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Special Pops - Peds > Cardio > Flashcards

Cardio Flashcards

1
Q

What are the key features of innocent murmurs in children?

A

Seven S’s

  1. Sensitive (changes w/position or respiration)
  2. Short duration
  3. Single
  4. Small
  5. Soft
  6. Sweet
  7. Systolic
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2
Q

If a murmur is present at birth, what should it be considered?

A

A valvular problem until proven otherwise

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3
Q

Heart murmurs in newborns?

A
  • Common in first days of life and do NOT usually signify structural heart problems
  • If murmur goes away before 24 hrs of life, infant can be discharged with FU auscultation in 2-3 days
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4
Q

Define transitional neonatal murmurs

A
  • Soft (grade 1-3/6)
  • Heard at left upper to midsternal border
  • Infant is pink, well-perfused, no resp distress
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5
Q

Signs of coarctaction of aorta in newborn?

A
  • Murmur persists beyond 24 hrs of age
  • BP in right arm and a leg shows a difference over 15
  • Difficult to palpate LE pulses
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6
Q

What is recommended in newborns to identify congenital heart disease?

A

Predischarge pulse ox screening

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7
Q

Describe Still’s murmur

A
  • Low frequency
  • Systolic
  • 3/6 intensity or less
  • LSB
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8
Q

Describe pulmonic flow murmur

A
  • Mid frequency
  • 3/6 intensity or less
  • Left upper sternal border
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9
Q

Describe venous hum

A
  • High frequency
  • 3/6 intensity or less
  • Sitting or standing, base of neck or supra/infraclavicular areas
  • Abolished by compression of jugular vein, change of head position, or assumption of supine position
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10
Q

Describe carotid bruit

A
  • Heard over carotid artery

- 3/6 intensity or less

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11
Q

Which murmur in newborns is low frequency and best heard at LSB?

A

Still’s murmur

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12
Q

Which murmur in newborns is mid frequency and best heard at left upper sternal border?

A

Pulmonic flow murmur

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13
Q

Which murmur in newborns is high frequency and best heard in sitting or standing position?

A

Venous hum

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14
Q

How does atrial septal defect present?

A
  • Frequently asymptomatic
  • Fixed, widely split S2
  • Grade 1-3/6 systolic ejection murmur at pulmonary area
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15
Q

How does ventricular septal defect present?

A
  • FTT, tachypnea, diaphoresis

- Holosystolic murmur at lower left sternal border

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16
Q

How does AV canal/septal defect present?

A
  • Murmur often INAUDIBLE

- Common in infants with Down Syndrome

17
Q

How does PDA present?

A
  • Continuous machinery murmur
  • Bounding peripheral pulses (if large ductus present)
  • FTT, tachypnea, diaphoresis
18
Q

How does pulmonary valve stenosis present?

A
  • Mild/mod: NO symptoms
  • Ductal dependent: cyanosis and right heart failure
  • RV lift
  • Dilated pulmonary artery on CXR
19
Q

What may present identical to pulmonary valve stenosis?

A

Subvalvular or supravalvular pulmonary stenosis

20
Q

How does peripheral (branch) pulmonary artery stenosis present?

A
  • Systolic murmurs may be heard over both lung fields anterior and posterior, radiating to axilla
  • Mild, nonpathologic stenosis produces a murmur in infancy that resolves by 6 months old
21
Q

What type of stenosis produces a murmur in infancy that resolves by 6 months old?

A

Mild, nonpathologic peripheral (branch) pulmonary artery stenosis

22
Q

How does aortic stenosis present?

A
  • Harsh systolic ejection
  • Systolic click at apex
  • Dilation of ascending aorta on CXR
23
Q

How does mitral valve prolapse present?

A
  • Midsystolic click

- Often overdiagnosed on routine cardiac US

24
Q

Which heart condition is often overdiagnosed in neonates on routine cardiac US?

A

Mitral valve prolapse

25
Q

Patients with bicuspid aortic valves have an increased incidence of what?

A

Aortic dilation and dissection (B blockers and ACEI used to lower BP and slow rate of aortic dilation)

26
Q

Patients with Turner Syndrome are at risk for what?

A

Aortic dissection

27
Q

How does tetralogy of Fallot present in infancy?

A
  • Hypoxemic spells

- Systolic ejection murmur at upper LSB

28
Q

How does pulmonary atresia with intact ventricular septum present?

A
  • Completely different lesion from pulm atresia with VSD

- Pulm blood flow is always ductal dependent

29
Q

What is sinus arrhythmia? How is it diagnosed?

A
  • Normal variation in HR

- Sinus rate varies with respiratory cycle (PQRST intervals remain stable)

30
Q

Define marked sinus arrhythmia?

A

More than 100% variation in HR

31
Q

How do benign PVCs present?

A

With exercise, they usually disappear

32
Q

How do abnormal PVCs present?

A

If exercise results in increased or coupling of contractions, underlying disease may be present

33
Q

What type of PVC is always abnormal?

A

Multifocal PVCs

34
Q

Which tachyarrhythmia is MC in newborns - narrow or wide complex? What do they possibly indicate?

A

Narrow (SVT) - may indicate structural heart disease, myocarditis, left atrial enlargement, aberrant conduction pathways

35
Q

Cardioversion treatment of SVT in newborns?

A
  • Rarely needed EXCEPT as acute treatment for hemodynamically unstable VT
  • Instead, ice to the face then IV adenosine

Special Pops - Peds (10 decks)

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