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Flashcards in Cardio Deck (43)
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1

Neonatal Murmurs are common when?

• Common in 1st days of life, don’t necessarily mean problem
• If murmur present at birth, consider a valvular problem
• The common benign transitional murmurs (PDA) aren’t audible until mins=hrs after birth

2

Transitional neonatal murmurs:

o not audible until hrs after birth
o infant pink, not in resp. distress, pulses are palpable and symmetrical
o soft, heard at left upper midsternal border
o loudest during 1st 24 hrs

3

When to evaluate for coarctation of aorta?

o murmur lasts longer than 24hrs,
o legs have difference of 15mmhg blood pressure from UE
o pulses in LE are hard to palpate

4

4 innocent murmurs

Stills
Pulmonic Flow Murmur
Venous Hum
Carotid

5

Stills Murmur

low frequency, systolic, grade less than 3
o Heard best along left sternal boarder
o Normal S2, no click,

6

Pulmonic Flow Murmur

less than or equal to grade 3
o Heard best at upper left sternal border
o Normal S2, no click
o No diastolic murmur

7

Venous Hum Murmur

high frequency, grade 3 or less
o Best heard sitting/standing at base of neck (infraclavicular or supraclavicular )
o Normal S2, systolic and or diastolic
o Stopped by compression of the jugular vein, change in head position, or assumption of supine position

8

Carotid Murmur

grade 3, heard over carotid
o no click, no aortic stenosis, no diastolic murmur, normal S2

9

If the right ventricle is enlarged how would the silhouette on the anteroposterior film?

apex of the heart tipped upward

10

If the left ventricle is enlarged how would the silhouette on the anteroposterior film?

apex of the heart tipped downward

11

If the right atrium is enlarged how would the silhouette on the anteroposterior film?

prominence right atrial border of the heart

12

If the left atrium is enlarged how would the silhouette on the anteroposterior film?

double shadow behind cardiac silhouette increase in subcarinal angle

13

Atrial Septal Defect

fixed, widely split S2, right ventricular heave
• grade 3 systolic ejection murmur at pulmonary area
• large shunts cause diastolic flow murmur at lower left sternal border
• EKG→ rsR’ in V1
• Often asx

14

Ventricular Septal Defect

holosystolic murmur at lower left sternal border w/RV heave
• Presentation & cause depend on size
• Clinical features→ FTT, tachypnea, diaphoresis when eating
• L→R shunt w/normal pulm vascular resistance
• Large defects can cause eisenmenger syndrome

15

Atrioventricular Septal Defect

• Often cant heat in neonates
• Loud S2
• Common w/downs syndrome
• EKG left axis deviation

16

Patent (Persistent) Ductus Arteriosus

• Continuous machinery type murmur
• Bounding peripheral pulses if large ductus
• Presentation & course depend on size of the ductus & pulmonary vascular resistance
• Clinical features→ FTT, tachypnea, diaphoresis w/feeds
• L→R shunt w/normal pulm vascular resistance

17

5 Right sided obstructive lesions

Pulmonary Valve stenosis
Peripheral (Branch) Pulmonary Artery Stenosis
Subvalvular Pulmonary Stenosis:
Supravalvular Pulmnonary Stenosis:
Ebstein Malformation of the Tricuspid Valve

18

Pulmonary Valve stenosis

• No sx when milder/moderate
• Cyanosis & often r sided HF in ductal dependent lesions
• RV lift w/systolic ejection click→ heard at 3rd left intercostal space
• S2 widely split w/soft to inaudible P2, systolic ejection murmur at pulmonary area
• Dilated pulmonary artery on chest radiograph

19

Peripheral (Branch) Pulmonary Artery Stenosis:

• Systolic murmurs
• can be heard over both lung fields anteriorly and posteriorly, radiating to axilla
• Mild no pathologic pulm branch stenosis produces mumur in infancy that resolves by 6mo

20

Ebstein Malformation of the Tricuspid Valve

• “atrialized” portion of the RV is thin-walled, does not contribute to RV output
• Portion of ventricle below displaced tricuspid is smaller in volume & represents the functioning RV

21

3 Left Sided Obstructive leisons

Coarctation of the Aorta
Aortic Stenosis
mitral valve prolapse

22

Coarctation of the Aorta

• Absent diminished femoral pulses
• Upper/lower extremity systolic bp gradient of >20mmHg
• Blowing systolic murmur→ heard in back or left axilla

23

Aortic Stenosis

• Harsh, systolic, ejection murmur @ upper right sternal border w/radiation to neck thrill in carotid arteries
• Systolic click at apex
• CXR→ see dilation of ascending aorta

24

Mitral Valve Prolapse

• Midsystolic click
• Late systolic whooping/honking
• Sx→ chest pain, palps, dizziness

25

3 diseases of the aorta

Bicuspid Aortic Valve
Marfan & Loeys-Dietz Syndromes
Turners syndrome

26

Bicuspid Aortic Valve

• Increased risk of aortic dilation & dissection
• Often get valvular stenosis adhesions and more prone to dissections

27

Marfan & Loeys-Dietz Syndromes

• Cardiac manifestations→ aortic root dilation & MVP
• At risk for aortic dilation & dissection
• Often restricted from contact sports
• B.blockers & ACE used to lower BP and slow rate of aortic dilation

28

Turners Syndrome

• Risk of aortic dissection
• Risk factors: HTN, aortic dilation, bicuspid aortic valve, coarctation of aorta

29

Tetralogy of Fallot:

• Hypoxia spells during infancy
• 25% of pts have a right sided aortic arch seen on CXR
• Systolic ejection murmur heard at upper left sternal border

30

Pulmonary Atresia w/Ventricular Septal Defect

• Sx depend on degree of pulmonary blood flow
• Pulmonary blood flow via PDA and/or aortopulmonary collaterals