cardiovascular

Question 1

bounding pulses

Answer 1

associated with aortic runoff lesions: PDA, truncus arteriosis, aortic regurg, sytemic AV fistula)

Question 2

active precordium

Answer 2

cardiac defects with increased ventricular volume like L->R shunt lesions (PDA or large VSD) or severe valvular regurg (mitral or aortic insufficiency)

Question 3

Palpating a heave

Answer 3

heave is a PMI that is slow rising and diffuse. Associated with volume overload.

Question 4

Palpating a tap

Answer 4

Tap is sharp, well-localized PMI. Associated with pressure overload.

Question 5

Thrill

Answer 5

denoted a grade IV or higher murmur.

Thrill over upper left sternal border originates from pulm valve or artery (associated wth PS, TET, or PDA)

Question 6

Four auscultatory areas

Answer 6

These are the aortic area (second intercostal space, right sternal angle), pulmonic area (second intercostal space, left sternal angle), tricuspid area (fourth intercostal space, left sternal angle), and mitral area (fourth intercostal space, left midclavicular line)

Question 7

sinus arrhythmia

Answer 7

This is a very common, normal variant in most newborns. It is associated with respirations.5 Sinus arrhythmia is characterized by irregularity of the R–R interval, with an otherwise normal cardiac cycle. No treatment is required for this rhythm

Question 8

Premature atrial contractions

Answer 8

an early beat arising from a supraventricular focus. Ventricular conduction is usually normal. The arrhythmia is almost always benign in the newborn, but can be abnormal when seen with CHD; sepsis; hypoxia; hyperthyroidism; cardiac tumors; myopathies; electrolyte abnormalities; digoxin toxicity; administration of caffeine, atropine, theophylline, or inotropic agents; irritation from a centrally placed catheter, and severe respiratory distress.

Question 9

premature ventricular contractions

Answer 9

early beat arising from an irritable ventricular focus, ventricular conduction will be abnormal, giving rise to a wide and bizarre QRS complex. The arrhythmia may result from hypoxia, CHD, irritation caused by an invasive catheter, or as the result of a surgical procedure. Treatment is unnecessary if the phenomenon is infrequent.

Question 10

S1 and S2

Answer 10

first heart sound (S1) is produced by closure of the mitral and tricuspid valves, best heard over mitral or tricuspid areas.
The second heart sound (S2) is produced by closure of the aortic and pulmonic valves, best heard over aortic or pulmonic areas. Should be split upon inspiration by 1-2 days of age.
(Sounds actually from blood deceleration, but visualize this way)

Question 11

Wide S2 splitting

Answer 11

can occur with ASD, pulmonary stenosis, Ebstein’s anomaly, partial anomalous pulmonary venous return, mitral regurgitation, or right bundle branch block

Question 12

S4

Answer 12

heard at the apex of the heart and is a low-pitched sound of late diastole. Always pathologic and is heard in conditions characterized by decreased compliance (especially cardiomyopathy) or congestive heart failure

Question 13

Ejection clicks

Answer 13

snappy, high-frequency sound heard after S1. Common in first 24 hours, but abnormal after that. Associated with PS, dilated PA, systemic or pulm HTN, TA, TET.

Question 14

Intensity of murmurs

Answer 14

Grade I: Barely audible, audible only after a period of careful auscultation

Grade II: Soft, but audible immediately

Grade III: Of moderate intensity (but not associated with a thrill)

Grade IV: Louder (may be associated with a thrill)

Grade V: Very loud; can be heard with the stethoscope rim barely on the chest (may be associated with a thrill)

Grade VI: Extremely loud; can be heard with the stethoscope just slightly removed from the chest (may be associated with a thrill)

Question 15

systolic ejection murmur

Answer 15

Innocent vibratory murmur, gr I-II, heard over upper left sternal border. Systolic ejection murmurs present within the first day of life, may last as long as 1 week, and are most likely the result of the significant increase in flow across the pulmonary valve associated with rapidly decreasing pulmonary vascular resistance

Question 16

Continuous systolic or crescendo systolic murmur

Answer 16

innocent. gr I-II murmur heard over left upper sternal border, presenting within first 8 hours of life. From L->R shunt through PDA

Question 17

Peripheral pulmonic stenosis murmur

Answer 17

innocent. gr I-II murmur heard in upper left sternal border with wide radiation to both lung fields, axilla, and back. Presents within 1-2 weeks, disappearing by 3-6 months. result from turbulence produced at the relatively acute angle of the bifurcation of the pulmonary artery.

Question 18

when to evaluate a murmur

Answer 18

louder than grade I or II, persisting after 48 hours of life, or in a symptomatic neonate need CXR, echo, and consult

Question 19

loud systolic ejection murmur

Answer 19

grade II to V, appearing within hours of birth. Almost always from aortic or pulm stenosis or a coarc

Question 20

Continuous murmur

Answer 20

occurs in 1/3 PDAs and in AV fistulas