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Critical Care I > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What are the most important perinatal history questions?

A

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?

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2
Q

What maternal infections are pertinent to a infant cardiac work up for cardiology?

A 
TORCH infections
Toxoplasmosis
Other
Rubella
Cytomegalovirus
Herpes
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3
Q

What maternal medications are pertinent to an infant cardiac work up for cardiology?

A

Phenytoin
Lithium
Retinoic acid
Warfarin

(all associated with cardiac malformations)

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4
Q

What is a good way to word palpitations when talking to a child?

A

Have you had any extra beats or skipped beats

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5
Q

What are you looking for during palpation on cardiac exam

A

Are they hyperdynamic?

Displaced point of maximal impact?

Do you feel a thrill?

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6
Q

What pulses should you be feeling for in an infant during a cardiac exam?

A

Brachial
lower femoral pulses

Are they bounding?
Is there a difference between upper and lower pulses?

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7
Q

What blood pressures should be taken on an infant for cardiac examination? why?

A

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

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8
Q

S1 is the sound of what valves closing?

A

Mitral (M1) and Tricuspid (T1)

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9
Q

S2 is the sound of what valves closing?

A

Aortic (A2) and Pulmonic (P2)

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10
Q

Splitting of S2 is normal in children to hear during variation with _______

A

Respirations

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11
Q

Widely split S2 can be indicative of what? (2 things listed)

A 
Volume overload
Electrical delay (R bundle branch block)
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12
Q

Narrowly split S2 can be indicative of what? (2 things listed)

A

Pulmonary HTN

Aortic stenosis

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13
Q

Entirely single S2 can be indicative of what? (2 things listed)

A

Severe aortic stenosis

Severe Pulmonary HTN

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14
Q

What areas do you auscultate on the heart

A

Aortic
Pulmonic
Tricuspid
Mitral

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15
Q

What grade murmur?

Barely audible

A

Grade I/VI

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16
Q

What grade murmur?

Soft but easily audible

A

Grade II/VI

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17
Q

What grade murmur?

Moderately loud but no thrill

A

Grade III/VI

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18
Q

What grade murmur?

Loud and accompanied by a thrill

A

Grade IV/VI

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19
Q

What grade murmur?

Audible with stethoscope barely on chest

A

Grade V/VI

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20
Q

What grade murmur?

Audible with stethoscope off the chest

A

Grade VI/VI

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21
Q

A Ejection systolic murmur

Usually can be caused by what 2 things

A

Pulmonary stenosis

Aortic stenosis

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22
Q

A late systolic murmur

Usually caused by

A

Mitral valve prolapse

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23
Q

Holosystolic murmurs are usually caused by what? (3)

A

Tricuspid regurgitation
mitral regurgitation
Ventricular septal Defect

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24
Q

Crescendo/decrescendo murmur is what

softer, louder, softer

A

Midsystolic (Ejection systolic murmur)

remember…this can be from Pulmonary stenosis or
Aortic stenosis

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25
Q

This murmur is heard throughout systole between S1 and S2 and can often obscure the beginning of diastole

A

Holosystolic Murmur

remember these are usually caused by
Tricuspid regurgitation
mitral regurgitation
Ventricular septal Defect

26
Q

Short regurgitant murmur. Heard right at the beginning of systole

A

Early systolic murmur

27
Q

Murmur that is Usually reflective of mitral regurgitation and are usually accompanied by a mitral click

A

Late systolic murmur

28
Q

What type of murmurs are always pathologic

A

Diastolic

29
Q

Early Diastolic Murmur
Higher pitched
Radiates to the apex

What causes this?

A

Aortic Regurgitation

30
Q

Early Diastolic Murmur
Higher pitched
Radiates along the left sternal border

What causes this?

A

Pulmonary Regurgitation

31
Q

Mid- Diastolic Murmur
Lower pitched
Best heard with bell of stethoscope
heard at the apex

What causes this?

A

Mitral stenosis

32
Q

Mid- Diastolic Murmur
Lower pitched
Best heard with bell of stethoscope
heard at the left lower sternal border

What causes this?

A

Tricuspid stenosis

33
Q

Causes of continuous murmurs

A

PDA
AV fistula
Shunt murmur post -surgery
Venous hum

34
Q

A venous hum murmur varies with patient position in what way?

A

louder when they are sitting with neck extended and softer or absent with the rotation of the neck or when they are supine.

35
Q

where are you going to hear aortic stenosis, what type of murmur?

A 
Aortic area (Right upper sternal border)
A Ejection systolic murmur
36
Q

Murmur heard in the Left upper sternal border

A

Pulmonary Murmurs

37
Q

Murmur usually heard along the apex

A

Mitral murmurs

38
Q

what murmurs are heard at the left lower sternal border

A

Tricuspid area
VSD
Tricuspid regurgitation
Stills murmur

39
Q

which murmur has a characteristic vibratory quality and is typically louder when they are supine rather than sitting

A

Still’s murmur

40
Q

Gallops are heard during what heart sounds

A

S3, S4

41
Q

S3 Gallop is best heard at the _____ if produced by a dilated or dysfunctional left ventricle

A

Apex

42
Q

S3 Gallop is best heard at the _____ if produced by dilated or dysfunctional R ventricle

A

Left sternal border

43
Q

Are S3 gallops always pathological

A

no, it can be normal in children and young adults or reflective of dilated ventricles and decreased compliance

44
Q

Are S4 Gallops always pathological

A

yes

45
Q

S4 heart sounds are heard best at

A

Apex

46
Q

An S4 heart sound are usually associated with

A

decreased ventricular compliance that occurs with myocardial ischemia or ventricular hypertrophy

47
Q

3 types of clicks

A

Ejection clicks
Mid-systolic click
Diastolic opening snap

48
Q

Ejection click is best heard where and is reflective of what

A

Apex
Aortic stenosis or
Bicuspid aortic valve

49
Q

Mid systolic clicks are heard where and are reflective of what

A

Apex

mitral valve prolapse

50
Q

Diastolic opening snaps are heard where and reflective of what

A

Apex or Left lower sternal border

Mitral stenosis

51
Q

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

A

Pericardial friction rub

52
Q

where is Pericardial friction rub best heard

A

between the apex and the sternum

53
Q

What is Pericardial friction rub usually indicative of

A

Pericarditis

54
Q

Most common congenital heart defect

A

VSD

55
Q

3 stenotic defects

A

Aortic stenosis
Pulmonary stenosis
Coarctation of the aorta

56
Q

Defects that have Right to Left shunting

A

Tetralogy
Transposition
Tricuspid atresia

57
Q

Defects that have Left to right shunting

A

Patent ductus arteriosus
VSD
ASD

58
Q

Defects that have mixing

A

Truncus
TAPVR
HLH

59
Q

Initial treatment for moderate to large VSDs

A

Diuretics, some providers use Digoxin and/or afterload reduction

if they continue to have poor growth or pulmonary HTN, they may require surgical closure

60
Q

3 types of ASDs and where are they located

A

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

61
Q

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

A

VSD

Critical Care I (27 decks)

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