<3 Flashcards
ToF 4 Features…
- Large VSD
- Pulmonary stenosis
- Aorta that overrides the VSD
- RV Hypertrophy
Patients with tetralogy have hypercyanotic spells, characterized by cyanosis, breathlessness and pallor. These can lead to myocardial ischaemia and death. Examination may reveal a loud, long ejection sys-tolic murmur heard best in the third intercostal space with a single heart sound. Chest X-ray may reveal a ‘boot-shaped’ heart, where the normally convex-shaped pulmonary artery on the left heart border becomes a concavity. Congenital cyanotic heart conditions can result in clubbing.
ToF sx…
cyanosis in first few days of life.
severe syanosis, hyper cyanotic spells.
irrability/ inconsolable crying
ToF murmur…
Loud harsh ejection systolic murmur at the left sternal edge – from day 1.
With increasing right ventricular outflow tract obstruction, which is predominantly muscular and below the pulmonary valve the murmur will shorten and cyanosis will increase.
What is ToGA?
Aorta connected to RV.
Pulmonary artery connected to LV.
Blue blood –> body.
Pink Blood –> lungs
ToGA sx…
Cyanosis!! At day 2 - when duct closes, marked reduction in mixing of blood.
MOst common CHD?
VSD
.You are asked to see a 2-day-old baby girl. She is tachycardic and cool to the touch. There is no murmur and no cyanosis. The femoral pulses are difficult to palpate.
Coarctation of the aorta.
severe presnts soon after birth - wehn ductus arteriosus closes
femoral pulses are weak - reduced blood flow in aorta distal to stenosis.
Milder stenosis - present adulthood, HF, murmur, HT.
CXR - Rib Notching
as large intercostal collateral arteries
A 4-month-old girl presents with breathlessness. Her health visitor is concerned, as she is failing to thrive. Over the last 2 months, there have been intermittent episodes of her turning blue, especially when she is upset. These episodes resolve spontaneously. A chest X-ray reveals a boot-shaped heart.
ToF
1.Large VSD2.Pulmonary stenosis3.Aorta that overrides the VSD4.Right ventricular hypertrophy
.A 4-month-old girl presents with breathlessness. Her health visitor is concerned, as she is failing to thrive. The parents deny any episodes of cyanosis. On examination, there is a moderate pansystolic murmur at the lower left sternal edge associated with a parasternal thrill. A chest X-ray reveals cardiomegaly.
VSD
small normally asx.
large - membranous.
present HF - SOB, difficulty feeding, xs sweaing, lower resp tract infrctions, failure to thrive.
ESM - small defect.
Pansystolic Murmu - larger.
not corrected –> irreversible pulomary HT is caused, then shunt reverses = Eisenmengers Syndrome.
You are asked to see a 2-day-old baby girl. She is tachycardic and cool to the touch. There is no murmur, but she looks blue. The femoral pulses are palpable.
ToGA
great vessels are reversed (transposed), with the aorta coming off the right ventricle and the pulmonary artery off the left ventricle.
therefore dependent on ductus arteriosis - to supply oxygenated vlood to systemic circulation.
Chest X-ray shows a characteristic narrow mediastinum with an ‘egg-on-side’ appear-ance of the heart shadow. The ‘switch operation’ (surgical swapping of the pulmonary artery and aorta) is required as definitive management.
A 4-month-old girl presents with breathlessness. Her health visitor is concerned, as she is failing to thrive. The parents deny any episodes of cyanosis. On examination, she has a loud murmur present throughout systole and diastole, heard best just inferior to the left clavicle. A chest X-ray reveals moderate cardiomegaly.
PDA
more common if prem
Features of PDA include a continuous machinery-sounding murmur inferior to the left clavicle.
If the PDA is significant, massive left-to-right shunting of blood causes heart failure. Management is with indometacin (a prostaglandin synthetase inhibitor that closes the defect) or surgical ligation.
Rx… CoA
surgical ligation/ balloon dilatation of stenosis.
A.Diastolic – second left intercostal space
B.Diastolic – second right intercostal space
C.Diastolic – fifth right intercostal space
D.Diastolic – apex
E.Ejection systolic – second left intercostal space
F.Ejection systolic – second right intercostal space
G.Pansystolic – fourth intercostal space, right adjacent to sternum
H.Pansystolic – fifth intercostal space, left adjacent to sternum
I.Pansystolic – apex
J.Systolic and diastolic – inferior to left clavicle
1.Ventricular septal defect
H – Pansystolic – fifth intercostal space, left adjacent to sternum
A ventricular septal defect is the most common congenital cardiac lesion in children. The murmur is pansystolic, which means that it is heard throughout systole. This murmur is caused by shunting of blood from the high-pressure left ventricle to the low-pressure right ventricle.
A.Diastolic – second left intercostal space
B.Diastolic – second right intercostal space
C.Diastolic – fifth right intercostal space
D.Diastolic – apex
E.Ejection systolic – second left intercostal space
F.Ejection systolic – second right intercostal space
G.Pansystolic – fourth intercostal space, right adjacent to sternum
H.Pansystolic – fifth intercostal space, left adjacent to sternum
I.Pansystolic – apex
J.Systolic and diastolic – inferior to left clavicle
Mitral Stenosis
.D – Diastolic – apex
Mitral stenosis is almost always caused by rheumatic fever, which in itself is now rare in the UK. The murmur is found at the end of diastole and is heard best in the mitral region (fifth intercostal space, left side, midclavicular line – the apex).
A.Diastolic – second left intercostal space
B.Diastolic – second right intercostal space
C.Diastolic – fifth right intercostal space
D.Diastolic – apex
E.Ejection systolic – second left intercostal space
F.Ejection systolic – second right intercostal space
G.Pansystolic – fourth intercostal space, right adjacent to sternum
H.Pansystolic – fifth intercostal space, left adjacent to sternum
I.Pansystolic – apex
J.Systolic and diastolic – inferior to left clavicle
Aortic Stenosis
F – Ejection systolic – second right intercostal space
In mild cases, aortic stenosis will usually cause no symptoms in early life. As the child gets older, the stenosis may become more severe due to calcification of the valve. In critical aortic stenosis, heart failure will ensue rapidly after birth. The murmur is systolic and is heard loudest at the second right intercostal space parasternally (the aortic area). The murmur is associated with an ejection click and the murmur may be conducted to the neck (carotids).
