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Transcript
20% 20% 20% 20% 20% 10 1 2 3 Countdown 4 5 • Venous hum: turbulent flow in yugular vein • Hypertrophic cardiomyopathy • VSD • ASD • PS 20% 1 20% 20% 2 3 20% 4 20% 5 10 Countdown Endocarditis prophylaxis ONLY FOR PTS WITH: a prosthetic heart valve Hx of previous endocarditis Hx of complicated unrepaired cyanotic congenital heart disease, or s systemic to pulmonar artery shunt or conduit Repair of congenital heart defect with prosthetic material < 6months ago Residual defects following repair of a congenital heart lesion Procedures that require prophylaxis Tooth extraction Tonsillectomy/ adenoidectomy Dental implants Periodontal or endodontal procedures Surgical procedures involving the respiratory mucosa GIVE AMOXICILLIN 50MG/KG max 2gr, 1 HR PRIOR 20% 20% 20% 20% 20% 10 1 2 3 4 5 Countdown PPS Common in newborns, resolved by 2-3 months II/VI systolic murmur best on LUSB, radiating to posterior lung fields and axillae Due to turbulent flow at the origin of the small branch pulmonary arteries as they exit the large main pulmonary artery •Pulmonary flow: systolic ejection murmur best in LUSB •turbulant flow where main pulmonary artery connects with RV •Vibratory or “still” murmur: II/VI mid systolic murmur heard best on LLSB and apex •blood flow in the LV that leads to vibrations in the ventricle or mitral structure •toddlers, school age 20% 1 20% 20% 2 3 20% 4 20% 5 10 Countdown • S4 rare in kids, better when pt supine or L lateral • S3 • during diastole ventricle fills up in 2 phases: early passive blood flow from atria vibration of ventricular walls and later a vigorous atrial ejection • HTN or severe anemia • Heard best with bell with pt on L lateral recumbent position • Apical systolic murmur associated with a mid-systolic apical click • Anorexic bradycardia, weak irregular pulses and hypotension 20% 1 20% 20% 2 3 20% 4 20% 10 5 Countdown • VSD • ASD • PDA • Best on left 2nd intercostal space, wide pulse pressure and bounding pulses • Coartation of aorta • TOF VSD ASD coartation of aorta PDA TOFpulmonary valve stenosis aortic valve stenosis transposition of the great arteries hypoplastic LV For Boards: Baby 3-4wks old coming with signs of shock, r/o VSD as cause of CHF 20% 1 20% 20% 2 3 20% 4 20% 10 5 Countdown A narrow mediastinum associated with mild cardiomegaly Marked cardiomegaly associated with increased pulmonary vascularity Normal heart size with decreased vascular markings • Stage One Blalock-Taussig (BT) shunt: first few days after birth, and establishes a systemic-to-pulmonary artery shunt between the brachiocephalic artery or the right subclavian artery, to the right pulmonary artery via (usually) a tubed homograft or synthetic graft. Glenn Procedure or Hemi-Fontan: usually performed at 4-6 months after birth as a bridge to Fontan completion. The BT shunt and pulmonary artery band is usually removed. The superior vena cava is then attached to right pulmonary artery, creating a systemic venous-topulmonary connection. Fontan Completion: Usually performed at 2-3 years of age; the inferior vena cava is connected to the right pulmonary artery via a tunnel like patch within the right atrium (Lateral Tunnel Fontan), or by creating a conduit for IVC flow outside the right atrium (Extracardiac Fontan). Decreased vascular markings associated with a “boot-shaped” heart Pulmonary edema associated with cardiac enlargement 20% 1 20% 20% 2 3 20% 4 20% 10 5 Countdown 20% 20% 20% 20% 20% 10 1 2 3 4 5 Countdown