Cardiovascular Issues and Disorders Flashcards
S1 heart sound
mitral/tricuspid (AV) valves closure
S2 heart sound
aortic/pulmonic (semilunar) valves closure
Systole heart sound
period between S1 and S2
Diastole heart sound
period between S2 and S1
S3 heart sound
ken-tuck-y, increased fluid states
S4 heart sound
ten-ne-ssee, stiff ventricular wall
APE TO MAN, auscultatory areas
A: aortic–right upper sternal border (2nd ICS)
P: pulmonic– left upper sternal border(2nd ICS)
E: erb’s point– 3rd ICS on left sternal border
T: tricuspid– lower left sternal border (4th ICS) **VSD
M: mitral–5th ICS on midclavicular line (apex)
Kawasaki Disease
Acute febrile syndrome causing vasculitis
leading cause of artery disease in children of an infectious etiology
most commonly noted in children under age of 2 and f Asian ethnicity
Diagnostic criteria for Kawasaki Disease
- Pt must have a fever–and at least 4 of the following:
- fever for >5 days
- bil conjuctival injection without exudate
- polymorphous rash (urticarial or pruritic)
- inflammatory changes of lips and oral cavity
- changes in extremities (erythema, edema)
- cervical lymphadenopathy
**if the pt has more than 4 of the criteria, coronary vessel involvement is most likely
Fiery CRASH in relation to Kawasaki Disease
Fiery: fever for more than 4 days C: conjunctival injection R: rash A: adenopathy S: strawberry tongue/lips H: hands
Laboratory and diagnostics with Kawasaki Disease
CBC
elevated ESR
Positive CRP
ECG changes: prolonged PR and QT interval
Management of Kawasaki disease
admit to hospital
immediate referral to a cardiovascular specialist
HIGH DOSE aspirin therapy:
80-100 mg/kg/day until afebrile for 48 hours (and sometimes IGG)
Then lower ASA dose (3-5 mg/kg/day) for anti platelet response
Discontinue ASA therapy in collaboration with cardiologist
Rheumatic Fever
a post-infectious disease that can affect the heart, joints, and CNS
it follows a group A strep infection of the upper respiratory tract and is the most common in ages 6-15 years
Which valve is most commonly affected in rheumatic fever?
mitral valve
What is the diagnostic criteria of rheumatic fever?
diagnosis of an initial attack of rheumatic fever plus 2 major OR 1 major and 2 minor criteria
What are the major manifestations of rheumatic fever?
carditis polyarthritis chorea (abnormal, involuntary movement) erythema marginatum (pink rings on trunk and inner surfaces of limbs) subcutaneous nodules
What are the minor criteria for rheumatic fever?
arthralgia without objective inflammation
fever >102.2
elevated ESR and CRP
prolonged interval on ECG with evidence of a group A b-hemolytic streptococcus infection
What are the laboratory and diagnostic tools for rheumatic fever?
postive throat culture postive rapid strep assay increased or rising strep antibody titer ECG echocardiogram
What is the management of rheumatic fever?
refer to a pediatric cardiology
aggressive strep infection treatment
bed rest if acute carditis is present
prophylactic antibiotics for invasive procedures, as indicated
What is hypertension?
a persistent elevation of average systolic/diastolic blood pressure >95th% with measurements obtained on at least 3 separate occasions per published tables for age and sex
What is secondary hypertension?
A symptom of other organ dysfunction–this is very common in children
Signs and symptoms of hypertension?
headaches vision problems dizziness respiratory distress irritability nosebleed
What are some differential diagnoses of hypertension in children?
kidney dysfunction
heart condition
pulmonary hypertension
What lab/diagnostic tests would you do in someone with hypertension?
chest xray (PA and lateral)
plasma aldosterone level to rule out aldosteronism
morning and evening cortisol levels to rule out cushion’s syndrome
UA, BMP, CBC, cholesterol, and triglycerides
ECG for dysrhythmias, bundle branch block, or LVH
Venous Hum
innocent, continous humming murmur
heard at the right upper sternal border
heard best in the sitting position, and disappears in the supine position
obliterated by turning head and/or compressing neck on same side of body
Still’s murmur
most common innocent murmur
musical systolic ejection murmur
heard best between LLSB and apex
due to narrowing of the left ventricular outflow tract
What is an innocent murmur?
no associated symptoms, failure to thrive or cyanosis
occurs in >50% of children :
thin chest wall
more angulated great vessels
more dynamic circulation
low intensity systolic murmur (grade I-III/VI)
may vary with position (sit>standing)
no radiation to neck/backCommon genetic syndromes and associated cardiac defects?
diGeorge syndrome: aortic arch anomalies
trisomy 18
trisomy 21: ASD, VSD
marfan syndrome: aortic regurgitation, mitral valve prolapse
turner syndrome: coarctation of the aorta, bicuspid arctic valve
Presenting signs and symptoms of a potential cardiac defect in a child
frequent resp infections exercise intolerance color changes, cyanosis tachypnea during sleep feeding problems diaphoresis abnormal heart sounds edema clubbing congestive heart failure
Acyanotic defects
left to right shunting–pink child:
ASD
VSD
PDA
Cyanotic defects
right to left shunting–blue baby:
TGA
Tetralogy of fallot
Obstructive lesions
aortic stenosis
pulmonic stenosis
coarctation of the aorta
What type of murmur would you hear for an ASD and where would you hear it?
systolic ejection, heard best at left upper sternal border
What type of murmur would you hear for an VSD and where would you hear it?
systolic ejection murmur
holosystolic thrill may be felt at the LLSB
thrill=VSD
What type of murmur would you hear for an PDA and where would you hear it?
Left upper sternal border, machinery sound
What would an X-ray show for a child with TGA?
egg on string
What type of murmur would you hear for a TGA and where would you hear it?
very similar to VSD—systolic ejection murmur
What are the 4 defects of tetralogy of ballot?
large VSD
pulm stenosis
overriding aorta
Right ventricular hypertrophy
**Vikings suck at running V: VSD large S: stenosis pulmonary A: aorta overriding R: right ventricular hypertrophy
What type of murmur would you hear for a tet and where would you hear it?
loud systolic ejection click at the middle and upper left sternal border
What would an X-ray show of a tet?
boot shaped heart
What is a tet spell?
hypercyantoic episode
stay in knee to chest position
stopping and squatting
What type of murmur would you hear for aortic stenosis and where would you hear it?
systolic thrill at the right upper sternal border
What type of murmur would you hear for an pulmonic stenosis and where would you hear it?
systolic loudest at the LUSB
click decreases with inspiration and increases with expiration
thrill at LUSB radiating to back and sides
What type of murmur would you hear for coarctation of the aorta and where would you hear it?
systolic ejection murmur
ejection click at the apex and RUSB if the bicuspid valve is involved
What will the BP be like in someone with a coarc?
BP in lower extremities will be lower than in upper extremities
What is one X-ray finding of someone with a coarc?
rib notching due to collateral circulation
What heart condition comprises up to 30% of all congenital heart defects?
VSD
What is characteristic of obstructive defects when auscultating?
ejection clicks heard due to turbulence
referred or radiated sound noted
Name the valves in the heart
To pay more attention T: tricuspid P: pulmonic M: mitral A: aortic
Explain the blood flow through the heart
SVC -> R atrium -> Tricuspid valve -> Right ventricle -> Pulmonic valve -> Pulmonary artery -> Lungs -> Pulmonic veins -> Left atrium-> Mitral valve-> Left ventricle-> Aortic valve -> Aorta -> Body-> SVC
- left side: oxygenated blood to body
- right side: no oxygenated blood to lungs to get oxygen
Fetal resistance and flow
increased pulmonary vascular resistance and decreased systemic vascular resistance
Neonatal resistance and flow
decreased pulmonary vascular resistance and increased systemic vascular resistance
