Notes: For unstable patients, use synchronized cardioversion. For patients older than 12 months, you may try diltiazem or verapamil.
Question: Which medication should you use for SVT if the following fails?
Aortic Regurgitation
Category: generalpediatrics-Cardiology
Findings: apical early diastolic murmur, bounding pulses, associated with Marfan syndrome
Aortic Stenosis
Category: generalpediatrics-Cardiology
Findings: mid-systolic murmur at RUSB, thrill at suprasternal notch, left ventricular hypertrophy, diminished pulses, cardiomegaly, pulmonary edema
Notes: Treat with balloon dilation.
Question: Which disease is associated with these findings?
AV Canal Defect
Category: generalpediatrics-Cardiology
Findings: loud S1 and S2, holosystolic apical murmur, biventricular hypertrophy, increased pulmonary vasculature, commonly associated with Down Syndrome and DiGeorge
Notes: Combined VSD and ASD
Question: Which disease is associated with these findings?
Beta Blocker
Category: generalpediatrics-Cardiology
Findings: Torsades
Notes: Looks like polymorphic ventricular tachycardia on EKG. You may need a defibrillator, and may also treat with magnesium.
Question: What class of medication do you use to treat the following?
Beta Blockers Or Calcium Channel Blockers
Category: generalpediatrics-Cardiology
Findings: Wolff-Parkinson-White syndrome and atrial fibrillation or flutter
Notes: These are AV nodal blocking agents and make conduction through an accessory pathway more likely. Instead, use ibutilide or procainamide if vagal manuevers or adenosine do not work. If no medications work you may try synchronized cardioversion or later even defibrillation if the rhythm does not termiante.
Question: Which medications are CONTRAINDICATED in a patient with the following condition?
Hypercalcemia
Category: generalpediatrics-Cardiology
Findings: shortened QT, widened T wave, gastrointestinal upset
Notes: Hypercalcemia may be caused by overactive parathyroid gland, medications, cancer, granulomatosis diseases, immobilization, and familial hypocalciuric hypercalcemia.
Question: Which electrolyte abnormality is associated with these findings?
Hyperkalemia
Category: generalpediatrics-Cardiology
Findings: peaked T waves, flat P waves, shortened QT, ventricular tachycardia
Notes: Give calcium gluconate and treat with therapies that lower potassium such as insulin + glucose infusion, albuterol, and polystrene.
Question: Which disease is associated with these findings?
Hypertrophic Cardiomyopathy (HOCM)
Category: generalpediatrics-Cardiology
Findings: increases with standing or Valsalva, decreases with squatting, laterally-displaced PMI, diminished by hand grip, early systolic murmur
Question: Which disease is associated with these findings?
Hypocalcemia
Category: generalpediatrics-Cardiology
Findings: prolonged QT, muscle weakness, tetany
Hypokalemia
Category: generalpediatrics-Cardiology
Findings: prolonged QT, ST depression, flattened T waves, U waves
Findings: single S1, widely split S2, harsh LUSB murmur, peaked P waves in lead II, RVH
Notes: P2 is even more delayed from A2. Seen with Noonan and Alagille syndrome.
Question: Which disease is associated with these findings?
Stills Murmur
Category: generalpediatrics-Cardiology
Findings: musical or buzzing murmur, mid-systolic, nonradiating, diminishes with standing
Tricuspid Stenosis
Category: generalpediatrics-Cardiology
Findings: mid-diastolic murmur heard at LLSB, can be congenital or caused later on by rheumatic fever or other causes
Question: Which disease is associated with these findings?
Venous Hum
Category: generalpediatrics-Cardiology
Findings: continuous vibratory right subclavicular murmur, present when sitting, resolves when supine
Notes: Benign.
Ventricular Septal Defect (VSD)
Category: generalpediatrics-Cardiology
Findings: holosystolic murmur at LLSB, hyperdynamic precordium, or no murmur and single S2, increased pulmonary vascular on CXR, biventricular hypertrophy
Notes: Treat with diuretics, digoxin, ACE inhibitor. May need to gave concentrated formula to decrease volume. More commonly seen in trisomies such as 13, 18 and 21 as well as Cri-du-chat.