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fixed split second heart sound
ASD
(sound comes from increased flow through pulmonary valve)
best heard at LUSB
harsh holosystolic murmur at LLSB
VSD
systolic click that varies with respiration, normal split S2, located at LUSB
pulmonary stenosis
may have thrill or radiate to back
systolic click heard at apex, does not vary with respiration
aortic stenosis
superior QRS axis
AV canal defect
left axis deviation without hypertrophy
tricuspid atresia and AV canal defects
LVH without left axis deviation
HOCM
systolic murmur in L axilla, louder in the back
coarctation of the aorta
tx of coarct
prostaglandins if neonate –> surgical
causes of cyanotic heart disease without murmur
TGA
tricuspid atresia
pulmonary atresia
TAPVR
causes of severe cyanosis in neonatal period
TGA
pulmonary atresia
tricuspid atresia
risk with cyanotic heart disease and polycythemia
stroke
infant with increased RV activity, cyanosis, hypoxia, pulmonary edema/congestion on CXR
TAPVR
components of Tet
pulmonary stenosis
overriding aorta
VSD
RVH and right axis deviation
signs of tet spell
sudden cyanosis and hyperpnea, murmur disappears
risk factors that worsen cognitive effects of cyanotic heart disease
decreased neurological baseline prior to surgery
seizures prior to surgery
coexistent problems
duration of intraop circulatory arrest
tx of tet spell
knee to chest
morphine
propraolol
volume expansion
cyanosis, egg shaped heart, increased pulmonary casbularity
TGA
tx TGA
prostaglandins, balloon septostomy
tx SVT
vagal maneuvers
adenosine
amiodarone/procainamide 2nd line
cardioversion esp if unstable or adenosine not available
emotional lability, purposeless rapid movements, muscle weakness
Sydenham’s chorea
Major Jones criteria
polyarthritis carditis subcutaneous nodules erythema marginatum sydenham chorea
minor jones criteria
arthralgia
fever
elevated inflamm markers
prolonged PR
rheumatic fever dx
2 major criteria or 1 major and 2 minor
tx rheumatic fever
penicillin
aspirin (for arthritis)
steroids for carditis?
most common bugs in endocarditis in children
S aureus and viridans streptococci
initial tx of endocarditis
vanc and gent
when do you need dental ppx
repaired cyanotic heart disease
surgery with hardware/device in last 6 months
residual defect near prosthetic device
most common cause of myocardiits
coxsackie B
most common causes of pericarditis
viral
collagen vascular disease
bacterial less common; most common bacterial cause is S aureus
