Peds Cardiology (Exam 4) Flashcards
What is an innocent heart murmur?
One that occurs in the absence of anatomic or physiological abnormalities of the heart or circulation
Roughly ___ of kids will have a murmur at some point
50%
What are the 6 types of innocent murmurs?
- New born murmurs
- Vibratory systolic murmur (Still’s murmur)
- mc- L sternal boader/apex - Venous hum
- Pulmonary systolic murmur
- Peripheral pulmonic systolic murmur
- Supraclavicular systolic murmur
What useful HPI concerns for a murmur?
- Easily fatigable, including difficulty w/ feeding
- disinterest, diaphoresis, change in resp patterns, cynaosis
- Claudication
- Sx that worsen w/ exertion (feeding)!!
- Syncope (Babies passing out is never a good thing!)
- Sig. Fam hx
- CP IS NOT USEFUL
What are concerning PE findings with murmurs?
- Falling off growth charts
- Unequal pulses/pressures
- Hyperactive precordium, displaced PMI
- Murmur itself (diastolic or continuous, Grade IV+)
What type of murmur is almost always abnormal?
Diastolic
Are lab studies necessary in dx a peds murmur?
No if asymptomatic- It adds practically nothing to the initial evaluation of an asymptomatic kid with a murmur (refer to peds cardiology)
When do you need to order an echo on a peds?
If the kiddo is symptomatic or asymptomatic with: -suspected diastolic or continuous murmur -ejection clicks -radiate to back or neck -grade 3 or louder -murmurs ass. with abnorm ekg or cx
Rheumatic fever is an ________ dx that occurs after a ______ infection
autoimmune/inflammatory dx
GROUP A STREP
If a pt comes in with rheumatic fever sx when would you do a rapid strep test?
Only if the HPI is consistent with an acute strep infection
What is the time frame of RF onset after a group A strep infection?
1-5 weeks
What lab tests do you want to get for a RF pt?
ASO titer (rises 1-3 wks after strep infx, peaks 3-5 wks)
CBC
CMP
ESR + CRP (if neg=not RF)
What is the diagnostic criteria for rheumatic fever?
Jones Criteria
What is the Jones Criteria?
DX based on presence of known group Q strep infection PLUS:
2 major OR
1 major and 2 minor criteria
What are the 5 major criteria of the Jones Criteria?
- Migratory polyarthritis (MC-80%)
- insanely painful joint pain that jumps to a new spot every 3-10 days
- must have associated swelling and limited movement - Carditis (valvulitis, myocarditis, pericarditis)
- Most serious complication
- present 40%
- Tachy, new murmur, cardiomegaly, CHF
- MV and AV mc affected - Erythema marginatum (less than 5%)
- macular, red, non itchy rash on trunk - Chorea (Sydenham’s)
- less than 15%
- rapid, purposeless movement (like Huntington’s dx)
- delayed onset (mo to yrs) - Subcutaneous nodules (uncommon <5%)
- non-tender, freely moving, over a joint
