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Paediatrics > Paediatric Cardiology - Heart Murmurs > Flashcards

Paediatric Cardiology - Heart Murmurs Flashcards

1
Q

What is paediatric cardiology mainly concerned with?

A
  • congenital heart defects
  • screening and monitoring inherited disease e.g. Marfan
  • acquired disease e.g. rheumatic fever
  • arrhythmias, mainly SVT
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2
Q

What are the 8 most common congenital heart defects?

A
  • VSD
  • Patent ductus arteriosus
  • ASD
  • Pulmonary stenosis
  • Aortic stenosis
  • Coarctation of the aorta
  • Transposition of the great arteries
  • Tetralogy of Fallot
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3
Q

What are the causes of congenital heart defects?

A
  • genetic susceptibility e.g. chromosomal abnormalities
  • environmental hazard
  • teratogenic insult days 18-60 post conception
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4
Q

What environmental factors can lead to congenital heart defects?

A
  • drugs e.g. alcohol
  • infections e.g. TORCH (toxoplasma, rubella, CMV, herpes)
  • maternal e.g. diabetes, SLE
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5
Q

What congenital heart defect is associated with Turner syndrome?

A

coarctation of aorta

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6
Q

What congenital heart defect is associated with Noonan syndrome?

A

pulmonary stenosis

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7
Q

What congenital heart defect is associated with William’s syndrome?

A

supra valvular AS

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8
Q

What congenital heart defect is associated with 22q11 deletion syndrome?

A

VSD, amongst others

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9
Q

What signs might you get from a history that may suggest that a child may have a congenital heart defect?

A
  • problems with feeding, weight and development
  • central cyanosis
  • lessened exercise tolerance
  • breathlessness
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10
Q

What features on examination might make you suspicious of a cardiac defect?

A
  • low weight and height
  • dysmorphic features
  • cyanosis
  • clubbing
  • tachypnoea
  • feel femoral pulses!!
  • murmurs
  • hepatomegaly
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11
Q

What are signs of acute decompensation of heart failure in children?

A
  • poor feeding
  • dyspnoea
  • tachycardia
  • hepatomegaly
  • cool peripheries
  • acidosis on ABG
  • pulmonary venous congestion on chest x ray
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12
Q

What investigations would you do in to congenital heart defects?

A
  • ECG, 24 hrs
  • ABG
  • chest x ray
  • catheter
  • angiography
  • MRI/MRI angiography
  • exercise testing
  • blood pressure
  • oxygen saturation
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13
Q

How would you manage heart failure in an infant?

A
  • sit upright
  • oxygen
  • calories via NG tube
  • diuretics (furosemide)
  • if have duct dependent cyanotic condition then will also require prostaglandin to keep duct patent
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14
Q

Where are the 4 places you might hear a murmur in children?

A
  • upper right sternal border
  • upper left sternal border
  • lower left sternal border
  • apex
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15
Q

Are innocent murmurs common in children?

A

yes - the majority are innocent murmurs

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16
Q

How many types of innocent murmur are there in children?

A

4

17
Q

What are common features of innocent murmurs?

A
  • they are systolic
  • no other signs of cardiac disease
  • soft murmur (grade 1 or 2/6)
  • vibratory, musical e.g. ‘twang’, ‘buzz’
  • localised i.e. no radiations
  • varies with position, respiration, exercise
18
Q

What are the 4 innocent murmurs?

A
  • Still’s murmur
  • pulmonary outflow murmur
  • Carotid/brachiocephalic arterial bruits
  • venous hum
19
Q

In what age range of children can you generally detect Still’s murmur?

A

age 2-7 years

20
Q

Where is Still’s murmur best heard and what does it sound like?

A
  • best heard at apex or left sternal border

- tends to be soft systolic; vibratory, musical, ‘twangy’ like an elastic being pulled

21
Q

What can make a Still’s murmur sound louder?

A

increases in supine position and with exercise

22
Q

In what age range of children can you generally detect a pulmonary outflow murmur?

A

8-10 years

23
Q

Where is a pulmonary outflow murmur best heard and what does it sound like?

A
  • best heard upper left sternal border, is localised and will not radiate
  • soft systolic; vibratory
24
Q

What can make a pulmonary outflow murmur sound louder?

A

increases in supine position and with exercise

25
Q

What is often a physical feature of a child who has a pulmonary outflow murmur?

A

a narrow chest

26
Q

In what age range of children can you generally detect a carotid/brachiocephalic arterial bruit?

A

2-10 years

27
Q

Where is a carotid/brachiocephalic arterial bruit best heard and what does it sound like?

A
  • supraclavicular, radiates to neck

- 1/6-2/6 systolic; harsh in quality

28
Q

What can make a carotid/brachiocephalic arterial bruit louder or abolish it?

A
  • louder with exercise

- decreases on turning head or extending neck

29
Q

In what age range of children can you generally detect a venous hum?

A

3-8 years

30
Q

Where is a venous hum best heard and what does it sound like?

A
  • supraclavicular
  • continuous murmur, sometimes louder in diastole
  • soft and indistinct
31
Q

Is there anything that will accentuate the venous hum or make it disappear?

A
  • heard only in upright position

- disappears on lying down or when turning head

Paediatrics (25 decks)

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