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N270.04: Pediatric Physical Assessment > Cardiac > Flashcards

Cardiac Flashcards

1
Q

upper chambers of heart

A

atria

low pressure receiving chambers

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2
Q

lower chambers of the heart

A

ventricles

high pressure pumping chambers

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3
Q

The ___ receives deoxygenated blood from the body

A

right atrium

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4
Q

The ___ pumps deoxygenated blood through the pulmonary artery to the lungs to become oxygenated

A

right ventricle

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5
Q

The ___ receives oxygenated blood from the lungs

A

left atrium

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6
Q

The ___ pumps oxygenated blood from the lungs out the aorta and into the body

A

left ventricle

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7
Q

Functional closure of the PDA occurs at

A

48-72 hours after birth

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8
Q

Complete closure of the PDA occurs at

A

2-3 weeks

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9
Q

Heart forms in the fetus by the ___ week after conception

A

third

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10
Q

By day ___ of conception the heart begins to beat

A

23

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11
Q

Heart formation in the fetus is complete by the ___ week after conception

A

8th

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12
Q

AV valves, location

A 
tricuspid valve (on the right)
mitral valve (on the left)
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13
Q

Semilunar valves, location

A

pulmonic valve (at the base of the pulmonary artery between the right ventricle and the pulmonary artery)

aortic valve (base of the aorta between the aorta and the left ventricle)

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14
Q

Infants with CHD may have tachypnea and tachycardia but typically do not present in ____ unless there is a significant increase in pulmonary blood flow or poor systemic output with acidosis

A

respiratory distress

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15
Q

___ are usually normal with CHD except for color if cyanotic

A

Apgar scores

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16
Q

Symptoms of ___ usually occur with feeding because of increased oxygen consumption and need for greater cardiac output

A

feeding

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17
Q

Blood pressure in infants should be taken where?

A

In all four extremities

At minimum in the right arm and in one leg to detect COA

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18
Q

In children, simultaneous palpation of which 2 pulses is important in assessing whether a coarctation is present?

A

Radial and femoral

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19
Q

What might pallor in an infant indicate?

A

Anemia

CHF

Shock

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20
Q

Children with cyanotic heart disease will appear blue/ruddy particularly around what area?

A

Perioral area

b/c of right-to-left shunting of blood at arterial level

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21
Q

___ occurs when arterial desaturation has been present for at least 6 months of longer

A

Clubbing

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22
Q

A pulse that’s absent or weaker in the lower extremities compared to the upper extremities is diagnostic of what condition?

A

COA

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23
Q

Normal liver size

A

1 to 2cm below the right costal margin

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24
Q

In conditions of abnormal cardiac position, where is the liver edge?

A

Midline or on the left side of the abdomen

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25
Q

Where is PMI normally palpated? What about in infants and newborns?

A

apex in the left mid-clavicular line

left lower sternal border (infants/newborns)

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26
Q

S1 is created by the closure of what two valves? Where is it best heard?

A

closure of tricuspid and mitral

best at LLSB or apex

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27
Q

S2 is created by the closure of what two valves? Where is it best heard?

A

aortic and pulmonic

left upper sternal border

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28
Q

The origin of a murmur is usually found at what point?

A

Where it’s heard the loudest

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29
Q

___ due to cardiac cause is rare, occurring in less than 4% of cases

A

Chest pain

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30
Q

Where is PMI in infants?

A

4th intercostal space

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31
Q

Where is PMI in children over 7?

A

5th intercostal space

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32
Q

large, laterally displaced PMI would indicate

A

cardiomegaly

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33
Q

Thrills are best assessed with what part of the hand?

A

supine (not fingertips)

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34
Q

Carotid thrill indicates what condition?

A

aortic stenosis

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35
Q

Surpasternal notch thrill could be an indication for what 3 conditions?

A

Aortic stenosis, PDA, coarctation

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36
Q

RUSB (right upper sternal border) thrill indicates what condition?

A

Aortic stenosis

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37
Q

LUSB thrill indicates what condition?

A

Pulmonary stenosis

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38
Q

LLSB thrill indicates what condition?

A

VSD

39
Q

Apex thrill indicates what condition?

A

Mitral regurgitation

40
Q

Size of liver with cardiac stuff indicates what?

A

Fluid status - the more congested/fluid-filled, the lower down the liver will be

41
Q

5 main red flags with HPI on cardiac patients

A
  1. FTT: feeding issues, poor weight gain
  2. Dyspnea/exercise intolerance
  3. Frequent respiratory infections
  4. Excessive weight gain (fluid?)
  5. Older children: HTN/new onset murmur
42
Q

Stethoscope diaphragm is to listen for high-frequency sounds such as (6):

A 
S1
S2
clicks
MR and AR murmurs
small VSDs
rubs
43
Q

Stethoscope bell is to listen for low-frequency sounds such as (4):

A

S3
S4
MS murmur
defects with increased flow across AV valves

44
Q

Clicks are usually what?

A

mechanical valve closing

45
Q

What does a rub sound like? What does it mean?

A

Sandpaper
(or what a chest tube sounds like)

Inflammation around the heart’s lining

46
Q

How do you treat a rub?

A

Round-the-clock Motrin for 5-7 days

47
Q

Aortic area of auscultation

A

2nd ICS, right sternal border

48
Q

Pulmonic area of auscultation

A

2nd ICS, left sternal border

49
Q

If aortic and pulmonic valves do not close at the same time it’s called a ____

A

split

50
Q

Tricuspid area of auscultation

A

5th ICS, left sternal border

51
Q

Mitral area of auscultation

A

5th ICS, left mid-clavicular line

52
Q

PDA is normally considered a non-cyanotic condition, but when can it be cyanotic as well?

A

PDA can be cyanotic as well if pulmonary hypertension develops when the high pressure aortic pumps blood into the pulmonary trunk

53
Q

Cyanotic or Noncyanotic: VSD

A

Noncyanotic

54
Q

Cyanotic or Noncyanotic: ASD

A

Noncyanotic

55
Q

Cyanotic or Noncyanotic: PDA

A

Noncyanotic (can also be cyanotic tho)

56
Q

Cyanotic or Noncyanotic: Pulmonary stenosis

A

Noncyanotic

57
Q

Cyanotic or Noncyanotic: Aortic stenosis

A

Noncyanotic

58
Q

Cyanotic or Noncyanotic: AV canal

A

Noncyanotic

59
Q

Cyanotic or Noncyanotic: Coarctation of the aorta

A

Noncyanotic

60
Q

Cyanotic or Noncyanotic: Ebstein’s Anomaly

A

Cyanotic

61
Q

Cyanotic or Noncyanotic: HLHS

A

Cyanotic

62
Q

Cyanotic or Noncyanotic: Pulmonary atresia

A

Cyanotic

63
Q

Cyanotic or Noncyanotic: Tetrology of Fallot

A

Cyanotic

64
Q

Cyanotic or Noncyanotic: TAPVR

A

Cyanotic

65
Q

Cyanotic or Noncyanotic: TGA

A

Cyanotic

66
Q

Cyanotic or Noncyanotic: Truncus Arteriosus

A

Cyanotic

67
Q

Cyanotic or Noncyanotic: Tricuspid atresia

A

Cyanotic

68
Q

DiGeorge syndrome is associated with what cardiac defects? (4)

A

Interrupted aortic arch, Truncus arteriosus, TOF, VSD

69
Q

Trisomy 21 is associated with what cardiac defects? (3)

A

AV canal defect, ASD, PDA

70
Q

Marfan syndrome is associated with what cardiac defect?

A

aortic root enlargement

71
Q

Noonan syndrome is associated with what cardiac defects?

A

PS or hypertrophic cardiomyopathy

72
Q

Trisomy 13 is associated with what cardiac defects? (3)

A

ASD, VSD, PDA

73
Q

Turner syndrome is associated with what cardiac defects? (2)

A

aortic valve stenosis, coarctation of aorta

74
Q

2 events in systole

A
  1. isovolumetric ventricular contraction

2. ventricular ejection

75
Q

2 events in diastole

A
  1. isovolumetric ventricular relaxation

2. atrial contraction

76
Q

Is a split S1 normal in children?

A

Yes - not affected by respiration

77
Q

When is a split S2 normal in children?

A

During inspiration

This is because increased venous return to right side of heart leads to slower contraction of RV

78
Q

When is a split S2 pathologic in children?

A

During expiration

This would be a sign of aortic stenosis or cardiomyopathy

79
Q

Loud Aortic S2 could indicate

A

arterial hypertension

80
Q

Loud Pulmonic S2 could indicate

A

pulmonary hypertension

81
Q

Fixed or widely split S2 could indicate what 3 events:

A

Late closure of pulmonic valve (ASD, Pulmonary stenosis)

Early closure of aortic valve (Severe MR)

Late closure of aortic valve (AS)

82
Q

S3: Ventricular gallop from rapid ventricular filling is common in what 3 defects

A

MR, TR, Heart failure

83
Q

S4: Atrial gallop is common in what 3 defects

A

Aortic stenosis, cardiomyopathy, or heart block

84
Q

Non-ejection clicks:

A

Mitral valve prolapse

85
Q

Opening snap:

A

Sharp, high frequency sound after S2

Mitral stenosis

86
Q

Aortic ejection click is heard where? What does it indicate?

A

LLSB

Aortic stenosis

87
Q

Pulmonic ejection click is heard where? What does it indicate?

A

LUSB

Louder with expiration

Pulmonary stenosis or pulmonary hypertension

88
Q

4 main examples of continuous murmurs

A
  1. **holosystolic murmur (seen in VSD)
  2. PDA
  3. BT shunt (single ventricle patients, post-Norwood)
  4. AV malformation
89
Q

____ is most common innocent murmur

A

Still’s murmur

90
Q

Type I TAPVR looks like what on x-ray?

A

Snowman

91
Q

TOF looks like what on x-ray?

A

Boot

92
Q

Partial anomalous pulmonary venous return looks like what on x-ray?

A

Sword

93
Q

Transposition of the great arteries looks like what on x-ray?

A

Egg on a string

94
Q

Infants with serious cardiac disease present early with (3):

A
  1. Congestive heart failure and pulmonary edema
  2. Cyanosis (central, differential)
  3. Shock

N270.04: Pediatric Physical Assessment (2 decks)

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