USMLE World Cardiology

What is the most likely cause for a 15mo to have loss of consciousness whenever the child gets frustrated or upset?
breath holding spells
– can lead to LOC w/ spontaneous resolution
– can be assoc w/ cyanosis, pallor
– simple vs. complicated (complicated = severe cyanotic or pallid type that is assoc w/ seizure activity)
– normal EEG
– work-up to r/o iron deficiency anemia

Intervention: reassure parents, no Tx unless anemic

How does myocarditis usually present in children?
fever, lethargy, signs of myocardial dysfxn after a viral prodrome–>respiratory distress from acute heart failure. May see holosystolic murmur secondary to dilated cardiomyopathy and resulting fxnal mitral regurg. Hepatomegaly 2/2 secondary congestion

CXR: cardiomegaly and pulmonary edema
Echo: global hypokinesis, LVH, LV dysfxn, pericardial effusion.
Bx: gold standard for dx

Intervention: admit to ICU b/c at risk for acute decompensation and fatal arrhythmias

viral infxn is most common form of myocarditis in children.

What is ventricular aneurysm?
complication that occurs DAYS to MONTHS after MI
Sx:
– CHF sx
– Ventricular arrhythmias
– mitral regurg
– thrombus formation

PE:
– pansystolic murmur at apex w/ radiation to axilla (MR)

EKG
– persistent ST elevations

ECHO:
– dyskinetic wall motion of portion of LV to confirm dx