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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

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2
Q

What is S2

A

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

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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)

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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!

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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)
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6
Q

Paradoxical splits are seen in conditions that

A

prolong LV emptying

LBBB and aortic stenosis

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7
Q

Widely split S2 is seen in conditions that

A

prolong RV emptying

RBBB, pulmonic stenosis

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8
Q

What is the acronym for Diastolic murmurs

A

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

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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)

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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!)

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11
Q

Where can you hear Ejection murmurs (clicks)

A

Pulmonic stenosis: LUSB, intensity changes with expiration

Aortic stenosis: Apex, no respiration change

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12
Q

What is pericarditis

A

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

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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
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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

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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

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16
Q

What are innocent murmurs

A

Stills murmur
Venous hum murmur
Peripheral pulmonary stenosis

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17
Q

What are pathologic murmurs

A

Systolic
Diastolic
Continuous

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18
Q

When evaluating murmurs, check

A 
Timing in cardiac cycle 
Location 
Intensity 
Shape 
Radiation 
Positional changes
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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

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20
Q

When is thrill noted on murmur grades

A

Grades 4-6 indicate presence of thrill

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21
Q

What are the types of ejection murmurs by sound

A

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

Holosystolic: VSD, MR, TR

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22
Q

What are the types of Diastolic murmurs

A

Early (semilunar valves): MS, AR, PR

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23
Q

What are the continuous murmurs

A

Patent ductus arteriosus
Venous hum murmur
coronary fistula

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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*
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25
Characteristics of pathologic murmurs are
``` 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* ```
26
What will supine position do to murmurs
Increase innocent murmur | Decrease HCM
27
What will sitting do to murmurs
Decrease innocent murmur
28
What will standing do to murmurs
Increase HCM and MVP | Decrease AS
29
What will valsalva do to murmurs
Decrease innocent murmur | Increase HCM
30
Standing and valsalva decrease all murmurs EXCEPT
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
31
How do different positions affect flow to sides of the heart
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)
32
What is Stills murmur
``` 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
What is a venous hum murmur
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
What is peripheral pulmonary stenosis
``` 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
How can you tell peripheral pulmonary stenosis from pulmonary valve stenosis
pulmonary valve has a "click", PPS is just a mid-systolic ejection murmur
36
What do baby colors indicate
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
What is Acrocyanosis
benign, peripheral cyanosis 2/2 vasospasms of small arterioles NO central cyanosis! Nl pulses, O2 sat Reassure they are fine
38
Tachypnea in a baby indicates
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
Volume overload can be 2/2
L-to-R shunt (ASD, VSD, PDA) Dilation of heart chambers On CXR: cardiomegaly, increased PBF (pulm blood flow)
40
Pressure overload can be 2/2
outflow obstruction (Aortic or pulmonary) Hypertrophy ECG shows LVH or RVH
41
Cyanotic lesion can cause
R-to-L shunt, no pulmonary blood flow, poor blood mixing | Poor saturation, low PaO2
42
What are the congenital heart defects
Acyanotic defects: volume load on heart (ASD, VSD, PDA, AV defect) Cyanotic defects Obstructive defects Single ventricle complex heart defect
43
Characteristics of Acyanotic defects include
``` 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
Sx of Acyanotic defects are
``` FTT Feeding intolerance Sweating with feeds Tachypnea SOB Recurrent pulmonary infections Hepatomegaly Gallop heart sounds ```
45
CXR for a L-to-R shunt shows
wet lungs (increased pulmonary blood flow) cardiomegaly enlarged pulmonary artery
46
What is ASD
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
Complications of placing an ASD device to close the defect are
``` CP pericardial effusion reosion embolization *Need CXR +/- echo after placement* ```
48
What is VSD
hole in ventricular septum causes Left heart overload Decreased PVR and size Harsh, holosystolic murmur at LSB Sx of HF!
49
CXR of VSD will show
Cardiomegaly and increased pulmonary blood flow | ASD only showed increased PBF
50
What are the types of VSD
- Perimembranous (harsh): small does not need intervention. big needs surgery if Sx or cardiomegaly - Muscular (small and squirty): no intervention, closes over time
51
What is Patent Ductus Arteriosus
``` Left heart overload Sx of HF Continuous murmur at LUSB Wide pulse pressure, bounding pulses Preterm: not cyanotic ```
52
How do you treat PDA in infants
Preterm (not cyanotic): Indomethacin to induce closure Cyanotic: Prostaglandins Tx: Medical, device, surgical
53
What is an AV canal defect
General heart volume overload, common in Trisomy 21 Increased pulmonary HTN HF Sx ECG shows superior QRS axis
54
How do you treat atrioventricular canal defect
Surgical repair at 4-6 months old
55
Cyanotic heart defects Require
Prostaglandins!!! | They maintain patency of PDA
56
What 2 mechanisms cause cyanosis
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
What cardiac issues can cause cyanosis
- 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
Signs of central cyanosis are
blue lips and tongue low saturations low PaO2 (ABG) and low O2 Congenital heart defect
59
What are the three shunts in fetal circulation
Ductus venosus Foramen ovale Ductus arteriosus -they allow heart defects to survive in utero
60
What is patent ductus arteriosus
When ductus arteriosus does not functionally close in 12-90 hours, or anatomically close in 2-3 weeks
61
Signs of obstruction to pulmonary flow are
Cyanosis, hypoxia (decreased sats) low PaO2 (<60) decreased pulmonary blood flow on CXR (black lungs)
62
Signs of obstruction to systemic flow
``` Cardiac shock (low CO) increased lactates poor pulses poor capillary refill narrow pulse pressure poor, pale color ```
63
When would you need to give prostaglandins to maintain patency of PDA
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
What is a complex heart
when you have a single ventricle | Goal saturation is 75-90%
65
What is PDA status in different color babies
Pink: closed Blue: closing (may need PGE) Grey: need to keep it open (PGE) Blue/purple: open
66
What findings would make you start a baby on PGE
``` 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
What are normal pulse ox levels
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
In cyanosis, what are your pulse ox levels
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
What is Truncus arteriosus
When the pulmonary artery and aorta do not separate
70
What is DiGeorge syndrome
``` 22q11.2 defect microdeletion (FISH probe) causing: Cardiac abnormality Abnormal facies Thymus atresia (T cell problems) Cleft palate (feeding problems) Hypocalcemia ```
71
What are signs of transposition of great arteries
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
How do you manage transposition of great vessels
Urgent transfer to childrens hospital for surgery | arterial switch
73
What is tricuspid atresia
tricuspid is not formed, so blood does not flow from RA to RV
74
What is tetralogy of fallot
``` -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
How do you manage tetralogy of fallot
Surgery at 3-6 months
76
What is a Tet spell
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
What is total autonomous pulmonary venous return
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
Ebstein's anomaly is noted with
WPW (pre-excitation pattern on ECG- short PR, wide QRS)

Summer Disciplines 2 (8 decks)

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