Peds Cardiology

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Author:
choward04
ID:
205435
Filename:
Peds Cardiology
Updated:
2013-03-11 10:25:50
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Peds
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Pediatric Cardiology
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  1. If a murmur is heard in an infant, what 2 important history parts should you asked?
    • 1. Weight gain/development
    • 2. Feeding patterns
  2. What are 3 main components of a PE for a murmur?
    • 1. General appearance
    • 2. Pulmonary exam
    • 3. Abdomen
  3. What pulse ox level may be considered abnormal?
    <94%
  4. Where should the PMI be felt?
    4th/5th ICS, midclavicular line
  5. Bradycardia might be a sign of: (3)
    • 1. heart block
    • 2. systemic dx
    • 3. medication
  6. Tachycardia may be a sign of: (5)
    • 1. systemic illness
    • 2. fever
    • 3. heart failure
    • 4. anemia
    • 5. arrhythmias
  7. The bell of stethscope hears high or low frequency? diaphragm hears high or low?
    • Bell--> low frequency
    • Diaphragm--> increase frequency
  8. What are the 2 "normal" cardiac sounds?
    S1, S2
  9. The 1st sound is closure of which valves?
    -tricuspid & mitral
  10. The 2nd heart sound is closure of which valves?
    -aortic & pulmonary valve
  11. When is a physiologic splitting of P2 (pulmonary valve) heard?
    -With inspiration, negative intrathoracic pressure
  12. What is signficant about a 3rd heart sound?
    • -low frequency sound, early diastole
    • -r/t to rapid diastolic filling of ventricle
    • -Abn loud S3--> CHF, large shunt
    • -KENTUCKY
  13. What is signficant about 4th heart sound?
    • -Low frequency in LATE diastole
    • -Decreased ventricular compliance
    • -TENNESSEE--> rare in kids
  14. What is signficant about a heart "click"?
    • -onset of systolic ejection period, opening of semilunar valves
    • -audible at base (like split S1)
    • -Valvar stenosis/dilated great arteries
  15. What are the 7 parts to describing a mumer?
    • 1. intensity
    • 2. classification
    • 3. pitch
    • 4. quality
    • 5. location
    • 6. radiation/transmission
    • 7. provocative maneuvers
  16. What grade is a murmur when a "thrill" is present?
    Grade IV
  17. T or F.  Systolic murmers are always pathological.
    FALSE  (diastolic are always pathological)
  18. When ages are innocent murmers most common?
    age 2-5yo
  19. What 6 types of murmers always need to be referred?
    • 1. diastolic
    • 2. associated with thrill (4 or >)
    • 3. Regurgitant murmur
    • 4. Abnormal heart sounds
    • 5. Abnormal pulses
    • 6. symptomatic
  20. What is the most important tool for assessing palpitations?
    History
  21. What are 2 red flags for arrhythmias?
    • 1. previous surgery
    • 2. palpitations
  22. What may be the best electrical tool for getting a child's rhythm strip?
    Loop monitor
  23. When should an electrophysiology study be used?
    Last ditch
  24. T or F.  If has palpitations r/t to SVT, diagnosis could take months to years.
    True
  25. What lab should be checked for kids with palpations?
    Thyroid, TSH
  26. What are the 6 causes of chest pain in kids?
    • 1. Anxiety
    • 2. pulmonary
    • 3. MSK
    • 4. GI
    • 5. Heart
    • 6. Idiopathic
  27. What are the 2 causes of cardiac chest pain?
    • 1. Imbalance of myocardial oxygen supply
    • 2. Irritation of pericardial serosa
  28. What structural abnormalities are associated with chest pain?
    • 1. Left ventricular outflow obstruction (aortic stenosis, obstr cardiomyopathy)
    • 2. Mitral valve prolapse
    • 3. coronary artery anomalies
  29. Name 4 acquired myopericardial or coronary artery diseases.
    • 1. Myocarditis
    • 2. Pericarditis
    • 3. Kawasaki dx
    • 4. Coronary arteritis/aneurysms
  30. What is the history assessment for chest pain (QRST)
    • Q-quality
    • R- radiation
    • S- severity
    • T- temporal
  31. T or F.  Chest pain in children and adolescents is a frequent but most often benign complaint.
    True
  32. What are some factors that may indicate organic etiology for chest pain?
    • -younger age
    • -acute-onset
    • -pre-existing medical conditions
    • -abnormal hx/PE
  33. T or F.  A consistently split S2 should be referred?
    True
  34. During physiologic split of S2, the P2 is wider from A2 during expiration or inspiration?
    Inspiration
  35. In S2, the A2 is louder or softer than P2?
    A2 is louder and fixed, P2 is softer and varies with inspiration
  36. A "narrow split" of S2 can suggest what 2 disorders?
    • 1. Pulmonary HTN
    • 2. Aortic stenosis
  37. A "wide split" of S2 can suggest a prolonged RV ejection or shortened LV ejection.  This sound can be associated with what 3 disorders?
    • 1. Volume overload
    • 2. pulmonary stenosis
    • 3. Right bundle branch block: delayed activation
  38. A midsystolic click is suggestive of? (2)
    • 1. Mitral valve prolapse
    • 2. Tricuspid valve prolapse
  39. Discuss an ejection click.
    • - Onset of systolic ejection period
    • -audible at BASE (unlike split S1)
    • -Secondary to:
    •       -Valvar stenosis
    •       -dilated great arteries
  40. A systolic murmer that is louder and shorter during ejection is associated with:
    Stenotic valve
  41. A systolic murmur that same intensity through murmur is suggestive of what kind of valve?
    Leaky valve
  42. Prediastolic murmers are associated with what?
    True mitral or tricuspid stenosis
  43. Mid-diastolic rumble is turbulence across the AVV and suggestive of:
    -anatomic or volume related stenosis
  44. Symptoms that may be suggestive of innocent murmurs are:
    Murmurs that are accentuated with increased output--> fever, anemia, exercise, anxiety

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