Peds - Congenital Cardiovascular Flashcards
Which valves are AV?
Between ATRIA and VENTRICLES
mitral
tricuspid
Which valves are semilunar?
aortic
pulmonic
What causes S1?
Closure of the AV valves
mitral
tricuspid
A is the 1st letter, AV make the S1 sound
What causes S2?
Closure of the semilunar valves
aortic pulmonic
When does systole occur?
Between S1 and S2
When does diastole occur?
Between S2 and S1
Generally speaking, what causes S3?
Increased fluid states
Generally speaking, what causes S4?
Stiff ventricular wall
What does S3 sound like?
Kentucky
What does S4 sound like?
Tennessee
Which valve is between the R atrium and the R ventricle?
Tricuspid
Which valve is between the L atrium and the L ventricle?
Mitral
Which valve is between the R ventricle and the pulmonary artery?
Pulmonic
Which valve is between the L ventricle and the aorta?
Aortic
Pneumonic for order of valves
To
Pay
More
Attention
Auscultation area - aortic #
R upper sternal border
Auscultation area - pulmonic #
L upper sternal border
Auscultation area - aortic or mitral
Apex (Erb’s point)
Auscultation area - tricuspid or VSD
L lower sternal border
What might a thrill indicate?
VSD
ex: Tetralogy of Fallot
Congenital murmurs tend to be:
Systolic
Obstructive defects tend to have:
Ejection clicks due to turbulence
Referred or radiating sound
What is the most common congenital heart defect?
VSD
30%
Acyanotic lesions shunt which way?
Left to Right
Cyanotic lesions shunt which way?
Right to Left
acyanotic defect
systolic murmur @ Left UPPER sternal border
R ventricular hypertrophy
Atrial Septal Defect (ASD)
acyanotic defect
systolic murmur @ Left LOWER sternal border
may feel a holosystolic THRILL
L ventricular hypertrophy
Ventricular Septal Defect (VSD)
acyanotic defect systolic murmur @ Left UPPER sternal border HOLOSYSTOLIC "machinery" sound L ventricular hypertrophy
Patent Ductus Arteriosus (PDA)
cyanotic defect (same murmur as VSD but with RVH)
systolic murmur @ Left LOWER sternal border
may feel a holosystolic THRILL
X-ray - “egg on a string”
Transposition of the Great Arteries
attempt to maintain PDA
cyanotic defect
loud systolic ejection click @ mid and UPPER L sternal border
THRILL #
X-ray - “boot shaped heart”
Tetralogy of Fallot
obstructive defect
systolic thrill @ R upper sternal border
ejection click which does NOT vary with respiration
L ventricular hypertrophy
Aortic Stenosis
obstructive defect
systolic murmur @ L upper sternal border
ejection click which DOES vary with respiration
R ventricular hypertrophy
Pulmonic Stenosis
obstructive defect
Coarctation of the Aorta
What can be given to stall closure of a PDA (as in the case of cyanotic defects)?
Prostaglandins
Four defects of Tetralogy of Fallot
- Large VSD
- pulmonary stenosis
- overriding aorta
- RVH
What is a “Tet spell” and with which disorder is it associated?
Hypercyanotic episode associated with Tetralogy of Fallot
often will squat or sleep in knee chest position to slow return of blood to the heart
periobital edema
What are the ACYANOTIC heart defects?
3
Atrial Septal Defect
Ventricular Septal Defect
Patent Ductus Arteriosus
What are the CYANOTIC heart defects?
2
Transposition of Great Arteries
Tetralogy of Fallot
What are the OBSTRUCTIVE heart defects?
3
Aortic Stenosis
Pulmonic Stenosis
Coarctation of Aorta
DiGeorge is associated with which cardiac defect?
aortic arch anomalies
Down’s syndrome is associated with which cardiac defect?
septal defects
Edward’s syndrome (Trisomy 18) is associated with which cardiac defect?
septal defects <
Marfan syndrome is associated with which cardiac defect?
aortic regurgitation
mitral valve prolapse
Turner’s syndrome is associated with which cardiac defect?
coarctation of the aorta
Presenting signs and symptoms of child with cardiac defect?
cyanosis exercise intolerance diaphoresis edema clubbing
feeding problems
frequent respiratory infections
tachypnea during sleep
Beck’s triad
Beck’s Triad -
includes what?
indication of what?
o Lowered BP; widening of pulse pressure
o Distant heart sounds
o Jugular venous distention
Indicates cardiac defect
Pulse pressure definition
the difference between the systolic and diastolic BP readings
Characteristics of innocent murmur
No association with failure to thrive or cyanosis
low intensity (grade I-III)
may vary with position
no radiation
Why do innocent murmurs occur in up to 50% of children?
thin chest wall
more angulated great vessels
more dynamic circulation
Most common innocent murmur?
quality?
location?
cause?
Still’s Murmur
musical
between L lower sternal border and APEX
caused by turbulence in LV outflow tract
(stiLL’s murmur LL border)
Are innocent murmurs systolic or diastolic or both?
Only systolic
Venous Hum
INNOCENT continuous hum R upper sternal border heard best in sitting position disappears when supine or by turning head/compressing neck ipsilaterally
