VSD- Loud, pansystolic murmur, LLSB
- NOT from flow through the defect; more from turbulent flow in the R ventricle
- Loud S2 if pulmonary HTN
- Potential for Eisenmenger Syndrome
- Also caused by ASD, PDA
- Left-to-right shunt => increased pulmonary flow => damage => pulmonary HTN => Right-to-left shunt => Cyanosis
- Presents with cyanotic episodes in teenage years
Innocent murmur
- Systolic
- Except venous hum, which is innocent but systolic + diastolic
- Soft
- Normal heart sounds
- Normal pulses
- No thrill
- No radiation
- Position dependent
- Asymptomatic
- Normal CXR and ECG
Kawasaki syndrome - Autoimmune medium-vessel vasculitis
- Diagnosis:
- Fever of ≥5 days' duration plus 4 of:
- Bilateral nonsuppurative conjunctivitis
- One or more changes of the mucous membranes of the upper respiratory tract
- Pharyngeal injection, dry fissured lips, injected lips, "strawberry" tongue
- One or more changes of the extremities
- Peripheral erythema, peripheral edema, periungual desquamation, generalized desquamation
- Polymorphous rash
- Cervical lymphadenopathy
- Can cause fatal coronary artery aneurysms
- Treatment:
- IVIG
- Aspirin
- One of the few conditions for which it's indicated in kids
- cf Rey's syndrome
- Plasma exchange
- Corticosteroids?
- Poor evidence and may increase risk of coronary artery aneurysms
IVIG therapy
- Contains the pooled, polyvalent, IgG from the plasma of over one thousand blood donors
- Effects last between 2 weeks and 3 months
- Mechanism unclear
- Activates inhibitory Fc receptors on dendritic cells
- => anti-inflammatory effects
- Indications
- Immune deficiencies
- X-linked agammaglobulinemia
- Hypogammaglobulinemia
- Acquired compromised immunity conditions featuring low antibody levels
- Autoimmune disease
- Inflammatory diseases
- Acute infections
Tet spells
- Problem
- Not entirely clear
- Sudden decrease in pulmonary blood flow and therefore oxygenation?
- Increased pulmonary vascular resistance? (Crying)
- Fall in systemic vascular resistance
- Begins a cycle:
- Acidosis => Hyperventilation
- => More systemic venous return
- => More R=>L shunt
- => Even less pulmonary blood flow
- Also spasm of pulmonary artery?
- Place in a knee-chest position
- Increase systemic vascular
resistance
- Oxygen
- IV morphine
- Venoconstriction => More peripheral venous blood pooling => Less venous return => Less R=>L shunt
- Sedative effect
- IV propranolol
- Relaxes the infundibular muscle spasm causing right ventricular (RV)
outflow tract obstruction (RVOTO)
Coarctation of the aorta- HARD TO FIND PULSES
- Ejection systolic murmur radiating to between the shoulder blades
- Symptoms depend on where to coarctation is
- Pre-dutal
- Ductal
- Post-ductal
- See rib notching on CXR, due to collateral vessels
Transverse myelitis
- Pathogenesis
- Inflammatory process of the spinal cord
- => axonal demyelination
- Transverse implies that the inflammation is across the thickness of the spinal cord
- Causes
- Progresses vary rapidly
- Presentation
- Depends on level
- Upper cervical cord => Quadriplegia, Resp. paralysis
- C5–T1 => Combination of upper and lower motor neuron signs in the upper limbs; exclusively upper motor neuron signs in the lower limbs
- T1–12 => Upper motor neuron signs in the lower limbs, presenting as a spastic diplegia
- L1–S5 => Combination of upper and lower motor neuron signs in the lower limbs
- Motor impairment
- Sometimes have some sensory impairment
Notes
- AMPLE
- Allergies
- Medications
- Past Medical History
- Last Eaten
- Events Leading
- Breathlessness in a baby makes it hard for them to feed => FTT
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