Cardiology Flashcards
How many shunts in fetal circulation
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
What does ductus venosus do?
Shunt connects umbilical vain to vena cava to bypass liver
What does foramen ovale do?
Shunt connects right atrium to left atrium to bypass right ventricle and pulmonary circulation
What does the ductus arteriosus do
Shunts blood from pulmonary artery to aorta to bypass lungs
5 features of a innocent murmur
5 s’s
Soft, short, systolic, symptomless, situation dependent (when unwell)
What is required to keep PDA open
Prostoglandins
Why does PDS close at birth
Baby breaths -> increase in O2 sats -> reduced prostaglandins -> PDA closes
What does the ductus venous become
Ligamentum venosum
Why does foramen ovale shut
Baby breaths -> alveoli expand -> decreased vascular resistance -> less RA strain -> pressure in left higher
Is a murmur that is louder on standing concerning
Yes - not a sign of an innocent murmur
3 pan systolic murmurs
Mitral regurgitation
Tricuspid regurgitation
VSD
3 ejection systolic murmurs
Aortic stenosis
Pulmonary stenosis
Hypertrophic obstructive cardiomyopathy
What is a split second heart sound and is it pathological
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
Atrial septal defect murmur sound
Mid systolic, crescendo-decrescendo loaded at UL sternal border
Fixed split second heart sound - DOES NOT CHANGE WITH INSPRIATION
PDA murmur sound
Continuous crescendo-decrescendo “machinery” murmur
May continue during second sound
TOF murmur
Pulmonary stenosis -> ejection systolic
Cause of cyanotic heart disease in previously asynotic disease
Right to left shunt
4 types of right to left shunt
VSD, ASD
PDA
Transposition of great arteries
Why are most patients with VSD ASD or PDA not cynotic
Pressure on left is greater than right so no R to L shunt
Will patients with transposition of great arteries be cyanosed?
Yes as relying on VSD to mix oxygenated blood
Eisenmenger syndrome
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
When should PDA close
1-3 days of birth will stop functioning
Fully close by 3 weeks
2 key risk factors for PDA
Rubella and prematurity
Untreated PDA causes what condition in adulthood
Heart failure
L and R ventricle hypertrophy
Why does untreated PDA cause heart failure
Aorta pressure>pulmonary artery pressure -> increase pulmonary resistance -> increased load for RV -> increased blood flow out of pulmonary vein into LA/LV -> heart failure
PDA diagnosis
Left to right shunt on echo
Management of PDA
wait until 1 year old then trans-catheter or surgical
Which side of heart fails in ASD
Right as L to R shunt
More blood in RV
RV works harder -> hypertrophy
Patient with ASD no longer has L to R shunt. Condition name and pathology
Eisenmenger syndrome
R to L as pulmonary pressure > systemic pressure
From persistent pulmonary HTN
Patient will now become cyanotic as bypassing lungs
What causes formation of atrial wall
Septum primum and septum secondum
Grow down from top of heart and form endometrial cushion
Cause of stroke after a DVT in patients with ASD
Clot can travel from RA to LA -> LV -> aorta -> carotid
4 complications of ASD
AF, stroke (DVT/ emboli cross), pulmonary HTN, Eisenmenger syndrome
Why is there a split heart sound in ASD
Blood flows from L to R, so greater volume in R, so pulmonary valve takes longer till it can close
ASD murmur sound
Mid systolic Crescendo - decrescendo Fixed split (pathological)
Other condition linked with ASD
Migraines with aura
Eisenmenger syndrome
2 genetics conditions associated with VSD
Downs and Turners
Shunt direction in VSD
L to R
Why does Eisenmenger syndrome develop in VSD
R to L shunt -> R side over load -> pulmonary HTN -> R side heart failure -> Eisenmenger syndrome
Murmur heard in VSD
Pansystolic
Possible systolic thrill
3 causes of pan systolic murmur
VSD, mitral regurgitation, tricuspid regurgitation
Type of infection that patients with a VSD are at am increased risk of
Infective endocarditis
ABX prophylaxis during surgical procedures
3 causes of Eisenmenger syndrome
ASD VSD PDA
Patients with eisenmenger syndrome develop what haematological change
Polycythemia as cyanotic so increased HB
Polycythemic patients are at an increased risk of what
Thrombus formation as blood more viscous
Pulmonary hypertension examination findings
RV heave
Loud P2
Raised JVP
Peripheral oedema
(chronic hypoxia changes - cyanosis, clubbing, dyspnoea, plethoric complexion)
Once Eisenmenger syndrome has developed what is the treatment
Transplant (heart and lung) as cannot reverse pulmonary HTN
Genetic condition associated with coarctation of the aorta
Turners syndrome
What is coarctation of the aorta
Narrowing of aortic arch, usually around the ductus arteriosus
Clinical sign of coarctation of the aorta
Weak femoral pulses
Likely dx, underdevelopment of legs, left ventricular heave, tachypnoea
Aortic coarctitation
Management of aortic coarctation
Prostoglandins can be given to keep DA open
Aortic valve number of leaflets
3
Aortic stenosis murmur
Ejection systolic
Crescendo - decrescendo
Radiates to carotids
Main complication of aortic valve stenosis
LV outflow tract obstruction -> heart failure -> arrhythmias -> sudden death
4 causes/ associations of pulmonary valve stenosis
Tetralogy of fallot
William syndrome
Noonan syndrome
Congenital rubella
Tetralogy of fallot pathologies
VSD, overriding aorta, pulmonary valve stenosis, RV hypertrophy
4 risk factors for TOF
Rubella, increased age, alcohol, diabetic mother
Overriding aorta meaning
Aorta opening is further to R and nearer to VSD -> body receives more deoxygenated blood
Cardiac shunt direction in TOF
R -> L
depends on degree of pulmonary stenosis
CXR appearance of TOF
Boot shaped
5 signs of TOF
Cyanosis, clubbing, poor wright gain, TET SPELLS, ES murmur
What are TET spells
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
Non medical management of TET spells
Squatting or knees to chest position
Increases systemic vascular resistance
Medical management of TET spells
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
Management of TOF in neonates
Prostoglandins to maintain DA
Surgery
What is Ebsteins anomaly
Tricuspid valve is set towards apex causing
Bigger RA, smaller RV
Therefore poor flow into pulmonary system
Conditions associated with Ebsteins anomaly
WPW syndrome
ASD (causing a R to L shunt)
ECG change in WPW
Delta wave upstroke
What is required for a baby with transposition of great arteries to survive
Shunt
PDA, ASD, VSD
Treatments for transposition of great arteries
Prostaglandin infusion to keep PDA open
Ballon septostomy (keep foramen ovale open)
Open heart surgery - arterial switch
Venus hums sound
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
Stills murmur
Low pitch sound
Type of innocent murmur
