Cardio Flashcards
What is the most common congenital heart disease?
VSD
Describe the classifications of congenital heart disease (cyanotic and non-cyanotic)
NON-CYANOTIC L-->R shunts 1. VSD 2. ASD 3. PDA Obstructive 1. Coarctation 2. Pulmonary stenosis 3. Aortic stenosis
CYANOTIC R-->L shunts 1. Transposition of great vessels 2. Truncus arteriosis Obstructive 1. Tetralogy of Fallot 2. Pulmonary and tricuspid atresia
What murmur is heart with VSD?
Pansytolic murmur at left sternal edge
- Louder with a smaller hole
What is Eisenmenger’s syndrome?
When a left to right shunt becomes a right to left shunt
- L->R shunt –> increased blood flow into pulmonary arteries –> increased pressure in the pulmonary system –> RV hypertrophy –> eventually pressure in right heart is greater than left –> right to left shunting
- Create hypoxia through septal defect or patent FO
Describe the cycle of ductus arteriosus
During gestation the DA is kept open through continued PGE2 from the placenta –> after birth (and removal of placenta) –> drop PGE2 plus the sudden oxygenation –> ductus closes
- Usually complete by 1 day, completely shut at 3 weeks
What are the complications of VSD?
Increased blood flow to lungs –> increasing lung stiffness and WOB
- RV hypertrophy –> Pulmonary hypertension –> Eisenmenger’s (L–>R becomes R–>L shunt)
What murmur is heard with ASD?
Fixed murmur at left sternal border
S2 splitting
Explain the closure of the foramen ovale
First breath –> increased oxygen in alveoli –> arteries begin to dilate –> decreased pulmonary pressure –> decreased pressure in R heart –> oxygenated blood now flowing back into LA –> high L press and low R press –> foramen ovale snaps closed
What is the usual cause of ASD?
Failure of septum secundum to fuse during FO closure
What is a complication of untreated ASD?
Paradoxical embolism
- DVT can cross over to L side and cause stroke rather than PE
What murmur is heard with a patent ductus arteriosus?
Continuous murmur, wide pulse pressure and bounding pulse
How is PDA treated?
NSAIDs (indomethacin) - inhibit PGE2 (normally keeps DA open)
What infection is commonly associated with PDA?
Congenital rubella syndrome
What are the clinical features of coarctation of aorta?
High blood pressure in arms (pink), low blood pressure in legs (blue)
>20 discrepancy
Impalpable femoral arteries
What murmur would you hear for AS? PS?
Ejection systolic at aortic area
Ejection systolic at pulmonary area
What are the 4 components that make up Tetralogy of Fallot?
CYANOTIC: Obstructive
- VSD (R–>L shunt)
- Pulmonary stenosis
- RV hypertrophy
- Overriding aorta
How will Tetralogy of Fallot present?
- Harsh ejection systolic murmur (due to RV outflow obstruction) radiating to back
- Gradually appearing cyanosis in first 6-12mo
- Hypoxic spells ‘tet spells’
- children squat to increase TPR –> decreased R–>L shunt
- Clubbing
Explain the pathophysiology of Tetralogy of Fallot
CYANOTIC: Obstructive
Obstruction to flow into lungs –> blood diverted through VSD –> Right to left shunt –> Reduced blood flow to lung –> cyanosis
What is pulmonary atresia?
CYANOTIC: Obstructive
Malformation of pulmonary valve complete obstruction of pulmonary outflow –> total diversion of blood from RV into the aorta
- ASD or VSD may be present to shunt blood
- Cyanosis develops early
What needs to remain open in pulmonary atresia? Why?
Usually have a VSD (rarely ASD - FO) PLUS
Need PDA so that blood from R heart can still reach the lungs
What is tricuspid atresia?
CYANOTIC: Obstructive
Congenital absence of tricuspid valve: NO outflow from RA –> RV
ASD/VSD required to allow oxygenation and pumping
Murmur not usually heard but can be holosystolic (VSD)
Requires PGE1 to keep PDA open!
What is truncus arteriosis?
CYANOTIC - R–>L shunt
1 single blood vessel comes out of RV and LV instead of pulmonary artery and aorta - receives blood from both ventricles –> passes across VSD into single arterial trunk
**VSD is always present
Holosytolic murmur from VSD
What is the most common cause for a cyanotic baby in the first 24hrs?
Transposition of great vessels
*Baby becomes blue immediately after birth
Requires PGE1 urgently to keep PDA open!
What is transposition of great vessels?
CYANOTIC - R–>L shunt
Failure of twisting of great vessels –> aorta attached to RV and pulmonary artery attached to LV
*Baby becomes blue immediately after birth
Has PDA, VSD, ASD
