Cardiology Flashcards
S1 is best heard where?
Apex
LLSB
S2 is best heard where?
Base
LUSB
Define sinus arrhythmia
Irregular rhythm related to respiration:
Increase rate with inspiration
Decrease rate with expiration
What does a widely split S2 indicate?
- Electrical delay: RBBB
- VSD repair
*can be a normal variant
What does a narrowed Split S2 indicate?
Pulmonary HTN
Loud S2
What does a Fixed Split S2 indicate?
Volume Overload: ASD
What does a Paradoxical Split (on expiration only) indicate?
LBBB
When would you hear S3?
EARLY diastole
What does an S3 heart sound indicate?
Rapid ventricular filling/volume overload
Common variant in children
Abnormal in adults
When would you hear an S4 heart sound?
LATE diastole
What does an S4 heart sound indicate?
Pathological
Obstruction, decreased ventricular compliance: HTN, Cardiomyopathy
When/where would you hear Aortic Stenosis?
Early systole
Apex
NO changes with respiration (pulmonary stenosis there is)
Causes for Frictional Rubs
- Percarditis
2. Post Pericardiotomy Syndrome (post ASD repair)
Pericarditis EKG findings
- PR depression
2. Diffuse ST elevation
Continuous murmur Ddx
- Patent Ductus Arteriosus (PDA)
- Venous Hum Murmur
- Coronary Fistula (rare)
What murmur INCREASES with supine?
Innocent heart murmur
What murmur INCREASES with sitting?
Venous hum murmur
What murmur INCREASES with Standing?
HCM
Mitral Valve Prolapse
What murmur INCREASES with Valsalva?
HCM
What is the MC innocent heart murmur?
Stills murmur
Describe the sound of a Still murmur
- Low frequency
- Musical
- Vibratory
- Systolic
When is a Still’s murmur the loudest?
- Supine
2. Stress: fever
When is a Venous Hum murmur the loudest?
Upright position
When does a Venous Hum murmur decrease?
- Supine
2. Turning neck
Describe the sound of Pulmonary Stenosis
Mid-Systolic Ejection murmur @ LUSB (NO click)
Radiates to axilla or back
What age is Pulmonary Stenosis MC in?
Newborns/infants
Preterm
Define Acrocyanosis
Peripheral Cyanosis
Benign
Vasospams of small arterioles
Normal saturation & PaO2
Acrocyanosis management
Reassurance
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
CXR findings in a Left to Right shunt
“West lungs”
Cardiomegaly
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
What does a “grey baby” indicate?
Decreased or no systemic blood flow
No pulse, no capillary refill
Acyanotic Defects si/sx’s
HF sx’s: Left to right shunt
- Tachypnea, SOB
- Hepatomegaly
- Gallop
- Feeding intolerance
- Increased Pulmonary Infections
CXR findings in Acyanotic Defects
- Cardiomegaly (volume overload)
- Increased pulmonary blood flow: “Wet lungs”
- Enlarged pulmonary artery
Acyanotic Defect treatment
- ACE-I
- Duiretic
- Digoxin
Define atrial septal defect (ASD)
Right heart volume overload
Secundum=Classic type
ASD murmur findings
Fixed or Widen S2 pulmonary component @ LUSB
No atrial shunt murmur!!!
ASD of what size will likely NOT close on it’s own?
> 8 mm
Define Ventricular Septal Defect (VSD)
Left heart Volume Overload
VSD heart murmur findings
Harsh, Holosystolic murmur @ mid-LSB
List the two types of VSD
- Perimembranous
2. Muscular
Perimembranous VSD treatment
Usually No intervention
Large: Surgery if sx’s or heart enlargement
Muscular VSD treatment
No intervention
Closes over time
Patent Ductus Arterioles (PDA) heart murmur findings
Continuous, MACHINERY murmur
Systolic>Diastolic
PDA physical exam findings
- Pulses: Widen pulse pressure, Bounding pulses
2. HF sx’s
Non-Cyanotic PDA treatment
Indomethacin: closure
Cyanotic PDA treatment
PGE’s
What is Atrioventricular Canal Defect associated with?
Trisomy 21 (Down syndrome)
Atrioventricular Canal Defect si/sx’s
- Pulmonary HTN
2. HF sx’s
Atrioventricular Canal Defect EKG findings
Superior QRS axis
Atrioventricular Canal Defect treatment
Surgical repair @ 4-5 months of age
What treatment does Cyanotic Heart defects require?
PGE’s!
@ what O2 saturation is visible cyanosis?
85%
What are the two basic mechanisms for Cyanosis?
- Lung: Inadequate alveolar ventilation (pneumonia)
2. Cardiac: Desaturated blood bypasses lungs to be oxygenated (does not improve with oxygen)
When does the PDA Functionally close?
@ 12-90 hrs
When does the PDA Anatomically close?
@ 2-3 weeks
Obstruction to pulmonary blood flow si/sx’s
- Cyanosis, hypoxia
- Decreased O2 sats
- CXR: Decreased PBF (black lungs)
Obstruction to systemic blood flow si/sx’s
- Cardiac shock: Decreased CO
- Increased lactate
- Weak, thready pulses
- Narrow pulse pressure
What is the goal saturation in a single ventricle?
75-90%
What is normal pre-ductal and post-ductal pulse ox sats?
95%= Passed Pulse Oximetry Screen for Congenital Heart defects
What is Truncus Arteriosus associated with?
DiGeorge Syndrome
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
CXR findings in Transposition of the Great Arteries (TGA)
“Egg on String”
Hypoxia with increased PBF
Transposition of the Great Arteries (TGA) treatment
Urgent transfer to Children’s Hospital
Surgical
What are the 4 components of Tetrology of Fallot?
- VSD
- RVH
- Overriding Aorta
- Pulmonary Stenosis
Tetrology of Fallot murmur findings
Harsh, Systolic murmur @ LUSB
CXR findings in Tetrology of Fallot
“Boot shaped”
TET spells
Fussy, cyanotic
loss of systolic heart murmur
TET spell treatment
- Oxygen
- IV NS bolus
- “Knee to chest” maneuver
- Morphine
- Propranolol
Tetrology of Fallot treatment
Surgical
TAPVR CXR findings
“Snowman”
Pulmonary venous congestion: white lungs
TAPVR treatment
Surgical Emergency! Obstruction
What is Ebstein’s Anomaly associated with?
Wolf Parkinson’s White
Ebstein’s Anomaly EKG findings
Pre-excitation pattern:
- Shortened PR interval
- Delta wave
- Prolonged QRS
Obstruction to pulmonary Blood Flow etiology
- Pulmonary stenosis
- Pulmonary Atresia
*Severe: PGE tx
Obstruction to systemic Blood Flow etiology
- Aortic stenosis
- Coarcation of Aorta
*Severe: PGE tx
Pulmonary stenosis findings
- Murmur: Hars, systolic ejection murmur @ LUSB. Click loudest w/ inspiration
- EKG: RVH
- Hypoxia
Pulmonary stenosis treatment
- PGE: maintains PBF
2. Cath lab: balloon valvuloplasty
Aortic stenosis findings
- Murmur: Systolic ejection murmur @ RUSB. Click has no respiratory variation
- EKG: LVH
- Concentric LV hypertrophy
Aortic stenosis treatment
- PGE
- Mild: monitor
- Surgical
- Balloon valvuloplasty
BP findings in Coarctation of Aorta
BP: >20 mmgHg
Increased UE
Decreased LE
Coarctation of Aorta treatment
PGE
What is Coarctation of Aorta associated with?
Turner’s syndrome
What lipid levels do you refer kids out?
- TC>200
- TG>200
- LDL>130