Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
75 Cards in this Set
- Front
- Back
|
Why would a kid have CHF?
|
due to congenital or acquired heart disease
|
|
|
Why congenital heart disease?
|
because volume or pressure overload eventually leads to failure
|
|
|
most common causes of CHF in the first few mos of life?
|
VSD
PDA endocardial cushion defects |
|
|
What does an ASD lead to?
|
it's a less high volume shunt so it would mostly lead to CHF in adulthood if left unrepaired
|
|
|
some other causes
|
metabolic abnormalities
myocarditis rheumatic fever cardiomyopthy drugs |
|
|
signs and sxs of CHF
|
respiratory distress
tachypnea tachycardia ShOB intercostal retractions edema cold sweat JVD |
|
|
classic auscultation sign for CHF
|
gallop
|
|
|
dx of CHF
|
CXR showing cardiomegaly, pulm edema
ECHO showing enlarged chambers, impaired ventricular function |
|
|
contraindications to digitalis
|
complete heart block
HCM |
|
|
hallmark tx's for CHF
|
digitalis
diuretics (loops) afterload-reducing agents |
|
|
What are afterload reducing agents?
|
ACE
CCBs nitroglycerin |
|
|
So one thing to remember about pediatric cards is that...
|
a lot of heart failure is actually right sided failure from congenital left to right shunts
|
|
|
So when we treat CHF we are often
|
preventing it by surgically correcting CHD
|
|
|
big side effect of using loop diuretics
|
hypokalemia- they often have to give potassium along with it
|
|
|
hypokalemia is espeically dangerous
|
with digitalis use
|
|
|
vasculitis that affects joints, kidneys, GI tract, and skin
|
HSP
|
|
|
characteristic rash for HSP
|
palpable purpura
|
|
|
most common season for HSP
|
winter
|
|
|
Why winter?
|
because a URI often precedes this event
|
|
|
what organ system is most affected by HSP usually?
|
GI- shows hematochezia, blood, abdominal pain
bleeding is both upper and lower GI origin |
|
|
What renal complications stem form HSP?
|
glomerulonephritis, can be severe enough to give renal failure
|
|
|
Why check a U/A with suspected HSP?
|
proteinuria
|
|
|
tx for HSP
|
supportive- steroids are controversial (apparently nephrologists would give steroids)
|
|
|
A 2 yo boy iwth fever for seven days reaching as high as 104 shows nonexudative conjunctivitis bilaterally, intensely red lips, palms and soles, and generalized target lesions. He also has a tender anterior cervical lymph node. Blood cultures are sterile but he also has significant thrombocytosis
|
Kawasaki
|
|
|
So what is the first crucial component of Kawasaki history?
|
fever lasting over 5 days
|
|
|
other features
|
mucosal changes, lymphadenopathy, polymorphous rash, conjunctival injection
|
|
|
another name for Kawasaki
|
mucocutaneous lymph node syndrome
|
|
|
what type of disease is Kawasaki?
|
a vasculitis just like HSP
|
|
|
most common racial group affected
|
asians
|
|
|
most common seasons for Kawasaki
|
winter/spring
more common in boys also |
|
|
some classic signs and symptoms
|
conjunctivitis
strawberry tongue mucosa changes desquamating rash on fingers and toes high ESR, CRP |
|
|
biggest sequellae to be aware of
|
coronary artery aneurysm
MI pericardial effusions, tamponade CHF |
|
|
best initial diagnostic test for Kawasaki
|
echocardiogram- to evaluate coronary vessels
|
|
|
tx of kawasaki?
|
IVIG and aspirin
geared toward preventing cardiac sequellae |
|
|
How do we dose the aspirin?
|
it depends on if there is a coronary artery abnormality or not.
|
|
|
low dose aspirin for platelet inhibition
|
and high dose for coronary artery dilations
|
|
|
do you use steroids for Kawasaki?
|
not generally- controversial, and is usually reserved for cases that appear refractory to IVIG mgmt
|
|
|
classic necrotizing inflammation of small and medium-sized vessels
|
PAN
|
|
|
signs and symptoms of PAN
|
PROLONGED fever
weight loss subcu nodules congestion and rhinorrhea |
|
|
So PAN is a chronic-appearing condition
|
with waxing/waning changes in presentation
|
|
|
most severe complication of PAN
|
gangrene of the distal extremities
|
|
|
dx test for PAN
|
none realy- but there are some abrnomal values that are associated with the disease
|
|
|
classic antibody for PAN
|
P-ANCA
|
|
|
what might be the best confirmatory dx test to run for PAN?
|
echo or something else that would show coronary artery or other medium-sized vessel aneurysm
|
|
|
tx for PAN
|
steroids to suppress symptoms
cyclophosphamide or azathioprine to induce remission |
|
|
chronic inflammatory disease of the large vessels like the aorta and its arterial branches
|
Takayasu artertitis (chronic aortoarteritis)
|
|
|
pathophys of takayasu
|
gives inflammatory, segmental lesions fo the aortic arch resulting in aneurysms
|
|
|
most common part of the aorta involved
|
thoracoabdominal aorta
|
|
|
classic patient for Takayasu
|
young ASian female
|
|
|
another name for Takayasu
|
pulseless disease
|
|
|
impt clues for PAN
|
htn, abdominal pain
|
|
|
so basically Takayasu is
|
arthritis, arthralgias and absence of pulses on extremity exam
|
|
|
tx for Takayasu
|
steroids
|
|
|
rhinorrha
nasal ulcers chronic sinusitis hematuria hemoptysis |
Wegener's granulomatosis
|
|
|
Wegener's is very rare
|
it shows both arteries and veins inflamed, usually in adults
is marked by widespread necrotizing granulomas in various tissues |
|
|
common cause of death with wegener's
|
arrhythmias from cardiac inflammation
|
|
|
antibody present in Wegener
|
c-ANCA
ESR is also really high |
|
|
dx test for WEgener's
|
c-ANCA and also biopsies of affected organs
|
|
|
drugs that actually give really good px for Wegener's
|
cyclophosphamide and azathioprine
|
|
|
What is the difference between central and acrocyanosis?
|
central just involves the mucous membranes and usually indicates underlying cardiac disease
acrocyanosis is found commonly in newborns and can be normal. It involves distal extremities and usually jsut results from low peripheral perfusion |
|
|
CYANOTIC HEART DEFECTS
|
ok
|
|
|
kids with cyanotic heart disease are at high risk for what?
|
strokes, scoliosis
Think of that patient you had |
|
|
5 T's of cyanotic heart disase
|
T of F
T of the GAs TAPVR Truncus arteriosus tricuspid atresia |
|
|
4 features of tetralogy
|
large overriding aorta
pulmonic stenosis RVH VSD |
|
|
What is a prenatal risk factor for developing T of F?
|
maternal rubella infection or other viral illness
|
|
|
What feature determines the severity of shunting in a T of F patient (and the presentation)?
|
the degree of pulmonic stenosis
|
|
|
So why were kids able to survive with T of F before?
|
they probablly had relatively mild cases where they could relieve the shunting by simply Valsalvaing
they had a small enough pulmonic stenosis to make up for it |
|
|
signs and symptoms of T of F?
|
variable cyanosis, clubbing
RV impulse squatting to relieve right to left shunting systolic ejection murmur |
|
|
Why do these patients squat?
|
it increases pulmonary blood flow and gives better oxygen sats of the pulmonary blood
|
|
|
What is a "tet spell"
|
it's an episode of cyanosis that occurs followeing stress, fever, exercise, hot temp, etc.
thought to be due to lowered systemic vascular resistance that causes a greater R to L shunt due to the higher cardiac output |
|
|
usually these tet spells are fairly short but
|
if prolonged can lead to seizure, cardiac arrest, syncope
|
|
|
CXR findings c/w T of F
|
boot shaped heart
decreased pulmonary markings right aortic arch (rare) |
|
|
tx for th T of F
|
obviously surgical correction, but sometimes requires temporary shunting into the pulmonary vasculature until the patient's condition is stable enough to allow for full repair
|
|
|
patients that do not undergo surgery
|
will not usually live past 20 or 30
half don't make it to 3 yo |
|
|
Some handwritten notes about transposition and
|
HLHS
|
