Peds Cardiology

Question 1

Paradoxial split

Answer 1

S2 is eliminated with inspiration
-Prolonged LV emptying
Ex. LBBB, aortic stenosis

Question 2

Widened split

Answer 2

-prolonged RV emptying

Ex. RBBB, pulmonic stenosis

Question 3

Fixed split

Answer 3

Atrial septal defect

-left to right shunt

Question 4

S3

Answer 4

• early diastole
• Ten-ne-see
• Rapid ventricular filling/volume overload (ex. pregnancy)
• common in children

Question 5

S4

Answer 5

• late diastole
• Kentucky
• Decreased ventricular compliance (ex. hypertension, cardiomyopathy)
• Always pathological in children**

Question 6

Pulmonic stenosis

Answer 6

• LUSB

- Intensity changes with expiration

Question 7

Aortic stenosis

Answer 7

• Apex (early systole)

- No change with respiration

Question 8

Pericarditis EKG

Answer 8

1. Diffuse ST elevation

2. PR depression

Question 9

Patent Ductus Arteriosus: pulse

Answer 9

Bounding (++++ in upper and lower extremity)

Question 10

Aortic stenosis: pulses

Answer 10

Weak, thready (upper and lower)

Question 11

Coartation: pulses

Answer 11

Upper -normal

Lower - poor, absent

Question 12

Peripheral amplification

Answer 12

BP in the legs is greater than the arms normally

Question 13

Radiation of murmurs

Answer 13

Neck = aortic stenosis
Back = pulmonary valve stenosis
Axilla = peripheral pulmonary murmur

Question 14

For murmurs, graded 1/6 to 6/6, when can you feel a thrill?

Answer 14

4/6

Question 15

Systolic Murmurs

Answer 15

Ejection:

1. Aortic or Pulmonary stenosis
2. Hypertrophic cardiomyopathy

Holosystolic

1. Ventricular septal defect
2. Mitral regurg
3. Tricuspid regurg

Question 16

Continuous Murmurs

Answer 16

1. PDA (patent ductus arteriosus)
   - Machine-like murmur
2. Venous hum murmur
   - common
   - loudest at base
   - “sounds like the ocean”

Question 17

Innocent Murmur

Answer 17

• systolic
• musical/vibratory
• louder with stress, fever, pain

Louder: supine position*
Quieter: seated position

Tx: reassurance (monitor clinically)

Question 18

Pathological Murmur

Answer 18

• Diastolic or continous
• Grade 4 (with thrill)
• Harsh
• Louder with standing
• Gallops
• S4
• Syncope
• Poor pulses

Tx: any of the above? –> refer to cardiology

Question 19

With standing and valsalva you have decreased blood flow to the heart. What happens to murmurs?

Answer 19

Standing & valsalva –> quieter murmurs

EXCEPT–>Hypertrophic cardiomyopathy

Question 20

With lying supine or sitting what happens to blood flow and murmurs?

Answer 20

More blood return, louder murmurs

Question 21

Hypertrophic cardiomyopathy murmur

Answer 21

louder with standing and valsalva

Question 22

Stills Murmur

Answer 22

• MC innocent murmur
• age 3-6
• Low frequency, musical, vibratory
• Loudest when supine
• Normal EKG

Question 23

Venous Hum Murmur

Answer 23

• Turbulence due to jugular venous drainage
• continous murmur
• age 3-6
• Base of the heart
• Diastolic louder than systolic
• Loudest in upright position
• Decrease with supine, or turning neck

Question 24

Peripheral pulmonary stenosis (PPS)

Answer 24

• turbulence due to mild narrowing of the pulmonary arteries
• common in newborns/infants preterm**
• Mid-systolic ejection murmur
• LUSB
• Radiates to axilla and back

Question 25

Acrocyanosis

Answer 25

- benign - peripheral cyanosis - normal pulses Tx: reassurance

Question 26

If patient has a Left to Right shunt, what will the CXR show?

Answer 26

"wet lungs" | large heart

Question 27

Right to left shunt (obstruction to the lungs)

Answer 27

"blue" | CXR: Low PBF

Question 28

What causes Grey Baby

Answer 28

Decreased systemic blood flow -lactic acidosis Tx: prostaglandin PGE to open PDA

Question 29

Acyanotic Heart Defects

Answer 29

- Volume load on heart* - ->breathing too fast to eat* - Increased pulmonary blood flow "wet lungs" 1. Ventricular septal defect 2. Atrial septal defect 3. Patent ductus arteriosus 4. AV-canal defect (Down syndrome) -no prostaglandins (PGE) required Tx: Ace inhibitor, Diuretic

Question 30

Atrial septal defect

Answer 30

- Right heart volume overload - Fixed or widened S2 pulmonary component (LUSB) - usually closes by age 4 -MC version is the secundum ASD in the middle of the atrial wall

Question 31

Ventricular Septal Defect

Answer 31

- Left heart volume overload (LVH) - Harsh, holosystolic murmur - Mid-LSB

Question 32

Patent Ductus Arteriosus (PDA)

Answer 32

-Left heart volume load (sx of heart failure) -LUSB, infraclavicular -Continuous, machinery murmur -Widen pulse pressures/Bounding pulses Tx: Prostaglandins to help close

Question 33

Atrioventricular Canal Defect

Answer 33

-Trisomy 21 -Pulmonary hypertension -Heart volume overload/HF symptoms EKG: superior QRS axis Tx: surgery 4-6 months

Question 34

Cyanotic heart defects require what?

Answer 34

prostaglandins to maintain patency of PDA | *does not improve with oxygen

Question 35

Complex Heart

Answer 35

-Single ventricle

Question 36

Where is pulse oximetry placed?

Answer 36

Pre-ductal on right hand Post-ductal on left hand **Needs to be above 95% sat to pass Failing is below 90% -Recheck every hour

Question 37

What are the 5 cyanotic heart defects?

Answer 37

1. Truncus Arteriosus 2. Transposition of the Great Arteries 3. Tricuspid Atresia 4. Tetralogy of Fallot 5. Total Anomalous of the Pulmonary Venous Return (TAPVR)

Question 38

1. Truncus arteriosus (think DiGeorge Syndrome)

Answer 38

- Truncus arteriosus | - CATCH 22 (cardiac anomaly, abnormal facies, thymus atresia, cleft palate, hypocalcemia)

Question 39

2. Transposition of the Great Arteries

Answer 39

- CXR: "egg on string" | - Severe hypoxia

Question 40

3. Tetrology of Fallot

Answer 40

- VSD - RVH - Overriding Aorta - Pulmonary stenosis -Systolic, harsh murmur LUSB CXR: boot shaped heart

Question 41

TET spell

Answer 41

- cyanotic spell of kid with tetrology of fallot - blue skin - crying - knee to chest

Question 42

Total Anomalous of Pulmonary Venous Return (TAPVR)

Answer 42

CXR: snowman

Question 43

Ebstein's Anomaly

Answer 43

EKG: Pre-excitation pattern | -Wolf Parkinson White

Question 44

Pulmonary stenosis: tx

Answer 44

Balloon valvuloplasty

Question 45

Bicuspid aortic valve

Answer 45

- associated with coarctation - LVH - Concentric hypertrophy

Question 46

Coarctation of aorta

Answer 46

Pulses higher in UE Pulses lower in LE -Association with Turner Syndrome (XO)