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Special Pops- Peds > Cardio > Flashcards

Cardio Flashcards

1
Q

Neonatal Murmurs are common when?

A
  • 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
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2
Q

Transitional neonatal murmurs:

A

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

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3
Q

When to evaluate for coarctation of aorta?

A

o murmur lasts longer than 24hrs,
o legs have difference of 15mmhg blood pressure from UE
o pulses in LE are hard to palpate

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4
Q

4 innocent murmurs

A

Stills
Pulmonic Flow Murmur
Venous Hum
Carotid

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5
Q

Stills Murmur

A

low frequency, systolic, grade less than 3
o Heard best along left sternal boarder
o Normal S2, no click,

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6
Q

Pulmonic Flow Murmur

A

less than or equal to grade 3
o Heard best at upper left sternal border
o Normal S2, no click
o No diastolic murmur

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7
Q

Venous Hum Murmur

A

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

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8
Q

Carotid Murmur

A

grade 3, heard over carotid

o no click, no aortic stenosis, no diastolic murmur, normal S2

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9
Q

If the right ventricle is enlarged how would the silhouette on the anteroposterior film?

A

apex of the heart tipped upward

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10
Q

If the left ventricle is enlarged how would the silhouette on the anteroposterior film?

A

apex of the heart tipped downward

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11
Q

If the right atrium is enlarged how would the silhouette on the anteroposterior film?

A

prominence right atrial border of the heart

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12
Q

If the left atrium is enlarged how would the silhouette on the anteroposterior film?

A

double shadow behind cardiac silhouette increase in subcarinal angle

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13
Q

Atrial Septal Defect

A

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

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14
Q

Ventricular Septal Defect

A

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

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15
Q

Atrioventricular Septal Defect

A
  • Often cant heat in neonates
  • Loud S2
  • Common w/downs syndrome
  • EKG left axis deviation
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16
Q

Patent (Persistent) Ductus Arteriosus

A
  • 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
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17
Q

5 Right sided obstructive lesions

A

Pulmonary Valve stenosis
Peripheral (Branch) Pulmonary Artery Stenosis
Subvalvular Pulmonary Stenosis:
Supravalvular Pulmnonary Stenosis:
Ebstein Malformation of the Tricuspid Valve

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18
Q

Pulmonary Valve stenosis

A
  • 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
19
Q

Peripheral (Branch) Pulmonary Artery Stenosis:

A
  • 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
20
Q

Ebstein Malformation of the Tricuspid Valve

A
  • “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
21
Q

3 Left Sided Obstructive leisons

A

Coarctation of the Aorta
Aortic Stenosis
mitral valve prolapse

22
Q

Coarctation of the Aorta

A
  • Absent diminished femoral pulses
  • Upper/lower extremity systolic bp gradient of >20mmHg
  • Blowing systolic murmur→ heard in back or left axilla
23
Q

Aortic Stenosis

A
  • 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
24
Q

Mitral Valve Prolapse

A
  • Midsystolic click
  • Late systolic whooping/honking
  • Sx→ chest pain, palps, dizziness
25
Q

3 diseases of the aorta

A

Bicuspid Aortic Valve
Marfan & Loeys-Dietz Syndromes
Turners syndrome

26
Q

Bicuspid Aortic Valve

A
  • Increased risk of aortic dilation & dissection

* Often get valvular stenosis adhesions and more prone to dissections

27
Q

Marfan & Loeys-Dietz Syndromes

A
  • Cardiac manifestations→ aortic root dilation & MVP
  • At risk for aortic dilation & dissection
  • Often restricted from contact sports
  • B.blockers & ACE used to lower BP and slow rate of aortic dilation
28
Q

Turners Syndrome

A
  • Risk of aortic dissection

* Risk factors: HTN, aortic dilation, bicuspid aortic valve, coarctation of aorta

29
Q

Tetralogy of Fallot:

A
  • Hypoxia spells during infancy
  • 25% of pts have a right sided aortic arch seen on CXR
  • Systolic ejection murmur heard at upper left sternal border
30
Q

Pulmonary Atresia w/Ventricular Septal Defect

A
  • Sx depend on degree of pulmonary blood flow

* Pulmonary blood flow via PDA and/or aortopulmonary collaterals

31
Q

Pulmonary Atresia w/Intact Ventricular Septum

A
  • Cyanosis at birth
  • Pulm blood flow is always ductal dependent, rarely w/aortopulmonary collateral arteries present
  • RV dependent coronary arteries sometimes present
32
Q

Tricuspid Atresia

A
  • Cyanosis at birth

* EKG= left axis deviation, right atrial enlargement, LVH

33
Q

Hypoplastic Left Heart Syndrome:

A
  • Mild cyanosis at birth
  • Minimal ausculatory findings
  • Ductal closure= rapid onset of shock
34
Q

Transposition of the Great Arteries

A
  • Cyanotic newborn w/out respiratory distress

* MC in males

35
Q

Total anomalous pulmonary venous return

A
  • Abnormal pulm venous connection leading to cyanosis
  • Occurs with or w/out murmur, may have accentuated P2
  • Right atrial enlargement & RVH
36
Q

Truncus Arteriosus

A
  • Early HF with or w/out cyanosis

* Systolic ejection click

37
Q

Sinus Arrhythmia

A
  • Normal variation of the heart rate
  • Rate varies w/respiratory cycle→ P-QRS-T intervals stay stable
  • Purely changes between the R’s
  • To test it→ speed up their HR, if it goes away that’s good, if it gets worse→ need to work it up
38
Q

Atrial Premature Beats

A

much more common than premature ventricular beats
• Triggered by ectopic focus in atrium
• Particularly common during fetal and newborn periods
• If they are isolated, they are benign and require no tx

39
Q

Ventricular Premature beat

A

PVC, ventricular ectopy
• Common (occur in 1-2% pf ppl)
• Usually benign in otherwise normal pt
• As HR increases, benign ventricular premature beats usually disappear
• If exercise causes increase/coupling of contractions→ underlying dz, work up
• Multifocal premature beats are always abnormal

40
Q

Are Arrhythmias Common during 1st few days of life?

A

PAC, PVC

Yes they are benign & often resolve within the first week

41
Q

Bradyarrhythmias in infants

A

often associated w/congenital heart block→ esp if pts mother has lupus, it can harm the child’s cardiac system
o Causes:
• If structural normal hear→ think lupus (of mother)
• Structural cardiac abnormalities
o Tx: pacing if CO is inadequate

42
Q

Tachyarrhythmias in infants

A

o Wide complex→ doesn’t follow conducting pathway
o Narrow complex (MC)→ SVT, can indicate structural dz, myocarditis, left atrial enlargement, aberrant conduction pathway

43
Q

Treatment for Tachyarrhythmias in infants

A

o Tx:
• Ice to face
• IV adenosine
• LT therapy w/digoxin or propranolol (unless they have WPW)
• Cardioversion only if pt is hemodynamically unstable

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