Week 11 CVS heme Flashcards
(27 cards)
Cardiac murmurs
red flags on history?
red flags on physical?
hx:
- SOB, palpitations
- exercise intolerance
- dizziness, syncope
- chest pain on exertion
PE:
- cyanosis, clubbing, cap refill
- weak or absent femoral pulses
- hepatomegaly
**any flag on history or physical makes it pathologic murmur regardless of auscultation
Characteristics of innocent murmur
- timing?
- quality?
- intensity?
- louder with…?
- extra heart sounds?
- systolic
- soft
- grade II or less
- exercise, anemia, fever
- no extra heart sounds, normal S2
Characteristics of pathologic murmur
- timing?
- quality?
- intensity?
- louder with…?
- extra heart sounds?
- diastolic, holosystolic
- harsh
- grade III or higher with possible thrill
- NO change with position
- click, S3, S4
- fixed split S2
when would you refer to peds cardio for murmur?
- suspect pathologic cause/uncertainty
- FHx congenital heart disease in first degree relative
- FHx Marfan or sudden cardiac death in young person
- genetic abnormality (eg trisomy 21)
characteristics of Still’s murmur
- age
- quality
- timing
- location
- increase with?
2-7 years old
musical/vibratory, sounds like a groan
systole
low pitched
LLSB/apex
louder with supine, quieter with Valsalva
-best heard with bell
characteristics of cervical venous hum
- age
- quality
- timing
- location
- increase with?
2-7
R>L
continuous rumbling
sternoclavicular junction
increased with turning head AWAY and lifting chin
disappears in supin
____% of healthy children have heart murmurs
_____% are innocent murmurs
50%
98%
questions to ask re: symptoms when cardiac murmur detected?
All the F’s
- fatigue
- feeding/failure to thrive
- family hx (think Marfan, congenital heart disease, sudden cardiac death at young age)
- face turning blue (cyanosis)
- feeling unwell (SOB, dizzy, CP, palpitations)
- femoral pulses weak/absent
murmurs are best heard with ____ of stethoscope
diaphragm
what are the 3 rhythms associated with pathological sudden cardiac death?
PEA
VF
pulseless VT
what testing should surviving first degree relatives of patients with sudden cardiac death undergo?
- ECG
- holter
- stress test
- echo
all children should under lipid screening once during this age range
9 to 11 years old
lipid screening is NOT recommended during this age range due to changes in lipids with puberty
12 to 16 years old
can start screening for risk factors for dyslipidemia at age_____
-testing tailored to risk profile (q1-3 years depending)
can start at age 2 if risk factors identified
lipid screening not needed before age 9 if no risk factors
diagnosis of dyslipidemia in children requires fasting lipid bloodwork done ____ times within _____ (time frame)
two separate measurements
*2 fasting measurements preferred
between 2 to 12 weeks apart
Sickle cell anemia
pain crisis related to _______ (patho)
vaso-occlusion
- leading cause of acute chest syndrome
- can be quite severe with central sensitization and hyperalgesia, altered opioid metabolism
red flag sign in pt with sickle cell disease?
fever
- medical emergency, needs to be evaluated within 4 hours of onset of fever
- child can die within 6 hours of fever
- aplastic crisis and splenic sequestration
pts with sickle cell are on prophylactic penicillin until at least age 5
what are the 3 categories of syncope?
what are the hallmarks of cardiac-related syncope?
- neurocardiogenic (ie vasovagal)
- cardiac (arrhythmia, defect, disease)
- noncardiac (breath-holding, seizures, hyperventilation)
often no prodrome
can have chest pain and palpitations
what is the workup for syncope?
ECG for all
holter (only catches 20% of arrhythmias)
loop recorder
stress test
iron storage is regulated by ______ synthesized by _____ (organ), absorbed in _____ (organ)
hepcidin
synthesized by liver
absorbed in intestine at brush border
recommended daily intake of iron
babies 7-12 months:
kids 1-3 years:
kids 4-8:
babies 7-12 months: 11 mg/day elemental iron
kids 1-3 years: 7 mg/day
kids 4-8: 10 mg/day
risk factors for IDA in babies before 2 years of age
complications associated with IDA in first 2 years of life?
- preterm birth
- low birthweight babies
- limited food access
- prolonged breastfeeding
- poverty
- Chinese
- early introduction of milk before age 12 months
- babies born to mothers with anemia or obesity
- early umbilical cord clamping
- male sex
- lead exposure
- chronic infection
- Indigenous communities
complications:
-lower cognitive and motor function (may persist beyond childhood)
what is the most common bleeding disorder?
Von willebrand disease
von Willebrand factor attaches to exposed collagen and binds to platelets –> aggregation –> clot
VWD is deficiency
what are some risk factors for chronic ITP
chronic = > 6 months
age >10
female
autoimmune disease
insiduous onset
