Rapid Acquisition Of Key Concepts Pediatrics Cardiovascular

Apr 8, 2024

Rapid Acquisition Of Key Concepts Cardiovascular

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) Orientation of leads is changed - Leads can be shifted to right side, ST elevation is in rV4	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
V1, V2, V3 leads are shifted to V4, V5, V6 V4, V5, V6 leads are shifted to V7, V8, V9 Kept in posterior scapular lines. ST segment elevation

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 pressure
Y 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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