hx and examination for paeds cardio Flashcards
important things to ask about in hx
- feeding, weight, development
- tachypnoea, dyspnoea
- exercise tolerance
- syncope
- palpitation
- joint problems
- chest pain
important things to check for in examination
- weight and height
- dysmorphic features
- cyanosis
- clubbing
- tachy/dyspnoea
- pulses, apex, femoral pulses
- heart sounds - clicks, split, S3, 4
- murmurs
important investigations
- BP
- oxygen sats, arterial BGA
- ECG - 12 lead, 24hrs, event monitor
- CXR
- echo
- catheter
- angiography
- MRI/A
- exercise testing - ECG, sO2
treatment principles
- 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
how to characterise murmurs
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)
cardiac cycle and when do the heart sounds occur
whata re the 4 murmur sites
upper R sternal borer
upper L sternal border
lower L sternal border
apex
what are innocent murmurs
70-80% of murmurs
NOT A DIAGNOSIS OF EXCLUSION
4 types with specific features
what are the 4 types of innocent murmurs
vibratory murmur - Still’s murmur (LV outflow)
pulmonary flow murmur
supraclavicular systemic flow murmur - carotid/braciocephalic arterial bruits
venous hums
common features of innocent murmurs
- 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
features of Still’s murmur - LV outflow murmur
- 2-7y/o
- soft systolic, vibratory, musical, twangy
- apex, L sternal border
- increases in supine position and w/ exercise
features of pulmonary outflow murmur
- 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
carotid/brachiocephalic arterial bruits
- 2-10y/o
- 1/6-2/6 systolic, harsh
- supraclavicular, radiates to neck
- increases w/ exercise, decreases on turning head or extending neck
features of venous hum
- 3-8y/o
- soft, indistinct
- continuous murmur, sometimes w/ diastolic accentuation
- supraclavicular
- only in upright position, disappears on lying down or turning head