Cardiology

pectus excavatum

-depression of the chest wall

-symmetrical or asymmetrical

-associated with: congenital heart disease, PCD, neuromuscular disorder

pectus carinatum

-protrusion of upper or lower portion of the sternum

-males

pectus tx

-surgical repair

murmurs

-heart sound caused by turbulent blood through the heart

-most common cardio finding

-intensity, quality, location, radiation, variation

-dx: echocardiogram

innocent murmurs

-common and benign

-produced by turbulent blood through NORMAL heart

-DO NOT represent structural or congenital heart disease

-tx: resolves without intervention

newborn murmur

-first few days of life

-heard in left sternal border

-soft I-II/VI, low pitch, short

-tx: disappears by age 2-3 weeks

Still's murmur

-most common innocent murmur of early childhood

-2-7 years of age

-heard between apex and the lower left sternal border

-mucical or vibratory, short, early systolic murmur

-best heard when supine

-louder while febrile

innominate murmur or carotid bruit

-most common in older child or adolescent

-supraclavicular area

-harsh long systolic ejection murmur

-accenuated by light pressure on carotid artery

venous hum

-musical hum

-heard loudest on right infraclavicular area

-appears after 2 years of age

-best heard when sitting

pulmonary ejection murmur

-appears age 3, continues through adolescence

-localized to upper left sternal border

-best heard supine and diminishes with valsalva

congenital heart disease can be caused by

-environmental factors: maternal diabetes, alcohol, infection

-genetics

-acyanotic and cyanotic (blue) types

cyanotic diseases

-teralogy of fallot

-pulmonary atresia

-hypoplastic left heart syndrome

-transposition of the great vessel

acyanotic

-artial septal defect

-ventricular septal defect

-patent ductus

-corarctation of the aorta

atrial septal defect

-common

-RF: advanged maternal age, downs, turners

patho: opening in the artial septum permitting the shunting of blood between atria

-left to right shunt

atrial septal defect types

-ostium secundum defect= most common

-ostium primum defect

-sinus venous defect

-coronary sinus defect

atrial septal defect sx

-asymptomatic

-older exersice intolerance, easy fatigue, heart failure

-systolic murmur, wide fixed split S2 that DOSE NOT VARY with respiration

atrial septal defect dx

-echocardiogram

-EKG: right artial enlarge

-CXR: cardiomegaly

atrial septal defect tx

-small: <5mm observe

-large: surgical

patent foramen ovale (PFO)

-opening between left and right atria

-no septal tissue missing

-sx: asymptomatic

-CLOT: always consider in CVA pt under 55

-dx: echocardiogram

-tx: antiplatelet therapy

-surgical PFO closure

ventricular septal defect (VSD)

-hole between ventricles

-left to right shunting of blood

-sx: small: asymptomatic

-large: failure to thrive, difficulty feeding, respiratory infection, congenital heart failure

-if L to R shunt for too long it will switch to R-L shunting leading to cyanosis

-murmur: high pitch, harsh, holosystolic

ventricular septal defect (VSD) dx/tx

-dx: echocardiogram

-tx: small: asymptomatic, will spontaneously resolve with first 2 years

-large: surgery

-complication: eisenmenger syndrome

eisenmenger syndrome

-occurs from unrepaired congenital heart defect that goes on for so long

-reversal of shunt causing right to left shunting = cyanotic

atrioventricular septal defect

-common in children with downs 40%

-patho: defect between both atria and both ventricules

-mixing oxygen and deoxygenated blood

atrioventricular septal defect sx

-partial presents like ASD

-failure to thrive, tachy, diaphoresis w feeds

-systolic murmur with diastolic murmur

-dx: echocardiogram

-tx: surgery required in first year

patent ductus arteriosus (PDA)

-normal in fetal circulation, should not be there when bay comes out

-females, preterm babies

-patho: shunting of blood between aorta and pulmonary artery

patent ductus arteriosus (PDA) sx

-failure to thrive

-tachypnea

-diaphoresis with feeds

-wide pulse pressure

-murmur: continuous machinery murmur heard throughout chest but best at LUSB

patent ductus arteriosus (PDA) dx/tx

-dx: echocardiogram

-tx: IV indomethacin (prostaglandin)

coarctation of aorta

-patho: narrowing of proximal thoracic aorta

-male

-associated with turners syndrome

coarctation of aorta sx

-differences between arterial pulses nd blood pressure in upper and lower extremities pathognomonic

coarctation of aorta dx/tx

-dx: echocardiogram

-tx: surgical repair

cyanotic congenital heart disease

-severe defects we leave the PDA open

-IV prostaglandins E1 to stabilize prostaglandin

Tetralogy of Fallot (TOF) types

-most common cyanotic CHD

-ventricular septal defect

-right ventricle hypertrophy

-right ventricular outflow tract obstruction

-overriding aorta

Tetralogy of Fallot (TOF)

-patho: obstruction of RV outflow with large VSD causes a right to left shunt at ventricular level > arterial desaturation > cyanosis

Tetralogy of Fallot (TOF) sx

-vary on RV outflow obstruction

-mild obstruction > minimaal cyanosis or acyanosis

-severe: cyanotic from birth

-murmur: harsh systolic, left to mid upper sternal border

-all acyanosis by 4 months

-easy fatigue and dyspnea

-digital clubbing

Tet spell or Tet squats

-hypoxemic cyanotic episodes = hallmark

-sudden onset of cyanosis and child squats downs and sx improve

Tetralogy of Fallot (TOF) dx

-echocardiogram

-CXR: boot shaped heart

Tetralogy of Fallot (TOF) tx

-surgical repair needed

-severe newborn: PDA may be open

-tet spell: squat or knee to chest

pulmonary atresia

-cyanotic

-malformation of pulmonic valve > obstruction of RV outflow > absent connection between the right ventricle and pulmonary ateries

pulmonary atresia sx

-pt may be stable

-cyanosis

-holosystolic murmur

pulmonary atresia dx/tx

-dx: echocardiogram

-tx: IV prostaglandin

-surgical repair

Hypoplastic Left Heart Syndrome

-cyanotic

-diminutive left ventricle and small left sided structures

Hypoplastic Left Heart Syndrome sx

-neonates: stable at birth bc ductus is patent

-deteriorate rapidly as ductus closes > shock and acidosis secondary

Hypoplastic Left Heart Syndrome dx/tx

-dx: fetal echocardiogram

-tx: IV prostaglandin at delivery to maintaine patent docus arteriosus

-surgical repair

Transposition of the Great Vessels

-cyanotic

-patho: aorta arises from the RV and pulmonary artery from the LV (switched)

Transposition of the Great Vessels sx

-neonates are large

-profound cyanosis at birth

-respiratory distress

-significant murmur present in some systolic

Transposition of the Great Vessels dx/tx

-dx: echocrdiogram

-tx: early corrective surgery

kawasaki disease

-mucocutaneous vasculitis

-viral cause suggested

-< 5yo

-japanese and korean descent

kawasaki disease sx

-fever >5 days and at least four of the sx

-conuunctivits

-lip cracking and fissuring, strawberry tonue, inflammation of oral mucosa

-polymorphous exanthem

-redness and swelling of hands and feet

-cardio manifestation

kawasaki disease dx/tx

-dx: elevated WBC, ESR, CRP

-echocardiogram

-tx: IVIG and high dose aspirin