Peds Cardiology (Exam 4) Flashcards

1
Q

What is an innocent heart murmur?

A

One that occurs in the absence of anatomic or physiological abnormalities of the heart or circulation

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2
Q

Roughly ___ of kids will have a murmur at some point

A

50%

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3
Q

What are the 6 types of innocent murmurs?

A
  1. New born murmurs
  2. Vibratory systolic murmur (Still’s murmur)
    - mc- L sternal boader/apex
  3. Venous hum
  4. Pulmonary systolic murmur
  5. Peripheral pulmonic systolic murmur
  6. Supraclavicular systolic murmur
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4
Q

What useful HPI concerns for a murmur?

A
  • Easily fatigable, including difficulty w/ feeding
    • disinterest, diaphoresis, change in resp patterns, cynaosis
  • Claudication
  • Sx that worsen w/ exertion (feeding)!!
  • Syncope (Babies passing out is never a good thing!)
  • Sig. Fam hx
  • CP IS NOT USEFUL
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5
Q

What are concerning PE findings with murmurs?

A
  • Falling off growth charts
  • Unequal pulses/pressures
  • Hyperactive precordium, displaced PMI
  • Murmur itself (diastolic or continuous, Grade IV+)
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6
Q

What type of murmur is almost always abnormal?

A

Diastolic

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7
Q

Are lab studies necessary in dx a peds murmur?

A

No if asymptomatic- It adds practically nothing to the initial evaluation of an asymptomatic kid with a murmur (refer to peds cardiology)

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8
Q

When do you need to order an echo on a peds?

A
If the kiddo is symptomatic or 
asymptomatic with: 
-suspected diastolic or continuous murmur
-ejection clicks
-radiate to back or neck
-grade 3 or louder
-murmurs ass. with abnorm ekg or cx
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9
Q

Rheumatic fever is an ________ dx that occurs after a ______ infection

A

autoimmune/inflammatory dx

GROUP A STREP

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10
Q

If a pt comes in with rheumatic fever sx when would you do a rapid strep test?

A

Only if the HPI is consistent with an acute strep infection

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11
Q

What is the time frame of RF onset after a group A strep infection?

A

1-5 weeks

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12
Q

What lab tests do you want to get for a RF pt?

A

ASO titer (rises 1-3 wks after strep infx, peaks 3-5 wks)
CBC
CMP
ESR + CRP (if neg=not RF)

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13
Q

What is the diagnostic criteria for rheumatic fever?

A

Jones Criteria

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14
Q

What is the Jones Criteria?

A

DX based on presence of known group Q strep infection PLUS:
2 major OR
1 major and 2 minor criteria

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15
Q

What are the 5 major criteria of the Jones Criteria?

A
  1. Migratory polyarthritis (MC-80%)
    - insanely painful joint pain that jumps to a new spot every 3-10 days
    - must have associated swelling and limited movement
  2. Carditis (valvulitis, myocarditis, pericarditis)
    - Most serious complication
    - present 40%
    - Tachy, new murmur, cardiomegaly, CHF
    - MV and AV mc affected
  3. Erythema marginatum (less than 5%)
    - macular, red, non itchy rash on trunk
  4. Chorea (Sydenham’s)
    - less than 15%
    - rapid, purposeless movement (like Huntington’s dx)
    - delayed onset (mo to yrs)
  5. Subcutaneous nodules (uncommon <5%)
    - non-tender, freely moving, over a joint
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16
Q

What are the 6 minor criteria of the Jones Criteria?

A
  1. Arthralgia (no joint swelling)
  2. Fever
  3. Elevated acute phase reactants (ESR, CRP)
  4. Prolonged PR interval (can’t use if pt has carditis as a major)
  5. Leukocytosis
  6. Previous h/o RF
17
Q

What is the treatment for acute RF?

A

Antibiotics ONLY if evidence of acute strep infx:

  • Penicillin
  • Erythromycin (if pen allergic)

Otherwise:

  • ASA for sx
  • (+/-) steroids
  • (+/-) valve replacement
  • Tx heart failure if present
18
Q

What is the preventative treatment for pts w/ h/o RF or RHD?

A

H/o RF: very low threshold for ABX with c/o ST
RHD: 5-10 yrs or until 21 yo prophylatic abxs
-DOC: Pen G Q4 weeks

19
Q

What is Reye Syndrome? What is it mc associated with?

A

Reyes syndrome: rapidly progressive encephalopathy
Sx: vomiting, AMS, seizures
90% of cases associated with ASA use
VERY RARE (less than one in a million kiddos per yr)