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Child Health > Paediatric Cardiology - Murmurs and Blue Baby > Flashcards

Paediatric Cardiology - Murmurs and Blue Baby Flashcards

1
Q

What are most heart murmurs in children like?

A

“innocent” - not associated with pathology

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2
Q

What features of a murmur should you comment on?

A

Timing - systolic or diastolic
Character - pan systolic or ejection systolic?
Loudness - out of 6, >=4 is palpable (thrill)
Radiation

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3
Q

What are the main types of innocent murmurs?

A

Ejection murmur

Venous hum

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4
Q

What are the hallmarks of an innocent murmur?

A 
Asymptomatic
Normal CVS exam
Systolic or continuous
No radiation
Variation with posture
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5
Q

What are ejection murmurs caused by?

A

Outflow tract either side of the heart

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6
Q

How do ejection murmurs sound?

A

Soft blowing systolic murmurs

Second and fourth left intercostal spaces

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7
Q

How are venous hums generated?

A

By head and neck veins

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8
Q

How do venous hums sound?

A

Continuous low pitched tumble

Heard beneath clavicle

Disappear on lying flat

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9
Q

When is an innocent murmur more likely to be noted?

A

During tachycardia e.g:

With fever
Anaemia
Exercise

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10
Q

What features if associated with a murmur make it significant?

A 
Syncope
Episodic cyanosis
Abnormal pulses, heart sounds, BP or cardiac impulse
Diastolic murmur
Pan systolic murmur
Murmur radiate to back
Thrill
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11
Q

What murmurs are most likely to be heard at the upper right sternal border?

A

Aortic stenosis

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12
Q

How does aortic stenosis sound?

A

Ejection systolic
Preceding ejection click
Radiate to neck

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13
Q

What is aortic stenosis associated with?

A

Williams syndrome

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14
Q

What murmurs are most likely to be heard at the upper left sternal border?

A

PDA
ASD
Pulmonary stenosis
Coarctation of the aorta

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15
Q

How does a Patent Ductus Arteriosus sound on auscultation?

A

Continuous machinery like murmur
Radiate to back
Bounding/collapsing pulse
Wide pulse pressure

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16
Q

How does an Atrial Septal Defect sound? What is it associated with?

A 
Ejection systolic murmur
Wide fixed (doesn't change with inspiration) splitting of S2

Associated with Down’s

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17
Q

How does pulmonary stenosis sound on auscultation? What is it associated with?

A

Ejection systolic murmur
Preceding ejection click
Radiate to back

Associated with Noonan’s syndrome

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18
Q

How does coarctation of the aorta sound on auscultation?

A

Systolic crescendo-descrendo murmur

Radiate to back

19
Q

What other clinical features does coarctation present with and what condition is it associated with?

A

Radio-femoral delay
BP Difference in upper and lower limbs

Associated with Turners syndrome

20
Q

What murmurs are heard at the left lower sternal border?

A

Innocent murmurs
VSD
Tricuspid regurgitation

21
Q

How does a Ventricular Septal Defect sound and what is it associated with?

A

Harsh pan systolic murmur
Radiate all over chest

Associated with Down’s, Patau’s and Edwards

22
Q

How does tricuspid regurgitation sound?

A

Loud pansystolic murmur

Louder on inspiration

23
Q

What murmurs are heard best at the apex?

A

Mitral regurgitation

Mitral valve prolapse

24
Q

Describe the mitral regurgitation murmur

A

Pansystolic murmur

Radiate to axilla

25
Q

Describe the mitral valve prolapse murmur

A

Late systolic murmur

Preceding systolic click

26
Q

What causes central cyanosis?

A

Desaturation of central arterial blood

27
Q

How does central cyanosis appear?

A

Blue colouration of mucous membranes of lips, tongue and extremities

28
Q

What causes peripheral cyanosis and how does it appear?

A

Decreased local circulation and increased extraction of O2 from tissues

Blue skin around lips and extremities (NOT MUCOUS MEMBRANES)

29
Q

What are the categories of causes of cyanosis?

A

Cardiac
Respiratory
Other

30
Q

What are the cardiac causes of cyanosis?

A

Transient cyanosis - can be central or peripheral (central much shorter)
Cyanotic congenital heart defects (ToF, transposition etc.)
Total anomalous pulmonary venous return
Truncus arteriosus

31
Q

What are the respiratory causes of cyanosis?

A 
Resp distress syndrome
Birth asphyxia
Transient tachypnoea of newborn
Meconium aspiration
Pneumothorax
32
Q

What are the other causes of cyanosis?

A

Infection
Seizures
Metabolic abnormalities

33
Q

What are some causes for cyanosis in an older child?

A 
Infection
Seizure
Metabolic disturbance
Pneumonia
Asthma
PE
CHD
Raynauds
34
Q

How do children with Duct Dependent Congenital Heart Disease’s present?

A

Acutely unwell within first 2-4 days of life due to ductus arteriosus closing

35
Q

What circulation can be dependent on the ductus arteriosus staying open?

A

Pulmonary and Systemic circulation

36
Q

How does a patient with duct dependent systemic circulation present?

A 
Hypoxic
Resp distress
Heart failure
No femorals
Metabolic acidosis
37
Q

How does a patient with duct dependent pulmonary circulation present?

A

Cyanosed
Tachypneic
Normal pulses

38
Q

How do you treat duct dependent Congenital Heart Disease’s?

A

IV Prostaglandin E2 - Dinoprostone

39
Q

What does Dinoprostone (prostaglandin E2) do?

A

Smooth muscle relaxant - keep DA patent

40
Q

What are the Adverse Drug Reaction’s associated with Dinoprostone?

A 
Hypotension
Bradycardia
Apnoea
Fever
Jittery
41
Q

What investigations should you do if a child is cyanosed?

A 
ABG
Hb
Infection markers, sputum and blood cultures
Echo - CHD
CXR
42
Q

What is the hyperoxia test?

A

Used to determine whether cyanosis is due to a R –> L shunt or another illness

43
Q

How is the hyperoxia test carried out and interpreted?

A

Give 100% O2 for 10 mins

If sats remain low –> CHD

44
Q

Why do sats not improve when giving a cyanosed child with Congenital Heart Disease oxygen?

A

Lungs are healthy and already fully saturated

Child Health (30 decks)

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