peds cardiology Flashcards
1
Q
what do weaker pulses in LE suggest
A
- coarctation
2
Q
what do bounding pulses suggest
A
- run off lesion
- PDA, AI
3
Q
what is pulsus paradoxus and what does it suggest
A
- exaggerated SBP drop with inspiration
- tamponade
- severe asthma
4
Q
what delivers oxygen in the fetal circulation
A
- placenta
5
Q
what does the umbilical v carry
A
- oxygenated blood
6
Q
how many vessels are found in the umbilical cord
A
- 1 vein
- 2 arteries
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
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
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
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
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
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
13
Q
adult version of foramen ovale
A
- fossa ovalis
14
Q
adult version of umbilical v
A
- ligamentum teres
15
Q
adult version of ductus venosus
A
- ligamentum venosus
16
Q
adult version of ductus arteriosum
A
- ligamentum arteriosum
17
Q
grade I murmur
A
- very soft
- heard in quiet room with a cooperative pt
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
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
26
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
27
red flags for murmurs
- diastolic murmur
- continuous murmur
- loud, esp with thrill
- little to no change with position
- symptoms
28
VSD
- BF from LV -> RV
- causes overflow of blood in lungs -> pulm sx
- most common of all congenital heart malformations
29
si/sx of VSD
- depends on size/ duration
- holosystolic
- heard at LSB with heave
- failure to thrive
- tachypnea
- murmur
- diaphoresis with feeding
30
PDA
- BF from aorta -> pulm a
| - possible tx with indomethacin
31
si/sx of PDA
- depends on size/ duratoin
- bounding pulse
- murmur
- HF
- poor growth and feeding
32
ASD
- BF from LA to RA
- present in childhood with murmur or exercise intolerance
- systolic ejection murmur
- heard in pulm area
33
tetralogy of fallot
- most common R -> L shunt
- RV outflow tract obstruction
- VSD
- overriding aorta
- RV hypertrophy
- boot shaped heart on xray
34
what causes the murmur of tetralogy of fallot
- pulmonic stenosis
35
rheumatic fever
- occurs after GAS pharyngitis
- 2-6 weeks later
- injury by GAS antibodies cross- react with tissue
36
earliest/ most common feature of rheumatic fever
- painful migratory arthritis
| - large joints most common
37
si/sx of rheumatic fever
- polyarthritis
- carditis
- syndenham's chorea
- erythema marginatum
- subcutaneous nodules
38
what does erythema marginatum look like
- skin rash
- over trunk, arms, legs
- clear centers
- round margins
- ring shaped
39
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
40
si/sx of HCM
- exs intolerance
- arrhythmias
- syncope
- sudden death
41
murmur of HCM
- systolic ejection murmur
- medium intensity
- heard at LSB and apex
- increases with valsalva or when erect
42
eval of HCM
- echo with doppler*
| - +/- EKG and holter monitoring
43
treatment of HCM
- avoid competitive sports
- BB or CCB
- surgical myomectomy
- implanted anti-arrhythmia devices
- abx ppx recommended
