peds cardiology Flashcards
what do weaker pulses in LE suggest
- coarctation
what do bounding pulses suggest
- run off lesion
- PDA, AI
what is pulsus paradoxus and what does it suggest
- exaggerated SBP drop with inspiration
- tamponade
- severe asthma
what delivers oxygen in the fetal circulation
- placenta
what does the umbilical v carry
- oxygenated blood
how many vessels are found in the umbilical cord
- 1 vein
- 2 arteries
what happens when cord is clamped
- 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
what happens when baby starts to breath
- 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
ductus venosis
- connects umbilical v to inferior vena cava
- bypasses liver
- carries oxygenated blood
- closes d/t fall in umbilical v pressure
foramen ovale
- 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
ductus arteriosus
- 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
size of ventricles at birth compared to later
- at birth RV and LV are equal in size
- end of first mo LV wall gets thicker, RV wall gets thinner
adult version of foramen ovale
- fossa ovalis
adult version of umbilical v
- ligamentum teres
adult version of ductus venosus
- ligamentum venosus
adult version of ductus arteriosum
- ligamentum arteriosum
grade I murmur
- very soft
- heard in quiet room with a cooperative pt
grade II murmur
- easily heard but not loud
grade III murmur
- loud
grade IV murmur
- loud with thrill
grade V murmur
- loud with thrill
- audible with stethoscope at 45 degree angle
grade VI murmur
- loud with thrill
- audible with stethoscope off chest 1 cm
characteristics of innocent murmurs
- change with position
- high output states accentuate murmur
- most common in preschool aged
still’s murmur
- most common innocent murmur
- vibratory, twangy, systolic murmur
- heard best at LSB and apex
- usu in kids 3-5
- soft/ disappears uprigt
pulmonary flow murmur
- usu in older kids and adolescents
- systolic ejection murmur over pulm area
- increased with supine
- decreases upright
- increased by high output states
venous hum
- 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
red flags for murmurs
- diastolic murmur
- continuous murmur
- loud, esp with thrill
- little to no change with position
- symptoms
VSD
- BF from LV -> RV
- causes overflow of blood in lungs -> pulm sx
- most common of all congenital heart malformations
si/sx of VSD
- depends on size/ duration
- holosystolic
- heard at LSB with heave
- failure to thrive
- tachypnea
- murmur
- diaphoresis with feeding
PDA
- BF from aorta -> pulm a
- possible tx with indomethacin
si/sx of PDA
- depends on size/ duratoin
- bounding pulse
- murmur
- HF
- poor growth and feeding
ASD
- BF from LA to RA
- present in childhood with murmur or exercise intolerance
- systolic ejection murmur
- heard in pulm area
tetralogy of fallot
- most common R -> L shunt
- RV outflow tract obstruction
- VSD
- overriding aorta
- RV hypertrophy
- boot shaped heart on xray
what causes the murmur of tetralogy of fallot
- pulmonic stenosis
rheumatic fever
- occurs after GAS pharyngitis
- 2-6 weeks later
- injury by GAS antibodies cross- react with tissue
earliest/ most common feature of rheumatic fever
- painful migratory arthritis
- large joints most common
si/sx of rheumatic fever
- polyarthritis
- carditis
- syndenham’s chorea
- erythema marginatum
- subcutaneous nodules
what does erythema marginatum look like
- skin rash
- over trunk, arms, legs
- clear centers
- round margins
- ring shaped
dx of rheumatic fever
- 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
si/sx of HCM
- exs intolerance
- arrhythmias
- syncope
- sudden death
murmur of HCM
- systolic ejection murmur
- medium intensity
- heard at LSB and apex
- increases with valsalva or when erect
eval of HCM
- echo with doppler*
- +/- EKG and holter monitoring
treatment of HCM
- avoid competitive sports
- BB or CCB
- surgical myomectomy
- implanted anti-arrhythmia devices
- abx ppx recommended
