FNP II Final Study 100% WORKING

Pedi CAD (From Burns) ● Know that a child should be referred for elevated B/P if under the age of 10. Chest pain in children: ○ Abnormal coronaries due to Kawasaki dz/other coronary artery disease ○ Cocaine abuse ○ ...

Pedi CAD (From Burns) ● Know that a child should be referred for elevated B/P if under the age of 10. Chest pain in children: ○ Abnormal coronaries due to Kawasaki dz/other coronary artery disease ○ Cocaine abuse ○ Pericarditis and myocarditis ○ Post pericardiotomy syndrome (recent heart sx) ● First goal of chest pain (CP) is to rule out cardiac causes. ● Causes of CP in children: ○ Arrhythmia ○ Aortic stenosis ○ Pulmonary stenosis ○ Hypertrophic cardiomyopathy ○ Mitral valve prolapse ○ Eisenmenger syndrome (congenital heart disease) ● Most frequent cause of chest pain is musculoskeletal originating in the chest wall. ● Chest wall pain with exercise indicates bronchospasm. ● Chest pain with syncope, exertional dyspnea, or irregularities in heart rhythm require cardiac eval. ● PE: complete chest, lung, heart, and abd. Exam. Listen for murmur’s, rubs, clicks. ● ECG for irregular heart rhythms. ● Point tenderness to costochondral joints made worse with physical activity or deep inspirations is suggestive of costochondritis, palpate each costochondral junction for tenderness. ● Note rales, wheezing, tachypnea, and decreased breath sounds can suggest pulmonary dz. ● Studies: CXR, pulmonary function test, 24-hour Holter monitor (24 hour or 30-day event monitor), stress test, ECG for suspected problems. ● Refer to Pedi cardiology with chest pain that worsens with exercise, angina or positive findings on examination. Long QT Syndrome ● Linked to 13 different genes. Genetic prolongation of the QT segment increases susceptibility to further drug-induced long QT-interval (antiarrhythmics like amiodarone/sotalol, psychotic drugs (haloperidol/ziprasidone), antibiotics (cipro, clarithromycin, erythromycin). ● Delayed repolarization (the long-QT interval). 2 ● May be asymptomatic until experiences syncope or sudden death from torsade de pointe V. tach. Some will have positive family history for syncope, sudden death, known QT syndrome, note that congenital deafness is a characteristic of one type of long-QT syndrome. Palpitations: (from up to date) ● Palpitations describe a noticeable heartbeat that may be concerning to the patient (eg, too fast, irregular, or too strong). Palpitations in children typically arise from physiologic stimuli, such as fever, exercise, anxiety, or anemia, rather than life-threatening causes (eg, cardiac arrhythmia). In addition, children with serious arrhythmias may report no palpitations. Children with a serious underlying cause for their palpitations often have a history of syncope, congenital heart disease, or cardiac surgery ● Causes of palpitations in children ○ Life threatening cardiac conditions ○ Arrhythmia (eg, Wolff-Parkinson-White syndrome, prolonged QT syndrome, cardiac structural abnormalities [congenital heart disease, intracardiac tumors]) ○ Hypertrophic cardiomyopathy (HCM) ○ Myocarditis ○ Sick sinus syndrome ○ Pacemaker malfunction ○ Life threatening non-cardiac conditions ○ Hypoglycemia ○ Toxic exposure ○ Pheochromocytoma ○ Common conditions ○ Premature atrial contractions ○ Premature ventricular contractions ○ Fever ○ Anemia ○ Exercise ○ Emotional arousal ○ Anxiety, panic attack ○ Hyperventilation syndrome ○ Drug-induced (caffeine, herbal medications, dietary supplements, albuterol, isotretinoin) ○ Postural orthostatic tachycardia syndrome (POTS) ○ Other conditions 3 ○ Acute rheumatic fever with valvular disease ○ Hyperthyroidism ○ Mitral valve prolapse