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Flashcards in Pediatric Cardiology Deck (16):
1

Which vessel carries oxygenated blood to the fetus?

THE Umbilical vein (carries blood back to the heart)

2

What is an Ebstein anomaly?

tricuspid leaflets displaced inferiorly

RV hypoplasia

tricuspid regurgitation or stenosis

+/- patent foramen ovale

80% have PFO with Right-to-left shunt

dilated right atrium leads to increaesd risk of SVT and WPW

physical exam characteristics:
widely split S2
tricuspid regurgitation

Treatment:
PGE
digoxin
diuresis
propanolol for SVT

3

Tetralogy of Fallot

RV outflow tract obstruction
right ventricular hypertrophy
VSD
overriding aorta

risk factors:
Down syndrome, Cri-du-chat, Trisomy 13 and 18

Early cyanosis, dyspnea, fatigue

squatting during tet spells
(forcing L to R to become R to L shunt)

Systolic ejection murmur at left sternal border

Tx: PGE to maintain PDA
O2, propanolol, fluids, morphine can help older kids
surgery indicated if symptomatic

4

Single canal

severe endocardial cushion defect, may be seen in Down syndrome

presents with heart failure and pneumonitis

EKG may show left axis deviation.

Echo is diagnostic

Treatment is surgical correction

5

presentation of mild endocardial cushion defects resembles...

ASD

6

What heart defects are Down patients at higher risk of having?

endocardial cushion defects
tetralogy of fallot
transposition of the great vessels

7

Croup

Parainfluenza virus (75%)
6% incidence annually in children under 6yo

less commonly,
RSV
influenza
adenovirus
mycoplasma

H and P: 12-72 hours mild fever and coryza (nasal congestion)--> hoarseness and barking cough (nondescript- barky/harsh/seal- like) --> peak resp distress at 24-48 hrs --> resolution in 1 week

dyspnea, stridor (inspiratory and upper airway NOT wheezing), retractions with increased breathing and inspiratory stridor, symptoms are worse at night

this is a clinical diagnosis
dark vertical stripe at trachea shows steeple sign

ER treatment: change ambient temperature, humidified oxygen mask, dexamethasone (IM or IV) or prednisolone for several days, racemic epinephrine if there is stridor at rest

Indications for admission:
progressive stridor
stridor at rest
no improvement after steroids
hypoxia/cyanosis
respiratory distress
unclear diagnosis

8

Epiglottitis

rare due to H. influenzae B
life-threatening

also strep species, staph, nontypable H flu

inflammation at epiglottis in child 2-7yo, unimmunized

presents with high fever, poor oral intake, drooling, respiratory distress, STRIDOR, hypoxia, muffled voice/crying
toxic- appearing
tripoding, sniffing position
cyanosis
"hot potato" voice- not moving soft palate

CBC: leukocytosis with bandemia
CXR: thumbprint sign
note- do not agitate child, and sending the child to xray is unsafe, only if prepared to intubate

direct or indirect laryngoscopy may be needed in older children to confirm the diagnosis: cherry red, swollen epiglottis

Treatment:
-minimize child anxiety during the interview
-intubation or tracheostomy as soon as possible upon making the diagnosis
-culture and sensitivity from blood and epiglottis surface
-EMPIRIC IV ABX: oxacillin, nafcillin, cefazolin, clindamyin or vancomycin+ceftriaxone, or cefotaxime

9

Bronchiolitis

Bronchioles are like the leaves of a the tree

Primarily 2/2 RSV, also influenza, parainfluenza type 3, adenovirus, metapneumovirus

RF: winter, spring,

10

RDS of the newborn

24-37 weeks gestation
pathophysiology: surfactant (dipalmotyl phosphotidyl choline) deficiency

tachypnea (>60 breaths/min)
nasal flaring
expiratory grunting
intercostal retractions
hypoxia
crackles
decreased breath sounds
diffuse hazy interstitial infiltrates with ground glass appearance

Treatment:
1. prevention
If L:S1500g) or if active, breathing spontaneously and not in respiratory failure

11

lecithin: sphingomyelin ratio as an indicator of fetal lung maturity

as the lungs mature at 35 weeks, the amount of lecithin produced increases while sphingomyelin remains constant

L:S ratio >2 obtained by amniocentesis, indicates fetal lung maturity

If L:S ratio is 1.5-1.9, 50% chance of developing RDS

If L:S

12

RDS vs TTN on CXR

RDS: low lung volume, diffuse ground glass appearance with air bronchograms

TTN: increased lung volumes with flattening of the diaphragm, prominent vascular markings from the hilum (sunburst pattern), fluid streaking in interlobular fissures +/- pleural effusions

13

Meconium aspiration syndromw

Big babies, difficult deliveries, meconium stained fluid? ask the OB
meconium staining of skin
respiratory distress signs immediately

CXR- atalectasis, hyperinflation

Treatment: prevention (suction naso/oropharynx)
debris should be suctioned from airway before it can be inhaled
supplemental O2, intubation, surfactant administration, consider empiric antibiotics if concerned about PNA or sepsis

Short-term complications include PTX, pulm HTN, reactive airway disease is increased

14

Cystic fibrosis

Most common fatal AR disorder in the US.
Meconium ileus at birth
Recurrent pulmonary infections including pseudomonas, staphylococcus aureus

Chronic productive cough, dyspnea, hemoptysis, chronic sinusitis, cyanosis, finger clubbing

FTT, pancreatic insufficiency, steatorrhea (fatty, greasy stools)

Diagnosis:
Sweat chloride concentration >60mEq/L on 2 or more occasions
Genetic testing for CFTR gene mutations

Nasal transepithelial chloride secretion measures abnormalities in ion transport across the nasal epithelium

15

What are the general strategies for treating pulmonary CF?

Beta2 agonist (albuterol, salmeterol, formoterol)

DNAse I (donrase alfa) to decrease sputum viscosity

Aerosolized hypertonic saline for chronic cough

Physiotherapy (aerobic exercise) for increased mucus clearance

Azithromycin used liberally, PRN, when lung function decreases in order to slow the decline in lung function and treat any pseudomonas aeruginosa

16

General strategies for managing GI component of CF

nutritional counseling
pancreatic enzyme supplements
fat- soluble vitamin supplements (ADEK)