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Is there a murmur? Cardiomegaly with cardiac murmurs suggests valvular disease, but it also suggests congestive heart failure and advanced myocardiopathies. One should also be sure that the murmur is not a pericardial friction rub.
Is ... DIAGNOSTIC WORKUP
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Is it acute or chronic? An acute cardiac arrhythmia should make one consider a myocardial infarction first.
Is the heart rate slow, normal, or fast? A rapid cardiac arrhythmia may be associated with ... DIAGNOSTIC WORKUP
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Could the murmur be extracardiac in origin? Extracardiac murmurs include the pericardial friction rub and cardiorespiratory murmurs.
Is the murmur continuous? A continuous murmur is most often due to a ... DIAGNOSTIC WORKUP
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Cardiomegaly is defined as enlargement of the heart above the normal size. When looking at a chest X-ray, one must be sure that an anterior-posterior view is being used, because the heart may appear falsely enlarged on a posterior-anterior view. When true... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Cardiac auscultation should be performed in a systematic manner. Normal heart sounds (S1, S2) should be identified, and the precordium should be examined for gallops (S3, S4) and additional heart sounds.
Differential Diagnosis ... Workup and Diagnosis ... Treatment
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The patient should be asked to describe the heart rhythm and to demonstrate it by either saying or tapping the speed and rhythm of the sensation. Additionally, teaching the patient to measure his or her pulse during the episode may give more clues as to... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Abnormal heart sounds are common in pediatric patients and usually benign. Approximately 50% of children will have an innocent murmur at some time, compared to a 1% incidence of congenital heart disease (nearly all of which present by 1 year of age).
... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Heart failure exists when adequate cardiac output cannot be maintained either at rest or with activity. It can be either acute, chronic, or an acute decompensation of the chronic state, and represents a wide range of anatomic and pathophysiologic conditions. The three main... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... If an x-ray film demonstrates cardiomegaly, the physician must find out what is causing this condition ( Table 13 ). You have already listened to the patient and he or she does not have a murmur. This seems to exclude the common
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... With few exceptions, the etiologies of cardiac arrhythmias like those of bradycardia can best be recalled using the mnemonic VINDICATE. The exceptions are from one pathophysiologic cause: obstruction and consequent dilatation of one or more of the chambers of the heart.
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... Left Heart Failure
Hypertensive heart disease
Coronary artery disease
Left ventricular diastolic dysfunction
Acute myocardial infarction
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... Arrhythmia (with or without digitalis intoxication)
Tachyarrhythmia
Ventricular fibrillation (e.g., prolonged QT syndromes)
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... Systolic
Early systolic
Physiologic (innocent)
Small ventricular septal defect
Large ventricular
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... In valvular heart disease, three types of mechanical disruption can occur: stenosis, or narrowing, of the valve opening; incomplete closure of the valve; or prolapse of the valve. They can result from such disorders as endocarditis (most common)... Treatment ... Special considerations ... Pictures
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... Signs and Symptoms Loss of consciousness, absent pulse, apnea, anuria, cool extremities
Treatment (Tx) CPR, fluids, epinephrine, vasopressin, oxygen, mechanical ventilation, defibrillation, amiodarone,
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... In cardiac arrhythmias (sometimes called cardiac dysrhythmias), abnormal electrical conduction or automaticity changes heart rate and rhythm. (See Normal cardiac conduction, page 1126.) Arrhythmias vary in severity, from those... Causes ... Signs and symptoms ... Diagnosis ... Special considerations ... Pictures
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... In cardiac tamponade, a rapid, unchecked rise in intrapericardial pressure impairs diastolic filling of the heart. The rise in pressure usually results from blood or fluid accumulation in the pericardial sac. If fluid accumulates rapidly, this condition requires emergency... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Signs and Symptoms Left-sided: dyspnea, orthopnea, crackles, wheezing, hypoxia, respiratory acidosis, cough, cyanosis, palpitations, arrhythmias, elevated blood pressure, pulsus alternans; right-sided: dependent peripheral edema, hepatomegaly, splenomegaly, jugular vein... Treatment (Tx) ... Pictures
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... Acute rheumatic fever is a systemic inflammatory disease of childhood, in many cases recurrent, that follows a group A beta-hemolytic streptococcal infection. Rheumatic heart disease refers to the cardiac manifestations of rheumatic fever and includes... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... John Coe and Ron Sand
Cardiomegaly is a common, nonspecific finding that can be detected by physical examination, electrocardiogram (ECG), chest radiograph, or echocardiogram. With rare exceptions, it is a sign of organic heart disease. The... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Anthony F. Jerant
Congestive heart failure (CHF) is the most frequent reason for hospitalization among older adults in the United States. Nearly one-third of a national cohort of 170,239 Medicare enrollees hospitalized for the first time with CHF... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... David E. Anisman and Gerald F. Farnell
A diastolic murmur is a finding that provides a clue to an underlying disease process. Unlike their systolic counterparts (Chapter 7.7), diastolic murmurs almost always indicate... Approach ... History ... Physical examination (PE) ... Testing ... Diagnostic assessment ... Pictures
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... Dale Bishop
Systolic murmurs can herald significant clinical deterioration and sudden death, or they can represent stable or clinically insignificant conditions. Although technologic advances in cardiac diagnostic testing continue, auscultation remains the... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Differential Overview
❑ Congestive heart failure
❑ Hypertensive left ventricular hypertrophy
❑ Anterior myocardial ischemia
... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Phenomena
❑ S4 gallop
❑ Midsystolic click
❑ S3 gallop
❑ Loud S2... Diagnostic Approach ... Clinical Findings
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... In valvular heart disease, three types of mechanical disruption can occur: stenosis, or narrowing, of the valve opening; incomplete closure of the valve; or prolapse of the valve. They can result from such disorders as endocarditis (most common),... Treatment ... Special considerations ... Pictures
... READ EXCERPTS »
... Abnormal electrical conduction or automaticity changes heart rate and rhythm in cardiac arrhythmias, also called cardiac dysrhythmias. (See Types of cardiac arrhythmias.)
Arrhythmias vary in severity, from those that are mild, asymptomatic, and... Causes ... Special considerations ... Pictures
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... With cardiac tamponade, a rapid, unchecked rise in intrapericardial pressure impairs diastolic filling of the heart. The rise in pressure usually results from blood or fluid accumulation in the pericardial sac.
If fluid... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
... READ EXCERPTS »
... A syndrome characterized by myocardial dysfunction, heart failure leads to impaired pump performance (reduced cardiac output) or to frank heart failure and abnormal circulatory congestion. Congestion of systemic venous circulation may result in peripheral edema or hepatomegaly;... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Often recurrent, acute rheumatic fever is a systemic inflammatory disease of childhood that follows a group A beta-hemolytic streptococcal infection. Rheumatic heart disease refers to the cardiac manifestations of rheumatic fever,... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Normal murmursare due to turbulence of normal blood flow. A normal murmur does not result insymptoms. Cardiovascular exam, chest radiograph, and ECG are normal.Other terms used to signify a normal murmur are benign, insignificant,or innocent. ... Principal Causes of Heart Murmurs (Asymptomatic) ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Clinicalsyndrome resulting from inability of myocardium to meet metabolicdemands of body. Combination of tachypnea, tachycardia,cardiomegaly, and hepatomegaly is cardiac failure until proved otherwise. In many cases, several... Principal Causes of Cardiac Failure ... Clinical Features and Diagnosis ... Diagnostic Approach ... Table 7.1. Diagnostic Classification of Common Causes of CardiacFailure ... References
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If an x-ray film demonstrates cardiomegaly, the physician must find out
what is causing this condition (Table 13). You have already
listened to the patient and he or she does not have a murmur. This seems to
exclude the common groups of causes—... Pictures
... READ EXCERPTS »
...
With few exceptions, the etiologies of cardiac arrhythmias like those
of bradycardia can best be recalled using the mnemonic VINDICATE. The
exceptions are from one pathophysiologic cause: obstruction and
consequent... Pictures
... READ EXCERPTS »
... Author:
Sarika Joshi, MD
What to Do - Take Action
Antibiotic prophylaxis for patients with certain types of heart disease (e.g.,
rheumatic heart disease, infective endocarditis, and congenital heart disease
[CHD]... Suggested Readings
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... Author:
Russell Cross, MD
What to Do - Make a Decision, Take Action
Ketamineisadirect-actinganestheticthatiswidelyusedinpediatricpractice
because of its dissociative properties and perceived beneficial cardiovascular
effects. It is... Suggested Readings
... READ EXCERPTS »
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