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Clinical Paediatric Examination > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What does cyanosis imply?

A

implies desaturated blood in the capillaries treated than 5 g/dL giving the skin and the mucous membranes a bluish discolouration

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2
Q

what is characteristic of cyanosis in regards to cardiac defects?

A

It is characteristic of right to left shunt within the heart or between the great arteries or as a consequence of inadequate oxygenation of the blood in the lungs

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3
Q

what arterial saturation corresponds to cyanosis?

A

75% for a haemoglobin between 12-16

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4
Q

what can give you appearance of cyanosis with a normal saturation?

A

polycythemia

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5
Q

what do you look at to determine central cyanosis?

A

tongue

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6
Q

what are you looking for in the face during your cardiovascular exam?

A

colour: cyanosis or pallor
teeth looking at dental caries

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7
Q

show me how you would look for clubbing?

A

put the two thumbs together looking for the nailed acute angle (meaning that there is space in the middle)

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8
Q

What is the space in the middle when you put two thumbs together looking for clubbing called?

A

Schamroth’s sign

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9
Q

What is absent radii associated with ?

A

VACTERL syndrome

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10
Q

What does VACTERL syndrome stand for?

A

it is an acronym that is made up of the first letters of the defects associated with the syndrome itself:
Vertebral defects. Anorectal anomalies. Cardiac defects. Tracheo-oesphageal fistula/oesophageal atresia and limb abnormalities

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11
Q

What is absent thumbs associated with?

A

Holt-Oram syndrome

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12
Q

What is Holt-Oram syndrome?

A

This is an AD condition that is associated with mutations in the TBX5 gene. Associated with absent thumbs (upper limb defect) and also CHD (ASD and VSD.

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13
Q

What are splinter haemorrhages and Osler’s nodes associated with

A

infective endocarditis

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14
Q

What should you look for in a hypertensive child on the upper limbs?

A

look for tuberous and tendon xanthomata of familial hypercholesterolamia

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15
Q

What are you looking for in the hand exam of a child with suspected CHD?

A

clubbing
boney anomalies of the radius or the thumbs
nail beds (splinter hemorrahages)
tendon xanthomata of familial hypercolesterolamia

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16
Q

what is a right thoracotomy scar associated with?

A

cardiac: blalock-taussig shunt
pulmonary artery banding
noncardiac: thoracotomy

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17
Q

What is a midline sternotomy scar associated with?

A

complex cardiac surgery

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18
Q

What is a left thoracotomy scar associated with

A

blalock-taussig shunt
patent ductus arteriosus ligation
coarctation repair
pulmonary artery banding
noncardaic: thoracotomy scar

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19
Q

What is a blalock- taussig shunt?

A

it is a surgical procedure used to create a pathway from the right subclavian artery to the right pulmonary artery used for palliation of cyanotic heart defects.

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20
Q

When looking at the chest what are you looking for?

A

RR, scars, asymmetry (anterior bulge left chest- cardiomegaly), left parasternal heave RVH, visible pulsations and Harrison’s sulci.

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21
Q

Talk to me about pulses- what if you don’t feel a left brachial pulse?

A

classic left blalock- taussig shunt, left subclavian artery repair of coarctation, cervical rib, embolisation

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22
Q

Pulses: absent right brachial pulse

A

classic right Blalock- Taussig shunt, previous cardiac catheterisation, embolisation

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23
Q

pulse- reduced left brachial pulse

A

flap aortoplasty repair of coarctation

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24
Q

pulse: brachial pulse absent on shoulder abduction

A

cervical rib

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25
Q

pulse: absent radial pulse

A

congenital malformation

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26
Q

what are the normal ranges for pulse rate in 2,2-6, greater than 6

A

0-2: 80-140
2-6: 75-120
greater than 6: 70-110

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27
Q

what are the causes of bradycardia

A

junior athletes, drugs (beta blockers or digoxin, complete heart block, eating disorder, sleep

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28
Q

causes of tachycardia

A

sinus tachycardia in an anxious child
super ventricular tachycardia
WPW

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29
Q

what are the different types of pulse rhythm

A

regular, regularly irregular, irregular irregular

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30
Q

irregular irregular pulse causation

A

multiple extrasystoles (common in young children and disappear on exertion)
atrial fibrillation (aSD, open heart surgery or atrial surgery, abstains anomaly of the tricuspid valve, rheumatic mitral stenosis

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31
Q

when commenting on the pulse what are you describing?

A

rhythm, volume, and character

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32
Q

what causes a regularly irregular pulse rhythm

A

pulsus bigeminous coupled extrasystoles (digoxin toxicity)

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33
Q

what causes a small volume pulse

A

pump failure (heart)
shock
outflow obstruction (AS or pericardial effusion)

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34
Q

what causes large volume pulses

A

anaemia, CO2 retention, thyrotoxicosis

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35
Q

what causes varying volume pulses

A

extrasystoles, AFib, and incomplete heart block

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36
Q

what terms would you use for the character of the pulse/

A

normal, slow rising (moderate to severe aortic stenosis, collapsing, (aortic incompetence, patent ductus arteriosus)
bisferiens

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37
Q

what is an abormal pulsus paradoxus

A

it is the fall of blood pressure during inspiration, greater than 15 mmHg is abnormal. causes include pericardial effusion, constrictive pericarditis and severe airway obstruction (unlikely in exam)

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38
Q

what causes a rapidly rising, ill-sustained jerky pulse

A

HOCM

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39
Q

what do you check the femoral pulses for/

A

absence of femoral pulses can be indicative of a coarctation.

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40
Q

what re you looking for at the suprasternal notch

A

gentle palpation will detect a thrill in Aortic stenosis

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41
Q

describe how to take a blood pressure

A

the cut must cover at least 2/3 of the upper arm with a bladder that completely encircles the arm.

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42
Q

which side do you check the rate, rhythm and character of the pulse

A

right brachial

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43
Q

what are you looking for with palpation?

A

position the apex beat, quality, thrills, and palpable heart sounds

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44
Q

describe how to find the apex beat

A

this is the furthest lateral and inferior position at which the finger is lifted by the cardiac impulse and is normally the fourth intercostal space in the midclavicular line.

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45
Q

what causes the apex beat to be displaced to the left

A

cardiomegaly, scoliosis and pectus excavated

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46
Q

what causes the apex beat to be displaced to the right

A

congenital dextrocardia (feel for the liver to confirm)
acquired dextrocardia (heart pushed or pulled to the right)
left diaphramatic hernia
collapsed lung on the right side,

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47
Q

What words would you use to describe the quality of the apex beat?

A

sustained
forceful
thrusting
parasternal heave

48
Q

what does a sustained apex beat

A

with pressure overload in aortic stenosis

49
Q

what does a forceful apex beat

A

left ventricular hypertrophy

50
Q

what does a thrusting apex beat mean

A

with volume overload, an active large large stroke volume ventricle in the mitral or aortic incompetence or left to right shunt

51
Q

what does a parasternal heave mean when palpating the apex

A

right ventricular hypertrophy

52
Q

what does the addition of a thrill mean with categorising a murmur using the number classification system?

A

the murmer will be at least 4/6 intensity

53
Q

what does it mean if you feel a systolic thrill along the lower left sternal edge

A

VSD

54
Q

what if you feel a thrill in the upper left sternal edge

A

pulmonary stenosis

55
Q

what does a palpable heart sound mean

A

a second heart sound reflects pulmonary hypertension

56
Q

what is a collapsing pulse associated with

A

aortic incompetence

57
Q

what does a suprasternal thrill mean

A

aortic stenosis

58
Q

what sound you be doing while auculating the four areas of the heart

A

palpate the right brachial pulse

59
Q

what are the four main areas of the heart that you should be listening to

A

the apex (and axilla if there is a murmur)
tricuspid area
aortic area (and neck if there is a murmur)
pulmonary area (listen to the back if there is a murmur)

60
Q

in auscultation which part should you start from?

A

you should listen over the apex first with the bell and then with the diaphragm of the stethoscope
then go tot he other areas

61
Q

if you hear a murmur radiate to the back what should that flag for you

A

innocent murmurs do not radiate to the back
murmurs of pulmonary stenosis however do radiate to the back

62
Q

if the murmur is loudest on expiration what does that mean

A

left sided heart disease

63
Q

what is the murmur is loudest on inspiration what does that mean

A

right sided heart disease

64
Q

what does the first heart sound correspond with

A

the sudden cessation of the mitral and tricuspid flow due to valve closure

65
Q

what does the second heart sound corresponds with

A

the sudden cessation of aortic and pulmonary flow due to valve closure

66
Q

is it normal to have a split second heart sound

A

in inspiration it is normal, but not in expiration

67
Q

what are the causes of a loud first heart sound

A

ASD, mechanical valve, mitral stenosis (rare)

68
Q

what causes variable loudness of the first heart sound

A

heart block or atrial fibrillation

69
Q

what is a loud second heart sound mean

A

increased pulmonary flow (PDA, ASD, large VSD)
pulmonary hypertension

70
Q

what causes a fixed split second heart sound

A

ASD

71
Q

what causes a widely spilt second heart sound

A

ASD, PS, right bundle branch block

72
Q

what causes reversed splitting (widening on expiration)

A

severe AS, left bundle branch block

73
Q

what causes a single second heart sound

A

tetralogy of Fallot
pulmonary stenosis

74
Q

what causes a split second heart sound

A

normal (widens on inspiration)
fixed spilt (no change in respiration) ASD
widely split (ASD, ps, right bundle branch block)
reversed splitting widens on expiration severe AS, left bundle branch block

75
Q

what causes single second sound

A

tetralogy of Fallot
pulmonary stenosis

76
Q

what causes a third heart sound

A

rapid ventricular filling (normal)
best heard with the bell over the apex
also heard in failure of wither ventricles

77
Q

what causes a fourth heart sound

A

never a normal finding
precedes first heart sound
failure of wither ventricle
pulmonary hypertension

78
Q

what causes an opening snap

A

after the second sound high pitched
mitral stenosis

79
Q

what causes an ejection click

A

after the first sound high pitched early systole
aortic or pulmonary stenosis

80
Q

what are the things you have to think about when describing a murmur

A

intensity
site where heard loudest
radiation
timing (systolic, diastolic or both)
duration (early/ late pansystolic)
pitch and quality
changes with respiration or posture

remember also to listen to the back (if it persists it is. a PDA, PS or coarctation)

81
Q

what are the 10 signs of a normal murmur

A

symptom free
systolic
short
soft
site (heard over a small area only)
sitting or standing (varies with posture)
sternal depression (murmur can happen with pectus excavated)
signs no other abnormal signs all pulses are normal
special tests (ECG and chest X-ray are normal)

82
Q

what is a stills murmur

A

it is a early soft systolic murmur heard over the lower left sternal edge. It is usually grade 2 in intensity but can be louder and often has a musical or buzzing sound to it. it will disappear on hyperextension.

83
Q

what is a pulmonary flow murmur

A

soft ejection systolic murmur less than grade 2 heard over the second left intercostal space associated with ASD but no wide fixed split of the second heart sound

84
Q

what is a venous hum

A

continuous murmur with diastolic accentuation heard below the right clavicle and radiating to the base. often loud grade three intensity decreases when supine and can be obliterated by gentle neck compression.

85
Q

what is a neonatal physiological peripheral artery stenosis murmur

A

maximal over the upper left sternal edge and usually less than grade 2. Radiates throughout the thorax to both axillae and to the back. most disappear by 6 months of age and all disappear by a year.

86
Q

what are the signs of a pathological murmur

A

pan systolic murmur
intensity greater than grade 3
intensity maximal at the left sternal edge
posterior propagation of the murmur
hearth quality
early or mid systolic click
abnormal second heart sound

87
Q

after listening to the heart what do you need to do

A

feel for hepatomegaly
femoral pulses
blood pressure
height and weight

88
Q

what causes cyanosis in the first week of life

A

transposition of the great arteries
total common mixing: total Av canal defect, truncus arteriosus
Total pulmonary atresia- duct dependent pulmonary circulation
tricuspid atresia- duct dependent pulmonary circulation
tricuspid regurgitation and Ebsteins anomaly with right to left shunt via ASD

89
Q

what are the non cardiac causes of cyanosis in the neonatal period

A

respiratory, persistent pulmonary hypertension of the newborn
metabolic
haematological
sepsis

90
Q

what cyanosis in neonate presents after the first week of life

A

tetralology of Fallot and total anomalous pulmonary venous drainage

91
Q

what causes heart failure in the neonatal period

A

hypo plastic left heart syndrome
coarctation
critical aortic stenosis
tricuspid atresia
interrupted aortic arch

92
Q

what causes heart failure in infancy

A

VSD
AVSD
large PDA
TAPVD

93
Q

what causes heart failure at any age

A

SVT
Myocarditis
cardiomyopathy

94
Q

what are the signs of heart failure

A

breathless
poor feeding
sweating
recurrent chest infections

95
Q

what are the symptoms of heart failure

A

failure to thrive
tachypnoea
tachycardia
cardiomegaly
murmur/ gallop rhythm
hepatomegaly
cool peripheries

96
Q

what are the causes of hypertension

A

cardiac (coarctation)
renal reflux nephropathy secondary to urinary tract infections
catecholamine excess- neuroblastoma, pheochromocytoma

97
Q

how do cardiac arrhymias present

A

syncope (pallor), and fits (turn blue)

98
Q

causes of cardiac arrhythmias

A

supra ventricular tachycardia
prolonged PR interval (down-ganong-levene)
prolonged QT syndrome

99
Q

what are the causes of stroke in children

A

(presents in fit, TIA, stroke)
emboli (right to left shunt)
thrombosis (polycythemia)
cerebral abscess

100
Q

what causes a cyanotic spell

A

fallots infundibular spasm spelling

101
Q

what are some cardiac causes of increased chest infections

A

ASD, VSD and TAPVD (due to increased pulmonary blood flow and congestion)

102
Q

what are you looking for in ECG

A

long QT interval

103
Q

what is downs syndrome associated with

A

AVSD, VSD and ASD

104
Q

turners syndrome is associated with which CHD

A

coarctation and aortic stenosis

105
Q

what is cri du chat syndrome associated with

A

VSD

106
Q

what does Williams syndrome

A

supravalvular aortic stenosis peripheral pulmonary stenosis

107
Q

what is associated with Noonans syndrome

A

pulmonary stenosis

108
Q

what is inter-uterine rubella infection associated with

A

PDA, septal defects peripheral pulmonary valve stenosis

109
Q

are the maternal disease associated with CHD

A

diabetes (all CHD especially septal hypertrophy)
lupus (congenital heart block)

110
Q

what effect might taking anticonvulsants during pregnancy have on the baby

A

AS, PS, and coarctation

111
Q

what does alcohol in pregnancy might do to baby’s heart

A

septal defects

112
Q

what are ABGs useful for

A

essentail to confirm central cyanosis

113
Q

what is the hyperopic test

A

taking baseline ABG then after 10 minutes exposure to 100% o2

114
Q

what other tests are helpful to order in CVD

A

ECG, ECHO, cardiac cauterisation

115
Q

what is the medication given in SVT

A

adenosine

116
Q

what are the 6 causes of acynotic heart disease

A

three holes (VSD, ASD, and PDA remember they are all left to right shunts)
three blocked pipes pulmonary stenosis, coarctation of the aorta, and aortic stenosis

117
Q

what are the three causes of cyanotic heart disease

A

three blue babies (TGA, TOF, and pulmonary atresia)

Clinical Paediatric Examination (11 decks)

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