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General Peds Boards > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Essential hypertension stages

A
  • Normal: < 120/80 or < 0th percentile for age/height
  • Elevated: 120/80 - 129/80 or between 90-95th percentiles
  • Stage 1: 130/80 - 139/89 or > 95th percentile + 12 mm Hg
  • Stage 2: > 140/90 or > 95th + 12 mm Hg
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2
Q

Essential hypertension workup/initial management

A
  • Start with lifestyle modifications and recheck in 3 months.
  • If still elevated, do ambulatory BP monitoring followed by investigation of cause and then treatment
  • Initial workup is often UA, electrolytes, 4 extremity pulse/BP
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3
Q

Infective endocarditis organisms

A

Staph aureus for native valve, strep viridans for abnormal valves (CHD, rheumatic heart disease, etc).

Others: AACEK (Kingella)

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4
Q

Infective endocarditis symptoms

A 
FROM JANE:
Fever
Roth spots (retinal hemorrhages)
Osler's nodes (painful nodules on toes/fingers)
Murmur
Janeway lesions (painless hemorrhagic lesions on palms/soles)
Anemia
Nail hemorrhage
Emboli

Duke criteria - need 2 major, 1 major and 3 minor, or 5 minor

Major:

  1. Positive blood culture with typical organism
  2. Echo consistent with endocarditis

Minor:

  1. Predisposing heart condition
  2. Fever
  3. Vascular phenomena
  4. Immunological phenomena
  5. microbiological evidence (positive culture but not consistent with IE organism)
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5
Q

Causes of hypertension

A
  • Polycystic kidney disease
  • 11 hydroxylase deficiency
  • Urinary reflux nephropathy
  • Renal artery stenosis
  • Neurofibromatosis
  • 17 hydroxylase deficiency
  • Coarctation
  • Pheochromocytoma
  • Lupus/rheum disorders
  • Cushings
  • Hyperthyroidism
  • Drugs: albuterol, OCPs, steroids, decongestants, illicit drugs
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6
Q

Family history of hypertension cause hint

A
  • Renal or endocrine problems that run in the family
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7
Q

Prematurity cause hint of hypertension

A

Renal artery stenosis secondary to umbilical catheterization

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8
Q

Joint pain/swelling cause hint of hypertension

A

Lupus

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9
Q

Flushing, palpitations, fever, weight loss cause hint of hypertension

A

Pheochromocytoma

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10
Q

Muscle craps, weakness cause hint of hypertension

A

Hyperaldosternoism

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11
Q

Onset with sexual development cause hint of hypertension

A

Enzyme deficiencies

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12
Q

Pharmacological management of hypertension

A
  • CCBs: nifedipine or amlodipine
  • Vasodilators: hydralazine
  • ACEIs: lisinopril or enalapril
  • ARBs: losartan
  • Beta blockers: propranolol or atenolol
  • Alpha 2 agonists: clonidine
  • Diuretics: thiazides, furosemide, spironolactone
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13
Q

Rheumatic fever diagnostic criteria

A

2 major OR 1 major plus 2 minor with evidence of GAS infection

Major: JONES

  • Joints (polyarthritis)
  • Heart (carditis)
  • Nodules (subq)
  • Erythema marginatum
  • Sydenham chorea (emotional lability with rapid movements of extremities - this is enough to diagnose RF alone)

Minor

  • Fever > 38.5
  • Arthralgia
  • Elevated ESR or CRP
  • Prolonged PR interval
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14
Q

Percentage of kids that will have a murmur at some point

A

90% of kids will have a murmur at some point in their life and only 5% are pathologic

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15
Q

Normal variant of 3rd heart sound

A

If child is lying down it could be normal, it will go away when they sit up if it’s benign

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16
Q

Fixed split second heart sound, decreased exercise tolerance, murmur at left upper sternal border

A

ASD

  • Murmur is from relative increase in flow through the pulmonary valve (relative pulmonic stenosis)
  • If ASD is missed it could lead to Eisenmenger syndrome (right to left flow due to PH and blue kid)
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17
Q

Blowing/harsh holosystolic murmur at left lower sternal border

A

VSD

  • Bigger the VSD = quieter murmur but more symptoms
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18
Q

Systolic (ejection) click that varies with respiration, normal splitting S2 with murmur at LUSB

A

Pulmonary stenosis

  • Often have RVH
  • Can also have a thrill and it can radiate to the back
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19
Q

Systolic (ejection) click heard at the apex that does NOT vary with respiration, murmur heard best at RUSB

A

Aortic stenosis

  • Often have LVH
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20
Q

To and fro or continuous machine murmur

A

PDA

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21
Q

Stills murmur vs venous hum

A
  • Venous hum is vibratory/musical and disappears with pressure on jugular vein
  • Stills murmur will be louder supine and softer on standing
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22
Q

Association with right sided aortic arch

A

22q11 deletion

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23
Q

Left axis deviation without LVH

A

Tricuspid atresia and AV canal defects (due to effect on conduction system)

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24
Q

LVH without left axis deviation

A

Hypertrophic cardiomyopathy

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25
Q

CCHD screening guidelines

A
  • Passing is 94-96%
  • Repeat screening can limit false positives for PDA
  • Most reliable after 24 hours of age
  • Greater sensitivity is achieved with pulse ox on right hand (pre-ductal) compared to pulse ox on a foot (post-ductal)
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26
Q

Systolic murmur in left axilla with radiation to back, can have early diastolic component

A

Coarctation

  • Have systolic hypertension and decreased pulses in lower extremities
  • Coarc in a neonate presents with RVH because RV is pumping chamber in fetus
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27
Q

HLHS neonatal symptoms

A
  • Trouble when PDA closes
  • No murmur because even though there is flow across the ductus the pressures in the aorta and pulmonary arteries are equal
  • Can have precordial hyperactivitiy and a loud single S2
28
Q

Cyanotic heart disease with no murmur

A
  • Transposition
  • Tricuspid atresia
  • Pulmonary atresia
  • TAPVR
29
Q

3 causes of severe cyanosis in the immediate newborn period (first few hours)

A
  • TGA
  • Pulmonary atresia
  • Ebstein malformation

–> central cyanosis with no respiratory distress and no significant murmur (will not improve with 100% oxygen)

30
Q

Associations with Ebstein’s anomaly

A
  • Lithium or benzo use in pregnancy

- Abnormality of the tricuspid valve leaflets

31
Q

Full term infant with increased RV activity, cyanosis, hypoxia, hypercarbia, and pulmonary edema

A

TAPVR

  • CXR will have pulmonary congestion but normal/small heart
32
Q

Most common cyanotic heart defect overall

A

Tetralogy of Fallot (but doesn’t present in the newborn period)

PROV: Pulmonary stenosis, RVH, Overriding aorta, VSD

33
Q

Most common cyanotic lesion seen in newborn period

A

TGA

34
Q

Palpable right ventricular impulse and a single 2nd heart sound

A

TOF

  • EKG will show RVH
  • CXR will show boot shaped heart with decreased pulmonary vasculature
  • Typically present at 3-5 months of age
35
Q

Factors that worsen cognitive prognosis with cyanotic heart disease

A
  • Decreased neurological baseline before surgery
  • Seizures after surgery
  • Coexisting problems (genetic issues)
  • Duration or intraoperative circulatory arrest greater than 75 minutes
36
Q

Infant suddenly turns blue with deep rapid respiratory pattern

A

Tet spell

  • Hypercyanotic hypoxic episodes due to increased R to L shunting during an acute episodes
  • Tx: squatting or knee to chest (increase peripheral vascular resistance), morphine, propranolol, and volume expansion
37
Q

Murmur from ToF

A
  • Systolic murmur from flow across the pulmonary valve (not the VSD)
  • The murmur disappears during a tet spell because of decreased flow to the lungs
38
Q

Exam and CXR findings with TGA

A
  • Single 2nd heart sound

- Egg shaped heart on CXR with increased pulmonary vascularity

39
Q

Reason for differential O2 sat in TGA

A
  • Arms are low because upper extremities are dependent on RV

- Legs are high because lower extremities are dependent on LV via duct

40
Q

22q11 heart defect

A

Conotrunctal defects and VSD

41
Q

Down syndrome heart defect

A

AV canal defect

42
Q

Marfan syndrome heart defect

A

Aortic root dissection, mitral valve prolapse

43
Q

William syndrome heart defect

A

Supravalvular aortic stenosis

44
Q

Noonan syndrome heart defect

A

Supravalvular pulmonic stenosis

45
Q

Turner syndrome heart defect

A

Coarctation of the aorta

46
Q

Percentage of heart beats per day that can be PACs and PVCs

A

4%

47
Q

EKG finding for atrial flutter/fib

A

Saw tooth waves

48
Q

EKG findings for WPW

A
  • Shortened PR interval (delta wave)

- Risk of SVT

49
Q

Most common symptomatic arrhythmia in children

A

SVT (narrow complex tachycardia over 200-220)

50
Q

Treatment of SVT

A
  • Stable child: get an EKG, vasovagal maneuvers, adenosine (long term use amiodarone or procainamide)
  • Unstable: adenosine then cardioversion
  • Adenosine effects are diminished by methylxanthines (caffeine)
  • Digoxin is sometimes used as long term med for SVT but CAN NOT be used in WPW
51
Q

Prolonged QT Syndrome presentation

A
  • While swimming
  • FH sudden death, one car accidents, near drowning
  • Can be followed by a seizure but the syncope happens first then the seizure
52
Q

Definition of VT and treatment

A
  • 3 or more PVCs in a row, rate will be 120-250

- Tx with synchronized cardioversion for sustained VT longer than 30 seconds

53
Q

Cardiac causes of syncope

A
  • Long QT syndrome
  • Cardiomyopathy
  • WPW syndrome
  • Coronary anomalies
  • Arrhythmias
  • Valvar aortic stenosis
54
Q

Most common murmur in rheumatic heart disease

A

Mitral regurg

55
Q

Rheumatic heart fever treatment

A
  • Penicillin to get rid of the strep and use for prophylaxis
  • Aspirin for arthritis
  • Steroids for carditis
  • Haloperidol for chorea
  • Digoxin if heart failure
56
Q

Infective endocarditis prophylaxis

A
  • If there is residual shunt or if had surgery in the last 6 months
  • Amoxicillin (clinda if allergic)
57
Q

New murmur in the setting of a recent viral illness

A

Myocarditis

  • EKG can show diffuse low voltages, diagnosis is by MRI
  • Often from coxsackie group B virus
  • Treatment is supportive
58
Q

Most common causes of pericarditis

A

Viral (URI), collagen vascular disease (JIA), bacteria (staph aureus)

59
Q

Symptoms of pericarditis

A
  • Leaning forward, pericardial friction rub, nonspecific chest/epigastric pain
  • Diffuse ST segment elevation on EKG
  • Muffled heart sounds
60
Q

Alagille syndrome heart defect

A

Branch pulmonary artery stnosis

61
Q

Digeorge syndrome heart defect

A

Truncus arteriosus

62
Q

Holt-Oram syndrome heart defect

A

ASD

63
Q

School aged child with early systolic vibratory murmur at LLSB

A

Still’s murmur

- Cause is ventricular false tendons

64
Q

Most common congenital heart disease

A
  • Bicuspid aortic valve (followed by VSD)
65
Q

Snowman heart on xray

A

TAPVR

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