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PNP cardiac
| Question | Answer |
|---|---|
| Cardiac anomaly that results from failure of the endocardial cushion to develop properly. Has 3 components-ASD, VSD and formation of AV valves. L>R shunting. | AV (atrioventricular) canal |
| cardiac lesion-failure of primitive arterial trunk to divide into aorta and PA causing mix of systemic and pulm. blood flow | Truncus Arteriosis |
| Is truncus arteriosis (TA) cyanotic or non-cyanotic | cyanotic |
| Management for truncus arteriosis (TA)? | Prostaglandin administration, manage shock and CHF. Surgery when stable. |
| Aorta arises from RV and PA rises from LV | Transposition of the Great Vessels |
| Management of transposition of the great vessels (TGV)? | If no ASD or VSD, will require immediate prostaglandin infusion, balloon septostomy ASAP |
| Cardiac lesion with 4 findings: outlet type VSD, RVOT obstruction, overriding aorta, RVH. R>L shunting. | Tetrology of Fallot |
| What is the treatment for a TET spell? | Legs to chest will increase SVR, phenylephrine is drug. |
| What cardiac lesion can be diagnosed later in life? | Coarctation of the Aorta |
| How does a coarctation present in the older child? | Systemic hypertension |
| Assessment of hypertension involves | BP eval (repeated), heart sounds, dysmorphic features, abnormal retinal exam (papilledema) abnormal growth parameters. |
| Diagnostic test for hypertension | CBC, UA, UC, uric acid, BUN, creatinine, lytes, lipid panel, renal US, echocardiography |
| Management of mild essential hypertension | dietary, exercise, wt loss |
| management of essential hypertension | diuretics, vasodialators, beta blockers, ACE inhibitors (never first line) |
| Management of secondary hypertension | find and tx underlying cause, referral to cardiology or nephrology |
| Definition of hypertension in kids | BP consistently >95% for age, gender, height measured on 3 separate occasions |
| Def secondary hypertension | usually renal vascular or systemic vascular with genetic syndrome, endocrine disorder, excess endogenous catecholamine |
| Def essential hypertension | multifactorial, genetic, familiar, enviro, dietary factors |
| Def kawasaki syndrome | Aquired heart disease. Acute systemic vasculitis of unknown origin. Acute and subacute phases. |
| Diagnosis/ symptoms of kawasaki disease | PRI: fever x5d, indurated palms & soles, erythematous rash, conjunctivae injection, desquam lips, strawberry tongue, LAD. SEC: vasculitis as murmur, N/V/D, abd pain, proteinuria, cough, joint swelling, seizures. 5D FEVER +4/5 PRIMARY OR 3+ CARDIAC INVOL |
| Treatment of kawasaki disease | IVIG, high dose aspirin, chronic aspirin if indicated, cardiology & ID consults. LT f/u echo's |
| Def rheumatic fever | Aquired heart disease. Collagen vascular disease of connective tissue resulting in vasculitis. Inflammation of joints & heart. Complication of GAS pharyngitis. |
| Diagnosis/ symptoms of rheumatic fever | Presents as migratory polyarthritis with joint pain, rash & subq nodules. Jones criteria: 2 major (carditis, polyarthritis, chorea, erythea marginatum, subq nodules) OR 1major & 2 minor (arthralgia, fever, elevated CRP, ESR, WBC, prolonged PR interval. |
| Rx & treatment for Rheumatic fever | Acute: penicillin, aspirin therapy. Bed rest until fever and symptoms resolove. cardiology and ID consults. Then PCN prophylaxis for endocarditis. |
| Symptoms of cardiomyopathies | CHF & decreased CO =>SOB |
| Etiology of cardiomyopathies | Acute or chronic sequelae of atypical viral disease. Dilated cardiomyopathy is most often seen. |
| Diagnosis of cardiomyopathies | CXR reveals cardiomegaly. ECHO globally decreased function. Work up for anatomic abnormalities, metabolic causes, infectious causes. |
| Treatment of cardiomyopathies | Acute: support cardiac output with inotropes and vasodilators, diuretics. Treat causes (IVIG, antivirals, surgery for ALCAPA) |
| Etiology of hypertrophic obstructive cardiomyopathy | 50% familial, often found on autopsy |
| Symptoms of hypertrophic obstructive cardiomyopathy | Acute decompensation, may be with sports or activity |
| Management of hypertrophic obstructive cardiomyopathy | Activity restriction, beta blocker, avoidance of catecholamines |
| Etiology of Long QT syndrome | Congenital disorders characterized by a prolongation of the QT interval on ECG and a propensity to ventricular tacharrhythmias, which may lead to syncope, cardiac arrest, or sudden death |
| Symptoms of Long QT syndrome | Typically diagnosed s/p cardiac event(syncope or arrest). Eval relatives: K+, mg+, thyroid. EKG & echo. |
| Management of Long QT syndrome | Treat with beta blockers. Implantable cardioverter/defibrillator. Avoid meds that prolong QT (inc amioderone, EES, zoles & most psyc meds) |
| Definition/description of ASD | Opening in atrial septum. Left -> right shunting. |
| Symptoms/ characteristics of ASD | Usually asymptomatic, with soft, systolic ejection murmur with fixed S2. EKG - may show right axis deviation, RVH, Echocardiogram. |
| Management of ASD | May close spontaneously. Echocardiogram is routine monitoring. Surgery for large lesions. |
| Definition/description VSD | Open in the ventricular septum. Left to right shunting. |
| Symptoms/ characteristics of VSD | Findings dependent on the size of lesion and pulmonary vascular resistance. Signs of CHF, holosystolic murmur, pulmonary hypertension. can occur. |
| Management of VSD | Control symptoms of CHF prior to surgical correction, nutrition. Surgical correction is usually after the age of one. |
| Diagnostic tests of VSD | Echo, CXR, B-type natriuretic peptide serum level, EKG, occasionally cardiac catheterization. |
| Definition/description of Atrioventricular canal | Results for failure of endocardial cushion to develop normally. 3 components: ASD, inlet VSD, abnormal AV valves. LEFT TO RIGHT SHUNTING. |
| Symptoms/ characteristics of Atrioventricular canal | Depend on type and configuration. Tachypnea, poor weight gain, other signs of CHF. |
| Management of Atrioventricular canal | Control CHF and encourage weight gain. Surgical management. |
| Diagnostic of Atrioventricular canal | Echocardiogram, CXR. |
| Definition/description of PDA | Vessel connects the left main pulmonary artery to the descending aorta, in utero is part of normal circulation, after birth, lesion closes, if remains open: LEFT TO RIGHT SHUNTING. |
| Symptoms/ characteristics of PDA | Symptoms depend on extent of shunting. Possible CHF or pulmonary HTN. Symptoms include murmur, widened pulse pressure, low diastolic pressure and bounding pulses. |
| Management of PDA | Allow spontaneous closure. Surgery can be used. NSAIDs and prostaglandin keep PDA open. |
| Definition/ description of Truncus Arteriosus | Rare lesion - failure of the primitive arterial truck to septate and divide into aorta and pulmonary artery causing mixture of systemic and pulmonary blood flow. RIGHT TO LEFT SHUNTING. |
| Symptoms/ characteristics of Truncus Arteriosus | Usually diagnosed prenatally. Symptoms occur soon after birth with normal fall of PVR and include shock. Bounding peripheral pulses, cyanosis, harsh systolic murmur. EKG _ left atrial enlargement and biventricular hypertrophy. |
| Management of Truncus Arteriosus | Prostaglandin administration managing shock and CHF. Surgery indicated once patient stable. |
| Definition/ description of Transposition of the Great Vessels | Aorta rises from the anatomic right ventricle and the pulmonary artery rises from the anatomic left ventricle. RIGHT TO LEFT SHUNTING. |
| Symptoms/ characteristics of Transposition of the Great Vessels | Two separate and parallel circulation present. |
| Management of Transposition of the Great Vessels | Infants with intact ventricular and atrial septums will require immediate prostaglandin infusion, balloon septostomy ASAP. |
| Definition/ description of Tetralogy of Fallot | 4 findings: outlet type VSD, right ventricular outflow tract obstruction, overriding aorta, RVH. RIGHT TO LEFT SHUNTING. |
| Symptoms/ characteristics of Tetralogy of Fallot | Degree of cyanosis is related to the degree of RV outflow tract obstruction. Presentation varies. Typically- TET spells. EKG - persistence of RVH beyond 3 months of age. CXR - "boot shaped" heart. |
| Management of Tetralogy of Fallot | Medical management of symptoms, nutrition until surgical repair which is only definitive treatment. |
| 4 Left to right shunting conditions | ASD, VSD, AV, PDA |
| 4 Right to left shunting conditions | Truncus Arteriosus, transposition of the great vessels, tetralogy of fallot, total anomalous pulmonary venous return. |
| What congenital cardiac condition has a boot shaped heart on CXR | Tetralogy of Fallot |
| Definition/ description of Total Anomalous pulmonary venous return (TAPRV) | Drainage of the pulmonary veins into a systemic venous structure or right atrium instead of left atrium. RIGHT TO LEFT SHUNTING. |
| Symptoms/ characteristics of Total Anomalous pulmonary venous return (TAPRV) | symptoms differ depending on obstruction type. Pulmonary venous HTN & pulmonary edema can develop. Presentation = CHF or inadequate growth, frequent pulmonary infections, mild cyanosis. "snowman" sign on CXR, Echocardiogram indicated. |
| Management of Total Anomalous pulmonary venous return (TAPRV) | Treatment of symptoms. Surgical repair by age 2 or 3. |
| Definition/ description of Coarctation of the Aorta | Obstructive condition. Variety of conditions occurring along the aortic arch - either discrete or generalized narrowing. |
| Symptoms/ characteristics of Coarctation of the Aorta | NN or older child. Pul edema occurs in NN w/ LV failure. Systemic HTN in older child. HF or cardiogenic shock in infant. Asymptomatic murmur/ HTN in older child. EKG, CXR- not conclusive for diagnosis. Echo or doppler studies, MRI definitive. |
| Management of Coarctation of the Aorta | Surgical repair, stent placement. |
| Post cardiac surgery emergencies | Pulmonary artery hypertension, cardiac tamponade, dysrhythmias, post pericardiotomy syndrome. |
| Definition/ description of Myocarditis | Serious, acute inflammation / infection of the myocardium. Often secondary to viral illness such as coxsackie or adenovirus. |
| Symptoms/ characteristics of Myocarditis | Sudden cardiac failure, murmur, gallop, tachypnea, life threatening arrhythmia. |
| Management of Myocarditis | Support while critically ill. ACE inhibitors, digoxin, diuretics, IVIG. |
| Diagnosis of myocarditis | gold standard = biopsy. Elevated troponin, flat T-waves on ECG |
| Definition/ description of Pericarditis | Sequelae to acute viral illness, such as inflammation of the pericardium of the heart. |
| Symptoms/ characteristics of Pericarditis | Fever, tachypnea, tachycardia, pericardial friction rub. May present in tamponade, ECHO may show fluid in pericardial sac. CXR= cardiomegaly. ECG= ST elevation, depression. |
| Management of Pericarditis | If tamponade, emergent pericardiocentesis; Abx 2-4 weeks for weeks for Staph & H flu. |
| Definition/ description of Endocarditis | Acute sepsis presentation |
| Symptoms/ characteristics of Endocarditis | Fever, murmur, embolic phemomena such as petechiae, vasculitis, osler nodes. Echo= vegetation and small, 2mm lesions |
| Management of Endocarditis | *Strep: PCN, Ceftraixone or Vanc. *Enterococci: ampicillin. *Staph Aureus: Nafcillin. Surgery for persistent +blood cx, absecess of valves &/or embloic events during abx tx. |
| Assessment and diagnosis of acute hypertension | Assessment: History, Symptoms, 4 extremity BP, heart sounds Diagnostics: EKG, echocardiogram, renal function, determine underlying cause. |
| Post pericardiotomy syndrome: | Post operative problem: febrile illness secondary to an inflammatory reaction involving the pleura and pericardium. |
| Post cardiac surgery complications | Pulmonary artery hypertension Cardiac Tamponade Dysrhythmias Post pericardiotomy syndrome |
| Cardiac Tamponade | cardiac compression occurring when blood or fluid builds up in the space between the myocardium and the pericardium. |
| Pulmonary artery hypertension | physiologic consequences of RV pressure overload and ventricular dysfunction. |
Created by:
jjenlouu
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