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Pediatric Cardiology
Cardiology in Pediatrics
| Question | Answer |
|---|---|
| What is the incidence of pediatric visits of chest pain | 3-6 out of 1000 visits |
| What is the most common cause of pediatric chest pain? | Musculoskeletal |
| What musculosketal conditions can potentially cause chest pain? | Trauma, getting hit, falling, muscle strain, exercise, weight lifting |
| What are the noncardiac causes of chest pain? | Musculoskeletal, Pulmonary, GI and Psychogenic |
| What are some cardiac causes of chest pain? | cardiomyopathy, kawasaki's disease, myocarditis, mitral valve prolaspe, myocarditis |
| What questions will you ask on history? | OLD CARTS onset location duration characteristics alieviating factors, relieving factors, time, severity, family hx, recent sickness, injury |
| How do you examine a child with chest pain? | Inspect, palpate, auscultate |
| What diagnostics tests would you do for someone with cp? | EKG, cxr. If you hear a PVC you might do a holter monitor. consider pediatric cardiology referral |
| What diagnostics might the pediatric cardiologist do to further investigate the c/o cp? | echocardiagram, or stress test |
| How are the definitions for HTN determined? | By age, gender and height |
| What is a normal blood pressure for a child? | Normal < 90th perctile of age, gender and height |
| What are the different categories of pediatric htn? | Pre hypertension 90th %ile to the 95th %ile, 95-99th %ile htn, >99th %ile severe htn |
| When are adolescents considered pre-hypertensive? | When there BP > 120/80 |
| When is HTN diagnosed? | After 3 consequtive readings usually 1 week apart |
| What would you do if the child came in today with an elevated BP? | Document it as elevated BP without the dx of HTN and RTO in 1 week for another BP reading |
| At what age should a bp in a child be routinely checked? | 3 years old |
| What do you do when a pt. is hypertensive outside the office but normotensive inside the office? | Ambulatory bp monitoring |
| What is called when a patient's bp is normotensive outside the office but hypertensive inside the office? | white coat htn |
| What is the most common cause of htn in children? | Secondary htn caused by kidney dysfunction |
| What is the most common cause of htn in adolescents? | Primary/essential HTN related to obesity. But you can not rule out secondary causes |
| What diagnostic tests would you do for a pt with htn? | UA, check for protein, and microalbumin. If you're still concerned then do a BUN/CR |
| What other blood test should you check for in a pt with htn? | choelesterol |
| What test would you consider in an adolescent with HTN? | drug screen |
| What is the nonpharmacological management of HTN | Diet, nutrition, exercise, smoking cessation, weight loss, salt restriction |
| What are the indications for pharmacological management? | Secondary htn, target organ damage, (ie proteinuria, LVH,) Diabetes, persistent htn not responsive to lifestyle changes |
| How long would you generally wait until you prescribe pharmacological treatment? | 3-6 months |
| What drug would you prescribe first for the treatment of HTN? | ACEI or ARB |
| What are the contrindications for ACEI or ARB | pregnancy. |
| What else beside an ACEI or ARB would you prescribe for HTN | CCB, BB, diuretic |
| What medicine would you not prescribe for a hypertensive child participating in sports? | diuretic or BB. |
| True or False Children with uncontrolled or severe htn should not participate in sports | True |
| What is the definitition of severe htn | >99th%ile Also known as stage 2 htn |
| At what age should screening start for a child with cholesterol? | 2 years old |
| How would you assess a child with cholesterol? | If the parents have total blood cholesterol >240 do a total blood cholesterol. If the child is positive for family Hx (parent or grandp w premature cardiac disease) do lipoprotein analysis |
| How would you analyze a cholesterol test in a child? | If it's less than 170 give teaching and test again in 5 yrs. If 170-199 repeat and average. if >199 do lipoprotein analysis |
| After a borderline reading and a repeat TC what would you recommend? | If the average is <170 pt education, recheck in 5 years. If the average is > 170 do a lipoprotein analysis |
| What would you do if a childs first total cholesterol reading was > 200 | do a lipoprotein analysis |
| Once a lipoprotein test is done what results are further decisions based upon? | LDL |
| What is an acceptable LDL level | < 110 |
| What would you do if the results of a lipoprotein analysis indicates the LDL > 100 | Repeat and average. If average < 110 acceptable. if 110-129 recommend step 1 diet, recheck in 1 year. if > 130 look @ secondary causes, Step 1, then step 2 diet |
| Primary hypercholesterolemia | familial, genetically transmitted |
| Secondary hypercholesterolemia | diseases, medication, diet (secondary to something else) |
| What is universal screening | Screening everyone |
| What is selective screening? | screening based on specific risk factors |
| When would you consider pharmacological treatment for dyslipidemia | >10 years old, After dietary modifications of 6-12 months. If LDL . 190 or > 160 plus family history |
| What drug categories would you recommend for the treatment of dyslipidemia? | Bile acid sequestering agent Cholistyromine (Questran). |
| True or false? Statins have been approved for use in children? | False. Statins have not been approved for use in children for the treatment of dyslipidemia |
| Do you need an ekg or echocardiogram for a kid needing a sports physical? | No. the sports physical form is a good H&P, that's all you need. |
| What is Marfan's disease | a genetic disorder of connective tissue, bones, muscles and ligaments, and skeletal structures. Risk of dying of sudden cardiac death. |
| What is the clinical manifestation of Marfan's disease | Arm span (from finger tip to finger tip) signficantly disproprotionate to height. |
| What would you do if you suspected Marfan's disease? | send them to a cardiologist and/or genetic testing. doesn't necessarily need an ekg or an echo |
| What is the management for prehypternsion | Therapeutic lifestyle changes, repeat BP in 6 months, consider diagnostic workup if overweight |
| what is the management for stage 1 hypertension? | Repeat BP over 3 weeks, workup includes target organ damage, if primary hypertension =>lifestyle changes weight reduction (if normal bmi => drug rx). If secondary HTN => treat for spcific cause, drug treatement |
| Management for stage 2 hypertension? | diagnostic work up include target organ damage, consider referral to expert in pediatric htn, if overweight =>weight reduction if normal BMI=> drug treatment |
| List the acyanotic congenital diseases? | ASD, atrioventricular canal, aortic stenosis, coarctation of the aorta, PDA, pulmonary stenosis, VSD |
| What are the cyanotic congentical anamolies? | Hypoplastic left heart, tetrology of fallot, transposition of the great arteries |
| What is the role of an NP in managing congenital anomalies? | Referral and consultation |
| What would you do if you heard a heart murmur in a child? | Get a good History (has anyone ever told you your child has a murmur, do they run and play with other children, do they get fatigued quickly, what are there activities like, what does the growth chart look like. |
| What is a Still's murmur | an innocent murmur often heard in a child 3-4 years old. |
| What is Kawasaki's disease? | The immune system is abnormally activated in response to an infectiou sagent (ie virus or environmental toxin) |
| At what age is Kawaski's typically seen? | Almost exclusively seen in children <8 years old |
| What are the clinical manifestations of Kawasaki's disease | acute febrile vasculitis,, which may lead to longterm cardiac complications from vasculitits of coronary arteries. |
| What time of the year do you see Kawasaki's diesease the most? | the numbers of cases peak in winter and spring. |
| What is the most common acquired heart disease in children | Kawasaki's disease |
| what are the classic signs/symptoms of Kawasaki's disease? | High fever lasting for >5 days, bilateral bulbar conjunctival injection without exudates, erythematous mouth and pharynx, strawverry tongue or red cracked lips, polymorphous exanthema, edema (hands/feet), cervical lymphadenopathy >1.5cm sing/unilateral |
| What is the presentation of atypical Kawaski's disease | more often seen in infants, consists of fever with fewer than four of the above criteria but findings of coronary artery abnormalities |
| What are other clinical findings of Kawasaki's disease? | anterior uveitis, arthritis and arthralgias aseptic meningtis, pericardial effusion gallbladder hydrop, carditis and perineal rash |
| What would the laboratory findings for Kawasaki's disease look like? | Leukocytosis with left shit (increased ciruclating imature neutrophils), neutrophils with vacuoles or toxic granules, elevated c-reative protein or erythrocyte sedimentation rate , thrombocytosis, sterile pyuria, increase liver function test. |
| What happens in the subacute phase of Kawasaki's diesease? | 11-25 days after onset. Resolution of fever, rash and lymphadenapothy. Often desquamation of fingertips or toes and thrombocytosis occur |
| what are some cardiovascular complications of Kawasaki's disease? | if untreated 15%-25% develop coronary artery aneurysms and dilation (peak prevelance occurs 2-4 weeks after onse of disease, and are at risk for coronary thrombosis acutely and coronary stenosis chornically. |
| what happens during the convalescent phase of Kawasaki's disease | ESR, c-reactive protein and platelet return to normal. |
| What is the management for Kawasaki's disease? | Probably not involved acutely. IVIG (iv immuneglobulin). ASA for antifinlammatory. |
| What is the initial dose of medication you would recommend for treatment of kawasaki's disease (not iv) | ASA 80-100 mg/kg/day dividided into 4 doses until fever resolves. |
| What diagnostic tests would you do for a pt with Kawasaki's disease? | Series echocariography (at time of diagnosis, 2-4 weeks, 6-8 w and 6-12 months. Done to assess coronary arteries and LV function |
| What is the most common pathogen of endocarditis? | Strep (S. viridans, enteroccocci) and Staph (S. aureus, spidermidis) and Haemophilus influenzae, gram negative bacteria and fungi |
| What are the clinical findings for endocarditis? | New heart murmur, fever, splenomegaly, petechiae, osler noeds, janeway lesions, splinter hemorrhages and roth spots |
| what is the treatment for endocarditits? | anti-inflammatories. If the patient has strep you can treat them with antibiotics |
| When is prophylaxis for endocarditis recommended? | When you have mitral valve prolaspe with regurgitation |
| What is dilated cardiomyopathy? | the end result of myocardial damage, leading to atrial and vetnricular dialtion with decrase contracilte function of the ventricles. |
| What are the symptoms of dilated cardiomyopathy? | Fatigue, weakness, SOB |
| What would you look for on PE in a pt with cardiomyopathy? | look for signs of CHF (tachycardia, cold extemities, peripheral edema, rales etc) |
| What is hypertrophic cardiomyopathy | an abormality of myocarrdial cells leading to significant ventricular hypertophy, particulary the LV. Contracitle function is increased, but filling is impaired secondar to stiff ventricles |
| What is the common type of hypertrophic cardiomyopathy? | asymmetric septal hpertrophy (aka idiopathic hypertrophic subaortic stenosis with variyind degress of obstruction) |
| What is the incidence of sudden death with hypertrophic cadiomyopathy? | 4-6% |
| What is pericardial disease? | Disease of the peridcardium. infalmation of visceral and parietal layers of the peridcardium |
| What causes pericarditis? | viral (echovirus or coxackieviur B) TB bacterial, ueremic, neoplastic collagen vascular, post-mi, radiation induced, drug induced. |
| What are the symptoms of pericarditis? | chest pain (retrosternal or precordial, radiating to back or shoulder, pleuritic in nature) dyspnea |
| What would the PE reveal for pericarditis? | pericardial friction rub, distant heart sounds, fever, tachypnea |
| what diagnostic tests would you do for pericarditis? | EKG diffuse ST segment elevation in alsmost all leads. |
| What is the treatment for pericarditis? | ofetn self-limited, treat underlying condition, provide symptomatic treatment with rest, analgesia and anti-infalmatory drugs |
| What is the most common disease condition associated with Rheumatic fever? | streptococcal pharyngitis caused by group a strep |
| What are the clinical findings for RF? | Strep pharyngits 1-5 weeks before onset of symptoms. Pallor, malaise, ease fatigability |
| How is RF diagnoses? | The Jones criteria: carditis, polyarthris, chorea, erhtyema marginatum, subcutaneous nodule |
| What are minor manifestations of RF | arthralgia, fever |
| What are the lab findings for RF? | elevated ESR, Elevated CRP, prlong PR interval. Plus supporting evidence of antecendent group A stretococcal infection. Pos throat culture or rapid strep antigen test, elev or rising strep antibody titer. |
| What diagnostic test would you do first for RF? | Antibody titre first and then throat culture |
| How can RF be prevented? | appropriate treatment of streptococcal pharyngitis |
| What is the treatment for RF? | NSAIID, penicillin, bed rest, salicylates, support mgmg of chf if present with diuretics, digoxin, or morphine. |
| What is the most common acquired heart disease? | Kawasaki's disease |
| What disease should you consider if the person has an untreated strep infection? | Rheumatic fever |
Created by:
lknightly
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