Trans - Pediatric Cardiac PE Flashcards
Harrison’s groove
rib deformity and sign of chronic heart failure with diaphragm enlargement
palpating for heaves - movement on which part of the hand indicates LV heave? RV heave?
[1] RV heave - palm/sternum
[2] LV heave - fingers
cause of thrills
turbulence of underlying murmurs
thrills can first be felt at what grade of murmurs
4/6
the stethoscope diaphragm is useful for picking up which sounds?
high pitched sounds - S1, S2, murmurs of aortic and mitral regurgitation, pericardial friction rubs
the stethocscope bell is useful for picking up which sounds?
low pitched sounds - S3, S4, murmur of mitral stenosis
how is ascultation of the pediatric patient done? why?
C manner (infraclavicular –> parasternal –> apex –> axilla), because most pediatric heart conditions are congenital
where is the normal splitting of S1 detected?
lower left sternal border
physiological splitting of S2 occurs when?
during inspiration
why does the physiological splitting of S2 occur?
During inspiration, the increase in negative intrathoracic pressure causes increased central venous return. Because this increased volume passes through the pulmonary trunk, causing the pulmonic valve to close a bit later than normal.
components of S2
A2, P2
which is louder? A2 or P2?
A2
[T/F] S3 or S4 in an athlete is an abnormal finding
F
how are murmurs differentiated from normal heart sounds?
murmurs have a longer duration
things to evaluate in auscultation [6]
[1] rate [2] rhythm [3] quality of heart sound [4] S1/S2 [5] extra heart sounds [6] murmur
where is S1 louder?
apex
where is S2 louder?
base
midsystolic murmur - description
begins after S1, stops before S2; gaps between murmur and heart sound
midsystolic murmur - lesions
deals with blood flow across semilunar valves
holosystolic murmur - description
starts with S1 and stops at S2
holosystolic murmur - lesions
often due to regurgitant flow across AV valves
late systolic murmur - description
in mid- late- systole persisting up to S2
late systolic murmur - lesions
mitral valve prolapse (may or may not be preceeded by systolic click)
early diastolic murmur - description
starts right after S2 without gap, fades into silence before next S1
early diastolic murmur - lesions
often accompany regurgitant flow across incompetent semilunar valves
middiastolic murmur - description
begins quickly after S2
middiastolic murmur - lesion
turbulent flow across AV valves
S3 rumbles - description
middiastolic murmur associated with S3, associated with torrential inflow
Austin Flint murmur - description
begin in middiastole, may be confined to middiastole or continue through presystole
S3 rumbles - lesion
AV regurgitation, ASD
Austin Flint murmur - lesion
aortic regurgitation
pericardial friction rub - causes
inflammation of pericardial sac
pericardial friction rub - components [3]
[1] atrial systole
[2] ventricular systole
[3] ventricular diastole
patent ductus arteriosus
open channel persists between aorta and pulmonary artery
patent ductus arteriosus - type of murmur
continuous murmur with silent interval late in diastole and loudest in late systole
[T/F] friction rubs are a type of heart murmur
F, not caused by flow
crescendo-decrescendo murmur - lesions
present in obstructive lesions
crescendo-decrescendo murmur - why?
crescendo - ventricles try to pump blood through obstruction
decrescendo - blood passes through, pressure is released
aortic regurgitation - type of murmur
diastolic
aortic stenosis - type of murmur
systolic
pulmonic regurgitation - type of murmur
diastolic
pulmonic stenosis - type of murmur
systolic
mitral stenosis - type of murmur
diastolic
mitral regurgitation - type of mumur
systolic
tricuspid regurgitation - type of murmur
systolic
tricuspid stenosis - type of murmur
diastolic
ventricular septal defect - type of murmur
uniform holosystolic murmur (due to pressure gradient present in systole)
patent ductus arteriosus - type of murmur
continuous murmur (due to pressure difference in both systole and diastole)
atrial septal defect - ascultatory findings [3]
[1] diastolic rumble in tricuspid (stenosis)
[2] pulmonic murmur (due to increased blood flow from right ventricle to pulmonic valve)
[3] widely fixed split S2 (due to increased blood flow through pulmonic valve)
atrial myxoma
mass in atrium causing mitral inflow obstruction
atrial myxoma - type of murmur
crescendo-decrescendo murmur in diastole
