Cardiology Flashcards
(38 cards)
What are typical presentations of ductal dependant congenital heart disease?
What is the initial treatment?
What treatment complication should you be prepared for?
- 2 typical presentations: 1) infant who is hypoxic and unresponsive to oxygen and 2) Patient presenting in shock unresponsive to fluids
- Tx with prostaglandin E1 and perform a sepsis eval
- You should consider intubating the patient as prostaglandin can induce apnea
How does a new diagnosis of congestive heart failure typically present and how should it be managed in the ED?
- Presents as a 2-6mo w/sxs of wheezing, retractions, tachypnea, hepatomegally, diaphoresis with feeds, failure to thrive, edema
- Tx it symptomatically, consider lasix for fluid overload, cards consult
Give a ddx for acquired heart disease
myocarditis, kawasaki disease, pericarditis, endocarditis, cardiomyopathy
What sxs should alert you to the possibility of myocarditis?
What history is typically present with myocarditis?
- Consider myocarditis w/persistent tachypnea CHF like sxs such as dyspnea on exertion, hepatomegally, SOB, fatigue
- Myocarditis it often preceded by URI
When vagal maneuvers are ineffective with SVT, what is your first line medication to give and how is it dosed?
- Adenosine!
- Dosed 0.1 mg/kg, maximum of 6mg
- remember to never give adenosine if qrs widening is present
Following vagal maneuvers and adenosine what are 2nd line treatment options to consider for SVT?
- Consider performing synchronized cardioversion
- secondary meds to consider include amiodarone, procainamide
- Cards can perform rapid atrial pacing
What are examples of vagal maneuvers?
-ice bag to the face for 15 seconds, blowing through a syringe, hang patient upside down
In which leads are T waves normal until adolescence?
V1-V3
What are indications to obtain an EKG?
- Syncope
- Drug ingestion
- Tachy/brady arrhythmia (ex. SVT or heart block)
- Exertional symptoms, ex. chest pain with running
- Electrolyte disturbance, ex. renal disease worry about potassium
- Diagnosis of congenital heart disease
- Heart failure
- Kawasaki
- Myocarditis
- Seizure
- Pericarditis
- Rheumatic fever
- Cyanotic episode
- S/p cardiac surgery
- Myocardial contusion (comotio cordis)
How should we check for sinus rhythm?
Ensure the following:
- every P followed by QRS
- every QRS followed by P wave
- P-wave axis between 0-90 degrees
- P wave morphology constant
What is a normal p wave axis and which should we look at to determine this?
- 0-90 degrees
- P waves are positive in I, II and aVF, and negative in aVR
Which leads should always have upright T waves?
T waves should always be upright in the following leads:
- Inferior leads: II, III, aVF
- lateral leads: V5, V6
Give heart rate estimates based on number of big boxes between qrs intervals
Sequentially: 300, 150, 100, 75, 60, 50
Give a ddx for prolonged qrs interval
-bundle branch blocks, toxin, acidosis, electrolyte abnormality, aberrant conduction from atrial foci (WPW), ventricular hypertrophy, cardiac surgery
When should you consider prolonged QT?
Anytime the QT interval is >/= 1/2 the R-R interval
What are potential causes of prolonged QT?
hypokalemia, hypocalcemia, hyopmagnesemia, neurological injury, medications
What are etiologies of R ventricular hypertrophy and what would you see on EKG?
- AV canal defect, VSD, ASD, TAPVR, ToF, pulmonary stenosis, pulmonary HTN
- R wave amplitude >98% for age in v1 or S wave >98% for age in v6, increased R/S ratio for age in v1 or decreased ratio in v6
What are etiologies of L ventricular hypertrophy and what would you see on EKG?
- VSD, PDA, aortic stenosis, systemic hypertension, cardiomyopathy
- R wave > 98% in v6, or S wave is > 98% in v1, increased R/S ratio in v6 or decreased in v1
The T wave of which lead is expected to invert on day of life 3-4 in a neonate?
V1-remember that the right heart is initially working harder to compensate for higher pulmonary pressures.
- What is the most sensitive sign of ischemia in a pediatric ekg?
- What are other signs of myocardial ischemia on EKG?
- Q wave prolongation
- Along with the obvious ST elevation, prolongation of the QT interval may indicate ischemia in the pediatric population, peaked T waves can be seen in early myocardial ischemia
-What is the most common EKG finding with tricuspid atresia?
The EKG is TA often shows right atrial enlargement, which is indicated by a peaked P-wave higher than 3mm in any lead
What are findings consistent with familial hypertrophic cardiomyopathy on EKG?
90% of patients with familial hypertrophic cardiomyopathy will demonstrate some abnormality, including left ventricular hypertrophy (R in V6 or S in V1 above 98% for age), atrial enlargement (p-wave >0.1 seconds), or ST-T wave changes.
What is the formula for correcting the QT interval?
Measured QT (seconds)/ the square root or the preceding RR interval (seconds)
- Which are the best leads to pick up a delta wave on EKG?
- What does a delta wave signify?
- It is best seen in leads 1, V5, and V6
- The delta wave, a slow upslurring of the QRS complex causing slight widening on a sinus rhythm EKG, represents the depolarization of the ventricle through both the AV node and the accessory pathway.
