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1. Disciplines 2 > Peds Cardiac > Flashcards

Peds Cardiac Flashcards

1
Q
  • Closure of AV valves
  • Mitral > Tricuspid
  • Apex or LLSB
A

S1 sound: systole

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2
Q
  • closure of semilunar valves
  • aortic > pulmonic
  • Base or LUSB
  • most important component
A

S2 Sound: end systole

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3
Q

What causes physiologic splitting of S2?

A

Respiratory inspiration

  • increase blood to R heart
  • increase blood into RV
  • delays emptying of RV
  • prolongs closure of S2
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4
Q

Widely split S2

A

electrical delay (RBBB)- VSD repair (TOF)

= inspiratory and expiratory split

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5
Q

Fixed split S2

A

volume overload (ASD) = inspiratory and expiratory split

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6
Q

Narrowed split S2

A

Pulmonary HTN (loud S2)

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7
Q

Paradoxical split S2

A

electrical delay (LBBB) =expiration only split

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8
Q

Single S2

A

complex heart defect (TGA) or Single ventricle defect (only 1 semilunar valve)

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9
Q
  • Low frequency sound in early diastole
  • Apex
  • from rapid ventricular filling/volume overload
  • common variant in children
A

S3

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10
Q
  • Low frequency sound in late diastole
  • Apex
  • Obstruction > decreased ventricular compliance
A

S4

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11
Q

Pulmonary stenosis:

what sound is heard?

Where?

change with respiration?

A
  • ejection click
  • LUSB
  • intensity change with expiration
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12
Q

Aortic stenosis:

what sound is heard?

Where?

change with respiration?

A
  • Ejection click
  • Apex (early systole)
  • no change w/ respiration
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13
Q

2 causes of friction rubs?

A
  • pericarditis
  • post pericardiotomy syndrome
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14
Q

How are pulses in Patent ductus arteriosus?

A

Increased in UE and LE

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15
Q

How are pulses in Aortic stenosis, HLHS?

A

Decreased weak, thready

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16
Q

How are pulses in pt w/ coarctation

A

UE > LE (LE= poor, absent, delay)

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17
Q

Is the BP in the legs normally lower or higher than it is in the arms?

A

Legs > arms

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18
Q

If you get a referral for HTN in a child, what do you need to first check?

A

where the BP was taken from if taken from the LE, it is higher

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19
Q

3 types of innocent heart murmurs

A
  • Stills murmur (systolic)
  • Venous Hum Murmur (continuous)
  • Peripheral pulmonary stenosis (systolic)
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20
Q

If a murmur radiates into the neck, what is causing the murmur?

A

aortic stenosis

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21
Q

If a murmur radiates into the back, what is causing the murmur?

A

pulmonary valve stenosis

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22
Q

If a murmur radiates into the axilla, what kind of murmur is it?

A

peripheral pulmonary murmur

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23
Q

When grading murmurs, what is the difference between 3/6 compared to 4/6?

A

3/6= loud w/o thrill

4/6= loud, w/ palpable thrill

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24
Q

Are diastolic or continuous heart murmurs considered innocent or pathologic?

A

pathologic

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25
Q

In supine position:

innocent heart murmur will?

HCM murmur?

A

innocent= increase

hypertrophic cardiomyopathy murmur= decrease

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26
Q

In sitting position:

Venous hum murmur?

Innocent heart murmur?

A

Venous hum murmur= increase

Innocent heart murmur= decrease

27
Q

In standing position:

HCM murmur?

Mitral valve prolapse?

Aortic stenosis?

A

HCM murmur= increase

Mitral valve prolapse= increase

Aortic stenosis= decrease

28
Q

W/ Valsalva:

innocent heart murmur will?

HCM murmur?

A

innocent heart murmur= decrease

HCM murmur= increase

29
Q

With standing and valsalva, decrease in all murmurs except??

A

hypertrophic cardiomyopathy

mitral valve prolapse

30
Q

MC innocent heart murmur (age 3-6)

A

Stills

31
Q

describe what a Stills murmur sounds like

A

low frequency

musical vibratory sound

32
Q

describe what a venous hum murmur sounds like

A

continuous murmur (R > L)

diastolic louder than systolic

33
Q

What is Acrocyanosis?

A
  • benign varient
  • peripheral cyanosis
  • no central cyanosis
  • nl pulses
  • no pathological murmur

=give reassurance

34
Q

What does tachypnea in a newborn indicate?

A

L > R shunt

  • PVR needs to fall (higher L > R shunt)
  • CXR, wet lungs, large heart
35
Q

What does cyanosis in a newborn indicate?

A

R>L shunt or obstruction to lungs

  • “blue” > cyanosis
  • low saturation
  • CXR “Low PBF”
36
Q

what does “grey baby” indicate in a newborn?

A

decreased of no systemic blood flow

  • poor perfusion (no pulse, cap refill)
  • lactic acidosis
37
Q

Acyanotic characteristics

A
  • L > R shunt
  • nl O2 sats
  • volume overload
  • cardiomegaly
  • increase PBF
  • “wet lungs”
  • enlarged pulmonary artery
38
Q

What does atrial septal defect cause?

A
  • R heart volume overload
  • fixed or widened S2 pulmonary component
  • LUSB -SOB, fatigue
39
Q

What does ventricular septal defect cause?

A
  • L heart volume overload
  • decrease PVR and size
  • harsh, holosystolic murmur LSB
40
Q

What does patent ductus arteriosus cause?

A
  • L heart volume overload
  • sx of heart failure
  • LUSB
  • continuous, machinery murmur
41
Q

Characteristic of arterioventricular canal defect?

A
  • heart volume overload
  • Trisomy 21
  • increase pulmonary HTN
  • HF sx
42
Q

Central Cyanosis Characteristics

A
  • blue lips, tongue
  • low sats
  • congenital heart defect
43
Q

What maintains patency of PDA (patent ductus arteriosus)?

A

prostaglandins

44
Q

If there is an obstruction to pulmonary blood flow:

  • color?
  • sats?
  • CXR?
A
  • cyanosis, hypoxia, blue
  • low sats
  • CXR: low PBF (black lungs)
45
Q

If there is an obstruction to systemic blood flow:

  • color?
  • pulse?
  • CO?
A
  • pale, poor color
  • poor cap refill
  • poor pulses
  • cardiac shock (low CO)
46
Q

Pink baby and relation to PDA?

A
  • normal > normal heart
  • PDA closed
47
Q

Blue baby and relation to PDA?

A
  • clue to congenital heart defect
  • PDA closing
48
Q

Grey baby and relation to PDA?

A

(no mixing of blood)

  • poor prognosis > intracardiac shunt closed
  • need PGE to open PDA
49
Q

Blue/Purple baby and relation to PDA?

A

(mixing of blood)

  • PDA patency open
  • palliation to provide PBF or systemic blood flow
  • sats 75-90%
50
Q

What are the normal pre-ductal and post-ductal sats in pulse ox screen for congenital heart defects?

A

pre-ductal > 95%

post-ductal > 95%

=red blood mixing w/ blue blood

51
Q

What are the pre-ductal and post-ductal sats in pulse ox screen for congenital heart defects for a baby w/ cyanosis?

A

pre-ductal (hands purple) ~94%

post-ductal (feet blue) ~85-90%

  • blue blood mixing red blood
  • elevated pulmonary pressures or increased PVR
52
Q

Cyanotic heart defects (5 T’s)

A
  1. Truncus arteriosus
  2. Transposition of the great arteries (TGA)
  3. Tricuspid Atresia (TA)
  4. Tetrology of Fallot (TOF)
  5. Total Anomalous of the Pulmonary Venous Return (TAPVR)
53
Q

What heart defect is a/w DiGeorge syndrome?

A

Truncus arteriosus

54
Q

What are TET Spells “Cyanotic spells”?

A

spasms of the RVOT infundibular muscle

-fussy, cyanotic

55
Q

Classic description of CXR for Total Anomalous of the Pulmonary Venous Return (TAPVR)

A

snowman

56
Q

Classic description of CXR for Transposition of the great arteries (TGA)

A

egg on string

57
Q

Classic description of CXR for Tetrology of Fallot (TOF)

A

boot shaped

58
Q

The only CXR that allows you to make a diagnosis. What is the dx?

A

Ebsteins Anomaly

59
Q

Bicuspid aortic valve causes?

A

aortic stenosis

  • systolic ejection murmus
60
Q

Coarctation is a/w what syndrome?

A

Turners syndrome

61
Q

According to the AHA recommendations, are EKG or echocardiogram recommended as part of cardiac sports screening?

A

NOPE

62
Q

A murmur that is louder when standing and quieter when squatting= what until proven otherwise

A

Hypertrophic cardiomyopathy

63
Q
  • Aortic root dilation
  • aortic root rupture
  • mitral valve prolase

these are all a/w what condition?

A

Marfan syndrome

64
Q

QTc longer than ??? is considered Long QT Syndrome?

A

> 460

1. Disciplines 2 (11 decks)

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