Heart Murmurs Flashcards
what type of shunt for ASD
L –> R
MCC cause Atrial septal defect
ostium secundum
second MC - ostium primum
Murmur and PE for ASD
Grade 2-6 systolic crescendo decrescendo ejection murmur @ LUSB 2nd ICS
wide, fixed split S2 that does not vary with respirations
may develop Eisenmenger
Dx ASD
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
Tx ASD
Most close spontaneously by age 3 (3-8mm)
close by 2-6y if large
MC congenital heart dz in childhood
VSD
What type of shunt for VSD
L –> R
VSD murmur and PE
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
Dx VSD
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
Tx VSD
Observe - most close by 12 mos
Patch closure by 2 years if large/sx (digoxin and diuretics first if large)
Shunt for Tetralogy of fallot
R –> L (cyanotic)
MC cyanotic heart defect in kids
Tetralogy of Fallot
4 main things for tetralogy of fallot
PROVe
pulmonary stenosis
RVH
Overriding aorta
Ventricular septal defect
Murmur tetralogy of fallot
Harsh systolic crescendo-decrescendo murmur LUSB (pulmonic) - due to RV outflow obstruction NOT VSD
Right ventricular heave (RVH)
loud single S2
Dx tetralogy of fallot
Echo
CXR - boot shaped heart - upturned apex and concave pulmonary artery (decreased pulmonary vascular markings)
EKG - increased RA and RV; check QRS annually
Tx tetralogy of fallot
surgery (definitive - within 12 mos, ideally 3-6 months)
prostaglandins pre-surgery to maintain PDA (provides adequate LE perfusion)
what is a PDA
persistent communication between pulmonary artery and descending thoracic aorta
shunt for PDA
L –> R
what promotes patency of PDA
low oxygen
prostaglandins
murmur and PE for PDA
continuous machine like murmur loudest at pulmonic area (LUSB 2nd ICS)
wide pulse pressure (> 30 mmHg)
bounding peripheral pulses
what is coarctation of the aorta
congenital narrowing of the aortic lumen at the distal arch or descending aorta, causing HTN in UE relative to LE
where does the narrowing in coarctation of aorta MC occur
below the origin of the left subclavian artery
what two things is coarctation of the aorta MC associated with
bicuspid aortic valve
Turner’s syndrome
Murmur and PE for coarctation of the aorta
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
