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;
94 Cards in this Set
- Front
- Back
|
innocent murmurs
|
are physiologic from 3-7 years
2/6 grade never diastolic lower left sternum |
|
|
diseases associated with VSDs
|
Down
Edward Patau Aperts |
|
|
Eisenmenger syndrome
|
any untreated left to right shunt becomes right to left
cyanosis results from high pulmonary blood flow with hypertrophy of pulmonary vessels and increased pulmonary resistance |
|
|
VSD presentation
|
if large --> dyspnea, feeding difficulties, poor growth, sweating, pulmonary infection, heart failure, harsh holosystolic murmur
|
|
|
VSD diagnosis
|
chest x-ray
ECG echocardiogram is definitive |
|
|
VSD treatment
|
small muscular more likely to close in 1-2 years than membranous
if larger --> medical treatment for heart failure indications for surgery in 1st year --> failure to thrive or failed medical treatment; pulmonary artery hypertension |
|
|
ASD presentation
|
loud S1
wide fixed splitting of S2 systolic ejection murmur along left mid to upper sternum |
|
|
ASD diagnosis
|
chest x-ray --> right enlargement, increased pulmonary vessel markings, edema
ECG --> right axis deviation and minor right ventricular conduction delays echo is definitive |
|
|
ASD treatment
|
most close spontaneously
symptoms do not appear until third decade surgery or transcatheter device closure for all symptomatic patients or 2:1 shunt |
|
|
endocardial cushion defects pathophsysiology
|
ASD and VSD are contiguous with abnormal AV valves
|
|
|
endocardial cushion defects presentation
|
heart failure early in infancy (hepatomegaly and failure to thrive)
Eisenmenger early heart hypertrophy loud S1, widely fixed split S2 pulmonary systolic ejection murmurand low-pitched diastolic rumble at left sternal border and apex |
|
|
endocardial cushion defects diagnosis
|
chest x-ray --> cardiomegaly
ECG --> biventricular hypertrophy, right atrial enlargement, superior QRS axis echo is definitive |
|
|
endocardial cushion defects treatment
|
perform surgical correction in infancy
|
|
|
PDA presentation
|
small --> asymptomatic
large --> heart failure, wide pulse pressure, bounding arterial pulses, machinery murmur |
|
|
PDA diagnosis
|
chest x-ray --> increased pulmonary artery and cardiomegaly
ECG --> left ventricular and biventricular hypertrophy echo --> increased left atrium to aortic root |
|
|
PDA treatment
|
indomethacin or surgery
|
|
|
syndromes with pulmonic stenosis
|
Noonan syndrome --> AD; Turner phenotype + pulmonic stenosis
Alagille syndrome --> arteriohepatic dysplasia |
|
|
pulmonic stenosis presentation
|
heart failure in severe cases in first month of life
right ventricular failure (hepatomegaly, peripheral edema, exercise intolerance) pulmonary ejection click after S1; this is heard less with increasing severity |
|
|
pulmonic stenosis diagnosis
|
ECG --> right ventricular hypertrophy with tall spiked P waves
chest x-ray --> poststenotic dilation of pulmonary artery echo --> best test |
|
|
pulmonic stenosis treatment
|
balloon valvuloplasty
emergent surgery |
|
|
aortic stenosis presentation
|
if severe --> left ventricular failure and decreased cardiac output
early systolic ejection murmur at apex; the more severe can hear it less increasing severity --> decreased pulses, cardiomegaly, left ventricular apical thrust |
|
|
aortic stenosis diagnosis
|
ECG --> left ventricular hypertrophy
chest x-ray --> prominent ascending aorta echo |
|
|
aortic stenosis treatment
|
balloon valvuloplasty
valve surgery valve replacement |
|
|
cardiac associations in Turner
|
preductal coarctation of the aorta and bicuspid aortic valve
|
|
|
adult-type coarctation of the aorta presentation
|
left ventricular hypertrophy
hypertension decreased blood pressure and pulses below constriction (femoral pulses weak or absent) rib notching due to collateral circulation |
|
|
infantile-type coarctation of the aorta presentation
|
PDA allows blood shunted to descending aorta
differential cyanosis of upper and lower body acidosis severe heart failure if PDA closes |
|
|
coarctation of the aorta diagnosis
|
chest x-ray --> infantile: cardiomegaly; adult: rib notching, poststenotic dilation of ascending aorta
ECG --> left ventricular hypertrophy in older children; right ventricular hypertrophy in neonates |
|
|
coarctation of the aorta treatment
|
PGE1 to maintain PDA then surgeryin infantile type
treat heart failure and hypertension then surgery in adult-type |
|
|
postoperative mesenteric arteritis
|
acute hypertension and abdominal pain with or without anorexia, vomitting, hemorrhage, bowel necrosis
treat with nitroprusside, esmolol or captopril with or without intestinal decompression |
|
|
tetralogy of Fallot presentation
|
pulmonary stenosis
VSD overriding aorta right ventricular hypertrophy dyspnea on exertion (squatting increases SVR and directs blood to lungs) paroxysmal cyanotic attacks with gasping, restlessness and syncope |
|
|
paroxysmal cyanotic attack treatment in TOF
|
lateral knee-chest position
O2 subcutaneous morphine beta blockers |
|
|
TOF physical exam
|
systolic thrill along 3-4 intercostal space on left sternal border
loud systolic ejection murmur at upper sternal border single S2 or soft pulmonic component |
|
|
tetrallogy of Fallot diagnosis
|
x-ray --> boot-shaped heart (apex is lifted from diaphragm)
ECG --> right axis deviation plus right ventricular hypertrophy echo is best test |
|
|
tetrallogy of Fallot treatment
|
PGE infusion to promote PDA
palliative systemic to pulmonary shunt then corrective surgery later |
|
|
tricuspid atresia pathophysiology
|
no tricuspid
blood passes to left heart via ASD then to right ventricle via VSD pulmonary blood flow depends on size of VSD |
|
|
tricuspid atresia presentation
|
severe cyanosis at birth
increased left ventricular impulse |
|
|
tricuspid atresia diagnosis
|
x-ray --> pulmonary undercirculation
ECG --> left axis deviation and left ventricular hypertrophy echo is best test |
|
|
tricuspid atresia treatment
|
PGE until aortopulmonary shunt can be performed
atrial balloon septostomy surgical correction later in infancy |
|
|
Ebstein anomaly presentation
|
from maternal lithium use
downward displacement of abnormal tricuspid into ventricle with large right atrium, small right ventricle and ASD with shunt can have severe cyanosis at birth, holosystolic murmur and cardiomegaly |
|
|
Ebstein anomaly diagnosis
|
x-ray --> cardiomegaly
ECG --> tall and broad P waves, RBBB, prolonged PR interval echo is gold standard |
|
|
Ebstein anomaly treatment
|
PGE1
systemic-pulmonary shunt corrective surgery later |
|
|
cyanotic cardiopathies with decreased pulmonary blood flow
|
tetrallogy of Fallot
tricuspid atresia Ebstein anomaly |
|
|
cyanotic cardiopathies with increased pulmonary blood flow
|
transposition of the great vessels
truncus arteriosus |
|
|
transposition of great vessels presentation
|
needs foramen ovale and PDA
cyanosis as PDA closes loud S2 |
|
|
transposition of great vessels diagnosis
|
x-ray --> cardiomegaly
ECG --> normal echo is gold standard |
|
|
transposition of great vessels treatment
|
PGE1
balloon atrial septostomy arterial switch surgery in first 2 weeks |
|
|
truncus arteriosus presentation
|
minimal cyanosis due to high volume of pulmonary flow but can develop Eisenmenger
heart failure |
|
|
truncus arteriosus diagnosis
|
x-ray --> cardiomegaly
ECG --> biventricular hypertrophy echo --> gold standard |
|
|
truncus arteriosus treatment
|
treat heart failure then surgery
|
|
|
total anomalous pulmonary venous return pathophysiology
|
drainage of pulmomary veins into systemic venous circulation
enlarged right atrium, right ventricle and pulmonary artery with small left heart |
|
|
total anomalous pulmonary venous return presentation
|
if obstruction --> severe pulmonary venous congestion, pulmonary hypertension low cardiac output and shock; emergency surgery
no obstruction --> total mixing with left-right shunt; mild cyanosis |
|
|
total anomalous pulmonary venous return diagnosis
|
chest x-ray --> snowman appearance
ECG --> right ventricular hypertrophy and tall spiked P waves echo is gold standard |
|
|
total anomalous pulmonary venous return treatment
|
PGE1 + surgery
|
|
|
hypoplastic left heart syndrome pathophysiology
|
atresia of mitral or aortic valves, left ventricle or ascending aorta --> right ventricle maintains pulmonary and systemic circulation --> pulmonary venous blood passes through ASD with systemic mixing --> ductus arteriosus supplies aorta and coronaries from retrograde flow
|
|
|
hypoplastic left heart syndrome presentation
|
cyanosis
heart failure +- shock cardiomegaly |
|
|
hypoplastic left heart syndrome diagnosis
|
x-ray --> cardiomegaly + increased pulmonary blood flow
ECG --> right ventricular hypertrophy and right atrial enlargement with decreased left-heart forces echo is gold standard |
|
|
hypoplastic left heart syndrome treatment
|
do nothing if associated malformations are incompatible with life or
surgical correction |
|
|
pulmonary insufficiency
|
decrescendo diastolic murmur
expected result of surgery from right ventricular outflow obstructions x-ray --> large pulmonary artery ECG --> normal echo is gold standard |
|
|
mitral insufficiency presentation
|
increased left atrium, left hypertrophy with dilation, increased pulmonary venous pressure
high-pitched holosystolic murmur at apex |
|
|
mitral insufficiency diagnosis
|
x-ray --> increased left atrial size
ECG --> left ventricular hypertrophy echo is gold standard |
|
|
mitral prolapse presentation
|
chest pain
palpitations arrhythmias apical late systolic murmur with pre-sistolic click associated with Marfan |
|
|
mitral prolapse diagnosis
|
x-ray --> normal
ECG --> may have biphasic T-waves echo is gold standard |
|
|
mitral prolapse treatment
|
no therapy necessary
if associated with mitral insuficiency --> endocarditis prophylaxis |
|
|
tricuspid insufficiency
|
associated with Ebstein anomaly
right ventricular dysfunction perinatal asphyxia in neonate |
|
|
infective endocarditis etiology
|
staph if not valve problems
strep viridians if valve problems or dental procedures group D strep after bowel or GU manipulation coagulase negative staph after indwelling catheters |
|
|
cardiac lesions that predispose to infective endocarditis
|
VSD, TOF, aortic stenosis, PDA
congenital bicuspid aortic valve, mitral prolapse valve replacement |
|
|
infective endocarditis presentation
|
prolonged intermittent fever
weight loss fatigue myalgia arthralgia new or changing murmur splenomegaly petechiae embolic stroke painful Osler nodes painless Janeway lesions splinter hemorrhages roth retinal exudates |
|
|
infective endocarditis diagnosis criteria
|
2 + 3 or 1 + 5
major --> positive blood culture (two separate); echocardiogram evidence minor --> predisposing condition, fever, emboli, immune complex disease, single positive blood culture |
|
|
endocarditis prophylaxis
|
dental/esophageal procedures --> amoxi
high risk GI or GU (prosthetic valves, previous endocarditis, heart disease, pulmonary shunts) --> ampi + gentamicin moderate risk GI or GU(acquired valve disease, hypertrophic subaortic stenosis, mitral prolapse with regurgitation) --> amoxi or ampi allergic --> clindamycin, ceph, macrolide |
|
|
prophylaxis not recommended for infective endocarditis
|
ASD isolated secundum
surgical repair of ASD, VSD, PDA coronary bypass mitral prolapse without regurgitation or thick valves Kawasaki theumatic fever without valve dysfunction pacemakers |
|
|
rheumatic fever presentation and diagnosis
|
microbiological or serologic evidence of GAS infection;
majora criteria --> carditis, migratory polyarthritis, erythema marginatum, Sydenhams chorea, subcutaneous nodules minor criteria --> fever, arthralgia, high ESR, prolonged PR |
|
|
rheumatic fever treatment
|
penicillin for GAS infection
antinflammatory --> once arthritis is confirmed to be migratory and no CHF give high dose aspirin if CHF --> prednisone then taper and aspirin + digoxin if chorea --> phenobarbital if carditis --> IM benzathine penicillin monthly for life prophylaxis |
|
|
causes of dilated cardiomyopathy
|
MCC idiopathic
nonviral infections hypothyroidism storage diseases connective tissue disease muscular dystrophies |
|
|
dilated cardiomyopathy presentation
|
heart failure signs
tachycardia decreased pulse pressure pale skin increased jugular venous pressure hepatomegaly edema rales cardiomegaly gallop rhythm AV valve insufficiency |
|
|
dilated cardiomyopathy diagnosis
|
x-ray --> cardiomegaly, pulmonary congestion
ECG --> atrial enlargement, left/right ventricular enlargement echo --> dilation |
|
|
dilated cardiomyopathy prognosis
|
progressive worsening with relapses, emboli, ventricular arrhythmias
|
|
|
dilated cardiomyopathy treatment
|
antiarrhythmics
implantable cardioverter/defibrillator systemic anticoagulation beta blocker trial of carnitine heart transplant referral |
|
|
hypertrophic cardiomyopathy presentation
|
weakness
dyspnea on exertion palpitations angina dizziness syncope |
|
|
hypertrophic cardiomyopathy diagnosis
|
x-ray --> mild cardiomegaly
ECG --> left ventricular hypertrophy +- ST depression and T wave inversion echo --> mostly septal left ventricular hypertrophy |
|
|
hypertrophic cardiomyopathy treatment
|
no sports or streneous exercise
digoxin and diuretics are contraindicated beta blockers or CCBs are indicated |
|
|
restrictive cardiomyopathy presentation
|
dyspnea
edema ascites hepatomegaly increased venous pressure pulmonary congestion cardiomegaly |
|
|
restrictive cardiomyopathy etiology
|
sarcoidosis
scleroderma amyloidosis mucopolysaccharidoses malignancy |
|
|
restrictive cardiomyopathy diagnosis
|
x-ray --> mild to moderate increase in heart size
ECG --> prominent P waves, low QRS voltage +- ST depression echo --> increased atrial size, abnormal filling by Doppler |
|
|
restrictive cardiomyopathy treatment
|
relieve heart failure
CCBs to increase filling antiarrhythmics ICD transplant |
|
|
myocarditis etiology
|
MCC is coxsackie B and adenovirus
diptheria, Rocky Mountain connective tissue disease granulomatous disease toxins idiopathic |
|
|
myocarditis presentation
|
left heart failure, arrhythmia, sudden death
fever, respiratory distress, shock, distant heart sounds mitral insuficiency, gallop fever + cardiomegaly + arrhythmia |
|
|
myocarditis diagnosis
|
supported by --> high ESR and CK-MB, may need biopsy during catheterizaation
x-ray --> cardiomegaly and pulmonary edema ECG --> sinus tachycardia, decreased QRS voltage echo --> poor ventricular function |
|
|
endocardial fibroelastosis
|
bright endocardial surface on echo due to fibroelastic thickening in left ventricle and valves
presents with variable congestive heart failure |
|
|
pericarditis etiology
|
MCC is viral: coxsackie B, adeno, influenza, echo
purulent --> bacteria acute rheumatic fever lupus uremia juvenile rheumatoid arthritis neoplasia - Hodgkin, leukemia |
|
|
cardiac tamponade
|
pulsus paradoxus (drop in BP > 20 during inspiration in child with pericarditis
|
|
|
pericarditis presentation
|
sharp stabbing precordial pain worsens in supine and better leaning forward
cough, dyspnea, abdominal pain, vomit friction rub, muffled heart sounds |
|
|
pericarditis diagnosis
|
x-ray --> water bottle appearance
ECG --> low voltage QRS, mildly elevated ST, generalized T-wave inversion echo --> echo-free space between epicardium and pericardium |
|
|
hypertension causes
|
most causes are renal
UTIs acute glomerulonephritis Henoch-Schonlein HUS acute tubular necrosis leukemia renal artery stenosis |
|
|
hypertension diagnosis
|
screen --> CBC, urinalysis, urine culture, electrolytes, glucose, BUN, creatinine, calcium, uric acid, lipids
echo to check if chronic (left hypertrophy) renal ultrasound angiography |
