Cardiac Flashcards by Toni Whitaker

What is Patent Ductus Arteriosus

Failure of ductus between aorta and pulmonary artery to close
Left to right shunt
Bounding pulse, systolic murmur
If more severe -> HF : desaturation and respiratory distress
If symptomatic -> indomethacin or surgical ligation

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What is Tetralogy of Fallot

An overriding aorta
Right ventricular outflow tract obstruction
Ventricular septal defect
Right ventricular hypertrophy

Assoc with: Noonan’s, Down’s,

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Congenital heart disease:
L –> R shunt
Breathless

Ventricular Septal Defect
Persistent Ductus Arteriosus
Atrial Septal Defect

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Congenital heart disease
R –> L shunt
Blue

Tetralogy of Fallot

Transposition of the Great Arteries

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Outflow obstruction in well child

Asymptomatic with murmur

Pulmonary stenosis
Aortic stenosis
Adult type coarctation if aorta

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Outflow obstruction in sick neonate

Collapsed with shock

Coarctation of the aorta

Hypo plastic left heart syndrome

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Innocent murmurs

aSymptomatic
Soft blowing murmur
Systolic murmur only
left Sternal edge

No parasternal thrill
No radiation

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Heart failure symptoms

Breathlessness
Sweating
Poor feeding
Recurrent chest infections

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Heart failure signs

Tachypnoea
Tachycardia
Murmur
Cardiomegaly
Hepatomegaly
Cool peripheries

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Neonatal cause of heart failure

Obstructed (duct dependent) systemic circulation:
Hypoplastic left heart syndrome
Critical aortic valve stenosis
Severe coarctation of the aorta
Interruption of aortic arch

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Causes of heart failure in infants

High pulmonary blood flow:
Ventricular septal defect
Atrioventricular septal defect
Large persistent ductus arteriosus

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Causes of heart failure in children

Right or left heart failure:
Eisenmenger syndrome: RHF
Rheumatic heart disease
Cardiomyopathy

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Loud pansystolic murmur
Lower left sternal edge
Quiet pulmonary second sound

Small ventricular septal defects
Smaller than the diameter of the aortic
Up to 3 mm

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Soft pansystolic murmur
Apical mid diastolic murmur
Tachypnoea
Tachycardia

Large ventricular septal defect

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Continuous murmur
Beneath L clavicle
Increased pulse pressure
Collapsing/ bounding pulse

Patent Ductus Arteriosus

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Hyperoxia / Nitrogen Washout Test

Differentiates betw resp and cardiac causes of cyanosis
10 mins 100% Oxygen = max saturation of pulm circulation

Cyanosis improves: resp cause
No improvement: R -> L shunt

Severe cyanosis
Hypercyanotic spells + irritability
Loud harsh ejection systolic murmur, left sternal edge from day 1

Tetralogy of Fallot

What is Eisenmenger syndrome

Large L->R shunt / common mixing = high pulm blood flow
Untreated -> thick walled pulm arteries = incr resistance to flow
Shunt reduces -> fewer symptoms
Shunt reversal at 10-15yrs = blue
-> R heart failure

What is Tricuspid Atresia

Only L ventricle effective
R ventricle small + non functional
Common mixing in L atria
Cyanosis if duct dependent
Blalock-Taussig shunt: subclavian -> pulm artery = early palliation

Signs of aortic stenosis

Slow rising pulse
Carotid thrill
Ejection systolic murmur at right sternal edge -> carotid
Delayed soft aortic second sound
Apical ejection click
Reduced exercise tolerance, chest pain/ syncope on exertion

Signs of pulmonary stenosis

Ejection systolic, upper L sternal edge
Ejection click, upper L sternal edge
r ventricular impulse with ventricular hypertrophy

Adult type coarctation

Not duct dependent
Severity increases with age
Asymptomatic
L ventricular hypertrophy

Signs of adult type coarctation of aorta

Ejection systolic
Upper sternal edge
Radio femoral delay
Systemic htn in R arm
CXR: rib notching, 3 sign

Baby in shock
Absent femoral pulses
Severe metabolic acidosis

Coarctation of aorta

Arterial duct tissue encircle aorta
Closure-> constriction of aorta

What is Interruption of the Aortic Arch

No connection betw proximal aorta and arch distal to ductus Dependent on VSD and R->L shunt via duct Collapse Absent femorals and left brachial pulse

What is Hypoplastic Left Heart Syndrome

``` Underdeveloped L side of heart Oft with coarctation of aorta Collapse Absence of all peripheral pulses Norwood procedure ```

What is supraventricular tachycardia

``` Most common arrhythmia 250-300 bpm 'Re-entry tachycardia' Poor cardiac output + pulm oedema HF symptoms Cause of hydrops ```

Managing supraventricular tachycardia

Vagal stimulating manoeuvres: carotid sinus massage IV adenosine: breaks re-entry circuit If fails: cardiovert Maintenance therapy: flecainide, sotalol, propranolol Treatment stopped at 1 yr if no further attacks

Wolf Parkinson White

Atrioventricular reciprocating tachycardia Due to abnormal accessory pathway: bundle of Kent Palpitations, dizziness, syncope Delta wave on ECG Percutaneous radio frequency ablation of accessory pathway

What is congenital complete heart block

Maternal antiRo / antiLa antibodies prevent normal dev of cardiac conduction system Can cause: hydrops, death in utero, HF, syncope Req endocardial pacemaker

What is long QT syndrome

Sudden loss of consciousness in late childhood Assoc with exertion, stress or emotion Can -> sudden death from ventricular tachycardia AD Assoc w. Erythromycin therapy, electrolyte disorders, head injury

What is rheumatic fever

Abnormal immune response to Beta- haemolytic strep pharyngitis -> 2-6 wk latent period Polyarthritis, mild fever, malaise With active myocarditis limitation if exercise essential High dose aspirin +- corticosteroids Symptomatic HF:diuretics ACEi Prevent recurrence: monthly Ben pen until 18 yrs

Manifestations of rheumatic fever

``` Pericarditis Myocarditis Polyarthritis Sydenham chorea Erythema marginatum Raised: ESR, CRP, leucocytes Prolonged PR interval ```

Infective endocarditis risk in children with congenital heart disease

Risk highest with turbulence: VSD, coarctation, PDA, prosthesis Suspect with: Fever, malaise, raised ESR, unexplained anaemia/ haematuria 6wks IV penicillin + aminoglycoside : strep viridans Prophylaxis: good dental hygiene

What is dilated cardiomyopathy

``` Due to: inheritance, metabolic disease, viral myocarditis Suspect with enlarge heart + HF Diuretics, ACEi, carvedilol Usually improves spontaneously Some may need heart transplants ```

Kawasaki and cardiac disease

``` Echo at diagnosis Pericardial effusion Myocardial disease Endocardial disease Coronary disease with aneurysm formation may req angio or MRI ```

Pulmonary hypertension

VSD, AVSD, PDA Left untreated -> pulmonary vascular disease Req heart/lung transplant eventually inhaled NO, IV magnesium sulphate, oral phosphodiesterase inhibitors e.g. Sildafenil, IV prostacyclin, inhaled iloprost

What is Transposition of the great Arteries

Congenital malformation Aorta arises from R ventricle and the pulmonary artery from the L Duct dependent due to two parallel circulations Presents with cyanosis

Diastolic murmur | Heard loudest at the apex

Mitral stenosis | Almost always caused by rheumatic fever