CLIPP 18 - CHF

Question 1

DDX infant feeding difficulty and respiratory distress (4)

Answer 1

• CHF
• Respiratory infection
• sepsis
• metabolic disorder

Question 2

Heart murmurs (6)

Answer 2

• VSD (blowing, holosystolic)
• ASD (widely split, fixed S2)
• Aortic stenosis (systolic ejection and early diastolic)
• Pulmonic stenosis (harsh systolic ejection murmur with click after S1)
• PDA (continuous, louder in systole)
• Innocent (vibratory and low-pitched, left lower sternal border)
• grade III or higher is likely pathologic

Question 3

Structural heart defects (8)

Answer 3

• ASD
• Coarctation (murmur, upper extremity HTN)
• VSD
• Aortic stenosis
• Pulmonic stenosis
• PDA
• Tetralogy of Fallot
• Bicuspid aortic valve (early systolic click)

Question 4

CHF features in kids (6)

Answer 4

• dyspnea with feeding
• diaphoresis
• poor growth
• active precordium
• hepatomegaly
• increased metabolic demand

Question 5

When should newborns be back to birth weight?

Answer 5

10-14 days

Question 6

Murmur intensity grading (I-IV)

Answer 6

I: faint and easily missed
II: obvious
III: loud
IV: associated with a thrill

Question 7

Heart defects that cause CHF (4)

Answer 7

• VSD
• Severe aortic stenosis
• Coarctation
• Large PDA

Question 8

Admission criteria for congenital heart disease (6)

Answer 8

-cyanosis, CHF, shock, increased respiratory effort, lethargy/AMS, feeding difficulty

Question 9

CHF treatment (3)

Answer 9

• furosemide (Lasix)
• digoxin
• Enalapril
• control symptoms and encourage growth

Question 10

Evaluation of congenital heart defects (3)

Answer 10

• ECG (chamber enlargement)
• Chest x-ray (cardiomegaly, pulmonary edema, increased pulmonary vascular markings)
• Echo