cardiology Flashcards
what are the presentations of CHD
CHF cyanosis murmur rhythm disturbances other (i.e family hx, screening)
what are the causes of CHF
- volume overload–preload
- pressure load–afterload
- myocardial causes
- -inotropy/contractility
- -chronotropy/heart rate
- -lusitropy/relaxation
what affects pressure load/afterload in the heart
- outlet obstruction
- -coarctation of the aorta
- -aortic stenosis
- -interruption of the aorta
- -HLHS
- -pulmonary stenosis - inlet obstruction
- -mitral stenosis
- -TAPVC
what causes increased volume load/preload in the heart
- shunts
- -ASD, AVSD, VSD, PDA, TAPVC - anemia
- AV valve regurg
- AV malformation
- sepsis
- complex
what causes myocardial problems in the heart
- arrhythmias
- sepsis
- viral
- metabolic
- asphyxia
- cardiomyopathy
- coronary arteries
- kawasaki disease
- rheumatic fever
- adriamycin
- post-op
if all pulses are poor, you think…
myocardial problem
if there is a palpable paradox pulse, you think…
pericardial fluid
if there are bounding pulses, you think…
run off lesion or sepsis
i.e PDA, truncus arteriosus, aortic interruption, AVM
if femoral pulses are weaker than radials, you think…
coarctation of the aorta with or without other lesions
if right brachial pulse is the only palpable pulse you think…
aortic interruption
if all pulses are decreased, with left brachial more than right, you think…
HLHS (hypoplastic left heart syndrome)
what are important points on history of the child with suspected CHD
FEEDING DIFFICULTIES
breathing difficulties
sweating
syncope
family hx
when should you worry about syncope
if the patient has….
no typical prodrome
abnormal cardiac exam
abnormal ECG
it is exertional syncope
family history of sudden death
what are the key points on physical exam for a murmur
growth parameters femoral pulses saturations second heart sound axillae
what features suggest a normal murmur
normal history normal peripheral exam not diastolic no thrill normal S2 usually low pitched, ejection
what % of kids have a murmur at some point
80%
will you always have a murmur when you have CHD
no
significant CHD can exist without murmur i.e large VSD or coarctation
is a murmur a diagnosis
NO
it is a physical sign
should you reassure or should you refer?
false reassurance is more dangerous than a “soft referral”
what are shunt lesions? in what pattern do symptoms of shunt lesions appear?
communications between systemic and pulmonary circulations
intracardiac shunts require pulmonary vascular resistance to FALL to become symptomatic
usually a GRADUAL onset of symptoms
how do rate and rhythm differ between pediatric and adult ecgs
in paeds–
rates are variable with wide range of normal
sinus arrhythmia is common
is the right side or left side of the heart dominant in babies?
right side
see this on ecg
right sided dominance regresses over the first decade, particularly over the first few months –> T WAVES INVERTED IN PRECORDIAL LEADS
prominent mid precordial voltages common
do you worry as much about ST elevation in paedatric ECGS
no–ST elevation is common
what leads do you use to check axis
I and aVF
R wave is mostly positive in I and aVF—this means…
normal axis
lies between 0 and +90 degrees
R wave is positive in I and negative in aVF–this means…
unclear, need more info
lies between 0 and -90 degrees… could be normal or could be left axis deviation
- -look at lead 2
- -if positive…normal
- -if negative…left axis deviation
R wave is negative in I and positive in aVF–this means…
right axis deviation
R wave is negative in both I and aVF
either far right or far left axis deviation
what is a “superior axis” on ECG
means leftward/left axis deviation
on ECG, if you have left axis deviation plus RVH, you think…
AVSD or complex
on ECG, if you have left axis deviation and LVH, you think…
tricuspid atresia
on ECG, if you have Q waves in I, aVL, V4-6 with left axis, LVH, you think…
anomalous left coronary
on ECG, if you have decreased RV forces, you think…
hypoplastic right side
*ebsteins if giant P wave in II
on ECG, if you have normal ECG but cyanosis clinically, you think…
transposition of the great arteries
on ECG, if you have RVH plus poor femorals, you think…
coarctation of the aorta
on ECG, if you have LVH plus poor pulses, you think…
aortic stenosis
on ECG, if you have ST changes or low voltages, you think…
myocardial problem
reading rate on ECG, what is the trick?
large lines… 300–150–100–75–60–50.
how do you assess rhythm on the ECG
regular or irregular
if irregular, how irregular
relationship of P waves to QRS complexes
how do you assess P waves in the ECG (what are you looking for?)
large upright P wave in II or V1 suggests right atrial enlargement
broad P wave in II or prominent negative in V1 suggests LAE
what are you looking at with the QRS complex?
width
R/S progression
Q, R and S
