Cardiac cases Flashcards

1
Q

4 yr old girl accompanied by mother. Examined her on her mum’s knees.

General inspection:
Small and short for her age (89.5cm, 12 kg). Wide nasal root otherwise no other obvious dysmorphic features.
Not on oxygen and not in respiratory distress.
Swollen hands with finger clubbing and pheripheral cyanosis. Previous venepuncture scars on bilateral dorsum of her hands. Pulse - 100 bpm regular. No RR delay.
Inside of eye lids - polycythaemic. ? Central cyanosis

Inspection of precordium:
Chest - Pectus Carinatum, Mid sternotomy scar + pericardial drains and central line access scars.

Palpation:
Apex 6th ICS, MCL, Heave +. No Thrills

Auscultation:
HS - S1 + Single S2 (loud). Grade 3/6 Continuous murmur LUSB radiating to the back.

No hepatomegaly.

A

A girl with Complex Cyanotic Heart disease who underwent Major intracardiac operation currently with palliative shunt (Modified Blalock Tussig shunt) in situ.

PMH - PAVSD + MAPCAs (Major Aortopulmonary Collateral Arteries)

N.B. In individuals with aortopulmonary collaterals, continuous murmurs may be auscultated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 yr old girl. Normal growth and development. Pink on air and not in respiratory distress.
No finger clubbing. No Central / Peripheral Cyanosis

Inspection of precordium:
No chest deformity. No scars.

Palpation:
Apex undisplaced. No heaves or thrills.

Auscultation:
HS I + II
Soft systolic murmur grade 2/6 localized at LLSB.

A

Innocent murmur

8s of innocent murmur

Soft
Sytolic
short
Sounds HS I and II normal
Symptomless
Sitting and Standing variation
Special tests (ECG and X-ray) - normal
Sternal depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

3yr old boy. Normal growth and development. Pink on air and not in respiratory distress.
No finger clubbing. No Central / Peripheral Cyanosis

Inspection of precordium:
No chest deformity. No scars.

Palpation:
Apex undisplaced. No heaves or thrills.

Auscultation:
HS I + II
Harsh ejection systolic murmur heard all over precordium grade 3/6 loudest at ULSB. No ejection click can be heard. No radiation to the back.

No Hepatomegaly

A

Pulmonary stenosis

Whats the significance of Ejection click?
If heard - it means the stenosis is at the valvular level.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

3 mth old boy preterm 34 weeks. Growth appropriate for age. Pink on air. No clubbing.
Palpation - thrill LUSB
Auscultation- long, loud, systolic murmur LUSB

A

A patient without cyanosis has a long, loud, systolic murmur with a thrill along the right ventricular outflow tract (RVOT).
Other conditions to consider when evaluating a patient with suspected Tetralogy of Fallot with pulmonary stenosis include acute anemia, asthma and reactive airway disease, bacteremia and sepsis, cardiogenic shock, Ebstein malformation of the tricuspid valve, pseudotruncus arteriosus, pulmonary atresia, septic shock, and ventricular septal defect (VSD).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Definition of Apex beat

A

The most lateral and inferior point where from the sternum where the strongest cardiac impulse can be felt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Location of Apex beat in children

A

From 1 to 3 years- 4 ICS, then moves to 5th thereafter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

If suspected Dextrocardia - what to do

A

Feel the trachea for any mediastinal shift. Look for Situs Inversus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
18mths boy.
Fast asleep. Comfy. Pink on air.
No dysmorphism. No clubbing. 
Pulse 80 reg 
No pallor / Jaundice.
Precordium: 
No scars / deformity
Apex undisplaced
HS I + II with ejection systolic murmur heard all over precordium, loudest LLSB grade 3/6.
No Liver
A

Dx PS

Ddx ASD- unlikely coz no fixed splitting of 2nd HS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Examine the chest of this 4yr old boy:

Alert, comfy at rest
Some sputum sound coughs
no dysmorphism 
No clubbing
HR 80 reg
pink
Chest: 
Multiple small old needle/ Iv line scars on chest n abdo
RR 32 
Apex on RR 5th ICS MCL
Heart sounds normal

Abdo - percussion dullness LT side. No organomegaly

A

Dx Kartageners

How well did you know this?
1
Not at all
2
3
4
5
Perfectly