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73 Cards in this Set
- Front
- Back
How do infants with possible heart failure present?
How might an older child present? |
1. feeding difficulties
2. easy fatigability 3. sweating while feeding 4. rapid respirations 1. SOB 2. Dyspnea on exertion |
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What might rales on ausultation indicate?
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Pulmonary edema & Left-sided heart failure
**Rales = crackles caused by explosive opening of alveoli |
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What heart problem might Hepatomegaly suggest?
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Right-sided heart failure
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What is a prominent Precordium seen with?
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Cardiomegaly
Precordium = region over the heart |
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-
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-
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Apical heave = ?
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LV enlargement
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Substernal thrust = ?
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RV enlargement
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Hyperdynamic precordium = ?
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Volume overload
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Silent Precordium = ?
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Pericardial effusion or cardiomyopathy
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Thrill = ?
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Palpable equivalent of murmur at area of maximum auscultation
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Ejection click = ?
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early-to-mid systolic; associated w/ pulmonary atery or aortic stenosis or dilatation
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S3 = ?
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may be normal in older children & adolescents w/ slow heart rate
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Gallop = ?
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S4 always abnormal; poor compliance of ventricle; atrial kick during ventricular filling
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Systolic ejection murmur = ?
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usually implies increased flow or stenosis across one of the ventricular outflow tracts
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Pansystolic murmur = ?
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related to blood exiting contracting ventricle via an abnormal opening or AV insufficiency
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Continuous murmur = ?
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systolic murmur that spills into diastole & indicates continuous flow
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To-and-fro murmur = ?
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systolic component ends before S2, & diastolic murmur begins after semilunar valve closure
-Aortic stenosis & aortic insufficiency |
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Late Systolic Murmur = ?
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may be heard after a midsystolic click; hallmark is Mitral Valve prolapse
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Venous hum = ?
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Turbulence of blow flow in jugular venous system; hear in Anterior upper chest & neck in systole & diastole
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Wide pulse pressure ( >40 mm Hg) = ?
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Thyrotoxicosis
PDA AI AV fistula |
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A 5 yo boy is seen for routine physical exam. Parents voice no concerns. Weight & height are at 75th%. Vital signs are normal. Exam is remarkable for a soft musical 2/6 murmur best heard at the left lower sternal border
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Innocent murmur = functional, normal, insignificant, or flow murmurs
Result from flow thru a normal heart, vessels, & valves |
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When are most innocent murmurs heard (at what age range)?
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3 & 7 years of age
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An innocent murmur is never _____. An innocent murmuris a soft, _____ or _____ best heard at the _______ border. Innocent murmurs are never greater than grade ______
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Diastolic
Soft or Vibratory Left lower to midsternal border 2/6 |
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High pitched, blowing, early systolic murmurs best heard in the second let parasternal space with the pt lying down
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Pulmonary flow murmurs
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Heard in the neck or anterior chest. It is heard in systole & diastole but can disappear w/ compression of the jugular vein
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Venous hum
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A 3-month-old child presents w/ poor feeding, poor weight gain, & tachypnea. Exam reveals a harsh, pansystolic 3/6 murmur at the left lower sternal border, & hepatomegaly
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VSD
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MC congenital cardiac malformation
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VSD
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Biventricular hypertrophy & notched peaked P waves
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Large VSD
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What are complications associated with VSD?
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Endocarditis
Pulmonary HTN leading to Eisenmenger |
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What are the most common defects in ASD?
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Ostium secundum
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Presentation: Many pts are asymptomatic. Exercise intolerance may develop in older childre. Systolic ejection murmur is heard in the left mid & upper sternal border; usually there is no thrill. Wide fixed split of S2
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ASD
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What does a chest radiograph show in ASD?
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Enlarge RA & Ventricle
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What are 3 complications of ASD?
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Atrial dysrhythmias
Valvular insufficiency (mitral/tricuspid) Heart failure |
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What is the defintion of PDA?
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failure of closure of the Ductus Arteriosus leading to blood flow from Aorta -> Pulmonary Artery
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What are the risk factors for PDA?
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1. Girls (2:1)
2. Maternal Rubella infection 3. Premature infants |
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When is a PDA beneficial?
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providing Pulmonary blood flow when there is an associated Right Ventricular outflow tract obstruction, or in supplying systemic flow in Coarctation of the Aorta
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Wide pulse pressure & bounding Arterial pulses with apical heave & a thrill heard at the 2nd left intercostal space
Machinery or to-and-from murmur heard in both systole & diastole |
PDA
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What does CXR show in PDA?
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Prominent Pulmonary Artery & increased Pulmonary Vascular markings
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What is the treatment for PDA?
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Indomethacin
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What are the risk factors for Coartation of the Aorta?
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Turner Syndrome
Boys 2:1 |
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A 6 month old infant is prone to epidoses of restlessness, cysnosis, & gasping respirations. Symptoms resolves when he is placed in the knee chest position. Exam reveals an underweight infant, wich a harsh holosystolic murmur & a single second heart sound
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Tetralogy of Fallot
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What is Tetralogy of Fallot?
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IHOP
-Interventricular Septum defect = VSD -RV HYPERTROPHY -Overriding aorta -Pulmonary Stenosis |
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When does Acyaontic (pink) Tetralogy occur?
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when there is sufficient pulmonary blood flow caused by mild obstruction (mild PS) & shunting across the VSD is balanced
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What does CXR show in TOF?
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boot-shaped heart w/ uptilted apex
lung fields are clear reflecting decreased pulmonary blood flow |
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What does ECG show in TOF?
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RVH & right axis deviation
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What is the treatment for TOF?
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Management includes maintaining the Ductus open in severe Right-sided obstructive lesions
Surgical correction is the definitive treatment Blue spells are treated w/ knee chest position, sedation, O2, & avoiding acidosis |
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What is the major complication associated with TOF?
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Cerebral thrombosis secondary to extreme polycythemia & dehydration
-more common in pts < 2 yoa Brain abscess, while less common is more common in pts > 2 yoa |
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This blue baby is more common in infants of Diabetic mothers & in boys
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Transposition of Great Vessels
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MC congenital heart disease to present w/ cyanosis in the first 24 h of life
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Transposition
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CXR demonstrates increased pulmonary blood flow as the pulmonary vascular resistance decreases
The appearance of an EGG ON A STRING is caused by the change in relationship of the great vessels as they exit the heart |
Transposition
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What is the treatment for Transposition?
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PGE1 to maintain the ductus open until surgical correction is performed
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Right ventricular blood backs up to the RA & is shunted across the foramen ovale. Cyanosis occurs after 2-3 days when the ductus closes. Single second heart sound is heard
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Pulmonary Atresia
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ECG shows tall spiked P waves of right atrial enlargement & also shows LVH
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Pulmonary Atresia
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Pt presents w/ cyanosis at birth & a pansystolic murmur is heard along the left sternal border, S2 sound is single. CXR shows decreased pulmonary bloood flow
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Triscuspid Atresia
-causes RV outflow obstruction -no outlet from the RA to the RV & blood shunts across the foramen ovale |
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Describe Total Anomalous Pulmonary Venous Return
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All the pulmonary veins drain back into the systemic venous circulation thru a circuitous route. These veins have a high risk of obstruction, leading to pulmonary congestion & pulmonary HTN.
Mixed blood reaches the LA thru an ASD or Foramen Ovale |
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Total Anomalous Pulmonary Venous Return
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Chest radiograph shows the characteristic "snowman" pattern
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This is when a single vessel arises from the Ventricles, supplying systemic, pulmonary, & coronary blood flow
What is always present? |
Truncus Arteriosus
VSD |
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Underdevelopment of the left heart that results in a small left heart, & the right ventricle is forced to do all the work. This results in inadequate systemic circulation & pulmonary venous hypertension. Infants quickly develop cyanosis, dyspnea, & hepatomegaly. Cardiomegaly develops rapidly on chest radiograph. ECG shows RVH
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Hypoplastic Left heart
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A 7 yo girl presents to the office w/ a 3 wk hx of progressive dyspnea, malaise, & fatigue. She recently recovered from a viral syndrome. Physical examination is remarkable for a holosystolic murmur & hepatomegaly
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Myocarditis
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What are the MCC of Myocarditis?
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Viruses = Adenovirus & Coxsackie B
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What is the most common presentation of Myocarditis?
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Heart failure
-less common are arrhythmias & sudden death |
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What does CXR show in Myocarditis?
What does ECG show? |
Large heart & pulmonary edema
Sinus tachycardia, reduced QRS complex, & abnormal S & ST waves |
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Characterized by thickened, white, fibroelastic endocardium. Clinical manifestations include congestive heart failure, dyspnea, & poor feeding in infants
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Endocardial Fibroelastosis
Heart transplantation is indicated after failure of medical management of CHF |
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A 6 yo girl complains of severe joint pains of her elbows & wrists. She has had a fever for teh past 4 days. Past hx reveals a sore throat 1 month ago. Exam is remarkable for swollen, painful joints & a heart murmur.
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Acute Rheumatic fever
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What are the major criteria for Acute Rheumatic Fever?
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1. Carditis
2. Polyarthritis 3. Erythema marginatum 4. Chorea 5. Subcutaneous nodules JONES = joints, O for heart shape, Nodules, Erythema, Sydenham chorea |
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What is the treatment for Acute Rheumatic Fever?
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-rx of the Strep infection & monthly penicillin prophylaxis
-Salicylates help control the arthritis & carditis -Steroids are used when there is carditis with heart failure |
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What is teh most common complication of Acute Rheumatic Fever?
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Valvular disease
-in order of frequency: Mitral, Aortic, Tricuspid, Pulmonary |
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A 6 yo boy has had high intermittent fevers for 3 weeks, accompanied by chills. He has a past history of biscuspid aortic valves & recently had dental work
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Endocarditis
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Most common pathogen of endocarditis after dental work
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Strep viridans
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MC pathogen of endocarditis if no underlying heart disease is present
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S. aureus
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What is teh cause of Primary HTN?
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Unknown underlying cause
Predisposing factors include: -hereditary -salt intake -stress -obseity |
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All children w/ Secondary HTN should have what done?
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Renal evaluation including culture, US, renin levels, BUN, & Creatinine
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