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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
Q

MCC Congenital heart disease

26
Q

Tx coarctation of aorta

A

Surgical correction
Balloon angioplasty +/- stent
Prostaglandin preoperatively to reduce sx & improve LE blood flow

27
Q

MC Cyanotic CHD

A

TOF

Cyanotic = key word 
TOF = MC cyanotic CHD
VSD = MC overall
28
Q

4 Features of TOF

A
  1. RVOT obs - pulmonic stenosis
  2. RVH
  3. VSD (large, unrestrictive)
  4. Overriding aorta
29
Q

CP TOF

A

Blue baby syndrome (cyanosis)
Odler: DOE, cyanosis worsens w/ age

“Tet-Spells” - paryoxysms of cyanosis - older children relieve by squatting

30
Q

Murmur a/w TOF

A

Harsh holosystolic murmur heard best at LUSB (like PS)

31
Q

PE Findings TOF

A

Harsh holosystolic murmur at LUSB
RV heave
Digital clubbing

Murmur of VSD = Loud, high-pitched, harsh holosystolic murmur at Left LOWER sternal border

32
Q

Dx TOF

A

CXR: Boot-shaped heart (prominent RV)
EKG: RVH, RAE
Echo: GOLD STANDARD FOR DX

33
Q

Tx TOF

A

Surgical repair performed in first 4-12 mo of life

PGE1 infusion - prevents ductal closure if pt cyanotic prior to surgery

34
Q

Prostaglandin E1 analog & it’s indications

A

Prostaglandin E1 analog = Alprostadil
Indications: Pt w/ cyanotic heart defects where it is beneficial to keep ductus arteriosus open (pulmonary atresia, TOF etc)

35
Q

Definition hypertrophic cardiomyopathy

A

Inherited genetic disorder of inappropriate LV and/or RV hypertrophy (especially septal)

36
Q

Pathophysiology hypertrophic cardiomyopathy

A

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
Q

CP Hypertrophic Cardiomyopathy (5)

A
  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
Q

Murmur of hypertrophic cardiomyopathy

A

Harsh systolic crescendo-decrescendo murmur best heard at LLSB (similar to AS)

39
Q

Murmur of hypertrophic cardiomyopathy:
Accentuated with _______
Diminished with ________

A

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
Q

Dx Studies hypertrophic cardiomyopathy

A

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
Q

Tx hypertrophic cardiomyopathy

A

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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