Pediatric Board Review String of Cardiology Pearls

1) Bacterial Endocarditis - 

Watch for mention of a central venous catheter. 

Strep ( associated with cardiac valves ) and Staph( no structural abnormalities)  are the typical Pathogens but on the Boards it can be caused by Gram negatives including : 

    Remember: Endocarditis Can be Kaused by the gram negative A list 

  Eikenella corrodens,

Cardiobacterium hominis, 

Kingella species, 

Aggregatibacter (parainfluenzae/ actinomycetemcomitans)

2) Prolonged QT syndrome 

    In addition to the more obvious history, including unexplained syncope or family history of unexplained sudden        death you could be presented with a history of unexplained near drowning or frequent heart palpitations 

    If you are presented with any of these signs the next step would be obtaining an EKG 

    It is associated with a torsades de pointes pattern on EKG and can be congenital or acquired without a family      history of sudden death 

  Azithromycin is contraindicated in patients diagnosed with prolonged QT syndrome 

3) Cardiac manifestations of thyroid disorders 

     Sinus tachycardia is associated with hyperthyroidism

     Methimazole is the first line treatment for Graves' disease

     Beta-blockers should be prescribed when hyperthyroidism diagnosed

 4) Murmuring Murmurs

       The nice thing about murmurs on the boards is you don't have to actually hear and recognize the murmur.               You only have to recognize the description and identify the wording. 

      Aortic Stenosis  loud systolic murmur at the right upper sternal border with an associated click 

      ASD heard during ejection at the upper left upper sternal border with a fixed split 2 

      VSD turbulent flow during the entire systole at the left lower sternal border ( easy to remember since the           atrium is above the ventricle and heard at the upper sternal border and ventricle at the lower sternal border) 

5) Acrocyanosis in the newborn. Cyanosis in the hands and feet of a newborn will most likely be a normal finding that requires no intervention

Stuart C. Silversteinm, MD, FAAP

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