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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
What might rales on ausultation indicate?
Pulmonary edema & Left-sided heart failure

**Rales = crackles caused by explosive opening of alveoli
What heart problem might Hepatomegaly suggest?
Right-sided heart failure
What is a prominent Precordium seen with?

Precordium = region over the heart
Apical heave = ?
LV enlargement
Substernal thrust = ?
RV enlargement
Hyperdynamic precordium = ?
Volume overload
Silent Precordium = ?
Pericardial effusion or cardiomyopathy
Thrill = ?
Palpable equivalent of murmur at area of maximum auscultation
Ejection click = ?
early-to-mid systolic; associated w/ pulmonary atery or aortic stenosis or dilatation
S3 = ?
may be normal in older children & adolescents w/ slow heart rate
Gallop = ?
S4 always abnormal; poor compliance of ventricle; atrial kick during ventricular filling
Systolic ejection murmur = ?
usually implies increased flow or stenosis across one of the ventricular outflow tracts
Pansystolic murmur = ?
related to blood exiting contracting ventricle via an abnormal opening or AV insufficiency
Continuous murmur = ?
systolic murmur that spills into diastole & indicates continuous flow
To-and-fro murmur = ?
systolic component ends before S2, & diastolic murmur begins after semilunar valve closure
-Aortic stenosis & aortic insufficiency
Late Systolic Murmur = ?
may be heard after a midsystolic click; hallmark is Mitral Valve prolapse
Venous hum = ?
Turbulence of blow flow in jugular venous system; hear in Anterior upper chest & neck in systole & diastole
Wide pulse pressure ( >40 mm Hg) = ?
AV fistula
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
Innocent murmur = functional, normal, insignificant, or flow murmurs

Result from flow thru a normal heart, vessels, & valves
When are most innocent murmurs heard (at what age range)?
3 & 7 years of age
An innocent murmur is never _____. An innocent murmuris a soft, _____ or _____ best heard at the _______ border. Innocent murmurs are never greater than grade ______

Soft or Vibratory

Left lower to midsternal border

High pitched, blowing, early systolic murmurs best heard in the second let parasternal space with the pt lying down
Pulmonary flow murmurs
Heard in the neck or anterior chest. It is heard in systole & diastole but can disappear w/ compression of the jugular vein
Venous hum
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
MC congenital cardiac malformation
Biventricular hypertrophy & notched peaked P waves
Large VSD
What are complications associated with VSD?

Pulmonary HTN leading to Eisenmenger
What are the most common defects in ASD?
Ostium secundum
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
What does a chest radiograph show in ASD?
Enlarge RA & Ventricle
What are 3 complications of ASD?
Atrial dysrhythmias
Valvular insufficiency (mitral/tricuspid)
Heart failure
What is the defintion of PDA?
failure of closure of the Ductus Arteriosus leading to blood flow from Aorta -> Pulmonary Artery
What are the risk factors for PDA?
1. Girls (2:1)
2. Maternal Rubella infection
3. Premature infants
When is a PDA beneficial?
providing Pulmonary blood flow when there is an associated Right Ventricular outflow tract obstruction, or in supplying systemic flow in Coarctation of the Aorta
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
What does CXR show in PDA?
Prominent Pulmonary Artery & increased Pulmonary Vascular markings
What is the treatment for PDA?
What are the risk factors for Coartation of the Aorta?
Turner Syndrome

Boys 2:1
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
Tetralogy of Fallot
What is Tetralogy of Fallot?

-Interventricular Septum defect = VSD
-Overriding aorta
-Pulmonary Stenosis
When does Acyaontic (pink) Tetralogy occur?
when there is sufficient pulmonary blood flow caused by mild obstruction (mild PS) & shunting across the VSD is balanced
What does CXR show in TOF?
boot-shaped heart w/ uptilted apex

lung fields are clear reflecting decreased pulmonary blood flow
What does ECG show in TOF?
RVH & right axis deviation
What is the treatment for TOF?
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
What is the major complication associated with TOF?
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
This blue baby is more common in infants of Diabetic mothers & in boys
Transposition of Great Vessels
MC congenital heart disease to present w/ cyanosis in the first 24 h of life
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
What is the treatment for Transposition?
PGE1 to maintain the ductus open until surgical correction is performed
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
Pulmonary Atresia
ECG shows tall spiked P waves of right atrial enlargement & also shows LVH
Pulmonary Atresia
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
Triscuspid Atresia
-causes RV outflow obstruction
-no outlet from the RA to the RV & blood shunts across the foramen ovale
Describe Total Anomalous Pulmonary Venous Return
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
Total Anomalous Pulmonary Venous Return
Chest radiograph shows the characteristic "snowman" pattern
This is when a single vessel arises from the Ventricles, supplying systemic, pulmonary, & coronary blood flow

What is always present?
Truncus Arteriosus

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
Hypoplastic Left heart
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
What are the MCC of Myocarditis?
Viruses = Adenovirus & Coxsackie B
What is the most common presentation of Myocarditis?
Heart failure
-less common are arrhythmias & sudden death
What does CXR show in Myocarditis?

What does ECG show?
Large heart & pulmonary edema

Sinus tachycardia, reduced QRS complex, & abnormal S & ST waves
Characterized by thickened, white, fibroelastic endocardium. Clinical manifestations include congestive heart failure, dyspnea, & poor feeding in infants
Endocardial Fibroelastosis

Heart transplantation is indicated after failure of medical management of CHF
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.
Acute Rheumatic fever
What are the major criteria for Acute Rheumatic Fever?
1. Carditis
2. Polyarthritis
3. Erythema marginatum
4. Chorea
5. Subcutaneous nodules

JONES = joints, O for heart shape, Nodules, Erythema, Sydenham chorea
What is the treatment for Acute Rheumatic Fever?
-rx of the Strep infection & monthly penicillin prophylaxis
-Salicylates help control the arthritis & carditis
-Steroids are used when there is carditis with heart failure
What is teh most common complication of Acute Rheumatic Fever?
Valvular disease
-in order of frequency: Mitral, Aortic, Tricuspid, Pulmonary
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
Most common pathogen of endocarditis after dental work
Strep viridans
MC pathogen of endocarditis if no underlying heart disease is present
S. aureus
What is teh cause of Primary HTN?
Unknown underlying cause

Predisposing factors include:
-salt intake
All children w/ Secondary HTN should have what done?
Renal evaluation including culture, US, renin levels, BUN, & Creatinine