Cardiovascular Flashcards
What areas should be included during auscultation?
Right and left intraclavicular areas, right anterior chest, both axillae, both sides of back, anterior fontanel, over liver
Minimum of 4 assessment points required.
What is the normal heart rate range for term newborns?
120-140 beats per minute
Preterm infants may have a slightly higher heart rate.
How is tachycardia defined in newborns?
> 180 beats per minute
Bradycardia is defined as <80 beats per minute.
What is the significance of heart rhythm assessment?
Requires ECG comparison with physical exam findings
Irregular rhythm may indicate a pattern.
What is the S1 heart sound associated with?
Closure of mitral and tricuspid valves at onset of ventricular systole
Loudest at the apex of the heart.
What does S2 heart sound indicate?
Closure of aortic and pulmonary valves
Heard best at the base of the heart.
What is S3 heart sound usually due to?
Rapid ventricular filling (increased flow across AV valves)
Heard best at apex during early diastole.
What does a gallop rhythm indicate?
Triple heart sounds (S1, S2 plus loud S3 +/- S4) and is always abnormal
S4 is pathologic in newborns due to decreased compliance of myocardium.
What does bounding pulses suggest?
Consider aortic run-off lesions (e.g., PDA, truncus arteriosus)
Comparison of right brachial and femoral pulses can indicate outflow tract obstruction.
What does cyanosis indicate in newborns?
Bluish color of skin, lips, tongue, nail beds due to significant arterial desaturation
Central vs. peripheral cyanosis can be distinguished.
What is the purpose of auscultation in cardiovascular assessment?
Requires lots of practice and should be done while the infant is quiet and inactive
Neonatal stethoscopes are used for this purpose.
What are the signs of pallor or mottling in newborns?
Vasoconstriction with shunting of blood away from skin to vital organs
Mottling can be a normal finding in a cold neonate.
What does a weak femoral pulse compared to a brachial pulse indicate?
Possible left outflow tract obstructive congenital heart disease (e.g., IAA, coarctation, HLHS)
This is assessed by simultaneous palpation.
What is the significance of a wide pulse pressure?
Consider aortic runoff lesions
Narrow pulse pressures may indicate low cardiac output or heart failure.
What is the grading scale for assessing pulse volume?
0 to +4 scale:
* 0 = not palpable
* +1 = difficult to palpate, easily obliterated, weak
* +2 = difficult to palpate, may be obliterated with pressure
* +3 = easy to palpate, not easily obliterated
* +4 = strong, bounding, not obliterated with pressure
Similar scales can be used for assessing volume and character.
What does the presence of innocent murmurs in the first 48 hours of life usually indicate?
Not associated with any other symptoms and likely due to falling pulmonary vascular resistance
Most are Grade I-II/VI.
What is the maximum intensity of a murmur?
Described by the point on the chest wall where the murmur is maximal and where else it can be heard
Assumes normally positioned heart and outflow tracts.
What is the grading system for murmur intensity?
Grade I: barely audible
Grade II: soft, but immediately audible
Grade III: moderate intensity (no thrill)
Grade IV: louder (+/- thrill)
Grade V: very loud (stethoscope barely on chest, +/- thrill)
Grade VI: extremely loud (heard with stethoscope barely off chest, +/- thrill)
Timing of murmur can indicate systolic, diastolic, or continuous.
What is the significance of preductal and postductal SaO2 measurements?
Indicates potential conditions like TGA with pulmonary hypertension or ductal-dependent systemic blood flow
A significant gradient can suggest coarctation of the aorta.
What does a hyperoxia test assess?
Response to high FiO2 to determine underlying conditions like cyanotic heart disease or parenchymal lung disease
Minimal change in SaO2 suggests cyanotic heart disease.
What is the method for measuring blood pressure in newborns?
Cuff width should be approximately 40-50% of arm circumference
Methods include palpation, Doppler, oscillometric, and indwelling arterial catheter.
What does central cyanosis indicate?
One of the best indicators of congenital heart disease (CHD)
Can also result from lung disease, sepsis, or neurologic disease.
