cardiac disorders Flashcards
causes of a left-to-right shunt?
- VSD
- ASD
- PDA
presentation of left-to-right shunt?
breathless
causes of a right-to-left shunt?
- ToF
- TGA
presentation of a right-to-left shunt?
blue
a) how does AVSD present?
b) why?
a) blue and breathless
b) blood from both ventricles is mixing
causes of outflow obstruction in a WELL child?
- PS
- AS
cause of outflow obstruction in a sick neonate?
CoA
which cardiac conditions can a maternal rubella infection cause?
- peripheral pulmonary stenosis
- PDA
cardiac presentation in child where there is maternal SLE?
- complete heart block
- anti-Ro
- anti-La
which cardiac conditions can maternal warfarin therapy cause?
- pulmonary valve stenosis
- PDA
which cardiac conditions can foetal alcohol syndrome cause?
- ASD
- VSD
- ToF
congenital heart diseases seen in Down syndrome?
- AVSD
- VSD
immediate management in duct-dependent cyanosis?
prostaglandin!!!
causes of ejection systolic murmur?
- AS
- ASD
- PS
- HOCM
- ToF
causes of pansystolic murmur?
- MR
- TR
- VSD (‘harsh’)
causes of a late systolic murmur?
- MV prolapse
- CoA
causes of an early diastolic murmur?
- AR
- PR
cause of continuous murmur?
PDA
which conditions could bring on an innocent murmur?
- febrile illness
- anaemia
4 Ss of an innocent murmur?
- soft blowing
- systolic only
- sternal edge (left)
- symptomless (pt is asymptomatic)
presentation of heart failure?
- breathlessness
- sweating
- poor feeding (and FTT)
- recurrent chest infections
- tachypnoea
- tachycardia
- hepatomegaly
- cool peripheries
character of murmur heard in heart failure?
galloping rhythm
causes of right-sided heart failure?
- pulmonary hypertension
- long-standing rheumatic fever
- tricuspid regurgitation
signs of right heart failure?
- ankle oedema
- sacral oedema
- ascites
commonest cause of heart failure in neonate?
- coarctation of the aorta
- severe aortic stenosis
- any other left ventricular outflow obstruction
causes of heart failure in infants?
- high pulmonary blood flow
- VSD
- ASD
- large PDA
causes of heart failure in older children?
- eisenmenger syndrome (right sided only)
- rheumatic heart disease
- cardiomyopathy
normal O2 sats for an infant?
> 93%
infectious cause of cyanosis with respiratory distress in neonate?
septicaemia following GBS infection
presentation of congenital heart disease?
- antenatal ultrasound finds increasing proportion
- murmur
- cyanosis
- heart failure
- left-to-right shunt usually
- shock
character of murmur in a small VSD?
- loud, pansystolic murmur at lower left sternal edge
- louder = smaller defect!
management of a small VSD?
- none
- they close spontaneously
- follow up shows that murmur has disappeared
main complication of a small VSD?
- bacterial endocarditis
- keep good dental hygiene
age at presentation of large VSD?
> 1 week old
features of large VSD?
- heart failure with breathlessness
- FTT
- recurrent chest infections
- hepatomegaly
- tachypnoea
- tachycardia
- active precordium
character of murmur in large VSD
- soft pansystolic murmur
- no murmur = very big VSD!
commonest type of ASD?
secundum ASD
features of ASD?
- asymptomatic
- recurrent chest infections / wheeze
- arrhythmia (in 40s)
- murmur
what is heard in auscultation in ASD?
- ejection systolic mumur
- loudest at upper left sternal edge
- fixed, split S2 sound
character of murmur in a partial AVSD?
apical pansystolic
signs on CXR of ASD?
- cardiomegaly
- enlarged pulmonary arteries
- increased pulmonary vascular markings
signs on ECG in secundum ASD?
- partial right bundle branch block
- right axis deviation
gold standard investigation for ASD?
echocardiography
management of
a) secundum ASD?
b) partial AVSD?
a) cardiac catheterisation
b) surgery at 3-5 years (to prevent RSHF)
purpose of nitrogen washout test?
to determine if cyanosed neonate has congenital heart disease
describe the nitrogen washout test
- neonate placed in 100% O2 for 10 mins
- if right radial arterial PaO2 <15kPa, then cyanotic heart disease (ToF, TGA)
- BUT must exclude pulmonary hypertension first
management of right-to-left shunt?
- ABCs
- prostaglandin infusion 5ng/kg/min
commonest cyanotic congenital heart disease?
tetralogy of Fallot
4 cardinal features of ToF?
- large VSD
- overriding aorta
- RVOTO
- RV hypertrophy (last sign)
symptoms of ToF?
- murmur in first 2m of life
- severe cyanosis
- clubbing of fingers and toes (older children)
character of murmur heard in ToF?
- loud, harsh ejection systolic
- left sternal edge
- from day 1 of life
signs on CXR of ToF?
- boot-shaped heart
- right-sided aortic arch
- pulmonary artery “bay”
- decreased pulmonary vascular markings
ECG changes in ToF?
- normal at birth
- RVH when older
management of ToF?
- surgery at 6 months
- closes VSD
- artificial patch can be put across pulmonary valve
management of hypercyanotic spells in ToF?
- most are self-limiting
- if lasts >15 mins, give morphine
- then IV propanolol
- bicarbonate (corrects the acidosis)
what is the artery set up in TGA?
- aorta comes out of RV
- PA comes out of LV
- O2 blood going to lungs, de-O2 blood going to body
- no mixing, two parallel circuits
symptoms of TGA?
- cyanosis
- loud, single S2
- may be a systolic murmur
X-ray signs in TGA?
- cardiac shadow looks like “egg on side”
- increased pulmonary vascular markings
ECG in TGA?
normal
management of TGA infant?
- maintain the ductus arteriosus with prostaglandins
- balloon atrial septostomy
explain eisenmenger syndrome
- happens following a L-to-R shunt
- pulmonary arteries eventually get stenosed
- they get more resistant to flow
- leads to pulmonary HTN
- shunt reverses (R-to-L)
- 10-15 years of age
- before shunt reverses, their symptoms get eased
a) conditions with common mixing?
b) presentation?
a) complete AVSD, tricuspid atresia
b) blue and breathless
which condition is complete AVSD most associated with?
Down syndrome
ECG finding in complete AVSD?
superior axis
presentation of complete AVSD in neonate?
- cyanosis
- heart failure at 2/3 weeks of age
management of complete AVSD?
- treat the heart failure
- surgical repair at 3-6 months
