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Terms in this set (37)

If they mention vibratory:
venous hum
what percentage will have murmur; number of these pathological?
90%; 5%
if they say third heart sound:
check position;
if lying down could be normal; if normal, should disappear when sits up
we know ASD has fixed S2 splitting; you may also be described a patient who has?
2. other murmur
3. if missed, may lead to:
decreased exercise tolerance
2. increased flow through pulmonary valve, so we hear at LUSB
3. Eisenmenger syndrome, with eventual R to left flow due to PHTN
VSD
1. best heard at
2. distinguish murmur
3. newborn period
4. larger VSD, softer?
5. other signs
1. LLSB;
2. harsh holostyolic, blowing..
3. not typically have murmur at this time
4. murmur because less turbulent flow
5. tachypnea, sweating with feeds, hyperdynamic precordium
high pitched holosytolic murmur
mitravel regurg
systolilc ejection click that varies with respiration
2. almost might be described
3. location of murmur
4. may also have____and radiate
pulmonary stenosis
2. RVH
3. lUSB
4. thrill, and radiate to the back
type of axis on ECG for AV Canal
Superior QRS axis (30- -90)
if you hear right sided aortic arch on any patient think?
22q11 deletion,
Stills murmur vs. venous hum
Still: louder supine and softer with standing; venous hum will disappear with pressure on jugular vein;
Core principles of congenital heart disease screening:
1. CUToff for sats, 94-96%;
2. repeat screening can limite false positive for PDA
3. more reliable after 24 hours of age
4. greater sensitivty is achieved with SaO2 on right hand (pre-ductal) compared to foot;
best initial therapy for heart failure is likely
lasix;
only murmur heard louder on back
2. for this murmur may just describe?
Coarc
2. shock and acidosis; gallop, nasal flaring, sweating while feeding; lethargic, not feeding well;
precordial activity and loud S2 after PDA closes:
2. for this disease, tell me about murmur?
3. so child presenting with shock, make sure?
Hypoplastic left heart; acute onset of severe CHF with market cardiomegaly
2. no murmur
3. include echo and ECG in workup;
cyanotic heart disease without murmur
1. transposition; 2. Tricuspid atresia; 3. pulmonary atresia; 4. TAPVR
grey: sepsis, cyanosis: ______-
cyanotic heart disease (for boards)
hyperoxia test and which ones?
failure to respond to 100% oxygen; the three severe cyanosis in newborn period: TGA, pulm. atresia, Ebstein malformation;
1. 3 causes of severe cyanosis in immediate newborn period
2. Fail to correct with?
3. to differentiate TGA?
4. tx of all three?
5. if similar presentation but improved with oxygen think?
1. pulm atresia; 2. TGA; 3. Ebstein malformation
2. hyperoxia test
3. radiograph, because this has increase pulmonary blood flow, other have decreased
4. PGE
5. persistent pulmonary htn of newborn (PPHN)
only true canosis in the first few hours of life prior to ductal closing:
TGA
a couple board worthy causes of ebsteins anomaly or ( abnormal of the tricuspid valve leaflets)
lithium or benzo use in pregnancy
1. MC cyanotic congenital heart defect overall
2. MC in newobrnss?
1. TOF
2. TGA
TOF typical age for presentation
2. an important feature of a tet spell
3-5 months;
2. inability to hear previous murmur;
egg shaped heart, increased pulmonary vascularity, and ductal dependent describes
2. a couple unique presenting signs
TGA
2. single secondar heart sound; tachypnea
differentiate TOF and TGA; both have single second heart sound:
TOF has decreased pulmonary vascularity while TGA has increased
WPW at risk for?
SVT
effects of adenosine are diminished via?
methylxanthines such as caffeine and theophylline
congenital long QT syndrome is caused by a variant in VTACH and can result in?
brief generalized Seizures;
recurrent syncope, no hx of family death, happens primarily with prolonged standing
neurocardiogenic syncope
rheumatic fever:
1. need in order to diagnose
2. delinate major and minors
3. correlate very well with recent strep infection
1. proof of a recent group A strep infection and: 2 major or 1 major 2 minor
2. majors: JONES; J(polyarthritis-75% of pts), O (heart shaped, CHF, new murmurs, cardiomegaly), N (nodules, subcutaneous, firm and painless over extensor surfaces of wrists, elbows, knees), E (ertyema marginatum), S (sydenham chorea, rapid purposeless movements of the face and UE); minor: arthralgia, fever, elevate acute phase reactant, prolonged PR interval
3. ASO titers or streptozyme
MC murmur in rheumatic fever:
mitral valve regurg, heard best at apex
three primary treatment goals for rheumatic fever:
1. eliminate GAS infection (PCN)
2. alleviate symptoms (asa used to treat migratory arthritis); steroids for carditis; haloperidol for chorea; dig for heart failure
3. Prophylaxis to prevent recurrence (PCN if needed)
tender nodules on the pads of fingers and toes in Infective endocarditis
osler nodes
non-tender red nodules on palms and soles in infective endocarditis
janeway lesions
unexplained fever; HSM; petechiae; new or changing murmur; myalgias, headache, malaise
2. best study to confirm diagnosis
3. MC two causes in children
4. initial tx
5. who gets routine prophylaxis for dental
6.dental prophylaxis, drugs:
Infective endocarditis
2. blood culture
3. S. aureus and Viridans streptococci
4. Vanc plus gentamicin for min 4-6 weeks, IV
5. patienets with congenital heart disease: repaired cyanotic heart disease, surgically corrected with hardware or other devices in last 6 months; residual defect near a prosthetic cardiac device;
6. amoxicillin first line 30-60 mins prior; if allergy, you can use Clina or azithromycin
EKG with diffuse low voltage
myocarditis (treatment supportive; no steroids)
MC causes of pericarditis:
1. MC causes viral; when caused by bacteria, usually infection elsewhere; Staph aureus is the MC bacterial cuase of pericarditis
pericarditis ECG changes
2. most important study to order when this is suspected
3. heart sounds
ST elevation
2. CXR
3. muffled
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