cardio Flashcards
what type of murmur is Turner’s syndrome associated with?
ejection systolic murmur due to bicuspid aortic valve
The consultant asks you to examine a 3-week-old girl on the neonatal ward. She was born prematurely at 27 weeks gestation. She is pink in colour and warm to touch, developing well and gaining weight appropriately. She is currently saturating well on oxygen and her lungs sound clear. On auscultation of her heart, you detect a continuous machinery murmur over the upper left sternal edge. The murmur does not vary with position or radiate.
Which murmur is this most likely to reflect?
Patent ductus arteriosus: machinery murmur at the upper left sternal edge
what is the ductus arteriosus?
A connection between the pulmonary artery and the aorta to allow blood to bypass the lungs in utero. It usually closes by 2 days after birth.
ejection systolic murmur over the left upper sternal edge
Pulmonary stenosis
systolic murmur in the left infraclavicular area and under the left scapula
coarctation of the aorta
murmurs typical of pulmonary stenosis and sometimes VSD and usually presents with hypercyanotic episodes around 1 month after birth
Tetralogy of Fallot
what are the types of innocent murmurs heard in children?
- ejection murmurs
- venous hums
- Still’s murmur
what is an ejection murmur?
due to turbulent blood flow at the outflow tract of the heart
what are characteristics of an innocent ejection murmur?
- soft-blowing murmur in the pulmonary area or short buzzing murmur in the aortic area
- may vary with posture
- localised with no radiation
- no diastolic component
- no thrill
- no added sounds (e.g. clicks)
- asymptomatic child
- no other abnormality
what is a venous hum?
due to turbulent blood flow in the great veins returning to the heart.
heard as a continuous blowing noise just below the clavicles.
what is a Still’s murmur?
Low-pitched sound heard at the lower left sternal edge
Cyanotic congenital heart disease presenting within the first days of life is…?
TGA
Cyanotic congenital heart disease presenting at 1-2 months of age is…?
TOF
what are the components of TOF?
- VSD
- Right ventricular hypertrophy
- Right ventricular outflow obstruction (pulmonary stenosis) – responsible for the ESM heard
- Overriding aorta
what is the classical CXR and ECG finding of TOF?
CXR: “boot-shaped” heart
ECG: RVH
what is the definitive mx for TOF?
surgical repair (around 6-months of age)
cyanotic spells are managed with b-blockers (to reduce infundibular spasm and thus prevent worsening of RV outflow obstruction).
what are the causes of cyanotic congenital heart disease?
- tetralogy of Fallot (TOF)
- transposition of the great arteries (TGA)
- tricuspid atresia
what is used in patent ductus arteriosus (PDA) to promote duct closure?
indomethacin or ibuprofen
inhibits prostaglandin synthesis
closes the connection
what is used to keep the ductus ateriosus present?
prostaglandin E2
indicated in complex congenital heart defects where a shunt is necessary to maintain life (e.g. TGA)
what is Turner’s syndrome associated with?
aortic coarctation and bicuspid aortic valve
what are the common causes of acyanotic heart disease?
- VSD
- ASD
- PDA
- coarctation of the aorta
- aortic valve stenosis
what is transposition of the great arteries (TGA)?
a form of cyanotic congenital heart disease, caused by failure of aorticopulmonary septum to spiral during septation
who are at an increased risk of TGA?
children of diabetic mothers
what are the basic anatomical changes in TGA?
- aorta leaves right ventricle
- pulmonary trunk leaves left ventricle
