PANCE Blueprint Cardiology (16%)

Physical Exam: Wide fixed split second heart sound (S2). Systolic ejection murmur at second left intercostals space with an early to mid-systolic rumble. Failure to thrive.

Diagnosis: Best diagnosed by passing catheter through defect

Treatment:

• Symptomatic: Diuretics, ACE inhibitors, digoxin
• Definitive: Surgical closure

Population: Turner’s syndrome

Physical exam: Higher blood pressures in the arms than in the legs and pulses are bounding in the arms but decreased in the legs

• The murmur associated with coarctation of the aorta may be nonspecific yet is usually a systolic murmur in the left infraclavicular area and under the left scapula

Chest radiograph: “Figure of 3 sign”

The figure 3 sign is seen in aortic coarctation and is formed by prestenotic dilatation of the aortic arch and left subclavian artery, indentation at the coarctation site (also known as the "tuck"), and poststenotic dilatation of the descending aorta.

• The ductus arteriosus is a blood vessel which connects the pulmonary artery to the aorta. In utero this allows most of the blood to bypass the lungs.  Treat with indomethacin

Population: Preterm infants

Physical exam:

• Wide pulse pressures. Bounding pulses
• A continuous "machinery murmur" at the upper left sternal border (mnemonic: ** remember the patient got a patent for his machine)

Treatment: Indomethacin if preterm

Presentation: Variable- asymptomatic to symptoms of heart failure

Physical exam: Loud, harsh, pansystolic murmur at the lower left sternal border

Treatment: Most close by age 6, surgery if large

Presentation: Difficult feeding, failure to thrive. "tet spells", baby with cyanosis and loss of consciousness with crying

Four features: PROVe

1. P ulmonary Stenosis
2. R ight ventricular hypertrophy
3. O verriding aorta
4. V entricular septal defect

Physical exam: Crescendo-decrescendo, holosystolic at LSB radiating to the back

Chest radiograph: Boot shaped heart

Tetralogy of Fallot