cardio

Question 1

innocent murmur?

Answer 1

soft
systolic
symptomless
standing
sitting

Question 2

co-arction of aorta murmur?

Answer 2

ejection systolic murmur

Question 3

pansystolic murmur?

Answer 3

ventricular septal defects

Question 4

atrial septal defect

Answer 4

ejection systolic murmur
with a fixed splitting of 2nd heart sound

Question 5

ejection systolic murmur heard at the left upper parasternal edge

Answer 5

Pulmonary stenosis

Question 6

congenital heart defects are classified as?

Answer 6

cyanotic -
acyanotic

Question 7

decrease in systemic oxygen saturation due to bypass of lungs is what type of congenital heart defect?

give examples?

Answer 7

cyanotic
results in bluish skin and mucous membranes

tetralogy of fallot
tricuspid atresia

Question 8

what is tetralogy of fallot ?

Answer 8

co-existing pathology of following:

Ventricular septal defect (VSD)
Overriding aorta
Pulmonary valve stenosis
Right ventricular hypertrophy

Question 9

how does toF present?

Answer 9

cyanosis
clubbing
poor feed
poor weight gain
ejection systolic murmur

Question 10

tet spell?

Answer 10

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

Question 11

what two factors cause a tet spell?

Answer 11

pulmonary vascular resistance increases
systemic resistance decreases

Question 12

mx of tet spell?

Answer 12

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

Question 13

toF each pathology explain
VSD
overriding aorta
pulmonary valve stenosis
right ventricular hypertrophy

Answer 13

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

Question 14

fetal circulation basics

Answer 14

blood travels from placenta > collect ocygen and nutrients and dispose waste products

Co2, lactate

Question 15

three shunt system of fetal circulation

Answer 15

ductus venosus
foramen ovale
ductus arteriosus

Question 16

ductus venosus

Answer 16

connects umbilical vein to inferior vena cava

blood bypasses liver

Question 17

foramen ovale

Answer 17

shun connects RA and LA
allows blood to bypass Rv, and pulmonary circulation

Question 18

ductus arteriosus

Answer 18

pulmonary artery with aorta
allows blood to bypass pulmonary circulation

Question 19

blood travels from placenta to body how?

Answer 19

umbilical vein > ductus venosus > inferior vena cava > ra > RV> PA> Ductus arteriosus into aorta > body

Question 20

how is pulmonary vascular resistance decreased at birth?

Answer 20

breaths baby takes expands alveoli decreasing PV resistance

Question 21

what causes closure of foramen ovale?

Answer 21

left atrial pressure > right atrial pressure squashes atrial septum to cause closure of FO

Question 22

when / what becomes fossa ovalis

Answer 22

closure of the formaen ovale after a few weeks of neonate from birth

Question 23

what helps maintain ductus arteriosus open?
increase in what causes a drop in circulating prostaglandins

Answer 23

prostaglandins

increased blood oxygenation causes a drop in circulating prostaglandins

this closes ductus arteriosus > ligamentum arteriosum

Question 24

what are prostaglandins?

what activates prostaglandins?

how are prostaglandin levels reduced?

Answer 24

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

Question 25

cyanotic murmur in a newborn at 2 days would be?
at 2 months would be?

Answer 25

tGA

TOF

Question 26

PDA is associated with what features?
what murmur?

Answer 26

continous machinery murmu due to continuous blood flow from high pressure aorta to lower pressure pulmonary artery

Question 27

PDA associated features

Answer 27

heaving apex beat (increased ventricular overload)
machinery murmur
wide pulse pressure
left subclavicular thrill

Question 28

Left subclavicular thrill can be found in patients with PDA

why?

Answer 28

thrill is a palpable vibration
over areas of turbulent blood flow
blood rushing through the PDA from aorta to the pulmonary artery

Question 29

Bisferiens pulse

Answer 29

2 systolic peaks separated by mid systolic dip

seen in HOCM
aortic regurgitation