Rapid Acquisition Of Key Concepts Pediatrics Cardiovascular
Apr 8, 2024
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Major Criteria for ARF
Minor Criteria for ARF
Comparison of All Heart Sounds
Characteristics of S1 sound
Features of S2 Sound
Wide Physiological splitting of S2
Reverse Splitting in S2
Types Of Myocardial Infarction
Biomarkers
Differences Between Carotid Pulsations And Jugular Venous Pulsations
Identification of waves
Heart sounds and cardiac cycle events
Major Criteria for ARF
Low Risk Population Moderate to high risk population Carditis present Carditis present Arthritis- only polyarthritis Arthritis- either mono arthritis or polyarthralgia Chorea present Chorea present Erythema marginatum present Erythema marginatum present Presence of subcutaneous nodules Presence of subcutaneous nodules
Minor Criteria for ARF
Low Risk Population Moderate to High Risk Population Polyarthralgia Monoarthralgia Fever ≥ 38.5° C Fever ≥ 38°C ESR ≥ 60mm in 1st hr ESR ≥ 30mm in 1st hr CRP ≥ 3.0mg/dl CRP ≥ 3.0mg/dl Prolonged PR interval Prolonged PR interval
Also Read: Fetal Circulation And Transition To Neonatal Circulation
Comparison of All Heart Sounds
Feature 1st Heart Sound 2nd Heart Sound 3rd Heart Sound 4th Heart Sound Character High pitched High pitched Low pitched Low pitched Duration 0.14 sec 0.11 sec 0.10 sec 0.10 sec Frequency 25 – 45 50 < 50 < 20 Cause Vibration between M1, T1 Due to closure of A2, P2 Rapid ventricular filling Atrial contraction Timings IVC IVR 1st rapid filling 2nd rapid filling Better heard with Diaphragm Diaphragm Bell Bell
Characteristics of S1 sound
Characteristics of S1 Character Value Frequency Medium to High Duration 0.14 sec M1-T1 interval 20 - 30 msec C-point of MV echocardiogram Coincides with M1 Down stroke of C wave of LA pressure Coincides with M1 Down stroke of C wave of RA pressure Coincides with T1
Features of S2 Sound
Characteristics Findings Frequency high Duration 0.11sec Incisura of Aortic Pressure coincides with A2 Incisura of pulmonary pressure coincides P2 A2-P2 interval Inspiration: 40-50 msec
Expiration: <30 msec
Heard as a single sound during expiration
Physiological split is seen in inspiration A2 is earlier than P2: due to more pressure on left side A2 is louder than P2
Wide Physiological splitting of S2
Early A2 Delayed P2 Mitral Regurgitation Pulmonary embolism Ventricular septal defect RBBB LV ectopy or LV paced beats ASD Pulmonary hypertension Pulmonary stenosis
Reverse Splitting in S2
Delayed A2 Early P2 LBBB WPW syndrome Type-B RV ectopic RV paced beats Patent Ductus Arteriosus
Also Read: Arrhythmias in Children : NEET SS Pediatrics
Types Of Myocardial Infarction
|
Type of MI |
ST Elevation |
Vessel Blocked |
|
Anterior Wall MI |
V1-V4 |
Left Anterior Descending artery |
|
Inferior Wall MI |
II, III, avF |
Right Coronary Artery |
|
Lateral Wall MI |
I, avL, V5, V6 |
Left circumflex artery |
|
Right Ventricular MI |
More ST elevation in lead III>II |
Right Coronary Artery |
|
(Precordial leads are placed on left side)
|
ST elevation in V1&V2 |
|
|
Posterior Wall MI |
In early stages, ST depression in V1-V3, R/S ratio > 1 in V1-V3 |
Posterior Descending branch of right coronary artery |
|
Biomarkers
Biomarker Onset Peak Return to Normal CK-MB 4-8 hrs 24hrs 48-72 hrs C Troponin I 2-4hrs 24-48hrs 7-10 days C Troponin T 3-4hrs 24-48hrs 10-14 days H- FABP(Heart – Fatty acid binding protein) 1.5hrs 4-6 hrs <24hrs MYOGLOBIN 1-4 hrs 6-12 hrs <24hrs IMA(Ischemia modified albumin) minutes 6hrs <12hrs
Differences Between Carotid Pulsations And Jugular Venous Pulsations
Carotid pulsations Jugular venous pulsations Relation with sternocleidomastoid Deep and medial. Superficial and lateral. Obliterate ability Not obliterable. Obliterable. Varying with position and respiration No effect. Increases on inspiration. Abdominal compression No effect. Elevated. Pulsatile Felt i.e. pulsatile. Not felt Waves No waveform. Seen. Peaks and troughs Single upstroke. 2 peaks (a and v wave) and 2 troughs (x & y). Descent Rapid. Slow.
Identification of waves
Wave form Phase of cardiac cycle Mechanical event A wave End-diastole. Atrial systole.
Dominant wave before carotid pulsations.
Dominant wave before appearance of S1.C wave Early systole. Cusps bulge into the right atrium.(Appears during x wave descent) X wave Mid-systole. Atrial relaxation. V wave Late systole. Venous filling.
Seen due to rise in right atrial pressureY wave Early diastole. Atrial emptying. H wave Pre-systolic (atrial) wave.
Seen just before the ‘a’ wave.
Heart sounds and cardiac cycle events
Heart sound Wave form Cardiac cycle events S1 C wave Isovolumetric contraction. S2 V wave Between S1 and S2 X wave Mid systole. Just Before S1 A wave End-diastole.
Hope you found this blog helpful for your NEET SS Pediatrics Cardiology preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.
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