pedscard.txt

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adamarine
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103206
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pedscard.txt
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2011-09-20 22:41:54
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cardio
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  1. Persistence of fetal pathways definition
    ductus artreriosus or forman ovale remain patent meaning blood is being shunted & not going where it needs to go
  2. life saving
    • patent ductus pulm atresia=narrow almost closed off
    • coarctation
    • patent foramen=transposistion
  3. Life stressing/threatening
    • pat duct=premature infant <28wks
    • pat duct & foramen=pulm hpt
  4. meds for persistence of fetal path
    • prostaglandin E=lesion open
    • indomethacin closes=<28wks life
  5. CHD Incidence
    • 8/1000 live births
    • >1% NB in US
    • 50-60% dx=1st mo
  6. CHD Etiology
    • unknown=80%
    • single gene defect=3%
    • chromosomal abn=13%
    • Environmental/maternal=2-4%
  7. Identifiable single gene defect
    • septal defects
    • coarctation
    • TOF
  8. chromosal abn
    • septal def
    • coarctation
    • TOF
  9. Environmental/maternal
    • moms=lupus, rubella, DM=inc risk child w/chd
    • drugs=lithium, etoh, warfarin, anticon
  10. CHD Defects
    • smaller hole=louder murmur
    • diastolic murmurs=never normal child
  11. opening btwn 2 atria=shunting
    ASD
  12. often asymptomatic or mild ftt/exs intolerance=present as CHF
    ASD
  13. r/ventricular lift, S2 widely split, systolic ejection murmur in left mid-upper sternal border, short rumbling mid-diastolic murmur, child may suck & pant when eating do to exs intolerance
    ASD
  14. opening between the 2 ventricles, results in shunting. Presentation varies according to size & severity of left to right shunting.
    VSD
  15. Loud harsh blowing holosystolic murmur LLSB,thrill & in the neonate the murmur greatest at apex
    VSD
  16. Clinical presentation in large VSD
    • dyspnea
    • diaphoresis
    • feeding diff
    • poor growth
    • duskiness
    • card fail
  17. Apical thrust w/systolic thrill that inc S2, blowing systolic murmur or low pitched diastolic rumble
    Large VSD findings
  18. most common cardiac malformation=25% of CHD
    large VSD
  19. when blood leaves the LV either through aorta or VSD, the direction is dependant upon resistance
    shunting
  20. In the first days of life, pulmonary vascular resistance is high and there is little flow across the VSD
    no murmur
  21. At 3 days of life, PVR falls & shunting begins
    murmur
  22. persists in extrauterine life. Often asymptomatic but with large shunting � cardiac failure or growth retardation are possible
    PAD
  23. continuous machinery systolic murmur 2nd left intercostal space and or radiate left sterna border or left clavicle
    PAD
  24. deformed valve cusps which do not fully open which results in right ventricular outflow obstruction
    PVS
  25. Most often asymptomatic but in severe cases right ventricular failure � hepatomegaly, peripheral edema, exercise intolerance
    PVS
  26. In neonate cyanosis is possible if shunting occurs though the foramen ovale. If heart failure occurs it is typically during the 1st month of life
    PVS
  27. Ejection click after S1, split S2, systolic ejection murmur pulmonic region radiating to the lungs
    PVS
  28. single or multiple constrictions along the branches of the pulmonary arteries. Often associated with other malformations
    Peripheral PS
  29. Presentation varies with severity and other defects. In neonatal period, there is a mild transient form
    peripheral PS
  30. Increase in right ventricular pressure and in the pulmonary artery proximal to the obstruction, systolic ejection murmur
    peripheral PS
  31. leaflet thickening and commissures are fused to variable degrees which results in left ventricular outflow obstruction and hypertrophy
    AS
  32. Presentation varies with severity. In severe cases � cardiomegaly, failure, pulmonary edema, decreased pulses and pallor
    AS
  33. ejection click at apex & LSB, split s2, systolic ejection murmur RUSB radiating neck & LMSB;soft D mur=present maybe
    AS
  34. constriction of the aorta, typically at the ductus arteriosus
    coarctation Aorta
  35. Most are symptomatic, may complain of weakness/pain in legs after exercise. Can go onto cardiac failure but rare. Often diagnosed when found to be hypertension on routine PE
    Coarct of aorta
  36. pulse disparity (pulses unequal), short systolic murmur and left sternal 3rd-4th intercostals space
    Coarct of aorta
  37. right ventricular outflow obstruction (pulmonary stenosis/atresia), VSD (right to left shunting), overriding aorta (or rather hypoplasia of pulmonary trunk) and right ventricular hypertrophy
    TOF
  38. most common type of cyanotic HD & 10-15% CHD
    TOF
  39. Presentation varies depending on degree of obstruction. Acyanotic � CHF. Cyanosis is typically present by 4 months and progressive
    TOF
  40. It is a major concern in neonates if dependent on a patent ductus arteriosus
    TOF
  41. Other � growth retardation, fatigue, exertion, dyspnea, clubbing. Hypoxemic or cyanotic spells can occur, especially under 2 years
    TOF
  42. 50% will have a systolic thrill at the left sternal border, single S2, loud harsh systolic murmur left sternal border and may radiate,CXR:boot shaped heart
    TOF
  43. the aorta arises from the right ventricle and the pulmonary artery from the left ventricle
    transposition of great arteries
  44. common cyanotic heart lesion that is often associated w/other cardiac defect
    trans great art
  45. presents as cyanosis, resp distress that depends on associated lesions; growth retardation & card fail
    trans great art
  46. single, loud S2, a soft systolic murmur left middle sternal border may be heard
    trans great art however tetrology more common so suspect this 1st
  47. In the neonate, the defect can be fatal. If suspected, begin prostaglandin E
    trans great art
  48. presentation varies w/severity, cyanosi, tachypnea, systolic murmur LSB, gallob rhythm=S3 or S4
    total anomalous pulm ven return
  49. a group of anomalies � underdeveloped left side of heart (aortic atresia, mitral stenosis) and hypoplasia of the ascending aorta
    hypoplastic LHsyndrome
  50. dependent on PDA & may be associated w/other anomalies=kidney/CNS
    HLHS
  51. cyanosis, cardiomegaly, CHF, dyspnea, hepatomegaly, low cardiac output, weak or absent pulses, systolic murmur, fata in most cases
    HLHS
  52. surgical intervention has a variable prognosis=normwood operation
    HLHS
  53. only one great vessel arises from heart and supplies both the systemic, pulmonary and coronary arteries, VSD present & relative rare cyanotic lesion
    truncus arteriosus
  54. presentation of CHD
    • Cyanosis
    • CHF
    • abnormal heart sounds
  55. distinguish between general (all) or circumoral cyanosis (around mouth) and acryocyanosis (hands and feet)
    cyanosis
  56. lasts >3hrs in newborn, warning sign-pulmonary etiology is absent, think cardiac & half will need surgery
    cyanosis
  57. CHD cyanosis DDx for dec pulm blood flow
    • TOF
    • PS
    • P.atresia
    • T.atresia
  58. cHD cyanosis DDx for inc pulm blood flow
    • transposition
    • hypoplastic LH
    • single ventrile
    • truncus arteriosus
    • total ana pvr
  59. presents with tachypnea, tachycardia, dyspnea with feeds, poor weight gain, hepatosplenomegaly
    CHF
  60. CHF DDx
    • ASD
    • VSD
    • PDA
    • coarctation
    • AS
    • hypoplastic heart
    • myocarditis
  61. abnormal heart sounds
    Dia murm=never normal
  62. Evaluation suspected congenital HD
    • Hx & PE=prenatal-high parity w/high spont abortions & fhx
    • 4extr BP=pulse disparity=coarctation
    • look at normal BP
    • pulse ox
    • hy=peroxic test
    • EKG=normal, axis dev or hypertrophy
    • chest x-ray
  63. giving O2 & watching symptoms=not helping probably not resp issue rather a card issue
    hyperoxic test
  64. Found in more than 30% of children and increases in the presence of fever, infection, and anxiety (due to increased demand on the heart)
    Innocent heart murm
  65. short systolic murmur at left mid-lower sternal border that changes with respiration or position. Usually does not radiate. Typically seen in 3-7 year olds
    Vibratory or �Musical� � aka �Still�s murmur;�
  66. higher pitched, blowing, early systolic murmur at 2nd left parasystolic space. Easier to hear when patient is supine
    innocent pulmonic murm
  67. soft humming sound during systole and diastole in neck and upper anterior chest (turbulence in the jugular venous system). Can vary by changing position or light compression of jugular vein
    venous hum
  68. It is a very unusual manifestation of cardiac disease w/inc in teens having MI's, HPT, hypercholesterolemia, obesity, cocaine
    chest pain
  69. what is important with chest pain
    hist & Pe=key
  70. Chest pain DDx
    • Musculoskeletal � trauma, exercise, costochondritis (inflammation of the costal cartilage along sternal border)
    • Pulmonary � asthma/rad, pneumonia, chronic cough, foreign body
    • Idiopathic � anxiety, panic disorder
    • GI � espohagitis, esophageal spasm, foreign body, reflux
    • Cardiac � pericarditis, mitral valve prolapse, arrhythmias, MI
  71. Preventative Cardiology
    • CAD=childhood perhaps
    • FHx & Shx=critical
    • Routine BP=3yo CHS
    • hypercholesterolemia & hyperlipidemia screen
    • Diet=fat restrictions not b4 1yo
    • Statins if lifestyle changes not enough >8yo w/high ldl
  72. hypercholesterolemia & hyperlipidemia screen in children & teens with
    • parent/GP=CAD b4 55yo
    • P=elevated cholesterol >240
    • fhx not available
    • RF's=smoking, obesity, dec phys act, high fat diet, fasting glucose >100, DM, HPT

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