Cardiovascular Issues & Disorders Flashcards
Peds CV - S1
-“Lubb”
-Mitral/tricuspid (AV) valve closure
-Aortic/pulmonic valves open
Peds CV - S2
-“Dubb”
-Aortic/pulmonic (semilunar) valve closure
-Mitral/tricuspid valves open
Peds CV - Systole
-Period between S1 and S2 - ventricles contract
Peds CV - Diastole
-Period between S2 and S1 - ventricles relax and fill
Peds CV - Auscultation Areas
-Aortic: RUSB
-Pulmonic: LUSB
-Mitral: Apex (bottom)
-Tricuspid: LLSB
Peds CV - Blood Flow
-Fetal: increased pulmonary vascular resistance and decreased systemic vascular resistance - no lung flow
-Neonatal: decreased pulmonary vascular resistance and increased systemic vascular resistance - lung flow
Peds CV - Characteristics to Note
-VSD: most common heart defect - has a thrill
-Obstructive defects:
*Ejection clicks due to turbulence
*Referred or radiated sound noted
Peds CV - Murmur Characteristics
-Grade I: soft, barely audible
-Grade II: clearly audible, but faint
-Grade III: moderately loud
-Grade IV: loud, with thrill *****
-Grade V: loud, heard with PART of the stethoscope on chest wall, thrill palpable
-Grade VI: very loud, heard WITHOUT stethoscope, thrill palpable and visible
Peds CV - Congenital Heart Diseases/Anomalies
-Etiology: chromosomal abnormalities, adverse environmental conditions
-Occurs in about 1% of births per year
-VSD, most common
-Acyanotic: left-to-right shunt (oxygenated blood goes from left to right side)
*Atrial septal defect (ASD)
*Ventricular septal defect (VSD)
*Patent ductus arteriosus (PDA)
-Cyanotic: right-to-left shunt (deoxygenated blood goes from right to left side)
*Transposition of the great arteries
*Tetralogy of Fallot
-Obstructive lesions
*Aortic stenosis
*Pulmonic stenosis
*Coarctation of the aorta
Peds CV - ASD
-Opening between RA and LA
-Acyanotic (left-to-right shunt) - oxygenated blood goes from left to right side
-Grade II-III/VI systolic ejection murmur
-EKG: RVH
-XR: Cardiomegaly
-Management: small ASDs close on their own - refer to cardio
Peds CV - VSD
-Opening between RV and LV
-Most common cardiac defect (30%), especially in Trisomy 21
-Acyanotic (left-to-right shunt) - oxygenated blood goes from left to right side
-Associated with a thrill (thrill has 2 LL and so does LLSB, which is where it is felt)
-Grade II-V/VI systolic ejection murmur - holosystolic thrill - LLSB
-EKG: LVH
-XR: Cardiomegaly
-Management: small VSDs close on their own - refer to cardio
Peds CV - PDA
-Opening between pulmonary artery and aorta
-Acyanotic (left-to-right shunt) - oxygenated blood goes from left to right side
-Very common in premature infants
-Murmur: LUSB, “machinery” sound, grade II-IV/VI holosystolic
-EKG: LVH
-XR: Cardiomegaly
-Management: refer to cardio - for preterm infants, give prostaglandin inhibitors (ibuprofen, indomethacin) may be used
Peds CV - Transposition of the Great Arteries
-Aorta and pulmonary artery are switched - blood goes from RV to aorta (deoxygenated)
-Cyanotic (right-to-left shunt) - deoxygenated blood goes from right to left side
-EKG: RVH
-XR: Egg on a string ***
-Management: refer to cardio for surgical repair - long-term supportive care and screening for developmental delays due to hypoxemia
Peds CV - Tetralogy of Fallot
-Four defects:
*Large VSD
*RVH
*Overriding aorta
*Pulmonary stenosis
-Cyanotic (right-to-left shunt) - deoxygenated blood goes from right to left side
-Murmur: Loud systolic ejection CLICK at the middle and LUSB
-XR: Boot-shaped heart ***
-Management: refer to cardio
Peds CV - Aortic Stenosis
-Obstructive lesion
-Murmur: systolic thrill at RUSB, systolic ejection click but DOES NOT vary with respirations
-EKG: LVH
-XR: CHF, if severe
-Management: refer to cardio, balloon aortic valvuloplasty, need clearance for sports
Peds CV - Pulmonic Stenosis
-Obstructive lesion
-Murmur: systolic, loudest at LUSB, thrill at LUSB radiating to the back and sides, grade II-V/VI ejection click decreases with inspiration and increases with expiration
-EKG: RVH
-Management: refer to cardio, follow-up every 6 months to 2-5 years, needs clearance for sports
Peds CV - Coarctation of the Aorta
-Obstructive lesion
-Narrowing of aorta
-Common in trisomy 21
-Murmur: II-III/VI systolic ejection murmur with radiation to the left inter scapular area
-Cardinal finding: BP and pulse in lower extremities will be lower than in upper extremities ***
-XR: Cardiomegaly, rib notching due to collateral circulation
-Management: refer to cardio
Peds CV - Genetic Syndromes and Associated Cardiac Defects
-DiGeorge: aortic arch anomalies
-Trisomy (18 and 21): atrioventricular septal defects, VSD
-Marfans: aortic root disease, mitral valve prolapse - risk for aneurysm, BB therapy
-Turners: coarctation of the aorta, bicuspid aortic valve
Peds CV - S/S in Cardiac Defects
-Most common is feeding problems and FTT (tachypnea and diaphoresis during feeding)
Peds CV - Innocent Murmurs
-Functional, benign
-Have no associated symptoms
-More than 50% of children have innocent murmurs
-Most common in ages 3-7 years
-Low-intensity, grades I-III/VI
-May vary with position change - good sign
-No radiation
-Types:
*Still’s Murmur
*Venous Hum
Peds CV - Still’s Murmur
-Most common innocent murmur
-Musical systolic, vibratory murmur
-Heard in periods of anxiety/stress
-Between LLSB and apex
-Louder when SUPINE ***
Peds CV - Venous Hum
-Continuous humming murmur
-RUSB, infraclavicular area
-Heard best in the SITTING position ***, disappears when supine or when turning the head
Peds CV - Heart Failure
-Example: obese teenager that continuously comes in for a cough - consider CHF and check a BNP
-S/S Infant/very young child:
*Poor feeding or prolonged feedings (vomiting after feeds is not associated with CHF)
*Irritability
*Chronic cough
*Tachypnea: nasal flaring, retractions
*FTT: poor weight gain
-S/S Older child/adolescent
*Exercise intolerance
*Abdominal pain
*Chest pain
*Syncope
Peds CV - HTN
-Acquired heart disease, usually secondary HTN - underlying cause
-To dx, must have a persistent high BP >95th percentile in at least 3 separate occasions
-Labs:
*Aldosterone: rule out aldosteronism
*Morning and evening cortisol: rule out Cushing’s
*UA, CBC, BMP, cholesterol, and triglycerides
*EKG to check for dysrhythmias
-Management:
*Refer to cardio
*DASH diet
*Treat underlying cause
