Cardiac Problems Flashcards by Megan Rose

What are the symptoms of cardiac disease in an infant?

Breathlessness
Difficulty feeding
Poor weight gain
Sweating with feeding
Cyanosis
Collapse

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What are the features of an innocent heart murmur?

Systolic (diastolic is never innocent)
Low intensity
Asymptomatic
Often loudest at left sternal edge but may be elsewhere (e.g. venous hum)

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Which type of cardiac defects are more likely to present with neonatal collapse?

Duct-dependent lesions

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What is the difference between systemic and cyanotic duct dependent lesions?

Systemic:

severe obstruction of blood flow out of left side of heart
systemic circulation dependent on PDA

Cyanotic:
- obstruction to pulmonary blood flow OR lack of oxygenation of systemic blood

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Which conditions are systemic duct dependent lesions?

Hypoplastic left heart syndrome
Critical aortic stenosis
Interrupted aortic arch (or severe coarctation)

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Which conditions are cyanotic duct dependent lesions?

Transposition of the great arteries

Pulmonary atresia with intact septum

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What are the features of an atrial septal defect (ASD)?

SOB, cyanosis, haemoptysis
Chest pain
Ejection systolic murmur in pulmonary area
Split S1, wide fixed split S2
Pulmonary hypertension
Raised JVP
AF

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How is ASD diagnosed?

Echo

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What would be seen on ECG and CXR in ASD?

ECG: right axis deviation, RBBB
CXR: cardiomegaly, prominent pulmonary artery

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How is ASD managed?

Surgical closure - open or trans catheter

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What are the features of a VSD?

Harsh pan systolic murmur at left sternal edge
CHF: tachycardia, SOB, hepatomegaly
Systolic thrill
Parasternal heave

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How is a VSD diagnosed?

Echo

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What would be seen on ECG and CXR in VSD?

ECG: LVH signs
CXR: cardiomegaly, large pulmonary arteries

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How is a VSD managed?

Initially medical as may close spontaneously:
- diuretics for HF
- ACE inhibitors to reduce afterload
Surgical closure if unsuccessful/complications

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What are the complications of VSD?

Aortic regurgitation
Infective endocarditis
Eisenmenger’s –> shunt reversal + cyanosis

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What is coarctation of the aorta?

Narrowing of the descending aorta –> LV pressure overload, CHF, HTN and hypo perfusion of lower body

What are the clinical features of coarctation of the aorta?

Raised BP
Radio-femoral delay +/- weak femoral pulse
Systolic murmur in left intraclavicular area + below left scapula
Early heart failure if severe

What might be seen on CXR in coarctation of the aorta?

CHF

Rib notching

How is coarctation of the aorta diagnosed?

Echo

If unclear –> CT or MRI

How is coarctation of the aorta managed?

Surgery:

indications: CHF or severe HTN
-> open angioplasty or balloon angioplasty with stenting

What are the features of a PDA?

Asymptomatic or SOB + poor feeding in infancy
Continuous machine like murmur
Left subclavicular systolic thrill
Displaced, heavy apex beat
Collapsing pulse and wide pulse pressure

How is PDA diagnosed?

Echo

How is PDA managed in a preterm infant?

Treat if symptomatic:

IV NSAIDs (first line)
surgical ligation (second line)

What is the most common congenital heart defect?

VSD

What are the risk factors for VSD?

``` Maternal diabetes Maternal rubella Foetal alcohol syndrome Uncontrolled maternal PKU Family history of VSD Trisomy 21, 13 and 18 ```

What are the complications of VSD?

Endocarditis

What are the four features of Tetralogy of Fallot?

VSD Pulmonary stenosis Right ventricular hypertrophy Overriding aorta

What are the risk factors for TOF?

``` Males Family history of CHD Teratogens: - alcohol - warfarin - trimethadione (anti epileptic) Genetics: - CHARGE syndrome - Di George syndrome - VACTERL association ```

What are the features of CHARGE syndrome?

``` Coloboma Heart defects Atresia choanae Retardation of growth/development Genitourinary anomalies Ear anomalies ```

What are the features of VACTERL?

``` Vertebral anomalies Anorectal malformation Cardiac defects Tracheo-oesophageal fistula Renal anomalies Limb malformations ```

What are the clinical features of TOF?

``` Poor growth SOB including acute hypoxic episodes Cyanosis + clubbing Ejection systolic murmur Toddlers may squat to increase peripheral resistance and hence reduce right --> left shunt ```

How is TOF diagnosed?

Echo

What might be seen on CXR in TOF?

Boot shaped heart

How is TOF managed?

``` Surgery by 1 year (earlier if severe) Medical therapy until then if symptomatic: - oxygen - morphine - beta blockers - prostaglandins to keep ducts open ```

What is transposition of the great arteries?

Aorta + pulmonary artery the wrong way round

What are the features of transposition of the great arteries?

Cyanosis in first 24 hours of life Prominent right ventricular heave Systolic murmur if VSD present No signs of respiratory distress

How is transposition of the great arteries diagnosed?

Echo

What does transposition of the great arteries look like on CXR?

'Egg on a string'

How is transposition of the great arteries managed?

Initial: - emergency prostaglandin to keep ductus arteriosus open - correct metabolic acidosis - atrial balloon septostomy to allow mixing Definitive: - surgical correction, usually before 4 weeks