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Peds I & II > Cardiology > Flashcards

Cardiology Flashcards

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1
Q

S1 is best heard where?

A

Apex

LLSB

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2
Q

S2 is best heard where?

A

Base

LUSB

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3
Q

Define sinus arrhythmia

A

Irregular rhythm related to respiration:
Increase rate with inspiration
Decrease rate with expiration

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4
Q

What does a widely split S2 indicate?

A
  1. Electrical delay: RBBB
  2. VSD repair

*can be a normal variant

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5
Q

What does a narrowed Split S2 indicate?

A

Pulmonary HTN

Loud S2

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6
Q

What does a Fixed Split S2 indicate?

A

Volume Overload: ASD

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7
Q

What does a Paradoxical Split (on expiration only) indicate?

A

LBBB

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8
Q

When would you hear S3?

A

EARLY diastole

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9
Q

What does an S3 heart sound indicate?

A

Rapid ventricular filling/volume overload
Common variant in children
Abnormal in adults

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10
Q

When would you hear an S4 heart sound?

A

LATE diastole

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11
Q

What does an S4 heart sound indicate?

A

Pathological

Obstruction, decreased ventricular compliance: HTN, Cardiomyopathy

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12
Q

When/where would you hear Aortic Stenosis?

A

Early systole
Apex
NO changes with respiration (pulmonary stenosis there is)

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13
Q

Causes for Frictional Rubs

A
  1. Percarditis

2. Post Pericardiotomy Syndrome (post ASD repair)

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14
Q

Pericarditis EKG findings

A
  1. PR depression

2. Diffuse ST elevation

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15
Q

Continuous murmur Ddx

A
  1. Patent Ductus Arteriosus (PDA)
  2. Venous Hum Murmur
  3. Coronary Fistula (rare)
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16
Q

What murmur INCREASES with supine?

A

Innocent heart murmur

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17
Q

What murmur INCREASES with sitting?

A

Venous hum murmur

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18
Q

What murmur INCREASES with Standing?

A

HCM

Mitral Valve Prolapse

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19
Q

What murmur INCREASES with Valsalva?

A

HCM

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20
Q

What is the MC innocent heart murmur?

A

Stills murmur

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21
Q

Describe the sound of a Still murmur

A
  1. Low frequency
  2. Musical
  3. Vibratory
  4. Systolic
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22
Q

When is a Still’s murmur the loudest?

A
  1. Supine

2. Stress: fever

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23
Q

When is a Venous Hum murmur the loudest?

A

Upright position

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24
Q

When does a Venous Hum murmur decrease?

A
  1. Supine

2. Turning neck

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25
Describe the sound of Pulmonary Stenosis
Mid-Systolic Ejection murmur @ LUSB (NO click) | Radiates to axilla or back
26
What age is Pulmonary Stenosis MC in?
Newborns/infants | Preterm
27
Define Acrocyanosis
Peripheral Cyanosis Benign Vasospams of small arterioles Normal saturation & PaO2
28
Acrocyanosis management
Reassurance
29
What kind of shunt does Tachypnea indicate?
L>R shunt | Red blood is being mixed with blue lungs=more blood going to lungs=breath faster
30
CXR findings in a Left to Right shunt
"West lungs" | Cardiomegaly
31
What kind of shunt does Cyanosis indicate?
R>L shunt Blue blood going to left side of heart, No blood flow going to lungs Low O2
32
What does a "grey baby" indicate?
Decreased or no systemic blood flow | No pulse, no capillary refill
33
Acyanotic Defects si/sx's
HF sx's: Left to right shunt 1. Tachypnea, SOB 2. Hepatomegaly 3. Gallop 4. Feeding intolerance 5. Increased Pulmonary Infections
34
CXR findings in Acyanotic Defects
1. Cardiomegaly (volume overload) 2. Increased pulmonary blood flow: "Wet lungs" 3. Enlarged pulmonary artery
35
Acyanotic Defect treatment
1. ACE-I 2. Duiretic 3. Digoxin
36
Define atrial septal defect (ASD)
Right heart volume overload | Secundum=Classic type
37
ASD murmur findings
Fixed or Widen S2 pulmonary component @ LUSB | No atrial shunt murmur!!!
38
ASD of what size will likely NOT close on it's own?
>8 mm
39
Define Ventricular Septal Defect (VSD)
Left heart Volume Overload
40
VSD heart murmur findings
Harsh, Holosystolic murmur @ mid-LSB
41
List the two types of VSD
1. Perimembranous | 2. Muscular
42
Perimembranous VSD treatment
Usually No intervention | Large: Surgery if sx's or heart enlargement
43
Muscular VSD treatment
No intervention | Closes over time
44
Patent Ductus Arterioles (PDA) heart murmur findings
Continuous, MACHINERY murmur | Systolic>Diastolic
45
PDA physical exam findings
1. Pulses: Widen pulse pressure, Bounding pulses | 2. HF sx's
46
Non-Cyanotic PDA treatment
Indomethacin: closure
47
Cyanotic PDA treatment
PGE's
48
What is Atrioventricular Canal Defect associated with?
Trisomy 21 (Down syndrome)
49
Atrioventricular Canal Defect si/sx's
1. Pulmonary HTN | 2. HF sx's
50
Atrioventricular Canal Defect EKG findings
Superior QRS axis
51
Atrioventricular Canal Defect treatment
Surgical repair @ 4-5 months of age
52
What treatment does Cyanotic Heart defects require?
PGE's!
53
@ what O2 saturation is visible cyanosis?
85%
54
What are the two basic mechanisms for Cyanosis?
1. Lung: Inadequate alveolar ventilation (pneumonia) | 2. Cardiac: Desaturated blood bypasses lungs to be oxygenated (does not improve with oxygen)
55
When does the PDA Functionally close?
@ 12-90 hrs
56
When does the PDA Anatomically close?
@ 2-3 weeks
57
Obstruction to pulmonary blood flow si/sx's
1. Cyanosis, hypoxia 2. Decreased O2 sats 3. CXR: Decreased PBF (black lungs)
58
Obstruction to systemic blood flow si/sx's
1. Cardiac shock: Decreased CO 2. Increased lactate 3. Weak, thready pulses 4. Narrow pulse pressure
59
What is the goal saturation in a single ventricle?
75-90%
60
What is normal pre-ductal and post-ductal pulse ox sats?
95%= Passed Pulse Oximetry Screen for Congenital Heart defects
61
What is Truncus Arteriosus associated with?
DiGeorge Syndrome
62
DiGeorge Syndrome si/sx's
``` CATCH 22: C-Cardiac anomaly A-Abnormal faceis T-Thymus atresia (T-cell problems) C-Cleft palate H-Hypocalcemia ``` 22q.11.2 microdeletion
63
CXR findings in Transposition of the Great Arteries (TGA)
"Egg on String" | Hypoxia with increased PBF
64
Transposition of the Great Arteries (TGA) treatment
Urgent transfer to Children's Hospital | Surgical
65
What are the 4 components of Tetrology of Fallot?
1. VSD 2. RVH 3. Overriding Aorta 4. Pulmonary Stenosis
66
Tetrology of Fallot murmur findings
Harsh, Systolic murmur @ LUSB
67
CXR findings in Tetrology of Fallot
"Boot shaped"
68
TET spells
Fussy, cyanotic | loss of systolic heart murmur
69
TET spell treatment
1. Oxygen 2. IV NS bolus 3. "Knee to chest" maneuver 4. Morphine 5. Propranolol
70
Tetrology of Fallot treatment
Surgical
71
TAPVR CXR findings
"Snowman" | Pulmonary venous congestion: white lungs
72
TAPVR treatment
Surgical Emergency! Obstruction
73
What is Ebstein's Anomaly associated with?
Wolf Parkinson's White
74
Ebstein's Anomaly EKG findings
Pre-excitation pattern: 1. Shortened PR interval 2. Delta wave 3. Prolonged QRS
75
Obstruction to pulmonary Blood Flow etiology
1. Pulmonary stenosis 2. Pulmonary Atresia *Severe: PGE tx
76
Obstruction to systemic Blood Flow etiology
1. Aortic stenosis 2. Coarcation of Aorta *Severe: PGE tx
77
Pulmonary stenosis findings
1. Murmur: Hars, systolic ejection murmur @ LUSB. Click loudest w/ inspiration 2. EKG: RVH 3. Hypoxia
78
Pulmonary stenosis treatment
1. PGE: maintains PBF | 2. Cath lab: balloon valvuloplasty
79
Aortic stenosis findings
1. Murmur: Systolic ejection murmur @ RUSB. Click has no respiratory variation 2. EKG: LVH 3. Concentric LV hypertrophy
80
Aortic stenosis treatment
1. PGE 2. Mild: monitor 3. Surgical 4. Balloon valvuloplasty
81
BP findings in Coarctation of Aorta
BP: >20 mmgHg Increased UE Decreased LE
82
Coarctation of Aorta treatment
PGE
83
What is Coarctation of Aorta associated with?
Turner's syndrome
84
What lipid levels do you refer kids out?
1. TC>200 2. TG>200 3. LDL>130

Peds I & II (8 decks)

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