Congenital Heart Disease
Terms
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- Statistics of Congenital Heart Disease
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Approx 1% of all live births (very conservative)
Majority follow non-mendelian genetics (not always predictable) - Causes of Congenital Heart Dis
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Multifactorial genetics (genetic & environ)
Chromosomal abnormalities - 10% (Downs - septal defects/AV canal, Turner Syn.-coarctation)
Maternal conditions -2-4% (DM, SLE, Fetal Alcohol Syn & drug addictions) - Which are Acyanotic Congenital Heart Diseases
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Ventricular Septal Defect (1 in 3)
Patent Ductus Arteriosus- 8% (50% will close on their own)
Atrial Septal Defect -7%
Coarctation -6%
Aortic Stenosis -5% - Which is Cyanotic Congenital Heart Dis?
- Tetralogy Fallot -5% (very dangerous - blue baby)
- What's involved in a Cardiac Assessment?
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Heart rate
Respiratory rate - most important vital sign
BP - also very important vital sign
Thrills
Pericardial friction rub
Heart sounds
Murmurs - What are types of Skin Assessments?
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Central cyanosis (arterial)
Peripheral cyanosis (venous
Acrocyanosis
Mottling - What is Acrocyanosis?
- Peripheral cyanosis - venous desaturation - blue around mouth & tips of extremities
- What is mottling?
- Lacy, fish-net appearance of skin - can be due to cold stress or sepsis
- What are signs of Peripheral Cyanosis?
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Blue hands/feet/perioral
Can be normal for weeks
Normal reduced Hb levels
Normal O2 saturations
Venous desaturation - not a worry - What are signs of Central Cyanosis?
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Blue inner lips & tongue
Abnormal after first few hours
Increased levels of reduced Hb
Decreased O2 sats
Arterial desaturation - great concern - What is the normal color of mucous membranes?
- Strawberry sherbert color
- What is the color of cyanotic membranes?
- Resembles rasberry sherbert (deeper color of pink)
- What can it mean if an infant is pale or washed out?
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May be hypoxic or anemic
Mild degrees of cyanosis can be easily missed! - What percentage of pediatric pts will have a heart murmur?
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50 - 90% at one time or another
Majority are functional or innocent murmurs - S1 Heart Sound
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Ausc with diaphragm
Located at LLSB
Due to M/T closure - S2 Heart Sound
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Ausc with diaphragm
Located LUSB
Due to A/P closure - S3 Heart Sound
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Ausc with bell
Located at LSB
Vibration - normal
Tensing - pathological -stiff heart - S4 Heart Sound
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Ausc with bell
Located at LSB
Vibration - normal
Tensing - pathological - stiff heart - Normal S1 & S2 Sounds
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High frequency sounds
Consists of 2 sounds:
1)Aortic and pulmonic components
Determined by amount of splitting during inspiration and expiration
Physiological split - normal
Fixed split - bad - when it remains thru expiration & inspiration - Grade I Systolic Murmur
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Very faint
Requires concentration to hear - Grade II Systolic Murmur
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Quiet
Can be heard without difficulty - Grade III Systolic Murmur
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Loud
Heard immediately when placing the stethoscope on the chest - Grade IV Systolic Murmur
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Loud
Can be associated with a thrill - can be felt - Grade V Systolic Murmur
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Heard with the stethoscope partially off the chest wall
Thrill present - Grade VI Systolic Murmur
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Heard with stethoscope off the chest
Thrill present - How are Diastolic murmurs graded?
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1-4/4
Always pathological until proven otherwise (in kids) - What are innocent murmurs?
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functional
nonorganic
benign
insignificant
No structural or hemodynamic problem
Due to turbulence of blood flow - Characteristics of Innocent Murmurs
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Normal history and physical
Soft intensity (GII, occasionally GIII)
Intensity varies with position
Short Duration (not holosystolic)
Musical quality - not harsh
Normal S1 & S2 (not a fixed split)
If evidence of cardiac disease is present - murmur should not be labeled "innocent" - What is a Functional Murmur?
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aka nonorganic or innocent
Diagnosis by exclusion in the neonate - What is a Functional Murmur with Venous Hum?
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Continuous humming murmur
Usually ages 2-5
Heart best under (R) clavicle
Movement of head or supine position changes murmur intensity
Differentiate from PDA (no change in PDA with head movement)