Cardio Flashcards
What is an atrial septal defect?
Birth defect in which there is a hole in the atrial septum.
Clinical features of an atrial septal defect, what murmurs are seen?
Often asymptomatic
Recurrent chest infections
Arrhythmias in later life
Ejection systolic murmur, loudest at the left upper sternal edge
Fixed and widely split second heart sound
Investigations of an atrial septal defect
Bedside
ECG
Imaging
CXR (may show evidence of heart failure and cardiomegaly)
Echocardiogram
May be done using bubble contrast to better visualise the defect
Management of an atrial septal defect
Often do not require treatment if the defect is small
Percutaneous closure of defect
What is an AVSD? Who is it commonly seen in?
Congenital heart defect in which there is an abnormal connection between the atria and the ventricles.
Commonly associated with Down syndrome
What does an AVSD present with?
Often asymptomatic
Symptoms of heart failure
Investigations of an AVSD
Bedside
ECG
Imaging
Echocardiogram
Management of an AVSD
Medical management of heart failure
Surgical closure
What is coarctation of the aorta? Who is it commonly associated with?
Congenital defect characterised by narrowing of the aorta.
Commonly associated with Turner syndrome
Cardiac defect in Down’s
AVSD
Cardiac defect in Turner’s
Coaractation of aorta
Clinical features of coarctation of aorta
Asymptomatic
Secondary cause of hypertension (should be considered in any young patient presenting with hypertension)
Radio-femoral delay
If severe, can cause heart failure and circulatory collapse
What diagnosis should be considered in any young patient with hypertension?
Aortic coarctationIn
Investigations of aortic coarctation
Bedside
ECG (features of left ventricular hypertrophy)
Imaging
CXR (rib notching)
ECG sign of aortic coarctation
LVH
CXR findings of aortic coarctation
Rib notchingM
Management of aortic coarctation
Often conservative if asymptomatic
May require surgical resection or stenting if severe
What is congenital complete heart block? what is it often assocaited with?
A congenital condition in which the electrical impulses from the atria does not transmit to the ventricles.
Often associated with maternal autoimmune disorders (e.g. SLE) and, in particular, the presence of anti-Ro and anti-La antibodies
Clinical features of congenital complete heart block
Bradycardia
Pale
Features of heart failure (e.g. shortness of breath)
Reduced exercise tolerance
Investigations of congenital complete heart block
Bedside
ECG
Imaging
Echocardiogram
Management of congenital complete heart block
Endocardial pacemaker insertion if symptomatic
What is Eisenmenger syndrome? Give examples of which conditions this can occur in
Serious complication of congenital heart disease characterised by reversal of a pre-existing left-to-right shunt. It has a very poor prognosis.
Causes of left to right shunt are PDA, ASD, VSD
THINK: 3 letters
Pathophysiology of Eisenmenger syndrome
In patients with a VSD or ASD, the left side of their heart will initially be stronger than the right, so blood from the left side will be shunted in to the right side.
This does not cause any major acute complications, however, it does lead to increased right heart pressures.
This, over time, will lead to right ventricular hypertrophy.
Eventually, the pressures generated by the right heart will exceed the pressures generated by the left heart resulting in reversal of the shunt. This will lead to cyanotic heart disease over time.
Clinical features of Eisenmenger syndrome
Cyanosis
Features of heart failure
Arrhythmia
Investigations of Eisenmenger syndrome
Bedside
ECG
Evidence of right ventricular hypertrophy
Imaging
Echocardiogram
Cardiac catheterisation
What may ECG and echo show in eisenemnger syndrome?
RVH
Management of eisenmenger syndrome
Difficult to treat once it is established
The only curative option is a heart-lung transplant
What is hypoplastic left heart syndrome?
Congenital heart defect characterised by underdevelopment of the left side of the heart resulting in features of left heart failure soon after birth.
Clinical features of hypoplastic left heart syndrome, why do these occur?
Cardiovascular collapse when the duct closes
This is because there is little output coming from the left ventricle, therefore, the right ventricle and the ductus arteriosus are responsible for maintaining the systemic circulation.
Management of hypoplastic left heart syndrome
Surgical correction (Norwood procedure)
Norwood procedure
Surgical correction of hypoplastic left heart syndrome
What is an interrupted aortic arch? What is it associated with?
Rare congenital heart defect in which there is no connection between the section of the aorta on either side of the ductus arteriosus
Associated with 22q11.2 deletion syndrome (DiGeorge Syndrome)
Clinical features of interrupted aortic arch
Features of heart failure and cardiogenic shock in the neonatal period
Features of DiGeorge syndrome (hypocalcaemia, palatal defects)
Cardiac defect in DiGeorgre syndrome
Interrupted aortic arch
Management of interrupted aortic arch
Prostaglandin infusion to maintain the ductus arteriosus
Surgical correction
What is patent ductus arteriosus?
Persistence of the ductus arteriosus (connecting the pulmonary artery to the aorta) after birth. It normally closes within 4 hours of birth.
RFs for patent ductus arteriosus
Prematurity
Maternal rubella
Clinical features of patent ductus arterious
Often asymptomatic and incidentally noted during routine neonatal examination
Can lead to features of heart failure (shortness of breath resulting from pulmonary oedema)
Management of PDA
Pharmacological Closure –> NSAIDs (e.g. IV Indomethacin, ibuprofen)
Surgical ligation or percutaneous catheter-guided closure
What is pulmonary stenosis? How does it usually present?
Narrowing of the pulmonary valve
Usually asymptomatic
Ejection systolic murmur
Evidence of right ventricular hypertrophy
Whaat mrumur is heard in PDA?
Gibson murmur –> continous, machine like
What murmur is heard in ASD?
ESM + fixed S2 splitting
Investigations for pulmonary stenosis
Bedside
ECG (right ventricular hypertrophy)
Imaging
CXR
Echocardiogram
Management of pulmonary stenosis
Transcatheter balloon dilatation
Criteria for Rheumatic Fever
Jones
What is in the criteria for Rheumatic fever?
What organism causes rheumatic fever?
Step pyogenes (group A strep)
Investigations for rheumatic fever
Bedside
ECG
Bloods
CRP
ESR
ASO Titre
Imaging
Echocardiogram
Management of rheumatic fever
Antibiotics
1stLine: Benzathine Benzylpenicillin
Alternative: Phenoxymethylpenicillin, Erythromycin
Arthritis
NSAIDs and Aspirin
Cardiac Complications
Anti-arrhythmics
ACE inhibitors
Diuretics
Chorea
Anticonvulsants
What antibiotics are used in rheumatic fever?
1stLine: Benzathine Benzylpenicillin
Alternative: Phenoxymethylpenicillin, Erythromycin
How is arthritis in rheumatic fever treated?
NSAIDs and Aspirin
How are cardiac complications in rheumatic fever treated?
Anti-arrhythmics
ACE inhibitors
Diuretics
How is chorea in rheumatic fever treated?
Anticonvulsants
What are the 3 types of cyanotic heart disease?
ToF
TGA
TA
What are the 3 types of left to right shunt? What type of heart disease do they cause?
PDA, ASD, VSD
They cause non-cyanotic heart disease
What are the two types of outflow obstruction? what do they cause?
Valve stenosis, aortic coarctation
non-cyanotic heart disease
What is the most common form of congenital cyanotic heart disease? What is it characterised by?
Tetralogy of Fallot
Large VSD
Overriding Aorta (caused by VSD)
Pulmonary Stenosis
Right Ventricular Hypertrophy (caused by pulmonary stenosis)
Clinical features of ToF
Infants develop cyanotic episodes often precipitated by exertion (e.g. feeding) - tet spells
May take up to 1 month for symptoms to be noted
When does cyanosis present in ToF? How does this compare to TGA and TA?
within days to months
TGA - hours
TA - minutes
Tet spells
ToF
What murmur heard in ToF
ejection systolic murmur at left sternal edge
Investigations in ToF
Bedside
ECG (often normal)
Imaging
CXR (boot-shaped heart)
Echocardiogram
CXR finding in ToF
boot shaped heart
Management of ToF
If the patient is profoundly cyanotic, they should be urgently started on a prostaglandin infusion (this keeps the ductus arteriosus open, thereby allowing blood from the systemic and pulmonary circulation to mix
Surgical correction
What is TGA?
Congenital cyanotic heart disease in which the main arteries leaving the heart are connected the wrong way around.
This means that blood is pumped from the right side of the heart directly into the systemic circulation, and blood from the left side of the heart is pumps back into the pulmonary circulation.
In essence, the two circuits are independent, and life is only sustained in utero due to mixing of blood via other connects (e.g. ductus arteriosus, septal defects)
Clinical features of TGA
Cyanosis soon after birth (usually within 2 days, as the ductus arteriosus closes)
NO murmur heard on auscultation
cyanotic heart disease with no murmur
TGA
Investigations for TGA
Bedside
ECG (often normal)
Hyperoxia Test
High-flow oxygen is applied to the patient but it fails to improve the saturation measured by the peripheral saturation probe as there is no connection between the pulmonary and systemic circulations.
Imaging
CXR (egg-on-a-string appearance)
Echocardiogram
How to assess whether cause is respiratory or cardiac in neonatal cyanosis?
Hyperoxia test
Do ABG on heel of baby, check initial pO2 and then give 100% o2 for 10 mins, then another ABG
If o2 increases respiratory not enough o2 to go into blood, then when supplemented issue resolves
If o2 remains low cardiac issue as even with supplemental o2, can’t get it to peripheries
CXR finding in TGA
egg-on-a-string appearance
Management of TGA
Acute Management of Cyanosed Infant
Promptly start prostaglandin infusion to keep the ductus arteriosus open
Balloon atrial sepstostomy may be considered to maintain connection between atria
Surgical correction (arterial switch)
What is tricuspid atresia? What does it result in?
Congenital heart defect in which the tricuspid valve fails to develop resulting in atrialisation of the right ventricle.
NOTE: As there is no connection between the right atrium and the right ventricle, there has to be a ventricular septal defect to allow blood to mix.
Clinical features of TA
Cyanosis
Shortness of breath
Management of TA
Prostaglandin infusion to maintain a patent ductus arteriosus
Surgical Intervention
Blalock-Taussig shunt (creates connection between subclavian artery and pulmonary artery)
Cavopulmonary anastomosis
Fontan procedure (redirect IVC and hepatic vein blood flow into the pulmonary circulation)
Blalock Taussing shunt
creates connection between subclavian artery and pulmonary artery –> used in surgical management of TA
What is VSD? How does it present?
Congenital heart defect in which there is a hole in the ventricular septum.
Often asymptomatic
Features of heart failure (e.g. shortness of breath)
Pansystolic murmur at the lower left sternal edge
What murmur in VSD?
Pansystolic murmur at the lower left sternal edge
Investigations in VSD
Bedside
ECG
Often normal
May show evidence of left or right ventricular hypertrophy
Imaging
CXR
Often normal but may show cardiomegaly and other changes associated with heart failure
Echocardiogram
Management of VSD
Defects often close spontaneously
Surgical closure of defect
