Cardiac Clinical Medicine Part 6: Pediatrics Flashcards
When a baby takes their first breath what embryological structures close?
1) Foramen ovale
2) Ductus arteriosus
3) Ductus venosus
What chromosomal abnormalities can cause structural defects?
1) Trisomy 21
2) Trisomy 18
3) DiGeorge syndrome
4) Turner syndrome
What structural defects are common with Down syndrome?
VSD, ASD, AVSD, PDA
What do L to R shunts result in?
What are examples?
1) Congestive HF
2) ASD, VSD, PDA
What do R to L shunts result in?
What are examples?
1) Cyanosis
2) Pulmonary atresia and tricuspid atresia
What is enlarged due to overfilling in atrial septal defect?
Due to over-circulation, what can result?
In what pediatric population do we want to watch for it?
What type of shunt does it cause?
What heart sound is notable of ASD?
1) RA and RV
2) Pulmonary HTN
3) Trisomy 21
4) L to R
5) Wide fixed split S2
What is the most common of all cases of isolated CHD?
VSD
What type of shunt is ventricular septal defect?
How are they characterized if they are smaller?
What can they cause if they are large?
Where is the holosystolic murmur heard?
1) L to R
2) Loud and harsh
3) CHF
4) LLSB
Patent ductus arteriosus is problematic if it stays open in premature infants because?
What is used to treat PDA in premature infants?
What is used to treat in term babies?
If the baby is symptomatic then what treatment is preferred?
What type of shunt is it?
Where is the murmur heard?
How is the murmur described in systole and diastole?
1) Floods lungs leading to CHF
2) Indomethacin
3) Coil embolization
4) Surgical ligation
5) L to R
6) LUSB
7) Crescendo in systole and decrescendo into diastole
What does tricuspid atresia results in structurally?
What blood flow is restricted?
What type of shunt is it?
It results in early onset?
1) Only a single useful ventricle (LV)
2) Pulmonary blood flow
3) R to L
4) Cyanosis or CHF
What type of shunt is pulmonary atresia?
It is ductal dependent until flow can be established through?
1) R to L at ASD
2) Pulmonary valve
A patient presents with feeling faint with exertion, SOB with exertion, and fatigue with activity. Which stenosis is most likely?
Aortic stenosis
What is done for treatment/management of aortic stenosis when they are old enough?
Where is the systolic ejection murmur heard?
1) Prosthetic valve
2) RUSB and radiates to carotids
What is the current standard of care for pulmonary stenosis?
While is it usually asymptomatic, it may have sx of?
Where is it best heard at?
1) Balloon valvuloplasty
2) Pulmonary congestion
3) LUSB and radiates to axilla
What is defective in Ebstein’s anomaly?
Where can a systolic thrill be heard with tetralogy of Fallot?
1) Tricuspid valve
2) LUSB
What are the 4 types of innocent murmurs?
1) Stills
2) Venous hum
3) Pulmonary flow
4) Carotid bruit
Which innocent murmur has a mid-frequency sound and is heard along the LUSB?
Pulmonic flow murmur
Which innocent murmur has a low pitched, “musical” sound and is heard along LSB or between apex and LLSB?
Still’s murmur
Which innocent murmur has a high frequency, is loudest when sitting/standing (goes away when supine), and is heard around clavicle?
Venous hum
Which innocent murmur is heard in older children and has decreased intensity with hyperextension of the shoulders?
Carotid bruit
What atrial arrhythmias occur in newborns?
1) AV reentrant tachycardia
2) Atrial flutter
3) Premature Atrial Contractions
Which atrial arrhythmia is associated with cocaine abuse in moms?
Atrial flutter
What causes increased precordial activity?
Increased RV or LV stroke volume
What is a thrill caused by?
In what murmur grades is it seen?
1) Blood flowing from high pressure to lower pressure
2) Grade IV and above
S1 occurs when what valve closes?
Due to?
1) AV valves (tricuspid and mitral)
2) Ventricular systole
S2 occurs when what valve closes?
Due to?
1) Semilunar valves (pulmonic and aortic)
2) Ventricular diastole
A fixed split S2 is usually indicative of?
ASD
If S1 and S2 are obscured then what murmur is heard?
What defect is most commonly seen in this scenario?
1) Holosystolic murmur
2) VSD
When is a physiologic split heard on S2?
When is a fixed split heard?
1) Upon inspiration
2) ASD
What are the 6 components of describing a murmur?
1) Grade 1-6 (Grade 4: associated with a thrill)
2) Timing (early, middle, late, or holosystolic)
3) Character (harsh, whooping, honking, blowing, musical, vibratory)
4) Location of highest intensity
5) Change with position of patient
6) Radiation
What part of the stethoscope should you use to listen to diastolic murmurs?
Why?
What does it mean if heard on its own?
1) Bell
2) Lower pitched rumbling
3) Never normal on its own
What is the only sound in diastole that does not warrant a referral to cardiology?
Venous hums
What causes a harsh, crescendo-decrescendo systolic murmur heard best at the apex and left sternal border?
When does it increase in intensity?
1) Hypertrophic cardiomyopathy
2) When patient stands or with the Valsalva maneuver
How is S2 described in ASD?
Widely split and fixed
What happens to still’s murmurs during inspiration, sittin up, or standing?
Decreased intensity
What are the 5 cyanotic congenital heart defects?
One big trunk: Truncus arteriosus
Two interchanged vessels: Transposition of Great vessels
Three: Tricuspid atresia
Four: Tetralogy of Fallot
Five words: Total Anomalous Pulmonary Venous Return
What are the 7 lesions looked out for when screening for critical congenital heart disease by using oxygen saturation?
1) Hypoplastic left heart syndrome
2) Pulmonary atresia
3) Tetralogy of Fallot
4) Total anomalous venous return
5) Transposition of the great arteries
6) Tricuspid atresia
7) Truncus arteriosus
