Pediatric Cardiology Flashcards
what is the most common isolated birth defect in newborns?
cardiac structural defects
what maternal factors put the baby at risk for cardiac defects?
family hx of CHD
maternal diabetes
maternal teratogen exposure (alcohol, dilantin, rubella)
what chromosomal abnormalities are at higher risk for CHD?
Trisomy 21
Trisomy 18
DiGeorge Syndrome
Turner Syndrome
when a baby is diagnosed with a CHD, what should the next step be?
check chromosomes
look for other dysmorphic features or congenital abnormalities (possible syndrome)
what are the left-to-right shunt defects?
VSD
ASD
PDA
what are the right-to-left shunt defects?
pulmonary atresia
tricuspid atresia
what are the obstructive defects?
pulmonary stenosis
aortic stenosis
what are the mixed defects?
ToF
Ebstein’s anomaly of the tricuspid valve
hypoplastic left heart syndrome
what are the “innocent murmurs”?
Stills murmur
pulmonary flow murmur
venous hum
carotid bruit
what is the presentation of an ASD?
RA and RV enlargement
pulmonary over-circulation –> pulm HTN
usually asymptomatic
what is heard on auscultation with ASD?
Grade 2-3 systolic ejection murmur
heard best at LUSB
wide fixed split S2
may have grade 1 or 2 diastolic flow murmur at LLSB
what is the presentation of VSD?
surgical repair required if hemodynamically significant
smaller defects are louder and harsher
can cause CHF
may close spontaneously
what is heard on auscultation with VSD?
grade 2-5 holosystolic murmur at LLSB
thrill at LLSB
what is the presentation of PDA?
possibly asymptomatic
may cause fatigue, CHF and resp symptoms
what is heard on auscultation with PDA?
continuous murmur
crescendo-decrescendo
grade 1-5
normal S1 and S2 may be buried in the murmur
what is the presentation of tricuspid atresia?
single LV
pulmonary flow restricted
obligate ASD and VSD
early onset cyanosis or CHF
what is heard on auscultation with tricuspid atresia?
holosystolic murmur at LLSB or midsternal border
murmur may be absent
what is the presentation of pulmonary atresia?
obligate ASD and VSD
PDA dependent until flow can be established
what is the presentation of aortic stenosis?
dyspnea, fatigue, syncope
can develop CHF
sudden death may occur
what is heard on auscultation with aortic stenosis?
systolic ejection murmur at RUSB
grade 2-5
radiates to carotids
thrill at ULSB or suprasternal notch with grade 4
what is the presentation of pulmonary stenosis?
usually asymptomatic
may have sx of pulmonary congestion
what is heard on auscultation with pulmonary stenosis?
systolic ejection murmur at LUSB
grade 2-5
radiates to axilla
systolic ejection click may be heard at LSB
what is the presentation of Tetralogy of Fallot?
VSD
overriding aorta
RVH
pulmonic valve stenosis
what is heard on auscultation with ToF?
grade 3-4 long systolic ejection murmur at LUSB
may have holosystolic murmur at LLSB
systolic thrill at LUSB if 4/6
single S2
what is Ebstein’s anomaly?
displaced, leaking tricuspid valve small RV enlarged RA ASD PDA
what is hypoplastic left heart syndrome?
underdeveloped LV
underdeveloped aorta
ASD
PDA
what are the staged surgeries for hypoplastic left heart syndrome?
- Norwood procedure: new aorta + BT shunt
- Bidirectional Glenn procedure; redirection of blood, BT shunt removed, ASD patched
- Fontan procedure: ASD patch removed, baffle build in R atrium with small hole
what is a still’s murmur?
low-pitched “musical”
LSB or between apex and LLSB
normal S2
what is a pulmonic flow murmur?
mid-frequency
LUSB
normal S2
what is a venous hum?
continuous, high frequency
loudest while sitting/standing
heard around clavicle/base of neck
goes away when supine
who should receive a complete cardiac exam?
any child w/ murmur
infant features of CHD: FTT cyanosis feeding intolerance respiratory sx
child features of CHD: CP on exertion syncope exercise intolerance fam hx of sudden death in young people
what is a complete cardiac exam?
vitals pulses perfusion precordial inspection/palpation auscultation
is splitting of heart sounds normal?
yes
S1 split in 40-70% of people
S2 split with inspiration
is a fixed S2 split normal?
no - indicative of ASD
you are examining a child for suspected CHD, when auscultating, their murmur increases in intensity when standing and again when they cough. what is your diagnosis?
hypertrophic cardiomyopathy
what will you hear at the RUSB?
aortic stenosis
venous hum
what will you hear at the LUSB?
pulm stenosis
pulm flow murmurs
ASD
PDA
what will you hear at LLSB?
Still's murmur VSD tricuspid valve regurgitation hypertrophic cardiomyopathy subaortic stenosis
what will you hear at the apex?
mitral valve regurgitation
what are the 7 S’s of innocent murmurs?
sensitive - change with position or respiration short duration single small soft sweet systolic
when should you refer to a cardiologist?
grade 4 murmur or above diastolic murmur increased intensity with standing symptomatic murmur obscure heart sounds weak femoral pulses clicks hyperactive precordium hx of sudden death
what are the 5 cyanotic congenital heart defects?
One big trunk: truncus arteriosus
Two interchanged vessels: transposition of great vessels
Three: tricuspid atresia
Four: Tetralogy of Fallot
Five words: Total Anomalous Pulmonary Venous Return
