cardio Flashcards
Foetal anatomy:
what are the 3 shunts and what are their functions?
-Foramen ovale (R + L Atria)
-Ductus arteriosus (pul artery + aorta)
(Both bypass lungs)
-Ductus venosus (umbilical vein into IVC)
What blood vessels run through the umbilical cord? what do they carry?
1 umbilical vein (oxygenated blood to baby)
2 umbilical arteries (deoxygenated away from baby)
Name some cyanotic cardiac disease?
-Tetrology of fallot
-transposition of great arteries
-tricuspid atresia
-total anomalous pulmonary venous return
cyanosis is when Hb is?
deoxygenated Hb >5g/dL
Acyanotic can become cyanotic due to?
Eisenmenger syndrome
what is eisenmenger syndrome?
ASD or VSD allows L to R shunting causing pulmonary htn
Pulmonary pressure > systemic, then R to L shunting
Blood bypasses lung = cyanosis
what do benign murmurs occur?
Turbulent flow through naturally smaller valves
Is a thrill normal or pathological?
when is a thrill common?
Thrill = pathological
Common during febrile illness and anemia (high CO)
How do benign murmurs sound?
Soft blowing murmur
aSx
Systolic only
left Sternal edge
no added Sounds
varies with poSture
what are the main RFs for congenital heart disease (CHD)?
Maternal rubella
diabetes
downs
what does CHD increase the risk of?
IE + arrhythmia risk
Sx of CHD?
Poor feed
Failure to thrive
Dx of CHD?
echo
Tx of CHD?
Surgery
Indomethacin / NSAIDS (<1y)
Alprostadil (prostaglandin E1) >1y
what is the MC CHD in babies?
ventricular septal defect
what is an atrial septal defect?
Failure of atrial septum to close
(acyanotic)
what are the types of atrial septal defects?
Ostium secundum (80%)
MC = Centre of atrial septum
osmium primum
(lower part of atria)
formen ovale
RF for atrial septal defect?
Downs!!
foetal alcohol syndrome
Sx of atrial septal defect?
what is heard on auscultation?
Mid systolic crescendo decrescendo at upper L sternal border
Fixed S2 splitting
(high O2 sats in RA, RV, PA = extra blood volume = delayed pul valve closure = S2 split)
Dx of atrial septal defect?
antenatal scan
newborn examination
Tx of Atrial septal defect?
Monitor child - small openings may close
Surgery - via catheter or open heart, patch/plug in place
Anticoagulants
Complications of atrial septal defect?
Paradoxical embolism (RA -> LA -> Systemic circulation)
Stroke
AF / Aflutter
Pulmonary htn
RHF
eisenmengers
what is a ventricular septal defect?
Septum between ventricles has opening
RF for ventricular septal defect?
Downs
what is heard in ventricular septal defect?
quieter = ?
Harsh pan systolic murmur at L lower sternal border
quieter = bigger
Dx of ventricular septal defect?
Antenatal scan
newborn examination
Tx of ventricular septal defect?
Small + no pulmonary htn or HF = watched over time
Bigger = surgical - tranvenous catheter / open
RF for atrioventricular septal defect?
Downs!
Sx and what is heard in atrioventricular septal defect?
No murmur
severe distress
Tx of atrioventricular septal defect?
ECHO
HF Tx
What is patent ductus arteriosus?
failure of ductus ateriosus to close leading to blood moving from aorta to pulmonary artery
High pul htn + right heart strain
when does the ductus arteriosus normally stop functioning and closes?
Stops functioning = 1-3 days
closes at 2-3 weeks
RF for patent ductus arteriosus
Rubella (1/3)
prematurity
Sx and what is heard in patent ductus arteriosus?
Poor growth, infections, dyspnoea, lower body cyanosis
-Continuous machinery murmur at L subclavian border
-Wide pulse pressure (bounding collapsing pulse)
-Heaving apex
Tx of patent ductus arteriosus?
ECHO monitoring
<1y = NSAIDs / Indomethacin
>1y = surgery
Dx of patent ductus arteriosus?
ECHO - ventricular hypertrophy
why do we give NSAIDS for patent ductus arteriosus?
Prostaglandins keep Ductus arteriosus open
NSAIDS inhibit prostaglandin activity
what is the MC cause of cyanotic CHD in 50-70% children?
tetralogy of fallot
what is tetralogy of fallot?
4 heart abnormalities
what are the 4 abnormalities in tetralogy of fallot?
- pulmonary stenosis
- R ventricular hypertrophy
- large ventricular septal defect
- Overriding aorta
RF for tetralogy of fallot?
Di Georges
Downs
Rubella
Maternal DM
M>40Y
Foetal alcohol
Sx of tetralogy of fallot?
what is heard?
Cyanosis of lips and fingers at birth
clubbing after months
feeding difficulties
fail to develop
Ejection systolic murmur at pulmonary valve
what are ‘tet spells’ in tetralogy of fallot?
High O2 = heart pumps more blood =
Sudden low O2 Sats (worsened L to R) = cyanotic episode = improved by squatting
why is a ‘tet spell’ in tetralogy of fallot improved by squatting?
High vascular resistance in peripheral arteries
high systemic circulation pressure
High pressure L>R side
Shunt temporarily reverses
Dx of tetralogy of fallot?
Antenatal
Chest x ray = boot shaped heart (RVH)
ECG = R axis deviation
ECHO = degree
Tx of a tet spell in tetralogy of fallot?
O2
Morphine
IV fluids (+ bicarb if acidotic)
IV Propanolol (peripheral vasoconstrictor = relaxed RV)
Tx of tetralogy of fallot?
Neonates = prostaglandin infusion
GS = total surgical repair - VSD closure, pul stenosis corrected (outflow tract enlarged) in 1st year life
what is transposition of great arteries?
Pulmonary arteries + aorta swap places
RF for transposition of great arteries?
associated with?
Maternal DM
VSD, CoA, pul stenosis
Sx of transposition of great arteries?
No Sx in utero as FO + DA
Cyanotic within 1h birth
tachypnoea
often another shunt present (ASD, VSD, PDA)
no murmur
Dx of transposition of great arteries?
ECHO
Chest xray = sideways egg
Tx of transposition of great arteries?
Neonates = prostaglandin E1 infusion (keeps DA open)
Surgical correction
what is levo - transposition of great arteries?
R + L ventricle switch too
normal function
Acyanotic
what is coarctation of the aorta?
narrowing of aorta, distal to branches, near ductus arteriosus
RF for coarctation of the aorta?
turners
Sx of coarctation of the aorta?
High BP in upper body + head, low BP in lower body
-Htn + bounding pulse in upper body
- weak/absent femoral pulse
- R-R / R-F delay
-Cold extremeties
- dizziness / epistaxis
what is coarctation of the aorta associated with?
berry aneurysm + HTN
Dx of coarctation of the aorta?
what is heard?
systolic murmur between 2 clavicles
Chest xray = intercostal artery tortousity, figure 3 sign, rib notching (Roester sign)
Tx for coarctation of the aorta?
Balloon angioplasty
what is triscupid atresia?
what is it associated with?
absence of tricuspid valve (no opening)
non functional RV
assoc with another shunt
What is hypoplastic Left heart syndrome?
malformation of L heart, hypoplastic LV + mitral atresia
What is ebstein anomaly?
Tricuspid valve (septal and posterior leaflets) is set lower in R side of heart towards apex = bigger RA and smaller RV
what is ebstein anomaly associated with?
RF for it?
associated with ASD + WPW
RF = maternal lithium
what murmurs are heard in ebstein anomaly?
gallop rhythm + sail sound
2x murmurs:
1. Pan systolic (tricuspid regurgitation)
2. Mid diastolic (tricuspid stenosis)
Heart failure manifests as?
oedema (facial and sacral)
Causes of Heart failure in:
neonates?
infants?
older?
severe co-arctation of aorta
L to R shunts eg. VSD, ASD, AVSD, PDA
Eisenmengers, RHD, cardiomyopathy
Sx of Left heart failure?
backs up in lungs
SOB, gallop rhythm, cool peripheries, cardiomegaly
Sx of right heart failure?
backs up In body
-peripheral oedema
-hepatomegaly
Tx for Heart failure?
-Ionotropes (increases heart contraction)
-ABAL (ACE-I, BB, Aldosterone agonist eg. spironolactone, Loop diuretics eg. furesomide)
-High calorie diet
What is infective endocarditis?
RF?
Infection into inflammation of heart valves
CHD
Causes of infective endocarditis?
S.aureus MC
S.viridans
S.epidermidis
HACEK
What would you typically see in a Px with infective endocarditis? How would it present?
What are all kids with IE + CHD having surgery given?
Fever and new murmur with increased risk in CHD
All kids with CHD having surgery given prophylactic Abx
Sx of infective endocarditis?
DUKE criteria
2 major or 1 major 2 minor
New murmur, fever, septic signs, immunological signs
vegetations = brain emboli / stroke
Dx of infective endocarditis?
Bloods (high WCC, ESR/CRP)
Blood cultures MC+S
ECHO (vegetations)
Tx of infective endocarditis?
High dose IV Abx for 4-6 weeks
IV Gentamicin + flucloxacillin
What Is rheumatic fever?
pathophysiology?
MC cause of?
Autoimmune condition which occurs 2-4 weeks post group A strep infection (sore throat)
T2 hypersensitivity vs M protein - molecular mimicry (strep antigens + Px tissues same) - cross react with smooth muscle
mitral stenosis
rheumatic fever
cause?
ages it affects?
M or F?
RF involves heart what % of the time?
Strep pyogenes
ages 5-15
M
50%
Sx of Rheumatic fever?
JONES FEAR
Major (Jones):
-Joints (migrating upwards polyarthritis)
-Organ inflammation (carditis)
-Nodules SC
-Erythema Marginatum (non itchy rash, red margin + clear centre - chest)
-Sydenham chorea (uncoordinated involuntary jerky movements)
Minor (Fear)
-Fever >38*c
-ECG changes (Prolonged PR)
-Arthralgia (without arthritis)
-Raised ESR/CRP
2 major or 1 major + 2 minor
Dx of Rheumatic fever?
Jones criteria
Bloods
Antistreptolysin O titre (ASOT)
Anti DNAase B +ve
ECG
ECHO
Aschoff body (nodules in heart of RF Px due to inflammation)
Tx of rheumatic fever?
stat IV Benzylpenicillin then PO phenoxymethylpenicillin
Pericarditis = NSAIDS
Chorea = haloperidol / diazepam
reduce reoccurrence = IM Benzathine benzylpenicillin
Complications of rheumatic fever?
Reoccurance
valvular HD
HF
Scarring
Fibrosis = RHD = myocarditis, endocarditis, pericarditis
what is brugada syndrome?
Dx?
Autosomal dominant
5CN5A mutation
Na+ channel
Dx = ECG
What are the ECG findings in brugada syndrome?
pseudo RBBB
ST segment elevation V1-V3
Saddle back ST-T elevation
What is the MC pads dysarrhythmia?
SVT
WPW
What does WPW cause on ECG?
Slurred delta wave
PR <120ms
Wide QRS
Tx of SVT?
Acute?
long term: medical + surgical ?
Acute = vasovagal, adenosine
medical = bisoprolol
surgical = catheter ablation (bundle of Kent)
