Cardio - 1 - Presentations/left-to-right shunts Flashcards
What are the presenting features of cardiac failure?
Breathlessness Sweating Poor feeding Recurrent chest infections Wheezing
Faltering growth Tachypnoea without recession! Tachycardia Heart murmur/Gallop rhythm Hepatomegaly Cool peripheries
What are the features of innocent murmur?
5 S (InnoSent) Soft Systolic only aSymptomatic left Sternal edge
Also, there is:
no parasternal thrills
no radiation
More common in <6 months
When are innocent murmurs more common in children?
During febrile illness or anaemia (increased cardiac output)
List the epidemiology of acyanotic heart diseases (VSD, ASD, AS, PS)
ASD: Secundum ASD (80%) Partial atrioventricular septal defect (pAVSD)
What are the features of ASD?
Primum and secundum are similar, except that secundum involves centre of septum with foramen ovale and a regurgitant left AV valve.
Commonly no symptoms
Recurrent chest infections
Arrhythmias (4th decade onwards)
What are the physical signs of ASD?
Increased flow through pulmonary valve leads to Ejection systolic murmur (upper left sternal edge)
Apical pansystolic murmur in pAVSD from atrioventricular valve regurgitation
What are the presenting features of ASD on CXR?
Enlarged heart
Enlarged pulmonary arteries
Increased pulmonary vascular markings
What are the features of ASD on ECG?
secundum ASD:
Right axis deviation (due to right ventricular enlargement)
Right BBB
pAVSD: Superior axis (negative deflection in lead AVF) because middle part of heart, where the AV node is, is displaced.
What is the mainstay of ASD diagnosis?
Echocardiogram
Delineates anatomy
How is ASD managed in children?
If significant (ie right ventricular enlargement)
Secundum ASD:
Cardiac catheterisation, inserting an occlusion device. (plug or patch)
partial AVSD:
surgical correction
At ca. 3-5 years of age to prevent RHF and arrhythmias in later life
What is the prevalence of different types of left-to-right shunts (breathless) in congenital heart disease?
VSD - 30%
Persistent arterial duct - 12%
Atrial septal defect - 7%
What are the causes for cardiac failure in neonates?
there is obstructed left ventricle and thus (duct-dependent) systemic circulation. Right-to-left flow via arterial duct
Hypoplastic left heart syndrome.
Critical aortic valve stenosis.
Severe coarctation of the aorta.
Interruption of the aortic arch.
What are the causes of heart failure in infants (>1week old)
VSD
ASD
large PDA
What are the causes of heart failure in older children and adolescents?
Eisenmenger syndrome (RHF)
Rheumatic heart disease
Cardiomyopathy
What are the symptoms, auscultation signs and ECG results of small VSD?
Management?
<3mm diameter.
Asymptomatic.
ECG normal.
CXR normal.
Loud pansystolic murmur at lower sternal edge!
Quiet pulmonary second sound (P2).
Lesion will close spontaneously. Good dental hygiene to prevent bacterial endocarditis.