Cardiology Lecture (380 KB)

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Cardiology Lecture (380 KB)

  1. 1. The Cardiovascular Exam in Infants and Children
  2. 2. Heart Rate <ul><li>Most labile of the vital signs </li></ul><ul><li>Wide variations are normal </li></ul><ul><li>Sensitive to multiple stimuli </li></ul>
  3. 3. Blood Pressure <ul><li>Blood pressure increases with age </li></ul><ul><li>Use appropriate cuff </li></ul><ul><li>Repeat if abnormal </li></ul>
  4. 4. Respiratory Rate <ul><li>Sensitive but non-specific for CHF </li></ul><ul><li>Most reliable while asleep </li></ul><ul><li>Minimal dyspnea with heart failure </li></ul>
  5. 5. Inspection <ul><li>Growth (linear growth is spared) </li></ul><ul><li>Color (cyanosis, pallor) </li></ul><ul><li>Respiratory effort </li></ul><ul><li>Precordial bulge </li></ul><ul><li>Apical impulse </li></ul>
  6. 6. Palpation <ul><li>Pulses (upper and lower) </li></ul><ul><li>Precordial activity </li></ul><ul><li>Thrills </li></ul><ul><li>Liver edge </li></ul><ul><li>Perfusion </li></ul><ul><li>Skin temperature </li></ul>
  7. 7. Pulses
  8. 8. Auscultation <ul><li>Use your own stethoscope </li></ul><ul><li>Insist on quiet surroundings </li></ul><ul><li>Be methodical </li></ul><ul><li>Be patient </li></ul><ul><li>Come back and listen again </li></ul><ul><li>Don’t get discouraged </li></ul>
  9. 9. Heart Sounds <ul><li>S1- closure of AV valves </li></ul><ul><li>Increased in ASDs </li></ul><ul><li>Obscured by holosystolic murmurs </li></ul><ul><li>Variable in complete heart block </li></ul>
  10. 10. Heart Sounds <ul><li>S2- closure of semilunar valves </li></ul><ul><li>Increased P2 if increased pulmonary artery pressure </li></ul><ul><li>Fixed splitting in ASDs </li></ul>
  11. 11. Heart Sounds <ul><li>S3- rapid filling of ventricles </li></ul><ul><li>Normal sound in children </li></ul><ul><li>Usually in ages 3 to 16 </li></ul>
  12. 12. Heart Sounds <ul><li>S4- atrial contraction </li></ul><ul><li>Uncommon in children, even in CHF </li></ul><ul><li>Usually indicates a cardiomyopthy </li></ul>
  13. 13. Ejection Clicks <ul><li>Early systolic, high frequency sounds </li></ul><ul><li>Occur shortly after S1 </li></ul><ul><li>Signify semilunar stenosis </li></ul><ul><li>Variable (louder on expiration) if pulmonary </li></ul><ul><li>Constant (don’t vary with respiration) if aortic </li></ul>
  14. 14. Holosystolic Murmurs <ul><li>Begin with or obliterate the first heart sound </li></ul><ul><li>Typical examples are VSD and MR </li></ul>
  15. 15. Murmurs
  16. 16. Systolic Ejection Murmurs <ul><li>Most common of all murmurs </li></ul><ul><li>Begin after S1 </li></ul><ul><li>Originate in outflow tracts </li></ul>
  17. 17. Decrescendo Diastolic <ul><li>Loudest in early diastole </li></ul><ul><li>High pitch typical of aortic regurgitation </li></ul><ul><li>Low pitch typical of pulmonary regurgitation </li></ul>
  18. 18. Diastolic Rumble <ul><li>Usually increased flow across a normal mitral or tricuspid valve </li></ul><ul><li>Very low frequency and intensity </li></ul><ul><li>Generally the result of VSDs and ASDs </li></ul>
  19. 19. Continuous Murmurs <ul><li>Any murmur which continues through S2 </li></ul><ul><li>Vascular in origin </li></ul><ul><li>Patent ductus arteriosus and venous hum are the most common source </li></ul>
  20. 20. Characteristics of Murmurs <ul><li>Loudness (Grade 1 to 6) </li></ul><ul><li>Location </li></ul><ul><li>Radiation </li></ul><ul><li>Changes with respiration, position, valsalva </li></ul><ul><li>Pitch or frequency </li></ul><ul><li>Length </li></ul>
  21. 21. Radiation of Murmurs <ul><li>Aortic -RUSB to neck </li></ul><ul><li>Pulm-LUSB to lungs </li></ul><ul><li>VSD-LLSB </li></ul><ul><li>MR-Apex to axilla </li></ul>Ao Pa VSD MR M
  22. 22. Innocent Murmurs <ul><li>Grade I-II/VI (rarely III/VI) </li></ul><ul><li>Systolic (except venous hum) </li></ul><ul><li>Often vibratory </li></ul><ul><li>Change with respiration and position </li></ul><ul><li>Short </li></ul><ul><li>Unassociated with abnormal heart sounds </li></ul><ul><li>Characteristic age 3 to 12 years </li></ul>
  23. 24. Congestive Heart Failure <ul><li>IS </li></ul><ul><li>Tachypnea </li></ul><ul><li>Tachycardia </li></ul><ul><li>Hepatomegaly </li></ul><ul><li>Cardiomegaly </li></ul><ul><li>IS NOT </li></ul><ul><li>Rales </li></ul><ul><li>Peripheral edema </li></ul><ul><li>Gallops </li></ul><ul><li>Venous distension </li></ul>

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