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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
pulse: absent radial pulse
congenital malformation
26
what are the normal ranges for pulse rate in 2,2-6, greater than 6
0-2: 80-140 2-6: 75-120 greater than 6: 70-110
27
what are the causes of bradycardia
junior athletes, drugs (beta blockers or digoxin, complete heart block, eating disorder, sleep
28
causes of tachycardia
sinus tachycardia in an anxious child super ventricular tachycardia WPW
29
what are the different types of pulse rhythm
regular, regularly irregular, irregular irregular
30
irregular irregular pulse causation
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
31
when commenting on the pulse what are you describing?
rhythm, volume, and character
32
what causes a regularly irregular pulse rhythm
pulsus bigeminous coupled extrasystoles (digoxin toxicity)
33
what causes a small volume pulse
pump failure (heart) shock outflow obstruction (AS or pericardial effusion)
34
what causes large volume pulses
anaemia, CO2 retention, thyrotoxicosis
35
what causes varying volume pulses
extrasystoles, AFib, and incomplete heart block
36
what terms would you use for the character of the pulse/
normal, slow rising (moderate to severe aortic stenosis, collapsing, (aortic incompetence, patent ductus arteriosus) bisferiens
37
what is an abormal pulsus paradoxus
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)
38
what causes a rapidly rising, ill-sustained jerky pulse
HOCM
39
what do you check the femoral pulses for/
absence of femoral pulses can be indicative of a coarctation.
40
what re you looking for at the suprasternal notch
gentle palpation will detect a thrill in Aortic stenosis
41
describe how to take a blood pressure
the cut must cover at least 2/3 of the upper arm with a bladder that completely encircles the arm.
42
which side do you check the rate, rhythm and character of the pulse
right brachial
43
what are you looking for with palpation?
position the apex beat, quality, thrills, and palpable heart sounds
44
describe how to find the apex beat
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.
45
what causes the apex beat to be displaced to the left
cardiomegaly, scoliosis and pectus excavated
46
what causes the apex beat to be displaced to the right
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,
47
What words would you use to describe the quality of the apex beat?
sustained forceful thrusting parasternal heave
48
what does a sustained apex beat
with pressure overload in aortic stenosis
49
what does a forceful apex beat
left ventricular hypertrophy
50
what does a thrusting apex beat mean
with volume overload, an active large large stroke volume ventricle in the mitral or aortic incompetence or left to right shunt
51
what does a parasternal heave mean when palpating the apex
right ventricular hypertrophy
52
what does the addition of a thrill mean with categorising a murmur using the number classification system?
the murmer will be at least 4/6 intensity
53
what does it mean if you feel a systolic thrill along the lower left sternal edge
VSD
54
what if you feel a thrill in the upper left sternal edge
pulmonary stenosis
55
what does a palpable heart sound mean
a second heart sound reflects pulmonary hypertension
56
what is a collapsing pulse associated with
aortic incompetence
57
what does a suprasternal thrill mean
aortic stenosis
58
what sound you be doing while auculating the four areas of the heart
palpate the right brachial pulse
59
what are the four main areas of the heart that you should be listening to
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
in auscultation which part should you start from?
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
if you hear a murmur radiate to the back what should that flag for you
innocent murmurs do not radiate to the back murmurs of pulmonary stenosis however do radiate to the back
62
if the murmur is loudest on expiration what does that mean
left sided heart disease
63
what is the murmur is loudest on inspiration what does that mean
right sided heart disease
64
what does the first heart sound correspond with
the sudden cessation of the mitral and tricuspid flow due to valve closure
65
what does the second heart sound corresponds with
the sudden cessation of aortic and pulmonary flow due to valve closure
66
is it normal to have a split second heart sound
in inspiration it is normal, but not in expiration
67
what are the causes of a loud first heart sound
ASD, mechanical valve, mitral stenosis (rare)
68
what causes variable loudness of the first heart sound
heart block or atrial fibrillation
69
what is a loud second heart sound mean
increased pulmonary flow (PDA, ASD, large VSD) pulmonary hypertension
70
what causes a fixed split second heart sound
ASD
71
what causes a widely spilt second heart sound
ASD, PS, right bundle branch block
72
what causes reversed splitting (widening on expiration)
severe AS, left bundle branch block
73
what causes a single second heart sound
tetralogy of Fallot pulmonary stenosis
74
what causes a split second heart sound
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
what causes single second sound
tetralogy of Fallot pulmonary stenosis
76
what causes a third heart sound
rapid ventricular filling (normal) best heard with the bell over the apex also heard in failure of wither ventricles
77
what causes a fourth heart sound
never a normal finding precedes first heart sound failure of wither ventricle pulmonary hypertension
78
what causes an opening snap
after the second sound high pitched mitral stenosis
79
what causes an ejection click
after the first sound high pitched early systole aortic or pulmonary stenosis
80
what are the things you have to think about when describing a murmur
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
what are the 10 signs of a normal murmur
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
what is a stills murmur
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
what is a pulmonary flow murmur
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
what is a venous hum
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
what is a neonatal physiological peripheral artery stenosis murmur
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
what are the signs of a pathological murmur
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
after listening to the heart what do you need to do
feel for hepatomegaly femoral pulses blood pressure height and weight
88
what causes cyanosis in the first week of life
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
what are the non cardiac causes of cyanosis in the neonatal period
respiratory, persistent pulmonary hypertension of the newborn metabolic haematological sepsis
90
what cyanosis in neonate presents after the first week of life
tetralology of Fallot and total anomalous pulmonary venous drainage
91
what causes heart failure in the neonatal period
hypo plastic left heart syndrome coarctation critical aortic stenosis tricuspid atresia interrupted aortic arch
92
what causes heart failure in infancy
VSD AVSD large PDA TAPVD
93
what causes heart failure at any age
SVT Myocarditis cardiomyopathy
94
what are the signs of heart failure
breathless poor feeding sweating recurrent chest infections
95
what are the symptoms of heart failure
failure to thrive tachypnoea tachycardia cardiomegaly murmur/ gallop rhythm hepatomegaly cool peripheries
96
what are the causes of hypertension
cardiac (coarctation) renal reflux nephropathy secondary to urinary tract infections catecholamine excess- neuroblastoma, pheochromocytoma
97
how do cardiac arrhymias present
syncope (pallor), and fits (turn blue)
98
causes of cardiac arrhythmias
supra ventricular tachycardia prolonged PR interval (down-ganong-levene) prolonged QT syndrome
99
what are the causes of stroke in children
(presents in fit, TIA, stroke) emboli (right to left shunt) thrombosis (polycythemia) cerebral abscess
100
what causes a cyanotic spell
fallots infundibular spasm spelling
101
what are some cardiac causes of increased chest infections
ASD, VSD and TAPVD (due to increased pulmonary blood flow and congestion)
102
what are you looking for in ECG
long QT interval
103
what is downs syndrome associated with
AVSD, VSD and ASD
104
turners syndrome is associated with which CHD
coarctation and aortic stenosis
105
what is cri du chat syndrome associated with
VSD
106
what does Williams syndrome
supravalvular aortic stenosis peripheral pulmonary stenosis
107
what is associated with Noonans syndrome
pulmonary stenosis
108
what is inter-uterine rubella infection associated with
PDA, septal defects peripheral pulmonary valve stenosis
109
are the maternal disease associated with CHD
diabetes (all CHD especially septal hypertrophy) lupus (congenital heart block)
110
what effect might taking anticonvulsants during pregnancy have on the baby
AS, PS, and coarctation
111
what does alcohol in pregnancy might do to baby's heart
septal defects
112
what are ABGs useful for
essentail to confirm central cyanosis
113
what is the hyperopic test
taking baseline ABG then after 10 minutes exposure to 100% o2
114
what other tests are helpful to order in CVD
ECG, ECHO, cardiac cauterisation
115
what is the medication given in SVT
adenosine
116
what are the 6 causes of acynotic heart disease
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
what are the three causes of cyanotic heart disease
three blue babies (TGA, TOF, and pulmonary atresia)

Clinical Paediatric Examination (11 decks)

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