EXAM #2: CARDIAC EVALUATION IN CHILDREN

Question 1

What are the important elements of the history when seeing a pediatric patient with a possible cardiac condition?

Answer 1

1) Birth weight and gestational age
2) Infection
3) Medications (teratogens)
4) Excessive smoking or alcohol consumption
5) Maternal conditions

Question 2

How is growth/development affected in neonates with heart disease?

Answer 2

Weight gain is specifically delayed b/c of excess calorie consumption for heart working harder

Question 3

What do you want to know about cyanosis in a child?

Answer 3

Permanent vs. paroxysmal

*Paroxysmal is more associated with GERD vs. permanent is cardiac

Question 4

What is tachypnea or dyspnea associated with in a neonate?

Answer 4

CHF

Question 5

What can exacerbate tachypnea or dyspnea in a neonate?

Answer 5

Feeding

Question 6

What is the most common referral to a pediatric cardiologist?

Answer 6

Heart murmur

Question 7

What are the two main forms of tachycardia in children?

Answer 7

1) Inappropriate sinus tachycardia

2) SVT

Question 8

What chromosomal syndrome is associated with a high degree of congenital heart defects?

Answer 8

Down Syndrome

Question 9

What should you remember when you see a child with Pectus excavatum or Pectus carinatum?

Answer 9

These deformities are associated with aortic root dilation

Question 10

A palpable thrill on chest exam is indicative of what grade murmur?

Answer 10

4+

Question 11

What does a higher systolic blood pressure in the arm vs. leg indicate?

Answer 11

Coarctation of the aorta

Question 12

What is the recommended sequence for auscultation of the heart?

Answer 12

1) Heart rate and regularity
2) Listen to S1 and S2
3) Systolic and diastolic sounds
- Check with pulse if unsure
4) Id. murmur

Question 13

What causes the first heart sound?

Answer 13

Closure of the mitral and tricuspid valves

Question 14

If you hear a “split” S1, what are you probably hearing?

Answer 14

Systolic ejection click

E.g. unhealthy aortic valve

Question 15

Where is the best place to listen for a systolic ejection click?

Answer 15

Apex of the heart

Question 16

What causes the second heart sound?

Answer 16

Closure of the aortic and pulmonary valves

Question 17

What causes physiologic splitting of the second heart sound?

Answer 17

Inspiration

Question 18

What causes fixed splitting of the second heart sound?

Answer 18

ASD

Constant volume overload of the RV b/c of the defect

Question 19

What three factors will impact a heart murmur?

Answer 19

1) Flow*
2) Viscosity
3) Orifice size

*I.e. need enough CO to make the murmur

Question 20

What are the three types of systolic murmurs?

Answer 20

1) Ejection
2) Regurgitant
3) Vibratory (innocent)

Question 21

What can cause a continuious murmur?

Answer 21

PDA

Question 22

Review the grading of heart murmurs.

Answer 22

See ppt.

Question 23

List the systolic ejection murmurs.

Answer 23

1) Aortic stenosis
2) Pulmonary stenosis
3) Tetralogy of Fallot
4) Coarctation of the aorta

Question 24

What are the systolic regurgitant murmurs?

Answer 24

1) VSD
2) ASD
3) Mitral regurgitation
4) Tricuspid regurgitation

Question 25

What are the diastolic murmurs?

Answer 25

1) Aortic insufficiency
2) Pulmonary insufficiency
3) Mitral stenosis