Cardiology Flashcards
Name 8 cyanotic congenital cardiac lesions
T5 (transposition of the great arteries, truncus arteriosus, tricuspid atresia, total anomalous pulmonary venous return, tetralogy of Fallot), EHP (Ebstein’s anomaly, hypoplastic left heart, pulmonary atresia)
What are the following hand signs classically signs of? Long tapering fingers Short fourth and fifth metacarpals Radial abnormalities Arachnodactyly Polydactyly Overlapping fingers Hyperconvex/hypoplastic nails Single palmar crease
Long tapering fingers: DiGeorge Short fourth and fifth metacarpals: Turner Radial abnormalities: VACTERL syndrome Arachnodactyly: Marfan Polydactyly: trisomy 13 Overlapping fingers: trisomy 18 Hyperconvex/hypoplastic nails: Turner IE: clubbing, splinters, Osler’s nodes and Janeway lesions Single palmar crease: Down syndrome, familial
Rule of thumb for estimating the upper limit of systolic BP according to child’s age?
Upper limit of systolic BP: 90 + 2(child’s age)
Normal systolic BP range for the following age groups: Newborn Mean BP Infancy Preschool School age >12 years
Newborn Mean BP ≥ gestation in weeks Infancy 80 – 95 mmHg systolic Preschool 80 – 100 mmHg systolic School age 90 – 110 mmHg systolic >12 years 110-120 mmHg systolic
Normal HR ranges for the following ages? Pulse Rate 12 years
12 years 60 – 100
Name three causes of a collapsing pulse character
Collapsing: AR, PDA, large AV fistula
Name two causes of a thready pulse character
CCF, shock
Give 4 causes of pulsus paradoxus
Pulsus paradoxus: cardiac tamponade/pericarditis, severe asthma/high intrathoracic pressures
Name three possible reasons for a child having a right lateral thoracotomy scar.
Right lateral thoracotomy: Modified BT shunt, Lung causes (lobectomy/biopsy), TOF repair
Name five possible reasons for a left lateral thoracotomy scar.
Left lateral thoracotomy: Modified BT shunt, Lung causes (lobectomy, biopsy), Coarctation repair, PDA ligation, Pulmonary artery banding
Causes of a median sternotomy scar?
Median sternotomy: Any bypass surgery
CVS Exam scheme
INTRODUCTION
Look around for alcohol gel and use it
Introduce yourself to parent and child
Ask for child’s name and age
Confirm who child has with them
Thank for coming to the exam
Explain that you have been asked to examine chest
Ask for permission (from parent only if young child)
Ask about any pain, tell child to stop you right away if anything you do hurts
Position +/- expose patient at 45 ° or if very young examine on parent’s lap
INSPECT
Growth
General health/comfort at rest
Dysmorphism
Paraphernalia – oxygen, feeding tubes, IV access, monitors, meds
Colour (pink, pale, cyanosed, jaundiced)
Work of breathing
Obvious scars
NB: In the small child who is quiet, consider auscultating first, but explain rationale to examiner.
HANDS/ARMS
Perfusion (cool or warm hands)
Cannula scars - ?ex-prem
Fingers/wrists for syndromic features
Nails, and make a show of looking for clubbing
Turn hand over and inspect palmar aspect
PULSES
Check both radial/brachial pulses: Symmetry, rhythm, character, COUNT RATE & RR
Consider checking for radiofemoral delay now + check for groin scars
Foot pulses in a neonate (unlikely in exam)
OFFER TO MEASURE BLOOD PRESSURE
Say you would confirm with second reading
Upper limit of systolic: 90 + 2(child’s age)
FACE
Again look for dysmorphic features
Conjunctival pallor
Oral mucosa for central cyanosis
Dental status
? high arched palate
NECK
JVP in older children
Catheter scars
Webbing, loose nuchal skin, etc
CHEST
Inspect
Expose fully where possible
Chest wall deformities
Visible impulses
Scars: lift arms/bra straps up (explain, ask permission!)
Palpate
Apex (feel for dextrocardia) location, character
Right ventricular heave
Thrills: LLSB, ULSB, URSB, suprasternal notch, carotids
Consider checking central CRT
Auscultate
Heart sounds: Both present? S1 normal? S2 normal? Is S2 louder than S1 over apex? S3 or S4?
Apex (mitral) + in left lateral position
Tricuspid, pulmonary, aortic
Listen for radiation to the neck if you hear an ESM or aortic murmur
With child leaning forward over tricuspid area
Listen (and have a last peek for missed scars) to the back: PS radiation, cardiac wheeze in infants, basal crackles
ABDOMEN
Feel for liver +/- spleen if you have time
Groin for scars if possible!
LEGS
Check for ankle oedema
TO COMPLETE MY EXAMINATION I WOULD LIKE TO:
- Measure height and weight and plot on a centile chart.
- If not done: BP, JVP, femoral pulses and radio-femoral delay, liver edge
- Saturations
- If any features of IE: fundoscopy, urine dip, spleen
- Obvious investigations to consider: CXR, ECG, echo
CVS presentation scheme
Turn to examiner and offer to complete exam with BP, JVP, saturations, etc. Give examiner a chance to ask you to proceed.
- I have examined the cardiovascular system of x-month/year-old Y.
- Y appears (comment on growth), and I would like to plot his/her growth on an appropriate centile chart.
- Paraphernalia: Oxygen, monitoring, feeding tubes, IV access, meds, etc
- Comfort at rest, effort of breathing
- Dysmorphism
- Other obvious things on general inspection, e.g.:
- Colour
- Scars
- Chest wall deformity
- Clubbing (and other obvious hand signs if present)
- Pulses: radial/brachial rate, rhythm, character, symmetry, radio-femoral delay; respiratory rate
- Face and neck signs if present: central cyanosis if not already commented, scars, ports, JVP
- On examination of the praecordium…
- Non-obvious scars
- Apex beat location/character, heaves/thrills
- Heart sounds: presence of S1,2 + additional sounds, intensity; only comment on splitting if you are very sure
- Murmurs: Grade, where in the cycle, where heard, where loudest, respiration, manoeuvres, radiation
- Lung fields, liver, oedema
- Groin scars if you got that far
- In summary, ….include comment on heart failure, cyanosis, any other apparent complications
- Differential diagnoses that I would consider…..commenting on features for/against
- Complications that I would be alert to….think nutrition, heart failure, IE, emboli, decompensation with intercurrent respiratory infections, specific problems associated with underlying syndrome if relevant…
- Baseline investigations that I would consider include….
