Cardiology Flashcards
Describe murmur of venous hum
Continuous, soft blowing, in right and left infraclavicular areas. Increased by sitting, standing, decreased by supine or turning head. Produced by flow in jugular veins
Describe pulmonary flow murmur
midsystolic, soft blowing best heard at 2nd LICS, 2/2 to flow in RVOT, increased when supine, expiration. heard at age 7-10 and persists into adulthood
Which congenital heart lesions typically present with heart failure in first 6 weeks of life
Obstructive lesions of the left side of the heart - aortic stenosis, coartation of the aorta, hypoplastic left heart. Also large shunt lesions cause pulmonary overcirculation and symptoms of heart failure.
Most common form of congenital heart disease?
Bicuspid Ao valve, then VSD
When is surgery for VSD performed?
3-6 months
Why do u get a fixed second heart sound in ASD?
Usually right ventricle empties slightly later than the left therefore get P2. The split is increased in inspiration because of more venous return. In an ASD, the right ventricle is always volume overloaded in expiration and inspiration this fixed second heart sounds.
What is EKG sign of right ventricle volume overload
RSR’ in V1
Signs of PDA in newborns
continuous machinery-like murmur at left infraclavicular area, wide pulse pressure, bounding pulses,
4 features of TOF
- Overriding aorta, 2. VSD, 3. Pulm stenosis or RVOF 4. RV hypertrophy
tet spell
Murmur is actually softer because less blood across RV OFT. . Treatment - assume knee-chest position, fluids, oxygen.
Egg on a string heart
Transposition of great arteries, directanterior posterior relationship of the arteries
Treatment of transposition of the great arteries
atrial septostomy, then arterial switch in first couple weeks of life
TAPVR
Pulmonary veins drain into the systemic venous system. Can get supracardiac - svc or innominate vein, cardiac - drainage into coronary sinus, infracardiac - into IVC.
Obstructed TAPVR
Not getting enough blood back to heart, pulmonary congestion and need emergent surgical repair
Who needs prophy antibiotics?
Prostetic cardiac heart valve, previous infective endocarditis, Unrepaired cyanotic CHD, including shunts and conduits, Completely repaired CHD with prostetic material or device within 6 months or with residual defects.
Jones Criteria
MAJOR: Carditis, Polyarthritis, Chorea, subq nodules, erythema marginatum MINOR: fever, prolonged PR interval, elevated Acure phase reactants, arthralgia, previour acute rheumatic fever. Need 2 major, 1 major and 2 minor PLUS evidence of recent strep test.
Kawasaki Disease Criteria
Fever for 5 days PLUS 4 of: Rash, conjunctivitis, mucosal changes, Lymphadenopathy, extremity erythema, edema
Treatment of acute rheumatic fever
ASA and pcn. Steroid only for severe carditis or symptoms not improved with asa
Why do you not want to use oxygen in pulmonary over circulation congenital heart syndrome?
Bc oxygen is a pulmonary vasodilator and systemic vasoconstrictor
Signs and symptoms of PDA
Wide pulse pressure bc have systolic and diastolic shunt and runoff in diastole. Bounding pulses. Machinery like murmur
What is the snowman sign on chest X-ray?
Total anomalous pulmonary venous return
What is the effect on oxygen on pulmonary and systemic circulation?
pulmonary vasodilator (therefore dont want to use in VSD or anything with increase pulm flow) systemic vasoconstrictor.
When do you start a statin in a kid with high cholesterol?
When they are over the age of 8 and have one of the following: 1.) LDL >190, 2.) LDL>160 and family member with premature CAD or 2 CAD risk factors. 3.) LDL>130 and diabetes
What does cyanosis of preductal structures suggest?
transposition of the great vessels.
