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Flashcards in Peds Cardio Deck (52)
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What Heart Sound is this?

•Respiratory inspiration:

↑ blood flow to right heart

↑ blood into RV

Delays emptying of RV

Prolongs the closure of S2

S2:  Pulmonary Component



What abnormal heart sounds are these 5 assocaited? 

1.Widely Split-Electrical delay (RBBB), VSD repair (TOF)

2.Fixed Split- Volume overload (ASD)

3.Narrowed Split Pulmonary hypertension (loud S2)

4.Paradoxical Split-Electrical delay (LBBB)

5.Single  Complex heart defect (TGA) or single ventricle defect (only 1 semilunar valve)




Abnormal S2 Sounds




What are the Inspiratory, Expiratory, and Both Sound Splits?



Inspiration: Normal Split, Narrow Split

Expiratory: Paradoxical

Both: Wide and Wide Fixed



What are the Other Adventitious Heart Sounds?

S3 Sound 

Best heard at apex

Rapid ventricular filling/volume overload

Pregnancy, MR/TR

Common variant in children


S4 Sound

Low pitch sound in late diastole

Best head at apex

Obstruction, ↓ ventricular compliance


Hypertension, cardiomyopathy

Pulmonary stenosis



What does a Friction rub mean?







What are the 3 innocent Murmurs?



•Still’s murmur

•Venous hum murmur 

•Peripheral pulmonary stenosis




What are the 3 Pathologic Murmurs









How can you Eval Murmurs?


1.Timing of cardiac cycle


3.Grade, intensity



Neck > aortic stenosis

Back > pulmonary valve stenosis

Axilla > peripheral pulmonary murmur

6. Positional changes




What Murmur grade are thrills present?



4/6 and above




How can you Evaluate Murmurs?



•Standing position: ↑ Hypertrophic cardiomyopathy,↑ Mitral valve prolapse,↓ Aortic stenosis

•Valsalva:↓ Innocent heart murmur, ↑ HCM

•Standing & Valsalva ↓ all murmurs, except… (↓ blood flow to left heart)


What Murmur is this?


Most common innocent heart murmur

•3 – 6 years of age

•Normal EKG 

Low frequency, musical, vibratory sound

•LMSB, LLSB, apex

•Loudest in supine position & stress (fevers)

•Changes intensity with sitting position

•Outgrow in adolescent years

•No echocardiogram needed



Still's Murmur


What Murmur is this?


AKA cervical hum murmur

•3 – 6 years of age 

Turbulence due jugular venous drainage

•Continuous murmur (right side > left side)

•Base of the heart

•Diastolic component louder than systolic

•Loudest with upright position

•Decreased with supine or turning neck

•No echocardiogram needed




Venous Hum Murmur


What type of Cyanosis is this?


•Normal saturations & PaO2

•Normal transitional newborn physiology



Peripheral Cyanosis


What Cyanosis is this?


•Blue lips, tongue

•Low saturations

•Low saturations & PaO2

•Congenital heart defect



Central Cyanosis


What type of Cyanosis is this?


Benign variant

Vasospasm of small arterioles

•Normal pulses

•No oxygen desaturations

•No pathological murmur









What are the 3 Fetal Circulation Shunts?



Ductus venosus

Foramen ovale

Ductus arteriosus



What Shunt is this?

•Post-natal can provide pulmonary of systemic BF

Functional closes 12-90 hours

•Anatomically closes 2-3 weeks



Patent Ductus Arteriosus


PDA helps Mix blood. What color is the baby?


1) Clue to congenital heart defect, PDA closing


2) Poor prognosis: intracardiac shunt closed, Need PGE to open PDA


3) PDA patency open, Palliation to provide PBF or systemic blood flow, Saturations 75-90%


1) Blue Baby


2) Grey Baby


3) Blue or Purple Baby



What are Congenital Heart Defect Sxs?

Think DNA nucleotides (ATGC)


1.Tachypnea: (L-R shunt), CXR: pulmonary edema, cardiomegaly

2.Cyanosis: (R-L shunt or obstruction to lungs), “Blue baby” = Cyanosis

3.“Grey baby”: (↓ or no systemic blood flow), Poor perfusion, Lactic acidosis


What are the 4 Congenital Heart Defects?

* associations*


2) TOF, TGA, TA (X2)

3) PS, COA




1) Acyanotic Defects

2) Cyanotic Defects

3) Obstructive Defects

4) Complex heart defect/ signle ventricle



What type of CHD?


Usually left-to-right shunt

Considered a “volume load” on the ventricles

The ventricle is carrying additional cardiac output

Volume loading dilates the ventricles (and atria)

No prostaglandins (PGE) are required to treat!



Acyanotic Defects




What are the Left -to- Right Shunting Sxs?

(think low CO)


* Large ASDs may be Asymptomatic*




•Poor feeding

•Exercise intolerance

•Poor growth



What type of Septal Defect is this?


•5-10% of all heart defects (relatively common)

•Can be seen as a part of more complex defects

•Can occur in several locations of the atrial septum

•Up to 25% of US population may have a patent foramen ovale (PFO - This is not and ASD)

RA, RV & PA can become enlarged as a result of _____



Atrial Septal Defect (ASD)



What Septal Defect has these Physical Exam Findings?

Precordial bulge

Hyperdynamic precordium


•Normal S1

Fixed split of S2

Grade 2-3/6 systolic ejection murmur at LUSB

•May hear diastolic “rumble” at RLSB

•Exam is similar to Still’s murmur, but doesn’t change with position

•EKG may have right axis deviation & right ventricular conduction delay



Atrial Septal Defect (ASD)




What is the Treatment for Atrial Septal Defect (ASD)?





Surgey to repair the defect

*Pulmonary vascular disease, arrhythmias, embolic events*



What is the Most common congenital heart defect?

•Most are small and asymptomatic

•Defects can occur within any part of the _________septum

•Muscular (most common)


•Conal septal hypoplasia

•Malalignment, AV canal type



Ventricular Septal Defect (VSD)



This defect (if moderate to large) can cause Death, Hepatomegaly, or diaphoresis with feeding.

May become irreversible during childhood



Ventricular Septal Defect (VSD)



What CHD is most commonly seen in premature newborns and newborns with primary pulmonary HTN.

Seen with hypoplastic left heart syndrome and pulmonary atresia.

May be seen in patients who are asymptomatic with a continuous murmur.

Closes within 72 hours of birth.



Patent Ductus Arteriosus (PDA)




Cause of cyanosis in newborn with lower ext sats < upper ext sats with R-L shunt is _____until proven otherwise. Continuous “machinery-like” murmur at LUSB/axilla


*requires mandatory pulse-ox screening of both RUE and LLE*



Patent Ductus Arteriosus (PDA)




Treatements for what CHD?

•Preemies:  NSAIDs and ductal ligation

•Small in older child that is audible:  coil/device occlusion, ductal ligation

•Rationale is to reduce risk of endocarditis

Incidentally found an non-audible:  no treatment needed



Patent Ductus Arteriosus (PDA)