Cardiology Flashcards
What are the most important perinatal history questions?
Were they healthy while they were pregnant?
Did they receive prenatal care?
US during pregnancy? if so, did they show anything?
Maternal infections?
Maternal Medications?
What maternal infections are pertinent to a infant cardiac work up for cardiology?
TORCH infections Toxoplasmosis Other Rubella Cytomegalovirus Herpes
What maternal medications are pertinent to an infant cardiac work up for cardiology?
Phenytoin
Lithium
Retinoic acid
Warfarin
(all associated with cardiac malformations)
What is a good way to word palpitations when talking to a child?
Have you had any extra beats or skipped beats
What are you looking for during palpation on cardiac exam
Are they hyperdynamic?
Displaced point of maximal impact?
Do you feel a thrill?
What pulses should you be feeling for in an infant during a cardiac exam?
Brachial
lower femoral pulses
Are they bounding?
Is there a difference between upper and lower pulses?
What blood pressures should be taken on an infant for cardiac examination? why?
Upper and a lower to make sure there is no gradient
A systolic BP >10mm Hg higher in the arm vs leg may signify a coarctation of the aorta
S1 is the sound of what valves closing?
Mitral (M1) and Tricuspid (T1)
S2 is the sound of what valves closing?
Aortic (A2) and Pulmonic (P2)
Splitting of S2 is normal in children to hear during variation with _______
Respirations
Widely split S2 can be indicative of what? (2 things listed)
Volume overload Electrical delay (R bundle branch block)
Narrowly split S2 can be indicative of what? (2 things listed)
Pulmonary HTN
Aortic stenosis
Entirely single S2 can be indicative of what? (2 things listed)
Severe aortic stenosis
Severe Pulmonary HTN
What areas do you auscultate on the heart
Aortic
Pulmonic
Tricuspid
Mitral
What grade murmur?
Barely audible
Grade I/VI
What grade murmur?
Soft but easily audible
Grade II/VI
What grade murmur?
Moderately loud but no thrill
Grade III/VI
What grade murmur?
Loud and accompanied by a thrill
Grade IV/VI
What grade murmur?
Audible with stethoscope barely on chest
Grade V/VI
What grade murmur?
Audible with stethoscope off the chest
Grade VI/VI
A Ejection systolic murmur
Usually can be caused by what 2 things
Pulmonary stenosis
Aortic stenosis
A late systolic murmur
Usually caused by
Mitral valve prolapse
Holosystolic murmurs are usually caused by what? (3)
Tricuspid regurgitation
mitral regurgitation
Ventricular septal Defect
Crescendo/decrescendo murmur is what
softer, louder, softer
Midsystolic (Ejection systolic murmur)
remember…this can be from Pulmonary stenosis or
Aortic stenosis
This murmur is heard throughout systole between S1 and S2 and can often obscure the beginning of diastole
Holosystolic Murmur
remember these are usually caused by
Tricuspid regurgitation
mitral regurgitation
Ventricular septal Defect
Short regurgitant murmur. Heard right at the beginning of systole
Early systolic murmur
Murmur that is Usually reflective of mitral regurgitation and are usually accompanied by a mitral click
Late systolic murmur
What type of murmurs are always pathologic
Diastolic
Early Diastolic Murmur
Higher pitched
Radiates to the apex
What causes this?
Aortic Regurgitation
Early Diastolic Murmur
Higher pitched
Radiates along the left sternal border
What causes this?
Pulmonary Regurgitation
Mid- Diastolic Murmur
Lower pitched
Best heard with bell of stethoscope
heard at the apex
What causes this?
Mitral stenosis
Mid- Diastolic Murmur
Lower pitched
Best heard with bell of stethoscope
heard at the left lower sternal border
What causes this?
Tricuspid stenosis
Causes of continuous murmurs
PDA
AV fistula
Shunt murmur post -surgery
Venous hum
A venous hum murmur varies with patient position in what way?
louder when they are sitting with neck extended and softer or absent with the rotation of the neck or when they are supine.
where are you going to hear aortic stenosis, what type of murmur?
Aortic area (Right upper sternal border) A Ejection systolic murmur
Murmur heard in the Left upper sternal border
Pulmonary Murmurs
Murmur usually heard along the apex
Mitral murmurs
what murmurs are heard at the left lower sternal border
Tricuspid area
VSD
Tricuspid regurgitation
Stills murmur
which murmur has a characteristic vibratory quality and is typically louder when they are supine rather than sitting
Still’s murmur
Gallops are heard during what heart sounds
S3, S4
S3 Gallop is best heard at the _____ if produced by a dilated or dysfunctional left ventricle
Apex
S3 Gallop is best heard at the _____ if produced by dilated or dysfunctional R ventricle
Left sternal border
Are S3 gallops always pathological
no, it can be normal in children and young adults or reflective of dilated ventricles and decreased compliance
Are S4 Gallops always pathological
yes
S4 heart sounds are heard best at
Apex
An S4 heart sound are usually associated with
decreased ventricular compliance that occurs with myocardial ischemia or ventricular hypertrophy
3 types of clicks
Ejection clicks
Mid-systolic click
Diastolic opening snap
Ejection click is best heard where and is reflective of what
Apex
Aortic stenosis or
Bicuspid aortic valve
Mid systolic clicks are heard where and are reflective of what
Apex
mitral valve prolapse
Diastolic opening snaps are heard where and reflective of what
Apex or Left lower sternal border
Mitral stenosis
This is heard when the 2 walls of the pericardium rub against each other, producing audible friction which sounds like grating, scratching or rasping.
Systolic and diastolic components
Best heard between the apex and the sternum
Pericardial friction rub
where is Pericardial friction rub best heard
between the apex and the sternum
What is Pericardial friction rub usually indicative of
Pericarditis
Most common congenital heart defect
VSD
3 stenotic defects
Aortic stenosis
Pulmonary stenosis
Coarctation of the aorta
Defects that have Right to Left shunting
Tetralogy
Transposition
Tricuspid atresia
Defects that have Left to right shunting
Patent ductus arteriosus
VSD
ASD
Defects that have mixing
Truncus
TAPVR
HLH
Initial treatment for moderate to large VSDs
Diuretics, some providers use Digoxin and/or afterload reduction
if they continue to have poor growth or pulmonary HTN, they may require surgical closure
3 types of ASDs and where are they located
secundum defect - hole in the region of the foramen ovale (most common)
Primum ASD - near the endocardial cushions
Sinus venosus defect - associated with anomalous pulmonary venous return
What murmur might I be?
Loud pansystolic heard best at the Lower left sternal border
may be a thrill
Large shunting may cause a mid-diastolic murmur at the apex
The splitting of S2 and intensity of P2 depend on the pulmonary artery pressure
VSD
