Cardiac Flashcards
What is the importance of prostaglandins?
keeps the ductus arteriosus open
What is the importance of ductus arteriosus?
connects the blood from the pulmonary artery and aorta to mix to provide O2 to the trunk and lower extremities of the body
When does prostaglandins start to drop?
FUNCTIONAL closure of the ductus arteriosus
When does the functional closure of the ductus arteriousus occur?
12-15hrs after birth
What happens during the functional closure of the ductus arteriousus?
- smooth muscle constricts
- drop of prostaglandins
When does the anatomic closure of the ductus arteriousus occur?
2-3 wks
How does the foramen ovale close after birth?
the pressure in the lungs increase causing a shunt from L to R; there is an increased pressure on the L atrium
What to check for in newborns - cardiac?
CAPIG Color Auscultation Pulse/palpitation Inspection General appearance
What is more concerning regarding cyanosis?
central is more alarming than peripheral cyanosis
What is acrocyanosis?
peripheral cyanosis
benign
What murmur will have a thrill?
4+/6
loud HARSH murmur
How do you take peripheral pulses?
take 2 from different areas
ie) femoral + femoral OR femoral + brachial
check the two pulses and if they is a delay –> suspect cardiac stenosis
How do you check for perfusion and what is normal?
press firmly for 5 sec
normal: <2 sec
How do you grade murmurs?
1-3: NO thrill
4: 3 PLUS thrill
5-6: no need stethoscope
Which is more concerning: systolic or diastolic murmur?
DIASTOLIC
What to check for BP?
1) RECHECK ANY ABNORMAL BP
2) always compare upper and lower BP
3) keep in mind of baby’s: ht, wt, and age
What can cx false low O2 readings?
severe anemia carbon monoxide hypotension hypothermia nail polish
What is normal pulse grade?
2+
1+: diminished
3+: hyperactive
What is the hyperoxia test?
1) give pt O2
if there is improvement –> respiratory defect
if there is NO improvement –> cardiac defect
*USED TO DIFFERENTIATE IF PROB IS FROM THE LUNGS OR THE CARDIAC
What should you check for re: CXR?
LVSSR (l-o-v-rs) Location Vasculature (lungs) Shape Size Ribs
CT ratio: neonates vs infant/child?
neonates: <45%
What does rib notching suggest?
masses
What is S1 and S2?
S1: mitral and tricuspid
S2: aorta and pulmonary
What do you hear in ASD?
FIXED SPLIT: valve is not working
What can you hear upon inspiration?
splitting
BUT FIXED SPLITTING = ASD
What is a murmur?
the turbulence that is heard from the chambers and valve
abnormal in adults but normal in kids
At what age are murmurs concerning (abnormal)?
usually all benign murmurs heard in newborns and infants
after 8yo- NOT normal
Whats the steps when you hear a murmur?
1) murmur heard
2) refer
3) cardio does an echo
What is a functional murmur?
when the murmur that is heard is BENIGN and normal and NOT pathologic
What are the common benign murmurs?
Peripheral pulmonary stenosis
Stills
Venous humm
At what age can you typical hear the peripheral pulmonary stenosis murmur?
newborn to 2yo
At what age can you hear the Stills murmur?
2-8yo
At what age can you hear the venous hum murmur?
3-6yo
Which murmur sounds like a musical/vibration?
Stills
b/c the chordae tendinae are vibrating
Which benign murmur is heard the loudest in SUPINE?
Stills
Which benign murmur is heard the loudest in SITTING position?
Venous Hum murmur
b/c gravity is pulling the blood down from the brain –> internal jugular –> subclavian vein = MORE TURBULENCE
What is the Venous Hum murmur?
the turbulence of the internal jugular vein AND subclavian vein that goes into the superior
What is concerning murmur?
over 8yo murmur does NOT change w/ position (supine/siting, etc) grade is 4 (b/c there is a thrill involved) murmur is heard with: -growth failure -click -cyanosis -has other congenital anomalies
What are the categories of congenital heart dz?
cyanotic: right -> left, parallel, and mixed
acyanotic: left -> right, obstructive
What are the right to left congential heart dz?
tetralogy of fallot
tricuspid
What is parallel congenital heart dz?
transposition of great vessels
total anomalous pulmonary return
What is mixed congenital heart dz?
Truncus arteriousus
What is tertalogy of fallot?
POVER Pulmonary stenosis Override aorta VSD RVH
Tetralogy of Fallot - sx?
pink- mild stenosis and able to send blood back
blue- severe stenosis and blood is shunted to systemic
Tetralogy Fallot - labs?
CXR: boot shpaed/egg on side
What is tet spell?
peripheral cyanosis
crying on the side in fetal position
Tetralogy Fallot - tx?
morphine to calm down
Phenlephrine to increase systemic vascular resistance and pulmonary circulation
What is transposition of the great vessel?
COMPLETELY TWO DIFFERENT CIRCUITS
R atria and ventricle pumps to the systemic
L atria and ventricle pumps to the lungs
NEVER crosses
What is tricuspid atresia?
missing the tricuspid valve so there is no connection between the right atria and ventricle
it is important to keep the foreman ovale and the ductus arteriosus open because it is the only way that the blood is able to flow between the right and left chambers of the heart (give them PROSTAGLANDINS!)
What is total anamlous pulmonary return?
all the blood from the pulmonary veins drain into the systemic veins or right atrium and does NOT into the venous circulation
What is truncus arteriosus?
the aorta and the pulmonary artery are ONE
Which cyanotic congenital heart dz has VSD?
Truncus arteriosus
Tricuspid Atresia
Tetralogy of Fallot
What are the cyanotic congenital heart dz?
Truncus Transitional Tricuspid Tetra Total Anamous Hypoplastic
What is hypoplastic left heart syndrome?
cyanotic
mitral valve is closed and the left ventricle is small
relies on the ductus arteriosus –> if closed –> bad news bear
What are the acyanotic congenital heart dz?
L to right
obstructive
What are the left to right congenital heart dz?
ASD
VSD
PDA
What is ASD?
atrial septal defect
right atria has blood from the left atria
What is VSD?
acyanotic
right ventricle has mixing of the blood from the left ventricle
What is PDA?
acyanotic
patent ductus arteriosus
aorta blood is mixing in with the pulmonary artery
What are the obstructive congenital heart dz?
coarctation of aorta
aortic stenosis
pulmonary stenosis
What is coarctation of the heart?
obstructive
acyanotic
there is a obstruction/squeeze of the aorta AFTER brachio, left common, and left subclavian –> upper extremities are perfused BUT lower extremities are NOT
Coarctation of the aorta - sx?
UE pulses stronger than LE
RIGHT radial/brachial is STRONG
Aortic stenosis and pulmonary stenosis?
narrowing of the aorta and pulmonary artery
acyanotic
obstructive
When do you need to administer prophylaxis bacterial endocartitis?
prosthetic valve
hx of infective endocarditis
congenital heart dz
What is the most common cause for HTN in kids?
renal dz (secondary HTN)
HTN in kids - sx?
HA
nosebleeds
What is the normal BP %?
below 90%
What is preHTN %?
90-95%
What is HTN %?
greater than 95%
When do you start checking for BP in kids?
3 yo
What if kid is OVERWT but under BP 95%?
HTN
What if kid is skinny with BP 95%?
HTN
If kid is 95% what labs would you order?
you're trying to find the cause of the HTN: 1) compare the BP UE and LE 2) UA 3) CBC 4) BMP (BUN, Cr) 5) Lipid 6) Renal ANYTHING TO CLUE IN OR R/O RENAL FAILURE
HTN - tx?
LIFESTYLE MODIFICATIONS
but if cause of HTN is secondary - start drugs (ACE, etc)
What are the causes of sudden cardiac death in children?
MAAHT Myocarditis Arrhthmias Aberrant coronary artery Hypertrophic cardiomyopathy Trauma to chest
What is hypertrophic cardiomyopathy?
most common cause of sudden cardiac death in children
autosomal dominant
murmur is LOUD sitting > supine
Hypertrophic cardiomyopathy - sx?
on exertion:
chest pain
palpitation
sycnope
What are the arrhythmias that cause sudden cardiac death?
long QT
WPW
What strucutral or fxnal heart dz can cause sudden cardiac death?
myocarditis
marfan
aortic stenosis
ARDS
What can cx long QT?
abx - quinolones
What should be asked when doing a PRE sports physical to prevent sudden cardiac death?
family hx of early death
deafness
chest pain w/ syncope
med hx of ADHD
What is commotio cordis?
when kid is hit in the chest during a sport
What is Marfan sx?
genetic dz
Marfan - sx?
long fingers - arachnodactyly ectopia lentis - lens are subluxed early scoliosis AA dral extasia pneumothorax
Marfan sx - PE?
steinberg sign
walker sign
