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CMN574 > Module 2 - Pediatric Cardiac Disorders > Flashcards

Module 2 - Pediatric Cardiac Disorders Flashcards

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1
Q

Cardiac abnormalities: trisomy 21

A

40% structural cardiac lesion

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2
Q

Cardiac abnormalities: Marfans

A

mitral/aortic valve regurgitation

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3
Q

Cardiac abnormalities: Turners

A

Coarctation of aorta

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4
Q

Cardiac abnormalities: Noonan

A

pulmonary stenosis
ASD
Cardiomyopathy

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5
Q

Cardiac abnormalities: Fetal ETOH Syndrome

A

VSD

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6
Q

Cues of the physical exam: (blood pressure) coarctation of aorta

A

discrepancy between upper and lower extremities

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7
Q

Cues of the physical exam: (blood pressure) supraventricular aortic stenosis

A

higher BP in right upper limb than left upper limb

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8
Q

Cues of the physical exam: (blood pressure) aortic valve stenosis

A

narrow pulse pressure

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9
Q

Cues of the physical exam: (blood pressure) aortic regurgitation of aortic insufficiency

A

wide pulse pressure

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10
Q

Gold standard for diagnosing congenital heart defect

A

ECHO

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11
Q

Innocent heart murmurs

A

Newborn
Still murmur
Pulmonary ejection
Venous hum
Carotid bruits
Cranial bruits

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12
Q

Innocent heart murmurs: newborn
-age
-type of murmur
-where is it heard
-position changes

A

-first few days of life
-short systolic grade I-II/VI
-lower left sternal border
-X

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13
Q

Innocent heart murmurs: Still murmur
-age
-type of murmur
-where is it heard
-position changes

A

-2-7 years
-Short, high-pitched, early systolic murmur (musical, vibratory)
-Midway between apex and left sternal border
-Loudest when patient is supine

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14
Q

Innocent heart murmurs: Pulmonary ejection
-age
-type of murmur
-where is it heard
-position changes

A

-3 years and over
-Soft systolic ejection murmur grade I-II/VI
-Left upper sternal border
-X

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15
Q

Innocent heart murmurs: Venous hum
-age
-type of murmur
-where is it heard
-position changes

A

-after 2 years of age
-Continuous musical hum, grade I-III/IV; diastolic murmur
-Right infraclavicular area
-best heard in sitting position (tends to go away in supine)

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16
Q

Innocent heart murmurs: carotid bruit
-age
-type of murmur
-where is it heard
-position changes

A

-older children (adolescent)
-Long systolic ejection, grade II-III/VI
-supraclavicular area
-X

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17
Q

Innocent heart murmurs: cranial bruit
-age
-type of murmur
-where is it heard
-position changes

A

-older children (adolescent)
-Long systolic ejection, grade II-III/VI
-supraclavicular area
-X

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18
Q

Innocent heart murmurs: newborn
-at what age is this murmur heard?

A

first few days of life

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19
Q

Innocent heart murmurs: stills murmur
-at what age is this murmur heard?

A

2-7 years

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20
Q

Innocent heart murmurs: pulmonary ejection
-at what age is this murmur heard?

A

3 years and over

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21
Q

Innocent heart murmurs: venous hum
-at what age is this murmur heard?

A

heard after 2 years

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22
Q

Innocent heart murmurs: carotid bruit
-at what age is this murmur heard?

A

older children - adolescent

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23
Q

Innocent heart murmurs: cranial bruit
-at what age is this murmur heard?

A

older children - adolescent

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24
Q

Innocent heart murmurs: newborn
-what type of murmur is heard?

A

short systolic

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25
Innocent heart murmurs: stills murmur -what type of murmur is heard?
musical/vibratory short high-pitched early systolic murmur
26
Innocent heart murmurs: pulmonary ejection -what type of murmur is heard?
soft systolic ejection
27
Innocent heart murmurs: venous hum -what type of murmur is heard?
continuous musical hum diastolic murmur
28
Innocent heart murmurs: Carotid bruit -what type of murmur is heard?
long systolic ejection
29
Innocent heart murmurs: cranial bruit -what type of murmur is heard?
long systolic ejection
30
Innocent heart murmurs: newborn -where is this murmur heard?
lower left sternal border
31
Innocent heart murmurs: stills murmur -where is this murmur heard?
midway between apex and left sternal border
32
Innocent heart murmurs: pulmonary ejection -where is this murmur heard?
left upper sternal border
33
Innocent heart murmurs: venous hum -where is this murmur heard?
right infraclavicular area
34
Innocent heart murmurs: carotid bruit -where is this murmur heard?
supraclavicular area
35
Innocent heart murmurs: cranial bruit -where is this murmur heard?
supraclavicular area
36
Innocent heart murmurs: newborn -position changes to help hear murmur
X
37
Innocent heart murmurs: stills murmur -position changes to help hear murmur
supine
38
Innocent heart murmurs: pulmonary ejection -position changes to help hear murmur
supine or increased cardiac output
39
Innocent heart murmurs: venous hum -position changes to help hear murmur
sitting (goes away when supine)
40
Innocent heart murmurs: carotid bruit -position changes to help hear murmur
X
41
Innocent heart murmurs: cranial bruit -position changes to help hear murmur
X
42
What is the most common murmur heard in older children and adults?
Pulmonary ejection
43
What is the most common innocent murmur of childhood?
Stills murmur
44
What are the causes of KAWASAKI DISEASE?
Bacterial, viral, genetic, environmental
45
Symptoms of KAWASAKI DISEASE?
FEVER + conjunctivitis erythema of lips and oral mucosa peripheral erythema/edema rash and peeling skin cervical adenopathy
46
How is KAWASAKI DISEASE diagnosed?
Echo Fever for 5days and 4/5 of symptoms (conjunctivitis, erythema of lips/oral mucosa, peripheral erythema/edema, rash and peeling skin, cervical adenopathy)
47
Treatment for KAWASAKI DISEASE?
Immunoglobulin, high dose aspirin
48
Who is at risk for rheumatic heart disease?
African Americans, children, adolescents, women
49
What is rheumatic heart disease usually preceded by?
Group A Beta hemolytic streptococcal infection of upper respiratory tract
50
What is the most serious consequence of rheumatic heart disease?
Carditis
51
Valves impacted in rheumatic heart disease?
Mitral valve Aortic valve
52
What are the clinical features criteria called to diagnose rheumatic heart disease?
Jones Criteria
53
rheumatic heart disease - Jones Criteria -major manifestations (5)
-carditis -polyarthritis -sydenham chorea -erythema marginatum -subcutaneous nodules
54
rheumatic heart disease - Jones Criteria -minor manifestations - clinical (3)
-previous rheumatic fever/rheumatic heart disease -polyarthralgia -fever
55
rheumatic heart disease - Jones Criteria -laboratory - acute phase reaction lab work
-ESR -C-reactive protein -leukocytosis (elevated WBC count)
56
rheumatic heart disease - Jones Criteria -laboratory - what EKG interval possibly prolongs?
PR interval
57
rheumatic heart disease - Jones Criteria -what infection can occur prior to rheumatic heart disease?
preceding streptococcal infection i.e. increased titers of antistreptolysin O or other streptococcal antibodies, positive throat culture for group A streptococcus
58
rheumatic heart disease - treatment
long-acting benzathine penicillin -ASA (naproxen), corticosteroids (carditis may be used)
59
Children with what disease are effected by endocarditis?
Congenital heart disease
60
What type of infection/Where is the infection in endocarditis?
Bacterial or fungal endocardium and valves
61
What are the clinical features of endocarditis?
Prolonged fever Vasculitis Clubbing of fingers Positive blood cultures
62
Treatment of endocarditis?
Antibiotics/antifungal therapy immediately --> amoxicillin ***prophylaxis for high risk patients
63
Endocarditis: vasculitis symptoms (5)
Petechiae Splinter hemorrhages of nails Conjunctival hemorrhages Janeway lesions Osler nodules
64
Endocarditis: vasculitis symptom - Janeway lesions -what are they? -how big? how long do they last? -associated with what? -believed to be caused by what?
-small, non-tender, irregular lesions that appear on palms and or soles of feet (can be erythematous, hemorrhagic, violaceous in color, can be macular, papular, nodular in shape -few millimeters in diameter; last for few days or weeks -associated with infective endocarditis (bacterial infection) -septic microemboli from valvular lesions that deposited bacteria and led to formation of microabscesses in dermis
65
Endocarditis: vasculitis symptom - Janeway lesions -where do these appear?
palms or soles of feet
66
Endocarditis: vasculitis symptoms - Osler nodules -what are they? -what precedes development of lesion? -what kind of manifestation is an Osler nodule? -what is it a result of/what causes it?
-red/purple, slightly raised, tender lumps, often with pale center -pain often precedes development of visible lesion by up to 24 hours -cutaneous manifestation of endocarditis -results from deposition of immune complexes --> the resulting inflammatory response leads to swelling, redness, pain that characterizes these lesions
67
Arrhythmias in children: are they always associated with syndrome?
No
68
Arrhythmias in children: can they occur in healthy children?
Yes
69
Arrhythmias in children: sinus arrhythmias -when does rate increase? -when does rate decrease -are P-QRS-T intervals stable? -require treatment?
-inspiration -expiration -yes -never
70
What arrhythmia is a major cause of sudden cardiac death in athletes?
Prolonged QT LQT1
71
Arrhythmias in children: prolonged QT -what causes prolonged QT?
congenital (more common) or acquired (meds) causes
72
Arrhythmias in children: prolonged QT -what length of time is considered a prolonged QT?
>460milliseconds
73
Arrhythmias in children: prolonged QT -how is prolonged QT diagnosed?
-ECG -possible exercise test -genetic testing
74
Arrhythmias in children: prolonged QT -types of prolonged QT and their implications
-LQT1: exercise -LQT2: auditory/emotional stimuli -LQT3: sleep; most common
75
Arrhythmias in children: prolonged QT -treatment
exercise restriction, treat with beta blockage, possible placement of internal cardioverter/defibrillator
76
Arrhythmias in children: PAC -does this require treatment? -are we worried about these?
-no treatment (if benign) -benign in absence of underling cardiac disease
77
Arrhythmias in children: Wandering atrial pacemaker -definition -what is the morphology of P wave?
-Rare type of arrhythmia/heart beat problem that occurs when heart's pacemaking activity originates from different areas of the atria instead of SA node = generates consecutive action potentials that are all conducted to the ventricles -P waves will all have different morphology
78
Arrhythmias in children: SVT -how to differentiate SVT from sinus tachycardia
-when HR goes too fast, P wave becomes lost in T wave -must slow rate down to evaluate 1. facial ice water immersion 2. adenosine -12 lead EKG **allows you to look for WPW syndrome
79
What can sinus rate be in children <1 year (when stressed, etc.)?
220-250bpm
80
Arrhythmias in children: SVT -what two methods are used to slow tachycardia down in infants/young children?
-facial ice water immersion -adenosine
81
Wolff-Parkinson-White Syndrome -type of arrhythmia it is associated with -characterized by? -how often does it occur with this arrhythmia?
-SVT -short P-R interval, delta wave, prolongation of QRS complex **Not evident when tachycardia present -25% of patients with SVT
82
what is the most common arrhythmia requiring tx in pediatrics?
SVT
83
What age is SVT presentation most common for pediatric patients?
First 3MO of life
84
Arrhythmias in children: SVT -characterized by?
-narrow QRS -rates vary with patient's age -P waves are difficult to define; if present 1:1 w/ QRS complex
85
Arrhythmias in children: SVT -average pediatric SVT HR -<=9MO SVT HR -Older kids SVT HR
-235bpm -270bpm -210bpm
86
Syncope -what do you obtain with new onset syncope or new-onset seizure that is atypical for classic vasovagal rxn? -what are you looking for? -differential dx?
-EKG -Look for "footprints" of possible arrhythmia causes -WPW syndrome, prolonged QT, AV block
87
Pediatric Structural Cardiac Defects (6)
-patent ductus arteriosus -patent foramen ovale -atrial septal defect -ventricular septal defect -atrial ventricular septal defect -coarctation of aorta
88
Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA) -when does the ductus arteriosus normally spontaneously close?
after 1-5 days
89
Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA) -where is this located?
persistence of normal fetal vessel joining pulmonary artery to the aorta
90
Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA) -what type of shunt is this?
Left to right
91
Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA) -clinical symptoms: anatomical
-continuous rough machinery type murmur -if large defect, bounding peripheral pulses
92
Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA) -where is this murmur best auscultated?
2nd left intercostal space
93
Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA) -clinical symptoms: sx of patient
failure to thrive tachypnea diaphoresis with feeding
94
Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA) -how is this diagnosed? (what imaging is used?)
ECHO
95
Pediatric Structural Cardiac Defect: patent ductus arteriosus (PDA) -treatment
-surgical closure -indomethacin in premature infants (80-90% success rate w/ birth weight >1200g)
96
Pediatric Structural Cardiac Defect: patent foramen ovale -is this normal in fetal circulation?
Yes
97
Pediatric Structural Cardiac Defect: patent foramen ovale -what occurs during this defect?
failure of foramen ovale to close at birth
98
Pediatric Structural Cardiac Defect: patent foramen ovale -what is this a variant of?
Atrial Septal Defect
99
Pediatric Structural Cardiac Defect: patent foramen ovale -Clinical symptoms
-systolic ejection murmur
100
Pediatric Structural Cardiac Defect: patent foramen ovale -Dx
imaging, ECHO
101
Pediatric Structural Cardiac Defect: patent foramen ovale -Tx
-surgeries -anticoagulants
102
What are PFO's and PDA's associated with?
stroke
103
What is the difference between PFO and ASD?
-PFO is a normal occurrence in fetal circulation but closes at birth -ASD is a congenital defect; abnormally exists r/t failure of septum between right and left atrium to develop properly
104
What are both PDA and PFO associated with?
migraines and can cause microthromboses and strokes
105
Pediatric Structural Cardiac Defect: atrial septal defect -definition
opening in the septum and shunting of blood between atria
106
Pediatric Structural Cardiac Defect: atrial septal defect -clinical features
-fixed widely split S2 right ventricle, heave -systolic ejection murmur -diastolic flow murmur at left lower sternal border in larger shunts -frequently asymptomatic and often goes unnoticed until adulthood
107
Which pediatric structural cardiac defect frequently goes unnoticed until adulthood?
atrial septal defect
108
Pediatric Structural Cardiac Defect: atrial septal defect -DX
ECHO
109
Pediatric Structural Cardiac Defect: atrial septal defect -TX
surgical or catheterization closure for symptomatic children with LARGER defect and associated right heart dilation
110
Pediatric Structural Cardiac Defect: atrial septal defect -what kind of murmur?
-systolic ejection murmur -diastolic flow murmur at left lower sternal border in larger shunts
111
Pediatric Structural Cardiac Defect: atrial septal defect -what kind of S2 occurs?
fixed widely split S2 right ventricle, heave
112
Pediatric Structural Cardiac Defect: atrial septal defect -what kind of problems can this defect have if untreated?
lung problems -when blood passes through ASD, larger volume of blood must be handled by the right side of the heart -extra blood passes through pulmonary artery into the lungs, causing increased amounts of blood flow in vessels of the lungs
113
114
What two structural cardiac defects have a clinical feature of heave?
ASD VSD
115
Pediatric Structural Cardiac Defect: ventricular septal defect -anatomy -type of shunt
-septal defect between ventricles -left to right shunt with normal pulmonary vascular resistance
116
Pediatric Structural Cardiac Defect: ventricular septal defect -Clinical symptoms
-usually appears in infancy -holosystic murmur at left lower sternal border with right ventricular heave -failure to thrive, tachypnea, diaphoresis when feeding
117
Pediatric Structural Cardiac Defect: ventricular septal defect -at what age do clinical features appear?
Infancy
118
Pediatric Structural Cardiac Defect: ventricular septal defect -what type of murmur is auscultated with this murmur? -where is this murmur auscultated?
-holosystic murmur -left lower sternal border with right ventricular heave
119
Pediatric Structural Cardiac Defect: ventricular septal defect -DX
ECHO
120
Pediatric Structural Cardiac Defect: ventricular septal defect -TX
-Manage HF -Surgery
121
Pediatric Structural Cardiac Defect: atrial ventricular septal defect (AVSD) -What disorder is common with this defect?
Down's syndrome
122
Pediatric Structural Cardiac Defect: atrial ventricular septal defect (AVSD) -anatomy/physiology
incomplete fusion of embryonic endocardial cushions -varying degrees of AV valves abnormalities
123
Pediatric Structural Cardiac Defect: atrial ventricular septal defect (AVSD) -Clinical sx
-murmur often inaudible in neonates -loud pulmonary components of S2
124
Pediatric Structural Cardiac Defect: atrial ventricular septal defect (AVSD) -Dx
-cardiac echo is diagnostic showing cardiac enlargement -ECG shows extreme left axis deviation
125
Pediatric Structural Cardiac Defect: atrial ventricular septal defect (AVSD) -Tx
-surgery required -urgency depends upon significance of defect and sx (arrhythmias, heart failure, pulmonary HTN)
126
Pediatric Structural Cardiac Defect: coarctation of aorta -in what disease does this impact women?
Turner's syndrome
127
What is the leading cause of HF among pediatric patients within the first month of life?
Coarctation of aorta
128
Pediatric Structural Cardiac Defect: coarctation of aorta -is this more prevalent in males or females?
Males (3x)
129
Pediatric Structural Cardiac Defect: coarctation of aorta -anatomy
narrowing of aortic arch
130
Pediatric Structural Cardiac Defect: coarctation of aorta -cardinal sign
absence of femoral pulses
131
Pediatric Structural Cardiac Defect: coarctation of aorta -clinical features
-cardinal sign: absent femoral pulses -upper to lower extremity systolic pressure gradient greater than 20mmHg -blowing systolic murmur in the back of left axilla
132
Pediatric Structural Cardiac Defect: coarctation of aorta -where is this best auscultated?
back of left axilla
133
Pediatric Structural Cardiac Defect: coarctation of aorta -what type of murmur is auscultated?
-blowing systolic murmur
134
Pediatric Structural Cardiac Defect: coarctation of aorta -Dx
radiographs, ECG, ECHO
135
Pediatric Structural Cardiac Defect: coarctation of aorta -Tx
PGE2 infusion until stabilized then surgical correction is warranted
136
Pediatric Structural Cardiac Defect: tetralogy of fallot -anatomy
anterior deviation of infundibular septum causes narrowing of the right ventricular outflow tract --> leads to VSD, aorta overrides crest of ventricular septum; RV hypertrophies. = right side arch of aorta in 1/4 of patients
137
Pediatric Structural Cardiac Defect: tetralogy of fallot -what type of shunt is this?
right to left
138
Pediatric Structural Cardiac Defect: tetralogy of fallot -what type of murmur occurs?
systolic ejection murmur (at left sternal border)
139
Pediatric Structural Cardiac Defect: tetralogy of fallot -where is this murmur heard best?
left sternal border
140
Pediatric Structural Cardiac Defect: tetralogy of fallot -what is common (25%) with the aorta arch?
right side aorta arch
141
Pediatric Structural Cardiac Defect: tetralogy of fallot -clinical sx (5)
-hypoxemia in infancy -fatigue -dyspnea on exertion -clubbing of fingers and toes -chronic arterial desaturation causes elevated RBCs and H&H
142
Pediatric Structural Cardiac Defect: tetralogy of fallot -Dx
2 dimensional imaging is diagnostic
143
Pediatric Structural Cardiac Defect: tetralogy of fallot -Tx
Surgical repair early
144
Pediatric Structural Cardiac Defect: tetralogy of fallot -what combination of four congenital abnormalities?
1. VSD 2. Pulmonary valve stenosis 3. misplaced aorta 4. thickened ventricular wall (right ventricular hypertrophy)
145
Heart Failure -what is the most important thing to determine?
the cause!
146
Heart Failure -what causes HF?
-right and left HF caused by volume or pressure overload -occurs when heart fails to meet circulatory and metabolic demands of the body
147
Heart Failure -clinical features (5)
children may present with irritability, diaphoresis with feedings, fatigue, exercise intolerance or evidence of pulmonary congestion
148
Heart Failure -DX
-based on sx -radiographs (x-ray), EKG, ECHO
149
Heart Failure -TX
therapy should focus on improving cardiac fx -ACEI and diuretics are first line therapy in children with HF requiring long-term therapy
150
Syndromes and trisomies with associated cardiovascular abnormalities: -DiGeorge
aortic arch abnormalities interrupted arch, right aortic arch
151
Syndromes and trisomies with associated cardiovascular abnormalities: fetal alcohol
VSD
152
Syndromes and trisomies with associated cardiovascular abnormalities: -marfan
dilation of ascending aorta/aortic sinus, aortic and mitral insufficiency
153
Syndromes and trisomies with associated cardiovascular abnormalities: Noonan
dysplastic pulmonic valve, atrial septal defect
154
Syndromes and trisomies with associated cardiovascular abnormalities: turner
coarctation of the aorta, bicuspid aortic valve
155
Syndromes and trisomies with associated cardiovascular abnormalities: trisomy 13
PDA, septal defects, pulmonic and aortic stenosis (atresia)
156

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