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EORE Peds > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Mid-systolic high-pitched musical, vibratory, noisy, twangy murmur

A

Still’s Murmur

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2
Q

Where is Still’s Murmur best heard?

A

LLSB & Apex (still’s murmur is thought to be 2/2 M&T valves vibrating

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3
Q

At what age is Still’s Murmur heard?

A

2 YO - preadolescence

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4
Q

What is the most common innocent murmur?

A

Still’s Murmur

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5
Q

Still’s murmur accentuated with _______

Still’s murmur diminished with ________

A

Accentuated: supine, fever
Diminished: standing, sitting, Valsalva

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6
Q

Qualities of innocent murmurs (4)

A

Soft w/o thrill
Not a/w symptoms
Position dependent
Occur during systole

Note: Venous hum only non-pathologic murmur that may occur during diastole - usu a SEM tho)

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7
Q

What are the three most common innocent murmurs

A

MC = Still’s murmur
2nd MC = Venous hum
3rd = Pulmonary ejection murmur

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8
Q

Innocent murmur that’s grade I-II harsh systolic murmur

A

Venous hum

Thought to be 2/2 sound of blood flowing from head & neck thru jugular veins to the heart - which is why best heard at right tor left upper sternal border - may also be diastolic

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9
Q

Venous hum accentuated with ______

Venous hum diminished with _______

A

Accentuated: Upright or seated w/ head extended
Diminished: Valsalva, pressure on juguar veins, supine or turning head fully

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10
Q

Mid-systolic harsh murmur heard best at 2nd intercostal space

A

Pulmonary ejection murmur

Thought to be due to blood flow across the pulmonary artery

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11
Q

Where is the venous hum murmur best heard at?

A

LUSB or RUSB

Accentuated: Upright or seated w/ head extended
Diminished: Valsalva, pressure on juguar veins, supine or turning head fully

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12
Q

Where is the pulmonary ejection murmur best heard at?

A

Second left intercostal space

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13
Q

Name the 5 cyanotic congenital heart defects

A 
Known as the 5 T's 
[1] Truncus Ateriosus
[2] Transposition of the great arteries 
[3] Tricuspid atresia 
[4] Tetralogy of Fallot
[5] Total anomalous pulmonary venous return
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14
Q

Describe VSD murmur & where it is best heard at

A

Loud high-pitched, harsh, holosystolic murmur

Best heard at LLSB

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15
Q

PE Findings PDA

A

Continuous machinery murmur loudest at pulmonic area
Wide pulse pressure - bounding peripheral pulses
Loud S2

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16
Q

CP PDA

A

Most asx - poor feeding, weight loss, frequent LRTI, pulmonary congestion

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17
Q

Dx PDA (CXR, EKG, Echo)

A

Echo = gold standard dx
CXR - normal or cardiomegaly
EKG - LVH, left atrial enlargement

18
Q

Tx PDA

A

IV Indomethacin (dec prostaglandins)

19
Q

Definition coarctation of the aorta

A

Congenital narrowing of thoracic descending aorta
Male: Female 2:1
Usually non-cyanotic

20
Q

Pathophysiology of Coarctation of aorta

A

Inc LV afterload with SNS activity & RAAS activation = HTN, LVH & CHF

21
Q

CP Coarctation of aorta

A

HTN
Bilateral claudication, DOE, syncope
Infants: FTT, poor feeding, shock

22
Q

Murmur of coarctation of aorta

A

Systolic murmur that radiates to the back/scapula/chest

23
Q

PE Findings Coarctation of aorta

A

Systolic murmur that radiates to the back/scapula/chest
Inc BP in UE > LE
Delayed/weak femoral pulses (2/2 dec flow distal to obs in lower extremities)

24
Q

Diagnosis coarctation of aorta

A

CXR:
Rib notching (2/2 inc collateral circulation to intercostal aa)
“3 sign” Narrowed aorta looks like the notch of number 3

EKG: LVH

ANGIOGRAM = GOLD STANDARD FOR DIAGNOSIS

25
MCC Congenital heart disease
VSD
26
Tx coarctation of aorta
Surgical correction Balloon angioplasty +/- stent Prostaglandin preoperatively to reduce sx & improve LE blood flow
27
MC Cyanotic CHD
TOF ``` Cyanotic = key word TOF = MC cyanotic CHD VSD = MC overall ```
28
4 Features of TOF
1. RVOT obs - pulmonic stenosis 2. RVH 3. VSD (large, unrestrictive) 4. Overriding aorta
29
CP TOF
Blue baby syndrome (cyanosis) Odler: DOE, cyanosis worsens w/ age "Tet-Spells" - paryoxysms of cyanosis - older children relieve by squatting
30
Murmur a/w TOF
Harsh holosystolic murmur heard best at LUSB (like PS)
31
PE Findings TOF
Harsh holosystolic murmur at LUSB RV heave Digital clubbing Murmur of VSD = Loud, high-pitched, harsh holosystolic murmur at Left LOWER sternal border
32
Dx TOF
CXR: Boot-shaped heart (prominent RV) EKG: RVH, RAE Echo: GOLD STANDARD FOR DX
33
Tx TOF
Surgical repair performed in first 4-12 mo of life | PGE1 infusion - prevents ductal closure if pt cyanotic prior to surgery
34
Prostaglandin E1 analog & it's indications
Prostaglandin E1 analog = Alprostadil Indications: Pt w/ cyanotic heart defects where it is beneficial to keep ductus arteriosus open (pulmonary atresia, TOF etc)
35
Definition hypertrophic cardiomyopathy
Inherited genetic disorder of inappropriate LV and/or RV hypertrophy (especially septal)
36
Pathophysiology hypertrophic cardiomyopathy
Subaortic outflow obs: Narrowed LVOT 2/2 hypertrophied septum Diastolic dysfunction: Stiff ventricular chamber - impaired ventricular relaxation/filling b/c thickened walls lead to smaller LV volume & dec LV filling
37
CP Hypertrophic Cardiomyopathy (5)
1. Dyspnea = MC initial complaint w/ fatigue 2. Angina pectoris -75%, in setting of normal angiogram 3. Syncope - including pre-syncope/dizziness (2/2 inadequate CO on exertion) 4. Sudden cardiac death - esp in adolescent/preadolescent children during extreme exertion - 2/2 ventricular fibrillation - DO CPR!!!
38
Murmur of hypertrophic cardiomyopathy
Harsh systolic crescendo-decrescendo murmur best heard at LLSB (similar to AS)
39
Murmur of hypertrophic cardiomyopathy: Accentuated with _______ Diminished with ________
Accentuated with decreased venous return (valsalva, standing) - may have loud S4, mitral regurg, S3 or pulsus bisferiens Murmur diminished with increased venous return (squatting, lying supine) b/c increased LV volume preserves outflow (inc fluid pushes septum out of way & dec SAM of mitral valve)
40
Dx Studies hypertrophic cardiomyopathy
Echo - asymmetrical wall thickness > 15mm, systolic anterior motion of mitral valve, small LV chamber size, dynamic outflow obstruction +/- mitral regurg EKG: LVH, atrial enlargement, anterolateral & inferior pseudo q waves CXR: Cardiomegaly
41
Tx hypertrophic cardiomyopathy
Focus: Early detection, medical management, surgical and/or ICD placement. Counseling to avoid dehydration & extreme exertion and exercise is VERY IMPORTANT 1. Medical - BB = 1st line medical tx , also CCB, disopyramiide (negative inotropes that inc ventricular diastolic filling time) 2. Surgical - myomectomy - in pt w/ severe , refractory sx despite medical management 3. Alcohol septal ablation - alternative to surgical management w/ good outcomes

EORE Peds (3 decks)

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