cardio Flashcards
innocent murmur?
soft
systolic
symptomless
standing
sitting
co-arction of aorta murmur?
ejection systolic murmur
pansystolic murmur?
ventricular septal defects
atrial septal defect
ejection systolic murmur
with a fixed splitting of 2nd heart sound
ejection systolic murmur heard at the left upper parasternal edge
Pulmonary stenosis
congenital heart defects are classified as?
cyanotic -
acyanotic
decrease in systemic oxygen saturation due to bypass of lungs is what type of congenital heart defect?
give examples?
cyanotic
results in bluish skin and mucous membranes
tetralogy of fallot
tricuspid atresia
what is tetralogy of fallot ?
co-existing pathology of following:
Ventricular septal defect (VSD)
Overriding aorta
Pulmonary valve stenosis
Right ventricular hypertrophy
how does toF present?
cyanosis
clubbing
poor feed
poor weight gain
ejection systolic murmur
tet spell?
R>L shunt is worsened > cyanotic episode
child physically exerts themself
generating Co2
co2 is a vasodilator > systemic vasodilation
reducing systemic vascular resistance
blood flow chooses path of least resisitance so blood is pumped from right ventricle to aorta instead of pulmonary vessels bypassing lungs
> reduced oxygenated blood
irritable, cyanotic sob
reduced consciousness
seizures
death
what two factors cause a tet spell?
pulmonary vascular resistance increases
systemic resistance decreases
mx of tet spell?
escalate to paeds emergency
o2
beta block - relaxes r ventricle
IV fluids ; preload increases
morphine - decreease resp drive
sodium bicarb - metabolic acidosis buffer
phenylephirine infusion
toF each pathology explain
VSD
overriding aorta
pulmonary valve stenosis
right ventricular hypertrophy
VSD - allows blood to flow between ventricles
overriding aorta ; entrance to aorta is further right, above VSD. so right ventricle can can send the blood upwards to aorta and you have a proprotionod deoxygenated blood entering aorta from right side of heart
stenosis of of PV; greater resistance to flow of blood from r ventricle
> blood into aorta rather than via pulmonary vessels. encourage right to left shunt = cyanosis
thickened heart muscle
fetal circulation basics
blood travels from placenta > collect ocygen and nutrients and dispose waste products
Co2, lactate
three shunt system of fetal circulation
ductus venosus
foramen ovale
ductus arteriosus
ductus venosus
connects umbilical vein to inferior vena cava
blood bypasses liver
foramen ovale
shun connects RA and LA
allows blood to bypass Rv, and pulmonary circulation
ductus arteriosus
pulmonary artery with aorta
allows blood to bypass pulmonary circulation
blood travels from placenta to body how?
umbilical vein > ductus venosus > inferior vena cava > ra > RV> PA> Ductus arteriosus into aorta > body
how is pulmonary vascular resistance decreased at birth?
breaths baby takes expands alveoli decreasing PV resistance
what causes closure of foramen ovale?
left atrial pressure > right atrial pressure squashes atrial septum to cause closure of FO
when / what becomes fossa ovalis
closure of the formaen ovale after a few weeks of neonate from birth
what helps maintain ductus arteriosus open?
increase in what causes a drop in circulating prostaglandins
prostaglandins
increased blood oxygenation causes a drop in circulating prostaglandins
this closes ductus arteriosus > ligamentum arteriosum
what are prostaglandins?
what activates prostaglandins?
how are prostaglandin levels reduced?
group of lipids called thromboxane derived from arachidonic acid
cox2
anti-inflammatory drugs like aspirin and ibuprofen block COX enzymes so reduce it - reduce inflammation in same way
cyanotic murmur in a newborn at 2 days would be?
at 2 months would be?
tGA
TOF
PDA is associated with what features?
what murmur?
continous machinery murmu due to continuous blood flow from high pressure aorta to lower pressure pulmonary artery
PDA associated features
heaving apex beat (increased ventricular overload)
machinery murmur
wide pulse pressure
left subclavicular thrill
Left subclavicular thrill can be found in patients with PDA
why?
thrill is a palpable vibration
over areas of turbulent blood flow
blood rushing through the PDA from aorta to the pulmonary artery
Bisferiens pulse
2 systolic peaks separated by mid systolic dip
seen in HOCM
aortic regurgitation
