CV Flashcards
(156 cards)
1
Q
Infantile CHD S/S?
A
No mumurs initially
- Sweating w/ feeds OR FTT - 1st S/S
2
Q
Older children w/ CHD may present w/?
A
Chest pain
3
Q
Standard cardiac tests of PEDs?
A
CXR - AP/LAT (r/o pulm dz) O2 test EKG Echo Cardiac Cath
4
Q
Oxygen test is used to?
A
Differs lung vs Cardiac etiology in cyanotic infant
5
Q
Oxygen test is performed how?
A
- Baseline SO2 or PaO2
- 100% O2 for 30m
- Recheck O2 sat/abg
Results - no Change = cardiac process
6
Q
MC symptomatic arrhythmia is?
A
SVT - responds to vagal maneuvers or adenosine
7
Q
Definitive Dx cardiac test?
A
Echo > confirmed w/ Cardiac cath (dx/txt)
8
Q
EKG may help differ what?
A
Hypertrophy from dilation
9
Q
Fx murmur is AKA?
A
Benign or innocent
10
Q
Types of Fx(benign) murmurs?
A
Fx murmur of peripheral arterial PS
Venous hum
Stills murmur (LV outflow)
Pulmonary flow murmur (RV outflow)
11
Q
Types of pathologic murmurs?
A
AS/PS - AR/PR MS/TS - MR/TR ASD/VSD PDA MVP
12
Q
Still murmur attributes?
A
Systolic EJ
LLSB or between LLSB and apex
Musical vibratory
Upright will decrease intensity
13
Q
V-Hum murmur attributes?
A
Continuous murmur Infraclavicular region (R>L) Upright = louder Changes = turn head, jugular vein compression
14
Q
Carotid Bruit attributes?
A
Systolic EJ - neck, over carotid artery
15
Q
Types of atrial dysrhythmias?
A
WAP - wandering atrial PM
PAC - Premature atrial contractions
A-Flut - Regular/Rapid - s/p surgery, myocarditis
A-Fib - Irregular/Rapid - s/p surgery, myocarditis
SVT
16
Q
MC atrial dysrhythmias? attributes?
A
SVT - rapid, regular, narrow QRS
HR - 280-300 in infants
17
Q
TXT of SVT?
A
Vagal maneuvers
IV adenosine
CV compromise = cardiovert
18
Q
SVT may be caused by what other dysrhythmias?
A
WPW
19
Q
Ventricular dysrhythmias?
A
PVCs - premature ventricular contraction
V-Tach
V-Fib
20
Q
PVC attributes?
A
Benign - Premature beat - NO p-wave
- Wide/bizarre QRS
21
Q
When should PVC be eval?
A
Syncope or Fam Hx
22
Q
V-tach attributes?
A
> 3 Consecutive PVCs = serious dz
23
Q
TXT of V-tach?
A
PVT - V-fib
Symptomatic pt = Cardiovert
Asymptomatic/alert = Lidocaine or Amiodarone
24
Q
Types of Heart blks?
A
1st D* - Prolonged PRI - asymp
2nd D* - Mobitz I vs II
3rd D* - Complete HB
25
Difference between Mobitz I vs II?
Mobitz I
- Progressive PRI prolonged until QRS drops - sleep
- no txt
Mobitz II
- PRI unchanged BUT QRS dropped intermittently
- +- Pacemaker to PVT 3rd D*
26
Compete HB - 3rd D* attributes?
Atria and Ventricles have NO relationship
| Must TXT
27
Fetal circulation shunts?
FO - R > L shunt between atria - bypass lungs
DA - R > L shunt between Pulm artery and Aorta - lungs
DV - Opening between Umbilical vein/IVC -O2 blood from placenta bypasses liver.
28
What is used to keep PDA open? and Why/When used?
Rx - Prostagladin E - to keep PDA open
IF
Cyanotic lesion is present
29
Types of acyanotic lesions?
ASD/VSD
PDA
Coarc
PS/AS
30
What type of shunt is an acyanotic lesion?
L > R shunt
31
MC congenital heart defect is?
VSD
32
VSD size correlation?
<3mm - Asymp
3-5mm - Mod S/S
> 5mm - CHF or FTT
33
VSD sounds like?
HARSH pansystolic murmur at LLSB
| II-V
34
VSD W/u?
CXR - Biventricular enlargement, CHF, Cardiomegaly
| EKG - LVH
35
VSD TXT?
1/3 - spon closure
> 3mm - Diuretics +- digoxin (reduce afterload)
Surgical if, FTT or Pulm HTN
36
When is surgery indicated for VSD?
FTT or Pulmonary HTN despite Rx TXT
37
ASD sounds like?
Early systolic at LUSB - I-III
- Fixed split of S2
+- rumbling diastolic murmur = flow across TV
38
ASD w/u?
CXR - RAE, Cardiomegaly, Pulm artery prominent
| EKG - RAD, RVH (deviation to hypertrophy)
39
TXT of ASD?
Rare - mostly asymptomatic
BUT
Sig ASD shunt present >3yo - closure via cath/surgery
40
2nd MC congenital heart defect?
PDA
41
PDA s/s - size correlation?
Small - asymp
| Mod-LRG - CHF
42
PDA sounds like?
Continuous machine like murmur
| - LUSB infraclavicular > Left back
43
PDA pulses will be?
Bounding, w/ Widened pulse pressure
44
PDA eval?
CXR - full pulmonary silhouette/vascularity
| EKG - RVH and +- LVH if pulm HTN present
45
PDA TXT?
Indomethacin- will close, CI if PDA is keeping PED alive
| Cardiac cath
46
SE of Indomethacin for PDA?
Transient renal insufficiency
47
AS/PS s/s?
DOE and fatigue
48
AS sounds like?
II-III rough Systolic w/ EJ click of LUSB radiating to BACK
49
PS sounds like?
II-III rough Systolic w/ EJ click of RUSB radiating to NECK
50
AS/PS w/u?
CXR/EKG
PS - EKG = RAD/RVH and CXR = Pulm artery dilation
AS - EKG = LVH and CXR = LVH/Aortic dilation
51
TXT of AS/PS?
1L - Balloon valvuloplasty (PS > AS outcomes)
| 2L - Surgery - Fails or Subvalvular PS
52
Types of AS/PS?
Supra-valvular
Valvular
Sub-valvular
53
COA is AKA?
Coarctation of the Aorta
54
MC site of COA?
Thoracic next to DA
55
COA is ass/w what other lesions?
PDA
VSD
Aortic valve lesions
56
COA is ass/w what genetic anomaly?
Turners syndrome
57
COA sounds like?
I-II systolic murmur at LUSB w/ radiation to Left upper back next to scapula
+- continuous if collaterals develop
58
BP/Pulses of COA?
Femoral pulse - delayed/weaker than R radial pulse
| BP Legs > Arms (HTN in arms)
59
COA is essential what?
Narrowed aorta
60
COA W/U? Infants vs Children?
CXR
Infants - RVH w/ cardiomegaly and PULM edema
Children - LVH, RIB NOTCHING and aortic bulge
EKG
Infants - RVH
Children - LVH
61
TXT of COA?
PG E1 - Alprostadil (PGE) - keeps DA open until
Surgery TOC
- Balloon angioplasty
62
Purpose of Prostaglandin E1 (PGE)?
Keeps DA open
63
Cyanotic lesions are essentially what type of shunt?
R > L - pushes deoxy blood into circulation
64
Types of Cyanotic lesions?
```
TOF
TGA
Tri-atresia
Trunc-arteriosus
TAVR - total anomalous venous return
Hypoplastic Left heart syndrome
Ebstein's Anomaly
```
65
Mnemonic for Cyanotic lesions?
HE has 5Ts
66
MC cyanotic heard defect?
TOF
67
TOF attributes?
Requires all 4
1. Overriding Aorta into RV
2. PS
3. VSD
4. RVH
68
What is the indicator of S/S severity w/ TOF?
Degree of PS
69
What do TOF PEDs experience?
TET - Hypoxic spells in older PEDs
70
What is a TET - Hypoxic spells?
Sudden - spon progressive cyanotic dyspnea
- loss of murmur
Resolves when - Squatting (increases Abd pressure)
71
TOF sounds like?
I-III Rough systolic LUSB (aka PS)
72
TOF w/u?
CBC - Polycythemia (Thombosis)
CXR - RVH - boot shaped heart
EKG - RAD/RVH
73
TXT of TOF?
PGE if cyanotic at birth - keep PDA open
Surgery (TET spells is indication)
Bacterial endocarditis PRPH 6mo s/p surgery
74
2nd MC cyanotic heart defect is?
TGA
75
What is TGA?
Aorta begins at RV - Deoxy blood in circulation
| Pulm artery begins at LV - Oxy blood cycles LV/Lungs
76
In TGA does peripheral circulation receive O2?
NO - not unless L>R shunt present (PFO, PDA, ASD, VSD)
77
Failure for baby to pink up at birth suggests what CHD?
TGA - cyanotic lesion
78
TGA W/U?
EKG - RAD, RVH
| CXR - egg on string shaped heart
79
TXT of TGA?
PGE - keep L>R shunt open (PDA)
| Surgery
80
Tricuspid atresia is essentially what?
Underdeveloped RV
81
What is required for life in Tricuspid atresia?
ASD - Systemic blood RA > LA
| VSD - LV > RV into pulmonary arteries
82
Mgmt of Tricuspid atresia if VSD not present?
PGE in order to keep PDA open at birth
83
TXT of Tricuspid atresia?
PGE - keep PDA open
| Surgery
84
What is the blood flow of Tricuspid atresia?
- IVC/SVC > RA > ASD > LA > LV > VSD > RV > Pulm arteries > Lungs
- NO VSD - LV > Aorta > PDA > Pulm arteries > Lungs
85
Truncus Arteriosus is essentially what?
Failure of septation of truncus causing no division of Pulmonary artery and Aorta
86
What CHD is also present w/ Truncus Arteriosus?
VSD
87
TXT of Truncus Arteriosus?
Surgery - septal creation (may require multiple surg)
| AND close VSD
88
Total Anomalous venous return is essentially?
Pulmonary veins (Oxy-bld) doesn't connect to LA but instead to Right side of heart (RA or SVC)
89
What is required for Total Anomalous venous return to be compatible w/ life?
ASD
90
TXT of Total Anomalous venous return?
Surgery - Pulm vein connected to LA
91
Hypoplastic Left heart syndrome is essentially?
Developmental failure of Aortic arch, Aortic valve, or MV - resulting in small LV
92
What is required for Hypoplastic Left heart syndrome to be compatible w/ life?
DA - R>L shunting
93
MC cause of cardiac deaths in 1st month of life?
Hypoplastic Left heart syndrome
94
TXT of Hypoplastic Left heart syndrome?
PGE - keep DA open
| - surgery - multiple
95
Ebsteins Anomaly is essentially?
Malformed TV sits too low and leaflets are partly attached to RV causing it to act like the RA partially
AND
Fibrous TV annulus
96
Ebsteins Anomaly is ass/w what other HD d/o?
TR - leaky TV
97
Pathophys of Ebsteins Anomaly?
Blood leaks from RV into RA causing RAE >
RAE enlrg causes increased pressure in RA >
RA pressure causes R > L shunt through FO >
Cyanosis due to PFO (Patent foramen ovale)
98
Ebsteins Anomaly pts will present as?
Cyanosis
CHF
Dyspnea
99
Ebsteins Anomaly W/U?
CXR - Box haped heart, decreased pulm markings
| EKG - RAD, RAH, Peaked/broad P-waves, RBBB
100
EKG reading of Ebsteins Anomaly?
Tall, peaked P-waves (L-2 and V-1)
RAH/RAD (L1 - aVL)
RBBB
101
What does cyanotic lesions generally require?
PGE1 to keep DA open (L>R shunt)
102
All CHD/lesions causing CHF or HTN require?
Diuretics +- digoxin until surgery/def TXT (cath)
103
Generally speaking when are acyanotic lesions corrected?
By 2yo w/ structural/developmental maturity
104
UN-Txt lesions will generally all lead to?
Pulm HTN
CHF
SBE
105
Trisomy 21 - downs is ass/w what CHD?
ASD, VSD, PDA
106
XO - Turners is ass/w what CHD?
COA, AS
107
Esophageal atresia is ass/w what CHD?
VSD - (VACTRL)
108
Rheumatic fever is?
GAS strep infection cross reacting w/ Cardiac antigens causing Valvular scarring
109
MC age of RF?
6-15yo
110
Labs ordered for RF?
Anti-streptolysin O titer
111
Dx of RF is based on what criteria?
```
Jones criteria (2 Major -or- 1 Maj + 2 minor)
+ evidence of GAS infection, Increased ASO lab, scarlet fever or POS throat culture
```
112
Major Jones criteria? (5)
```
Carditis (Murmur, CHF, Pericarditis)
Polyarthritis
Sydenhams chorea
Erythema marginatum (pink serpiginous macs)
Sub-Q nodules
```
113
Minor Jones criteria? (6)
```
EKG changes - Prolonged PR or Heart BLK
Arthralgias
Fever (101-102)
Elevated ESR/CRP
Increased WBC
Hx of RF/RHD
```
114
TXT of RF?
ABX - strep infection (PCN G Benz or Erythromycin)
ASA/NSAIDs - anti-inflammatory
(PO) CCS - prednisone or methylprednisolone (Carditis)
115
RF prph?
PCN G Benz (IM) Q/28d
116
Pericarditis is?
Inflammation of parietal/visceral pericardium
117
MC etiology of pericarditis?
Viral
118
MC bacteria to cause pericarditis?
Strep. Pneumo -or- S.A
119
S/S of pericarditis?
SML effusion - well tolerated
LRG effusion BUT slow build - well tolerated
Rapid build of fluid = hemodynamic compromise
120
When does pericarditis effusion become a problem?
If effusion builds rapidly
121
Manifestations of PERICARDITIS?
Pulsus Paradoxus - >10mmHg w/ inspiration
Narrow pulse pressure
Kussmual sign
(CP, Dyspnea, Distended neck veins, Pericardial knock)
Edema/Ascites
122
Pericarditis Imaging?
Echo - effusions
CXR - Rounded globular silhouette cardiomegaly
EKG
123
Pericarditis Labs?
ASO titers - Viral titers
| Cardiac Enzymes
124
EKG results of pericarditis?
St elevation
Tachy-C
Electrical alternans - swinging heart in effusion
125
Pericarditis TXT?
Pericardiocentesis - drain fluid
Viral - NSAIDs
Bacteria - Abx
CHF txt PRN
126
When is pericarditis poor prognosis?
<6o old
| Recurrent S/S
127
Infective endoarditis is essentially?
Infection of the endothelial surface of heart resulting in vegetations MC on valve leaflets
128
MC cause of in PEDs for infective endocarditis?
Viridian streptococci - PEDs w/ CHD w/out surgery
OR
S.A or Coag-Neg Staph - PEDs s/p cardiac surgery w/ prosthetic material
129
Highest RF of infective endocarditis?
Hx of infective endocarditis
W/in 6mo - Prosthetic valves/material
Unrepaired congenital heart disease
130
Other RF of Infective endocarditis?
Dental/oral procedure recently
Respiratory, GU, GI surgeries
RHD
131
Neonate RF of infective endocarditis?
Central catheters or surgery
132
MC early S/S of infective endocarditis?
Fever, Malaise, Wgt loss
| Tachycardia - new/changed murmur
133
W/U for infective endocarditis?
Blood Cx
134
Difference between Acute vs Subacute infective endocarditis?
Subacute infective endocarditis - slow process
| Acute infective endocarditis - similar to sepsis
135
Acute infective endocarditis MC organism?
S.A.
136
Infective endocarditis criteria?
DUKES criteria
- HF
- Splenomegaly
- Petechiae
- Embolic phenomena (Osler nodes/Roth Spots/Janeway lesions/Splinter hemorrhages)
137
PVT of Infective endocarditis in High risk pts?
Prph Abx - all dental/resp/skin/muscle procedures
- (PO) Amoxicillin 30-60m before procedure
(Clindamycin or Azithromycin = PCN allergy)
138
NL correct BP check protocol of PEDs?
>3yo - Child sitting quiet 5m prior
139
HTN - classified as?
Primary (Essential) HTN
and
Secondary HTN
140
MC type of HTN in adolescents?
Essential HTN
141
Obese children more likely to have what type of HTN?
Essential HTN
142
MC cause of 2ndy HTN in PEDs?
Renal disease
143
Which type of HTN is more severe?
2ndy HTN
144
Which type of HTN occurs MC in younger PEDs?
2ndy HTN
145
When to eval for 2ndy causes?
PEDs BMI is <85th%
| BP >140/100
146
2ndy causes of HTN + Turners syndrome indicates?
COA
147
2ndy causes of HTN + Café-au-lait spots or Abd bruits indicates?
Renal Artery Stenosis
148
2ndy causes of HTN + Precocious puberty indicates?
Renal artery stenosis
149
2ndy causes of HTN + Edema indicates?
Renal disease
150
2ndy causes of HTN + Excess sweating indicates?
Pheochromocytoma
151
2ndy causes of HTN + Striae in boys indicates?
Drugs/Steroids
152
Pediatric HTN eval?
UA, CMP (BUN/Cr,Lytes)
| Renal U/S
153
TXT of Stage 1 asymptomatic PEDs HTN?
Lifestyle mod only
154
Stage 1 HTN essentially means?
No organ damage or systemic disease
155
Indications for Rx in PEDs HTN?
Failed lifestyle Mod
Stage 1 HTN + symptomatic
Stage 2 HTN
DM
156
HTN Rx by order used?
1L - CCB or ACEI
| - Then - ARB, BB, Diuretic
