Arrythmias
Most common pediatric tachy dysrhythmia.
What is Paroxysmal Supraventricular Tachycardia?
Dx of a child who has acute episodes of severe dyspnea and hypoxemia either spontaneously or after prolonged crying with a CXR showing a "boot shaped heart"
What is Tetralogy of Fallot? The "episodes" are also called "TET Spells" 10% of cases of Congenital Heart disease
Likely class of congenital heart disease in an infant with SpO2 of the right arm 99% and of the left leg of 89%?
What is acyanotic heart disease? Other hints: absent lower extremity pulses, decreased lower extremity BP, heart murmur, S3 gallop and enlarged heart on CXR. SpO2 of <92% in the leg with >7% increase in the arm found in 85% of infants with left heart obstructive dz and in 79% of infants with other forms of congenital heart dz's.
Treatment & reason we treat for Kawasaki Disease.
What is ASA & IVIG to prevent coronary artery aneurysm and death? 25-30% of KD patients will develop coronary artery aneurysm without therapy, with an overall mortality rate of 1-3% 5-8% will do so with IVIG & ASA ,with an overall mortality rate estimated at 0.08%
Percentage (within +/-5 points) of cases of pediatric CHF that occur in the first year of life.
What is 90%? (accept 85-95) Sx in infants of CHF: irritability, tachypnea, tachycardia, diaphoresis, poor feeding (failure to thrive) & in severe cases mottling & cyanosis older children CP, palpitations, syncope, fatigue & dyspnea.
Treatment for an asymptomatic hemodynamically stable patient with SVT where Vagal maneuvers have not worked? (Complete order)
What is Adenosine 0.1 mg/kg (max 6 mg) rapid IV push followed by saline flush? (EKG prior and during conversion)
Dx of a child with the most common congenital cyanotic heart lesion in newborns with a CXR showing a "egg on a string".
What is Transposition of Great Arteries? X ray: cardiomegaly or narrowed mediastinum EKG: Right Axis Deviation & Right Ventricular Hypertrophy
Treatment for 10 day old presents with pallor, poor perfusion, and diminished pulses in all 4 extremities. SpO2 87% on RA and does not improve with 100% O2.
What is the initiation of prostaglandin E1? (to maintain a patent ductus arteriosus)
At least 3 characteristics of pediatric heart murmurs that signal innocent causes.
What are murmurs during systole, rarely obscuring normal heart sounds, with a vibratory or musical quality, that are short in duration and vary with changes in pt position, hydration status, and respirations?
Most common cause of CHF in a Pt with flat facial profile w/ epicanthal folds, upward slant to eyes, short neck, low set ears, and single, deep transverse crease on palms of hand.
What is atrioventricular canal and ventricular septal defect.
Treatment for an unstable patient with SVT? (Complete order)
What is immediate synchronized cardioversion 0.5-1.0 J/kg? (may not work in presence of hypoxia or acid-base disturbance)
Dx of a child with cyanotic heart disease with a CXR showing a "snowman sign"
What is Total Anomalous Pulmonary Venous Return without pulmonary venous obstruction?
How to preform the test used to determine the etiology of a child's cyanosis (respiratory vs cardiac).
What is a hyperoxia test conducted by applying 100% O2 and using ABG (can use O2 sat increase >10% suggests pulmonary process)? pO2 >220 mm Hg suggests lung dz 100-220 mm Hg requires eval for CHD 100 mm Hg suggests cyonotic congenital heart dz 40-50 mm Hg likely Transposition of Great Arteries with poor mixing
Commonly used classed of medications used in CHF for adults but contraindicated in kids (especially <1 y/o) because of risk of extreme bradycardia and hypotension
What are Calcium Channel Blockers?
2 Drugs used for kids with CHF who require inotropic support.
What is dobutamine or milrinone?
Three categories of Atrial tachycardia.
What are Atria flutter, fib and ectopic tachycardia?
Dx of a child with cyanotic heart disease with a CXR showing a small heart heart with pulmonary edema.
What is Total Anomalous Pulmonary Venous Return with pulmonary venous obstruction?
4 adverse effects associated with Prostaglandin E1 infusions.
What are hypotension, apnea, fever, and seizure? Consider intubation before initiation of Prostaglandin drip and have inotropic support available. Use RA (21% O2) so as to not accelerate ductal closure.
Dx of 4y/o with a grade 2 systolic ejection murmur best heard at the LLSB and cardia apex that disappears with Valsalva.
What is Stills or vibratory murmur? The most common benign pediatric murmur resulting from vibration from the left heart.
Most common cause of CHF in older children. (either the main category or two of the primary causes.)
What is cardiac muscle dysfunction? (2/2 hypoxia, hypoglycemia, hypocalcemia, myocarditis or sepsis)
Number 1 cause of SVT in infants?
What is idiopathic SVT 50%? (WPW 10-20%; the rest associated with post op cardiac surgery or congenital heart defects)
Dx of a child with cyanotic heart disease with a single S2, a CXR showing a normal to large heart with decreased pulmonary vascular markings & EKG showing decreased right ventricular forces, QRS negative with right atrial enlargement.
What is Tricuspid Atresia? In addition to having no Tricuspid valve there is underdevelopment of the RV & pulmonary valve so for survival ASD, VSD and PDA are crucial.
The four defects in Tetralogy of Fallot.
What are ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy,y overriding aorta
Along with a fever of at least 5 days in duration and no other explanation for the illness these are four of the five physical exam findings needed to diagnose Kawasaki Disease.
What are Bilateral, non purulent conjunctival injection Inflammatory changes of lips & oral mucosa Erythema or swelling of hands or feet Non-vesicular rash, primarily truncal Cervical lymphadenopathy (usually unilateral)
Most common cause of CHF in first 6 weeks of life? (either major category or 2 primary causes)
What is the decompensation of a congenital heart lesion with ductal closure? (Hypo-plastic Left Heart Syndrome, aortic stenosis, total anomalous pulmonary venous return & pulmonary stenosis) or coarctation syndrome.