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Clinical Disciplines II > Peds Cardiology > Flashcards

Peds Cardiology Flashcards

1
Q

Paradoxial split

A

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

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2
Q

Widened split

A

-prolonged RV emptying

Ex. RBBB, pulmonic stenosis

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3
Q

Fixed split

A

Atrial septal defect

-left to right shunt

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4
Q

S3

A
  • early diastole
  • Ten-ne-see
  • Rapid ventricular filling/volume overload (ex. pregnancy)
  • common in children
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5
Q

S4

A
  • late diastole
  • Kentucky
  • Decreased ventricular compliance (ex. hypertension, cardiomyopathy)
  • Always pathological in children**
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6
Q

Pulmonic stenosis

A
  • LUSB

- Intensity changes with expiration

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7
Q

Aortic stenosis

A
  • Apex (early systole)

- No change with respiration

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8
Q

Pericarditis EKG

A
  1. Diffuse ST elevation

2. PR depression

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9
Q

Patent Ductus Arteriosus: pulse

A

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

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10
Q

Aortic stenosis: pulses

A

Weak, thready (upper and lower)

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11
Q

Coartation: pulses

A

Upper -normal

Lower - poor, absent

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12
Q

Peripheral amplification

A

BP in the legs is greater than the arms normally

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13
Q

Radiation of murmurs

A 
Neck = aortic stenosis
Back = pulmonary valve stenosis
Axilla = peripheral pulmonary murmur
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14
Q

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

A

4/6

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15
Q

Systolic Murmurs

A

Ejection:

  1. Aortic or Pulmonary stenosis
  2. Hypertrophic cardiomyopathy

Holosystolic

  1. Ventricular septal defect
  2. Mitral regurg
  3. Tricuspid regurg
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16
Q

Continuous Murmurs

A
  1. PDA (patent ductus arteriosus)
    - Machine-like murmur
  2. Venous hum murmur
    - common
    - loudest at base
    - “sounds like the ocean”
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17
Q

Innocent Murmur

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

Louder: supine position*
Quieter: seated position

Tx: reassurance (monitor clinically)

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18
Q

Pathological Murmur

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

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

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19
Q

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

A

Standing & valsalva –> quieter murmurs

EXCEPT–>Hypertrophic cardiomyopathy

20
Q

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

A

More blood return, louder murmurs

21
Q

Hypertrophic cardiomyopathy murmur

A

louder with standing and valsalva

22
Q

Stills Murmur

A
  • MC innocent murmur
  • age 3-6
  • Low frequency, musical, vibratory
  • Loudest when supine
  • Normal EKG
23
Q

Venous Hum Murmur

A
  • 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
24
Q

Peripheral pulmonary stenosis (PPS)

A
  • turbulence due to mild narrowing of the pulmonary arteries
  • common in newborns/infants preterm**
  • Mid-systolic ejection murmur
  • LUSB
  • Radiates to axilla and back
25
Q

Acrocyanosis

A
  • benign
  • peripheral cyanosis
  • normal pulses

Tx: reassurance

26
Q

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

A

“wet lungs”

large heart

27
Q

Right to left shunt (obstruction to the lungs)

A

“blue”

CXR: Low PBF

28
Q

What causes Grey Baby

A

Decreased systemic blood flow
-lactic acidosis

Tx: prostaglandin PGE to open PDA

29
Q

Acyanotic Heart Defects

A
  • 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

30
Q

Atrial septal defect

A
  • 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

31
Q

Ventricular Septal Defect

A
  • Left heart volume overload (LVH)
  • Harsh, holosystolic murmur
  • Mid-LSB
32
Q

Patent Ductus Arteriosus (PDA)

A

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

33
Q

Atrioventricular Canal Defect

A

-Trisomy 21
-Pulmonary hypertension
-Heart volume overload/HF symptoms
EKG: superior QRS axis

Tx: surgery 4-6 months

34
Q

Cyanotic heart defects require what?

A

prostaglandins to maintain patency of PDA

*does not improve with oxygen

35
Q

Complex Heart

A

-Single ventricle

36
Q

Where is pulse oximetry placed?

A

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

37
Q

What are the 5 cyanotic heart defects?

A
  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)
38
Q
  1. Truncus arteriosus (think DiGeorge Syndrome)
A
  • Truncus arteriosus

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

39
Q
  1. Transposition of the Great Arteries
A
  • CXR: “egg on string”

- Severe hypoxia

40
Q
  1. Tetrology of Fallot
A
  • VSD
  • RVH
  • Overriding Aorta
  • Pulmonary stenosis

-Systolic, harsh murmur LUSB
CXR: boot shaped heart

41
Q

TET spell

A
  • cyanotic spell of kid with tetrology of fallot
  • blue skin
  • crying
  • knee to chest
42
Q

Total Anomalous of Pulmonary Venous Return (TAPVR)

A

CXR: snowman

43
Q

Ebstein’s Anomaly

A

EKG: Pre-excitation pattern

-Wolf Parkinson White

44
Q

Pulmonary stenosis: tx

A

Balloon valvuloplasty

45
Q

Bicuspid aortic valve

A
  • associated with coarctation
  • LVH
  • Concentric hypertrophy
46
Q

Coarctation of aorta

A

Pulses higher in UE
Pulses lower in LE

-Association with Turner Syndrome (XO)

Clinical Disciplines II (15 decks)

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