CV disease in kids Flashcards
Chest pain ddx in peds
Anxiety PNA PE PTX Asthma viral synovitis costrochondritis GERd Rib fx
Syncope/dizziness ddx in peds
Cardiogenic: arrhythmia, HOCM, obstructive, prolonged QT, hypercyanotic (tetralogy Fallot)
Other: hypovolemia, situational (stress, vagel), orthostaticm seizure hypoglycemia, vertigo
Dyspnea ddx in peds
ARDS, asthma, brochiectasis, pneumonia, cardiopulmonary syndrome, pneumothorax, ventricular septal defect
Hypertension ddx in peds
Renal artery stenosis, pheochromocytoma, essential hypertension, pre-eclampsia
Pulmonary stenosis
eti: congenital anomaly
s/sx: exercise intolerance, JVD, peripheral edema
Murmur: Ejection click at LUSB, murmur decreases with inspriation
EKG: R axis deviation
Rheumatic heart disease
Peak age 5-15 developing countries.
Eti: Rheumatic fever, GAS
Jones criteria: 2 major or 1 major + 2 minor criteria.
Murmurs: mitral regurg and stenosis, and aortic regurg the most common.
Sxs present 2-3 weeks after the initial pharyngitis
Dx: clinical dx, strep pos.
Jones criteria
Major: polyarthritis, carditis, subQ nodules, erythema marginatum, sydenham chorea
Minor: arthralgia, prolonged PR interaval, fever, elevated ESR/CRP
Kawasaki’s disease
Epi: common <8yr, leading cause of heart disease in developed countries
Eti: unknown
S/sx: high fever + 4 of the following:
- bilateral painless bulbar conjunctival injection without exudate
- erythematous mouth and pharynx / strawberry tongue, cracked lips, polymorphous exanthema
- swelling of hands and feet with erythema of palms and soles
- cervical LAD, usually single and unilateral
Dx: CMP, LFT, CBC, urinalysis, ESR, CRP, Echc
Hypertrophic cardiomyopathy
Epi: 0.47 in 100,000 in US
Eti: autosomal dominate
Sx: easily fatigued, angina pain, SOB, occasional palpitations, L ventrical heave, sharp upstroke arterial pulse
Murmur: midsystolic ejection along the LMSB increasing in intensity in the standing postion
CXR: Globular shaped heart, LV enlargement
ECG: LVH, prominent Q waves, ST segment and T wave changes, arrhythmias
Atrial septal defect
25-30% diagnosed in adulthood
L->R acyanotic shunt, often asymptomatic
exercise intolerance, fatigue, HF, hyperactive heart
Wide S2 split, grade 3/4 systolic ejection soft murmur at LUSB
CXR: cardiac enlargement
Ventricular septal defect
Most common
Eti: congenital
S/sx: L->R shunt, acyanotic
Murmur: 2 5/6 holosystolic murmur loudest at LLSB, harsh blowing, systolic thrill +/- apical diastolic rumble with large shunt
CXR: cardiomegaly
EKG: LVH
Patent ductus arteriosus
40-60% of very low birth weight infants
Eti: most often due to prematurity
L->R shunt, acyanotic
Murmur: 1 4/6 continuous rough machinery murmur loudest at LUSB
Tx: indomethacin used to close in preemies only
Atrioventricular septal defect or endocardial cushion defect
Epi: most occur in pts with downs syndrome
Eti: incomplete fusion of the embryonic endocardial cushion of the AV canal
L->R acyanotic shunt
S/sx: poor feeding, FTT, cough, diaphoresis, tachypnea, recurrent pneumonia
Murmur: hyperactive precordium with systolic thrill at LLSB and low S2 holosystolic regurgitant murmur
Coarctation of the aorta
Acyanotic but not L->R shunt
Eti: narrowing in the aortic arch that usually occurs in the proximal descending aorta near takeoff of the L subclavian artery
Sx: decreased or absent femoral pulses, decreased BP in LE
Murmur: 2 3/6 systolic ejection murmur at LUSB radiating to left intrascapular area, radiates to back
CXR: Figure 3 sign + rib notching from collateral circulation, cardiomegaly
Leading cause of CHF in 2nd week of life
Tetralogy of Fallot
Most common cyanotic cardiac lesion. 4 abnormalities:
- VSD
- Pulmonary stenosis
- RV hypertrophy
- Overriding aorta
Boot shaped heart
S/sx: hypoxemic spells, sudden onset of cyanosis
Murmur: grade 2-6 rogh systolic ejection, lf sternal border radieates to back
<95% pulse ox
