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FALL15 N833 Adv Pedi Probs > Pedi Cardiology > Flashcards

Pedi Cardiology Flashcards

(53 cards)

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1
Q

What is neurocardiogenic syncope?

A

“Vasovagal syncope” a hypersensitive autonomic response
heart rate slows, and the blood vessels in legs dilate, blood pools in LEs > BP drops. Lower HR and BP > diminished blood flow to your brain > syncope

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2
Q

Prodrome to syncope

A

nausea, palpitations, diaphoresis, tinnitus, pallor, dizziness, lightheadedness, blurred vision, weakness

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3
Q

Tx for near syncope

A

Lie down, elevate legs

increases blood return to brain

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4
Q

Classifications of syncope

A

Neurally mediated (vasovagal), Cardiovascular, Other (metabolic, neurologic, psychologic)

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5
Q

Causes of CV syncope

A

congenital HD (impaired CO), CAD, arrhythmia

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6
Q

Bezold-Jarisch reflex

A

paradoxical response of bradycardia, vasodilation, hypotension in vasovagal syncope

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7
Q

Syncope: when to worry

A

family Hx sudden death or seizure do (misdiagnosed long QT)
Myocardial dz
occurs w/exercise
associated palpations or CP

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8
Q

Work up for syncope

A

EKG to evaluate for: long QT, WPW, Complete Heart Block, Ventricular hypertrophy, myocardial ischemia

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9
Q

When to consult cardiology regarding syncope?

A

recurrent w/o identifiable cause
arrhythmia suspected or identified
occurs during exercise

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10
Q

Tx for vasovagal syncope

A

Volume & solute replacement
Mineralcorticoids (problematic & recurrent syncope)
BBs

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11
Q

Who is at risk for myocardial ischemia (as a cause of CP)?

A

Kawasaki dz, Transposition of the great arteries w/coronary switch operation, Ross operation
anomalies in coronary arteries (single coronary, ALCAPA, pulmonary atresia)

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12
Q

Sx of myocardial ischemia

A

pressure sensation +/- burning
radiation to neck, shoulder, arm
during or following exercise
improves w/rest

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13
Q

Sx pericarditis

A 
severe substernal CP
squeezing or tightening
worse w/movement, breathing
Lean forward, may refuse to lie down
reproducible by sternal pressure
Friction rub if small or no effusion
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14
Q

Tx pericarditis

A

NSAIDs 2-6weeks (always w/GI prophylaxis!), steroids if severe/recurrent

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15
Q

When to consult cardiology regarding CP

A 
w/or after exercise
w/syncope or near syncope
known cardiac dz
acute sudden onset w/marfan 
abnormal PE findings
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16
Q

Sx of hypertrophic cardiomyopathy

A

> 50% have murmurs r/t LVOT obstruction
exertional dyspnea, palpitations, syncope, CP
95% have EKG abnormalities

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17
Q

When to consult cardiology regarding palpitations

A

PACs and single monomorphic PVCs
Associated w/exercise, syncope, symptoms
asymptomatic generally no referral

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18
Q

How much of AP width does cardiac silhouette occupy on CXR?

A

50-55%

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19
Q

What are you looking for on CXR when assessing CV system?

A

size of heart (small, normal, large)
contours of heart (enlarged, absent, displaced)
pulmonary vascularity (diminished, normal, increased)

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20
Q

ASD on CXR

A

Prominent pulmonary vasculature and enlarged right heart

increased compliance LV, L-> R shunting

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21
Q

VSD on CXR

A

Enlarged pulmonary vasculature, left heart dilation

L-> R shunt, increased P blood flow & return to LA and LV

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22
Q

PDA on CXR

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A

Left heart dilation and cardiomegaly

L–>R shunt at arterial level, inc P blood flow and return to LA and LV

23
Q

AV canal defect on CXR

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A

Prominent pulmonary vasculature, dilation all 4 chambers

often w/ASD & VSD, L–>R shunting, inc Pulm blood flow, regurgitation AV valves

24
Q

AS on CXR

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A

Dilated ascending aorta, LV dilated & hypertrophic, displaced downward and lateral
(increased velocity across narrowed LVOT, LV works harder)

25
ToF on CXR
``` small, hypo plastic or atretic Pas Mediastinum appears narrowed RVH d/t PS Uplifting of cardiac apes BOOT SHAPED HEART Diminished pulmonary vascular markings (PA restricts PBF) ```
26
TAPVR on CXR
Snowman appearance, pulmonary vasculature prominent | TAPVR--> vertical vein --> innominate vein --> SVC
27
Pathogenesis of IE
formation of small thrombus on abnormal endothelial surface > secondary infection w/bacteria transiently circulating > proliferation of bacteria > vegetations on endothelial surface
28
2007 changes in prophylaxis for IE?
More likely to get it w/daily activities than procedures. Good oral hygiene more important.
29
Who gets IE prophylaxis?
prosthetic cardiac valve / material for valve repair Hx IE cardiac transplant w/abnormal valves CHD (unrepaired cyanotic HD, 1st mth after complete repair, repaired but w/residual defect, 1st 6mo after transcatheter device placement)
30
What procedures merit IE prophylaxis?
Dental procedures involving manipulation of gingival tissues, including routine cleaning Respiratory/airway procedures: T&A, airway biopsy, bronchoscopy w/biopsy NOT for GI, GU, orthodontic, vaginal procedures, c-section
31
What is given for IE prophylaxis
amox or ampicillin 1st line
32
ADHD meds: initial workup
patient & FH PE for murmurs, HTN, irregular HR, stigmata of marfan ECG baseline
33
What is kawasaki Dz?
idiopathic multisystem dz characterized by vasculitis of small and medium blood vessels including coronary arteries
34
Predisposing factors to KD?
age around 2.3 yrs, asian american, winter or spring
35
Diagnostic criteria for KD
R/o other origin Fever 5+ days (high w/reduced response to antipyretics) At least for of following: 1) changes in extremities (edema, erythema, desquamation, 2) polymorphous exanthem (typically truncal), 3) conjunctival injection (non purulent), 4) erythema +/- fissuring of lips and oral cavity, 5) cervical LSD
36
Lab finding supporting KD
``` Leukocytosis w/left shift mild normocytic, normochromic anemia thrombocytosis >450 Elevated ESR & CRP hypoalbuminemia elevated transaminases sterile pyuria mild hyponatremia ```
37
Phases of KD
ACUTE: 1-2w from onset (febrile, toxic appearing; oral changes, rash, erythema) SUBACUTE: 2-8w from onset (desquamation, gradual improvement even w/o Tx) CONVALESCENT: months to years (remaining sx resolve, lab criteria normalize)
38
Signs and Symptoms of KD
Respiratory (rhinorrhea, cough, pulmonary infiltrate) GI (V/D, abd pain, gallbladder hydrops) Neurologic (irritability, aseptic meningitis (IVIG)) MS (myositis, arthralgias, arthritis)
39
KD cardiac changes on EKG
EKG: arrhythmias, abnormal Q waves, prolonged PR and or QTc, low voltages, ST-T wave changes
40
KD cardiac changes on CXR
cardiomegaly
41
KD cardiac changes on PE
suggestive of myocarditis (tachy, m/g, CHF), pericarditis (distant heart sounds friction rub, tamponade), valvulitis (murmur, tachy)
42
When are aneurysms of KD more likely to occur?
``` 8yrs Fever >14 days Male Thrombocytosis Evidence of cardiac involvement on exam (Mitral regurg or pericardial effusion) ```
43
Principle cause of death in KD?
MI, most often in 1st year, majority while at rest/sleeping | about 1/3 asymptomatic
44
Tx KD
IVIG 2g/kg as one time dose Aspirin: high dose (80-100mg/kg/day div q6h) until afebrile + 48h; Low dose (3-5mg/kg/day) x 6wks or until normalization of acute phase reactants (CRP, ESR, PLT) *repeat IVIG if failure to respond or recurrent fever after 24h after 1st dose
45
F/U for KD
lifelong. 6mo-5y depending on risk
46
What is WPW?
Wolff Parkinson White | abnormal accessory conduction pathways between atria and ventricles - risk for SVT
47
ECG changes associated w/WPW?
Delta wave, short PR interval, widened QRS complex
48
WPW associated w/structural HD?
Not usually, but Ebstein anomaly and HCM in some
49
Risks associated w/WPW
SVT, afib, SCD
50
Tx for WPW
transcatheter ablation
51
High risk for SCD w WPW
``` Male, less than 30 Hx afib Hx syncope Familial WPW CHD ```
52
Atypical KD
Less than 4 of 5 Dx criteria Compatible labs Coronary aneurysm risk
53
When is atypical KD more common
Less than 6mo | Older than 10 years

FALL15 N833 Adv Pedi Probs (10 decks)

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