Cardiac cases Flashcards
4 yr old girl accompanied by mother. Examined her on her mum’s knees.
General inspection:
Small and short for her age (89.5cm, 12 kg). Wide nasal root otherwise no other obvious dysmorphic features.
Not on oxygen and not in respiratory distress.
Swollen hands with finger clubbing and pheripheral cyanosis. Previous venepuncture scars on bilateral dorsum of her hands. Pulse - 100 bpm regular. No RR delay.
Inside of eye lids - polycythaemic. ? Central cyanosis
Inspection of precordium:
Chest - Pectus Carinatum, Mid sternotomy scar + pericardial drains and central line access scars.
Palpation:
Apex 6th ICS, MCL, Heave +. No Thrills
Auscultation:
HS - S1 + Single S2 (loud). Grade 3/6 Continuous murmur LUSB radiating to the back.
No hepatomegaly.
A girl with Complex Cyanotic Heart disease who underwent Major intracardiac operation currently with palliative shunt (Modified Blalock Tussig shunt) in situ.
PMH - PAVSD + MAPCAs (Major Aortopulmonary Collateral Arteries)
N.B. In individuals with aortopulmonary collaterals, continuous murmurs may be auscultated.
3 yr old girl. Normal growth and development. Pink on air and not in respiratory distress.
No finger clubbing. No Central / Peripheral Cyanosis
Inspection of precordium:
No chest deformity. No scars.
Palpation:
Apex undisplaced. No heaves or thrills.
Auscultation:
HS I + II
Soft systolic murmur grade 2/6 localized at LLSB.
Innocent murmur
8s of innocent murmur
Soft Sytolic short Sounds HS I and II normal Symptomless Sitting and Standing variation Special tests (ECG and X-ray) - normal Sternal depression
3yr old boy. Normal growth and development. Pink on air and not in respiratory distress.
No finger clubbing. No Central / Peripheral Cyanosis
Inspection of precordium:
No chest deformity. No scars.
Palpation:
Apex undisplaced. No heaves or thrills.
Auscultation:
HS I + II
Harsh ejection systolic murmur heard all over precordium grade 3/6 loudest at ULSB. No ejection click can be heard. No radiation to the back.
No Hepatomegaly
Pulmonary stenosis
Whats the significance of Ejection click?
If heard - it means the stenosis is at the valvular level.
3 mth old boy preterm 34 weeks. Growth appropriate for age. Pink on air. No clubbing.
Palpation - thrill LUSB
Auscultation- long, loud, systolic murmur LUSB
A patient without cyanosis has a long, loud, systolic murmur with a thrill along the right ventricular outflow tract (RVOT).
Other conditions to consider when evaluating a patient with suspected Tetralogy of Fallot with pulmonary stenosis include acute anemia, asthma and reactive airway disease, bacteremia and sepsis, cardiogenic shock, Ebstein malformation of the tricuspid valve, pseudotruncus arteriosus, pulmonary atresia, septic shock, and ventricular septal defect (VSD).
Definition of Apex beat
The most lateral and inferior point where from the sternum where the strongest cardiac impulse can be felt
Location of Apex beat in children
From 1 to 3 years- 4 ICS, then moves to 5th thereafter
If suspected Dextrocardia - what to do
Feel the trachea for any mediastinal shift. Look for Situs Inversus.
18mths boy. Fast asleep. Comfy. Pink on air. No dysmorphism. No clubbing. Pulse 80 reg No pallor / Jaundice. Precordium: No scars / deformity Apex undisplaced HS I + II with ejection systolic murmur heard all over precordium, loudest LLSB grade 3/6. No Liver
Dx PS
Ddx ASD- unlikely coz no fixed splitting of 2nd HS
Examine the chest of this 4yr old boy:
Alert, comfy at rest Some sputum sound coughs no dysmorphism No clubbing HR 80 reg pink
Chest: Multiple small old needle/ Iv line scars on chest n abdo RR 32 Apex on RR 5th ICS MCL Heart sounds normal
Abdo - percussion dullness LT side. No organomegaly
Dx Kartageners
