Pediatric CIS Dow Flashcards
Tools for Evaluation of the Pediatric Cardiovascular System
History
Physical
Routine studies:
EKG
CXR
Studies for the cardiac patient:
cardiac cath
echocardiogram
PRENATAL exposures
Infections
Perinatal infections account for 2% to 3% of all congenital anomalies
TORCH and
Coxsackievirus B, CMV, HSV
In early pregnancy are teratogenic; later in pregnancy may cause myocarditis
***Active HSV lesions at time of delivery is an indication for cesarean section.
TORCH:
are some of the most common infections associated with congenital anomalies (a lot of eye and skin findings in common) including cardiac defects
Most of the TORCH infections cause mild maternal morbidity, but have serious fetal consequences including fetal loss.
Toxoplasmosis
Other (syphilis, varicella-zoster, parvovirus B19, HIV)
Rubella (think “bluebella”)
congenital rubella syndrome includes cardiac manifestations: PDA, PS
Cytomegalovirus (CMV)
HSV
Prenatal exposures- meds/ substances
Amphetamines–> VSD, PDA, ASD, TGA
Anticonvulsants
hydantoin: PS, AS, coarc, PDA
trimethadione: TGA, TOF, hypoplastic left heart
Alcohol –> FAS: in which VSD, PDA, ASD, and TOF are common
Prenatal exposures- Maternal conditions
Of course, maternal congenital heart disease: increases risk of CHD from 1% to 15%.
Infant of diabetic mothers (IDM):
cardiomyopathy, TGA, VSD, PDA
Also hypoglycemia, hypocalcemia, polycythemia, ***LGA (large for gestational age) or SGA (small for gestational age)
**Maternal lupus/mixed connective tissue disease: congenital heart block
Buzz words of presentation for considering CV:
infant who presents with diaphoresis and tachypnea with feeding, cyanosis, FTT (feeding is all they do = exertional symptoms) –> consider heart failure
Family history of rheumatic fever
Frequently occurs in more than one family member: higher incidence among relatives of rheumatic children, unknown genetic component
abnormal facies implies
chromosomal syndrome
Cornelia de Lange
(thick eyebrows, distinct facial features): VSD, ASD
CHARGE
Coloboma (normal tissue in or around the eye is missing from birth
) , Heart defects, choanal Atresia, growth/mental Retardation, GU anomalies and genital hypoplasia, Ear anomlies
conotruncal anomalies (truncus, TOF)
aortic arch anomalies
Holt Oram
(cardiac-limb): defects or absence of thumb or radius
ASD
VSD
acrocyanosis
newborn always has it – bluish hands and feet
BP norms in kids are based on
on age, gender, and height percentile
Auscultation of heart sounds
in kids
wide and fixed split S2 is abnormal
Murmurs in PE
Not present in many severe forms of CHD, such as tricuspid atresia, coarctation of the aorta and transposition of the great vessels.
When a murmur is associated with a cardiac defect, the intensity of the murmur is unrelated to the severity of the abnormality.
innocent murmurs
: in children, physiologic murmurs are more common than in adults
** Low pitched (non-turbulent, not high velocity)
** Still’s: low-pitched sounds heard at the lower left sternal area, “** musical.” These most commonly occur between age 3 and adolescence. Low pitched - best heard with the bell of the stethoscope. Can change with position alteration and then can decrease or disappear with the Valsalva maneuver. No clicks are present.
venous hum: low-pitched continuous murmurs made by blood returning from the great veins to the heart - bell
pulmonary flow murmur: upper left sternal border. High pitched - best heard with the diaphragm. Also known as benign peripheral pulmonary stenosis of the newborn. Also seen in adolescents or in children with pectus excavatum. Prominent in high-flow situations, such as when a child has a fever or is anemic.
