Term
| where does oxygenation occur |
|
Definition
|
|
Term
| 55% of umbilical venous blood returns to IVC-RA via what? |
|
Definition
|
|
Term
| where should you take BP in children? |
|
Definition
|
|
Term
| what are you ruling out when you take BP in all 4 limbs? |
|
Definition
|
|
Term
| low BP in legs, high BP in arms |
|
Definition
| coarctation after L subclavian |
|
|
Term
| low BP in L arm, high in R arm and leg |
|
Definition
| coarc before L subclavian |
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Term
| Split heart sounds are normal in children, But if it's widely split, what might be the problem? |
|
Definition
| RBBB or Ebstein's anomaly (inferior displacement of tricuspid valve) |
|
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Term
| What phase of respiration is better to hear a split S2? |
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Definition
|
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Term
| 3 differentials for wide split S2 |
|
Definition
|
|
Term
| 3 differentials for narrowly split S2 |
|
Definition
1)pulmonary HT
2)single semilunar valve
3)transposition of great arteries |
|
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Term
| Increased P2 (pulmonic closure) indicates what? |
|
Definition
|
|
Term
| Decreased P2 indicates what 3 things? |
|
Definition
1)severe PS
2)TOF
3)TA=tricuspid atresia |
|
|
Term
| S3 can be normal in children. But if it's loud, what might it be? |
|
Definition
|
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Term
|
Definition
| no-it indicates poor compliance |
|
|
Term
| an ejection click heard at the base may indicate what 4 things? |
|
Definition
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|
Term
| Pt has a midsystolic click heart @ apex; what is it associated with? |
|
Definition
| MVP-rare except in Marfan's |
|
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Term
| 5yo child has a grade II systolic murmur w/a musical sound, localized to LLSB, and it increases when child is supine. When the child runs, the murmur is louder. What is the murmur? |
|
Definition
| Still's murmur: common bw 2-7yo |
|
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Term
| Child has a grade 2 blowing, high pitched murmur @ Left sternal border that increases when child is supine. What is the differential diagnosis? How can you differentiate? |
|
Definition
ASD and pulmonic flow murmur
diff by EKG |
|
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Term
| Child has a continuous murmur below the clavicle that is loudest when the child is sitting and disappears when the child is supine. The murmur gets louder when the child moves their head away from the murmur. What is it? |
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Definition
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Term
| Premature infant has a short systolic ejection murmur that radiates to the axilla. At 4mo, the murmur is gone. What is the murmur and what causes it? |
|
Definition
-peripheral pulmonic stenosis
-hypoplastic branched arteries and angle of takeoff cause this murmur. as child grows, the angle decreases and the murmur disappears |
|
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Term
| If mom is an alcoholic, what is the child at risk for? |
|
Definition
1)VSD
2)ASD
3)TOF
4)coarctation |
|
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Term
| Child is born w/Ebstein's anomaly or tricuspid atresia. What is the most likely teratogen? |
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Definition
|
|
Term
| Fetal hydrantoin is most likely to cause what? |
|
Definition
1)VSD
2)ASD
3)PDA
4)TOF
5)coarctation |
|
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Term
| Child is born with conotruncal abnormalities. What is most likely to cause? |
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Definition
|
|
Term
| What is the most common trisomy with multiple malformations? |
|
Definition
|
|
Term
| 40% of downs syndrome patients have what heart problems? |
|
Definition
| VSD or complete AV canal defect |
|
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Term
| Trisomy 18 (Edward's syndrome) px are most likely to have what CHD? |
|
Definition
| VSD-polyvalvular nodular dysplasia |
|
|
Term
| Patau's syndrome (13) px are most likely to have what CHD? |
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Definition
|
|
Term
| Marfan's px have a defect in what chromosome that codes for what protein? |
|
Definition
| chr 15 coding for fibrillin |
|
|
Term
| What is the major cardiac finding in Marfan's px? |
|
Definition
|
|
Term
| Can a 15yo Marfan's px try out for the football team? |
|
Definition
|
|
Term
| Replace f the aortic dissection is greater than what? |
|
Definition
|
|
Term
| What's the mortality rate for a pregnant Marfan's px? |
|
Definition
|
|
Term
| A Noonan's px is most likely to have what? |
|
Definition
| valvular pulmonary stenosis |
|
|
Term
| 80% of digeorge's patients (22q11 deletion) have what type of defect? |
|
Definition
conotruncal
-Truncus arteriosus
-TOF
-interrupted aortic arch
-VSD |
|
|
Term
| A short stature 20yo female hasn't gone through puberty yet. She has coarctation of the aorta and a bicuspid aortic valve. What is her syndrome? What causes it? |
|
Definition
Turner syndrome:
-she is missing one pair of chromosomes
-45X0 |
|
|
Term
| A 2mo has an EKG w/RAD and inverted T waves in V1 and V3. What is the diagnosis? |
|
Definition
|
|
Term
| If ERAD in infant's EKG, what is it? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Px has complete heart block and HR of 42. What is the tx? |
|
Definition
|
|
Term
| A child w/congenital heart block is most likely to be born to a mother that has what type of disease? |
|
Definition
| maternal collagen vascular disease |
|
|
Term
| A child w/congenital heart block is most likely to be born to a mother that has what type of disease? |
|
Definition
| maternal collagen vascular disease |
|
|
Term
| A child w/congenital heart block is most likely to be born to a mother that has what type of disease? |
|
Definition
| maternal collagen vascular disease |
|
|
Term
| An infant has surgery to repair a VSD. After the surgery, the child has a surgical heart block that has been present for more than 2 weeks. What is the tx? |
|
Definition
permanent pacemaker
-if sx last 10 days to 2weeks, it is a temporary pacemaker |
|
|
Term
| Though tachycardia isn't a primary cardiac problem, what are 2 major cardiac causes you must rule out? |
|
Definition
1)myocardial disease (myocarditis)
2)CHF |
|
|
Term
1)During what phase of respiration does HR increase?
2)What nerve mediates this variation? |
|
Definition
|
|
Term
| An otherwise normal newborn has a PAC. Should you be worried? |
|
Definition
| No, they are normal (20% of kids have them) |
|
|
Term
| Do you worry if you see a PAC + PVC? |
|
Definition
| yes, there's a blockage (aberrancy) |
|
|
Term
| How do you treat SVT d/t WPW? |
|
Definition
propranolol: to slow AV conduction
-can also use digoxin |
|
|
Term
| 2 patients come in w/SVT. One is 3mo, the other is 6yo. Which is more likely to have a recurrence? |
|
Definition
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|
Term
| Infant presents w/HR of 275 (260-280). Px also is tachypneic, coughing, not eatin well, and irritable. You diagnose him w/SVT. When do you need to worry about the development of CHF? |
|
Definition
|
|
Term
| Px has palpitations, clammy skin, sx while resting, HR 250-270, episodes that last 10-15 minutes, lightheadedness (no syncope) and no CHF. What is the diagnosis? |
|
Definition
|
|
Term
| 8 yo has SVT. What is the emergency tx? |
|
Definition
1)vagal maneuvers
--diving reflex, valsalva
2)adenosine: but will not terminate primary atrial tachycardia |
|
|
Term
| How is SVT tx different in children and infants? |
|
Definition
Infants: NO IV VERAPAMIL (CV SHOCK)
-Use IV adenosine in both! |
|
|
Term
| If infant is unresponsive to adenosine or ice, what do you do? |
|
Definition
| synchronized direct current cardioversion |
|
|
Term
| What drug do you use for immature fetal SVT? |
|
Definition
digoxin: need toxic doses to cross the placenta
hydropic fetus will NOT respond to maternal therapy |
|
|
Term
| 15yo soccer player has LVH, nonspecific ST-T wave changes, Q wave changes, and has a HR of 52. Should you forbid them to play? |
|
Definition
| no: all are false positive findings in athletes |
|
|
Term
| What are 3 things you must rule out in PVC patient? |
|
Definition
1)HCM
2)long QT syndrome
3)RV dysplasia |
|
|
Term
| Child has an idiopathic seizure. What do you do? |
|
Definition
|
|
Term
| During workup, px has exercise induced PVCs. What is the prognosis? |
|
Definition
| poor-benign PVCs are suppressed by exercise |
|
|
Term
| What are the 3 ions involved in long QT syndrome? |
|
Definition
|
|
Term
| What is the difference bw Jervell, Lange-Nielsen, and Romano-Ward forms of Congenital long QTc syndrome? |
|
Definition
Jervell and Lange-Nielsen:
---rare, autosomal recessive
Romano-Ward
----autosomal dominant |
|
|
Term
| Px faints during exercise or w/loud noises or stress. Px has a family member that died suddenly @ 30yo. What is the likely cause? |
|
Definition
|
|
Term
| How do you treat long QT syndrome? |
|
Definition
AVOID DRUGS THAT PROLONG QT INTERVAL
no competitive sports
beta blockers
implantable defibrillator |
|
|
Term
Does the foramen ovale always close?
A patent FO is risk for what? |
|
Definition
no, it is open in 25-30% of kids
-emboli |
|
|
Term
| Px has dilated RA and RV. On EKG, she shows RAD, prolonged PR interval, RSR @ V1. She has a soft systolic flow murmur and a widely split S2. What type of ASD does she have? |
|
Definition
|
|
Term
| What are the 2 syndromes: Ellis van Crevald and Holt Oram Syndrome? |
|
Definition
1)EVC: autosomal recessive prob, shows ASD and upper extremity anomalies: not sure if EVC shows both
2)HOS: autosomal dominant: ASD and UE anomalies |
|
|
Term
| What major problem can secundum ASDs cause to lungs? |
|
Definition
| irriversible pulmonary HT |
|
|
Term
| What is the concern w/surgical closure of ASD? |
|
Definition
post pericardiotomy syndrome
-elevated ST segment
-px looks sick
to tx: give anti-inflammatories |
|
|
Term
| 1wk old px has CHF sx, EKG shows first degree AV block and superior axis. chest xray shows cardiomegaly and increased pulm vasc markings. What defect is this? What is causing it? |
|
Definition
atrioventricular septal defect: complete defect
1)large primum ASD: common in down's
2)large VSD
3)common atrioventricular valve |
|
|
Term
| What is the most common form of CHD? |
|
Definition
VSD
most common VSD: perimembranous
needs surgery ASAP |
|
|
Term
| 4yo px has a small, restrictive VSD. Px is asymptomatic and no endocarditis or aortic insufficiency. Should you perform surgery? |
|
Definition
| no, the risk of surgery will outweigh the benefit |
|
|
Term
| 2mo has sx of LV failure. EKG shows LVH, prominent q waves, tall R, and peaked T @ V5,6 (RVH). She has cardiomegaly and increased pulm vasc markings @ CXR. What is her condition and how is it diagnosed? |
|
Definition
moderate or large VSD
diag by ECHO |
|
|
Term
| What are the physical findings of a large PDA? |
|
Definition
1)Continuous murmur @ LUSB that doesn't change based on position
2)LA/LV enlargement
3)CHF |
|
|
Term
| What group of infants need surgery for PDA? |
|
Definition
| premature and symptomatic neonates |
|
|
Term
| What other defect has similar findings to PDA? |
|
Definition
| aortopulmonary window: complete division bw aorta and pulm artery: hear a continuous murmur |
|
|
Term
| What are the 2 MC obstructive lesions? |
|
Definition
|
|
Term
| Px has a SEM @ LSB (pulmonic area) that radiates to axilla. Px has Noonan's syndrome but is otherwise asymptomatic. What type of obstructive lesion do they most likely have? |
|
Definition
|
|
Term
| Neonate has CHF and shock sy. What type of lesion do they most likely have? |
|
Definition
|
|
Term
| Px has fatigue and chest pain. Finding show SEM and systolic ejection click. EKG shows LVH and LV. What is the likely diagnosis? |
|
Definition
|
|
Term
| Px w/turner's syndrome has diminished femoral pulses and upper extremity HT. She has a SEM @ the base and axilla that radiates to the L interscapular region. What is her condition? |
|
Definition
|
|
Term
| What is the difference bw EKG in an infant and older child w/coarctation? CXR? |
|
Definition
EKG:
-infant: RVH
-child: LVH
CXR:
-3rd sign
-rib notching |
|
|
Term
| What are the sx of critical coarctation in an infant? |
|
Definition
|
|
Term
| What are the tx options for coarctation? |
|
Definition
-surgery:
---end to end anastomosis
---subclavian flap
-catheter:
---balloon angioplasty
---stent placement |
|
|
Term
| What is blue or dusky discoloration of the skin and mucus membranes d/t inadequate oxygen? |
|
Definition
|
|
Term
| px presents w/cyanosis around their mucus membranes and lips. What type is it? |
|
Definition
| central: correlates better w/hypoxemia |
|
|
Term
| What are classic examples of R to L shunting? |
|
Definition
1)TOF
2)Transposition of Great Arteries
3)Hypoplastic L heart syndrome
4)TAPVR |
|
|
Term
| Px presents w/cyanosis, no resp distress, and normal pulses. Px has a single S2, marked hypoxemia, and decreased pulm blood clow. What are the possible lesions? |
|
Definition
1)TOF
2)Pulm atresia
3)critical pulm stenosis
4)tricuspid atresia w/o VSD |
|
|
Term
| What is the most common cause of cyanotic CHD? |
|
Definition
|
|
Term
| What are the anatomic findings of TOF? |
|
Definition
Pulmonic stenosis
RVH
Overriding aorta
VSD
(like PROVE) |
|
|
Term
| What is the classic CXR sign of TOF? |
|
Definition
|
|
Term
| Px has profound cyanosis hour after birth, normal pulses, marked hypoedema, acidosis, large heart, and egg on a string appearance of pedicle. What type of lesion? |
|
Definition
| Transposition of Great Arteries |
|
|
Term
| What do you do to tx TGA? |
|
Definition
| create ASD: balloon atrial septotomy |
|
|
Term
| What is the other inadequate mixing lesion besides TGA? |
|
Definition
|
|
Term
| Px has gray skin, tachypnea, decreased/absent pulses, and a gallop rhythm. They have a single S2, RV heave, hepatomegaly, metabolic acidosis, and cardiomegaly. What type of lesion do they have? |
|
Definition
decreased systemic flow d/t L heart obstruction:
1)hypoplastic left heart syndrome
2)critical coarctation of aorta
3)interrupted aortic arch |
|
|
Term
| What can happen w/closure of PDA in hypoplastic left heart syndrome? |
|
Definition
| cardiogenic shock: don't give oxygen or inotropes (dopamine, dig) |
|
|
Term
| What are the 3 types of TAPVR? |
|
Definition
supracardiac: vertical vein to SVC
infracardiac: vertical vein to hepatic veins....super sick
cardiac: usually to coronary sinus |
|
|
Term
| Severely cyanotic neonate shows massive cardiomegaly. They also have WPW. What is the most likely diagnosis? |
|
Definition
| Ebstein's Anomaly: dysplastic redundant tricuspid valve |
|
|
Term
| Baby comes in with apnea and fever. They had been given something to maintain ductal patency. What had they been given? |
|
Definition
|
|
Term
| What are the 3 types of infectious Acquired Heart Disease? |
|
Definition
myocarditis
endocarditis
pericarditis |
|
|
Term
| What are the 3 types of inflammatory AHD? |
|
Definition
rheumatic fever
post-pericardiotomy syndrome (ASD surgery)
collagen vascular syndrome |
|
|
Term
| What are the 2 traumatic causes of AHD? |
|
Definition
|
|
Term
| 3yo asian boy presents w/hx of fever for 7 days, rash @ diaper area, red and painful oral membranes, cervical lymphadenopathy, non-purulent conjunctivitis. Acute phase reactants, ESR and platelets are elevated, what is the dx? |
|
Definition
|
|
Term
| How do you treat Kawasaki's? |
|
Definition
|
|
