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Peds I & II > Cardiology > Flashcards

Cardiology Flashcards

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
Q

Describe the sound of Pulmonary Stenosis

A

Mid-Systolic Ejection murmur @ LUSB (NO click)

Radiates to axilla or back

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26
Q

What age is Pulmonary Stenosis MC in?

A

Newborns/infants

Preterm

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27
Q

Define Acrocyanosis

A

Peripheral Cyanosis
Benign
Vasospams of small arterioles
Normal saturation & PaO2

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28
Q

Acrocyanosis management

A

Reassurance

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29
Q

What kind of shunt does Tachypnea indicate?

A

L>R shunt

Red blood is being mixed with blue lungs=more blood going to lungs=breath faster

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30
Q

CXR findings in a Left to Right shunt

A

“West lungs”

Cardiomegaly

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31
Q

What kind of shunt does Cyanosis indicate?

A

R>L shunt
Blue blood going to left side of heart, No blood flow going to lungs
Low O2

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32
Q

What does a “grey baby” indicate?

A

Decreased or no systemic blood flow

No pulse, no capillary refill

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33
Q

Acyanotic Defects si/sx’s

A

HF sx’s: Left to right shunt

  1. Tachypnea, SOB
  2. Hepatomegaly
  3. Gallop
  4. Feeding intolerance
  5. Increased Pulmonary Infections
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34
Q

CXR findings in Acyanotic Defects

A
  1. Cardiomegaly (volume overload)
  2. Increased pulmonary blood flow: “Wet lungs”
  3. Enlarged pulmonary artery
35
Q

Acyanotic Defect treatment

A
  1. ACE-I
  2. Duiretic
  3. Digoxin
36
Q

Define atrial septal defect (ASD)

A

Right heart volume overload

Secundum=Classic type

37
Q

ASD murmur findings

A

Fixed or Widen S2 pulmonary component @ LUSB

No atrial shunt murmur!!!

38
Q

ASD of what size will likely NOT close on it’s own?

A

> 8 mm

39
Q

Define Ventricular Septal Defect (VSD)

A

Left heart Volume Overload

40
Q

VSD heart murmur findings

A

Harsh, Holosystolic murmur @ mid-LSB

41
Q

List the two types of VSD

A
  1. Perimembranous

2. Muscular

42
Q

Perimembranous VSD treatment

A

Usually No intervention

Large: Surgery if sx’s or heart enlargement

43
Q

Muscular VSD treatment

A

No intervention

Closes over time

44
Q

Patent Ductus Arterioles (PDA) heart murmur findings

A

Continuous, MACHINERY murmur

Systolic>Diastolic

45
Q

PDA physical exam findings

A
  1. Pulses: Widen pulse pressure, Bounding pulses

2. HF sx’s

46
Q

Non-Cyanotic PDA treatment

A

Indomethacin: closure

47
Q

Cyanotic PDA treatment

A

PGE’s

48
Q

What is Atrioventricular Canal Defect associated with?

A

Trisomy 21 (Down syndrome)

49
Q

Atrioventricular Canal Defect si/sx’s

A
  1. Pulmonary HTN

2. HF sx’s

50
Q

Atrioventricular Canal Defect EKG findings

A

Superior QRS axis

51
Q

Atrioventricular Canal Defect treatment

A

Surgical repair @ 4-5 months of age

52
Q

What treatment does Cyanotic Heart defects require?

A

PGE’s!

53
Q

@ what O2 saturation is visible cyanosis?

A

85%

54
Q

What are the two basic mechanisms for Cyanosis?

A
  1. Lung: Inadequate alveolar ventilation (pneumonia)

2. Cardiac: Desaturated blood bypasses lungs to be oxygenated (does not improve with oxygen)

55
Q

When does the PDA Functionally close?

A

@ 12-90 hrs

56
Q

When does the PDA Anatomically close?

A

@ 2-3 weeks

57
Q

Obstruction to pulmonary blood flow si/sx’s

A
  1. Cyanosis, hypoxia
  2. Decreased O2 sats
  3. CXR: Decreased PBF (black lungs)
58
Q

Obstruction to systemic blood flow si/sx’s

A
  1. Cardiac shock: Decreased CO
  2. Increased lactate
  3. Weak, thready pulses
  4. Narrow pulse pressure
59
Q

What is the goal saturation in a single ventricle?

A

75-90%

60
Q

What is normal pre-ductal and post-ductal pulse ox sats?

A

95%= Passed Pulse Oximetry Screen for Congenital Heart defects

61
Q

What is Truncus Arteriosus associated with?

A

DiGeorge Syndrome

62
Q

DiGeorge Syndrome si/sx’s

A 
CATCH 22:
C-Cardiac anomaly 
A-Abnormal faceis
T-Thymus atresia (T-cell problems)
C-Cleft palate
H-Hypocalcemia

22q.11.2 microdeletion

63
Q

CXR findings in Transposition of the Great Arteries (TGA)

A

“Egg on String”

Hypoxia with increased PBF

64
Q

Transposition of the Great Arteries (TGA) treatment

A

Urgent transfer to Children’s Hospital

Surgical

65
Q

What are the 4 components of Tetrology of Fallot?

A
  1. VSD
  2. RVH
  3. Overriding Aorta
  4. Pulmonary Stenosis
66
Q

Tetrology of Fallot murmur findings

A

Harsh, Systolic murmur @ LUSB

67
Q

CXR findings in Tetrology of Fallot

A

“Boot shaped”

68
Q

TET spells

A

Fussy, cyanotic

loss of systolic heart murmur

69
Q

TET spell treatment

A
  1. Oxygen
  2. IV NS bolus
  3. “Knee to chest” maneuver
  4. Morphine
  5. Propranolol
70
Q

Tetrology of Fallot treatment

A

Surgical

71
Q

TAPVR CXR findings

A

“Snowman”

Pulmonary venous congestion: white lungs

72
Q

TAPVR treatment

A

Surgical Emergency! Obstruction

73
Q

What is Ebstein’s Anomaly associated with?

A

Wolf Parkinson’s White

74
Q

Ebstein’s Anomaly EKG findings

A

Pre-excitation pattern:

  1. Shortened PR interval
  2. Delta wave
  3. Prolonged QRS
75
Q

Obstruction to pulmonary Blood Flow etiology

A
  1. Pulmonary stenosis
  2. Pulmonary Atresia

*Severe: PGE tx

76
Q

Obstruction to systemic Blood Flow etiology

A
  1. Aortic stenosis
  2. Coarcation of Aorta

*Severe: PGE tx

77
Q

Pulmonary stenosis findings

A
  1. Murmur: Hars, systolic ejection murmur @ LUSB. Click loudest w/ inspiration
  2. EKG: RVH
  3. Hypoxia
78
Q

Pulmonary stenosis treatment

A
  1. PGE: maintains PBF

2. Cath lab: balloon valvuloplasty

79
Q

Aortic stenosis findings

A
  1. Murmur: Systolic ejection murmur @ RUSB. Click has no respiratory variation
  2. EKG: LVH
  3. Concentric LV hypertrophy
80
Q

Aortic stenosis treatment

A
  1. PGE
  2. Mild: monitor
  3. Surgical
  4. Balloon valvuloplasty
81
Q

BP findings in Coarctation of Aorta

A

BP: >20 mmgHg
Increased UE
Decreased LE

82
Q

Coarctation of Aorta treatment

A

PGE

83
Q

What is Coarctation of Aorta associated with?

A

Turner’s syndrome

84
Q

What lipid levels do you refer kids out?

A
  1. TC>200
  2. TG>200
  3. LDL>130

Peds I & II (8 decks)

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