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Flashcards in Cardiology Deck (27)
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-BP consistently above 95% of age, gender, height on 3 separate occasions
-essential: multifactorial -> diuretics, vasodilators, beta blockers, ace inhibitors never first line**
-secondary: usually renal vascular
-hypertensive emergencies: IV calcium channel blockers



-described by: intensity (grading I-VI), timing (systolic vs diastolic), location, radiation/transmission, quality
-innocent murmurs accentuated by high output states (fever, illness, anemia)
**Still's murmur: low frequency, LLSB when supine, quiet or gone when upright**, louder with illness/anemia/excitement, common ages 3-6yr
-pulmonary ejection murmur: LUSB, mid systolic, grating sound without radiation
-peripheral pulmonic stenosis: LUSB, common in newborns (caused by turbulent flow through hypoplastic PA branch after ductus closes), usually gone by 3-6mo
-venous hum: turbulent jugular venous flow, continuous murmur, heard only when upright


Rheumatic fever

-collagen vascular disease of connective tissue --> vasculitis 2-4wks after a Strep A pharyngitis**
-arthritis, carditis, chorea, erythema marginatum, sub cutaneous nodules, progressive valve damage
-diagnosis based on Jones Criteria** 2 major or 1 major and 2 minor (arthralgia, fever, elevated ESR & CRP, prolonged PR)
-mgmnt: penicillin, aspirin, bedrest --> prevention with penicillin prophylaxis


Long QT syndrome

-usually not diagnosed until child has cardiac event or family history
-treatment with beta blockers and possibly ICD/ defribillator


Valvular stenosis

-mitral stenosis: commonly caused by rheumatic fever, LA enlargement, a-fib, pulmonary edema --->frequent pulm infections and apical murmurs
-aortic stenosis: sub-valvar, moderate LVH --> CHF, harsh loud mid-systolic murmur that radiates to neck



-acute infection/inflammation of myocardium from viral infection --> sudden cardiac failure with murmur, gallop or arrhythmia, tachycardia, elevated troponin and BNP
-supportive care: digoxin, ace inhibitors, diuretics, IVIG



-inflammation of pericardium --> fever, tachycardia, friction rub, tamponade symptoms, cardiomegaly, ST elevation, PR depression
-management with pericardiocentesis and ABX for 3-4 weeks for presumed staph and hflu



-acutely septic presentation --> fever, murmur, emboli phenomenon, petichiae, vasculitis, Osler nodes
**strep: PCN, rocephin, vanco
**enterococci: ampicillin
**staph aureus: nafcillin
-6 months of ABX



-3 types: dilated (most common), hypertrophic, restrictive
-dilated: systolic dysfunction, LA/LV affected, decreased contractility, poor function --> beta blockers
-restricted: atrial diastolic dysfunction, walls of ventricle stiff, preload dependent *** (avoid diuretics and beta blockers)
-hypertrophic obstructive cardiomyopathy: autosomal dominant --> ace inhibitors, beta blockers, intropes, vasodilators, diuretics, **preload dependant volume restriction
-treatment of arrhythmia with cardiomyopathy is amiodarone --> can cause hyper/hypothyroidism, thyroid crisis, liver dysfunction
-SOB, CHF, fatigue, lethargy, decreased appetite, exercise intolerance --> echo with decreased CO and global function, EKG with sinus tach, prolonged PR, ST wave changes, hypertrophy


Atrial septal defect

-acyanotic (flow left to right), often asymptomatic and close spontaneously, widely split fixed** S2 grade 2-3/6
-can have device closure (at risk for migration)


Ventricular septal defect

-acyanotic (flow left to right), most common**
-regurgitant harsh holosystolic murmur
-enlarged LA, CHF, pulmonary hypertension with lg defects


AV canal

-acyanotic (flow left to right), associated with t21
-ASD, inlet VSD, abnormal AV valve formation** --> FTT, CHF, tachypnea --> surgery around 6 months of age



-acyanotic (flow left to right), common in preterm infants
-continuous machinery like murmur, CHF, tachycardia, tachypnea, bounding pulses, widened pulse pressure --> surgically ligated


CHF management

-diuretics, digoxin, afterload reducers (enalapril), anticoagulants, maximize nutrition


Transposition of the great vessels

-cyanotic defect (right to left shunting)
-aorta rises from RV/ PA arises from LV--> desaturated blood returns from lungs to RA and out to body, oxygenated blood returns from LA to PA --> parallel circulation** not compatible with life, need ASD or VSD (may need to create), PFO not large enough - balloon septostomy and prostaglandins , presents with cyanosis without respiratory distress
-treatment is arterial switch (moving coronary arteries***) --> need LV support post op


Tetralogy of fallot

-acyanotic (flow left to right), RVOT obstruction and pulmonary stenosis --> VSD, RVOT obstruction, overriding aorta, RV hypertrophy (seen as boot shaped heart on CXR)
-tet spells: results from lack of preload and extreme right to left shunting --> goal to increase systemic vascular resistance (SVR), increase pulmonary blood flow and reverse acidosis
-oxygen: pulmonary vasodilator
-morphine: sedation
-bicarbonate: alkalosis --> pulmonary vasodilator
-increased SVR: knee to chest, phenylphrine


Total anomalous pulmonary venous return

-acyanotic (flow left to right), obstructive type requires emergency atrial septostomy
-pulmonary veins drain into right atrium or SVC (instead of LA) --> snowman sign on CXR**


Coarctation of aorta

-narrowing of aortic arch causing decreased flow --> upper extremity hypertension, absent or weak LE pulses


Pulmonary atresia

-degree of cyanosis depends on presence of tricuspid regurgitation


Hypoplastic left heart syndrome

-ducal dependent lesion --> immediate decompensation with duct closure, presents with acidosis and shock
-keep duct open with prostaglandins (side effects apnea and hypotension), staged repair
1) Norwood/sano: create systemic perfusion via shunt from RV to system circulation
2) bidirectional Glenn: decrease volume load on RV via anastomoses between SVC and PA
3) Fontan: separate pulmonary and systemic circulations by baffling IVC to PA and providing extra cardiac conduit with defenestration or pop off for RA


Cardiac transplant

-present with symptoms of failure unresponsive to therapy, may need inotropic support or have malignant arrhythmias
-end organ function assessed for by labs for kidneys, liver, pulmonary function and lipid profile, testing sent for immunologic and infectious labs (CMV, HSV, EBV, HIV, varicella, toxoplasmosis, hepatitis, tuberculosis, HLA typing)

-first 72 hours most critical --> goal to maintain coronary perfusion, systemic blood pressure and adequate cardiac output
-early failure due to primary graft failure and right sided HF from elevated PVR


Cardiac tamponade

-cardiac compression from blood or fluid built up between myocardium and pericardium
-beck's triad: JVD, muffled heart sounds, hypotension --> causes narrowed pulse pressure
-requires pericardial thoracentesis



-rapid rhythm occurring above bundle of his
-stable --> valsalva and vagaries maneuvers
-unstable --> synchronized cardioversion 0.5-1 j/kg
adenosine 0.1mg/kg/dose

-long term management: digoxin, propranolol, amiodarone



-common causes: elevated ICP, hypoxia, hypothyroidism, hyperkalemia, sedation, sleep, drugs
-fix problem, follow PALS algorithm --> epinephrine, atropine


Pulmonary artery hypertension

-RV pressure overload and ventricular dysfunction, PA pressure >25mmHg at rest --> balance of nitric oxide (vasodilator), prostacyclin (vasodilator), endothelin (vasoconstrictor)

-management: oxygen, diuretics, calcium channel blockers, prostaglandins, anticoagulation, inhaled nitric oxide, phosphodiesterase inhibitors (sildenafil)


Low cardiac output syndrome

-predictable fall in cardiac output after bypass at 6-18hours
-balance of BP and SVR
**HR x SV = CO


Post pericardiotomy syndrome

-febrile illness due to cell mediated immune inflammatory reaction --> fever, pericardial effusion, fatigue --> can lead to cardiac tamponade
-management with NSAIDs or systemic steroids