Cardiology Flashcards
What is an ASD?
ASD occurs when the septum between the left and right atrium is not formed properly - oxygenated blood from the left atrium goes into the right atrium
What are some risk factors for ASD?
Maternal smoking in 1st trimester, maternal diabetes, maternal rubella, maternal drug use, Treacher Collins syndrome
What is found on auscultation of an ASD?
Soft systolic ejection murmur best heard over pulmonary valve region (2nd ICS)
Wife, fixed split S2
Diastolic rumble in lower left sternal edge in patients with large ASD
How is an ASD investigated?
ECG - tall P wave, right BBB, right axis deviation
Tranthoracic echocardiogram
How is an ASD managed?
If ASD <5mm, spontaneous closure should occur within 12 months of birth
If ASD >1cm - surgery
What are some complications of an untreated large ASD?
Arrhythmias, pulmonary hypertension, Eisenmenger syndrome, peripheral oedema, TIA/stroke
What is Tetralogy of Fallot?
Cyanotic congenital heart disease - tetrad of:
- VSD
- Pulmonary stenosis
- Right ventricular hypertrophy
- Overriding aorta
What are some risk factors for TOF?
Male Family history Teratogens (alcohol, warfarin, trimethadione) CHARGE syndrome Di George syndrome
What can be seen on CXR for Tetralogy of Fallot?
Boot shaped heart and reduced pulmonary vascular marking
What are the 3 categories of TOF?
1) Mild (Pink TOF) - mild PS/RVH and usually asymptomatic but disease progresses as the child grows so cyanotic by age 1-3 years
2) Moderate-severe (cyanotic TOF) - moderate-sever PS may present in the first few weeks of life with cyanosis and respiratory distress - prone to developing recurrent chest infections and or fail to thrive
3) Extreme - duct dependent lesions where the only way deoxygenated blood can flow to the lungs is through a PDA
What are hypoxic (‘tet’) spells?
Paroxysm of hyperpnoea
Irritability
Increasing cyanosis
What can be heard of auscultation of TOF?
Loud, single S2 (closure of aortic valve in diastole with absent/reduced pulmonary valve closure
Pansystolic murmur - best osculated either mid or upper left sternal edge (the smaller the VSD, the louder the murmur)
Ejection click - due to presence of dilated aorta
Continuous machinery murmur best heard at upper left sternal edge - occurs in the presence of PDA with extreme forms of TOF, especially those on prostaglandin infusion
What is the management of TOF?
Medical
- Squatting
- Prostaglandin infusion - maintains PDA
- Beta blockers
- Morphine
- Saline 0.9% bolus
Surgical - definitive repair
What are some complications of untreated TOF?
Polycythaemia, stroke, cerebral abscess, infective endocarditis, congestive cardiac failure, death
What is transposition of the great arteries?
Ventriculoarterial discordance in which the aorta rises from the morphologic right ventricle and the pulmonary artery arises from the morphologic left ventricle
What is the most common cause of cyanosis in the newborn?
Transposition of the great arteries
What are the 3 common anatomical sites for mixing of oxygenated and deoxygenated blood in TGA to allow life to be sustained?
- Patent foramen ovale/ASD
- VSD
- PDA
What are the clinical features of TGA?
Cyanosis appears in first 24 hours
Mild cyanosis particular when crying
Signs of CHF - tachypnoea, tachycardia, diaphoresis, failure to gain weight
Prominent right ventricular heave
Single second heart sound, loud A2
Systolic murmur potentially if VSD present
What is the management of TGA?
Emergency prostaglandin E1 infusion to keep PDA patent
Correct metabolic acidosis
Atrial balloon septostomy
Surgical correction before the age of 4 weeks
What are the long term consequences of TGA?
Neopulmonary stenosis Neoaortic regurgitation Neoaortic root dilatation Coronary artery disease Sudden cardiac death Higher incidence of Neurodevelopmental abnormalities
Which is the most common congenital heart defect?
VSD - hole in the septum separating the left and right ventricles
What is Eisenmenger’s syndrome?
A condition where the pressure in the right ventricle exceeds that of the left and is caused by a significant gradual increase in the pulmonary vascular resistance
Results in a shunt reversal with deoxygenated blood flowing from the right ventricle into the left and entering the systemic circulation
This causes decreased systemic oxygen saturation and these patients become cyanotic
What are some risk factors for VSD?
Maternal diabetes, maternal rubella, fetal alcohol syndrome, family history, Down’s syndrome, trisomy 13 and 18
How would a baby with a moderate VSD present?
Excessive sweating, easily fatigued, tachypnoea
Usually obvious by 2-3 months of age
How would a baby with a large VSD present?
Dyspnoea, problems with feeding, developmental issues, frequent chest infections
Which is the most likely type of murmur to be heard with VSD?
Holosystolic (pan systolic) murmur - lower left sternal border
What is the management of VSD?
Diuretics, ACE inhibitors, digoxin
Surgical repair
What are the complications of untreated VSD?
CHF, growth failure, aortic valve regurgitation, pulmonary vascular disease, frequent chest infections, infective endocarditis, arrhythmias, sudden death
