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If a murmur is heard in an infant, what 2 important history parts should you asked?
- 1. Weight gain/development
- 2. Feeding patterns
What are 3 main components of a PE for a murmur?
- 1. General appearance
- 2. Pulmonary exam
- 3. Abdomen
What pulse ox level may be considered abnormal?
Where should the PMI be felt?
4th/5th ICS, midclavicular line
Bradycardia might be a sign of: (3)
- 1. heart block
- 2. systemic dx
- 3. medication
Tachycardia may be a sign of: (5)
- 1. systemic illness
- 2. fever
- 3. heart failure
- 4. anemia
- 5. arrhythmias
The bell of stethscope hears high or low frequency? diaphragm hears high or low?
- Bell--> low frequency
- Diaphragm--> increase frequency
What are the 2 "normal" cardiac sounds?
The 1st sound is closure of which valves?
-tricuspid & mitral
The 2nd heart sound is closure of which valves?
-aortic & pulmonary valve
When is a physiologic splitting of P2 (pulmonary valve) heard?
-With inspiration, negative intrathoracic pressure
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
What is signficant about 4th heart sound?
- -Low frequency in LATE diastole
- -Decreased ventricular compliance
- -TENNESSEE--> rare in kids
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
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
What grade is a murmur when a "thrill" is present?
T or F. Systolic murmers are always pathological.
FALSE (diastolic are always pathological)
When ages are innocent murmers most common?
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
What is the most important tool for assessing palpitations?
What are 2 red flags for arrhythmias?
- 1. previous surgery
- 2. palpitations
What may be the best electrical tool for getting a child's rhythm strip?
When should an electrophysiology study be used?
T or F. If has palpitations r/t to SVT, diagnosis could take months to years.
What lab should be checked for kids with palpations?
What are the 6 causes of chest pain in kids?
- 1. Anxiety
- 2. pulmonary
- 3. MSK
- 4. GI
- 5. Heart
- 6. Idiopathic
What are the 2 causes of cardiac chest pain?
- 1. Imbalance of myocardial oxygen supply
- 2. Irritation of pericardial serosa
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
Name 4 acquired myopericardial or coronary artery diseases.
- 1. Myocarditis
- 2. Pericarditis
- 3. Kawasaki dx
- 4. Coronary arteritis/aneurysms
What is the history assessment for chest pain (QRST)
- R- radiation
- S- severity
- T- temporal
T or F. Chest pain in children and adolescents is a frequent but most often benign complaint.
What are some factors that may indicate organic etiology for chest pain?
- -younger age
- -pre-existing medical conditions
- -abnormal hx/PE
T or F. A consistently split S2 should be referred?
During physiologic split of S2, the P2 is wider from A2 during expiration or inspiration?
In S2, the A2 is louder or softer than P2?
A2 is louder and fixed, P2 is softer and varies with inspiration
A "narrow split" of S2 can suggest what 2 disorders?
- 1. Pulmonary HTN
- 2. Aortic stenosis
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
A midsystolic click is suggestive of? (2)
- 1. Mitral valve prolapse
- 2. Tricuspid valve prolapse
Discuss an ejection click.
- - Onset of systolic ejection period
- -audible at BASE (unlike split S1)
- -Secondary to:
- -Valvar stenosis
- -dilated great arteries
A systolic murmer that is louder and shorter during ejection is associated with:
A systolic murmur that same intensity through murmur is suggestive of what kind of valve?
Prediastolic murmers are associated with what?
True mitral or tricuspid stenosis
Mid-diastolic rumble is turbulence across the AVV and suggestive of:
-anatomic or volume related stenosis
Symptoms that may be suggestive of innocent murmurs are:
Murmurs that are accentuated with increased output--> fever, anemia, exercise, anxiety