Cardio Flashcards
Neonatal Murmurs are common when?
- Common in 1st days of life, don’t necessarily mean problem
- If murmur present at birth, consider a valvular problem
- The common benign transitional murmurs (PDA) aren’t audible until mins=hrs after birth
Transitional neonatal murmurs:
o not audible until hrs after birth
o infant pink, not in resp. distress, pulses are palpable and symmetrical
o soft, heard at left upper midsternal border
o loudest during 1st 24 hrs
When to evaluate for coarctation of aorta?
o murmur lasts longer than 24hrs,
o legs have difference of 15mmhg blood pressure from UE
o pulses in LE are hard to palpate
4 innocent murmurs
Stills
Pulmonic Flow Murmur
Venous Hum
Carotid
Stills Murmur
low frequency, systolic, grade less than 3
o Heard best along left sternal boarder
o Normal S2, no click,
Pulmonic Flow Murmur
less than or equal to grade 3
o Heard best at upper left sternal border
o Normal S2, no click
o No diastolic murmur
Venous Hum Murmur
high frequency, grade 3 or less
o Best heard sitting/standing at base of neck (infraclavicular or supraclavicular )
o Normal S2, systolic and or diastolic
o Stopped by compression of the jugular vein, change in head position, or assumption of supine position
Carotid Murmur
grade 3, heard over carotid
o no click, no aortic stenosis, no diastolic murmur, normal S2
If the right ventricle is enlarged how would the silhouette on the anteroposterior film?
apex of the heart tipped upward
If the left ventricle is enlarged how would the silhouette on the anteroposterior film?
apex of the heart tipped downward
If the right atrium is enlarged how would the silhouette on the anteroposterior film?
prominence right atrial border of the heart
If the left atrium is enlarged how would the silhouette on the anteroposterior film?
double shadow behind cardiac silhouette increase in subcarinal angle
Atrial Septal Defect
fixed, widely split S2, right ventricular heave
• grade 3 systolic ejection murmur at pulmonary area
• large shunts cause diastolic flow murmur at lower left sternal border
• EKG→ rsR’ in V1
• Often asx
Ventricular Septal Defect
holosystolic murmur at lower left sternal border w/RV heave
• Presentation & cause depend on size
• Clinical features→ FTT, tachypnea, diaphoresis when eating
• L→R shunt w/normal pulm vascular resistance
• Large defects can cause eisenmenger syndrome
Atrioventricular Septal Defect
- Often cant heat in neonates
- Loud S2
- Common w/downs syndrome
- EKG left axis deviation
Patent (Persistent) Ductus Arteriosus
- Continuous machinery type murmur
- Bounding peripheral pulses if large ductus
- Presentation & course depend on size of the ductus & pulmonary vascular resistance
- Clinical features→ FTT, tachypnea, diaphoresis w/feeds
- L→R shunt w/normal pulm vascular resistance
5 Right sided obstructive lesions
Pulmonary Valve stenosis
Peripheral (Branch) Pulmonary Artery Stenosis
Subvalvular Pulmonary Stenosis:
Supravalvular Pulmnonary Stenosis:
Ebstein Malformation of the Tricuspid Valve
Pulmonary Valve stenosis
- No sx when milder/moderate
- Cyanosis & often r sided HF in ductal dependent lesions
- RV lift w/systolic ejection click→ heard at 3rd left intercostal space
- S2 widely split w/soft to inaudible P2, systolic ejection murmur at pulmonary area
- Dilated pulmonary artery on chest radiograph
Peripheral (Branch) Pulmonary Artery Stenosis:
- Systolic murmurs
- can be heard over both lung fields anteriorly and posteriorly, radiating to axilla
- Mild no pathologic pulm branch stenosis produces mumur in infancy that resolves by 6mo
Ebstein Malformation of the Tricuspid Valve
- “atrialized” portion of the RV is thin-walled, does not contribute to RV output
- Portion of ventricle below displaced tricuspid is smaller in volume & represents the functioning RV
3 Left Sided Obstructive leisons
Coarctation of the Aorta
Aortic Stenosis
mitral valve prolapse
Coarctation of the Aorta
- Absent diminished femoral pulses
- Upper/lower extremity systolic bp gradient of >20mmHg
- Blowing systolic murmur→ heard in back or left axilla
Aortic Stenosis
- Harsh, systolic, ejection murmur @ upper right sternal border w/radiation to neck thrill in carotid arteries
- Systolic click at apex
- CXR→ see dilation of ascending aorta
Mitral Valve Prolapse
- Midsystolic click
- Late systolic whooping/honking
- Sx→ chest pain, palps, dizziness
