hx and examination for paeds cardio

Question 1

important things to ask about in hx

Answer 1

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

Question 2

important things to check for in examination

Answer 2

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

Question 3

important investigations

Answer 3

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

Question 4

treatment principles

Answer 4

• 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

Question 5

how to characterise murmurs

Answer 5

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)

Question 6

cardiac cycle and when do the heart sounds occur

Answer 6

Question 7

whata re the 4 murmur sites

Answer 7

upper R sternal borer

upper L sternal border

lower L sternal border

apex

Question 8

what are innocent murmurs

Answer 8

70-80% of murmurs

NOT A DIAGNOSIS OF EXCLUSION

4 types with specific features

Question 9

what are the 4 types of innocent murmurs

Answer 9

vibratory murmur - Still’s murmur (LV outflow)

pulmonary flow murmur

supraclavicular systemic flow murmur - carotid/braciocephalic arterial bruits

venous hums

Question 10

common features of innocent murmurs

Answer 10

• 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

Question 11

features of Still’s murmur - LV outflow murmur

Answer 11

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

Question 12

features of pulmonary outflow murmur

Answer 12

• 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

Question 13

carotid/brachiocephalic arterial bruits

Answer 13

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

Question 14

features of venous hum

Answer 14

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