Exam 1 Cardiac Flashcards
Functional closure of PDA at:
48-72 hours after birth
Complete anatomical closure of PDA at:
2-3 weeks
Medical closure of PDA with what drug?
Prostaglandin inhibitor, like indomethacin
What 2 conditions can be detected by blood pressure measurements in children?
#Coarctation of the aorta #Systemic hypertension
How long does it take for fingernail clubbing to begin?
At least 6 months of arterial O2 desaturation
What peripheral pulse finding is present with coarctation of the aorta?
Pulse is absent or weaker in lower extremities in comparison with upper ones
Hepatomegaly, when noted in conjunction with other heart findings, is a strong indicator of what condition?
Right heart failure
Heave
PMI is diffuse, rises slowly
Tap
PMI is well localized & sharp
What percentage of kids have an innocent murmur?
50%
Innocent murmurs: Still’s
#Between LLSB & apex #Grade 1-3 systolic ejection #Most commonly 2-7 yrs old #Disappears with Valsalva
Innocent murmurs: peripheral pulmonic
#LUSB with radiation to back & axillae #Grade 1-2 systolic ejection #Premature or low birth weight infants. Document resolution by 4-5 months vs organic cause or valve involvement
Innocent murmurs: pulmonary ejection
#Localized to LUSB #Grade 1-2 systolic ejection #Disappears with valsalva #8-14 yrs old, mostly adolescents
Innocent murmurs: venous hum
#Inferior to clavicles @ RUSB, LUSB #Grade 1-3 continuous #Obliterated by light jugular venous compression #3-6 yrs old
Innocent murmurs: supraclavicular carotid bruit
#Superior to clavicles, radiation to neck #Grade 1-3 holosystolic #Diminishes with shoulder hyperextension #Common @ any age
Criteria for positive pulse ox screening
#Any O2 sat < 90% #Any O2 sat < 95% in both extremities on 3 measures taken 1 hour apart #Any 3% absolute difference between readings in upper & lower extremity on 3 measure taken 1 hour apart
What CXR finding indicates cardiomegaly?
A cardiothoraic (CT) ratio greater than 0.65
Usefulness of ECG in pediatric cardiology
To confirm rather than diagnose a structural heart defect, or to diagnose an arrhythmia
Usefulness of echocardiogram in pediatric cardiology
Basically the diagnostic tool for EVERYTHING structural
What percentage of pediatric chest pain is cardiac in origin?
4%
Questions to ask in pediatric chest pain
#Recent fever or illness #Related to activity, breathing, exercise, or rest #Sports activities or injuries preceding #Palpitations, dizziness, or fainting #Aggravating/Alleviating #Illicit drugs, caffeine supplements or energy drinks
Serious business chest pain
Associated with exertion, dizziness, fainting, palpitations or radiates to back, jaw, or left arm
Maternal infections that may cause cardiac anomalies in the infant:
#Rubella #Viruses: cytomegalovirus, herpesvirus, coxsackievirus B teratogenic in early pregnancy, myocarditis in late pregnancy #HIV assoc with infant cardiomyopathy
Maternal medications that may cause fetal anomalies
#Amphetamines #Anticonvulsants #ACE inhibitors and ARBs #Lithium #Retinoic acid #Valproic acid #Progesterone, estrogen #Alcohol #Cigarette smoking (intrauterine growth delay)
Maternal conditions associated with infant heart defects
#Diabetes #Lupus erythematosus and connective tissue disease #Congenital heart defect history
Growth impairment patterns in patients with CHD:
#Cyanotic: height and weight #Acyanotic: weight problems more than height #Acyanotic with pressure overload lesions without shunt show normal growth
Inspection points in pediatric CHD
#General appearance & nutritional state #Obvious syndrome or chromosomal abnormalities #Color #Clubbing #Respiratory rate & effort #Diaphoresis #Chest inspection
CXR: Transposition of the great arteries
Egg on a string
CXR: Total anomalous pulmonary venous return (TAPVR)
Snowman
CXR: Partial anomalous pulmonary venous return
Scimitar
CXR: Endocardial cushion defects
Gooseneck
CXR: Tetralogy of Fallot
Boot (Dansko!) shaped heart
CXR: Coarctation of the aorta
Figure of 3 or reverse figure of 3
CXR: Ebstein anomaly
Box-shaped heart