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clin med IV > peds cardiology > Flashcards

peds cardiology Flashcards

1
Q

what do weaker pulses in LE suggest

A
  • coarctation
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2
Q

what do bounding pulses suggest

A
  • run off lesion

- PDA, AI

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3
Q

what is pulsus paradoxus and what does it suggest

A
  • exaggerated SBP drop with inspiration
  • tamponade
  • severe asthma
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4
Q

what delivers oxygen in the fetal circulation

A
  • placenta
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5
Q

what does the umbilical v carry

A
  • oxygenated blood
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6
Q

how many vessels are found in the umbilical cord

A
  • 1 vein

- 2 arteries

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7
Q

what happens when cord is clamped

A
  • clamped 30-60 sec after birth- allows BF to baby
  • once clamped SVR is increased
  • arteries are low resist pathways, closure at birth -> signif increase in SVR
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8
Q

what happens when baby starts to breath

A
  • lungs fill with air instead of fluid
  • causes higher oxygen levels in blood
  • alveoli filled with air -> lung expansion
  • aeration causes decreased pulm v resistance and increased pulm BF
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9
Q

ductus venosis

A
  • connects umbilical v to inferior vena cava
  • bypasses liver
  • carries oxygenated blood
  • closes d/t fall in umbilical v pressure
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10
Q

foramen ovale

A
  • during transition the R -> L flow may occur through foramen ovale
  • closure occurs initially as functional change
  • later dev anatomic closure d/t proliferation of endothelial and fibrous tissue
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11
Q

ductus arteriosus

A
  • protects lungs from being overloaded before birth
  • should functionally close within 24-48 hours
  • structurally closes with a few weeks
  • decreased pulm, decreased prostaglandin E2, and increased O2 sat causes closure
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12
Q

size of ventricles at birth compared to later

A
  • at birth RV and LV are equal in size

- end of first mo LV wall gets thicker, RV wall gets thinner

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13
Q

adult version of foramen ovale

A
  • fossa ovalis
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14
Q

adult version of umbilical v

A
  • ligamentum teres
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15
Q

adult version of ductus venosus

A
  • ligamentum venosus
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16
Q

adult version of ductus arteriosum

A
  • ligamentum arteriosum
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17
Q

grade I murmur

A
  • very soft

- heard in quiet room with a cooperative pt

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18
Q

grade II murmur

A
  • easily heard but not loud
19
Q

grade III murmur

A
  • loud
20
Q

grade IV murmur

A
  • loud with thrill
21
Q

grade V murmur

A
  • loud with thrill

- audible with stethoscope at 45 degree angle

22
Q

grade VI murmur

A
  • loud with thrill

- audible with stethoscope off chest 1 cm

23
Q

characteristics of innocent murmurs

A
  • change with position
  • high output states accentuate murmur
  • most common in preschool aged
24
Q

still’s murmur

A
  • most common innocent murmur
  • vibratory, twangy, systolic murmur
  • heard best at LSB and apex
  • usu in kids 3-5
  • soft/ disappears uprigt
25
Q

pulmonary flow murmur

A
  • usu in older kids and adolescents
  • systolic ejection murmur over pulm area
  • increased with supine
  • decreases upright
  • increased by high output states
26
Q

venous hum

A
  • often heard in toddlers and young adults
  • low pitched cont murmur
  • heard in infraclavicular area
  • normal heart sounds
  • loudest upright
  • decreases in supine or with jugular v compression
  • continuous but may be louder during systole
27
Q

red flags for murmurs

A
  • diastolic murmur
  • continuous murmur
  • loud, esp with thrill
  • little to no change with position
  • symptoms
28
Q

VSD

A
  • BF from LV -> RV
  • causes overflow of blood in lungs -> pulm sx
  • most common of all congenital heart malformations
29
Q

si/sx of VSD

A
  • depends on size/ duration
  • holosystolic
  • heard at LSB with heave
  • failure to thrive
  • tachypnea
  • murmur
  • diaphoresis with feeding
30
Q

PDA

A
  • BF from aorta -> pulm a

- possible tx with indomethacin

31
Q

si/sx of PDA

A
  • depends on size/ duratoin
  • bounding pulse
  • murmur
  • HF
  • poor growth and feeding
32
Q

ASD

A
  • BF from LA to RA
  • present in childhood with murmur or exercise intolerance
  • systolic ejection murmur
  • heard in pulm area
33
Q

tetralogy of fallot

A
  • most common R -> L shunt
  • RV outflow tract obstruction
  • VSD
  • overriding aorta
  • RV hypertrophy
  • boot shaped heart on xray
34
Q

what causes the murmur of tetralogy of fallot

A
  • pulmonic stenosis
35
Q

rheumatic fever

A
  • occurs after GAS pharyngitis
  • 2-6 weeks later
  • injury by GAS antibodies cross- react with tissue
36
Q

earliest/ most common feature of rheumatic fever

A
  • painful migratory arthritis

- large joints most common

37
Q

si/sx of rheumatic fever

A
  • polyarthritis
  • carditis
  • syndenham’s chorea
  • erythema marginatum
  • subcutaneous nodules
38
Q

what does erythema marginatum look like

A
  • skin rash
  • over trunk, arms, legs
  • clear centers
  • round margins
  • ring shaped
39
Q

dx of rheumatic fever

A
  • based on jones criteria
  • must have GAS preceeding infx
  • rising ASO titer or anti- DNASE b titer
    • throat culture
    • rapid antigen test with consistent sx
40
Q

si/sx of HCM

A
  • exs intolerance
  • arrhythmias
  • syncope
  • sudden death
41
Q

murmur of HCM

A
  • systolic ejection murmur
  • medium intensity
  • heard at LSB and apex
  • increases with valsalva or when erect
42
Q

eval of HCM

A
  • echo with doppler*

- +/- EKG and holter monitoring

43
Q

treatment of HCM

A
  • avoid competitive sports
  • BB or CCB
  • surgical myomectomy
  • implanted anti-arrhythmia devices
  • abx ppx recommended

clin med IV (23 decks)

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