Cardio - congenital heart defects Flashcards
What does rubella increase the risk of - in terms of congenital heart defects?
PDA
What does SLE increase the risk of - in terms of congenital heart defects?
complete heart block
What does diabetes increase the risk of - in terms of congenital heart defects?
increased likelihood of any abnormality
What does mum taking warfarin during pregnancy increase the risk of - in terms of congenital heart defects?
pulmonary stenosis
PDA
What does mum drinking alcohol during pregnancy increase the risk of - in terms of congenital heart defects?
fetal alcohol syndrome:
ASD
VSD
tetralogy of Fallot
What does Down syndrome increase the risk of - in terms of congenital heart defects?
atrioventricular septal defect
VSD
What does Turner syndrome increase the risk of - in terms of congenital heart defects?
aortic valve stenosis
coarctation of the aorta
Name 5 cyanotic heart diseases
1-5 T’s!
1) Truncus arteriosus (aorta and pulmonary artery arise as one vessel)
2) transposition of the great arteries
3) tricuspid atresia
4) tetralogy of Fallot
5) total anomalous pulmonary venous return (pulmonary veins go into RIGHT atrium, not left)
name 3 non-cyanotic congenital heart defects (holes)
and 3 non-cyanotic congenital heart defects (obstructions)
ventricular septal defect
atrial septal defect
patent ductus arteriosus
pulmonary stenosis
aortic stenosis
coarctation of the aorta
ventricular septal defect
how and when does it present?
if big - breathless, failure to thrive, heart failure - enlarged liver - ^RR ^HR
pansystolic murmur - louder when VSD is SMALLER - small ones tend to close by themselves (and be asymptomatic)
presents, if big, breathless after 1 week, if not within a few weeks of birth
ventricular septal defect - management
ECG/ECHO
small - close spontaneously
big - treat heart failure (captopril and diuretics), extra calories
surgery at 3-6 months
what’s the risk of untreated right to left shunt with pulmonary hypertension - in VSD’s?
Eisenmenger syndrome - where the shunt reverses to right to left.
Will die in 40s-50s
patient turns blue - cyanotic
atrial septal defect - overview of the two types
secundum ASD where the septum secundum doestnt develop properly - this is 80% of ASDs and 10-15% all heart defects
primum ASD the septum primum doesnt go all the way down - common id Down syndrome
atrial septal defect - presentation
often asymptomatic, but recurrent chest infections
ejection systolic murmur heard best at upper left sternal edge (pulmonary stenosis murmur)
cardiomegaly
ECG changes - right ventricular enlargement (R axis dev) - [secundum ASD]
ECHO for diagnosis
when is ASD treated surgically
if large, cardiac catheterisation with occlusion device for hole
done between 3-5 years of age
(otherwise Right heart failure/arrhythmias later)
patent ductus arteriosus - presentation
normal in preterms because it hasnt closed yet
expected to close in first month
continuous murmur, collapsing pulse
asymptomatic (if v bad - HF/pul. HTN)
closed to prevent endocarditis with catheter or ibuprofen
ECHO to see it
heart murmurs in newborn - what are characteristics of an innocent murmur?
asymptomatic
slow blowing murmur
left sternal edge
systolic only
normal hearts sounds, no thrills or radiation
often heard infebrile illness/anaemia - because of increased cardiac output
clinical features of heart failure in kids
breathless - on feeding/exertion (poor feeding)
sweaty - unusual for kids otherwise
recurrent chest infections
poor weight gain ^RR ^HR heart murmur - gallop rhythm cardiomegaly, hepatomegaly cool peripheries
differentials for cyanosis and ^RR in newborn
cyanotic congenital heart disease
respiratory distress syndrome (surfactant deficiency)
meconium aspiration
infection - GBS sepsis
inborn error of metabolism (metabolic acidosis and shock)
to see if there is a heart disease - nitrogen washout - put in 100% O2 to see if blood gas is still low in O2 - cyanotic heart disease if so
management of cyanosed neonate
ABC
Prostaglandin IV
SEs- apnoea, jittery, seizures, flushing, vasodilation, hyotension
tetralogy of Fallot - 4 components
large VSD
overriding aorta (outflow obstruction)
pulmonary stenosis [which causes..)
right ventricular hypertrophy
presentation of tetralogy of Fallot
cyanosis soon after birth
hypercyanotic spells - squatting on exercise when older - these can cause MI, stroke - they cry lots, irritable, breathless and pale
older get clubbing
harsh ejection systolic murmur at upper left sternal edge from day 1
ECHO
management of tetralogy of fallot
surgery at 6 months (close VSD, relieve pulmonary stenosis)
if very cyanosed - shunt
hypercyanotic spells - morphine (pain and sedation)
propanolol IV
fluids IV
bicarbonate for acidosis
transposition of the great arteries - overview, presentation
the aorta and pulmonary artery are switched
severe cyanosis on day 2 of life when the duct closes
ECHO
management of transposition of the great arteries
IV prostaglandins
balloon atrial septstomy - open foramen ovale
surgery to correct
atrioventricular septal defect - overview
mainly seen in Down syndrom
cyanosis at birth/heart failure at 2-3 weeks
ECHO
surgical repair at 3-6 months
aortic stenosis in neonate
duct dependent?
when critical - duct dependent, heart failure and shock
pulses of small volume and slow rising
carotid thrill
ejection systolic murmur and upper right sternal edge radiating to neck
but if not critical asymptomatic and murmur
ECHO
balloon dilation if Rx required but will need aortic valve replacement later in life
pulmonary stenosis - overview
mostly asymptomatic with murmur
if critical - pulmonary blood flow is duct dependent
ejection systolic murmur heard best upper left sternal edge +heave if severe
ECG
Rx transcatheter balloon dilation if severe
coarctation of the aorta overview
is it duct dependent
outflow obstruction
can be duct dependent if severe
sick baby, heart failure
no femoral pulses
severe metabolic acidosis
Rx ABC, IV prostaglandins, surgery
hypoplastic left heart syndrome
small left side of heart
very sick
duct dependent circulation
v weak pulses all over
lots of surgeries
