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82 Cards in this Set
- Front
- Back
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A 4 week old has difficulty feeding, weight loss, FTT, tachypnea and tachycardia. What is your diagnosis and treatment?
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CHF. If the CHF is due to left to right shunting, then diurese.
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Which 2 of the following medications is contraindicated in kids?
A) Beta-blockers B) Hydralazine C) Furosemide D) Lisinopril E) Verapamil |
B and E
Hydralazine can lead to sinus tachycardia and worsen CHF Verapamil is contraindicated in kids less than 1yo |
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A 4 day old infant has tachycardia, lethargy, poor feeding and has a non-specific galop, nasal flaring and sweating.
How do you make a diagnosis? What is your diagnosis and treatment. |
Check four limb BP, if higher in the upper extremities than lower extremities this is coarctation of the aorta. Treatment is to maintain PDA with PGE therefore increasing blood flow to the descending aorta.
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Name 4 cyanotic congenital heart diseases.
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TAPVR
Tetrology of Fallot Transposition of the great vessels Tricuspid atresia |
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Which of the following is not an indicator of cognitive prognosis of a child with a congenital heart disorder.
A) Age at time of sugery B) Neurological baseline before surgery C) Post operative seizures D) Co-morbidity E) Duration of intraoperative circulatory arrest |
A. Greater than 75 min of intraoperative arrest makes for poor prognosis.
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How do you identify cyanotic heart disease in a child with a pulse ox of 88% who does not appear cyanotic?
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Look at the HCT. If the child has a high HCT, this indicates excess fetal hemoglobin which is seen in cyanotic heart diseases.
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A child who lives in the countryside on a farm is brought in to ED with tachycardia without tachypnea, hypotension and acidosis. He appears cyanotic but pulse ox is 96% on RA. What is his most likely diagnosis and treatment?
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This is methemoglobinemia. See that there is cyanosis and tachycardia with no respiratory distress and that HCT will be high.
Treatment is to remove the trigger (well water) and/or give methylene blue. |
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True or False.
You can rule out PDA with an oxygen challenge. |
False.PDA can have high pulse ox despite low PO2
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An otherwise healthy 6 month old is brought in because he has had periodic episodes of blue fingers and toes. He has no other problems. What is his most likely diagnosis and treatment?
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This is likely episodic acrocyanosis. Do nothing.
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An infant has increased RV activity, cyanosis, hypoxia & hypercarbia from pulmonary edema. She has a single S2 and a short systolic murmur. On CXR you find a normal sized heart and pulmonary congestion. What is the most likely diagnosis and treatment?
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TAPVR-- Give PGE to to keep ductus patent until surgery as patient is depending on R to L shunting.
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What are normal oxygen sats on the right and left sides of the heart as measured by cardiac cath?
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Right is close to 70 and Left is close to 100.
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A 2 day old had Apgars 7 and 9 at birth and now has become cyanotic and tachycardic and tachypnic. The CXR has no increase in lung markings. What can you say is an underlying problem with this baby?
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She has a ductal dependent heart lesion.
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What is the normal physiology of the ductus arteriosus?
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In the developing fetus, the ductus arteriosus (DA) is a shunt connecting the pulmonary artery to the aortic arch that allows most of the blood from the right ventricle to bypass the fetus' fluid-filled lungs.
When the newborn takes a breath the pulmonary resistance begins to fall and the ductus closes so that blood may enter the pulmonary circulatory system to be oxygenated. |
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What happens in PDA with otherwise normal kids?
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Blood continues to be shunted away from the pulmonary system and there is no way to oxygenate the system.
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How do you keep the PDA open in ductal dependent defects?
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PGE or Nitric oxide
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Which of these is not a component of TOF?
1. Pulmonary stenosis 2. Overriding aorta 3. PDA 4. VSD 5. RVH |
3.
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What is the most common cyanotic lesion in newborns?
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Transposition of the great arteries.
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What is the most common cyanotic lesion overall?
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TOF
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A 5 month old has a palpable right ventricular impulse, a single S2, RVH.
What do you expect on echo? |
This is TOF. You would see:
Pulmonary stenosis Overriding Aorta VSD RVH |
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True or False.
TOF is often asymptomatic at birth |
True
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True or False.
After surgical repair of TOF, infants should not have any further cardiac complications. |
False. Arrhythmias are common.
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A child with cardiac disease has brief hypercyanotic hypoxic episodes. What are these and what are they a cause of?
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These are Tet spells due to increased R to L shunting, triggered by anemia.
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How do you relieve a tet spell?
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Squat
Morphine Phenylephrine IV propranolol Volume expansion Anything to increase peripheral vascular resistance. |
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A 3 day old infant has severe congestive heart failure with a loud S2 and precordial activity and marked cardiomegaly on CXR. What is the diagnosis?
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hypoplastic left heart.
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True or False.
There is no murmur with hypoplastic left heart. |
True.
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A 10 day old has tachypnea and thready pulses along with an enlarged liver. You accompany the infant to the ED and get an ABG which reveals metabolic acidosis and an EKG consistent with aortic stenosis. Which of the following medications should you use first?
A) dobutamine B) epinephrine C) Nitric oxide D) PGE E) IV fluids. |
D. Keep PDA
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A 4 day old is tachypnic, cyanotic and has a single S2 along with increased pulmonary vascularity on CXR and an egg shaped hear. What is the diagnosis?
A) TOF B) TAPVR C) Truncus Arteriosus D) Transposition of the Great Arteries E) Tricuspid atresia |
Transposition of the great arteries. This is because there is a single S2 AND increased pulmonary vascularity.
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What is the initial treatment for Transposition of the Great Arteries?
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PGE to keep PDA
OR balloon septostomy to maintain patent ASD. |
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A child has been having weight loss, night sweats, fatigue and has a dusky color and facial swelling. Her pulse ox is normal. What is the likely diagnosis?
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SVC syndrome
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True or False.
CHF can present as cough, fatigue, exercise intolerance and poor appetite. |
True
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How do you monitor digoxin in kids?
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Check the PR interval. It should be about 200ms.
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What is persistent fetal circulation?
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It is when the pulmonary vascular resistance continues to exceed the systemic resistance and you get right to left shunting of blood. It is common in interstitial pulmonary diseases.
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A 6 hour old infant develops respiratory distress with pulse ox lower in lower extremities than in upper extremities. On exam you note a precordial lift. What is your diagnosis?
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Persistent fetal circulation. ECHO will show RVH. There is desaturated blood flowing down the descending aorta.
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A 2 month old presents with 2 week history of lethargy and low grade fever, splenomegaly, petechiae, tender lesions on the pads of fingers and toes and a systolic ejection click with a diastolic murmur on the right side. What is the best test to confirm your diagnosis.
A) Blood Culture B) CXR C) TTE D) TEE E) Cardiac cath B) |
A.
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True or False.
JRA is associated with valvular heart disease and rheumatic fever is associated with carditis. |
False it is flipped. JRA is associated with carditis and rheumatic fever is associated with valve disease.
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What are osler nodes and janeway lesions?
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Osler nodes are tender nodules on the pads of fingers and toes.
Janeway lesions are red nodules on the palms or soles. |
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What is the most common cause of acute bacterial endocarditis?
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S. aureus.
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What is the most common cause of subacute bacterial endocarditis?
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S. viridans
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What is the most common cause of myocarditis?
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Coxsackie virus
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A 6 month old has been healthy other than a recent URI. He now presents with tachycardia, hepatomegaly and a S3 gallop. There is no other murmur and lungs are clear. What is the likely diagnosis? How do you confirm the diagnosis?
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Viral Myocarditis. Usually coxsackie but not always. Viral serology and viral cultures will confirm the diagnosis.
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What is pulsus paradoxus?
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Drop in systolic pressure from exhalation to inspiration greater than 10.
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True or False.
Myocarditis may present with pulsus paradoxus. |
True
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True or False.
Steroids are the mainstay of treatment for viral myocarditis. |
False. This is controversial.
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What is pericarditis? What is the most likely etiology?
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Inflammation of the pericardial sac due to viral infection or collagen vascular disease.
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What are the two most common causes of pericarditis in kids?
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Viral and collagen vascular disease.
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What is pericardial effusion?
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Pericarditis plus fluid in the sac.
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Muffled heart sounds
Friction Rub Low grade fever JVD Left sided chest pain worse on lying down and better when sitting. History of recent URI What is your diagnosis? |
Pericardial effusion.
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True or False.
Pericardial effusion may present with pulsus paradoxus. |
True
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What do you screen for and then confirm pericardial effusion? What is the single most important test to order when suspecting pericardial effusion or pericarditis?
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CXR will show enlarged heart. Confirm with ECHO. Treat with cardiac window and consult cards STAT.
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10 days post op after corrective open heart surgery a 6 year old is noted to have anorexia, fatigue, nausea and vomiting. The patient appears pale with barely palpable peripheral pulses especially when he takes a deep breath. He has thready peripheral pulses but a strong heart rate. What is the best next step?
A) Surgical intervention B) NSAIDS C) Cardioversion D) Steroids E) Pericardiocentesis/Pericardial window. |
E.
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What do these three have in common?
Vibratory Venous hum Carotid (Vascular) bruit |
All are innocent murmurs
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What do the following have in common when coupled with a murmur?
Exercise intolerance Feeding difficulties Dyspnea Cyanosis Syncope Wheezing |
They are mean murmur is not innocent. These are all accomplices.
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An infant has tachypnea and some associated physical finding. What is your next question in history?
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Is there family history of cardiac disease. This is likely a syndrome.
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Pansystolic murmur at LLSB. What kind of murmur is this?
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VSD
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Hyperdynamic precordium with loud S2. What is this?
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VSD
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What cardiac anomaly is associated with maternal prenatal lithium?
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Epstein anomaly.
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What cardiac anomaly is associated with alcohol?
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VSD/ASD
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True or False.
Carotid bruits are innocent in kids. |
True
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Bounding carotid pulse with decreased peripheral pulses is consistent with what?
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Carotid bruit.
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Harsh Pansystolic or continuous crescendo murmur. What is this?
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PDA
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A 4yo has an S3 upon lying down but it disappears upon sitting. What do you conclude?
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This is innocent.
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What are the expected ECG findings for aortic stenosis?
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LVH
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What are the expected ECG findings in Coarctation of the aorta in the newborn?
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RVH because in the fetus the RV is the dominant ventricle.
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What is the expected finding on ECG in TOF?
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RVH with Right axis deviation.
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What are the ECG findings for AV Canal defects?
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Superior QRS axis + Left axis deviation.
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True or False.
Hypertrophic cardiomyopathy does result in LVH and left axis deviation |
False. HOCM is associated with LVH but not LAD.
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What two cardiac defects have left axis deviation?
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Tricuspid atresia and AV canal defects
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When are PACs in kids concerning?
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When they are in kids on digoxin and when they are in kids < 1yo because then PAC can progress to a-flutter.
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Saw tooth wave on ECG
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A-flutter
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What are the ECG findings of WPW?
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Shortened PR interval and/or a delta wave that looks like a dip before the QRS.
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What is the most frequent ECG finding in someone with family history of sudden death?
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Prolonged QT
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A patient has recurrent episodes of syncope while standing for prolonged periods of time. There is no family history of sudden death in the family or premature ACS. What is the most likely diagnosis?
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Neurocardiogenic or vasovagal syncope.
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A very athletic teenage boy has been playing varsity basketball and is in great condition. In the past 6 weeks, however, he has passed out twice during practice despite adequate hydration. UDS is negative. Family history is non-contributory. What is your next step in management? What further history do you want?
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Obtain a cardiology consult. The child may not play sports until cleared by a cardiologist. Uncover the true family history.
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What is the most common rapid rhythm in kids?
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SVT
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What is your first step for a stable child with SVT (HR > 220)?
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12 lead ECG
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How do you treat a patient with labile BP, palpitations and diaphoresis with SVT?
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First try vaso-vagal maneuvers like ice bag. If that does not work, try adenosine. If that does not work cardiovert.
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How do you treat a patient with SVT who is in cardiac failure?
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Try adenosine. If no success, cardiovert.
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True or False.
Digoxin is sometimes used as longterm management of kids with SVT. |
True
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When is Digoxin contraindicated?
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In WPW
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What is the 3 major risks of AV Block with widened QRS?
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Seizure
Syncope Viral Myocarditis |
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A patient presents with anxiety and sinus tachycardia. Which of the following is LEAST likely?
A) SVT B) Pheochromocytoma C) hyperthyroidism D) dehydration E) infection |
A.
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When would you be concerned of cardiac chest pain in a kid?
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If pain is dull, pressure like substernal pain with radiation to neck and left arm AND there is relative with cardiac disease < 50yo who is on lipid lowering meds.
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