Pediatric Cardiology Flashcards
What makes the S1 sound?
Closure of the AV valves (mitral/tricuspid)
What makes the S2 sound?
Closure of the semilunar valves (aortic/pulmonic)
What is systole?
ventricular contraction
What is diastole?
ventricular relaxation
What is S3?
“Ken-tuck-y”
increased fluid states (pregnancy, CHF)
What is S4?
“Ten-nes-see”
Ventricular wall hypertrophy (chronic hypertension, young athletes)
What are the three main types of congenital heart defects?
Acyanotic (left to right shunting)
Cyanotic (right to left shunting)
Obstructive
Atrial Septal Defect (ASD)
acyanotic
LUSB
EKG shows RVH
Ventricular Septal Defect (VSD)
acyanotic
LLSB, thrill
EKG shows LVH
When does PDA normally close in full term babies?
2 days to 2 weeks
What is the ductus arteriosus?
Vessel that goes from pulmonic artery to aorta that allows blood to go around the baby’s lungs before birth
Patent ductus arteriosus (PDA)
acyanotic
LUSB, “machinery” sound
EKG shows LVH
What is transposed in “The Transposition of the Great Vessels”?
Aorta comes from the right ventricle, and pulmonary artery comes from the left ventricle.
Transposition of the Great Vessels
cyanotic as soon as PDA closes
mirrors VSD (LLSB, thrill, EKG shows RVH)
X-ray shows “egg on a string”
What are the 4 defects of Tetralogy of Fallot?
- Ventral septal defect (VSD)
- Pulmonary artery stenosis
- Overriding aorta
- Right ventricular hypertrophy
Tetralogy of Fallot
cyanotic
systolic ejection click at M-LUSB
thrill at LLSB
EKG shows RVH
X-ray shows “boot shaped heart”
“Tet spell”
- related to Tetralogy of Fallot
- hypercyanotic episode where child stops and squats to bring blood back to the brain
Aortic stenosis
obstructive
ejection click and thrill at RUSB
EKG shows LVH
Pulmonic stenosis
obstructive
LUSB ejection click with less intensity on inspiration
LUSB thrill that radiates to back and sides
EKG shows RVH
Coarctation of the aorta
obstructive
ejection click at apex
EKG shows RVH progressing to LVH
X-ray shows “rib notching”
BP and pulse ox differs from upper to lower extremities
What are some characteristics of innocent murmurs?
no associated signs/symptoms
low intensity (grades I-III of VI)
may change with position
no thrill or radiation
Still’s murmur
innocent murmur
“musical” between LLSB and apex
Venous Hum
innocent murmur
continuous humming at RUSB
- heard best sitting, then disappears with laying or with turning head and compressing neck ipsilaterally
Diagnosis of pediatric hypertension
SBP and/or DBP greater than 95th percentile measured on 3 separate occasions
Rheumatic Fever
after group A strep infection
mitral valve is most commonly affected (permanent)
Jones Criteria
Jones’ major and minor criteria
- Major: carditis, polyarthritis, chorea, erythema marginatum (sandpaper rash), subcutaneous nodules
- Minor: arthralgia, fever greater than 102.2, increased acute phase reactants, prolonged PR on EKG
Lab diagnostics for rheumatic fever/heart disease
positive for strep, rising strep antibody (by titer), EKG, echo
Kawasaki disease
life-threatening vasculitis, most common in Asian kids under 2 years old
can lead to coronary artery disease
Diagnostic criteria for Kawasaki’s disease
FIERY- fever x5 days
C- conjunctival injection, bilateral, without exudate
R- rash, polymorphic
A- adenopathy, cervical
S- “strawberry tongue” and lips
H- hands with desquamation
Lab diagnostics for Kawasaki disease
- CBC
- ESR, CRP
- EKG changes (prolonged PR or QT)
Management of Kawasaki disease
cardiology referral
high dose aspirin therapy (the only kids that ever get aspirin)
Management of rheumatic fever
cardiology referral
aggressive treatment of strep infection
bed rest of acute carditis
Levine Scale (Murmurs)
I. Very difficult to hear
II. Faint but audible
III. Easily audible, no thrill
IV. Thrill
V. Audible with only part of stethoscope touching chest, thrill
VI. Audible with stethoscope off the chest, thrill
