[5] Heart Disease in Children

Question 1

What causes Murmurs?

Answer 1

Turbulence of blood flow from high pressure chamber to low pressure chamber

Question 2

Are there such a thing as innocent murmurs in children?

Answer 2

Yes, present in 40-60% of children and may not go away with age

Question 3

What causes the innocent murmurs in neonates?

Answer 3

1. Closing Ductus Arteriosus
2. Pulmonic Flow
3. Tricuspid Regurgitation

Question 4

Why is the main Pulmonary Artery large?

Answer 4

It used to be connected to the ductus arteriosus

Question 5

Describe: Vibratory Still’s Murmur

Answer 5

2-7 Years Old

Grade 1-2/6 Vibratory, Twanging, Honky, Groaning Systolic Murmur

Question 6

Where can you hear Vibratory Still’s Murmur the Loudest?

Answer 6

Loudest 3rd ICS, between LLSB and Apex

Question 7

When in doubt, what kind of a murmur is it?

Answer 7

Systolic

Question 8

Differentiate Stenosis vs. Atresia

Answer 8

Stenosis: Obstructed but with forward flow

Atresia: No forward flow at all; structure may not have “opened up” at all

Question 9

If your cyanosis lasts 6 months what do you get?

Answer 9

Clubbing

Question 10

What are the values for a Hyperoxia Test if you have Cyanotic Heart Disease?

What if it’s not a cardiac cause?

Answer 10

CHD: < 150 mmHg

Non-Cardiac: > 150 mmHg

Question 11

Mechanisms of Cardiac Cyanossi

Answer 11

1. Decreased pulmonary blood flow
2. Right to left blood flow through a shunt lesion
3. Cardiac chamber / Structure discordance
4. Low Cardiac Output

Question 12

Is chest pain in young children a problem?

Answer 12

No, it is usually benign

Question 13

Top Causes of Chest Pain in Children

Answer 13

Idiopathic (21%)
Musculoskeletal (16%)
Cough (10%)
Costochondritis (9%)
Cardiac (4%)

Question 14

Earliest sign of Congestive Heart Failure

Answer 14

Tachycardia