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MOD 1 Test > CV Evaluation of the Pediatric Patient > Flashcards

CV Evaluation of the Pediatric Patient Flashcards

(75 cards)

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1
Q

Acyanotic lesions?

A

Increased volume/ left to right shunts

Increased pressure/ obstructive lsions

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2
Q

Increased volume/left to right shunts?

A

Severe lesions can present early with signs and symptoms of heart failure
milder lesions
left untreated can progress to Eisenmenger Syndrome

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3
Q

Increased pressure/Obstructive Lesions?

A

Typically identified by classic exam findings

Left untreated severe lesions can progress to heart failure

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4
Q

Maternal health concerns?

A 
Diabetic
Maternal SLE
Maternal CHD
Rubella
CMV, HSV, Coxsackie B, Parvovirus
HIV
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5
Q

Teratogens?

A 
Fetal alcohol
Lithium
Phenytoin
Retinoic acid
Warfarin
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6
Q

Fetal alcohol cause?

A

VSD, ASD, TOF, PDA

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7
Q

Lithium can cause?

A

Severe right heart abnormalities (Ebstein anomaly)

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8
Q

Phenyoin can cause?

A

PS, AS, coarc, PDA

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9
Q

Warfarin can cause?

A

PDA, ASD

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10
Q

Characteristic features of fetal alcohol syndrome?

A

FAS Facial characteristics

  • small eye openings
  • smooth philtrum
  • thin upper lip
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11
Q

Postnatal history, growth and development?

A

poor weight gain and delayed development are often seen with heart failure (HF)

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12
Q

Feeding patterns? Postnatal history

A

poor feeding can be an early sign of HF
fatigue, diaphoresis, or cyanosis during feeds
Unable to stay awake for the full feeding

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13
Q

Cyanosis? Postnatal history

A

Onset, severity, frequency, affected areas (lips, toes, fingers)

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14
Q

Respiratory distress? Postnatal history

A

tachnypnea, dyspnea, retractions, etc

**squatting during distress suggests TOF

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15
Q

Tet spells?

A

cyanotic spell in infants or young children with uncorrected TOF
caused by any even that decreases SVR and produces a large R to L ventricular shunt leading to decrease in pulmonary blood flow which is already compromised

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16
Q

Characterize a tet spell?

A 
rapid and deep respiration
worsening cyanosis
disappearance of murmur
restlessness
gasping respiration
possible syncope
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17
Q

Sometimes relieve a tet spell?

A

infant in knee-chest position which traps venous blood in legs to decrease venous return and calm child

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18
Q

treatment for tet spell?

A

oxygen and morphine

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19
Q

History, Exercise intolerance/fatigue?

A

infants- feeding patterns
preschool/school-keep up with other children
older- how many blocks can he run? how many flights before fatigue?

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20
Q

History, edema puffy eyelids or sacral edema?

A

signs of CHF, venous congestion, frequency of lower respiratory infections

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21
Q

Heart murmur history?

A

timing and circumstances discovered

what was done about it?

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22
Q

History syncope?

A

with exercise? arrhythmia (long QT)/ obstuctive lesion
while sitting? seizure, arrhythmia
prolonged standing? Vasovagal
with exertion and CP? possible cardiac etiology

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23
Q

History of palpitations?

A

SVT, hyperthyroidism, premature beats, MVP

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24
Q

Family history congenital heart disease?

A

Risk of CHD in 2nd pregnancy after previous child is 2-6%

Risk is up to 20-30% when having CHD in 2 first degree family members

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25
Family history Hereditary diseases?
some associated with CV disease (marfans, aortic aneurysm)
26
Family history rheumatic fever?
often occurs in multiple family members, no known genetic factor but thought to be inherited susceptibilty
27
Vital signs?
heart rate -poor heart function leads to tachy to maintain CO respiratory rate -tachypnea, hyperventilation to improve oxygenation pulse ox -hypoxemia height/weight -growth and development are key markers of cardiac health in children
28
Palpation of peripheral pulses?
R/L upper compared with lower
29
Strong upper/ weak lower pulses?
coarctation of aorta
30
Bounding pulses, wide pulse pressure?
PDA, AI, increased CO
31
Weak pulse?
HF, pericardial tamponade, decreased CO
32
Diaphoriesis?
cold sweat, can be seen in children with HF
33
Clubbing?
indicates chronic low arterial saturation | loss of nail bed angle and distal hypertrophy of the digit
34
Eisenmenger Syndrome?
Shunt becomes R to L due to pulmonary hypertension initially L to R shunt occurs long term in lesions with increased volume of blood on right side resulting in medial hypertrophy and/or intimal hyperplasia in the pulmonary vasculature
35
Symptoms Eisenmenger Syndrome?
2nd/3rd decade | cyanosis, dyspnea, fatigue, arrhythmias
36
Apical impulse?
PMI normally located at the 4th left intercostal space medial to the midclavicular line under age 7 yrs
37
Apical heave?
suggests LV hypertrophy
38
Substernal thrust?
suggests RV hypertrophy
39
hyperactive precordium?
suggests volume overload, but can be normal in very thin individuals
40
Silent precordium?
suggests severe cardiomyopathy or pericardial effusion
41
Thrills?
palpable equivalent of murmurs correlate with area where the murmur is heard the loudest on auscultation always pathological best felt with palm of hand, finger over neck thrills over the suprasternal notch suggest LV outflow tract stenosis
42
S1?
closing of AV valves heard best at apex, lower left sternal border slight splitting can be normal but not common
43
S2?
closing of aortic and pulmonary valves heard best at the upper left sternal border splitting is normal, increases in inspiration, and decreases in expiration fixed splitting suggests a cardiac defect Splitting can be hard to hear in neonates due to rapid heart rates, so obvious splitting should raise concern
44
S3?
heard in early mid diastole during initial phase of rapid passive ventricular filling low frequency, it is heard best at the apex with the bell can be heard in healthy kids/athletes at apex but loud s3 is abnormal may be heard as gallop rhythm in patients with heart failure and tachycardia
45
S4?
heard in late diastole and usually pathologic | associated decreased ventricular compliance
46
Ejection clicks?
heard in early systole, may be confused with split s1 best heard at mid to upper sternal borders associated with AS, PS, or conditions that cause aortic/ PA dilation a midsystolic click heard best at the lower sternal border suggest MVP
47
Heart murmurs?
``` I: barely audible II: soft, but easily audible III: moderately loud, but no thrill IV: louder, with thrill V: audible with stethescope barely on chest VI: audible with stethescope off chest ```
48
Murmurs, Benign?
innocent, functional common in children all are accentuated during high output state, usually during febrile illness all are associated with normal EKG and CXR findings
49
Classic vibratory murmur/ Still's murmur?
Most common typically detected btw 3 and 6 yo, may be present in newborn midysytolic ejection murmur Low-pitch, best heard with bell of stethescope, patient supine grade 1-3/6, typically heard best LLSB Vibratory, twaning string, musical Intensity with fever, anemia, after exercise, during excitment
50
Pulmonary flow of murmur of newborns? (PPS)
premature and full term newborns, usually disappears by 3-6 months midsystolic grade1-3/6 maximal at upper left sternal border Transits well to L and R chest, axillae, and back Caused by turbulent flow through pulmonary arteries when ductus closes that are relatively hypoplastic b/c they didnt recieve much blood flow during fetal life
51
Pulmonary ejection murmur of childhood?
8-14 yo, early to midsystolic grade 2-3/6, blowing quality heard best at the upper left sternal border represents exaggeration of normal ejection vibrations in pulmonary trunk
52
Venous hum?
typically noted at 3-6 months heard only in upright position and disappears in supine position Continous murmur medium pitch, grade 1-3/6 best heard at L or R supra/infraclavicular areas can be obliterated by rotating head from turbulens in jugular venous system
53
Carotid bruit?
``` any age, early systolic murmur grade 2-3/6 R supraclavicular area over carotids Occasional thrill noted over carotis from turbulence in crachicephalic or carotid arteries ```
54
Features that suggest a pathologic murmur?
``` diastolic murmur loud systolic murmur (3/6 >) associated with a thrill long in duration transmit well associated with any other abnormal heart sounds associated with strong/ weak pulses other associated CV symptoms, general exam findings, or abnormal CXR/ ECG ```
55
ASD exam findings?
``` palpation - RV displaced PMI heart sounds -fixed, widely split S2, SEM at ULSB other -possible RVH on EKG/CXR ```
56
VSD exam findings?
``` Palpation -LV displaced PMI, Thrill at LLSB Heart sounds -possible wide split at s2, harsh or blowing holosys murmur at LLSB other - possible LVH on EKG/CXR ```
57
AV canal exam findings?
``` Palpation -hyperactive precordium Heart Sounds -Loud S1, Holosys murmur at LLSB, Diastolic rumble Other -Cardiomegaly, HF ```
58
PDA exam findings?
``` Palpation -Hyperactive precordium Heart Sounds -continuous machinery like murmur at LLSB Other -bounding pulses ```
59
PS exam findings?
``` Palpation -RV displaced PMI Heart sounds -Ejection click, SEM at ULSB Other -Possible RVH on EKG/ CXR ```
60
AS exam findings?
``` Palpation -LV displaced PMI Heart sounds -Ejection click, SEM at URSB, mid LSB other -Possible LVH on EKG/CXR ```
61
ABG on room air tells you?
can confirm or refute central cyanosis | elevated PCO2 could mean CNS or pulmonary problem
62
Pre and postductal ABG/saturation tells you?
Arterial PO2 from right upper extremity that is 10 to 15 mmHg higher than umbilical artery or lower extremity site is significant and suggests a R to L ductal shunt
63
Hyperoxia test?
way to diagnose right to left shunt | take an ABG on room air, place the infant on 100% oxygen for at least 10 min, recheck ABG
64
Hyperoxia test if PaO2 rises above 150 mmHg?
intracardiac shunts are likely suggest pulmonary disease or other cause of hypoxemia saturation increases of 15% or greater also suggestive of other causes
65
Hyperoxemia test if PaO2 remains < 150 mmHg?
suggest R-L shunt (cyanotic congential heart disease)
66
Chest xray?
evaluate cardiac size and shape as well as position of apex asses pulmonary vascular markings evaluate associated pulmonary and thoracic abnormalities
67
Trasposition of the great arteries on CXR?
Egg shaped or egg on a string appearance
68
Tatrology of fallow on CXR?
boot shaped heart
69
Total Anomalous Pulmonary venous return (TAPVR)?
Snowman sign
70
Echocardiography?
shows cardiac structure and function as (wall thickness, ejection fraction, cardiac output, blood flow, presecence of clots, pericardial fluid) useful for assessment of suspected heart disease, endocarditis, concerning heart murmurs usually transthroacic (TTE), but transesophagel (TEE) if suboptimal TTE
71
Signs of PDA?
``` classic heart murmur bounding peripheral pulses hyperactive precoridum hypotension respiratory deterioration ```
72
Close a pathologic PDA?
Nsaids | surgery/ transcatheter approach
73
2 drugs used to close PDA?
Indomethacin | Ibuprofen
74
Indomethacin?
prostaglandin synthase inhibitor renal side effects: decreased UOP and GFR decreased mesenteric blood flow
75
Ibuprofen?
effective as indomethacin fewer renal side effect does not decrease renal or mesenteric blood flow

MOD 1 Test (5 decks)

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