Pediatric Cardiac Flashcards
1
Q
What are features of innocent murmurs?
A
- sensitive to change in position or respiration- louder laying down
- short duration
- single- no clicks or gallops
- small- limited to a small area, usually left sternal border
- soft- low amplitude
- sweet- not harsh sounding
- systolic- occurs during and limited to systole
- dont radiate
2
Q
Peripheral Pulmonary Flow
A
- occurs during infancy, up to 1 year
- turbulent flow through narrowed pulmonary artery
- Grade 1-2
- low-medium pitch
- best heard in the back
- louder supine, resolves sitting up
3
Q
Patent Ductus Arteriosus
A
- occurs during infancy, within the first 24 hours of life and resolves within hours to days
- connection between the aorta and pulmonary artery remain open
4
Q
What benign murmurs occur in infancy?
A
patent ductus arteriosus
peripheral pulmonary flow
5
Q
Still’s murmur (vibratory murmur)
A
- pre-school to early school age, ages 2-6
- turbulent flow in left or right ventricle outflow tract or vibrations through the pulmonary valve leaflets
- Grade 1-3, heard best over the tricuspid and mitral areas
- vibratory quality
- increases supine, decreases standing
6
Q
Venous Hum
A
- pre-school to early school age, ages 3-6
- turbulent flow through slightly angulated internal jugular veins or through the superior vena cava at the junction of the internal jugular and subclavian veins
- Grade 1-6, continuous murmur in diastole
- Heard best in supra and infra ventricular areas
- louder on right
- increases sitting up, decreases supine
- may diminish with pressure on IJV
7
Q
Pulmonary Flow
A
- Older child- adolescence benign murmur
- Grade 2-3 systolic ejection murmur
- heard best at the left sternal border pulmonary area
- harsh, non-vibratory
- increases supine, decreases upright and holding breath
8
Q
Atrial Septal Defect
A
- left to right shunt of blood through opening in atria
- can be large or small
- hear at left sternal border
- radiates to back
9
Q
Ventricular Septal Defect
A
- left to right shunting of blood through a defect in the ventricular septum
- most common congenital defect
- heard left lower sternal boarder
- pansystolic, usually harsh
- Thrill: 3rd or 4th left inter coastal space
10
Q
Patent Ductus Arteriosus
A
- flow from aorta to pulmonary artery when ductus arteriosus, does not close after birth
- presentation depends on the size of the opening and the resulting left to right shunting of blood
- small: left infraclavicular region, not affected by position change
- medium: associated with ventricular overload and displaced PMI
- large: continuous murmur with widened pulse pressure, bounding pulses, thrill
11
Q
Atrioventricular Septal Defect
A
- deficiency in AV septum and AV valves
12
Q
Transposition of the Great Arteries
A
- aorta arises from the right ventricle
- pulmonary artery arises from the left ventricle
- causes: cyanosis, HF and VSD 50% of the time
13
Q
Tetralogy of Fallot
A
- VSD
- Pulmonary Stenosis
- Deviation of the origin of the aorta to the right
- Right ventricular hypertrophy
- presentation depends on the degree of right ventricle obstruction
- cyanotic
- Have “tet” spells
- “pink variant”- squatting during spells help increase systemic vascular pressure
- murmur related to pulmonary stenosis or VSD
14
Q
Tricuspid Atresia
A
- Agenesis (poor formation) or absence of tricuspid valve
- no direct communication between right atrium and ventricle
- associated with atrial septal defect
- right ventricular hypoplasia
- identified in utero or first month of life
15
Q
Pulmonary Valve Stenosis
A
- normal valve with fusion of the leaflets, restricting flow
- left upper sternal border
- problems with back flow
