Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Summer Disciplines 2 > Peds cardio > Flashcards

Peds cardio Flashcards

1
Q

What is S1

A

Systole;
Closure of AV valves (mitral>tricuspid)
Heard best at Apex of LLSB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is S2

A

Diastole or End Systole;
Closure of semilunar valves (aortic>pulmonic)
Heard best at Base or LUSB
Most important!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens during inspiration

A

increased blood flow to the right heart and RV
Delayed emptying of RV
Prolonged closure of S2 (physiologic splitting)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is sinus arrhythmia

A

Irregular rhythm related to breathing
Increased rate on Inspo
Decreased rate on expo
*This is normal, do not need to send to cardiology!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are abnormal S2 sounds

A 
Widely split (RBBB, Tetralogy)  
Fixed split (ASD) 
Narrowed split (Pulmonary HTN) 
Paradoxical split (LBBB, aortic stenosis) 
Single S2 (single ventricle defect) 
(these will be heard on inspiration and expiration, except paradoxical split heard only on expo)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Paradoxical splits are seen in conditions that

A

prolong LV emptying

LBBB and aortic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Widely split S2 is seen in conditions that

A

prolong RV emptying

RBBB, pulmonic stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the acronym for Diastolic murmurs

A

( I just DIed in your) ARMS
Aortic Regurg
Mitral Stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is S3

A

low frequency sound in early diastole, at Apex
S1—S2-S3 (Ten—ne-see)
Normal in kids, abnormal in adults
Indicates rapid ventricular filling or volume overload (preggers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is S4

A

low frequency in last diastole, at Apex
S4-S1—S2 (Ken-Tuc—ky)
Always bad! indicates HTN, cardiomyopathy, heart rejection (obstruction and decreased V compliance!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where can you hear Ejection murmurs (clicks)

A

Pulmonic stenosis: LUSB, intensity changes with expiration

Aortic stenosis: Apex, no respiration change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is pericarditis

A

Viral or bacterial infection causing frictional rub on auscultation
Fever and tachycardia
PR depression, Diffuse ST elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is post-pericardectomy syndrome

A 
AKA pericardial effusion!! 
Post ASD repair you develop CP, SOB, and fever 
Cardiomegaly on CXR 
Effusion on Echo 
Treat with NSAIDS and Pericardiocentesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What can be some pathologic causes of change in LE pulses

A

Patent ductal arteriosus: Bounding (3+)
Aortic stenosis: weak, thready
Coarcation: poor, absent, delay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Suspect coarcation when you have these PE findings

A

LE pulses are weak and thready OR if BP is lower in LE than UE
If UE and LE pulses and BP match, you likely do not have coarcation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are innocent murmurs

A

Stills murmur
Venous hum murmur
Peripheral pulmonary stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are pathologic murmurs

A

Systolic
Diastolic
Continuous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When evaluating murmurs, check

A 
Timing in cardiac cycle 
Location 
Intensity 
Shape 
Radiation 
Positional changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Radiation can tell you what about murmurs (specific)

A

Radiation to neck: aortic stenosis
Radiation to back: pulmonary stenosis
Radiation to axilla: peripheral pulmonary murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When is thrill noted on murmur grades

A

Grades 4-6 indicate presence of thrill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the types of ejection murmurs by sound

A

Crescendo-Decrescendo (ejection: AS, PS, HCM)

Holosystolic: VSD, MR, TR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the types of Diastolic murmurs

A

Early (semilunar valves): MS, AR, PR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the continuous murmurs

A

Patent ductus arteriosus
Venous hum murmur
coronary fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Characteristics of an innocent murmur are

A 
Systolic 
Grade 1-3 
Musical, vibratory 
Altered w/ position or breathing 
No S3/S4, associated Sx
Louder w/ stress (fever, pain, anxiety) 
*Reassurance! monitor*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Characteristics of pathologic murmurs are

A 
Diastolic 
Continuous 
Grade 4-6 
Harsh 
No change with position or breathing (but louder when standing) 
Clicks or S4 
Gallop rhythm 
Unequal UE/LE BP/pulse
Abn ECG (hypertrophy, arrhythmia) 
Cardiomegaly on CXR 
Syncope 
Trisomy 21 
*Refer to cardiology*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What will supine position do to murmurs

A

Increase innocent murmur

Decrease HCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What will sitting do to murmurs

A

Decrease innocent murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What will standing do to murmurs

A

Increase HCM and MVP

Decrease AS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What will valsalva do to murmurs

A

Decrease innocent murmur

Increase HCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Standing and valsalva decrease all murmurs EXCEPT

A

HCM
This is increased bc the heart has to work harder to pump blood and you have HCM so it gets louder as the heart pumps more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How do different positions affect flow to sides of the heart

A

Stand/valsalva: decrease flow to left heart (you are pumping out harder)
Supine/sitting: increase flow to left heart (you are relaxing and filling more)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is Stills murmur

A 
MC innocent murmur, 3-6 y/o 
Normal ECG 
Apex 
Loudest in supine and when stressed (fever) 
Change in intensity w/ sitting 
Outgrow in teens 
No echo needed!
33
Q

What is a venous hum murmur

A

Innocent continuous murmur (right to left side), 3-6 y/o
Turbulence 2/2 jugular venous drainage
Base of heart (diastole louder than systole)
Loudest when upright , decreased w/ supine or turning neck
No echo!

34
Q

What is peripheral pulmonary stenosis

A 
turbulence 2/2 mild narrowing of (peripheral) pulmonary arteries 
Newborn/preterm 
Mid-systolic ejection murmur @ LUSB 
Radiates to axilla and back 
Gone by 6-8 months 
\+/- echo
35
Q

How can you tell peripheral pulmonary stenosis from pulmonary valve stenosis

A

pulmonary valve has a “click”, PPS is just a mid-systolic ejection murmur

36
Q

What do baby colors indicate

A

Pink baby: good!
Blue baby: hole in heart or blocked lungs causing cyanosis. Low O2, low PBF on CXR
Grey baby: obstruction, no systemic blood flow. Lactic acidosis (need PGE)

37
Q

What is Acrocyanosis

A

benign, peripheral cyanosis 2/2 vasospasms of small arterioles
NO central cyanosis!
Nl pulses, O2 sat
Reassure they are fine

38
Q

Tachypnea in a baby indicates

A

L-to-R shunt (red blood goes to blue blood= more blood to the lungs so they breathe faster)
CXR shows wet lungs and large heart

39
Q

Volume overload can be 2/2

A

L-to-R shunt (ASD, VSD, PDA)
Dilation of heart chambers
On CXR: cardiomegaly, increased PBF (pulm blood flow)

40
Q

Pressure overload can be 2/2

A

outflow obstruction (Aortic or pulmonary)
Hypertrophy
ECG shows LVH or RVH

41
Q

Cyanotic lesion can cause

A

R-to-L shunt, no pulmonary blood flow, poor blood mixing

Poor saturation, low PaO2

42
Q

What are the congenital heart defects

A

Acyanotic defects: volume load on heart (ASD, VSD, PDA, AV defect)
Cyanotic defects
Obstructive defects
Single ventricle complex heart defect

43
Q

Characteristics of Acyanotic defects include

A 
L-to-R shunt (1.5:1) 
Normal O2 sat (red blood to blue blood) 
Volume overload 
Heart chamber enlargement 
Increased pulmonary blood flow on CXR 
(use ACE, diuretics, or digoxin to Tx HF associated with acyanotic defects!)
44
Q

Sx of Acyanotic defects are

A 
FTT 
Feeding intolerance 
Sweating with feeds 
Tachypnea 
SOB 
Recurrent pulmonary infections 
Hepatomegaly 
Gallop heart sounds
45
Q

CXR for a L-to-R shunt shows

A

wet lungs (increased pulmonary blood flow)
cardiomegaly
enlarged pulmonary artery

46
Q

What is ASD

A

hole in atrial septum causes more blood to fill the RV= Right heart overload
Fixed or wide S2 at LUSB
NO atrial shunt murmur
Pulmonary systolic flow murmur
ASx
Closes by 4 y/o (unless >8mm, wont close)

47
Q

Complications of placing an ASD device to close the defect are

A 
CP 
pericardial effusion 
reosion 
embolization 
*Need CXR +/- echo after placement*
48
Q

What is VSD

A

hole in ventricular septum causes Left heart overload
Decreased PVR and size
Harsh, holosystolic murmur at LSB
Sx of HF!

49
Q

CXR of VSD will show

A

Cardiomegaly and increased pulmonary blood flow

ASD only showed increased PBF

50
Q

What are the types of VSD

A
  • Perimembranous (harsh): small does not need intervention. big needs surgery if Sx or cardiomegaly
  • Muscular (small and squirty): no intervention, closes over time
51
Q

What is Patent Ductus Arteriosus

A 
Left heart overload 
Sx of HF 
Continuous murmur at LUSB 
Wide pulse pressure, bounding pulses 
Preterm: not cyanotic
52
Q

How do you treat PDA in infants

A

Preterm (not cyanotic): Indomethacin to induce closure
Cyanotic: Prostaglandins
Tx: Medical, device, surgical

53
Q

What is an AV canal defect

A

General heart volume overload, common in Trisomy 21
Increased pulmonary HTN
HF Sx
ECG shows superior QRS axis

54
Q

How do you treat atrioventricular canal defect

A

Surgical repair at 4-6 months old

55
Q

Cyanotic heart defects Require

A

Prostaglandins!!!

They maintain patency of PDA

56
Q

What 2 mechanisms cause cyanosis

A

Lungs (inadequate alveolar ventilation): PNA, Meconium aspiration, pulmonary edema- will improve w/ oxygen!
Cardiac: Desaturated blood bypasses lungs. will NOT improve w/ oxygen because blood bypasses lungs!

57
Q

What cardiac issues can cause cyanosis

A
  • Poor blood mixing: no A or V defect, PDA is closed
  • Obstruction or atresia of PBF: PS or pulm atresia
  • Parallel blood flow: transposition
58
Q

Signs of central cyanosis are

A

blue lips and tongue
low saturations
low PaO2 (ABG) and low O2
Congenital heart defect

59
Q

What are the three shunts in fetal circulation

A

Ductus venosus
Foramen ovale
Ductus arteriosus
-they allow heart defects to survive in utero

60
Q

What is patent ductus arteriosus

A

When ductus arteriosus does not functionally close in 12-90 hours, or anatomically close in 2-3 weeks

61
Q

Signs of obstruction to pulmonary flow are

A

Cyanosis, hypoxia (decreased sats)
low PaO2 (<60)
decreased pulmonary blood flow on CXR (black lungs)

62
Q

Signs of obstruction to systemic flow

A 
Cardiac shock (low CO) 
increased lactates 
poor pulses 
poor capillary refill 
narrow pulse pressure 
poor, pale color
63
Q

When would you need to give prostaglandins to maintain patency of PDA

A

In situations like transposition of great vessels (aorta and pulm trunk are parallel), Grey baby (intracardiac shunt closed= no blood mixing) or a complex heart, so PDA can provide pulmonary or systemic blood flow
PVR and obstruction dictate blood flow

64
Q

What is a complex heart

A

when you have a single ventricle

Goal saturation is 75-90%

65
Q

What is PDA status in different color babies

A

Pink: closed
Blue: closing (may need PGE)
Grey: need to keep it open (PGE)
Blue/purple: open

66
Q

What findings would make you start a baby on PGE

A 
Blue or grey in color 
5 cyanotic heart defects (transposition of great arteries, tetralogy of fallot, others we dont need to know) 
obstructed lungs or systemic flow 
Abnormal CXR, ECG, ABG (acidosis)
fail to improve with oxygen
failed pulse ox testing
67
Q

What are normal pulse ox levels

A

pre-ductal (hand): >95%
post-ductal (foot): >95%
Red blood is mixing blue blood! (not sure what this means)
(<90% in any area indicates a failed test)

68
Q

In cyanosis, what are your pulse ox levels

A

Hands purple: 94% or less
Feet blue: 85-90%
Blue blood is mixing Red blood (not sure what this means)
will have high pulmonary pressures or PVR

69
Q

What is Truncus arteriosus

A

When the pulmonary artery and aorta do not separate

70
Q

What is DiGeorge syndrome

A 
22q11.2 defect microdeletion (FISH probe) causing: 
Cardiac abnormality 
Abnormal facies 
Thymus atresia (T cell problems) 
Cleft palate (feeding problems) 
Hypocalcemia
71
Q

What are signs of transposition of great arteries

A

Severe hypoxia (sats 40-60%)
reverse differential (hands blue 65%, feet red 85%)
No specific murmur
Cxr: egg on a string, hypoxia with increased blood flow

72
Q

How do you manage transposition of great vessels

A

Urgent transfer to childrens hospital for surgery

arterial switch

73
Q

What is tricuspid atresia

A

tricuspid is not formed, so blood does not flow from RA to RV

74
Q

What is tetralogy of fallot

A 
-VSD, RVH, aortic over-ride, PS
systolic harsh murmur over LUSB 
Cyanos is larger than degree of PS 
Blue is more severe than pink 
CXR: Boot shape
75
Q

How do you manage tetralogy of fallot

A

Surgery at 3-6 months

76
Q

What is a Tet spell

A

Spasm of RVOT muscle (around pulmonary valve)
Fussy, cyanotic baby
LOSE systolic heart murmur
-Keep infant calm, Oxygen, NS bolus, hold knees to chest*, Give morphine and propranolol!

77
Q

What is total autonomous pulmonary venous return

A

Oxygenated and deoxygenated blood returns to RA so mixed blood is pumped
CXR: snowman, pulm venous congestion (white lungs)
Need to fix ASAP 2/2 obstruction!

78
Q

Ebstein’s anomaly is noted with

A

WPW (pre-excitation pattern on ECG- short PR, wide QRS)

Summer Disciplines 2 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions