Cardio Flashcards
What does the ductus venosus become when it closes?
After delivery becomes ligamentum rotundum of the liver
Mixing of oxygenated and deoxygenated blood occurs where in the heart?
RIGHT ATRIUM
Between what is the foramen ovale located?
Between the 2 atriums
What connection exists between the pulmonary artery and the aorta?
DUCTUS ARTERIOSUS
(right to left shunt)
What changes occur in the fetal circulation at birth?
- Pulmonary VR FALLS
- Pulmonary BF rises
- SVR rises
Ductus arteriosus, foramen ovale and ductus venosus close
Patent ductus arteriosus is very common in preterm infants: How is it treated?
Fluid restriction/diuretics, prostaglandin inhibitors (indomethacin, ibuprofen), surgical ligation
In term babies there is a good chance of spontaneous closure, not prostaglandin sensitive
Is pulmonary stenosis symptomatic?
Asymptomatic in mild stenosis, in moderate and severe get exertional dyspnoea & fatigue
What murmur can be felt in pulmonary stenosis?
Ejection systolic murmur upper left sternal border with radiation to back
If intervention is required (as determined by echo in moderate + cases) in pulmonary stenosis what is the most common intervention?
Balloon valvoplasty
When is valve replacement often delayed till?
After puberty ideally
What is the most common valvular problem in childhood?
Pulmonary stenosis
Aortic stenosis is mostly asymptomatic but what symptoms do you get if its severe?
Reduced exercise tolerance, exertional chest pain, syncope
Ejection systolic murmur upper right sternal border, radiation into carotids
(Williams syndrome-supravalvular aortic stenosis)
Why is valve replacement often required earlier after a balloon valvoplasty in aortic stenosis (compared to pulmonary stenosis)?
Aortic regurg is not as well tolerated
Where does coarctation of the aorta usually happen?
On the descending part of the arch-where ductus enters (delayed closure can mean condition is picked up later…thats nae good)
What is the clinical presentation of coarctation of the aorta?
Weak or absent femoral pulses
Radio-femoral delay (only in chronic co-arctation)
Systolic murmur loudest on back
Sudden deterioration and collapse
How is coarctation of the aorta managed?
- Re-open PDA with prostaglandin E1 or E2
- Resection with end to end anastomosis
- Subclavian patch repair
- Balloon Aortoplasty
What is the prescence of central cyanosis almost always due to?
A cyanotic heart defect and signifies a right to left shunt
What is transposition of the great arteries?
When the aorta comes out of the right ventricle while the pulmonary artery comes out of the left ventricle
If there is no shunt between these two circulations the baby wont be able to survive very long
To survive transposition of the great arteries what do you need?
Either an open ductus arteriosus (infusion of prostaglandin), a large ASD or a large VSD or a combo
Rashkind procedure can be performed if duct does close
To survive transposition of the great arteries what do you need?
Either an open ductus arteriosus (infusion of prostaglandin), a large ASD or a large VSD or a combo
Rashkind procedure can be performed if duct does close
What is the definitive treatment for transposition of the great arteries?
Switch procedure
What is the Tetralogy of Fallot?
4 abnormalities
- Narrowing of the right ventricular outflow tract
- Pulmonary valve stenosis
- Ventricular septal defect
- Overriding aorta
In Tetralogy of fallot what is the result of the right ventricle outflow obstruction?
There is marked right ventricular hypertrophy and the right ventricular pressure is so high that it suppresses the left ventricular pressure and there is a large right to left shunt over the VSD
This means that the baby will become centrally cyanosed
Corrected surgically at around 6 months (5kg body weight)
How is tetralogy of fallot managed?
- Palliative measures=beta blockers, Blalock Taussig shunt
- Full correction at 5kg body weight
- Life long follow up due to recurring RVOT (right ventricular outflow tract obstruction)
What are the 3 main types of ventricular septal defects?
- Subaortic
- Perimembranous
- Muscular
Where is a pansystolic murmur felt?
Lower left sternal edge, sometimes with a thrill
What murmurs are heard in small vs large VSDs?
In very small VSDs, early systolic murmur
In very large VSDs diastolic rumble due to relative mitral stenosis
Signs of cardiac failure in large VSDs, eventually leading to biventricular hypertrophy and pulmonary hypertension
What is Eisenmenger syndrome characterised by?
Long-standing left-to-right cardiac shunt caused by a congenital heart defect (typically by a ventricular septal defect, atrial septal defect, or less commonly, patent ductus arteriosus) causes pulmonary hypertension[1][2] and eventual reversal of the shunt into a cyanotic right-to-left shunt.
How can VSD closure be done?
Amplatzer or other occlusion device, trans-catheter
Patch closure, open heart surgery
Atrial septal defects: what is the course of these conditions?
Few clinical signs in early childhood, good chance of spontaneous closure
Sometimes detected in adulthood with AF, HF or pulmonary HT
Wide fixed splitting of 2nd heart sound, pulmonary flow murmur
What is Atriovetriculo-septal defect or endocardial cushion defect or AV canal defect associated?
Associated with Trisomy 21
Singular AV valve with ostium primum ASD and high VSD
Can you get Atrioventricular septal defects?
YES
AVSD (atrioventricular septal defect)- can be a complete AVSD
What is crucial to look at in an examination related to CVS?
Weight and Height
Dysmorphic features
Cyanosis
Clubbing
Tachy-/Dyspnoea
Pulses/Apex (femoral pulses!)
Heart Sounds (clicks, split, 3rd and 4th)
Murmurs
Are most murmurs in children innocent murmurs?
70-80% of murmurs
NOT A DIAGNOSIS OF EXCLUSION
Specific Features
4 Types
What are the common features of an innocent murmur?
Systolic murmur (continuous in venous hum)
No other signs of cardiac disease
Soft murmur, grade 1/6 or 2/6
Vibratory, musical
Localised
Varies with position, respiration, exercise
What arrythmia is mainly seen in paediatric cardiology?
SVT
What is the aetiology of congenital heart defects?
Genetic susceptibility-environmental hazard
Teratogenic insult (18-60 days post conception)
What environmental factors can affect CVS of foetus?
- Drugs (alcohol, amphetamines, lithium etc)
- Infections (TORCH-Toxoplasma, Rubella, CMV, Herpes)
- Maternal (DM, SLE)
What CHD is associated with Trisomy 21?
Specifically AVSD but ASD and VSD are more common
What CHD is associated with Turner syndrome?
COARCTATION OF AORTA
What CHD is associated with Noonan syndrome?
PULMONARY STENOSIS
What CHD is associated with Williams Syndrome?
SUPRAVALVULAR AORTIC STENOSIS
22q11 deletion syndrome is also associated with CHD: what syndrome is this?
Di George syndrome
