A12 - Pediatric Cardiology 2025

22 days

Primitive heart tube is formed during which embryological age?

25 days

Septation of the ventricles happens during what embryological age?

30 days

Septation of the atria happens during what embryological age?

3 months

AV valve and semilunar valve formation is completed at what embryological age?

Increase in SVR

Closure of the ductus venosus

Important cardiac events following cord clamping

Functional closure of PFO

After the first breath, increase in LA pressure results in?

PDA

Increased arterial O2 saturation in the newborn period results in closure of?

10-15 hours after birth

Functional closure of PDA happens when?

2-3 weeks of age

Anatomic closure of PDA happens when?

Grade 4

Murmur grade associated with Thrill

Systolic regurgitant murmur

Murmur that results from flow of blood from a chamber that is at a higher pressure throughout systole than the receiving chamber and usually occur while the semilunar valves are still closed. Associated with only VSD, MR, & TR

AS, PS

Associated disease with ejection murmur

TR, VSD

Associated condition with pansystolic murmur at the tricuspid area

TS, ASD

Associated condition with mid-to-late diastolic murmur at the tricuspid area

MR

Associated condition with pansystolic murmur at the apex

MS

Associated condition with mid-to-late diastolic murmur at the apex

Eisenmenger syndrome

Untreated VSD resulting in RVH and pulmonary hypertension → bidirectional shunting and cyanosis

RBBB

Cause of widely split S2 in ASD

PDA

Child with continuous "machinery-like" murmur at the 2nd left infraclavicular area, bounding pulses, wide pulse pressure, and left-sided enlargement. Impression?

VSD

Child with systolic regurgitant murmur at LLSB, loud and single S2, and L-sided enlargement. Impression?

ASD

Child with Systolic ejection murmur at 2nd LICS, widely split S2, and R-sided enlargement.

Marfan syndrome

Connective tissue disease associated with mitral valve prolapse and progressive enlargement of the aorta

Hunter syndrome (MPS II)

Genetic disorder wherein GAGs build up in body tissues, resulting in thickening of cardiac valves and improper valve closure

TOF

Cyanosis manifesting after the first year of life, usually in an infant or a toddler. (+) Systolic ejection murmur. Impression?

TGA

Cyanosis manifesting within few hours at birth or within few days of life. Impression?

• Tricuspid atresia

• Tetralogy of Fallot

• Single ventricle with PS

Cyanotic heart diseases with decreased pulmonary blood flow

• Boot-shaped heart

• Decreased pulmonary vascular markings

Chest x-ray finding in TOF

POSH

• Position (Knee-chest)

• Oxygen

• Sedation with Ketamine (increased SVR also)

• Hydration (IV boluses)

Other meds:

• NaHCO3- (1 mEq/kg) slow IV

• Morphine sulfate

• Phenylephrine

• Propranolol (may stabilize vascular reactivity of the systemic arteries)

Management of hypoxic spell

Blalock-Taussig Shunt (BTS)

Palliative systemic-to-pulmonary artery shunt performed to augment pulmonary artery blood flow in Tetralogy of Fallot

Modified BTS

Gore-Tex conduit anastomosed side to side from the subclavian artery to the homolateral branch of the pulmonary artery

Tricuspid atresia

Glenn shunt, Fontan procedure

Child with systolic regurgitant murmur at LLSB. On echo, hypoplastic RV and on ECG, LAD and LVH. Impression and surgical management?

TOF

BTS

Child with systolic ejection

murmur at 2nd LUSB; loud &

single S2, and boot-shaped heart on x-ray. Impression and surgical management?

• Transposition of the great vessels

• Total anomalous pulmonary venous return

• Truncus arteriosus

Cyanotic heart diseases with increased pulmonary blood flow

TGA

Most common cause of cyanotic CHD in the newborn and characterized by single & loud S2. On x-ray, with egg-shaped cardiac silhouette. Impression?

• Rashkind

• Senning

• Mustard

• Jatene

Surgical management of TGA?

Truncus arteriosis

Patient with single S2 and systolic ejection murmur at LSB. There is minimal cyanosis in neonates, but older children present with heart failure. Impression?

Rastelli procedure

Surgical treatment of Truncus arteriosus?

TAPVR

Patients with systolic murmur at LSB in mild cases and notable snowman sign on chest x-ray.

Coarctation of aorta

Turner syndrome

Child with weak femoral pulses and are delayed bilaterally. Noted with systolic murmur at 3rd-4th LICS with radiation to (L) infrascapular area. The disease described and associated syndrome?

Rib notching

Chest x-ray findings in older children with coarctation of aorta?

Primary re-anastomosis

or a patch aortoplasty

Surgical management for coarctation or aorta

Pulmonic stenosis

Child with systolic ejection

murmur at LUSB with

radiation to the upper

back. Impression?

MVP

Child with complaints of

exercise intolerance, easy fatigability. On PE, noted late systolic murmur with an opening click. Impression?

Norwood

Surgical procedure for hypoplastic L heart syndrome

Ebstein anomaly

Associated congenital heart defect in an infant born to a mother exposure to Lithium

Complete heart block

Associated congenital heart condition in an infant born to a mother with lupus

PDA

Most common CHD in a patient with congenital rubella?

• F – Fever

• R – Risk Factor (Previous RH or RHD)

• A – Arthralgia

• P – Prolonged PR interval on ECG

• E – Elevated acute phase reactants: ESR / CRP / leukocytosis

Minor criteria in RF?

Subclinical carditis

In RF, this refers to when classic auscultatory findings of valvar dysfunction either are not present or are not recognized by the clinician but 2Decho reveals mitral or aortic valvulitis.

Erythema marginatum

Nonpruritic serpiginous or annular erythematous evanescent rashes most prominent on the trunk and inner proximal portions of the extremities in RF.

CRP >3.0 mg/dL

• ESR >60 mm/hr (low risk popn)

• ESR >30 mm/hr (mod and high risk popn)

Elevated acute phase reactants in RF?

ASO titer

Well-standardized test to prove evidence of antecedent Group A strep infection

• > 2 major manifestations, or;

• > 1 major + 2 minor manifestations

• With evidence of previous streptococcal infection

Diagnosis of initial RF requires how many criteria fulfilled?

Past Hx of RF PLUS:

1. 2 major, or;

2. 1 major plus 2 minor, or;

3. 3 minor manifestations

Diagnosis of recurrent RF requires how many criteria fulfilled?

Oral Penicillin or Erythromycin x 10 days

OR

Benzathine Penicillin IM SD

To eradicate GAS in RF, what is the treatment regimen?

ASA 100 mkDay 4-6 doses x 3-5 days then 75 mkDay q6 hrs x 4 weeks

OR

Prednisone 2 mkDay q6 hrs x 2-3 wks & taper

To control inflammation in RF, what is the treatment regimen?

Pen VK 250 mg BID PO

OR

Benzathine PCN 0.6-1.2 MU IM q21 days

Recommended secondary prophylaxis for RF

5 years or until 21 years of

age, whichever is longer

How long do you give prophylaxis for patients with RF WITHOUT carditis?

10 years or until 21 years of

age, whichever is longer

How long do you give prophylaxis for patients with RF WITH carditis but NO valvular heart disease?

10 years or until 40 years of

age, whichever is longer

How long do you give prophylaxis for patients with RF WITH carditis and WITH valvular heart disease?

• Staphylococcus aureus

• viridans Streptococcus,

• Enterococcus

Most common organisms causing IE?

2 MAJOR criteria, or

1 MAJOR criterion and 3 MINOR criteria, or

5 MINOR criteria

Clinical criteria requirement for IE

Possible IE

A patient fulfilling 1 major criterion and 1 minor criterion, or 3 minor criteria of IE is tagged as?

-2 separate sites 12 hours apart

-3 or more 1 hour apart

Blood culture to be counted as 1 major criterion in IE must be taken?

Osler nodes

Tender, pea-sized intradermal nodules in the pads of fingers & toes that falls under immunologic criterion in IE?

Janeway lesions

Painless small erythematous hemorrhagic lesions on the palms and soles in IE?

CONSIDER for dental procedures requiring manipulation of the gingiva or periapical region, or perforation of oral mucosa

High-risk procedure for which IE prophylaxis is needed

Viridans Streptococci

IE in patients with underlying heart disease and underwent dental procedure. Organism involved?

Group D Streptococcus

IE in patients with GUT or lower bowel manipulation. Organism involved?

Staphylococcus/Pseudomonas

IE in patients with Hx of IV drug abuse. Organism involved?

CONS

IE in patients with CVP, prosthetic valves. Organism involved?

4-6 weeks

Recommended antibiotic duration of treatment for IE?

Vancomycin

DOC for IE patients without a prosthetic valve but with high risk for Staphylococcus aureus, viridans Streptococcus, enterococcus.

Aq Pen G

OR

Ceftriaxone (+/- Gentamicin)

DOC for native valve endocarditis due to viridans Streptococcus and Streptococcus bovis

Oxacillin

DOC for Endocarditis due to Staph without prosthetic materials