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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
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
26
PDA diagnosis
Left to right shunt on echo
27
Management of PDA
wait until 1 year old then trans-catheter or surgical
28
Which side of heart fails in ASD
Right as L to R shunt More blood in RV RV works harder -> hypertrophy
29
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
30
What causes formation of atrial wall
Septum primum and septum secondum Grow down from top of heart and form endometrial cushion
31
Cause of stroke after a DVT in patients with ASD
Clot can travel from RA to LA -> LV -> aorta -> carotid
32
4 complications of ASD
AF, stroke (DVT/ emboli cross), pulmonary HTN, Eisenmenger syndrome
33
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
34
ASD murmur sound
``` Mid systolic Crescendo - decrescendo Fixed split (pathological) ```
35
Other condition linked with ASD
Migraines with aura | Eisenmenger syndrome
36
2 genetics conditions associated with VSD
Downs and Turners
37
Shunt direction in VSD
L to R
38
Why does Eisenmenger syndrome develop in VSD
R to L shunt -> R side over load -> pulmonary HTN -> R side heart failure -> Eisenmenger syndrome
39
Murmur heard in VSD
Pansystolic | Possible systolic thrill
40
3 causes of pan systolic murmur
VSD, mitral regurgitation, tricuspid regurgitation
41
Type of infection that patients with a VSD are at am increased risk of
Infective endocarditis ABX prophylaxis during surgical procedures
42
3 causes of Eisenmenger syndrome
ASD VSD PDA
43
Patients with eisenmenger syndrome develop what haematological change
Polycythemia as cyanotic so increased HB
44
Polycythemic patients are at an increased risk of what
Thrombus formation as blood more viscous
45
Pulmonary hypertension examination findings
RV heave Loud P2 Raised JVP Peripheral oedema (chronic hypoxia changes - cyanosis, clubbing, dyspnoea, plethoric complexion)
46
Once Eisenmenger syndrome has developed what is the treatment
Transplant (heart and lung) as cannot reverse pulmonary HTN
47
Genetic condition associated with coarctation of the aorta
Turners syndrome
48
What is coarctation of the aorta
Narrowing of aortic arch, usually around the ductus arteriosus
49
Clinical sign of coarctation of the aorta
Weak femoral pulses
50
Likely dx, underdevelopment of legs, left ventricular heave, tachypnoea
Aortic coarctitation
51
Management of aortic coarctation
Prostoglandins can be given to keep DA open
52
Aortic valve number of leaflets
3
53
Aortic stenosis murmur
Ejection systolic Crescendo - decrescendo Radiates to carotids
54
Main complication of aortic valve stenosis
LV outflow tract obstruction -> heart failure -> arrhythmias -> sudden death
55
4 causes/ associations of pulmonary valve stenosis
Tetralogy of fallot William syndrome Noonan syndrome Congenital rubella
56
Tetralogy of fallot pathologies
VSD, overriding aorta, pulmonary valve stenosis, RV hypertrophy
57
4 risk factors for TOF
Rubella, increased age, alcohol, diabetic mother
58
Overriding aorta meaning
Aorta opening is further to R and nearer to VSD -> body receives more deoxygenated blood
59
Cardiac shunt direction in TOF
R -> L | depends on degree of pulmonary stenosis
60
CXR appearance of TOF
Boot shaped
61
5 signs of TOF
Cyanosis, clubbing, poor wright gain, TET SPELLS, ES murmur
62
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
63
Non medical management of TET spells
Squatting or knees to chest position Increases systemic vascular resistance
64
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 ```
65
Management of TOF in neonates
Prostoglandins to maintain DA Surgery
66
What is Ebsteins anomaly
Tricuspid valve is set towards apex causing Bigger RA, smaller RV Therefore poor flow into pulmonary system
67
Conditions associated with Ebsteins anomaly
WPW syndrome | ASD (causing a R to L shunt)
68
ECG change in WPW
Delta wave upstroke
69
What is required for a baby with transposition of great arteries to survive
Shunt PDA, ASD, VSD
70
Treatments for transposition of great arteries
Prostaglandin infusion to keep PDA open Ballon septostomy (keep foramen ovale open) Open heart surgery - arterial switch
71
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
72
Stills murmur
Low pitch sound Type of innocent murmur

Leeds MBCHB Year 4 Peads (21 decks)

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