Pediatrics (Cardiology)

Front 1

Name the murmur:
Vibratory, twanging murmur heard over left sternal border. Loudest supine and with exercise

Back 1

Still's murmur

Front 2

Name the murmur:
Continous murmur heard at the neck and subclavicular. Head only while standing or sitting

Back 2

Venous hum

Front 3

What type of ASD is associated with Down's syndrome? What sx might be expected?

Back 3

Ostium primum - can develop MR

Front 4

What is the most common ASD?

Back 4

Ostium secundum - generally no sx

Front 5

Name the murmur:
Fixed split S2 with systolic ejection murmur heard over LUSB. Increased R ventricular impulse

Back 5

ASD - creates L --> R shunt. Systolic ejection murmur is increased pulm blood flow

Front 6

Name the murmur:
High-pitched HOLOSYSTOLIC murmur at LLSB

Back 6

VSD

Front 7

When is a VSD closed?

Back 7

Heart failure refractory to med management
Large VSD with pulm HTN closed bt2 3-6 months
Small VSD closed btw 2-6 years

Front 8

Name the murmur:
MACHINERY-LIKE continous murmur at LUSB. You note widened pulse pressure and brisk pulses.

Back 8

PDA - moderate to large PDAs can lead to CHF - can close with indomethacin medically

Front 9

Name the heart condition:
You note increased BP in the R arm, decreased femoral pulses, and a cresceondo-decrescendo murmur at the RUSB that radiates to the carotids. On CXR, you note rib notching

Back 9

Aortic coarctation - often associated with biscuspid aortic valve

Rib notching - collateral development via intercostals

Front 10

A neonate presents with suspected aortic coarctation. What's the most important next step in management?

Back 10

IV PGE1 to keep the PDA open

Front 11

A newborn is born without any complications. 24 hrs later however, he presents with signs of CHF. On PE, you note a crescendo-decrescendo murmur at the RUSB. What's the most likely dx?

Back 11

Critical aortic stenosis - signs of CHF develop when PDA closes

Front 12

A child presents with cyanosis to your ED. You administer 100% O2 and note a mild increase in his PAO2. What's your ddx?

Back 12

Cyanosis most likely 2/2 cyanotic congenital heart disease
1) Tetratology of Fallot
2) Transposition of the great arteries
3) Tricuspid atresia
4) Truncus arteriosus
5) Total anomalous pulmonary venous connection

Front 13

Name the cyanotic congenital heart disease:
1) Boot-shaped heart"/ increased RV impulse/ murmur of pulmonary stenosis
2) Heart looks like an egg on a string/ single S2/ no murmur
3) Only cyanotic heart disease with LVH/ No murmur/ Single S2
4) Single S2/ systolic ejection murmur along LSB/ diastolic murmur at apex

Back 13

1) Tetralogy of fallot --> repair srgically at 4-8 mo
2) TGA
3) Tricuspid atresia
4) Truncus arteriosus

Front 14

Name the 4 anatomic components of a tetralogy of fallot

Back 14

1) VSD
2) Pulmonary stenosis
3) RVH
4) Overriding aorta

Front 15

What worsens/improves cyanosis in tetralogy of fallot?

Back 15

Worsens --> "tet" spells
1) Decrease SVR - exercise/vasodilation
2) Increase resistance through RVOT - crying

Improve
1) Increase SVR - squatting, place in knee-chest position
2) Reduce resistance through RVOT

Front 16

What is total anomalous pulmonary venous connection and what are the signs?

Back 16

TAPVC - pulmonary veins drain into systemic venous side instead of LA --> blood flows into L heart via PFO/ASD

Signs:
Pulmonary flow murmur - increased pulm blood flow

Front 17

You have a child with suspected bacterial endocarditis. What are the most likely pathogens? Next best step in dx? Tx

Back 17

Pathogens - S. viridans, S. aureus

Signs - Splinter hemorrhages, Osler's nodes (tender), Janeway lesions (non-tender), Roth spots (retina)

Dx - blood culture, TEE

Tx - IV abx for 4-6 weeks

Front 18

All patients with structural heart disease should receive Abx ppx before dental work, invasive GI/urologic procedures. What's the exception?

Back 18

Secundum ASD

Front 19

Pericarditis
1) Causes
2) Sx
3) Diagnosis
4) Management
5) FEARED COMPLICATION

Back 19

Causes
1) Viral - coxsackie
2) Purulent pericarditis - S. aureus/ S. pneumo --> lead to constrictive pericarditis

Sx
1) Pleuritic CP that worsens while laying down
2) On PE, pericardial friction rub with distant heart sounds

Dx
1) Pericardiocentesis
2) ECG - diffuse ST-changes/ low voltage

Management
1) Abx/anti-inflammatory

Feared complication
Cardiac tamponade - pulsus paradoxus

Front 20

A young athlete presents with dyspnea and malaise. She says that she had a viral URI one week ago. On PE, you note muffled heart sounds and an EKG makes you worried about an MI. What's the most likely dx?

Back 20

Myocarditis - supportive tx

Front 21

What are some treatment options for a child with SVT?

Back 21

Vagal manuvers
IV adenosine
Cardioversion

Front 22

Name the syndrome
1) Long QT syndrome associated with congenital deafness
2) Long QT by itself

Back 22

1) Jervell-Lange-Nielsen - AD
2) Romano-Ward syndrome

Front 23

Name the heart defect:
Cardiomegaly with a "snowman" appearance

Back 23

Total anomalous pulmonary venous connection