Cardiology Flashcards

(248 cards)

1
Q

what is cardiomegaly?

A

Enlarged left heart or right heart

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2
Q

what if pulm circulation is overcirculated?

A

prominence of pulmonary vasculature

“wet appearing” lung ,

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3
Q

Egg on a String - shaped heart..

A

Transposition of the great arteries

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4
Q

Boot shaped heart

A

T of F

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5
Q

what does an echo show?

A

Structures

  • Blood flow
  • Estimates of pressure in chambers
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6
Q

Increased precordial activity –

A

cardiomegay lg right side of heart

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7
Q

Displaced PMI

A

enlarged

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8
Q

RV heave =

A

rv HTN

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9
Q

liver size enlargement

A

enlarged from congestion

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10
Q

extremities what do you look for?

A

perfusion, edema, clubbing

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11
Q

Wk LE pulse

A

CoA

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12
Q

bounding pulse

A

run-off lesions (L→R PDA shunt, AI )

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13
Q

Weak pulses

A

cardiogenic shock or CoA

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14
Q

what is Pulsus paradoxus and what does it indicate

A

exaggerated SBP drop with inspiration → tamponade or bad asthma

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15
Q

what is pulses alterans? indicates?

A

altering pulse strength → LV mechanical dysfunction

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16
Q

what is S1

A

closing of mitral and tricuspid valves, LLSB or apex

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17
Q

what is S2

A

closing of aortic (A2)and pulmonic (P2) valves

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18
Q

what is S3

A

– heard in diastole ,related to rapid ventricular filling , can be normal, or abnormal -accentuated with dilated ventricles

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19
Q

what is S4?

A

Always bad..late in diastole just before S1 – always bad.

Decreased vent compliance / heart failure

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20
Q

Ejection click

A

AS or PS

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21
Q

Mid-systolic click

A

MVP

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22
Q

Loud S2

A

Pulmonary HTN

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23
Q

Single S2

A

= one semilunar valve (truncus), anterior aorta (TGA), pulmonary HTN

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24
Q

Fixed, split S2

A

ASD, PS

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25
Gallop (S3)
may be due to cardiac dysfunction/ volume overload
26
Muffled heart sounds and/or a rub
pericardial effusion ± tamponade
27
innocent heart murmurs?
Heart murmurs which occur in the absence of anatomic or physiologic abnormalities of the heart or circulation
28
heart murmur described based on
Location and radiation Relationship to cardiac cycle and duration Intensity Quality
29
heard first days of life, LLSB , 1-2/6 , gone by 2-3 weeks of life
newborn
30
often in newborn period from branching PA. Heard in axillae and back short, high pitched 1-2/6
Peripheral pulmonary arterial stenosis (PPS
31
most common murmur of early childhood. Heard ages 2-7yrs. Musical, vibratory, mid to lower LSB, 1-3/6. loudest when patient supine.
Still murmur
32
most common innocent murmur in older children, ages 3 yrs and up. ULSB, soft ejection murmur , 1-2/6.
Pulmonary ejection Murmur –
33
heard after age 2, infraclavicular (where blood is coming together from jug and subclav) R>L, Continuous musical hum. Best heard sitting. Comes from turbulence at confluence of subclavian and jugular vein.
Venous Hum
34
older child and adolescent. Rt supraclavicular area, harsh, 2-3/6.
Innominate or carotid Bruit
35
LOC and muscle tone | Usually benign
syncope
36
in kids syncope is d/t
Vasovagal or neurocardiogenic
37
what Usually has prodrome of pallor, lightheadedness | Can be in response to pain, heat, blood, fright
syncope
38
if syncope is d/t cardiac disease...
BAD - arrhythmia or CHD
39
if syncope is d/t circuation what is it?
Hypovolemia, orthostatic hypotension
40
chest pain in child is...
rarely cardiac...;Usually musculoskeletal Pulmonary origin GERD asthma
41
if CP is d/t cardiac?
ischemia, inflammation, arrhythmia
42
what is common. Some conducted, some non-conducted. Slight not-quite compensatory pause before next beat. Benign
PACs
43
what has wide QRS, no compensatory pause, typically benign unless they come several in a row
PVC's
44
very uncommon in young children | Seen occasionally in older children and adolescents...
PVC
45
3 PVC’s in a row means
Vtach , uncommon, unstable, needs cardioverting
46
most common arrhythmia in kids
PAC
47
Supraventricular Tachycardia (SVT) is defined as
280-300 bpm Well tolerated unless underlying heart disease
48
what is Wolff-Parkinson-White Syndrome
Re-entrant tachycardia - Abrupt onset and termination
49
how do you stop SVT?
adenosine
50
how do you manage SVT
B blocker
51
Prolonged QTc syndrome
can but someone in SVT also but not as common as reentrant
52
what is the most common SVT in kids
Re-entrant tachycard
53
what causes congenital heart block
Maternal Lupus
54
what is result of first degree heart block?
prolonged PR
55
what is 2nd degree heart block?
not all P waves are conducted
56
what is type 1 second degree HB?
progressively longer PR interval until a QRS is dropped
57
what is type 2 second degree HB?
same PR interval, occasional QRS droppedThird Degree – complete dissociation of SA with AV
58
what is 3rd degree HB
Av node does not transmit message from SA | from maternal lupus CHB -->moms lupus damages the AV node of baby
59
Children’s heart disease is particularly d/t
congenital heart disease is due to structural abnormalities
60
what is the number one cause of congenital heart disease?
multifactorial>genetic>Maternal infections and diseases and teratogens:
61
what are examples of maternal infections and diseases and teratogens that cause CHD
Examples: fetal alcohol syndrome, Down syndrome, Trisomy 13 and Trisomy 18, Turner syndrome, congenital rubella syndrome, Maternal Lupus
62
Coxsackie B in mom causes
Myocarditis
63
parvo in mom causes
Myocarditis
64
rubella in mom causes
PDA, PS, AS, TOF
65
Lithium in mom causes
ebsteins
66
ibuprofen antinatally
PHTN
67
ETOH antenatally
VSD, ASD, TOF, CoA
68
phenytoin
ASD, VSD, CoA, PDA, PS, TOF
69
Retinoic Acid
TGA, TOF, DORV, TA, AA probs, HLHS
70
Lupus in mom
Congenital Heart Block
71
diab in mom
TGA, VSD, ventricular hypertrophy
72
5%, most common CHD presenting in the first week of life
Transposition of Great Arteries
73
1%, second most common presenting in the first week of life
Hypoplastic Left Heart Syndrome
74
10%, most common CHD presenting beyond infancy
TOF
75
For the fetus the ____ is the oxygenator so the lungs do little work
placenta
76
in fetus _____ contribute equally to the systemic circulation and pump against similar resistance
RV and LV
77
what are the shunts in the fetus needed for survival? 3
``` ductus venosus (bypasses liver) foramen ovale (R→L atrial level shunt) ductus arteriosus (R→L arterial level shunt) ```
78
what is ductus venosus
by passes liver
79
what is foramen ovale
R-->L atria
80
ductus arteriosis
R-->L arteral shunt
81
what happens to the fetal heart at birth? 3 things.. what constricts ductus arteriosis, and closes foramen ovale?
1. Mechanical expansion of lungs and increased arterial PO2 decreases pulmonary vascular restrictive 2. Over several days the increased PaO2 constricts the ductus arteriosis 3. The increased plmonary blood flow returning to left atrium increases pressure in LA leading to closure of PFO.
82
Cyanotic CHD?
= R --> L shunt ( blood bypasses lungs)
83
Acyanotic CHD
L --> R shunt
84
what are obstructions in CHD?
Coarctation, stenosis
85
what are mixing/ reversal of flow CHD?
Septal defects, patent fetal paths
86
what are parallel circuit of CHD?
Transposition of the Great Vessels
87
If acyanotic?
Left to Right shunt or Obstruction to outflow ex. of l--> shuntopening in the VSD -->blood will flow from l to r during systole
88
if cyanotic...
Right to Left shunt or | Parallel circuit
89
if increase pulmonary flow
Left to Right shunt – blood flows to chamber with lower
90
if decreased pulmonary flow
right to left shunt ie pulm valve is stenotic
91
symptoms of decrease pulm flow in infant..
Cyanosis Squatting Loss of Consciousness
92
symptoms of decrease pulm flow in older child
Dizziness | syncope
93
symptoms of increased pulm flow in infant
Tachypnea with activity/feeds Diaphoresis Poor weight gain
94
symptoms of increased pulm flow in older child?
Exercise intolerance | Dyspnea on exertion/diaphoresis
95
acyanotc CHDs 6 types
``` Atrial septal defects (ASD)10% Ventricular septal defects (VSD) 25% Patent ductus arteriosus (PDA) 5-10% Obstruction to blood flow Pulmonic stenosis (PS)10% Aortic stenosis (AS) 5% Aortic coarctation 10% ```
96
how does ASD present
childhood w/ murmur or exercise intolerance
97
what is going on in ASD?
Flow is from L > R - RA and RV volume overload (enlargement) - Increased pulmonary blood flow
98
ASD is not a problem when?
at birth --> problem shows up later
99
Clincal findings of SD - growth, symptoms, heart sounds, murmur?
-Most children are asymptomatic -May be undergrown -Easy fatigueability in older children /adults -Acyanotic, RV lift, normal pulses -Persistently split second heart sound (S2) Pulmonary ejection murmur Diastolic flow murmur over tricuspid valve
100
what finding is consistent with split S2?
ASD
101
how do you treat ASDs?
ASDs may be closed either by device placement during catheterization or surgically
102
ADSs after ___y/o will not close alone
2
103
what is VSD
opening in the ventrical
104
what happens in the VSD?
-L -->R shunt because of low pulmonary vascular resistance -Increased pulmonary blood flow - Increased pressure -Pulmonary venous congestion Left sided overload (enlargement) and hypertrophy – back up of flow. -Pulmonary hypertension - Primarily right sided problem
105
What are VSD symotoms and at inc risk for what?
``` Congestive heart failure Poor growth Shortness of breath/Increased respiratory effort Easy fatigue Recurrent respiratory infections ```
106
what are clinical findings of VSD? growth, resp, precordial, murmors?
``` Growth and development may be delayed Respiratory effort and heart rate may be increased if heart failure Precordial activity may be “bounding” Holosystolic murmur –holosystolic, harsh LLSB, +/- thrill Systemic and pulmonary venous congestion ```
107
how do you treat VSD
``` 30% will close spontaneously Observation Anti-congestive heart failure medications diuretics Fortified diet Surgery (open heart defect) ```
108
``` Endocardial cushion defect AV valve insufficiency Heart Failure over 6-8 weeks Poor growth Trisomy 21... what is this? ```
AVSD
109
what is the treatment of AVSD
surgery
110
what is a PDA treatment
indocin/ibuprofen….. surgery
111
what if a pt has symp of T21 what is the murmur d/t
AVSD
112
what do you give to keep PDA like in coarc?
PG
113
what does persistent PDA cause?
increase pulmonary flow; pulmonary overload
114
murmur of PDA
Soft murmur LLSB 1-3/6
115
pulmonic stenosis
cant get blood out into Pulm art very well so back up to r side of heart
116
aortic stenosis is primarily
bicuspid valve
117
what is: Obstruction of LV output LV hypertrophy Low cardiac output LV failure
aortic stenosis
118
what is first sign of AS
Heart murmur is usually the first sign Ejection click Basilar ejection murmur Precordial or suprasternal thrill
119
what may AS cause if severe
low cardiac output or congestive heart failure | Neonatal heart failure
120
older child with AS presents with...
chest pain, dizziness, syncope (especially with exertion)
121
how do you treat mild A stenosis?
may not req tx
122
how do you treat AS
All treatment is palliative Balloon valve angioplasty Surgery , valve replacement Life style alterations
123
what is the physiology of CoA?
Narrowing near where the ductus enters the aorta
124
what other defect is CoA associated with
bicuspid aortic valve
125
Pt with CoA has what?
Poor perfusion, left ventricular failure
126
when does CoA present
mostly in infants
127
what is CoA thought to be from?
Not closing of PDA
128
neonates CoA present with
severe congestive cardiac failure and cardiovascular collapse
129
Older kids with CoA present with
hypertension, absent or weak femoral pulses, leg cramps, chronic pulmonary congestion, headaches, epistaxis
130
CoA murmur?
blowing systolic in left axilla
131
Lower body is cooler(less pulses) than upper body
CoA
132
what has a blowing systolic murmur in left axilla
CoA
133
treatment of CoA
surgery
134
Cyanotic CHD - 8
``` Tetralogy of Fallot (TOF) Tricuspid atresia (TA) Total anomalous pulmonary venous return (TAPVR) Truncus arteriosus Transposition of the great vessels 5 T’s Hypoplastic left heart syndrome (HLH) Pulmonary atresia (PA) / critical PS Double outlet right ventricle (DORV) ```
135
what is truncus arterioisis? shunt and PBF?
R-->L shunt increase PBF
136
how does truncus art present?
Presents more often with heart failure (except TGA) | Pulmonary congestion worsens as neonatal PVR lowers
137
what is the shunt of TOF? PBF?
R--> L decreased
138
how does TOF present? xray?
Presents more often with cyanosis | See oligemic lung fields (black --> more blood)
139
what makes TOF worse?
PDA closure
140
what are the 4 things of TOF
Ventricular septal defect Pulmonic valve stenosis Right ventricular hypertrophy Overriding aortic valve
141
what are the typical features of TOF?
Cyanosis after the neonatal period Hypoxemic spells during infancy Right-sided aortic arch in 25% of all patients Systlic ejection murmur at the upper LSB
142
what is the murmor of TOF
Systlic ejection murmur at the upper LSB
143
what is a hallmark of TOF
tet spells
144
what is a tet spell? 4 things
Sudden onset or deepening of cyanosis Sudden onset of dyspnea Alterations of consciousness Decrease in intensity of systolic murmur
145
what happens to blood in TOF?
Limitation of pulmonary blood flow.. Right to left shunting
146
how does a child present with TOF? color, murmur, symptoms, other
``` Cyanosis Loud murmur (LUSB) Irritability, poor feeding, poor growth Hypercyanotic ‘spells’ Squatting ```
147
how do you treat TOF?
Treatment is dependent upon age, anatomy and degree of cyanosis: PGE1 (prostaglandin ) (Emergency) systemic to pulmonary shunt Complete repair
148
what is Transposition of the Great Arteries
2 trunks but they are on the wrong sides...
149
how does TGA present? color, murmur, labs?
Varying degrees of cyanosis Typically no murmur Tachypnea Normal ECG for age
150
how do you treat TGA?
``` Balloon septostomy Create ASD Prostaglandin infusion Ductal dependent Surgical Correction ```
151
Infants WITH TGA whose ____ has closed and who have a small ___ will be intensely cyanotic
PDA, ASD
152
what causes obstruction to blood flowing out to lungs?
pulmonary stenosis
153
what causes obstruction to blood flowing out to body?
Aortic stenosis
154
what is a ductal dependent obstructive lesion?
requires open PDA to get blood beyond the obstruction
155
what are 3 ductal dependent obstructive lesions?
Critical PS/AS Critical CoA/IAA HLHS
156
how do you ductal dependent obstructive lesions present? and what is the treatment? at what age?
in CV shock at 2-3 days of age when PDA closes +/- cyanosis Needs PGE1
157
what are 3 non-ductal dependent obstructive lesions?
Mild-moderate AS Mild-moderate CoA Mild-moderate PS
158
how does non-ductal dependent obstructive lesions present? in what age?
Presents in older child w/ murmur, exercise intolerance, or HTN (in CoA) Not cyanotic
159
what is hypoplastic left heart? what if you dont treat? how do you treat?
``` mitral atresia Aortic atresia Both. Death at 5-7 days untreated PGE ```
160
how does hypoplastic l heart present?
Shock and acidosis
161
hw does nonductal dependent present?
Presents in older child w/ murmur, exercise intolerance, or HTN (in CoA) Not cyanotic
162
in infants with HF how do they present?
dyspnea, fatigue, poor feeding, FTT, tachycardia, gallop rhythm, hepatomegaly
163
heart sound associated with HF is
S4
164
in older children with HF how do you present?
exercise intolerance, somnolence, anorexia, (cough, wheeze, crackles in late failure)
165
what is cough wheeze and rales?
long standing HF with fluid in lungs
166
what is the best study for HF?
ECHO
167
ECHO measures?
heart size, function, structure
168
an infant with hepatomegaly and murmur what do you think?
long standing HF
169
what is the most common cardiomyopathy in kids?
dilated
170
what is dilated cardimyopathy?
Increased ventricle size with decreased contractility | (no evidence of coronary,valvular or pericardial disease
171
what other heart things are associated with dilated cardiomyopathy
Mitral insufficiency, ventricular ectopy, tachyarrhythmias
172
how do ppl present with dilated cardiomyopathy?
SOB, exercise intolerance, Fatigue
173
how do we treat dilated cardiomyopathy?
ACEI, B-blockers, Digoxin
174
dilated cardiomyopathy s/s?
inadequate CO and HF Tachycard and pnea Narrow pulse pressure Rales may be audible
175
what is dilated cardiomyopathy caused by?
Often idiopathic infection - echovirus and coxsackie B Familial or 2ndary to systemic disease (lupus) or drugs
176
Cardiomyopathy on xrays show...
cardiomegaly
177
EKG of cardiomyopathies show
always abn but nonspecific: | Abd St-T wave seg, LV hypertrophy
178
Treatment for cardiomyopathies
diuretics, inotropic meds, afterload meds
179
what are 4 acquired heart diseases?
Myocarditis – Viral Endocarditis , Pericarditis Rheumatic Heart Disease Kawasaki Disease
180
what is pericarditis caused by?
Most often viral | If bacterial: Staph A, Strep Pneumo
181
what are symptoms of pericarditis?
related to pericardial effusion
182
what is the best test for pericarditis?
ECHO best test
183
what does pericarditis show on CXR
cardiomegaly
184
how do you treat pericarditis
anti-inflammatories
185
how is at high risk for infective endocarditis?
with CHD not with simple ASD
186
what is infective endocarditis?
Vegetations on valves | Create clots
187
how does endocarditis present?
Fever , Anemia, Pallor, Splinter hemorrhages in nailbeds, clubbing, retinal infarcts
188
what is the number one cause of infective endocarditis? 2nd?
``` Strep Viridans (30-40%), Staph Aureus (25-30%) Need GOOD dental hygiene for prevention ```
189
how do you treat infective endocard?
high dose PCN and aminoglyc
190
what are tests for infective endocarditis?
: blood cluture ESR and CRP | CBC – leukocytosis, anemia
191
what are complications of infective endocarditis?
heart damage and clots
192
what is the most common cause of acquired HD?
kawasaki
193
what organs does RF affect?
heart, jts, brain, skin, subq nodules
194
how does RF affect heart?
Heart muscle & valves – myocarditis & endocarditis (pericarditis rare w/o the others)
195
how does RF affect joints
polyarth
196
how does RF affect brain?
Sydenham’s Chorea (“milkmaid’s grip” or better yet, “motor impersistance”)
197
how does RF affect skin?
erythema marginatum (serpiginous border) due to vasculitis
198
how does RF affect nodules?
non-tender, mobile and on extensor surfaces
199
what are pk ages of RF?
5-15
200
what is onset of RF
1 – 3 weeks following group A beta-hemolytic strep throat / pharynx infection
201
what is the patho of RF?
Abnormal immune response of B lymphocytes leading to antibodies/ complexes that cross-react with antigens on cardiac muscle -> inflammation of myocardium and valves, and other tissue Also affects connective tissue and perivascular tissue Arthritis , skin (subcutaneous nodules or erythema marginatum), CNS (chorea)
202
what question should you ask for RF
recent strep infection?
203
what are PE findings with RF?
Symptoms such as rashes, arthritis, | Heart rhythms or murmurs (pericardial rub)
204
what are labs to run for RF?
ESR and CRP (non specific) often elevated Antistreptococcal antibody titer –difficult to obtain and interpret Throat culture ECG if signs of heart failure (call cardiology)
205
kid has gangrene on 3rd toe... what might it be?
Lesions from emboli | From endocarditis.. RF
206
what are 5 major jones criteria?
Migratory polyarthrits and carditis | chorea, erythma marginatum and subq nodules
207
what is the most common finding of RF?
migratory polyarthritis
208
what is Pink, slightly raised, non-pruritic rings on trunk and inner surfaces of extremities
erythema marginatum
209
what are minor findings for RF 4
Arthralgia (Cannot consider if patient also has arthritis) Fever Elevated acute phase reactants (ESR, CRP) Prolonged P-R interval
210
how do you treat RF - 6
Benzathine penicillin G 0.6-1.2 million units IM x 1 Continuous antistreptococcal prophylaxis Bacterial endocarditis prophylaxis Aspirin for symptoms of pain and fever (2-4wks) Corticosteroids for severe carditis and cardiac Rx for congestive heart failure Prophylaxis- Pen V BID PO or Pen G IM q 4weeks until low risk.
211
what is a systemic vasculitis?
kawasaki disease
212
how do you tx kawasaki disease?
CBC, CMP, CRP, ESR, EKG, ECHO
213
how do you treat kawasaki disease?
IVIG - decreases coronary art dilation
214
what is mucocutaneous lymphnode syndrome?
kawasaki disease
215
what are the 3 phases of kawasaki disease? symptoms of all
Acute – Fever, mucocutaneous symptoms (up to 2 wks) Subacute – Thrombocytosis, coronary artery changes (wk 2-4) Chronic – Slow resolution (2 months)
216
how do you treat kawasaki?
IVIG and high dose aspirin
217
what is the criteria of dx KD?
Must have fever PLUS 4 of the 5 other symptoms OR coronary aneurysms
218
what are the 6 symptoms of KD? describe them..
Fever – minimum 5 days Conjunctivitis – injection without exudate, painless Rash – polymorphous, usually urticarial, may be scarlatiniform Changes in hands and feet – erythema and swelling, followed by desquamation Mucous membrane involvement – swollen lips, pharyngitis, “strawberry tongue” Cervical adenopathy – Often unilateral
219
what heart defect is associated with down syndrome
AVSD
220
what heart defect is associated with Turner syndrome?
CoA, bicuspid aortic valve
221
what heart defect is associated with Marfan syndrome
MVP, dilated aortic root, MR
222
what heart defect is associated with FAS?
VSD, PPS
223
what heart defect is associated with maternal rubella?
PDA, PPS
224
what heart defect is associated with T18?
VSD, AVSD, AS
225
what heart defect is associated with T13?
TOF ASD VSD
226
what heart defect is associated with VACTERL
VSD, TOF
227
what cyanotic HD have increased PBF? 4
Truncus arteriosus Total anomalous pulm. venous return (TAPVR) Transposition of the great arteries (TGA) Tricuspid Atresia with large VSD
228
what cyanotic HD have decreased PBF? 4
Pulmonary Stenosis / Atresia Tetralogy of Fallot Tricuspid atresia HLHS
229
what is heard in first days of life at the LLSB 1-2/6 and gone by the first 2-3 wks of life?
newborn murmur - common functional murmur
230
what is often in newborn period from a branching pulmonary artery. Heard in the axillae and back, short high pitched 1-2/6
peripheral pulmonary artery stenosis
231
what is the most common murmur of early childhood?
still murmur
232
what is heard in ages 2-7, described as musical vibratory mid-lower LSB 1-3/6 and loudest when the pt is supine?
still murmur
233
what are 4 signs of concerning murmurs as far as hx?
easy fatiguability, claudication, worse on exertion, FTT
234
what are the 6 most common fxnl murmurs
newborn murmur, peripheral pulmonary artery stenosis, still murmur, pulmonary ejection murmur, venous hum, innominate or carotid bruit.
235
what is most common innocent murmur in older children ages 3 and up?
pulmonary ejection murmur
236
what is heard at the ULSB soft ejection murumr 1-2/6?
pulm ejection murmur
237
what is heard after age 2, infraclavicular R>L, Continuous musical hum. Best heard sitting. Comes from turbulence at confluence of subclavian and jugular vein.
venous hum
238
what is heard in older child and adolescent. Rt supraclavicular area, harsh, 2-3/6.
innomate or carotid bruit
239
what are signs of concerning murmur on PE?
-Unequal pulses/pressures -Hyperactive precordium, displaced Point of Maximum Impulse (PMI) -Murmur itself Holosystolic or continuous Grade IV or higher Other
240
what has s&s of inadequate output and HF, tachycardia and tachypnea, a narrow pulse pressure, and may have audible rales?
dilated cardiomyopathy
241
what are causes of dilated cardiomyopathy?
idiopathic or infection (echovirus or coxackie B) or could be familial or secondary to systemic disease (lupus) or meds
242
what is the most common cardiomyopathy?
dilated
243
what has increase in ventricle size with decreased contractility?
dilated cardiomyopathy
244
what cardiomyopathy has an assoc prolonged QT interval
hypertrophic
245
what does the xray show on cardiomyopathies
cardiomegaly
246
what may be the initial presentation of cardiomyopathy in older children
sudden death
247
what cardiomyopathy has LV hypertrophy?
hypertrophic
248
what is the treatmenf of all cardiomyopathies?
Diuretics, inotropic medications, afterload reducers