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mod 1 test > CV Evaluation of the Pediatric Patient > Flashcards

CV Evaluation of the Pediatric Patient Flashcards

1
Q

Acyanotic lesions?

A

Increased volume/ left to right shunts

Increased pressure/ obstructive lsions

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2
Q

Increased volume/left to right shunts?

A

Severe lesions can present early with signs and symptoms of heart failure
milder lesions
left untreated can progress to Eisenmenger Syndrome

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3
Q

Increased pressure/Obstructive Lesions?

A

Typically identified by classic exam findings

Left untreated severe lesions can progress to heart failure

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4
Q

Maternal health concerns?

A 
Diabetic
Maternal SLE
Maternal CHD
Rubella
CMV, HSV, Coxsackie B, Parvovirus
HIV
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5
Q

Teratogens?

A 
Fetal alcohol
Lithium
Phenytoin
Retinoic acid
Warfarin
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6
Q

Fetal alcohol cause?

A

VSD, ASD, TOF, PDA

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7
Q

Lithium can cause?

A

Severe right heart abnormalities (Ebstein anomaly)

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8
Q

Phenyoin can cause?

A

PS, AS, coarc, PDA

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9
Q

Warfarin can cause?

A

PDA, ASD

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10
Q

Characteristic features of fetal alcohol syndrome?

A

FAS Facial characteristics

  • small eye openings
  • smooth philtrum
  • thin upper lip
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11
Q

Postnatal history, growth and development?

A

poor weight gain and delayed development are often seen with heart failure (HF)

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12
Q

Feeding patterns? Postnatal history

A

poor feeding can be an early sign of HF
fatigue, diaphoresis, or cyanosis during feeds
Unable to stay awake for the full feeding

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13
Q

Cyanosis? Postnatal history

A

Onset, severity, frequency, affected areas (lips, toes, fingers)

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14
Q

Respiratory distress? Postnatal history

A

tachnypnea, dyspnea, retractions, etc

**squatting during distress suggests TOF

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15
Q

Tet spells?

A

cyanotic spell in infants or young children with uncorrected TOF
caused by any even that decreases SVR and produces a large R to L ventricular shunt leading to decrease in pulmonary blood flow which is already compromised

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16
Q

Characterize a tet spell?

A 
rapid and deep respiration
worsening cyanosis
disappearance of murmur
restlessness
gasping respiration
possible syncope
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17
Q

Sometimes relieve a tet spell?

A

infant in knee-chest position which traps venous blood in legs to decrease venous return and calm child

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18
Q

treatment for tet spell?

A

oxygen and morphine

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19
Q

History, Exercise intolerance/fatigue?

A

infants- feeding patterns
preschool/school-keep up with other children
older- how many blocks can he run? how many flights before fatigue?

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20
Q

History, edema puffy eyelids or sacral edema?

A

signs of CHF, venous congestion, frequency of lower respiratory infections

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21
Q

Heart murmur history?

A

timing and circumstances discovered

what was done about it?

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22
Q

History syncope?

A

with exercise? arrhythmia (long QT)/ obstuctive lesion
while sitting? seizure, arrhythmia
prolonged standing? Vasovagal
with exertion and CP? possible cardiac etiology

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23
Q

History of palpitations?

A

SVT, hyperthyroidism, premature beats, MVP

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24
Q

Family history congenital heart disease?

A

Risk of CHD in 2nd pregnancy after previous child is 2-6%

Risk is up to 20-30% when having CHD in 2 first degree family members

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25
Q

Family history Hereditary diseases?

A

some associated with CV disease (marfans, aortic aneurysm)

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26
Q

Family history rheumatic fever?

A

often occurs in multiple family members, no known genetic factor but thought to be inherited susceptibilty

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27
Q

Vital signs?

A

heart rate
-poor heart function leads to tachy to maintain CO
respiratory rate
-tachypnea, hyperventilation to improve oxygenation
pulse ox
-hypoxemia
height/weight
-growth and development are key markers of cardiac health in children

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28
Q

Palpation of peripheral pulses?

A

R/L upper compared with lower

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29
Q

Strong upper/ weak lower pulses?

A

coarctation of aorta

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30
Q

Bounding pulses, wide pulse pressure?

A

PDA, AI, increased CO

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31
Q

Weak pulse?

A

HF, pericardial tamponade, decreased CO

32
Q

Diaphoriesis?

A

cold sweat, can be seen in children with HF

33
Q

Clubbing?

A

indicates chronic low arterial saturation

loss of nail bed angle and distal hypertrophy of the digit

34
Q

Eisenmenger Syndrome?

A

Shunt becomes R to L due to pulmonary hypertension
initially L to R shunt
occurs long term in lesions with increased volume of blood on right side resulting in medial hypertrophy and/or intimal hyperplasia in the pulmonary vasculature

35
Q

Symptoms Eisenmenger Syndrome?

A

2nd/3rd decade

cyanosis, dyspnea, fatigue, arrhythmias

36
Q

Apical impulse?

A

PMI normally located at the 4th left intercostal space medial to the midclavicular line under age 7 yrs

37
Q

Apical heave?

A

suggests LV hypertrophy

38
Q

Substernal thrust?

A

suggests RV hypertrophy

39
Q

hyperactive precordium?

A

suggests volume overload, but can be normal in very thin individuals

40
Q

Silent precordium?

A

suggests severe cardiomyopathy or pericardial effusion

41
Q

Thrills?

A

palpable equivalent of murmurs
correlate with area where the murmur is heard the loudest on auscultation
always pathological
best felt with palm of hand, finger over neck
thrills over the suprasternal notch suggest LV outflow tract stenosis

42
Q

S1?

A

closing of AV valves
heard best at apex, lower left sternal border
slight splitting can be normal but not common

43
Q

S2?

A

closing of aortic and pulmonary valves
heard best at the upper left sternal border
splitting is normal, increases in inspiration, and decreases in expiration
fixed splitting suggests a cardiac defect
Splitting can be hard to hear in neonates due to rapid heart rates, so obvious splitting should raise concern

44
Q

S3?

A

heard in early mid diastole during initial phase of rapid passive ventricular filling
low frequency, it is heard best at the apex with the bell
can be heard in healthy kids/athletes at apex but loud s3 is abnormal
may be heard as gallop rhythm in patients with heart failure and tachycardia

45
Q

S4?

A

heard in late diastole and usually pathologic

associated decreased ventricular compliance

46
Q

Ejection clicks?

A

heard in early systole, may be confused with split s1
best heard at mid to upper sternal borders
associated with AS, PS, or conditions that cause aortic/ PA dilation
a midsystolic click heard best at the lower sternal border suggest MVP

47
Q

Heart murmurs?

A 
I: barely audible
II: soft, but easily audible
III: moderately loud, but no thrill
IV: louder, with thrill
V: audible with stethescope barely on chest
VI: audible with stethescope off chest
48
Q

Murmurs, Benign?

A

innocent, functional
common in children
all are accentuated during high output state, usually during febrile illness
all are associated with normal EKG and CXR findings

49
Q

Classic vibratory murmur/ Still’s murmur?

A

Most common
typically detected btw 3 and 6 yo, may be present in newborn
midysytolic ejection murmur
Low-pitch, best heard with bell of stethescope, patient supine
grade 1-3/6, typically heard best LLSB
Vibratory, twaning string, musical

Intensity with fever, anemia, after exercise, during excitment

50
Q

Pulmonary flow of murmur of newborns? (PPS)

A

premature and full term newborns, usually disappears by 3-6 months
midsystolic
grade1-3/6
maximal at upper left sternal border
Transits well to L and R chest, axillae, and back
Caused by turbulent flow through pulmonary arteries when ductus closes that are relatively hypoplastic b/c they didnt recieve much blood flow during fetal life

51
Q

Pulmonary ejection murmur of childhood?

A

8-14 yo, early to midsystolic
grade 2-3/6, blowing quality
heard best at the upper left sternal border
represents exaggeration of normal ejection vibrations in pulmonary trunk

52
Q

Venous hum?

A

typically noted at 3-6 months
heard only in upright position and disappears in supine position
Continous murmur
medium pitch, grade 1-3/6
best heard at L or R supra/infraclavicular areas
can be obliterated by rotating head
from turbulens in jugular venous system

53
Q

Carotid bruit?

A 
any age, early systolic murmur
grade 2-3/6 
R supraclavicular area over carotids
Occasional thrill noted over carotis
from turbulence in crachicephalic or carotid arteries
54
Q

Features that suggest a pathologic murmur?

A 
diastolic murmur
loud systolic murmur (3/6 >)
associated with a thrill
long in duration
transmit well 
associated with any other abnormal heart sounds
associated with strong/ weak pulses
other associated CV symptoms, general exam findings, or abnormal CXR/ ECG
55
Q

ASD exam findings?

A 
palpation
- RV displaced PMI
heart sounds
-fixed, widely split S2, SEM at ULSB
other
-possible RVH on EKG/CXR
56
Q

VSD exam findings?

A 
Palpation
-LV displaced PMI, Thrill at LLSB
Heart sounds
-possible wide split at s2, harsh or blowing holosys murmur at LLSB
other
- possible LVH on EKG/CXR
57
Q

AV canal exam findings?

A 
Palpation
-hyperactive precordium
Heart Sounds
-Loud S1, Holosys murmur at LLSB, Diastolic rumble
Other
-Cardiomegaly, HF
58
Q

PDA exam findings?

A 
Palpation
-Hyperactive precordium
Heart Sounds
-continuous machinery like murmur at LLSB
Other
-bounding pulses
59
Q

PS exam findings?

A 
Palpation
-RV displaced PMI
Heart sounds
-Ejection click, SEM at ULSB
Other
-Possible RVH on EKG/ CXR
60
Q

AS exam findings?

A 
Palpation
-LV displaced PMI
Heart sounds
-Ejection click, SEM at URSB, mid LSB
other
-Possible LVH on EKG/CXR
61
Q

ABG on room air tells you?

A

can confirm or refute central cyanosis

elevated PCO2 could mean CNS or pulmonary problem

62
Q

Pre and postductal ABG/saturation tells you?

A

Arterial PO2 from right upper extremity that is 10 to 15 mmHg higher than umbilical artery or lower extremity site is significant and suggests a R to L ductal shunt

63
Q

Hyperoxia test?

A

way to diagnose right to left shunt

take an ABG on room air, place the infant on 100% oxygen for at least 10 min, recheck ABG

64
Q

Hyperoxia test if PaO2 rises above 150 mmHg?

A

intracardiac shunts are likely
suggest pulmonary disease or other cause of hypoxemia
saturation increases of 15% or greater also suggestive of other causes

65
Q

Hyperoxemia test if PaO2 remains < 150 mmHg?

A

suggest R-L shunt (cyanotic congential heart disease)

66
Q

Chest xray?

A

evaluate cardiac size and shape as well as position of apex
asses pulmonary vascular markings
evaluate associated pulmonary and thoracic abnormalities

67
Q

Trasposition of the great arteries on CXR?

A

Egg shaped or egg on a string appearance

68
Q

Tatrology of fallow on CXR?

A

boot shaped heart

69
Q

Total Anomalous Pulmonary venous return (TAPVR)?

A

Snowman sign

70
Q

Echocardiography?

A

shows cardiac structure and function as (wall thickness, ejection fraction, cardiac output, blood flow, presecence of clots, pericardial fluid)

useful for assessment of suspected heart disease, endocarditis, concerning heart murmurs

usually transthroacic (TTE), but transesophagel (TEE) if suboptimal TTE

71
Q

Signs of PDA?

A 
classic heart murmur
bounding peripheral pulses
hyperactive precoridum 
hypotension
respiratory deterioration
72
Q

Close a pathologic PDA?

A

Nsaids

surgery/ transcatheter approach

73
Q

2 drugs used to close PDA?

A

Indomethacin

Ibuprofen

74
Q

Indomethacin?

A

prostaglandin synthase inhibitor
renal side effects: decreased UOP and GFR
decreased mesenteric blood flow

75
Q

Ibuprofen?

A

effective as indomethacin
fewer renal side effect
does not decrease renal or mesenteric blood flow

mod 1 test (5 decks)

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