Pediatrics Cardiovascular Flashcards by Robbie Rodriguez

S1 is?

Lub sound
small valves close
Mitral/Tricuspid (AV) valves close

Aortic/ pulmonic (semilunar) valve open

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S2 is?

Dub sound
large valves closeAortic/ pulmonic (semilunar) valves close

Mitral/Tricuspid (AV) valves open

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Kentucky sound

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not usual sound
-further investigation needed

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Auscultation Areas

Aortic: RUSB
Pulmonic: LUSB
Aortic/ Mitral: Erbs points/ 3rd intercostal space
Ventricular Septal defect or tricuspid: LLSB

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Murmur loudness scale

grades
1- soft, barely audible
2-clearly audible but faint
3-MODERATELY LOUD
4-loud w/ thrill
5-Loud, heard w/ part stethoscope on chest and thrill palpable
6-Very loud, heard W/OUT stethoscope, thrill palpable and visible

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Most common of all congenital heart defects?

Ventral Septal defect (VSD)
-THRILL
-LLSB

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Types of Herat defects in pediatrics

-Acyanotic (left to right shunting)
-Cyanotic (right to left shunting)
-obstructive lesions

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Types of Acyanotic Defects

ASD
VSD
PDA

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Atrial Septal Defect (ASD)

Acyanotic Septal Defect
left to right shunting

-LUSB
-some small ASDs close w/out intervention
-medium to large require sx intervention

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Ventricular Septal Defect (VSD)

Acyanotic Septal Defect
left to right shunting

-ThriLL=LLSB

-a holosystolic thrill may be felt at LLSB

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Patent Ductus Arteriosus (PDA)

Acyanotic Septal Defect
left to right shunting

PDA = PREMATURE DUCTUS ARTERIOSUS
-PDA usually closes right by delivery, so premies are at high risk

Murmus: LUSB
grade 2 II to IV holosystolic
-“machinery” sound

-for premature. infants, prostaglandin. inhibitors (ibuprofen, indomethacin)

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Transposition of the Great Arteries

Cyanotic Defects
(right to left shunting)

XR shows “egg on a string”, w/ cardiomegaly and increased pulmonary vascular markings

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Tetralogy of Fallot

Cyanotic Defects
(right to left shunting)

Four Defects
1-large VSD
2-Pulmonary Stenosis
3-Overriding Aorta
4-RVH

-Murmur: loud systolic ejection click
-heard middle and upper left sternal border M-LUSB

XR- boot shaped heart

tet spells- child running and then squats=increases vascular resistence

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Obstructive Lesion for heart defects in pediatics

Aortic Stenosis
Pulmonic Stenosis
Coarctation of the Aorta

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Aortic Stenosis

Obstructive Lesion
-murmur, systolic thrill at RUSB
-systolic ejection click that does not vary with respirations

Pulmonic Stenosis

Obstruction Lesion

-Murmur loudest at LUSB
Intensity of ejection click decreases with inspiration and increases with expiration

Coarctation of the aorta

Obstruction Lesion
*Trisomy 21

Cardinal sign: decreased of absent pulses
BP in lower extremities will by lower than upper extremities

-may have ejection click at apex and RUSB if bicuspid valve is involved

DiGeorge Syndrome and which heart defect?

Aortic Arch anomalies

Trisomy conditions and which heart defect?

Trisomy 18/ Edwards
Trisomy 21/ Down syndrome

Atrioventricular septal defect, VSD

Marfans syndrome and which heart defect?

Aortic root disease
mitral valve prolapse

*give Beta Blocker to prevent aneurysm rupture

Turner Syndrome and which Heart defect?

Coarctation of the aorta
bicuspid aortic valve

innocent murmurs?

a.k.a functional murmurs/ benign murmurs/ physiological murmurs

-no associate symptoms
-thin chest wall
-no radiation to neck/back/ axilla

Most common innocent murmur

Stills Murmur
*musical systolic/ vibratory murmur
-heard LLSB and apex
-loudest when supine
-d/t turbulence in left ventricular outflow tract

Venous hum.

continuous humming murmur -RUSB *obliterated by turning head and/ or compressing neck ipsilaterally

S/S of Heart Failure in Pediatrics

Infant/ very young *poor feedings/ prolonged feeding *lethargy or irritabilty - chronic cough Older child/ adolescent *exercise intolerance *Abdominal pain *chest pain *Syncope -jugular vein distention

HTN in pediatrics

-Persistent elevation of systolic/ diastolic BP on *at least three separate occasion S/S -HA -Visual Problems -Dizziness -Resp distress -irritability -nosebleeds *S4 may be present *peripheral edema may be present

Rheumatic Fever/ Heart Disease in. pediatrics

Post infectious inflammatory disease, that affects heart, joints, and CNS -follows a group "A" beta-hemolytic streptococcus (GABHS) *Mitral valve is most commonly affected

S/S to Diagnose Rheumatic Fever

Jones Criteria -plus 2 major or -one major and two minor Major: Carditis Polyarthritiis Chorea Erythema Marginatum Subcutaneous Nodules Minor" Arthralgia w/out objective. inflmmation fever>102.2F (39C) Elevated levels of acute phase reactants (ESR/CRP) Prolonged PR interval on EKG w/ GABHS infections

Acute febrile syndrome causing vasculitis

Kawasaki Disease

Diagnostic criteria for Kawasaki Disease

Patient must have fever and at least four other 1-fever for at least 5 days *fever has 5 letters = 5 days 2-bright conjunctival injection w/ out exudate *bright red eyes 3-Polymorphous rash (urticarial or pruritic) 4-Inflammatory changes in lips and oral cavity *peeling lips 5- changes in extremities *erythema of palms/soles, edema, peeling skin 6-cervical lymphadenopathy

How to manage Kawasaki Disease

-Immediately Cardio referral -IVIG 2g/kg as a single infusion over 10-12hours -*high-dose ASA therapy (worried about coagulopathy, usually no ASA w/ kids bc it can cause Reys Syndrome) -ASA- 80-100mg/kg/day until afebrile for 48hours then lower ASA dose 3-5mg/kg/day for anti platelet response -D/C ASA therapy with Cardiologist collaboration