Exam 3: Cardio Flashcards
When there is a palpable thrill on exam, what is the lowest grade murmur that patient can have?
Needs to be at least a grade 4
Grade 1, 2, and 3 have no palpable thrill
What is the gold standard of pediatric cardiology diagnostic tools?
Echocardiogram (TEE and TTE)
What is the most common innocent murmur of childhood?
Still murmur
What kind of murmur has musical or vibratory quality best heard at the LLSB, and is loudest when supine and diminishes with inspiration or sitting?
Still murmur
What is the most common murmur in older children and adults?
Pulmonary flow murmur
- This murmur does not occur in infancy
What kind of murmur sounds like a musical hum best heard at the R and L USB that is louder in diastole and while sitting with the head extended, but disappears with turning the head or laying supine?
Venous hum -Innocent murmur
What are the 3 kind of innocent murmurs?
Still murmur, pulmonary flow, and venous hum
What are the acyanotic congenital heart diseases?
VSD, ASD, patent ductus arteriosus, and coarctation of the aorta
What are the cyanotic congenital heart diseases?
-Tetraology of fallot, transposition of the great arteries, tricuspid atresia, truncus arteriosus, total anomalous Pulmonary venous return, and hypoplastic left heart syndrome
What is the most common congenital heart defect?
VSD
What does VSD sound like on auscultation?
Harsh, holosystolic murmur at the LLSB
What are the diagnostic tests for VSD?
ECHO, EKG, and CXR
What are the treatments for VSD?
1) wait if asymptomatic, it may spontaneously close
2) treat CHD with diuretics, ace inhibitors, possibly digoxin
3) Surgery if failure of medical management
What is the most common location fo ASD?
Ostium secundum
** may also be located at ostium primum or sinus venosus
What is the common PE finding with ASD?
-Fixed and widely split S2 at pulmonary area
How is ASD diagnosed?
ECHO
What kind of ASD is often associated with other defects?
ASD of the ostium primum
When is Patent Ductus arteriosus (PDA) commonly seen?
Premature infants, more often in females, and maternal rubella
What is the normal direction of flow in PDA? What can change this?
- normally L-> R shunting occurs with normal pulmonary vascular resistance.
- Eisenmerger syndrome: shunt can reverse and become R-L if high pulmonary pressures causing cyanosis
What are the common physical exam findings with PDA?
- Continuous machinery like murmur
- Wide pulse pressure with bounding pulses
What do you give to keep PDA open?
IV prostaglandin E1
What do you give to close PDA?
IV indomethacin
What is coarctation of the aorta?
Narrowing of the aortic arch, usually in the proximal descending aorta near the takeoff of the let subclavian artery and the ductus arteriosus
What syndrome is coarctation commonly associated with?
Turner syndrome
- Also seen in children with unexplained hypertension
