cardiology Flashcards
systolic murmurs
PAT
Pulmonary stenosis (mid to L upper sternal border)
Aortic stenosis
tetralogy of fallot (mid to left upper sternal border)
Hyperthophic cardiomyopathy (apex, lower left sternal border)
holosystolic murmurs
tricuspid atresia (VSD)
ebstein anomaly (tricuspid regurgitation)
continuous murmurs
- transposition of great arteries
hypoplastic left heart syndrome
coarctation of aorta
cyanotic CHD
HE blue 5 Transvestite’s (makes you blue)
Hypoblastic Left Heart Syndrome
Epstein Anomaly (lithium use)
Truncus arteriosus
Transposition of Great Vessels
Tricuspid Atresia
Total Anomalous pulmonary venous return
Tetralogy of Fallot
truncus arteriosus
pulmonary artery and aorta share a trunk that overrides VSD
Associated with Digeorge syndrome
asymptomatic at birth, but CHF develops within first month of life as more blood flows to lungs => pulmonary overcirculation
CXR: Increased pulmonary vascularity
Echo: large truncal artery overriding VSD
Tx: surgery and CHF therapy
Di george syndrome
cardiac anomalies and no thymus
-Truncus arteriosus, tertralogy of fallot
Transposition of great arteries
Pulmonary artery comes off LV, aorta comes off of RV
Fatal unless mixing occurs via shunt
Cardiac examL loud s2, no murmur, reduced femoral pulse
if VSD, systolic murmur at left sternal border
CXR shows egg on string appearance,
Hyperoxia Test: <150mm Hg after administration of O2
TX: start prostaglandin to keep PDA open
Surgery within first 2 weeks of life
Tricuspid Atresia
No tricuspid valve/ connection between RA and RV
CHF, cyanosis
ECG: LVH with left axis deviation (unique)
Holosystolic murmur at lower left sternal border
Tetralogy of Fallot
PROV
Pulmonary stenosis
Right ventricular hypertrophy
Overriding aorta over both ventricles
VSD
CXR: boot shaped heart
symptoms: tet spell due to cyanosis from exertion, feeding or agitations due to increases pulmonary vascular resistance causing RVOT obstruction => shunting from RV=> LV
Total anomalous pulmonary venous return
pulmonary vein drains into the venous system and not the left atrium
obstructed TAPVR, presents immediately at birth, poor prognosis, need surgery w/i first 24h of life
unobstructed: increased workof breathing, tachypnea, growth failure
CXR snowman shape to heart
FIxed split S2 or loud S2
systolic ejection murmur with diastolic rumble
Hypoplastic left heart syndrome
LV inflow obstruction, LV outflow obstruction,
underdeveloped small LV
hypoplastic ascending aorta & aortic arch
Newborns iwll present with shock shortly after birth
CXR mild cardiomegaly, pulmonary congestion
Coarctation of aorta
narrowing in aorta causing obstruction to flow
critical: shock and decreased femoral pulse, strong pulse in upper extremity
mild: systolic murmur, decreased femoral pulse, strong pulse in upper extremity hypertension
Tx: prostaglandins, surgery
Hypertrophic Obstructive cardiomyopathy
hypertrophy of left ventricular septum obstructs outflow from LV => aorta
Systolic ejection murmur
- handrip and squat will improve murmur since it improves obstruction (increased resistance)
-standing and valsalva will worsen it, since volume is pulled away form heart
how do you ,manage hypertrophic cardiomyopathy in newborn?
IV fluids and beta blockers to increase LV volume
Betablockers, slows heart rate, inc, diastolic filling time
hypertrophic pyloric stenosis
projectile non bilious vomiting, palpable olive-shape mass in RUQ
Tx: pyloromyotomy ( surgery), after rehydrating patient and correcting any abnormalities
partial anomalous venous return
- right sided cardiac enlargement
- increased O2 sat in RA, RV vs IVc, SVC
- only some of the pulmonary veins drain into the RA
when to get an ECG or echocardiogram in newborn with murmur
holosystolic, diastolic
harsh, grade: 3 or great
worse intensity with standing and valsalva
weak femoral pulse,
hepatomegaly
