Cardio, Pulmonary, Endocrine & Renal Flashcards
___% of kids have a benign murmur
30
Two types of benign murmurs
stills murmur and venous hum
Stills murmur
SYSTOLIC,
Venous hum
best heard in anterior neck, disappears when jugular vein is compressed
Murmurs that are NEVER normal; tx
DIASTOLIC, anything >II/VI; get an echo
Dx–Newborn is cyanotic @
birth, O2 does not improve; most common in ____; [NO MURMUR]
transposition of great arteries; infants of diabetic mothers
Transposition of great arteries–tx
PGE1 to keep PDA patent
Dx–2y/o child who gets cyanotic and hyperpnea while playing, squats down; tx
TOF [pulm stenosis, RA hypertrophy, overriding aorta, VSD]; O2 and knees to chest, sx
TOF–murmur type
harsh SEM + single S2
Dx–Bipolar woman gives birth to a child w/ holosystolic murmur worse on inspiration
Ebstein anomaly
Ebstein anomaly
Tricuspid insuficciency 2/2 TV displacement into RV
Ebstein anomaly–arrhythmia
Wolff-Parkinson-White
Dx–Cyanosis @ birth with holosystolic murmur, depends on VSD or ASD for life. EKG shows LVH
Tricuspid atresia
Tricuspid atresia–tx
PGE1 until sx
Dx–Heart defect associated with DiGeorge syndrome. CXR shows ↑pulm blood flow and bi-ventricular hypertrophy
Truncus arteriosis
In truncus arteriosis, _____ develops early. Tx w/ sx in first few weeks of life
Eisenmenger
Describe Eisenmenger syndrome
increased blood flow to lungs instead of body causing extreme pulm HTN–>instead blood goes through shunt from RV to LV and gives O2-poor blood to body
MC congenital heart murmur; describe murmur
VSD; harsh holosystolic over LL sternal border, loud P2
If harsh holosystolic over LL sternal border at II/VI in 2mo w/ no sxs, next step
continue to monitor [VSD must close by 1-2yrs]
Gold standard test for murmurs
echo
VSD–surgery is indicated if____
FTT, 6-12mo w/ pHTN, >2yr w/ Qp/Qs >2:1
VSD–is louder murmurs better or worse? why?
Better. It means the defect is small. Most often membranous. More likely to spontaneously
close
Dx–Loud S1 w/ fixed and split S2. Older child w/ exercise intolerance
ASD
Dx–Most common defect in Down Syndrome baby
Endocardial cushion defect
Endocardial cushion defect–describe murmur
Fixed & split S2 + SEM w/ diastolic rumble
Endocardial cushion defect—-tx
sx before pHTN at 6-12mo [at risk for early Eisenmengers]
Dx–Continuous machine-like murmur w/ bounding pulses and wide pulse pressure
PDA
PDA–associated pathologies
prematurity, congenital rubella syndrome
PDA–tx
if not closed by 1wk, give indomethacin or sx
Dx–Most common defect in Turner’s baby
Coarctation of aorta
Dx–Decreased femoral pulses, “reverse 3 sign”, “notching” @ inf rib border 2/2 incr collateral
Coarctation of aorta
Dx–15yo athlete w/ occasional palpations, angina, dizziness. Last week, fainted during baseball game
Hypertrophic CM
