Shared Flashcard Set

Details

Medicine - Pediatrics
Lec 7 - Cardiology
45
Medical
Graduate
02/22/2010

Additional Medical Flashcards

 


 

Cards

Term

Cyanosis

  1. Blue mucous membranes and tongue indicate ____
  2. __ gms/dL of unoxygenated hgb to appear cyanotic
  3. ____ is very common as infant transistions in the first couple hours
Definition
  1. central cyanosis (does not include lips)
  2. 5 gms/dL
  3. acrocyanosis
Term

Left to Right shunts

  • systemic blood circulated to pulmonary circuit
  • as pulmonary vascular resistance drops, blood shunted from high pressure L to low pressure R

Give 3 examples

Definition
  1. PDA
  2. VSD
  3. ASD
Term

Patent Ductus Arteriosus (PINK)

  1. functionally closed within __hrs, completely in up to __wks
  2. large PDA can cause ____ d/t pulm and L heart volume overload
  3. ____ babies at greatest risk
  4. associated with a ____ murmur heard best ____
  5. can be closed medically with ____
Definition
  1. 15-48 hrs; 3 wks
  2. heart failure
  3. premature
  4. continuous, "machine-like"; below L clavicle
  5. indomethacin
Term
What is the M/C form of CHD?
Definition

ventricular septl defect (VSD)

Term

VSD (PINK)

  1. associated with a ____ murmur
  2. get ____ with age
  3. __ spontaneously close by 1 year, __ by 5 years
  4. ____ VSDs more likely to close than ____
  5. small VSDs may lead to ____
  6. large VSDs may lead to ____
Definition
  1. harsh, holosystolic
  2. smaller
  3. 1/3; 2/3
  4. muscular; membranous
  5. endocarditis if jet against aortic valve disrupts endothelial membrane
  6. pulmonary and L heart volume overload
Term
What is seen on CXR of VSD?
Definition

PA CXR shows cardiomegaly

 

pulmonary arterial markings increased

Term
When and how will infants with large VSDs present?
Definition

start to become symptomatic as PVR drops

 

poor weight gain, tachycardia, tachypnea

Term
How do you treat VSD?
Definition
  • initially medical managed - diuretics, increase calories
  • closure - surgical, device closure in cath lab
Term
What is Eisenmenger's physiology?
Definition

increased flow to lungs has been reversed by increased resistance in the pulmonary bed

  • no murmur!
  • EKG: R ventricular hypertrophy
  • once flow is reversed, pt becomes cyanotic
  • requires heart transplant
Term

Atrial Septal defect

 

do not usually cause symptoms in infancy/childhood

  1. associated with a ____
  2. large defects lead to ____
Definition
  1. fixed split S2 (may dev. midsystolic pulm/systolic ejection murmur 2ndary to increased blood flow across pulm valve)
  2. pulmonary and Right heart volume overload
Term
How do you treat ASD?
Definition

87% spontaneous closure

 

surgical patch or occlusion: Amplatzer device at age 2-4

Term

Name the defect

  • involves malformation of tricuspid and mitral valves
  • assoc w/ Down's syndrome
  • often present with heart failure by 2 mos
Definition

AV Canal

 

(atrio-ventricular defect)

Term

Name the defect

  • Right outflow tract obstruction (pulm stenosis)
  • Right ventricular hypertrophy
  • large VSD
  • over-riding aorta
  • BLUE (R-L shunt)
Definition

Tetralogy of Fallot

Term
Describe a child having a tet spell
Definition
  • child suddenly becomes cyanotic, hyperpnic, altered consciousness and squats on the floor

 

Term
What is happening physiologically during a tet spell?
Definition

peripheral dilation of blood vessels - systemic vascular resistance drops - less blood flow to pulm bed - blood chooses path of least resistance, across VSD

 

squatting augments venous return - increasing intravascular volume and systemic resistance

Term
How do you treat a tet spell?
Definition
  • calm infant, sedate if necessary
  • give morphine (helps spasm around pulm valve)
  • give oxygen
  • knee chest position
  • phenylephrine to increase afterload
  • beta-blocker to decrease infundibulum stenosis
  • operate
Term
  1. Classic CXR of older tets shows ____
  2. Classic EKG of older tets shows ____

Hypertrophic RV develops ectopic foci, runs of Vtach triggered by these can lead to sudden death

Definition
  1. boot shaped heart
  2. RVH
Term
What type of murmur do you hear with TOF?
Definition

systolic ejection murmur d/t pulm stenosis

 

S2 single - pulm component barely audible

Term
What is the most common cyanotic lesion in the first few days of life?
Definition

Transposition of great arteries (TGA)

Term
What is necessary to provide pulm or systemic blood flow in an infant with TGA?
Definition

open ductus arteriosus

 

Management issues: keep ductus open, establish mixing lesion more stable than ductus

Term
What test is helpful to narrow DDx in suspected TGA?
Definition

Hyperoxia test:

check arterial PaO2, give 100% O2 for 10 min, recheck

if PaO2 >150, TGA less likely

 

Term

What do you do if pt fails hyperoxia test?

 

Life saving measure?

Definition

start prostaglandin (Alprostadil)

 

*PGE 1 opens PDA but puts pt at risk for apnea*

 

Balloon atrial septostomy life saving

Term
What is the "egg on a string"?
Definition

appearance of heart with TGA on CXR

Term

Name the defect

  • one great vessel that branches to bring blood to body and lungs
  • always assoc w/VSD
  • dyspnea and heart failure
Definition

Truncus arteriosus (BLUE)

Term
How do you treat truncus arteriosus?
Definition

surgically

  • pt placed on bypass
  • single trunk fashioned into aorta, pulm vessels removed
  • VSD patched
  • conduit created to take blood from RV to pulm arteries
Term

Name the defect

  • valve b/t R atrium and R vent doesn't develop
  • blood from RA must pass through ASD to LA
  • needs to be repaired to single ventricle
  • BLUE
Definition

tricuspid atresia

Term

Name the defect

  • cyanotic, respiratory distress, grunting, labored breathing
  • requires surgical repair, ECMO for stabilization if can't be fixed immediately
  • all have ASD also
Definition

TAPVR

 

all pulm veins return to R atrium instead of L

Term
List the 5 cyanotic lesions
Definition
  1. truncus
  2. transposition
  3. tricuspid atresia
  4. tetrology of fallot
  5. TAPVR
Term
What are four findings in the hx that may lead you to suspect CHD?
Definition
  • feeding difficulties - failure to thrive
  • easy fatigability
  • sweating while feeding (esp forehead)
  • tachypnea
Term
What's the most definitive diagnostic test for CHD?
Definition

echocardiogram

Term

Coarctation of the Aorta

  1. occurs most commonly ____
  2. classically presents at __ wks
  3. may develop ____
  4. chest x-ray shows ____
  5. repair with ____
Definition
  1. next to the ductus
  2. 2 wks when ductus closes
  3. LVH, heart failure
  4. rib notching
  5. balloon angioplasty (not for infants <6mos)
Term

What is the most common, symptomatic arrhythmia in children?

 

How is it characterized?

 

What are the BPM parameters?

Definition

SVT

 

by abrupt onset and termination

 

>220 bpm in infants

>180 bpm in older children

Term
What's the first line treatment for SVT if vagal maneuvers don't work?
Definition

IV adenosine

 

if that fails, synchronized cardioversion

Term

Name the defect

  • autosomal-dominant
  • assoc w/syncope and sudden cardiac death
  • EKG diagnostic
  • B-blockers, implantable defibrillators for treatment
Definition

Long QT syndrome

Term

Name the defect

  • familial disorder
  • pain, lightheadedness, syncope
  • at risk for arrhythmias - sudden death
  • +/- harsh SEM at LLSB, louder as pt stands from sitting/squatting position
  • ECHO diagnostic
Definition

hypertrophic obstructive cardiomyopathy

Term
What is the least important part of CV exam?
Definition

murmur

Term
  1. Systolic ejection murmur louder at ____
  2. Regurgitant/holosystolic murmur louder in ____
Definition
  1. base of heart
  2. lower chest
Term
Describe the 6 grades of murmur intensity
Definition
  1. soft, barely audible
  2. easily audible
  3. loud
  4. loud with a thrill, can be heard w/steth partially off chest
  5. loud, heard w/steth off chest
  6. loud, heart w/o steth
Term

Name the murmur

  • common in newborns
  • disappears by 3-6 mos
  • 1-2/6 SEM heard best at ULSB
  • radiates to axilla and back
Definition

Peripheral pulmonic stenosis murmur

Term

Name the murmur

  • common in kids b/t 3-6 yrs
  • heard only when child is upright, disappears when lying down
  • heard in R and L infraclavicular areas
Definition

venous hum

Term

Name the murmur

  • uncommon before age 2
  • mid L sternal border
  • mid-systolic
  • musical, vibratory quality
Definition

Still's murmur

Term

Name the murmur

  • early systolic ejection murmur
  • best heard in supraclavicular fossa or over carotid arteries
  • found in children of any age
Definition

carotid bruit

Term
List 6 types of abnml murmurs
Definition
  • diastolic
  • continuous (except venous hum)
  • holosystolic/pansystolic/regurgitant
  • late systolic
  • palpable thrill
  • other abnml CV exam finding
Term

Name the defect

  • M/C cause of death from CHD during first month of life
  • symptoms develop as PDA closes
  • inadequate systemic circulation with pulmonary venous HTN
  • cyanosis, dyspnea, hepatomegaly
Definition

Hypoplastic Left heart syndrome

Term
How do you treat HLHS?
Definition

Norwood procedure

Supporting users have an ad free experience!