CLIPP 18: 2-week male, poor feeding Flashcards
Newborns should regain their birth weight by wheN?
Day 10-14
List 4 diagnoses that may cause respiratory distress and difficulty feeding in an infant
CHF
Respiratory infection
Sepsis
Metabolic Disorder
Normal respiratory rate in a newborn?
40-60 bpm
Can a normal liver edge be palpated in an infant?
Yes: 1-2 cm below the right costal margin
Classic findings of CHF in an infant?
Dyspnea with feedings Diaphoresis Poor growth Active precordium Hepatomegaly
Most commonly heard innocent murmur?
The most commonly heard innocent murmur is the Still’s murmur. This is often described as musical or vibratory, and is heard best at the left lower sternal border in the supine position.
At what age is an ASD generally first detected?
Age 3-5
The pathognomonic physical finding of an ASD is a widely split, fixed S2, which is a subtle physical finding and difficult to detect on a potentially uncooperative infant with a higher resting heart rate.
Listening for wide splitting of the second heart sound is the most helpful way to distinguish an ASD from an innocent murmur.
List 4 heart defects that present with a murmur and signs of CHF in a newborn
VSD
Severe aortic stenosis
Coarctation of the aorta
Large PDA
How does tetrology of fallot present?
Cyanosis
Three imaging techniques to evaluate a congenital heart defect?
EKG
Echo
Chest X-ray
Hallmark Chest x-ray findings on a left to right shunt due to congenital heart defect?
Enlarged cardiac silhouette
Increased vasculature
Pulmonary edema
List the three structures of a septum of the heart
the inlet septum (embryologic endocardial cushion)
the outlet septum (embryologic conotruncus) and
the muscular septum (embryologic trabecular septum)
What two embryologic errors result in a VSD?
The “fusion” point of these structures is the membranous septum. VSDs occur due to either a lack of tissue (such as an endocardial cushion defect resulting in an inlet VSD) or a lack of fusion (lack of fusion of the embryologic components at the membranous septum, resulting in a “peri” membranous defect)
What is the prognosis for a VSD?
VSDs tend to diminish in size with time with spontaneous closure of approximately 75% of small defects and between 25-50% of all defects
Why is VSD not heard in the nursery?
The murmur of a VSD will not appear until the PVR drops, usually at a few days to weeks of age. This is why, typically, VSD murmurs are not heard in the nursery
List three drugs used in the treatment of congenital CHF
Furosemide
Digoxin- shown to improve symptoms due to VSD in infants
Enalapril- twice daily dosing vs captopril (TID)
By what age should surgical decision about VSD closure be made?
6 months
What are EKG findings consistent with a VSD?
EKG shows high voltage QRS complexes in leads V1 and V2
Describe why you don’t hear the VSD murmur until a few days to weeks of age
A heart murmur from a VSD is typically not appreciated in the immediate newborn period, as the pulmonary vascular resistance is still quite elevated. During this time, since the pulmonary vascular resistance equals the systemic vascular resistance, there is no shunting of blood through the open VSD. However, after a few days to weeks after birth, the pulmonary vascular resistance decreases, and the murmur appears, reflecting the shunted flow of blood through the open VSD (from left to right).
What is the normal fetal circulation through the heart?
In fetal circulation, the foramen ovale connects the RA to the LA, allowing a portion of the blood to bypass the RV and the lungs. Approximately a third of the blood that enters the RA passes through this route (preferentially the most oxygenated which is then delivered to the brain and heart), leaving the majority of the blood to travel into the RV. Closure of the foramen ovale is a normal transition from fetal to extrauterine circulation
What blood flow causes the murmur in an ASD (marked by a wide-split S2?)
his patient’s murmur is likely caused by an atrial septal defect, which causes flow of additional blood through the pulmonary outflow tract and should be evaluated
How might an ASD present?
If the defect is large enough, pediatric patients may present with easy fatigability, recurrent respiratory infections, or exertional dyspnea
