Pedi Cards Flashcards
Thrills suggest what in peds
anatomic abnormality
RV heave= what in peds
RV hypertension
Differential pulses, weak in the lower extremities=
CoArc
Bounding pulse= ???
bounding pulse
Weak pule=
cardiogenic shock or CoArc
Pulsus paradoxus (exaggerated SBP drop with inspiration)= ???
tamponade or severe asthma
Pulsus alternans= ??
LV mechanical dysfunction
What must you identify when listening to heart sounds in kids
S1 and S2
Mid-systolic click= ???
MVP
Loud S2= ??
pulmonary HTN
Fixed, splits S2= ??
ASD, PS
S3 gallop—>
may be due to cardiac dysfunction/volume overload
Muffled heart sounds and/or a rub—>
pericardial effusion +/- tamponade
What are the types of murmurs
- systolic ejection murmur= turbulence across a valve
- holosystolic murmur- turbulence begins w/ systole
- continuous murmur= pressure difference in systole and diastole
Shunts present in the fetus and where they shunt blood
- ductus venosus: bypasses liver
- foramen ovale: R to L arterial shunt
- ductus arteriosus: R to L arterial shunt
Holosystolic murmurs in babies have what
palpable thrill
What happens when you clamp the umbilical cord
systemic vascular resistance is increased
Ductus venousus connects what
umbilical vein to inferior vena cava, bypassing the liver
Why does the ductus venosus close
due to fall in umbilical vein pressure
What promotes lung expansion at birth
the alveoli filling with air instead of fluid
Aeration of lungs at birth leads to what
- decreased pulmonary vein resistance
- increased pulmonary blood flow
How does the foramen ovale close
proliferation of enothelial and fibrous tissue
What does the ductus arteriosus do
protects the lungs against circulatory overload
What aid in the closing of the ductus arteriosus
- increased O2 sat
- decreased pulmonary resistance
- decreased prostaglandin E2 levels
Fetal structures that correspond to adult structures
foramen ovale–> fossa ovalis
umbilical vein–> ligamentum teres
ductus venosus–> ligamentum venousus
ductus arteriosum–> ligamentum arteriosum
Still’s murmur?
vibratory, twangy, systolic murmur best hear at LSB and apex
In what population is a Still’s murmur most commonly heart
children 3-5 years
When is a Still’s murmur loudest
supine position
*changes with position
If a murmur has a thrill–>
NOT NORMAL
What causes a Still’s murmur
vibration of the great vessels and/or LVOT
How does a pulmonary flow murmur change
- increases with supine position
- decreases upright
- increased by high output states
Venous hum?
low pitched continious murmur often heard best in infraclavicular area, normal heart sound
Positional changes with a venous hum
- loudest uprught
- diminishes with supine or compression of jugular vein
Murmur red flags!
- diastolic murmur (venous hum ok)
- loud murmurs, especially thrills
- little or no effect with change in position
- symptoms, especially cyanosis
Ways to classify congenital heart disease
- acyantotic
- cyanotic
- obstructive lesions
L—> R shunts, “acyanotic”
- VSD
- PDA
- ASD
VSD
blood flows from high pressure left ventricle to low pressure right ventricle
PDA
blood flows from high pressure aorta to low pressure pulmonary artery
ASD
blood flows from high pressure left atrium to lower pressure right atrium
VSD and PDA present how
in infant w/ heart failure, murmur and poor growth/ feeding
*left heart enlargement
ASD present how
in childhood w/ murmur or exercise intolerance, typically asx
*right heart enlargement if severe
Most common heart malformation
VSD
Murmur in VSD
holosystolic murmur at lower left sternal border with a heave
Clinical features of VSD
- failure to thrive
- tachypnea
- diaphoresis with feeding
Where is an ASD mumur heard
pulmonary area
*large shunts cause a diastolic flow murmur at left lower sternal bored
Clinical features of PDA
- failure to thrive
- diaphoresis with feeds
- bounding pulse
How can PDA be treated
indomethacin
Cyanotic CHD is what kind of shunt
R–> left shunt
Tetralogy of Fallot is what things
- rt ventricular outflow tract obstruction
- VSD
- overriding aorta
- right ventricular hypertrophy
Tetralogy of fallot on xray
boot shaped heart with concave pulmonary segment
What is the murmur is tetralogy of fallot from
pulmonic stenosis, not from VSD
Treatment of tetralogy of fallot
systemic pulmonary artery shunt in early infancy with later relief of the right ventricular outflow tract obstruction and closure of the ventricular defect
Rheumatic fever is what
a post infectious connective tissue disease
*follow GAS pharyngitis by several weeks
Earliest and most common feature of rheumatic fever
painful migratory arthritis
Presentation of acute rheumatic fever
- chorea
- erythema marginatum
- subcutaneous nodules
