Cardiac Problems Flashcards
What are the symptoms of cardiac disease in an infant?
Breathlessness Difficulty feeding Poor weight gain Sweating with feeding Cyanosis Collapse
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)
Which type of cardiac defects are more likely to present with neonatal collapse?
Duct-dependent lesions
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
Which conditions are systemic duct dependent lesions?
Hypoplastic left heart syndrome
Critical aortic stenosis
Interrupted aortic arch (or severe coarctation)
Which conditions are cyanotic duct dependent lesions?
Transposition of the great arteries
Pulmonary atresia with intact septum
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
How is ASD diagnosed?
Echo
What would be seen on ECG and CXR in ASD?
ECG: right axis deviation, RBBB
CXR: cardiomegaly, prominent pulmonary artery
How is ASD managed?
Surgical closure - open or trans catheter
What are the features of a VSD?
Harsh pan systolic murmur at left sternal edge
CHF: tachycardia, SOB, hepatomegaly
Systolic thrill
Parasternal heave
How is a VSD diagnosed?
Echo
What would be seen on ECG and CXR in VSD?
ECG: LVH signs
CXR: cardiomegaly, large pulmonary arteries
How is a VSD managed?
Initially medical as may close spontaneously:
- diuretics for HF
- ACE inhibitors to reduce afterload
Surgical closure if unsuccessful/complications
What are the complications of VSD?
Aortic regurgitation
Infective endocarditis
Eisenmenger’s –> shunt reversal + cyanosis
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
