Cardio Flashcards
What are innocent murmurs?
Flow related heart murmurs, that are not associated with any significant haemodynamic abnormalities, present in 30% of children
What are common causes innocent murmurs in children
- Systolic ejection
- Venous hum
- Vibration Murmur
What are common pathological paediatric heart murmurs?
- VSD (Pansystolic LL Sternal border)
- ASD (soft systolic 2ICS Left)
- Aortic stenosis
- Corctation of the Aorta
(Others include Pulmonary Valve stenosis, Patent ductus ateriosus, Fallot Teratology, Mitral Valve incompetence)
What are the most common signs and symptoms of heart failure in children?
Symptoms
- Fatigue
-Breathlessness
Signs
- cyanosis
- Failure to thrive
- (Extreme) Tachycardia
- Dependant on Pathology (e.g. murmur, Pulses, Heaves, thrills, etc.)
- Absent femoral pulses (Coarctation of the Aorta)
What are signs for Innocent heart murmurs on examination?
Sound
- mid-systolic or continuous (venous hum). No added clips
- Musical humming or vibratory quality
Position
- Left sternal border, neck , upper chest and no radiation
- Vary with intensity or posture/respiration/head position
Examination
- Asymptomatic
- Normal peripheral pulses
What are signs for pathological heart murmurs on examination (vs innocent)
Sound
- Harsh or long
- Mid or pan systolic murmur or diastolic continuer (PDA)
- Clicks and abnormal 2nd sound
Signs (ALWAYS Pathological)
- thrill
- Cardiomegaly
- Any cardiac symptoms
What murmur would a VSD present with?
harsh, pan systolic at left lower sternal border
- radiating all over chest
What murmur would a ASD present with ?
Soft Systolic in 2nd left ICS
Wide fixed splitting of 2nd HS
what Murmur would a Coarctation of Aorta present with?
Systoic murmur over left side of chest, especially in back
What murmur would pulmonary stenosis present with?
Systolic ejection murmur
Upper part of left chest
(Anterior, radiation to the back or axillae usually preceded by opening click)
2nd HS might be split, but not fixed
What Murmur would a PDA present with?
Patent ductus Ateriosus
Continous murmur after 3 months of age
Usually Pansystoic/Ejection systolic murmur in neonates
What additional examination finding would you expect in a 4 months old presenting with a continous (diastolic) murmur?
PDA
Associated with collapsing pulse O/E
How would you investigate innocent murmurs?
No investigation required (except if not all pathological murmur can be excluded)
You have a baby presenting with Cyanosis.
What features would you make lean more towards a cardiac cause of cyanosis, that a Pulmonary or benign cause?
- Persistent central cyanosis
(Low O2 sats (60-70%)
Admission of oxygen makes little different to sats
What features of a faint episode (e.g. in teenagers) makes you think more of a cardiac cause than vasovagal/ neurological?
Generally rare if child is otherwise well
- Exercise-induced syncope (during or just after exercise)
- Fainting with lying down/sitting
- Underlyign disease/infection
- Family History of cardiac disease or premature death
What is an aortic flow murmur? What does it sound like?
It is an innocent (Functional murmur)
1. short systolic murmur during left ventricular ejection
2. heart left sternal edge (2nd ICS or apex)
3. Musical in character (Like vibration of tuning fork)
When does a aortic flow murmur intensifies?
Fever
Exitement
Exercise
When does a innocent aortic flow murmur decrease in intensity?
Positional change from lying to standing/sitting
(If this intensifies, suggest pathology e.g. hypertrophic cardiomyopathy)
What is a pulmonary flow murmur?
What does it sound like?
Innocent murmur
Systolic ejection murmur caused by rapid flow over normal pulmonary valve
Brief, high pitched blowing, best heard in 2nd left ICS when child lying down
What is venous hum?
What does it sound like?
Innocent murmur
Caused by flow through systemic great veins
blowing, continous murmur heart at base of heart (just below clavicles), during both systole and diastole
Varies with position/ change of head
Usually disappears when child lies down ^
What are the commonest Causes for a Left to Right Cardiac shunt in paediatrics
- VSD
- ASD
What is Eisenmengers Syndrome?
Irreversible complication from severe, longstanding ASD or VSD
Prolonged pulmonary hypertension due to a left-to-right shunt causes reactive constriction with permanent remodeling of pulmonary vessels → irreversible pulmonary hypertension
Management
Needs Cardio-pulmonary transplant or lung transplant with VSD repair
What is a Cyanotic Congenital Heart Defect?
A congentital Heart defect, that cases a Right to Left Shunt –> entering of non-oxygenated blood into the circulation –> cyanosis and hypoxia
Generally Present with Cyanosis earlier
What are examples for “common” cardiac cyanotic congenital heart diseases?
- Teratology of Fallot
- Transposition of the Great Vessels
