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40 Cards in this Set
- Front
- Back
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Congestive heart failure
A. def B. pathophysio |
A. inadq O2 delivery to meet demand
B. hypoperfuison of end organs --> hypoperfusion = kidney retain salt and water --> catecholamines to incr HR + contractiility |
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CHF
A. etiology |
A. congenital heart disease
- incr pulmonary flow (VSD, PDA, TGA, TAPVC) - obstructiv elesions (valve stenosis, coarctation) B. acquired heart disease - viral myocarditis, endocarditis, dysarhythmia C. severe anemia |
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CHF
A. sx |
- tachypnea, cough, wheezing, pulmonary edema
- tachycardia, sweating, dim urine output, enlarged cardiac silhouette - heaptomegaly, peripheral edma - FTT, ppor feeding |
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CHF
A. tx |
- cardiac glycosides (digoxin): incr mycoardial eff
- loop diuretics: dim ventricular dilation = improved fxn - inotropic (dobutamine, dopamine) - interventional catheterization (balloon valvuloplasty) |
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Acyanotic congenital heart disease
- name |
- ASD
- VSD - PDA - coarctation - aortic/pulmonary stenosis |
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ASD
A. classification B. sx C. complications |
A. ostium primum (assoc w/ down sndrome)
ostium secundum (middle portion): most comon) sinus venosus: TAPVC assoc B. inr RV impulse, fixed split C. Right sided HF, pulmonary hpertension, dysrythmia |
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VSD
A. pathophysio B. factors determining sx C. small VSD: murmur characteristics D. moderate-large VSD: murmur character |
A. left to right shunt = more pulmonary circ = pulmonary hypertrophy and pulmonary HTN
B. siz fo VSD and degree of PVR C. smaller VSD size, more intensity the murmur. holosystolic D. low intensity, holosystolic. may have diastolic murmur of mitral turbulence (apex) b/c incr pulmonary filling |
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VSD
A. result of INCR PVR |
- mitral filling rumble disappears b/c dim lpulmonary blood flow
- eisenmenger syndrome: becomes RIGHT to left shunt |
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Patent ductus arteriosus
A. def/patho B. sx C. tx |
A. in fetus, is pulmonary --> systemic shunt. afte rbirth, left to right shunt = incr pulmonary flow
B. signs of CHF machinery like conitnuous murmur at upper left sternal diastolic rumble at mitral valve widened pulse pressure (>30), brisk pulses c. INDOmethacin |
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Coarctation of aorta
A. location B. sx |
A. below origin of left subclavian artery, proximal to ducturs arteriosus
B. before CHF, bp of upper extremitites incr an dlow in lower extremitites once CHF = bp of extremitites are poor, no murmur |
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Coarctation of aorta
A. sx of older children |
A. bruit of turbulence: left upper back newar scapula
bp and pulse findings less prominent if intercosta collateral arteries develop radio-femoral delay (femoral after raidal pulse - viseversa normally) HTN in right arm, low pb in lower extremitites |
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Coarctation of aorta
A. tx |
- intravenous PGE to open ductus
- inotropic medication + dopamine to max renal perfusion and fxn - ballow angioplasty |
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Aortic stenosis
A pathophysio B. sx C. tx |
A. reduced left ventricular output. imbalance btw myocardial o2 demand (incr work) and myocardial supply == myocardial ischemia
B. exercise intolerance, chest pain, syncope, sudden death C. balloon valvuloplast |
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Pulmonary stenosis
A. pathophysio B. sx C. tx |
A. fusion of valve commissure usually = incr RV pressure adn low RV output
B. right-to-left shunting through patent formen ovale C. balloon valvuloplasty |
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Cyanotic congenital heart disease
A. two classification B. noncardiac causes of central cyanosis C. name cardiac causes of "" |
A. peripheral cyanosis b/c of vasoconstriction (cold)
central cyanosis (tongue, mucousa): cardiac or noncardiac B. pulmonary dz, sepsis, hypoglycemia polycythemia, neuromuscular disorder C. 5T's tetralogy of allot, transposition of great arteries, tricuspid atresia, truncus arteriosus and total anomalous pulmonary venous connection |
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Cyanotic that increase pulmonary flow
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Transposition of great artereis
TAPVC Truncus arteriosus single ventricle |
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Cyanotics that cause decr pulmonary flow
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- tetralogy fo fallot
- pulmonary atresia - tricuspid atresia |
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Tetralogy of Fallot
A. def B. sx C. what worsent D. what helps |
A. VSD, overriding aorta, pulmonary stenosis, RV hypertrophy
B. cyanosis, incr RV pulse, systolic ejection murmur (pulmonary stenosis) C. decr SVR (exercise, vasodilation) or incrse R through RVOT (crying, tachycardia) = right to left shunting D. incrse SVR or decr R through RVOT (hypertension, valsalva, bradycardia) |
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Tetrology of Fallot
A. hypercyanotic spells B. tx |
A. trigger is something that decr arterial O2
child cries --> worsen shunt sudden syanosis, alterations of consciousness and hyperpnea solution: child learn to squat, peta-adrenergic blocker to slow HR, sedation, bicarb for any acidosis B. balloon pulmonary valvuloplasty, Blalock-Taussig shunt |
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Transposition of the Great Arteries
A. pathophysio B. sx C. tx |
A. pumonary and systemic in parallel. must have shunt
B. cyanosis right after birth, no murmur, single S C. PGE, balloon atrial septostomy, arterial switch operation |
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Tricuspid atresia
A. def B. pathophysio C. sx D. tx |
A. plate of tissue at floor of RA where the valve should be. ASD or PFO always present
B. if no VSD, pulmonary atresia is present. need PDA to survive = after birth, cyanotic if VSD, acceptable saturation C. if no VSD --> no murmur, single S2 If VSD --> VSD murmur only cyanosis in newborn period that results in LAD, + LAH D. fontan procedure (IVC to pulmonary arteries), Glenn shunt (SVC to right pulmonary artery) |
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Truncus Arteriosus
A. def B. pathophysio C. sx |
A. aorta dn pulmonary artery originate from common truncus
B. mildly desat, sometimes cyanotic, excessive lung flow = CHF C. systolic ejection murmur, single S2 diastolic murmur across mitral vlave hihg pitched systolic murmur at base = insuf truncal valve |
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TAPVC
A. def B. pathophysio C. sx |
A. pulmonary veins ddrain into systemic enous side
B. PFO or ASD present C. cyanosis, pulmonary flow murmur (incr pulmonary blood flow) |
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Acquired heart disease
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- Kawasaki disease
- acute rheumatic fever - infective endocarditis - pericarditis - myocarditis - cardiomyopathy |
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Infective endocarditis
A. def B. etiology |
A. microbial infxn of endocardium (internal surface)
B. those who ahve structural abnormalities Stept viridans, staphylococcus fungal in chronically ill child |
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Infective endocarditis
A. pathophysio B. dx C, tx |
A. bacteria introduced during invasive procdure
fibrin, platelets adhere = vegetation B. blood culture, ESR elevated, transthoracic echocardiography C. IV therapy, abx prophylaxis in postop or structural heart disease except secundum ASD |
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Infective endocarditis
- sx |
- fever
- splenomegaly - hematuria (endocarditis-assoc glomerulonephritis) - splinter hemorrhages - osler's nodes (small, raised pink swollen lesions on palms, soles) - janeway lesion (small, erythematous hemorrhagic lesions on palms/soles) - Roth spots (round or oval white spots in retina) |
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Pericarditis
A. etiology B. pathophysio C. sx |
A. viral (cox, adenovirus, in/parainfluenza, EBV)
bacterial = purulent (staph and strepnuemo) --> constrictive pericarditis collagen vascular diz (SLE) postpericardiotomy syndrome B. inflam --> exudation of fluid that impair venous return and cardiac filling cardiac tamponade = critically impaired LV output C. fever, chest pain supine but relieved when upright pericardial friction rub, distant heart sounds pulsus paradoxus (>10 drop in SPB in deep respiration), hepatomegaly |
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Pericarditis
A. dx B. tx |
A. pericardiocentesis
in any one with dyspnea + fever ESR elevated B. anti-inflam for viral or postpericardio, antibx for bacteria, drainage |
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Myocarditis
- A. etiology B. pathophysio |
A. vius (cosackievirus)
bacteria (c.diphtheriae, strep pyogen, staph aureus, TB) fungi (candida, cryptococcus) Protozoa (trypanosoma cruzi = chagas' dz) autoimmune (SLE, sarcoidosis) Kawasaki B. infectious infiltration that damage myocardial cells or lymphocytes that attack myocardium |
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Myocarditis
A. sx B. dx C. tx |
A. follows viral/flu infxn, dyspnea, malaise
resting tachycardia, fuffled sounds, tachypnea B. ESR, CRP, ckMB elevation, PCR of endomyocardial biopsy C. supportive: inotropic, diuretics, afterload-reducing drugs |
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Cardiomyopathy
- 3 types and def |
A. dilated cardiomyopathy: primary disorder of ventricular dilation and red cardiac fxn
B. Hypertrophic cardiomyopthy: asymmetric septal hypertrophy or idiopathic hypertrophic subaortic stenosis C. restrictive cardiomyopathy: excessive rigid ventricular walls that impair diastolic filling |
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Dilated cardiomyopathy
A. teiology B. dx C. tx |
A. viral myocarditis, mitochondrial abdl, carnitine def, med, hyppocalcemia
B. viral serologies, serum carnitine level C. supportive for CHF, tx of underlying problem |
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Hypertrophic cardiomyopathy
A. apthophysio B. sx C. tx |
A. poor LV filling
dynamic left ventricular outflow tract obstruction caused by anterior mitral leaflet swept into subarotic region C. chest pain, exercise intolerance harsh, systolic ejection murmur (apex) valsalva/standing reduce LV volume = worsen murmur C. calcium-channel blockers reduce LVOT obstruction no competitive sports, surgical myomectomy |
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Restrictive cardiomyopathy
A. etiology B. sx C. tx |
A. amyloidosis, inherited infiltratvie disorder (hemosiderosis, Fabry dz, Gaucher dz)
B. dyspnea, weakness, exercise intolerance elevated central venous pressure = ascites, hepatomegaly C. diuretics, beta-blockers, calcium-channel blockers |
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Dysrhthmias
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- supraventricular tachycardia
- heart block - long QT syndrome |
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SVT (supraventricular tachycardia)
A. def B. pathophysio |
A. rapid heart rhythm originative prox to biferucation
B. atrioventricular re-entrant tachycardia (AVRT): retrograde conduction throuh accessory pathway atrioventricular node re-entrant tachycarida (AVNRT): abnl in different pathways within atrioventricular node Wolff-Parkinson-White (WPW) anterograde conduction through bypaass tract |
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SVT
A. sx B. dx C. tx |
A. palpitation, chest pain, dyspena
B. WPW = delta wave = slurred upslope of QRS) C. vagal (valsalva, ice pack to face), adenosine, radiofreq catheter ablation |
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Heart block or AV block
A. classification B. etiology C. tx |
A. by ECG findings or ratio of atrial to ventricular impulse
1st degree: PR prolongation 2nd degree: type 1 = Wenckebach = PR prolong to failed AV conduction type 2 abrupt failed AV conduction with PR prolong 3rd degree: complete block B. congenital 3rd degree = SLE bacterial endocarditis C. pacemaker |
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Long QT syndrome
A. def B. etiology C. sx |
A. can lead to torsades de pointes
B. jervell-Lange-Nielsen assoc congenital deafness Romano-Ward syn not assoc deafness (AD) c. SYNCOPE, cardiac arrest, palpitation |
