week 4 module 12 special considerations

Question 1

fetal circulation

Answer 1

R. atrium -> foramen ovale -> L. atrium

R. ventricle -> patent ductus arteriosus not lungs

Question 2

fetal/infant ventricle size

Answer 2

equal in weight and size because both pump blood systemically.

Question 3

infants and dyspnea

Answer 3

look for enlargement of heart and position

Question 4

Closure of PDA

Answer 4

closes by 48 hours

Question 5

closure of foramen ovale

Answer 5

closes as pressure in L. atrium increases

Question 6

bulging precordium in child

Answer 6

long-standing heart enlargement

Question 7

sinus arrhythmia in child

Answer 7

a physiologic event

Question 8

most acquired murmurs in children are a result of

Answer 8

kawasaki disease

Question 9

still murmur

Answer 9

causes by vigorous expulsion of blood from L. ventricle into the aorta
- inc. with activity
- dec. with rest
Most common in ages 3-7 
vibratory, groaning, or musical

Question 10

SAFER

Answer 10

Children at high risk of underlying structural heart defect

• Syndromic features: syndromes or chromosomal anomalies
• Age: murmur in infant more likely pathologic
• Family Hx: congenital heart defects have multifactorial inheritance (3-5% chance in offspring)
• Evaluation of feeding and growth: feeding diff. sweating
• Rheumatic fever/ PMH: kawasaki, rheumatic fever

Question 11

systemic vascular resistance during preg

Answer 11

decreases

Question 12

BP during preg

Answer 12

dec. in 2nd trimester, returns to nml in 3rd

Question 13

heart sounds during preg

Answer 13

change with increased blood volume

• audible splitting of S1 and S2
• S3 may be heard after 20wks
• systolic ejection murmurs may happen in 90%

Question 14

blood volume during preg

Answer 14

inc. 40-50%
- > inc. workload of the heart
- returns to nml 3-4 wks after delivery

Question 15

CO during preg

Answer 15

inc. 30-40%
peaks at 25-32wks
- returns to nml ~ 2wks after delivery

Question 16

apical pulse and older adults

Answer 16

harder to find

• inc. anteroposterior chest diameter
• obesity

Question 17

S4 and older adults

Answer 17

sound is more common

- may indicate dec. L. ventricular compliance

Question 18

heart size and older adults

Answer 18

may dec. unless pt has HTN or CV disease

Question 19

older adults and CO

Answer 19

during exercise decreases 30-40%

Question 20

structural changes to heart in older adults

Answer 20

endocardium thickens
myocardium more rigid -> dec. contractility
fibrosis and sclerosis

Question 21

infants signs of CV issues

Answer 21

tiring during feeding
breathing changes 
cyanosis 
Wt gain 
knee-chest position favored 
mothers health during preg

Question 22

children signs of CV issues

Answer 22

tiring during play
naps
headaches
nosebleeds
joint pain
fever
ht and wt gain
physical and cognitive development

Question 23

S3 and children

Answer 23

normal

Question 24

defining murmurs

Answer 24

timing and duration
pitch
intensity
pattern 
quality
location and radiation
respiratory phase variations

Question 25

Bounding pulses in infant

Answer 25

PDA | aortic regurgitation

Question 26

Thready pulses in infant

Answer 26

aortic stenosis

Question 27

congenital heart defects usually occur

Answer 27

within the first 8 weeks of gestation

Question 28

chromosomal abnormalities account for

Answer 28

nearly 10% of all cardiac malformations

Question 29

environmental or maternal conditions account for

Answer 29

2-4% of all CHD - lupus - diabetes - PKU - SLE - viruses - ETOH - anticonvulsant use

Question 30

pulmonary systolic ejection murmur

Answer 30

common in peds | slightly harsh systolic ejection murmur heard best at 2nd or 3rd ICS

Question 31

supraclavicular arterial bruit

Answer 31

common in peds | early systolic murmur heard above the clavicles

Question 32

physiologic peripheral pulmonary stenosis

Answer 32

common in peds low-intensity systolic ejection murmur upper-left sternal boarder, axillae, and back bilaterally - in neonates up until 3-6months

Question 33

venous hum

Answer 33

humming continuous with murmur usually at RUSB will decrease or disappear when supine

Question 34

kawasaki disease

Answer 34

inflammation in walls of small and medium sized arteries throughout the body

Question 35

coarctation of the aorta

Answer 35

usually presents with other defects Males:females 3:1 usually in thoracic portion of descending aorta - must check femoral pulses

Question 36

hypertrophic cardiomyopathy

Answer 36

most common cause of death in competitive athletes - syncope - heart racing