18- poor feeding

Question 1

organic causes of failure to thrive

Answer 1

Congenital heart defects
Cystic fibrosis
Gastroesophageal reflux
Neurologic disorders
Metabolic disease

Question 2

definition of FTT

Answer 2

an infant is < 5th percentile for weight
an infant is < 5th percentile in weight for length, or
the rate of growth results in the infant crossing more than 2 major lines on the standard infant growth curve.

Question 3

presentation of CHF in infant

Answer 3

dyspnea with feedings
diaphoresis
poor growth
an active precordium
hepatomegaly

Question 4

regular newborn resp rate

Answer 4

40-60

Question 5

are diastolic murmurs always pathologic?

Answer 5

yes

Question 6

differential for hepatomegaly in infant

Answer 6

Congestive heart failure
Congenital infections
Inborn errors of metabolism
Anemias, and (less commonly)
Tumors.

Question 7

most common murmur in child and in what ages

Answer 7

innocent murmur

3-7 yo

Question 8

questions to ask to make sure the murmur is innocent

Answer 8

Is the child otherwise well?
Is the precordial activity normal?
Is the second heart sound normally split?
Is the murmur less than or equal to grade II/VI?
Is the oxygen saturation normal?

Question 9

which murmurs are heard better as kids rather than infants?

Answer 9

ASD and bicuspid aortic valve

Question 10

bicuspid aortic valve presentation

Answer 10

early systolic click made by the abnormal valve when it opens (occurring shortly after the first heart sound, signifying the end of isovolumic contraction when the aortic valve opens to allow left ventricular outflow)

Question 11

heart defects that can cause CHF

Answer 11

VSD
Severe aortic stenosis
Coarctation of the aorta
Large patent ductus arteriosus

Question 12

what tests should you do to assess murmur in infant?

Answer 12

EKG
Echo
chest x ray

Question 13

EKG findings in small, moderate, and large VSD

Answer 13

small- EKG normal

mod- LVH (LV overload)

large- RVH (RV overload- pulm HTN)

Question 14

EKG in normal infant compared to normal adult

Answer 14

more right ventricular voltage, and have a more rightward axis

reason: lungs not contributing as much to ventilation –> PVR elevates–> RVH–> rightward axis

Question 15

when do congenital heart disease infants need to be admitted?

Answer 15

sepsis
cyanosis
CHF

Question 16

how does VSD cause CHF?

Answer 16

The infant with a VSD is supplying enough blood to the tissues to meet the body’s metabolic needs, but is doing so from an elevated filling pressure (due to the left ventricular volume overload). The adequate cardiac output is achieved by creating a high adrenergic state and by activating the renin-angiotensin system. Many of the symptoms of CHF in the infant are caused by these neurohormonal changes.

Question 17

why isn’t VSD heard in the nursery?

Answer 17

elevated Pulm vascular resistance in newborn

Question 18

drugs to treat CHF

Answer 18

furosemide- rid fluids

digoxin

enalapril- ACEI decrease SVR

Question 19

what to do if VSD doesn’t decrease by 6 months?

Answer 19

camrdiopulm bypass surgery to avoid eisenmengers syndrome (late cyanosis from pulm HTN)- live until 20s

Question 20

does ASD cause CHF?

Answer 20

no

Question 21

Still’s murmur

Answer 21

most common innocent murmur

vibratory, musical, low pitched

heard at lower left sternal border