axis** **I+** & **aVF+** = **1+** & **aVF-** = **1-** & **aVF+** =
Normal LAD RAD
26
What causes peaked pointed T waves? (3)
Hyperkalemia LVH Head Injury
27
Wide P wave
**LAE** VSD, PDA, mitral stenosis
28
What is the boat or sail-shaped opacity that can obscure the heart in newborn and small infant CXR?
Thymus Involutes after puberty Not seen in premature newborns
29
Increased pulmonary vascular markings
Acyanotic: ASD, VSD, PDA, endocardial cushion defect, partial APVR Cyanotic: Total APVR, transposition, hypoplastic L heart, truncus, or single ventricle
30
Decresaed pulmonary vascular markings i.e. dark lung fields with small vessels
Pulmonary/Tricuspid stenosis and atresia Tetralogy of Fallot
31
Snowman Shape Heart
Total Anomalous Pulmonary Venous Return
32
How long after a **Group A Strep** infection of the _pharynx_ can one develop Rheumatic Fever?
Average 3 weeks (1-5w)
33
How do you diagnose Rheumatic Fever?
**Jones Criteria** (2 major or 1 major + 2 minor) **J**oints - polyarthritis **\<3** - carditis **N**odules **E**rythema marginatum **S** ydenham's Chorea **Minor** = Joint pain, fever, inc. ESR or CRP, prolonged PR interval + **ASO titer**
34
What does this person have?
Erythema Marginatum - non-pruritic, disappears when cold Rheumatic Fever!
35
What do you use to treat a patient with Rheumatic Fever's arthritis? What if it doesn't improve within 48 hours?
Aspirin Probably not rheumatic fever
36
How do you treat Rheumatic Fever?
Benzathine Penicillin G 1.2 mil units IM + Prednisone/ASA to prevent carditis PPX throughout adolescence/indefinitely
37
What is the most common cause of endocarditis?
**α-hemolytic strep** i.e. Strep viridins 67% Most is left-sided
38
What are signs/symptoms of endocarditis
Fever New/changing murmur Chest pain, dyspnea, arthralgia, myalgia, headache Hematuria + red cell casts TIA Roth spots, splinter hemorrhages, Osler nodes, Janeway lesions
39
A 6 yo girl with PDA develops fever and anorexia. Hgb is 9, she has hematuria, increased ESR, positive rheumatoid factor, and immune complexes are present.
Think Bacterial Endocarditis
40
Myocarditis is most often cause by \_\_\_\_\_\_\_. (4)
**Viruses**: Coxsackie and echo **Immune-mediated**: Acute rheumatic fever, Kawasaki **Collagen Vascular Disease** **Toxic Ingestions**
41
How does myocarditis present?
Asymptomatic - Fulminant CHF Usually symptomatic/supportive treatment
42
What causes pericarditis?
**Viral** (most common) **Bacterial**: Rheumatic Fever, S. Aureus, Neisseria, H. Flu Complications from **heart surgery** **Uremia** **Collagen Vasc. Disease** **Meds**: Dantrolene, Onc. Agents
43
Pericardial friction rub and chest pain relieved by standing Pulsus Paradoxus Diffuse ST Elevation
Pericarditis
44
Henoch-Schonlein Purpura
Immune vasculitis: **IgA vasculitis** **GN** Colicky abdominal pain - **intuss**., N/V **Palpable purpura** and joint pain **Supportive treatment**, recover in 4-6 weeks
45
What drugs do you use to treat CHF in kids?
Digitalis Diuretics Afterload reducing: ACE/CCB/Nitro
46
What is the danger in using diuretics and digitalis together?
Loop diuretics can cause hypokalemia which can precipitate digitalis toxicity.
47
Kawasaki's Disease
**Sterile pyuria**, aseptic meningitis DX Criteria - need 5+ **Fever \> 104 for 5 days** Bilateral conjunctivitis Strawbery tongue/dry cracked lips Erythema/Edema in UE and LE Polymorphic rash Cervical LAD
48
What are the most dangerous sequelae of Kawasaki Disease? How do you treat the disease?
Coronary Aneurysm, Pericardial Effusion, CHF, MI **IVIG** and **High dose ASA**
49
Polyarteritis Nodosa
Prolonged fever/weight loss, malaise, **subcutaneous nodules on extremities,** rashes**, g****angrene**of distal extremities,**HTN + abdominal pain** **Abnormal cell counts, p-ANCA** Treat with **steroids**
50
Takayasu's Arteritis
Chronic inflammatory disease involving aorta and branches Aneurysmal/saccular dilation of aorta Polyarthralgias, loss of radial pulse, LV dysfunction, HTN Treat with **Steroids**
51
Wegener's Granulomatosis
Necrotizing granulomas Rhinorrhea, **nasal ulcers** **Hematuria** Cough, **hemoptysis**, pleuritis Arrhythmias (granulomas in heart) **c-ANCA, ESR** **Steroids +/- cyclophosphamide or azathioprine**
52
Children with cyanotic heart disease are at increased risk for what 2 things?
Strokes and scoliosis

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