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UW Peds Cardiology: 7.30 q 1-12

Terms in this set (61)

Dx'ic Criteria for Kawasaki
Fever >/= 5 days + >/= 4 of:
i. conjunctivitis: bil, nonexudative
ii. mucositis: injected/fissured lips or pharynx, strawberry tongue
iii. cerv LNopathy: >/= 1 LN >1.5 cm diam
iv. rash: erythematous, polymorph, generalized; perineal erythema & DESQUAM; morbiliform (trunk & extrem's)
v. erythema & edema of hands/feet
Cmplxn Kawasaki
i. Cor A. Aneurysms
ii. MC infarxn & ischemia

(Trt w high dose ASA & IV-Ig w/i 10 days onset of feer to prev c'ac cmplxns)
(Perform baseline Echo & rpt 6-8 wks later)
Kawasaki Dis aka
mucocutaneous LN synd
Childhood risk w ASA
Reye's synd: hepatic encephalopathy
Scarlet Fever
-cmplxn of untrtd Strep pharyngitis
-tonsillar exudates
-'sandpaper' rash NOT palms or soles
-(zillion little bumps)
Rash on palms & soles, best trtd w Doxy for 5-7 days:
Rockt Mt Spotted Fever
-incl HA & GI sx
Which maneuvers inc intensity of HOCM & MVP? Why?
a) dec Preload:
i. Valsalva
ii. abrupt standing
iii. Nitroglycerin
Which maneuvers dec intensity of HOCM & MVP? Why?
a) inc Afterload:
i. sustained hand grip

b) inc afterld & inc preload:
i. squatting

c) inc preload
i. passive leg raise
carotid pulse w/ dual upstroke
HOCM
-due to midsystolic obstrxn dur cardiac contraxn
-HOCM w signif LVOT obstrxn: syst ejxn murmur along LSB w strong apical impulse
coarc of aorta & hypoplastic LH synd generally present with ___________ due to impaired systemic perfusion
shock

-pale or mottled
-signif murmur
midsystolic click w late systolic murmur
MVP
Williams synd assoc w what cardiac abn's?
-supravalvular ao stenosis
-pulm stenosis
-septal defects
6 mo old w accentuated peripheral pulses
PDA

-also cont'ous murmur
3 mo old 'bluish-pale' dur bottle fdg
-tired, tachypnic few min after fdg
-O2 sat 80% on room air, crying, cyanosis esp lips & tongue
-single S2
-harsh cresc-decresc systolic murmur LUSB
Tetralogy of Fallot
What is the primary murmur: cresc-decresc systolic murmur over LUSB in TOF?
turbulence at stenotic Pulm A.
22 mo old easily fatigable; 10th %ile for wt; 2/4 holosystolic murmur over LLSB w diastolic rumble over cardiac apex
dx?
VSD
cmplxns of large VSD
FTT, easy fatigability, heart failure
2-hour old boy, worsening cyanosis
-single loud S2
-hood O2 doesn't help
dx?
Transpos of great vessels
XR: 'egg on a string'
-single S2
Transpos of great vessels
XR: boot-shaped heart (RVH)
-harsh pulmonic stenosis murmur LUSB
Tet of Fallot
Single S2
-VSD murmur
-minimal pulm BF
Tricuspid atresia
Single S2
-systolic ejxn murmur
-inc BF
-edema
-persistent truncus arteriosus
-severe cyanosis
-resp distress
-'snowman sign': enl supracardiac vv & SVC
-pulm edema
TAPVR w obstrxn
1st steps if suspect Transpos of GV
i. PGE1 and echo
4 major causes of sudden cardiac death
i. CAD
ii. c'myop (HCM)
iii. arrh (eg: long QT synd)
iv. congen heart defect
EKG changes in HCM
i. Cornell criteria (LVH)
a. aVL: tall R wave
b. V3: deep S wave
ii. Repol changes in anterolat leads:
a. inverted T-wave in: I, aVL, V4-V6
commotio cordis is:
fatal V-fib after sudden blunt chest wall trauma athletes w/o preexisting cardiac dis, us'ly baseball
aortic aneurysm in adolescent likely due to:
Marfan synd
(vs atheroscl in adults)
fatal complxns of HOCM:
i. fatal LV outflow tract obstrxn
ii. ventric arrh's
6 yo boy congenital DEAFNESS + FAINTING; 7 yo brother died of sudden drowning
dx?
trt?
i. Long QT synd
ii. BB & p'maker
normal QT interval
M: <440 ms
F: <460 ms
pts w congenital long QT synd are at high risk of:
i. syncope
ii. life-threatening ventric arr like Torsade de Pointes
iii. sudden death
Trt of long QT
i. avoid vigorous exercise
ii. avoid meds that cause long QT
iii. normalize: Ca, K, Mg,
iv. BB: Propranolol or class II antiarrh's
v. if sx'ic or hx of syncope: add long-t pacemaker too
inherited long QT synd (2):
i. Jervell-Lange-Nielsen synd: AR
ii. Romano-Ward synd: AD
Acquired long QT due to what electrolyte probs?
hypOcalcemia
hypOkalemia
hypOmagnesemia
What meds can cause long QT or Torsades??
i. Macrolide abx
ii. Fluoroquin abx
iii. Antipsychotics, TCA, SSRI
iv. Opioids (methadone, oxycodone)
v. Antiemetics (ondansetron, granisetron)
vi. Antiarrh's (Quinidine, procainamide, Flecainide, Amiodarone, Sotalol)
Class IA anti-arr'ic that blocks Na & K+ ch's
-CI due to axn on K+ ch's can prolong QT interval
Quinidine
Class III antiarrh'ic that can prol QT interval by blocking K+ ch
Sotalol
What meds can be used to trt HCM?
BB or CCB
1 wk old boy:
-central cyanosis
-maternal uncle died of hypopl LH synd after birth
-2/4 holosyst murmur LLSB
-DEC pulm vasc markings
-Lt axis dev
-tall peaked P waves
Tricuspid Valve Atresia
EKG findings in Tricuspid Atresia
I, aVF - Lt axis deviation
II - tall, peaked P waves
V1-V3 (precordial): minimal or short R waves
Left axis deviation and DEC pulm vasc markings
Tricuspid Atresia

-due to hypoplasia of RV & Pulm Outflow tract
-severe TR
-RA enl't
-tall P waves
-Rt axis deviation
-extreme cardiomegaly
Ebstein's anomaly (maternal Lithium dur preg)
-normal EKG
-CXR: cardiomegaly, inc pulm vasc markings fr/ heart failure & pulm overcirculation
-truncus arteriousus

-strong assoc w DiGeorge
tachyc, tachyp
-distant muffled heart sounds
-cardiomegaly
-pericardial effusion w/ progression to cardiac tamponade
Pericardial tamponade: 'Beck's triad'
i. distant heart sounds
ii. JVD (or infant scalp vv)
iii. hypOtension

+/- tachyc, tachyp, dysp
-pulsus paradoxus
-cardiomegaly
trt for PC effusion
Pericardiocentesis or pericardiectomy
CXR of CHF
-like a partial whiteout
-pulm vasc congestion & interstitial edema
LHF can cause
pulm edema
RHF can cause
-hepatomegaly
-periph edema
-JVD
Sx of bacterial endocarditis
-fever
-new murmur
-petechiae
-splinter hemorr
-Osler nodes
-Janeway lesions
-Roth spots
blunt costophrenic angles suggest
pleura effusions
What is the most common cause of pediatric MCitis?
-present w fever, lethargy, signs of HF after prodrome of 'runny nose, cx, etc'
Viruses

i.e. Viral Myocarditis

-monitor in ICU due to risk of acute decompensation & fatal arrh
2 yo M, fever, resp distress
-runny nose & nasal cx for 1 wk
-5 days fever
-inc'ly tired w mm aches & SOB
-no relief w albuterol
-O2 95% room air
-nasal flaring, subcostal retraxns, scattered wheezes at lung bases
-scattered mobile LN, palp in ant cervical chain
-3/4 holosystolic murmur at apex
-CXR: blurred heart margins
Viral myocarditis
etiology of pediatric viral MCitis
i. Coxsackie B vir
ii. Adenovir
dx'ic studies for viral MCitis
i. CXR: cardiomeg, pulm edema
ii. EKG: sinus tachy
iii. echo: dec EF, diffuse hypokinesis
**iv. Gold Std: EndoMC bx: infl'ory infiltrate of the MC w myocyte necrosis
Causes of MC'itis
-infxns
-toxins
-AI dis
-Viral: esp coxsackie b & adenovir

p'gen: dir viral inj & AI inflamm ld to myocyte necrosis w/ subseq impairm't of systolic & diastolic fxn
Viral MC'itis often confused w:
asthma or pneumonia

MCitis resp distress (tachyp, dysp, wheezing, cracckles) fr/ acute LHF & pulm edema
normal transverse cardiothoracic ratio of CXR of healthy infant <1 y/o
</= 60%

children > 1 y/o: </= 50%
Trt of viral MCitis
diuretics, inotropes
ICU: monitor for shock or arrh
MCitis caused by acute RF:
-strep pharyngitis 2-4 wks earlier
**arthritis as 1st manif
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