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Peds EOR > Heart Murmurs > Flashcards

Heart Murmurs Flashcards

1
Q

what type of shunt for ASD

A

L –> R

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2
Q

MCC cause Atrial septal defect

A

ostium secundum
second MC - ostium primum

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3
Q

Murmur and PE for ASD

A

Grade 2-6 systolic crescendo decrescendo ejection murmur @ LUSB 2nd ICS

wide, fixed split S2 that does not vary with respirations

may develop Eisenmenger

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4
Q

Dx ASD

A

Echo - initial best
EKG - RBBB, crochetage age sign (notching of peak of R wave in inferior leads)
CXR - cardiomegaly, dilation of RA and RV and prominent main pulmonary artery segment and increased pulmonary vascular markings
Cardiac Cath - definitive; rarely used

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5
Q

Tx ASD

A

Most close spontaneously by age 3 (3-8mm)

close by 2-6y if large

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6
Q

MC congenital heart dz in childhood

A

VSD

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7
Q

What type of shunt for VSD

A

L –> R

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8
Q

VSD murmur and PE

A

high pitched harsh holosystolic murmur at LLSB (3rd or 4th ICS)
may have thrill at mitral area
may have diastolic rumble at mitral area
handgrip increases murmur

can develop eisenmenger

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9
Q

Dx VSD

A

Echo > Cath
EKG - may be normal, may have LVH, may have LVH + RVH (katz-wachtel phenomenon)
CXR - may be normal, may have enlarged pulmonary artery and increased pulmonary vasculature

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10
Q

Tx VSD

A

Observe - most close by 12 mos
Patch closure by 2 years if large/sx (digoxin and diuretics first if large)

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11
Q

Shunt for Tetralogy of fallot

A

R –> L (cyanotic)

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12
Q

MC cyanotic heart defect in kids

A

Tetralogy of Fallot

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13
Q

4 main things for tetralogy of fallot

A

PROVe
pulmonary stenosis
RVH
Overriding aorta
Ventricular septal defect

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14
Q

Murmur tetralogy of fallot

A

Harsh systolic crescendo-decrescendo murmur LUSB (pulmonic) - due to RV outflow obstruction NOT VSD

Right ventricular heave (RVH)

loud single S2

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15
Q

Dx tetralogy of fallot

A

Echo
CXR - boot shaped heart - upturned apex and concave pulmonary artery (decreased pulmonary vascular markings)
EKG - increased RA and RV; check QRS annually

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16
Q

Tx tetralogy of fallot

A

surgery (definitive - within 12 mos, ideally 3-6 months)
prostaglandins pre-surgery to maintain PDA (provides adequate LE perfusion)

17
Q

what is a PDA

A

persistent communication between pulmonary artery and descending thoracic aorta

18
Q

shunt for PDA

A

L –> R

19
Q

what promotes patency of PDA

A

low oxygen
prostaglandins

20
Q

murmur and PE for PDA

A

continuous machine like murmur loudest at pulmonic area (LUSB 2nd ICS)

wide pulse pressure (> 30 mmHg)

bounding peripheral pulses

21
Q

what is coarctation of the aorta

A

congenital narrowing of the aortic lumen at the distal arch or descending aorta, causing HTN in UE relative to LE

22
Q

where does the narrowing in coarctation of aorta MC occur

A

below the origin of the left subclavian artery

23
Q

what two things is coarctation of the aorta MC associated with

A

bicuspid aortic valve
Turner’s syndrome

24
Q

Murmur and PE for coarctation of the aorta

A

harsh systolic murmur along the left sternal border radiation to the back, left infrascapular region, or chest; murmur could be late systolic or continuous

UE HTN with LE Hypotension

diminished or delayed femoral pulses

25
Q

Dx coarctation of the aorta

A

echo
CXR - posterior rib notching; figure 3 sign (narrowed aorta)
EKG - LVH
angiography - gold standard

26
Q

what is the gold standard dx for coarctation of the aorta

A

angiography

27
Q

tx coarctation of aorta

A

surgery - balloon angioplasty with or without stent placement

prostaglandins prep to maintain PDA

28
Q

inheritance of HCM

A

autosomal dominent

29
Q

is HCM diastolic or systolic dysfunction

A

diastolic

30
Q

histology HCM

A

myocyte hypertrophy w a gross disarray of myofibrils and disorganization of muscle architecture

31
Q

PE and murmur for HCM

A

S4

pulses bisferiens - biphasic pulse

harsh crescendo decrescendo systolic murmur heard at apex and LLSB - no carotid radiation

decreased with sitting, squatting, supine, leg raise

32
Q

Dx HCM

A

echo - asymmetric ventricular wall thickness (esp inter ventricular septum) 15 mm or greater

EKG - LVH, prominent abnormal Q waves

33
Q

Tx HCM

A

BB - first line
Non DHP CCB (verapamil, diltiazem)

34
Q

what med is contraindicated for HCM

A

digoxin

Peds EOR (9 decks)

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