Cardiology Flashcards
What is a Blalock-Taussig shunt? what is scar?
A Blalock-Taussig (BT) connects arterial supply to lungs
Usually L side thoracotomy scar
What are the syndromes likely to appear in cardiac exam?
Downs, Turners, Noonan’s, di George, Marfans
What CHD is associated with Marfans?
Mitral valve prolapse/ regurgitation
Aortic regurgitation
Aortic root dilatation
What condition is associated with coarcation of the aorta?
turner’s syndrome
What CHD is associated with Downs syndrome?
VSD, AVSD, pulmonary hypertension
What condition is associated with pulmonary artery stenosis?
Noonans
What are congenital long- QT syndromes?
Romano-Ward Syndrome
Jervell-Lange-Nielsen Syndrome - a/w deafness
Absent/ strange thumb suggests what?
VACTERL syndrome (absent radii) - multiple cardiac anomalies
Holt-Oram syndrome funky radii absent thumb - ASD
What to comment on from end of bed:
Nutritional status: ‘I would like to plot his height and weight on a growth chart’
O2 tank/ sats monitor
Work of breathing: Respiratory rate, recessions Cyanosis
Dysmorphism – Down’s Williams, Digeorge Turner’s , Noonan’s, Marfans
what to check on fingers during cardiac exam?
Clubbing
Peripheral cyanosis
Splinter haemorrhages
Capillary refill
What to check on hands ?
JAneway nodes, osler lesions, xanthomas
thumb anomalies!
How to measure HR ?
radial/ brachial
(Count, rhythm, character) – count over 6 sec X10
What to comment on face?
Eyes: Sclera – Jaundice ( Congestive cardiac failure à Hepatic congestion)
Conjunctive – Pallor (Anaemia)
Face: Mitral flush / malar flush
Polycythaemia (Cyanotic heart disease à Increased haematocrit)
Tongue: Central cyanosis ( Right to left shunt/ Inadequate oxygenation in lungs)
Lips/oral mucosa: Pallor
Teeth: Dental Caries
Palate: High arch palate (Marfan’s)
What to look for on neck
JVP (in older child) can be high if hepatic congestion
What to look for on chest?
Chest wall - asymmetry? Harrison’s sulcus,
Scars - thoractomoy/ sternotomy. IF b/l thoracotomy Tetralogy of fallot repair. See slides
Visible pulsations (hyperdynamic apex beat)
Chest drain scars
Mediastinal drains
Chest wall pacemaker
Apex beat displaced to left means what?
Cardiomegaly, pectus excavatum, scoliosis
Apex beat displaced to right means what?
Congenital dextrocardia (feel for liver- Kartagener syndrome),
Left diaphragmatic hernia,
Where should you feel for thrills?
Parasternal notch - aortic stenosis
Lower left sternal edge -VSD
Upper left sternal edge- pulmonary stenosis
If you hear a murmur how should you describe it?
– Systolic / diastolic murmur
– Site
– Loudness (Grade 1-6)
– Radiation
– Character: harsh, blowing, high-pitched, low-pitched
What murmurs can be heard at upper left sternal edge?
Ejection systolic - Pulmonary stenosis
Diastolic- Aortic regurgitation, pulmonary regurgitation
What murmur can be heard at lower left sternal edge?
Pansystolic: Tricuspid regurgitation
VSD
Diastolic: Tricuspid stenosis
Aortic regurgitation
Still’s murmur
What murmur can be heard at the apex?
Pansystolic: Mitral regurgitation
VSD
Late systolic: Mitral Valve Prolapse
Mid-diastolic: Mitral stenosis
What murmur can be heard at upper right sternal edge?
Ejection systolic: Aortic stenosis
Continuous: Rt BT shunt
Venous hum
Where to also auscultate and why?
- Axillary area (if there is murmur at Apex or LUSE)
– Back (If there is murmur at LUSE)
– Neck (if there is murmur at RUSE) - AS radiates to corotid
How do you differentiate between aortic stenosis and pulmonary stenosis?
Murmurs louds in expiration à Left heart disease à Aortic stenosis
Murmurs loudest in inspiration à Right heart disease à Pulmonary stenosis
Complete this sentence: I would like to complete my cardiac examination by :
Feeling for hepatomegaly
Feeling for femoral pulses and looking for scars on inguinal area for cardiac catheterisation/ arterial lines
Measure blood pressure and oxygen saturation (if not mentioned earlier )
Measure height and weight and plot on growth chart appropriate for age and size
Feeling for peripheral and sacral oedema
Auscultate lung bases (if not done earlier)
What are salient points of cardiac exam?
Cyanosis/Pink
Stable/not in respiratory distress
Clubbing
Scars
Heart sounds I + II + murmur (grade)
