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2 Peds Cardiology
| Question | Answer |
|---|---|
| Most common congenital heart defect | bicuspid aortic valve. Incidence of congential heart disease: 8-10/1000 (.8%), but if you take into consideration bicuspid aortic valves, the incidence is: 15/1000 |
| 4 heart defects | Hypoplastic left heart syndrome, congenital aortic stenosis, Coarctation of aorta, transposition of the great heart vessels. Almost always symptomatic when born. |
| Most defects occur in | otherwise healthy, well-developed, term infants.Transition from fetal to more adult circulation unmasks the defects. Hypoplastic left and right heart is perfectly protected in utero b/c of fetal circulation. |
| Heart has finished its formation at about | 60 days post conception. 60% of spontaneous abortions occur due to lethal heart disease |
| Heart Disease associated with Down's Syndrome | AVSD (no true tricuspid or bicuspid valve, only an AV valve), TOF. (50% of all Down's Syndrome kids will have a heart disease). These kids tend to age faster: never drop pulmonary resistance to nl. Can go from birth to pulmonary vascular dz in 5 months. |
| Heart Dz associated with Turner's Syndrome | Bicuspid aortic valve, coarctation of the aorta (COA) |
| Heart Dz associated wtih DPH syndrome | PS |
| Heart Dz associated with Trisomy 13/18 | VSD, DORV |
| Heart Dz associated with Marfan's syndrome | MVP (mitral valve prolapse), MR (mitral regurgitation), AI, DAA |
| First thing to do in Down's | EKG (in nl kids, you will see a right axis deviation b/c they have a very thick R ventricle) in down's: Left axis deviation. Good marker for AVSD. Then do Echo to find extent of defect |
| First Breath | clears out all the fluid from the lung. Pulmonary vascular resistance drops but doesn't get to normal until 3-6 months of life. PO2 blood levels increase b/c you are bleeding, Pulmonary blood flow increases, pulmonary venous return to atrium goes up. |
| Increased PO2 causes | closure of the vaso vasorum around the ductus arteriosus. remnant of ductus arteriosus is the ligament arteriosum |
| Disconnecting placenta | increases vascular resistance, Left ventricle dilates. Now able to provide more output to the periphery! |
| 3 presentations of heart disease | cyanosis, CHF, murmur/abnormal physical exam |
| Early recognition is | first few days of life. late - a week out |
| Most common cause of V/Q mismatch in premies | lack of surfactant. Other causes: meconium, pneumonia, retained amniotic fluid, etc. |
| reversible form of heart failure in DM moms. | neonatal hypoglycemia (high circulating insulin levels, with no way to put out glucose fast). |
| First sign of CHF in babies | Tachypnea, then tachycardia, then hepatomegaly (not edema and rales like in adults!). |
| Cost of tachypnea | myocardial oxygen consumption |
| Sequence of evaluation | History, Physical Examination, Electrocardiogram, Chest Radiograph, Echocardiogram, Other Studies including stress test, 24-Holter, ambulatory ECG monitoring, cardiac cath, angiocardiography, nuclear imaging, cardiac MRI |
| Where is the thrill of aortic stenosis felt? | In the suprasternal notch |
| In patients with severe pulmonary htn, where is palpable pulmonary closure (P2) frequently noted? | at the upper left sternal border |
| Sx of decreased pulmonary blood flow in an infant/toddler | cyanosis, squatting, loss of consciousness |
| Sx of Increased Pulmonary blood flow in an infant/toddler | tachynpnea with activity/feeds, Diaphoresis, poor weight gain |
| Sx of Decreased pulmonary blood flow in an older child | dizziness, syncope |
| Sx of Increased Pulmonary blood flow in an older child | exercise intolerance, dyspnea on exertion, diaphoresis |
| S1 | First heart sound is teh atrioventricular (AV) valve closure. Best heard at the lower left sternal border |
| S2 | semilunar valve closure. Best heard at the upper left sternal border. Two sounds A2 and P2 (aortic and pulmonary valve closure). Normal splitting: widening w/ inspiration and narrowing with expiration. Abnl splitting of S2 may be an indication of heart dz |
| S3 | the sound of rapid filling of the left ventricle. A persistent S3 often heard in the presence of a dilated LV caused by cardiomyopathy or large L-to-R shunt |
| S4 | Associated with atrial contraction and is normally not audible. Occurs before S1. It is heard in the presence of atrial contraction into a noncompliant ventricle as in hypertrophic or restrictive cardiomyopathy or hypertrophied LV from other causes |
| ____% of children have an innocent murmur at some time during childhood | 40-45% |
| How do describe murmurs | Location and radiation, Relationship to cardiac cycle and duration (systolic, pansystolic, diastolic, and continuous), Intensity, Quality (harsh, musical, rough; high, medium, or low in pitch), Variation with position (supine, sitting, standing,squatting) |
| Murmurs heard during systolic ejection | semilunar valve stenosis (AS/PS/truncal stenosis), ASD, Coarctation |
| Causes of Pansystolic murmurs | VSD, AVVR (atrioventricular valve regurgitation) |
| Causes of diastolic murmurs | Semilunar valve regurgitation (AI/PI/truncal insufficiency), AV valve stenosis (MS/TS) |
| Causes of continuous murmurs | Runoff lesions (PDA/AVM/aortopulmonary collaterals) |
| 6 Most common Functional murmurs in childhood are: | Newborn murmur, Functional murmur of peripheral arterial pulmonary stenosis, still murmur, pulmonary ejection murmur, venous hum, innominate or carotid bruit |
| Where is a newborn murmur heard? | lower left sternal border; first few days of life, usually disappears by age 2-3 weeks. |
| Systolic ejetion murmur heard with equal intensity at the upper left sternal border, at the back and in both axillae; usually disappears before age 2 | Functional murmur of peripheral arterial stenosis; results from the normal branching of the pulmonary artery |
| Most common innocent murmur of early childhood | still murmur. Usually heard between ages 2-7 years. Musical, vibratory, short, high-pitched, systolic. |
| Most common innocent murmur in older children | Pulmonary ejection murmur. Heard from age 3 years onward. Usually a soft systolic murmur, well localized to the upper left sternal border |
| This functional murmur is continous and is produced by turbulence at the confluence of the subclavian and jugular veins | venous hum |
| long harsh systolic murmur that is heard in the right supraclavicular area. Functional | Innominate or carotid bruit |
| Bounding pulses are characteristic of | run-off lesions, including patent ductus arteriosus (PDA), aortic regurgitation, arteriovenous malformation (AVM), or any condition with low diastolic pressure (fever, anemia, or septic shock) |
| Extracardiac Examination | Arterial Pulse, Quality and amplitude of pulse, arterial BP (UE & LE), Extremities (cyanosis, clubbing, edema), Abdomen |
| Cardinal sign of right heart failure | hepatomegaly. Hepatomegaly can also be seen in a child with pulmonary edema from lesions causing L-R shunting or left heart failure. Splenomegaly may be present in pts with longstanding CHF & is characteristic of infective endocarditis |
| heart size in relation to chest in child older than 1 yr | heart size should be less than 50% of the chest diameter |
| Components to check on CXR | 1. position of cardiac apex, 2.Position of abdominal viscera, 3. Cardiac Size, 4. Cardiac configuration, 5. Character of the pulmonary vasculature |
| Dextrocardia | heart on the right side of the chest. Levocardia - on the left, mesocardia-in the middle |
| This imaging technique is useful in assessing fixed and reversible areas of ischemia | Nuclear imaging. Valuable in evaluating myocardial perfusion in patients with Kawasaki dz, etc. |
| What causes the closure of the ductus arteriosus? | Pulmonary vascular resistance falls below that of the systemic circuit, resulting in a change in blood flow across the ductus arteriosus from left to right which closes the flap. Usually closes between 7-14 days |
| The one-way valve in fetal life that shunts blood from the inferior vena cava to through the right atrium to the left atrium | foramen ovale. At birth, pulmonary and systemic vascular resistance increase; left atrial pressure rises above that of the right atrium.This functionally closes the flap preventing flow across the septum. 10-15% of adults have a probe patent foramen ovale |
| Persistent pulmonary htn is a clinical syndrome that occurs in | full-term infants |
| In the nl newborn, pulmonary vascular resistance and the pulmonary arterial pressure (Decrease/increase) | Decrease; this phenomenon results from demusclularization of the pulmonary arterioles |
| HF | condition in which the heart fails to meet the circulatory and metabolic needs of the body. Usually occurs in infants before 6 months. Common causes in infancy: VSD, PDA, COA, AVSD, Large AVMs, and chronic atrial tachyarrhythmias |
| Children with HF may present with | irritability, diaphoresis with feeds, fatigue, exercise intolerance, or evdienceof pulmonary congestion, tachypnea |
| In CHF, when ventricular systolic dysfunction presents, what neurohormone is activated? | catecholamines from the adrenal glands are released and results in tachycardia, diaphoresis, and indirectly through activation of the renin-angiotensin system, peripheral vasoconstriction, and salt and water retention |
| Acyanotic heart disorders | ASD & VSD, PDA, Coarctation of the Aorta, Aortic stenosis, MVP |
| ASD: Rarely presents as CHF. Peripheral pulses nl and equal. | RV heave felt best at the mid to lower left sternal border. Ejection-type systolic murmur heard best at left sternal border at 2nd intercostal space. Murmur caused by increased flow across pulmonic valve |
| Most common congenital heart malformation | Simple VSD, accounting for about 30% of all cases of congenital heart dz. 80-85% are small and close spontaneously. |
| Consequence of Large VSD | CHF. Large: 6-10mm in diameter |
| VSD presentation | small to moderate: no CV sx. Large: ill early in infancy. Frequent upper and lower respiratory infxns. Gain weight slowly. Dyspnea, diaphoresis, exercise intol and fatigue common. |
| AVSD | Common in Down's kids.CHF develops in infancy, recurrent bouts of pneumonia common. Heart is significantly enlarged. Echo is the diagnostic test of choice. |
| PDA |
Created by:
ltm12