Cards Flashcards
wide splitting of 2nd heart sound (persistently)
Can be due to delayed right ventricular emptying and may indicate ASD, RBBB or severe pulmonic stenosis
Paradoxical splitting of S2
(normally see split with inspiration)
- But if you hear split with expiration then this is sue to a delay in left ventricular emptying with the aortic closure sound coming after the pulmonic.
- I.E. in severe aortic stenosis of LBBB
Third heart sound
in early diastole
- “stiff” ventricle
- Can be normal in children and in pregnant women
Fourth heart sound
in late diastole
- never normal
- Aortic stenosis, mitral regard, HOCM and LV hypertroph
Innocent systolic murmurs
-Should get louder when child is supine, (sometimes with exercise, anxiety, anemia or fever)
Stills murmur
systolic ejection murmur
vibratory quality
best in the lower precordium
very common
Physiologic peripheral pulmonic stenosis
- soft, harsh systolic ejection murmur best hear in axillae and both the right and left hemithoraces
- Usually disappears by 12 months
Venous hum
- due to blood draining down the collapsed jugular veins in to the dilated intrathoracic veins
- low pitched murmur
- Generally absent when supine
- Valsalva, turning of the head or compression of the jugular vein also makes it go away
QRS duration
usually < 100 ms
- May be longer in:
- BBB, PVC, WPW, electrolyte problems
QTc
Normalls 340-440 ms
-Prolonged: tendency to develop torsaddes
Causes of prolonged QTc
- Tricyclic OD
- Hypocalcemia
- Hypomagnesemia
- Hypokalemia
- CNS insult
- Azithromycin
- Liquid protein diet
Long QT + sensorineural deafness
Jervell and Lange-Nielsen syndrome
Normal P wave
positive in II and negative in aVR
Peaked T wave
Hyperkalemia
Intracerebral hemorrhage
Diffuse ST segment changes
most often pericarditis
1st degree AV block
prolongs the PR interval by more than 200 ms for age
2nd degree AV block- type 1
Mobitz 1
- progressive prolongation of the PR interval until there is a drop in QRS
- Occasional follow-up recommended
- No treatment usually required
2nd degree AV block- type 2
Mobitz 2
- Normal PR intervals but occasional drop in QRS
- Often requires a pacemaker
3rd degree AV block
Complete heart block
-complete AV dissociation
Left to right shunts
systemic circulation is shunted to pulmonary circulation
- determined based on:
- Size of the shunt
- Pressure difference between the 2 vessels
- Total outflow (vascular bed) resistances
PDA- normal closure
10-15 hours after birth, but may take up to 3 weeks
PDA- murmur
Continuous murmur, “machinery” like murmur
best below left clavicle
Large PDA
May increase LV output, increases stroke volume
- May see a bounding pule (b/c flow continues during diastole so you get a low diastolic pressure)
- EKG may show evidence of LV hypertrophy
- CXR will show increased pulmonary markings which may eventionally lead to irreversible pulmonary hypertension (Eisenmenger syndrome)
VSD
- Most common congenital heart defect in the first few years of life
- In <1 year: typically muscular septum and will close spontaneously
- In > 1 year: typically membranous septum, just below the aortic valve
VSD- murmur
Harsh/high-pitched murmur
- Holosystolic as it increases in size
- Generally best at LLSB, radiates through precordium
ASD-murmur
Systolic ejection murmur that is crescendo-decrescendo and heard best at ULSB
Most common heart defect in Down Syndrome
Complete AV Canal defect (AV septal defect, Endocardial Cushion Defect)
Aortic regurgitation- murmur
High pitched early diastolic murmur
Mitral regurgitation
Apical, high pitched blowing systolic murmur
- Can radiate to the left axilla and the back
- Most common cause, world-wide, is rheumatic fever
Mitral valve prolapse- murmur
late-systolic crescendo murmur at apex, almost always preceded by 1 or more clicks
- With sitting/standing (decreased LV volume) the murmur will get longer and the click moves earlier
- With laying or squatting (increased LV volume) the murmur gets shorter and the click moves later
Pulmonary regurgitation- murmur
Low-pitched, decrescendo diastolic murmur
Pulmonic stenosis- murmur
Systolic ejection click (that varies with respiration) along the left sternal border, followed by a crescendo-decrescendo murmur
