hx and examination for paeds cardio Flashcards

1
Q

important things to ask about in hx

A
  • feeding, weight, development
  • tachypnoea, dyspnoea
  • exercise tolerance
  • syncope
  • palpitation
  • joint problems
  • chest pain
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2
Q

important things to check for in examination

A
  • weight and height
  • dysmorphic features
  • cyanosis
  • clubbing
  • tachy/dyspnoea
  • pulses, apex, femoral pulses
  • heart sounds - clicks, split, S3, 4
  • murmurs
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3
Q

important investigations

A
  • BP
  • oxygen sats, arterial BGA
  • ECG - 12 lead, 24hrs, event monitor
  • CXR
  • echo
  • catheter
  • angiography
  • MRI/A
  • exercise testing - ECG, sO2
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4
Q

treatment principles

A
  • fix it if you can
  • if you can’t:
    • medication
    • palliative e.g. BT shunt, balloon valvoplasty, prostaglandin infusion, pulmonary banding
  • if you can’t do either - replace it
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5
Q

how to characterise murmurs

A

timing in cardiac cycle: systole/diastole/continuous

duration: early/mid/late, ejection/holo or pan systolic

pitch/quality: harsh or mixed frequency (turbulence), soft or indeterminate, vibratory/pure frequency (laminar flow)

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6
Q

cardiac cycle and when do the heart sounds occur

A
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7
Q

whata re the 4 murmur sites

A

upper R sternal borer

upper L sternal border

lower L sternal border

apex

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8
Q

what are innocent murmurs

A

70-80% of murmurs

NOT A DIAGNOSIS OF EXCLUSION

4 types with specific features

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9
Q

what are the 4 types of innocent murmurs

A

vibratory murmur - Still’s murmur (LV outflow)

pulmonary flow murmur

supraclavicular systemic flow murmur - carotid/braciocephalic arterial bruits

venous hums

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10
Q

common features of innocent murmurs

A
  • systolic murmur - continuous in venous hum
  • no other signs of cardiac disease
  • soft murmur, grade 1/6 or 2/6
  • vibratory, musical
  • localised
  • varies w/ position, respiration, exercise
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11
Q

features of Still’s murmur - LV outflow murmur

A
  • 2-7y/o
  • soft systolic, vibratory, musical, twangy
  • apex, L sternal border
  • increases in supine position and w/ exercise
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12
Q

features of pulmonary outflow murmur

A
  • 8-10y/o
  • soft systolic, vibratory
  • upper L sternal border, well localised, not radiating to back
  • increases in supine position, w/ exercise
  • often children w/ narrow chest
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13
Q

carotid/brachiocephalic arterial bruits

A
  • 2-10y/o
  • 1/6-2/6 systolic, harsh
  • supraclavicular, radiates to neck
  • increases w/ exercise, decreases on turning head or extending neck
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14
Q

features of venous hum

A
  • 3-8y/o
  • soft, indistinct
  • continuous murmur, sometimes w/ diastolic accentuation
  • supraclavicular
  • only in upright position, disappears on lying down or turning head
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