Cardiovascular Flashcards
Congenital Heart Defects
Murmurs
innocent murmur: early systolic and loudest over both axillae. transient murmur middle low left sternal border in newborn can be d/t tricuspid regurgitation. soft systolic ejection murmur at upper left sternal border may be closing PDA. Echo needed to verify. dx: CXR, EKG, echo, hyperO2 test, cardiac Cath, MRI. innocent murmurs change with position, may vary in loudness or presence, may increase in intensity with fever/anemia/exercise/anxiety, are musical or vibratory in quality, systolic minus venous hum, short duration, best in LLSB or pulmonic area, rarely transmitted, normal vitals etc. Pathologic: child with syndrome, diastolic murmur, systolic with thrill, pan systolic, continuous, clicks, opening snaps, fixed splitting of second heart sound, accentuated S2, S4 gallops, not positional, harsh.
Hypertension
Cuff: 2/3 length of upper arm from axilla to a/c. BP > 95th percentile for age stage 1, stage 2 >99th percentile. >13 years old, its >130/80 stage 1 and >140/90 stage 2. more common in males, related to obesity, sedentary, stress. Primary cause of secondary HTN is renovascular diseases. Neo’s with HTN usually ill with neuro/cardiac/renal s/s. assess for signs of end organ damage. S/s: headache, chest pain, dyspnea, muscle weakness, palpitations, decreased vision, sweating. edema, pallor, flushing, skin lesions. elevated BP on 3 occasions.
Rheumatic fever
post trep infection/inflammation of heart. rash of erythema marginatum (evanescent, nonpruritic, sharp serpiginous margins, inner aspects of arms/thighs/trunk). SubQ Nodules rare but severe disease on bony prominences of large joints. parasternal lift, loud pulmonic closure sound, apical pan systolic high pitched murmur of mitral regurgitation, mid-diastolic apical rumble, and high pitched decrescendo diastolic murmur at left sternal border of aortic regurgitation.
Rate/Rhythm changes
common benign: sinus arrhythmia (has P waves), wandering atrial pacemaker (p wave flips up and down), PACs, PVCs, first degree AV block. most commonly treated: SVT, V-tach, etc.
Myocarditis
rare inflammatory illness of heart muscles. caused often by viruses (Adeno, coxsackievirus A, Parvo, echovirus, poliovirus). inflammation > dilation of cardiac chambers > poor function and stretching with regurgitation. Healing may have replacement of myofibers with fibroblasts/scar formation > decreased elasticity and performance > ventricular arrhythmias. s/s: CHF, fever, irritability, diaphoresis, pallor, flu/GI viral illness, decreased appetite, rashes, palpitations, RDS, cyanosis, mottling, gallop, muffled heart sounds, weak pulses, murmur, hepatomegaly, JVD. Dx: CXR, EKG, echo, MRI, CBC, ESR, CRP, cardiac/liver enzymes, BNP, viral titers, blood cultures, metabolic studies. Diff: sepsis, asthma, chronic viral. Tx: supportive, diuretics, anticoagulation/antiarrhythmia meds. Recovery may take 2-3 months and f/u is lifelong.
Hypercholesterolemia
Kawasaki Disease
acquired heart disease. medium vessel vasculitis with mucocutaneous features often <5 years old. Fever, conjunctivitis, erythema of lip/oral mucosa, extremity changes, rash, cervical adenopathy, sometimes coronary artery aneurysms. rash often hands and feet and pt doesn’t want to walk. Beau lines in fingernails, strawberry tongue. urethritis/inflammation. myocarditis in acute phase. elevated ESR/CRP, leukocyte with left shift, anemia, thrombocytosis. high risk MI. tx with IVIG.
HTN labs
<10years old with stage 2 need more labs. CBC, ESR, CRP, urinalysis culture, electrolytes, BUN, creatinine, plasma renin. do BP checks annually >3, if elevated recheck within 1-2 months and manually. try diet, exercise, weight management, caloric restriction with exercise. avoid smoking, caffeine, alcohol. if persists, refer to nephrologist/cardiologist. Reduce BP to <95th percentile or <90 if comorbid. If max dose/AE then second med.
HTN complications
increase in LV mass, increased carotid intimal medial thickness, coronary artery calcification. prehypertensive recheck 6months. Stage 1: repeat 1-2 weeks, average it. stage 2: repeat 1 week.
