Pediatric Cardiology Flashcards
What are the 3 major closures that occur?
Foramen ovale, ductus arteriosus and ductus venosus close after birth
What is the purpose of the foramen ovale?
Allows oxygen rich blood from the placenta to cross directly into the LA therefore bypassing the lungs; after birth its closure allows all blood from the IVC to flow into the RA -> RV -> pulmonary arteries -> lungs
What is the purpose of the ductus arteriosus?
Allows deoxygenated blood to flow from the pulmonary trunk to the aorta (bypassing the lungs); Low oxygen blood returns to the heart via SVC and IVC -> RA -> RV -> pulmonary trunk -> aorta -> out to body; the closed ductus arteriosus forms the ligamentum arteriosum
What is the purpose of the ductus venosus?
Allows oxygen rich blood from the ublilcal vein to flow into the IVC (placenta -> umbilical vein -> ductus venosus -> IVC -> RA); the closed ductus venosus forms the ligamentum venosum
What is the purpose of the newborn pulse oximetry screening test?
ID babies who may be at risk for sudden death from critical congenital heart disease (CCHD); the idea is to check the room air oxygen sat in what would be pre- and post-ductal extremities; if a baby fails it means that further work up for the cause of hypoxemia needs to occur
What are the criteria for failing the pulse oximetry screening?
Oxygen sats anywhere are <90%; saturation in the R hand is 90-95% or difference between right hand and foot is >3% (times 3 with 1 hour between each screening)
What are the sx of hemodynamically significant cardiac dz in newborns/infants?
Tachypnea, cyanosis, diaphoresis, feeding intolerance (can’t finish a bottle), developmental delay, cough, failure to gain weight
What are the PE findings for hemodynamically significant cardiac dz in newborns/infants?
Tachycardia, tachypnea, hypoxia, wheezes/crackles, murmur, poor perfusion, cyanosis, edema, abnormal pulses
What are the sx of hemodynamically significant cardiac dz in older children/adolescents?
Dizziness, near syncope or syncope, palpitations, CP, diaphoresis, easy fatigue/exercise intolerance, poor growth, asthma like sx, cough, DOE
What are the PE findings for hemodynamically significant cardiac dz in older children/adolescents?
Same as for newborns/infants
What is a sign of congenital heart dz?
silent tachypnea (RR >60 breaths/min) in a baby
What are some Ddx for a baby with tachypnea and some element of distress?
Transient tachypnea of the newborn (basically excessive lung fluid, usually resolves spontaneously), respiratory distress syndrome (premature babies due to lack of surfactant), meconium aspiration (the baby defecates in utero), infection (pneumonia, sepsis), congenital heart defect, pneumothorax
What should be asked during history in older kids?
If any relatives have died suddenly at a young age and if so what were the circumstances, ask about palpitations, dizziness/fainting, CP, cough, exercise/activity intolerance, sleep position, cyanosis
What should be asked about during a history in a neonates/infants?
Ask about head bobbing while eating, diaphoresis, ability to gain weight, feeding tolerance, cyanosis, cough
What are the 6 components included when describing and documenting a cardiac murmur?
Grade 1-6, timing (early, mid, late, holosystolic, diastolic), character (harsh, machinery, whooping, honking, blowing, musical, vibratory, sing-song), location (best heard at..), radiation (listen in axilla and back), changes with position of pt
What are the key features of innocent murmurs in children?
Sensitive (changes with position), shorter duration (not holosystolic), single (the murmur is the only abnormal sound aka no rubs, gallops, clicks), small (limited to a small area, non-radiating), soft (low amplitude, no more than grade 3), sweet (not harsh), systolic (venous hums are innocent and continuous and have a diastolic component)
What is the exception to the sensitive rule of murmurs?
The pathologic murmur of idiopathic hypertrophic sub aortic stenosis (IHSS) which gets louder when a pt goes from a supine to an upright position
What is the criteria for referring a pediatric pt with a heart murmur?
Grade 4 or above (thrill palpable), diastolic, increased intensity when pt stands (IHSS), any murmur that is symptomatic, S1 and/or S2 obscured, fixed split S2 (ASD?), weak femoral pulses (aortic stenosis? coarctation of the aorta?), clicks, hyperactive precordium at rest, Fhx of the sudden death of an individual at a young age, abnormal or extra heart sounds (except S3 in children or young adults), conditions (chromosomal or prenatal) predisposing a pt to congenital heart lesions, anytime you get “that feeling”
What are the 5 T’s of cyanotic congenital heart dz?
Tetralogy of Fallot (VSD, over riding aorta, RVH, RV outflow obstruction), transposition of the great arteries, truncus arteriosus, total anomalous pulmonary venous return, tricuspid valve abnormalities and hypoplastic right heart syndrome
How does a small BP cuff change the BP reading?
BP will be artificially high
How does a large BP cuff change the BP reading?
BP will be artificially low
