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Flashcards in Pediatric Cardiology Deck (36)
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1
Q

What is normal adult circulation starting from the right side

A

S and L vena cava drop blood to RA -> RV -> Pulmonary arteries -> Lungs -> pulmonary veins -> LA -> LV -> aorta -> body

2
Q

What are structural differences for normal fetal circulation

A

Placenta provides oxygen,ductus venosus brings blood to the inferior vena cava, foramen ovale moves blood from right atrium to left atrium, ductus arteriosous connects pulmonary artery to the aorta

3
Q

T/F: Cardiac output in a fetus is strongly tied to HR BUT raising the cardiac output is much more difficult than decreasing the cardiac output

A

True

4
Q

How is pulmonary vascular resistance diffrent in the fetus, what happens when it is born

A

It is much higher causing little to no pulmonary circulation as a fetus, PVR drops dramatically allowing pulmonary blood flow and the fetus to get its own oxygen

5
Q

What causes the foramen ovale to close, closure of ductus arteriosus

A

Decrease in right atrial pressure, increase in pO2 and decrease in circulating prostaglandins (PGE2)

6
Q

What is the usual heart rate of neonates, blood pressure

A

140-160, 70/50

7
Q

What are genetic factors that can lead to congenital heart defects, envornmental factors

A

Complex syndromes/ viruses, fetal exposure to drugs and substances, maternal disease states

8
Q

What are the classifications of congenital heart defects

A

Left to right shunts, right to left shunts, Obstructive lesions, regurgitant lesions

9
Q

What occurs in a left to right shunt

A

Blood shunts from systemic circulation (left) to pulmonary circulation (right) through abnormal connection causing already oxygenated blood to recirculate through the lungs, low cardiac output

10
Q

What are consequences of a left to right shunt

A

Decreased renal fucntion, decreased systemic perfusion, pulmonary edema, right heart failure

11
Q

T/F: Patent ductus arteriousus is a type of left to right shunt because blood leaves aorta and enters the pulmonary vein

A

True

12
Q

What are clinical features for ductus arteriosus, how is it confirmed

A

Cardiac murmur, tachycardia, tachypnea/ echocardiogram

13
Q

What contributes to the closure of the ductus arteriosus

A

Reduction in circulating prostaglandin

14
Q

How should patent ducuts arteriosus symptoms be managed, actual closure

A

Fluid restricution, diuretics/ prostaglandin inhibitors, surgical closure through ligation

15
Q

What prostaglandin inhibitors would be used to close a ductus arteriosus

A

Indomethacin 3 doses every 12-24 hours or ibuprofen 3 doses every 24 hours

16
Q

What are side effects of the prostaglandin inhibitors

A

Renal dysfunction, increased Scr, increased risk of bleeding

17
Q

What are the contraindications of use for prostaglandin inhibitors

A

active bleeding, thrombocytopenia, renal impairment, ductal-dependent congenital heart defect

18
Q

What are right to left shunts

A

Blood shunts from systemic venous circulation to systemic arterial circulation therefore not becoming oxygenated due to abnormal connections

19
Q

T/F: In right to left shunts the ducuts arterious should be closed immediately just like in left to right shunts

A

False: In right to left shunts the ducutus arterious is the only reason the body gets oxygenated blood. It should stay open until corrections are made

20
Q

What drug should be given to keep the ducuts arteriosus open, side effect

A

Prostaglandin E1 (Alprostadil)/ apnea, fever, flushing, hypotension

21
Q

What is the most common cause of primary hypertension in kids

A

Obesity

22
Q

What is the cutoff for children to be considered in the correct ranges for BP

A

13

23
Q

T/F: Children can be considered to have hypertension after one reading

A

False: Diagnosis for hypertension is confirmed by 3 separate readings taken at least 1 week apart

24
Q

How are kids categorized with regards to their blood pressure

A

Normal: less than the 90th percentile, Elevated BP: Greater than or equal to the 90th percentile but less than the 95th percentile, HTN 1: greater than the 95th percent + 12 mmHg, HTN 2: greater than the 95th percentile + 12 mmHg

25
Q

What are drugs that kids could take that could cause elevated blood pressure

A

Stimulants, corticosteriods, tricyclic antidepressants, decongestants, caffeine, cocaine, amphetamines

26
Q

T/F: Kids usually need at least five minutes of minimal movement before taking their blood pressure

A

True

27
Q

What are the steps for assessing a child’s BP

A

Step 1: Obtain patient information/ Step 2: Use BP tablets to find the 50th, 90th, 95th percentile for patient’s age, gender, and height/ Step 3: Compare the patient’s BP to percentile BPs to determine the category

28
Q

What is the treatment algorithm if a child is considered to have elevated BP

A

Recommende lifestyle changes -> recheck in 6 months -> if NO target organ damage routine rechecks OR target organ damage initiate therapeutic therapy

29
Q

What is the treatment algorithm if a child is considered to have HTN 1

A

Recommend lifestyle changes-> recheck in 1-2 weeks or sooner if symptomatic -> if normal BP routine rechecks OR if BP persistently elevated on 2 additional checks refer to hypertension/nephrology clinic

30
Q

What is the treatment algorithm if a child is considered to have HTN 2

A

Refer to nephrology/hypertension clinic

31
Q

What are the goals of therapy

A

Reduce the BP to less than the 90th percentile for age, gender, and height/ prevent target organ damage

32
Q

What are indications for pharmacologic management

A

Failed at least 6 months of lifestyle modifications, stage 2 HTN or symptomatic, presence of other comorbidities

33
Q

What are the comorbidities present that would cause pharmacologic treatment to be given immediately if BP is elevated

A

Hyperlipidemia, diabetes, renal disease

34
Q

What are thre drug classes that are acceptable options for a child with hypertension, when can they be considered

A

ACE/ARB ( diabetic or proteinuric renal diseae), CCBs (concurrent migraines), Thiazide diuretics, Beta-blockers (concurrent migraines)

35
Q

T/F: Just like in adults beta-blockers should not be first line and ACE/ARBs do not work as well in blacks

A

True

36
Q

Why should a child with diabetes not be given beta-blockers

A

BB could mask the symptoms of diabetes