Unit 2: Ped Cards Flashcards
______% of pts with trisomy 21 have what type of cardiac lesions?
40%
structural cardiac lesions
all patients with Trisomy 21 should have what diagnostic test?
echo
what two valve regurgitations are common in pts with Marfans?
Mitral and Aortic (MArfans)
What cardiac defect is associated with Turners?
Coarctation
What three cardiac defects are associated with Noonan syndrome?
- pulmonary stenosis
- ASD
- cardiomyopathy
what cardiac defect is common in pts with fetal alcohol syndrome?
- VSD
* vodka septal defect
what difference in blood pressures would you expect to see in Coarctation of Aorta?
- discrepancy btwn upper and lower extremities
- arms are higher bp than legs
- if 20mm hg difference suspect COA
what difference in blood pressures would you expect to see in Supravalvular Aortic Stenosis?
- Higher in right arm than left arm
- supravalvular… R comes before L
- R > L
what difference in blood pressure would you expect to see with Aortic Valve Stenosis?
Narrow pulse pressure
what BP difference would you expect to see in Aortic Regurg or Insufficiency?
Wide pulse pressure
things to look for in general PE (8 things)
- distress
- cyanosis
- clubbing
- edema
- squatting (compensatory reaction)
- diaphoresis
- syncope
- tachypnea
4 things to inspect or palpate for on cardiac assessment
- lifts
- heaves
- thrills
- PMI
3 things to inspect or palpate for on abd assessment
- hepatomegaly
- spleenomegaly
- ascites
what three dx tests help define cardiac disease?
- xrays “radiographs”
- ECG
- ECHO
most common pediatric cardiology referral is what?
“innocent heart murmurs”
name the 5 innocent heart murmurs from the ppt
- newborn
- still murmur
- pulmonary ejection
- venous hum
- carotid and cranial bruits
newborn murmur is heard when in the lifespan?
first few days of life
where is the newborn murmur heard?
LL sternal border
newborn murmur description?
short systolic grade I-II
newborn murmur is heard at the ______ sternal border and is described as _______ systolic, grade_____
- LL sternal border
- short systolic
- grade I-II/VI
still murmur is heard when in the lifespan?
*2-7y
still murmur is described as?
*musical or vibratory
still murmur is described as long or short?
short
still murmur is low or high pitched?
high
still murmur is systolic or diastolic?
sys
still murmur is loudest where? and in what position?
- midway btwn apex and L sternal border
* loudest when supine
which murmur is the most common in older kids and adults?
(a common tourist site, Pulmonary cannon…)
pulmonary ejection murmur
when is pulm ejection murmur heard in the lifespan?
3y and up
is pulm murmur soft or loud?
soft
is pulm ejection murmur systolic or diastolic/
sys
where is pulm ejection murmur heard?
Left upper sternal border (Light Up Sky Bombs)
what grade is pulm ejection murmur?
grade I-II/VI
can launch 1-2 hundred yards
when in the lifespan is a venous hum heard?
2y and up (venus has 2 musical note tattoos)
where is the venous hum located? and best heard in what position?
- Right infraclavicular area
* sitting position
how is venous hum described?
continuous musical
what grade is venous hum?
Grade I-III/VI (tattoo took 1-3 hours)
carotid bruit is heard when in the lifespan?
“older child & adolescent”
where is the carotid bruit heard?
supraclavicular area
how is carotid bruit described? (length and timing)
long systolic (long HYStory of being ejected from school…)
what grade is carotid bruit?
grade II-III/VI
innocent murmurs must be distinguished from what?
murmurs due to underlying pathology
what 3 acquired heart diseases do we need to know?
- kawasaki
- rheumatic fever
- endocarditis
kawasaki causes (4)
- bacterial
- viral
- environmental
- genetic
what is kawasaki’s effect on the heart/vessels?
inflammation in medium arteries including coronaries
clinical s/s of kawasaki
- fever
- conjunctivitis
- erythema of lips and oral mucosa
- peripheral erythema/edema
- rash and peeling skin
- cervical adenopathy
how is kawasaki dx’d?
- ECHO
* must have 5d of fever and at least 4/5 symptoms
who is most at risk for rheumatic heart disease?
- AAs
- females
- children
- adolescents
RHD is usually proceeded by an ______ infection with what pathogen?
- URI
* Group A beta-hemolytic
what is the most serious consequence of rheumatic fever?
carditis
treatment of RHD
long acting benzathine PCN
- ASA (naproxen)
- corticosteroids for carditis
endocarditis usually occurs in children with a history of ??
*congenital heart disease
endocarditis can occur due to?
invasive instrumentation like central venous catheters
“A&P of endocarditis”
*infection of endocardium from fungus or bacteria