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Leeds MBCHB Year 4 Peads > Cardiology > Flashcards

Cardiology Flashcards

1
Q

How many shunts in fetal circulation

A 
Ductus venosus (umbilical vein to inferior vena cava to bypass liver)
Foramen ovale (right atrium with left atrium to bypass lungs and ventricles)
Ductus arteriosus (pulmonary artery to aorta to bypass lungs
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2
Q

What does ductus venosus do?

A

Shunt connects umbilical vain to vena cava to bypass liver

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3
Q

What does foramen ovale do?

A

Shunt connects right atrium to left atrium to bypass right ventricle and pulmonary circulation

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4
Q

What does the ductus arteriosus do

A

Shunts blood from pulmonary artery to aorta to bypass lungs

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5
Q

5 features of a innocent murmur

A

5 s’s

Soft, short, systolic, symptomless, situation dependent (when unwell)

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6
Q

What is required to keep PDA open

A

Prostoglandins

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7
Q

Why does PDS close at birth

A

Baby breaths -> increase in O2 sats -> reduced prostaglandins -> PDA closes

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8
Q

What does the ductus venous become

A

Ligamentum venosum

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9
Q

Why does foramen ovale shut

A

Baby breaths -> alveoli expand -> decreased vascular resistance -> less RA strain -> pressure in left higher

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10
Q

Is a murmur that is louder on standing concerning

A

Yes - not a sign of an innocent murmur

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11
Q

3 pan systolic murmurs

A

Mitral regurgitation
Tricuspid regurgitation
VSD

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12
Q

3 ejection systolic murmurs

A

Aortic stenosis
Pulmonary stenosis
Hypertrophic obstructive cardiomyopathy

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13
Q

What is a split second heart sound and is it pathological

A

Can be if doesn’t change with inspiration (ASD)

Inspiration -> negative intra-thoracic pressure -> right side fills faster as blood is pulled from venous system -> takes longer for RV to empty blood -> pulmonary valve to close slightly later

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14
Q

Atrial septal defect murmur sound

A

Mid systolic, crescendo-decrescendo loaded at UL sternal border

Fixed split second heart sound - DOES NOT CHANGE WITH INSPRIATION

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15
Q

PDA murmur sound

A

Continuous crescendo-decrescendo “machinery” murmur

May continue during second sound

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16
Q

TOF murmur

A

Pulmonary stenosis -> ejection systolic

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17
Q

Cause of cyanotic heart disease in previously asynotic disease

A

Right to left shunt

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18
Q

4 types of right to left shunt

A

VSD, ASD
PDA
Transposition of great arteries

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19
Q

Why are most patients with VSD ASD or PDA not cynotic

A

Pressure on left is greater than right so no R to L shunt

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20
Q

Will patients with transposition of great arteries be cyanosed?

A

Yes as relying on VSD to mix oxygenated blood

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21
Q

Eisenmenger syndrome

A

When pulmonary pressure > systemic pressure blood shunts from right to left across cyanotic heart disease defect.

This is from previous long standing L to R shunt causing a greater pulmonary HTN

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22
Q

When should PDA close

A

1-3 days of birth will stop functioning

Fully close by 3 weeks

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23
Q

2 key risk factors for PDA

A

Rubella and prematurity

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24
Q

Untreated PDA causes what condition in adulthood

A

Heart failure

L and R ventricle hypertrophy

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25
Q

Why does untreated PDA cause heart failure

A

Aorta pressure>pulmonary artery pressure -> increase pulmonary resistance -> increased load for RV -> increased blood flow out of pulmonary vein into LA/LV -> heart failure

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26
Q

PDA diagnosis

A

Left to right shunt on echo

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27
Q

Management of PDA

A

wait until 1 year old then trans-catheter or surgical

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28
Q

Which side of heart fails in ASD

A

Right as L to R shunt
More blood in RV
RV works harder -> hypertrophy

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29
Q

Patient with ASD no longer has L to R shunt. Condition name and pathology

A

Eisenmenger syndrome

R to L as pulmonary pressure > systemic pressure

From persistent pulmonary HTN

Patient will now become cyanotic as bypassing lungs

30
Q

What causes formation of atrial wall

A

Septum primum and septum secondum

Grow down from top of heart and form endometrial cushion

31
Q

Cause of stroke after a DVT in patients with ASD

A

Clot can travel from RA to LA -> LV -> aorta -> carotid

32
Q

4 complications of ASD

A

AF, stroke (DVT/ emboli cross), pulmonary HTN, Eisenmenger syndrome

33
Q

Why is there a split heart sound in ASD

A

Blood flows from L to R, so greater volume in R, so pulmonary valve takes longer till it can close

34
Q

ASD murmur sound

A 
Mid systolic
Crescendo - decrescendo
Fixed split (pathological)
35
Q

Other condition linked with ASD

A

Migraines with aura

Eisenmenger syndrome

36
Q

2 genetics conditions associated with VSD

A

Downs and Turners

37
Q

Shunt direction in VSD

A

L to R

38
Q

Why does Eisenmenger syndrome develop in VSD

A

R to L shunt -> R side over load -> pulmonary HTN -> R side heart failure -> Eisenmenger syndrome

39
Q

Murmur heard in VSD

A

Pansystolic

Possible systolic thrill

40
Q

3 causes of pan systolic murmur

A

VSD, mitral regurgitation, tricuspid regurgitation

41
Q

Type of infection that patients with a VSD are at am increased risk of

A

Infective endocarditis

ABX prophylaxis during surgical procedures

42
Q

3 causes of Eisenmenger syndrome

A

ASD VSD PDA

43
Q

Patients with eisenmenger syndrome develop what haematological change

A

Polycythemia as cyanotic so increased HB

44
Q

Polycythemic patients are at an increased risk of what

A

Thrombus formation as blood more viscous

45
Q

Pulmonary hypertension examination findings

A

RV heave
Loud P2
Raised JVP
Peripheral oedema

(chronic hypoxia changes - cyanosis, clubbing, dyspnoea, plethoric complexion)

46
Q

Once Eisenmenger syndrome has developed what is the treatment

A

Transplant (heart and lung) as cannot reverse pulmonary HTN

47
Q

Genetic condition associated with coarctation of the aorta

A

Turners syndrome

48
Q

What is coarctation of the aorta

A

Narrowing of aortic arch, usually around the ductus arteriosus

49
Q

Clinical sign of coarctation of the aorta

A

Weak femoral pulses

50
Q

Likely dx, underdevelopment of legs, left ventricular heave, tachypnoea

A

Aortic coarctitation

51
Q

Management of aortic coarctation

A

Prostoglandins can be given to keep DA open

52
Q

Aortic valve number of leaflets

A

3

53
Q

Aortic stenosis murmur

A

Ejection systolic
Crescendo - decrescendo
Radiates to carotids

54
Q

Main complication of aortic valve stenosis

A

LV outflow tract obstruction -> heart failure -> arrhythmias -> sudden death

55
Q

4 causes/ associations of pulmonary valve stenosis

A

Tetralogy of fallot
William syndrome
Noonan syndrome
Congenital rubella

56
Q

Tetralogy of fallot pathologies

A

VSD, overriding aorta, pulmonary valve stenosis, RV hypertrophy

57
Q

4 risk factors for TOF

A

Rubella, increased age, alcohol, diabetic mother

58
Q

Overriding aorta meaning

A

Aorta opening is further to R and nearer to VSD -> body receives more deoxygenated blood

59
Q

Cardiac shunt direction in TOF

A

R -> L

depends on degree of pulmonary stenosis

60
Q

CXR appearance of TOF

A

Boot shaped

61
Q

5 signs of TOF

A

Cyanosis, clubbing, poor wright gain, TET SPELLS, ES murmur

62
Q

What are TET spells

A

Cyanotic episodes

pulmonary vascular resistance increases or systemic vascular resistance decreases

For example, playing child -> increased CO2 -> CO2 vasodilates -> blood passes from RV to aorta to miss pulmonary vessels

63
Q

Non medical management of TET spells

A

Squatting or knees to chest position

Increases systemic vascular resistance

64
Q

Medical management of TET spells

A 
O2
Beta blockers to relax RV
IV fluid to increase pre-load
Morphine for effective breathing
Sodium bicarbonate to buffer acidosis
Phenylepherine to increase SVR
65
Q

Management of TOF in neonates

A

Prostoglandins to maintain DA

Surgery

66
Q

What is Ebsteins anomaly

A

Tricuspid valve is set towards apex causing
Bigger RA, smaller RV
Therefore poor flow into pulmonary system

67
Q

Conditions associated with Ebsteins anomaly

A

WPW syndrome

ASD (causing a R to L shunt)

68
Q

ECG change in WPW

A

Delta wave upstroke

69
Q

What is required for a baby with transposition of great arteries to survive

A

Shunt

PDA, ASD, VSD

70
Q

Treatments for transposition of great arteries

A

Prostaglandin infusion to keep PDA open

Ballon septostomy (keep foramen ovale open)

Open heart surgery - arterial switch

71
Q

Venus hums sound

A

Due to the turbulent blood flow in the great veins returning to the heart.

Heard as a continuous blowing noise heard just below the clavicles

72
Q

Stills murmur

A

Low pitch sound

Type of innocent murmur

Leeds MBCHB Year 4 Peads (21 decks)

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