Pediatric Cardio Disorders BEFORE BREAK.pdf

Pediatric Cardio Disorders Murmurs • Nearly 90% of all infants, children and adolescents will have a heart murmur • Less than 5% are considered pathologic • Evaluated on 5 characteristics: o Loudness or intensity o Timing w cardiac cycle o Location on thorax o Radiation from point of maximum intensi...

Pediatric Cardio Disorders Murmurs • Nearly 90% of all infants, children and adolescents will have a heart murmur • Less than 5% are considered pathologic • Evaluated on 5 characteristics: o Loudness or intensity o Timing w cardiac cycle o Location on thorax o Radiation from point of maximum intensity o Change in intensity with movement Normal Murmurs (vs. Pathologic, know the difference) • Still’s Murmur: Benign systolic ejection murmur from turbulent flow in LV outflow tract • Pulmonary Flow Murmur: Murmur from turbulence in RV outflow tract • Supraclavicular Flow Murmur: Turbulent flow from arterial branches off aortic arch • Venous Hum: Turbulent flow from jugular veins and superior vena cava • Mammary souffle (pregnant/lactating): Turbulent blood flow in dilated breast blood vessels Pathologic Murmurs • Diastolic o Aortic Regurgitation: Early diastolic, decrescendo, high-pitched “blowing” murmur. o Mitral Stenosis: Follows opening snap (OS). Delayed rumbling mid-to-late murmur. • Continuous o Patent Ductus Arteriosus: Continuous machinelike murmur, best heard at left infraclavicular area • Systolic o Aortic stenosis: Crescendo-decrescendo ejection murmur, loudest at heart base. o Mitral/tricuspid regurgitation: Holosystolic, high-pitched “blowing” murmur. Loudest at apex, radiates to axilla o Mitral valve prolapse: Late crescendo murmur with midsystolic click (MC) that occurs after carotid pulse. Best heard over apex. Loudest just before S2. o Ventricular septal defect: Holosystolic, harsh-sounding murmur. Loudest at tricuspid area. Chest Pain in Children • Cardiac Causes of Chest Pain o Coronary artery abnormalities (congenital and acquired) o Mitral valve prolapse o Myocarditis o Left ventricular outflow tract obstruction o Pericarditis o Dysrhythmias o Pulmonary hypertension, endocarditis, acquired cardiac disease • Non-Cardiac Causes of Chest Pain o Pulmonary (6-20%most common): asthma, pneumonia, foreign body aspiration, tumors, pleural effusions § (6-20% OF ALL CHEST PAIN) o Musculoskeletal: costochondritis, chest trauma, fractured rib or clavicle, myositis the next most common cause of chest pain) o Gastrointestinal o Miscellaneous: mediastinal tumors, psychogenic, vaso- occlusive crisis, ingestion, drug use (cocaine) Dysrhythmias • Bradydysrhythmias: SA node dysfunction (2-3rd AV degree block) caused by: • Tachydysrhythmias include: o Treatment: Never use Ca blockers, it will cause HTN and Cardiac arrest in following: § Infants § Anyone w wolff Parkinson white syndrome § Children w CHF § Children taking beta blockers Syncope in Children • Sudden loss of consciousness and postural tone due to transient cerebral underperfusion w spontaneous recovery • 10% SYNCOPE IS CARDIAC RELATED: no prodrome symptoms, always arrhythmia seen • 90% IS NON-CARDIAC • Noncardiac Causes (Neural Mediated) o Vasovagal syncope (most common) § Lasts < 1 min § Prodrome: • dizziness • pallor • nausea • diaphoresis • hyperventilation • Clinical Evaluation o History is most important and includes: § Precipitating factors § All other signs and symptoms occurring during event § Any assc illnesses, surgery, family hx o Physical exam should focus on: § Orthostatic hypotension based on tilt test § Cardiac examination looking for murmurs, clicks, gallops, other abnormal heart sounds § Neurologic exam for mental status, neuro deficits, postictal state Red flags for Syncope • Recurrent, atypical or unexplained episodes • Syncope w exercise • Syncope w heart palpitations or chest pain • History of cardiac abnormalities • Abnormal cardiac physical exam or ECG • Neurologic deficits • Hx or family hx of neurologic disorder EXCEPT! Is not included on the exam question (#17)