NURS 653 Exam 1 (Maryville University) study guide
atrial septal defect (ASD) an opening in the septum separating the atria
ASD pathophysiology Acyanotic defect, shunting blood between 2 atria
-ostium secundum- most common (mid septum) Embryologic defect
3 types of ASD -stium primum Lower septum most common in Downs
-sinus venosus
-Often no CV symptoms! in infants and young kids
-Older kiddos/adults=exercise intolerance/fatigue/HF
Clinical findings in ASD - S2 widely split on auscultation
- Best heard at pulmonic valve
-Murmur easy to her age 2-3yrs due to inc. blood flow across pulmonary valve
-Most common congenital heart defect (20-30%!)
VSD (ventricular septal defect)
-Hole in ventricular septum
1) Perimembranous (most common)
2) Muscular
VSD types
3) Inlet
4) Subpulmonary
-Classic loud murmur
-Small VSD- harsh high pitched Large- low pitched holosystolic
-Large VSD- low-pitched holosystolic with rumble at apex
VSD clinical findings
-S3 S4 gallop if CHF is developing
-Presentation depends on size of defect and the PVR.
-Left-to-right shunt
-common asymptomatic until age 6 months
-most close spontaneously by age 4 (increase in pitch over time
VSD
means spontaneous closure)
- 95% have no chromosomal abnormalities
-Clinical features are FTT, tachypnea, and diaphoresis with feeds.
VSD clinical features
- monitor weight- may need increased calories
, -Normal heart sounds
-asymptomatic
- < 3/6 intensity
benign heart murmurs characteristics -systolic-most common
of: -changes with position
-varies in loudness with fever, anemia anxiety or excer.
-Musical quality
Systolic- *most common
Heart murmurs classification: Diastolic murmur* always indicates cardiac
pathology! Continuous * most common
PDA
Grade 1-6
1: barely audible
2: soft easily audible
Murmur grades- does not always
3: moderately loud, no thrill
indicate severity
4: Loud present over widespread area + thrill
5: Loud audible with stethescope barely on chest,
+precoridal thrill present 6:loud, can heart without
stethoscope (rare)
-newborn
-Peripheral pulmonary artery stenosis
-still murmur
types of innocent murmurs
-pulmonary ejection murmur
-venous hum
-carotid bruit
-Diasolic murmur always pathologic
-THRILL always pathologic
-pansystolic murmur (obscures S1)
Pathologic murmur qualities: - systolic murmur with thrill
-fixed splitting
-not positional
-grade 3/4 or higher
begins with systole S1 and end with S2; Classic mitral regurgitation or VSD
What is a holosystolic murmur?
may also occur with ventricular septal defects and patent
ductus arterioles NOT benign
most
common
What is a still murmur? Heard at
ISB,
increases when supine
musical
benign
innocent, but NOT
What is a pulmonary flow murmur? positional common
older kids/teens
+ thin chest walls
Innocent and
atrial septal defect (ASD) an opening in the septum separating the atria
ASD pathophysiology Acyanotic defect, shunting blood between 2 atria
-ostium secundum- most common (mid septum) Embryologic defect
3 types of ASD -stium primum Lower septum most common in Downs
-sinus venosus
-Often no CV symptoms! in infants and young kids
-Older kiddos/adults=exercise intolerance/fatigue/HF
Clinical findings in ASD - S2 widely split on auscultation
- Best heard at pulmonic valve
-Murmur easy to her age 2-3yrs due to inc. blood flow across pulmonary valve
-Most common congenital heart defect (20-30%!)
VSD (ventricular septal defect)
-Hole in ventricular septum
1) Perimembranous (most common)
2) Muscular
VSD types
3) Inlet
4) Subpulmonary
-Classic loud murmur
-Small VSD- harsh high pitched Large- low pitched holosystolic
-Large VSD- low-pitched holosystolic with rumble at apex
VSD clinical findings
-S3 S4 gallop if CHF is developing
-Presentation depends on size of defect and the PVR.
-Left-to-right shunt
-common asymptomatic until age 6 months
-most close spontaneously by age 4 (increase in pitch over time
VSD
means spontaneous closure)
- 95% have no chromosomal abnormalities
-Clinical features are FTT, tachypnea, and diaphoresis with feeds.
VSD clinical features
- monitor weight- may need increased calories
, -Normal heart sounds
-asymptomatic
- < 3/6 intensity
benign heart murmurs characteristics -systolic-most common
of: -changes with position
-varies in loudness with fever, anemia anxiety or excer.
-Musical quality
Systolic- *most common
Heart murmurs classification: Diastolic murmur* always indicates cardiac
pathology! Continuous * most common
PDA
Grade 1-6
1: barely audible
2: soft easily audible
Murmur grades- does not always
3: moderately loud, no thrill
indicate severity
4: Loud present over widespread area + thrill
5: Loud audible with stethescope barely on chest,
+precoridal thrill present 6:loud, can heart without
stethoscope (rare)
-newborn
-Peripheral pulmonary artery stenosis
-still murmur
types of innocent murmurs
-pulmonary ejection murmur
-venous hum
-carotid bruit
-Diasolic murmur always pathologic
-THRILL always pathologic
-pansystolic murmur (obscures S1)
Pathologic murmur qualities: - systolic murmur with thrill
-fixed splitting
-not positional
-grade 3/4 or higher
begins with systole S1 and end with S2; Classic mitral regurgitation or VSD
What is a holosystolic murmur?
may also occur with ventricular septal defects and patent
ductus arterioles NOT benign
most
common
What is a still murmur? Heard at
ISB,
increases when supine
musical
benign
innocent, but NOT
What is a pulmonary flow murmur? positional common
older kids/teens
+ thin chest walls
Innocent and
