Cardiology Flashcards Preview

Pediatrics > Cardiology > Flashcards

Flashcards in Cardiology Deck (81):
1

Describe murmur of venous hum

Continuous, soft blowing, in right and left infraclavicular areas. Increased by sitting, standing, decreased by supine or turning head. Produced by flow in jugular veins

2

Describe pulmonary flow murmur

midsystolic, soft blowing best heard at 2nd LICS, 2/2 to flow in RVOT, increased when supine, expiration. heard at age 7-10 and persists into adulthood

3

Which congenital heart lesions typically present with heart failure in first 6 weeks of life

Obstructive lesions of the left side of the heart - aortic stenosis, coartation of the aorta, hypoplastic left heart. Also large shunt lesions cause pulmonary overcirculation and symptoms of heart failure.

4

Most common form of congenital heart disease?

Bicuspid Ao valve, then VSD

5

When is surgery for VSD performed?

3-6 months

6

Why do u get a fixed second heart sound in ASD?

Usually right ventricle empties slightly later than the left therefore get P2. The split is increased in inspiration because of more venous return. In an ASD, the right ventricle is always volume overloaded in expiration and inspiration this fixed second heart sounds.

7

What is EKG sign of right ventricle volume overload

RSR' in V1

8

Signs of PDA in newborns

continuous machinery-like murmur at left infraclavicular area, wide pulse pressure, bounding pulses,

9

4 features of TOF

1. Overriding aorta, 2. VSD, 3. Pulm stenosis or RVOF 4. RV hypertrophy

10

tet spell

Murmur is actually softer because less blood across RV OFT. . Treatment - assume knee-chest position, fluids, oxygen.

11

Egg on a string heart

Transposition of great arteries, directanterior posterior relationship of the arteries

12

Treatment of transposition of the great arteries

atrial septostomy, then arterial switch in first couple weeks of life

13

TAPVR

Pulmonary veins drain into the systemic venous system. Can get supracardiac - svc or innominate vein, cardiac - drainage into coronary sinus, infracardiac - into IVC.

14

Obstructed TAPVR

Not getting enough blood back to heart, pulmonary congestion and need emergent surgical repair

15

Who needs prophy antibiotics?

Prostetic cardiac heart valve, previous infective endocarditis, Unrepaired cyanotic CHD, including shunts and conduits, Completely repaired CHD with prostetic material or device within 6 months or with residual defects.

16

Jones Criteria

MAJOR: Carditis, Polyarthritis, Chorea, subq nodules, erythema marginatum MINOR: fever, prolonged PR interval, elevated Acure phase reactants, arthralgia, previour acute rheumatic fever. Need 2 major, 1 major and 2 minor PLUS evidence of recent strep test.

17

Kawasaki Disease Criteria

Fever for 5 days PLUS 4 of: Rash, conjunctivitis, mucosal changes, Lymphadenopathy, extremity erythema, edema

18

Treatment of acute rheumatic fever

ASA and pcn. Steroid only for severe carditis or symptoms not improved with asa

19

Why do you not want to use oxygen in pulmonary over circulation congenital heart syndrome?

Bc oxygen is a pulmonary vasodilator and systemic vasoconstrictor

20

Signs and symptoms of PDA

Wide pulse pressure bc have systolic and diastolic shunt and runoff in diastole. Bounding pulses. Machinery like murmur

21

What is the snowman sign on chest X-ray?

Total anomalous pulmonary venous return

22

What is the effect on oxygen on pulmonary and systemic circulation?

pulmonary vasodilator (therefore dont want to use in VSD or anything with increase pulm flow) systemic vasoconstrictor.

23

When do you start a statin in a kid with high cholesterol?

When they are over the age of 8 and have one of the following: 1.) LDL >190, 2.) LDL>160 and family member with premature CAD or 2 CAD risk factors. 3.) LDL>130 and diabetes

24

What does cyanosis of preductal structures suggest?

transposition of the great vessels.

25

Describe the murmur of physiologic peripheral pulmonic stenosis

due to fetal anatomy - pulmonary arteries come off very acutely and are small. Creates turbulence. Causes soft, harsh, SEM heard in the axilla. disappears by 12 months

26

What drug should never be used in Aflutter for patients < 1 and why?

verapamil bc it can cause heart failure or hypotension

27

Which drugs can worsen torsades de pointes?

quinidine or procainamide can worsen

28

What conditions should you avoid verapamil?

young infants, afib with WPW, a flutter, wide complex tachycardias, beta blockers

29

What class is quinidine and what are major side effects?

Ia, prolongs QT segment -> torsades, diarrhea, hearing loss and tinnitis

30

What class is procainamide and what are major side effects?

prolongs QT and QRS. Can cause blood dyscrasias, drug induced lupus, caution in HF patients

31

What class is lidocaine and what are major side effects?

class Ib. Seizures

32

What class is amio and what are major side effects?

class III; very long half life. Corneal deposits, pulm fibrosis, sun sensitivity. No hematologic changes

33

which conditions worsen dig toxicity?

hypokalemia or hypercalcemia

34

What cardiac lesion is noonan syndrome associated with?

pulmonic stenosis or HCOM

35

What cardiac lesion is apert syndrome associated

VSD or coarct

36

What cardiac lesion is holt-oram syndrome associated

ASD, VSD

37

What cardiac lesion is alagille syndrome associated

pulmonic stenosis

38

What cardiac lesion is cri-du-chat syndrome associated

ASD

39

What cardiac lesion is trisomy 13 syndrome associated

VSD

40

What cardiac lesion is trisomy 18 syndrome associated

VSD

41

Where are VSDS most likely in kids <1

muscular septum

42

Where are VSDs most likely in kids >1

membranous septum

43

Most common form of ASD

ostrium secundum

44

How do you distinguish ASDs in ostium secundum from primum on EKG?

primum have left axis deviation and RVH (secundum only have RVH, no LAD)

45

In what lesion does paradoxic splitting occur?

aortic stenosis because increased LV load takes longer to get out.

46

Which congenital lesion can cause increased bp of 15mmHg in right arm?

supravalvular aortic stenosis

47

What are the congenital heart defects with left axis deviation

ostium primum ASD, complete AV canal, tricuspid atresia

48

snowman or figure 8 shaped heart

TAPVR without obstruction

49

Egg shaped heart

transposition of the great arteries

50

boot shaped heart

TOF

51

What is right atrial isomerism?

bilateral right-sidedness with bilateral 3 lobed lungs, a horizontal liver, no spleen. bilateral RA with 2 sinus nodes, common bowel malrotations and other congenital heart disease

52

Left atrial isomerism

bialteral left sidedness - 2 lobed lungs, polysplenia, increased risk of bowel malrotation and congenital heart disease

53

Which syndromes is right aortic arch common?

TOF and truncus arteriosus

54

what syndrome is aortic arch abnormalities associated with?

Digeorge syndrome

55

what is anomalous origin of the left coronary artery

left coronary artery comes off of the pulmonary artery

56

Kussmaul sign

Increased JVP with inspiration because right heart cannot accomodate increased venous return and it backs up, usually JVP decreased with inspiration. Seen in tamponade and constrictive pericarditis

57

Pulsus paradoxus

normally with inspiration, bp falls 4-10mmHg. With tamponade, the aortic pressure will fall 10-15mmHg

58

Becks triad

Increased JVP, dropping systolic bps, muffled heart sounds = tamponade physiology

59

What happens to chamber pressures in tamponade and constrictive pericarditis?

end diastolic pressure equalize

60

Dobutamine effects

B1 adrenergic effects - increases contractility without increasing HR or BP

61

Epinephrine effects

stimulates both alpha and beta adrenergic receptors

62

Dopamine effects

increases myocardial contractility by stimulating NE release. dilates peripheral beds at low dose, alpha adrenergic at higher doses

63

Milrinone

noncatecholamine - inotropic and vasodilator by inhibitis phosphodiesterase

64

what meds increase digoxin levels

quinidine, verapamil, amiodarone, beta blockers, tetracycline, erythromycin

65

Describe digoxin toxicity

arrythmias, color vision changes, confusion, vertigo, n/v/d. ignore dig levels

66

What are criteria for acute rheumatic fever?

Proof of group A strep infection. 2 Major, or 1Major and 2 minor.
Major Jones criteria for ARF are polyarthritis, carditis, Sydenham chorea, subcutaneous nodules, and erythema marginatum.

Minor Jones criteria for ARF are fever, arthralgia, prolonged PR interval on electrocardiograph, and elevated acute-phase reactants.

67

first and second most common causes of SCD in young athletes

HCOM and anomalous coronary artery

68

side effects of spironolactone

gynecomastia, hyperkalemia

69

Which infection can put you at risk for pneumothorax

pcp pneumonia

70

Who needs SBE prophylaxis

prosthetic heart valve, previous endocarditis, unrepaired cyanotic heart disease, repair congenital diz with prosthetic material <6 mos post op, heart transplant pts with valvulopathy

71

What is used for SBE prophy is pcn allergic?

clindamycin or keflex or azithro

72

Most common age for kawasakis

6 months to 5 years

73

How long after IVIG for kawasakis do you need to postpone vaccines?

live attenuated for 11 months. Can give other routine vaccines. Important to give killed flu vaccine to decrease risk of Reyes while on ASA

74

What do you need to think about before giving O2 to baby with possible cyanotic disease?

O2 will close PDA faster, decrease vascular resistance in lungs causing increased pulmonary blood flow to the lungs. Also O2 is a systemic vasoconstrictor, forcing more blood to the pulmonary circulation

75

Snowman heart

TAPVR

76

supravalvular aortic stenosis is associated with what genetic syndrome

Williams syndrome

77

Holt-Oran syndrome heart defect

ASD, VSD

78

should lasix be given fast or slow IV?

slow - fast associated with otoxocity

79

Which heart arrhythmia is associated with drownings?

Long Qtc syndrome

80

What is the incidence of CHD in patients with Downs?

50%

81

Jervell and Lange-Neilsen syndrome

long Qt syndrome and SNHL