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Physical Diagnosis > Lecture Two ( peds heart)-Exam 2 > Flashcards

Lecture Two ( peds heart)-Exam 2 Flashcards

1
Q

What is the normal heart rate for newborn through adolescent?

A
  • Newborn: Faster
  • Adolescent: Slower more like adult
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2
Q

Definition of arrhythmias?

A
  • a condition in which the heart beats with an irregular or abnormal rhythm
  • an alteration in rhythm of the heartbeat either in time or force
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3
Q

What are some asymptomatic arrhythmias in children?

A

● Sinus arrhythmia
● Ventricular premature beats (VPBs) or Premature ventricular contractions (PVCs)
●Atrial premature beats (APBs) or Premature atrial contractions (PACs)

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4
Q

What is sinus arrhythmia? When can it be hard to hear?

A

A normal physiologic variant that is characterized by an increased heart rate during inspiration and a decreased heart rate during expiration which is a benign condition
* Hard to hear in slow HRs for example athletic children

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5
Q

What are some arrhythmias of symptomatic children?

A

● Atrial arrhythmias
● Supraventricular tachycardia (common)
● Ventricular tachycardia
● Sinus node dysfunction
● Second degree heart block

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6
Q

What are the common symptoms of arrhythmias? (difference between children and newborn)

A
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7
Q

What are some common symptoms of arrhythmias in babies?

A
  • Fainting
  • Palness
  • Slow heartbeat
  • Feeling pauses between heartbeats
  • Sweating
  • SOB
  • Irritability in infants
  • Difficulty feeding (infants)
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8
Q

What are some common symptoms of arrhythmias in older children?

A

*Weakness
*Tiredness
*Palpitations
*Feeling lightheaded or dizzy
*Fainting or near fainting
*Paleness
*Chest pain
*A fast heartbeat
*Feeling pauses between heartbeats
*Sweating
*Shortness of breath
*Irritability in infants
*Difficulty feeding (infants)

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9
Q

What are the causes of arrhythmias?

A

*Infections: via vag canal, in utero, and in the world
*Chemical imbalances: electrolytes
*Fever: need to be careful because it can instestify
*Medications: albuterol
*Heart defect: could happen so need echo and EKG
*Cardiomyopathy (disease of the heart muscle)

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10
Q

Supraventricular Tachycardia (SVT):
* What is it?
* Most common what?
* How many in general pediatric population
* How many in congenital heart disease?
* Majority of patients presenting with SVT have what?

A
  • Definition: abnormally rapid heart rhythm originating above the ventricles
  • Most common rhythm disturbance in children
  • ~0.1% to 0.4 % in the general pediatric population
  • Among children with congenital heart disease it occurs in ~7%
  • Majority of patients presenting with SVT have structurally normal hearts.
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11
Q

Supraventricular Tachycardia (SVT):
* The heart rate is _ dependent
* What are the HR typical ranges for infants and children+adolescents? ⭐️
* What is the duration of event?

A

Heart rate - age-dependent

Typical ranges
● Infants: 220 - 280 beats per minute (bpm)
● Children and adolescents: 180 - 240 bpm

Duration of event
● average duration is 10 - 15 minutes, some episodes last only one to two minutes, while others persist for hours

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12
Q

What are the symptoms of SVT in infants?

A
  • Pallor, fussiness, irritability, poor feeding, and/or cyanosis
  • The symptoms can be subtle, and tachycardia may go unrecognized for long periods of time
  • Infants often present with symptoms of heart failure (ex: tachypnea, fatigue with feeding, poor weight gain)
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13
Q

SVT all the time can lead to what?

A

Heart failure

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14
Q

What are the symptoms of SVT in children and adolescents?

A
  • Palpitations, chest discomfort, fatigue, lightheadedness
  • Syncope is less common and may be a warning sign for increased risk of sudden death
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15
Q

SVT is usually characterized by what?

A

by abrupt onset and termination. Most SVT episodes occur at rest, although exercise can be a trigger in some patients.

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16
Q

Supraventricular Tachycardia (SVT):
* SVT in early infancy often what?
* Is long term therapy needed?
* Some patients may have what?
* When does SVT tend to stay lifelong?

A
  • SVT in early infancy often resolves by age 1 year
  • Long-term therapy may not be needed (b-blockers and ablasion)
  • Some patients may have recurrence later in childhood
  • SVT present >5 years tends to persis
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17
Q

Vagal maneuver for SVT?

A

Ice to face, blow into straw, rectal stimulation
* NO carotid massages on children

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18
Q

What is dextrocardia?

A

an abnormal condition in which the heart is situated on the right side and the great blood vessels of the right and left sides are reversed

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19
Q

What are the areas that you need to listen to for newborn heart?

A
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20
Q

Where should we listen to the heart sounds for dextrocardia?

A
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21
Q

Why are heart murmurs interesting in infants and children?

A

Heart murmurs are common in infants and children, but only a minority of patients with murmurs have heart disease

22
Q

Association of murmurs with heart disease is higher in who? When does it decrease?

A

Association of murmurs with heart disease is higher in infants and decreases with age during childhood and adolescence

23
Q

What are the common causes of murmurs in neonates and infants?

A
  • Patent ductus arteriosus
  • Tricuspid regurgitation
  • Ventricular septal defects
  • Peripheral pulmonary stenosis
  • Pulmonary stenosis
  • Aortic stenosis
  • Coarctation of the aorta (check pulses)

PACT PVP

24
Q

Patent ductus arteriosus:
* Presents when? Occurs as what?
* Best heard where?
* Closes when?
* Prolonged PDA occurs in who?

A
  • PDA present just after birth, as part of a normal transition, it usually occurs as a soft systolic murmur which disappears in a few hours or a few days.
  • Best heard at the left upper sternal border and often described as a continuous “washing machine-like“ sound
  • Closes in approximately 90% of full-term neonates by 48 hours
  • Prolonged PDA occurs most commonly in premature infants

PDA is normal for a few hours in the left (sternal) corner of the laundry mat (washing machine)

25
Q

What does PDA sound like?

A

“washing machine-like“ sound

26
Q

What is the most common cardiac abnormality?

A

VSD

27
Q

VENTRICULAR SEPTAL DEFECT (VSD):
* When is it heard?
* Best heard where?
* What type of murmur?
* Many VSDs will do what?

A
  • VSD is the most common cardiac abnormality
  • Often not heard at birth, but as the ductus arteriosus closes and the pressure gradient between the two ventricles becomes greater the murmur intensifies
  • Best heard at the left lower sternal border as a harsh murmur often on day 2 or 3.
  • Holo- or pansystolic murmur
  • Many VSDs will close spontaneously over the course of several weeks to months.
28
Q

When is the VSD more silent?

A

When it is larger

29
Q

What are common causes of murmurs in children (over a year old)

A
  • Innocent Still murmur ⭐️
  • Cervical venous hum ⭐️
  • Atrial septal defect
  • Mitral regurgitation
  • Bicuspid aortic valve
  • Pericarditis

⭐️ =most common

30
Q

1/3 to 3/4 of children have what?

A

an innocent murmur noted at some time between age 1 - 14 years old

31
Q

INNOCENT STILL MURMUR-
* Where is the max intensity?
* What does it sound like?
* When is it louder?

CERVICAL VENOUS HUM-
* Best heard where?
* When is it the loudest?

A

INNOCENT STILL MURMUR-
* Maximum intensity at the left lower sternal border or between the left lower sternal border and apex.
* Systolic Murmur with a characteristic vibratory or musical quality.
* Louder supine than in the sitting position and in hyperdynamic states (fever, anxiety)

CERVICAL VENOUS HUM-
* Heard best at the left or right upper sternal borders or infraclavicular or supraclavicular regions.
* Continuous Murmur that is loudest when the patient is sitting with head extended.

32
Q
  • Innocent still murmur= _
  • Cervical venous hum= _
A
  • Innocent still murmur= systolic murmur
  • Cervical venous hum= continuous murmur
33
Q
  • What is a Foramen Ovale?
  • What happens during fetal development?
  • What happens after birth?
A
  • An opening in the septum between the two atria of the heart that is normally present only in the fetus
  • During fetal development the oxygenation of the blood is via the placenta and not the lungs. The foramen ovale allows blood from the venous system to bypass the lungs and go to the systemic circulation. A layer of tissue begins to cover the foramen ovale during fetal development, and will close it completely soon after birth.
  • After birth, the pressure in the pulmonary circulation drops, and the foramen ovale closes.
34
Q

What is a patent foramen ovale? When does it close usually and if does not close?

A
  • NOT a congential heart disease
  • Flap fusion is complete by age two in 70 - 75 % of children, the remaining 25% have a PFO which persists into adulthood.
  • Most patients with a PFO remain asymptomatic
35
Q

What is cyanosis?

A

a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.

36
Q

What are noncardiac causes of cyanosis?

A
  • Pulmonary disorders
  • Persistent pulmonary hypertension
  • Poor peripheral perfusion
  • Acrocyanosis
37
Q

What is Peripheral Cyanosis- Acrocyanosis? Where does the blue color come from?

A
  • Painless condition where the small blood vessels in your skin constrict, turning the color of your hands and feet bluish
  • The blue color comes from the decrease in blood flow and oxygen moving through the narrowed vessels to your extremities
38
Q

What are the cardiac causes of cyanosis 🌟

A

●Transposition of the great arteries (TGA)
●Tetralogy of Fallot (TOF)
●Truncus arteriosus
●Total anomalous pulmonary venous return (TAPVR)
●Tricuspid valve abnormalities

39
Q

What is central cyanosis?

A

Congenital heart disease

40
Q

Cyanotic cardiac lesions account for approximately _ of all congenital heart disease (CHD) cases and _ of potentially fatal forms of CHD

A

Cyanotic cardiac lesions account for approximately 15 % of all congenital heart disease (CHD) cases and 1/3 of potentially fatal forms of CHD

41
Q

A patient that has a known history of cardiovascular disease including a myocardial infarction and positive ankle-brachial index indicating peripheral arterial disease in his left leg is now having some issues with erectile dysfunction (ED). The clinician suspects it may be due to medications or further vascular disease. He does not complain of any other symptoms. If his symptoms are related to vascular disease, where would the lesion likely be located?

A. Superficial femoral
B. Popliteal
C. Common femoral
D. Aortorenal
E. Iliac pudendal

A

E. Iliac pudendal

42
Q

A 61-year-old retired librarian was recently diagnosed with ovarian cancer. She was otherwise healthy until her recent cancer diagnosis. She has not been feeling well lately and has had a cough and some mild shortness of breath for the past couple of days. She now presents to the clinic complaining of pain and swelling in her right groin and leg, which she says is been there for about a week but is worsening. On physical examination, 2+ edema of the right leg up to the thigh; 1+ femoral, popliteal, dorsalis pedis, and posterior tibial pulses; and no significant erythema are noted. What is the chief concern with this patient?

A. Acute arterial occlusion
B. Superficial thrombophlebitis
C. Ovarian metastasis
D. Acute lymphangitis
E. Pulmonary embolism (PE)

A

E. Pulmonary embolism (PE)

Cancer patients are at high risk of deep venous thrombosis (DVT), and, with the presenting symptoms of swelling and pain in her groin, along with recent history of cough and shortness of breath, this patient’s presentation is suspicious for PE.

43
Q

A 68-year-old retired administrative assistant complains of a 3-month history of recurring pain after ambulating that radiates from her back in the upper lumbar region into both buttocks, bilateral thighs, and mid-calf regions. Her pain is typically improved by sitting or by leaning forward. The origin of her pain is likely secondary to which of the following?

A. Peripheral arterial disease (PAD)
B. Acute arterial occlusion
C. Venous stasis
D. Neurogenic claudication
E. Abdominal aortic aneurysm

A

D. Neurogenic claudication
* Neurogenic claudication can mimic PAD by causing pain related to walking; however, it is typically relieved simply by sitting or by leaning forward

44
Q

A 73-year-old retired salesman presents to the Emergency Department complaining of chest pain that started about 2 hours ago. Electrocardiogram, cardiac enzymes, and chest x-ray are normal. The nurse notes that his blood pressures in the right arm are significantly lower than of blood pressures in his left arm. Based on history and physical examination, which of the following will most likely explain his signs and symptoms?

A. Dissecting aortic aneurysm
B. Myocardial infarction (MI)
C. Pericarditis
D. Pulmonary embolism (PE)
E. Coarctation of the aorta

A

A. Dissecting aortic aneurysm

45
Q

A 19-year-old carwash attendant sustained a laceration to the ulnar aspect of his mid-forearm while at work last week. He did not have it evaluated at that time and is now noticing purulent discharge and increasing pain from the wound along with fever and chills. Where would the clinician expect to find the first signs of lymphadenopathy?

A. Epitrochlear nodes
B. Infraclavicular nodes
C. Central axillary nodes
D. Lateral axillary nodes
E. Cervical chain nodes

A

A. Epitrochlear nodes

46
Q

A 44-year-old retail salesperson has noticed an increasing dilatation of the veins in her legs. Upon inspection, it is noted that she has significant varicosities on the posterior aspects of both legs which begin in the lateral side of the foot and pass upward along the posterior calf. The remainder of the veins in the legs appears normal at this time. Which veins are currently affected?

A. Femoral
B. Great saphenous
C. Small saphenous
D. Dorsal venous arch
E. Perforating

A

C. Small saphenous

47
Q

A clinician, evaluating a patient for valvular competency in the communicating veins of the saphenous system, starts with the patient supine, then elevates one leg to about 90° to empty it of venous blood. Next, the great saphenous vein in the upper part of the thigh is occluded with manual compression, and the patient stands. The clinician keeps the vein occluded while watching for venous filling in the leg. Which test is being performed?

A. Ankle-brachial index
B. Allen
C. Trendelenburg
D. Romberg
E. Straight-leg raise

A

C. Trendelenburg

48
Q

The clinician is palpating pulses in the foot of a diabetic patient while in the clinic. A strong pulse is felt located on the dorsum of the foot, just lateral to the extensor tendon of the big toe. Which artery is being assessed?

A

Dorsal Pedis

49
Q

A 32-year-old cabdriver complains of pain in his left leg. He has a history of type 2 diabetes, is a smoker, and recently was diagnosed with hypertension. He does not remember injuring his leg; however, he notes that there is a small wound on the lateral aspect of his mid-shin. Upon examination, some mild erythema surrounding the wound and flat, nonpalpable red streaks progressing up his leg are noted. What do these streaks likely represent?

A. Occluded arterial vessels
B. Dilated arterioles
C. Dilated veins secondary to incompetent valves
D. Draining lymphatic channels
E. Thrombus formation in a superficial vein

A

D. Draining lymphatic channels

Acute lymphangitis is typically caused from an acute bacterial infection of the skin that causes red streaks from distal drainage through the lymphatic system. The streaks are typically flat, not palpable cords as found in thrombus formation in a superficial vein

50
Q

When assessing for the femoral pulse, where should the clinician begin deeply palpating?

A. Below the inguinal ligament, just medial to the anterior superior iliac spine
B. Below the inguinal ligament, just lateral to the symphysis pubis
C. Below the inguinal ligament, midway between the anterior superior iliac spine and symphysis pubis
D. Above the inguinal ligament, just medial to the anterior superior iliac spine
E. Above the inguinal ligament, just lateral to the symphysis pubis

A

C. Below the inguinal ligament, midway between the anterior superior iliac spine and symphysis pubis

51
Q
A

Physical Diagnosis (17 decks)

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