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Cardiology Flashcards

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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
CCHD screening guidelines
- 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)
26
Systolic murmur in left axilla with radiation to back, can have early diastolic component
Coarctation - Have systolic hypertension and decreased pulses in lower extremities - Coarc in a neonate presents with RVH because RV is pumping chamber in fetus
27
HLHS neonatal symptoms
- 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
Cyanotic heart disease with no murmur
- Transposition - Tricuspid atresia - Pulmonary atresia - TAPVR
29
3 causes of severe cyanosis in the immediate newborn period (first few hours)
- TGA - Pulmonary atresia - Ebstein malformation --> central cyanosis with no respiratory distress and no significant murmur (will not improve with 100% oxygen)
30
Associations with Ebstein's anomaly
- Lithium or benzo use in pregnancy | - Abnormality of the tricuspid valve leaflets
31
Full term infant with increased RV activity, cyanosis, hypoxia, hypercarbia, and pulmonary edema
TAPVR - CXR will have pulmonary congestion but normal/small heart
32
Most common cyanotic heart defect overall
Tetralogy of Fallot (but doesn't present in the newborn period) PROV: Pulmonary stenosis, RVH, Overriding aorta, VSD
33
Most common cyanotic lesion seen in newborn period
TGA
34
Palpable right ventricular impulse and a single 2nd heart sound
TOF - EKG will show RVH - CXR will show boot shaped heart with decreased pulmonary vasculature - Typically present at 3-5 months of age
35
Factors that worsen cognitive prognosis with cyanotic heart disease
- Decreased neurological baseline before surgery - Seizures after surgery - Coexisting problems (genetic issues) - Duration or intraoperative circulatory arrest greater than 75 minutes
36
Infant suddenly turns blue with deep rapid respiratory pattern
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
Murmur from ToF
- 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
Exam and CXR findings with TGA
- Single 2nd heart sound | - Egg shaped heart on CXR with increased pulmonary vascularity
39
Reason for differential O2 sat in TGA
- Arms are low because upper extremities are dependent on RV | - Legs are high because lower extremities are dependent on LV via duct
40
22q11 heart defect
Conotrunctal defects and VSD
41
Down syndrome heart defect
AV canal defect
42
Marfan syndrome heart defect
Aortic root dissection, mitral valve prolapse
43
William syndrome heart defect
Supravalvular aortic stenosis
44
Noonan syndrome heart defect
Supravalvular pulmonic stenosis
45
Turner syndrome heart defect
Coarctation of the aorta
46
Percentage of heart beats per day that can be PACs and PVCs
4%
47
EKG finding for atrial flutter/fib
Saw tooth waves
48
EKG findings for WPW
- Shortened PR interval (delta wave) | - Risk of SVT
49
Most common symptomatic arrhythmia in children
SVT (narrow complex tachycardia over 200-220)
50
Treatment of SVT
- 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
Prolonged QT Syndrome presentation
- 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
Definition of VT and treatment
- 3 or more PVCs in a row, rate will be 120-250 | - Tx with synchronized cardioversion for sustained VT longer than 30 seconds
53
Cardiac causes of syncope
- Long QT syndrome - Cardiomyopathy - WPW syndrome - Coronary anomalies - Arrhythmias - Valvar aortic stenosis
54
Most common murmur in rheumatic heart disease
Mitral regurg
55
Rheumatic heart fever treatment
- 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
Infective endocarditis prophylaxis
- If there is residual shunt or if had surgery in the last 6 months - Amoxicillin (clinda if allergic)
57
New murmur in the setting of a recent viral illness
Myocarditis - EKG can show diffuse low voltages, diagnosis is by MRI - Often from coxsackie group B virus - Treatment is supportive
58
Most common causes of pericarditis
Viral (URI), collagen vascular disease (JIA), bacteria (staph aureus)
59
Symptoms of pericarditis
- Leaning forward, pericardial friction rub, nonspecific chest/epigastric pain - Diffuse ST segment elevation on EKG - Muffled heart sounds
60
Alagille syndrome heart defect
Branch pulmonary artery stnosis
61
Digeorge syndrome heart defect
Truncus arteriosus
62
Holt-Oram syndrome heart defect
ASD
63
School aged child with early systolic vibratory murmur at LLSB
Still's murmur | - Cause is ventricular false tendons
64
Most common congenital heart disease
- Bicuspid aortic valve (followed by VSD)
65
Snowman heart on xray
TAPVR

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