Cardiology Flashcards
define ventricular septal defects (VSD)
a birth defect of the heart in which there is a hole in the wall (septum) that separates the two lower chambers of the heart
aetiology of VSD
septum dividing the left and right ventricle that fails to completely close - causes left to right shunting
clinical features of VSD
if small, often asymptomatic
if large: dyspnoea on exertion poor weight gain tachypnoea failure to thrive
examination findings in VSD
pan-systolic murmur at left lower sternal border
systolic thrill
investigations of VSD
echocardiogram
CXR
ECG
management of VSD
if small:
self-resolve in 1yr
calorie intake increase
observations
if large/causing symptoms:
diuretics (e.g. captopril)
transvenous catheter closure
open heart surgery
additional requirements in VSD surgery
consider antibiotic prophylaxis to reduce risk of infective endocarditis
conditions commonly associated with VSD
Down’s Syndrome
Turner’s Syndrome
define atrial septal defect (ASD)
a cardiac malformation causing the hole between left and right atria that allows left-right shunting of blood
types of ASDs
ostium secondum (failure of septum secondum to close) patent foramen ovular ositum primum (septum primum fails to close)
clinical features of ASDs
often asymptomatic but can present with:
dyspnoea
difficulty feeding
poor weight gain
recurrent LRTIs
examination findings in ASD
ejection systolic murmur in upper left sternal edge
fixed split second heart sound
management of ASD
refer to paeds cardiologist
if small: watching + waiting
if large: transvenous catheter closure or open heart surgery
additional requirements in ASD
provide anticoagulants (e.g. warfarin, aspirin and NOACs) to reduce clot and stroke risk
complications of ASD
strokes (in context of DVT) atrial fib/flutter pulmonary hypertension Eisenmenger Syndrome right sided heart failure
define coarctation of the aorta
a narrowing of the aorta just before the ductus arteriosus causing diversion of blood into the brachiocephalic artery, constricting flow to distal branches supplying of the right leg
conditions associated with coarctation of the aorta
Turners Syndrome:
XO karyotype
webbed neck
wide spaced nipples
clinical features of coarctation of aorta
tachypnoea
poor feeding
greying and floppy baby
underdeveloped limbs
examination findings in coarctation of aorta
systolic murmur below left clavicle and scapula
left ventricular heave
radio-femoral delay
investigations of coarctation of aorta
CXR - rib notching appearance
echocardiogram
management of coarctation of aorta (mild)
echo monitoring
management of coarctation of aorta (severe)
prostaglandin E (alprostadil) stent insertion or surgical repair
reasoning behind use of prostoglandin E (alprostadil) in coarctation surgeries
keeps ductus arteriosus open while waiting for surgery
types of coarctation of aorta
preductal - before ductus
postductal - after ductus
complications of coarctation of aorta
cerebral aneurysms due to triggering of renin-angiotension-aldosterone system
define patent ductus arteriosus (PDA)
failure of ductus arteriosus to close after birth
clinical features of PDA
dyspnoea
difficulty feeding
poor weight gain
LRTIs
examination findings in PDA
continuous crescendo-decresendo ‘machinery’ murmur during 2nd heart sound
collapsing pulse
systolic thrill
bradycardia
investigations in PDA
echocardiogram
doppler
CXR
ECG (if older)
management of PDA (haemodynamically stable)
indomethacin - inhibits prostaglandin synthesis
management of PDA (haemodynamically unstable)
trans-catheter
surgical ligation/closure
define Tetralogy of Fallot
congenital condition of four existing pathologies:
VSD
overiding aorta
pulmonary valve stenosis
right ventricular hypertrophy
risk factors of Tetralogy of Fallot
rubella infection
increased maternal age
alcohol consumption in pregnancy
diabetic mother
clinical features of Tetralogy of Fallot
appearance of antenatal scans
Tet spells (acute cyanotic episodes with hypoxia, pain, crying and cyanosis)
poor feeding
poor weight gain
examination findings in Tetralogy of Fallot
ejection systolic murmur
investigations in Tetralogy of Fallot
echocardiogram
doppler flow studies
CXR - will show ‘boot shaped’ heart
management of Tet spells in Tetralogy of Fallot
knees to chest position supplemental oxygen beta blockers morphine IV fluids sodium bicarbonate phenylephrine infusion
management of Tetralogy of Fallot
prostoglandin infusion (alprostadil) total surgical repair
