Cardiac conditions Flashcards
Cardiac failure
Causes (neonates, infants, children), signs and symptoms
Causes:
-
Neonates: Left heart obstruction
- Coarctation of the aorta
- Hypoplastic left heart syndrome (failure of LV development)
- Critical aortic valve stenosis
- Interruption of the aortic arch
-
Infants: High pulmonary blood flow (due to failure of blood to pass to the left side of the heart to be pumped into systemic circulation)
- VSD
- AVSD
- Large persistent ductus arteriosus
-
Older children and adolescents: Left or right sided heart failure
- Eisenmenger syndrome (Right sided only)
- Long standing L→ R shunt causes pulmonary hypertension and eventual reversal of the shunt into a cyanotic R → L shunt)
- Rheumatic heart disease
- Cardiomyopathy (dilated/hypertrophic/restrictive)
- Eisenmenger syndrome (Right sided only)
Symptoms:
- Breathlessness (worsened by feeding and exertion)
- Sweating
- Poor feeding
- Recurrent chest infection
Signs:
- Poor weight gaiin/faltering growth
- Tachypnoea
- Tachycardia
- Heart murmur - gallop rhythm
- Cardiomegaly
- Hepatomegaly
- Cool peripheries
Clinical presentation of congential heart disease
Signs and symptoms
- Antenatal cardiac USS diagnosis
- Detection of a heart murmur
- Heart failure
- Shock
- Cyanosis
Risk factors for congenital heart disease
- Genetics
- Down’s syndrome, Marfan’s
- External teratogens
- Warfarin, alcohol
- Maternal conditions
- Rubella, SLE, diabetes mellitus
Heart murmurs
Features of innocent heart murmurs, presentation of VSD/patent ductus arteriosus
*The most common presentation of congenital heart disease*
Features of innocent heart murmurs:
- Soft
- Systolic
- aSymptomatic
- left Sternal edge
- No parasternal thrill, no radiation
Febrile illness and anaemia → increased cardiac output → murmur heard - requires examination post-resolution of these conditions to confirm whether the murmur is pathological
Presentation of VSD/patent ductus arteriosus
- No symptoms or murmur at birth as pulmonary vasculature resistance is still high
- May only become symptomatic at several weeks of age (when the pulmonary vasculature resistance decreases)
Causes of heart failure in paedriatrics
Acyanotic congenital heart disease
Atrioventricular septal defect
Coarctation of the aorta
Duct-dependent lesions
Patent ductus arteriosus
SVT
Tetralogy of Fallot
Transposition of the Great Vessels
Ventriculoseptal/atrioseptal defects
Cardiac disease and association with other syndromes
Hypoplastic left heart
Myocarditis
HBE
Conditions causing left-to-right shunt
- Atrial septal defects
- Secundum ASD: A defect in the center of the atrial septum, involving the foramen ovale
- Partial atrioventricular septal defect (AVSD or prinum ASD)
- VSDs
- Persistent ductus arteriosus (PDA)
Atrial septal defects
Causes/classification, signs and symptoms
Causes/classification:
- Secundum ASD: A defect in the center of the atrial septum, involving the foramen ovale
- Partial atrioventricular septal defect (AVSD or prinum ASD)
Symptoms:
- Commonly, NONE
- Recurrent chest infections/wheeze
- Arrhythmias (4th decade onwards)
Signs:
- Ejection systolic murmur: Due to increased flow through the pulmonary valve, caused by the left to right shunt
- Fixed and widely split 2nd heart sound: Ventricular stroke volume is equivalent in both inspiration and expiration
- Partial AVSD → apical pansystolic murmur from AV valve regurgitation
List the key features that distinguish innocent from pathologic murmur.
Describe the features of a venous hum.
a.k.a. Nun’s murmur
!An innocent heart murmur!
- Best heard at the upper left sternal edge
- Right side of the neck, just above the clavicle
- ‘Machinery’ quality sound
- Due to flow through the great venous vessels
- Arises due to compression of the internal jugular vein by the clavicle. Causes the walls of the vessels to vibrate
- Distinguishing venous hum from PDA: Rotation/flexion of the neck or placing a finger on the jugular vein will abolish/change the murmur
Following CVS examination, be able to diagnose common murmurs.
Be able to describe the presenting features of cardiac failure
Usually related to poor tissue perfusion, rather than systemic congestion.
Related to increased compensatory sympathetic drive
Symptoms:
- Sweating (worsened by exertion/feeding)
- Dyspnoea
- Fatigue
- Cough
- Recurrent chest infections
Signs:
- Tachycardia
- Gallop rhythm
- Tachypnoea
- Auscultatory crackles (pulmonary oedema)
- Hepatomegaly
- Oedema
Be able to consider the differential diagnosis of cardiac failure.
- Nephrotic syndrome
- PE
- Pneumonia
*
Outline the initial management of a child with cardiac failure.
Bed rest and nurse in an up-right position
Supplemental oxygen (not in L → R shunt)
Ensure adequate nutrition
Diuretics
ACEi
List the epidemiology, features and management of common types of acyanotic heart disease e.g. VSD/ASD/AS/PS
