Cardiology Flashcards
What are the 4 cardiac abnormalities that are classically found in Tetralogy of Fallot?
VSD
Overriding aorta
Pulmonary valve stenosis
Right ventricular hypertrophy
Is Tetralogy of Fallot a cyanotic or acyanotic condition? What determines the extent of cyanosis?
Tetralogy of Fallot is a cyanotic lesion
The severity of the pulmonary stenosis is what determines the extent of the cyanosis
What murmur is heard with Tetralogy of Fallot?
Ejection systolic
What are the S+S of Tetralogy of Fallot?
Cyanosis Clubbing Poor feeding Poor weight gain/failure to thrive Ejection systolic murmur Tet spells
What is the investigation of choice to diagnose Tetralogy of Fallot?
Echocardiogram
What is the characteristic feature seen in CXR with Tetralogy of Fallot?
Heart has a “boot-shaped” appearance
This is due to RVH
What are Tet spells?
Intermittent periods where the right-to-left shunt becomes temporarily worsened, precipitating a cyanotic episode
Occurs in situations where pulmonary vascular resistance increases or systemic resistance decreases (exercise, walking, crying)
This allows blood to flow from the RV into the aorta
How do Tet spells typically present?
Irritability Cyanosis SOB Reduced consciousness Seizures
Older children may be squatting (this increases systemic vascular resistance)
How are Tet spells managed?
Older children - squat
Younger children - knees to chest
Supplementary O2 Beta blockers IV fluids Morphine Sodium bicarbonate Phenylephrine infusion
How is Tetralogy of Fallot managed?
Neonates - prostaglandin infusion to maintain PDA
Definitive management - open heart surgery
Prognosis >90%
What is Transposition of the great vessels?
Congenital heart defect in which the attachments of the aorta and pulmonary trunk are swapped
Why might babies with Transposition of the great vessels survive immediately after birth?
An additional heart defect - PDA, VSD, ASD
How does Transposition of the great vessels present?
Presents with cyanosis at birth
If initially compensated by PDA/VSD/ASD: Respiratory distress Tachycardia Poor feeding Failure to thrive Sweating
What is the definitive management for Transposition of the great vessels?
Open heart surgery
Cardiopulmonary bypass machine is sued to perform an arterial switch procedure in the first few days of life
How might Transposition of the great vessels be managed until definitive corrective surgery can be performed?
Prostaglandin E2 to maintain PDA
Balloon septostomy - create ASD
What is the most common congenital cardiac defect?
VSD
What conditions are associated with VSD?
Down’s syndrome
Turner’s syndrome
Is VSD a cyanotic or acyanotic lesion?
Acyanotic
How does a VSD present?
Can be symptomless and only present in adulthood
Typical symptoms: Poor feeding Dyspnoea Tachypnoea Failure to thrive
What type of murmur is typically heard with a VSD?
Pan-systolic
Left lower sternal border in the 3rd and 4th intercostal spaces
May be a systolic thrill
How should a small VSD be managed?
Watch and wait - may close spontaneously or become smaller
How should larger VSDs be managed?
Surgical correction - transvenous catheter closure via femoral vein or open heart surgery
Is ASD a cyanotic or acyanotic lesion?
Acyanotic
List the types of ASD from most to leas common.
Ostium secundum
Patent foramen ovale
Ostium primum
How does an ASD present?
SOB Difficulty feeding Poor weight gain/failure to thrive LRTI Murmur
What type of murmur is typically heard with an ASD?
Mid-systolic, crescendo-decrescendo murmur
Loudest at upper left sternal border
Fixed split second heart sound
How are ASDs managed?
Small and asymptomatic: Watch and wait
Larger and/or symptomatic: Surgical correction via transvenous catheter closure and anticoagulants (aspirin, warfarin, NOACs)
What are the potential complications of ASDs?
Stroke
Atrial fibrillation or atrial flutter
Pulmonary hypertension and right-sided heart failure
Eisenmenger syndrome
Describe the typical presentation of PDA?
SOB Difficulty feeding Poor weight gain LRTI Murmur
What type of murmur is typically heard with PDA?
Continuous crescendo-decrescendo ‘machinery’ murmur
May be a left subclavicular thrill
What is the best imaging modality to diagnose PDA?
Echocardiography
How are PDAs usually managed?
Can monitor until 1 year of age via echo
Administer Indomethacin
Unlikely that a PDA will close spontaneously after 1 year - transcatheter or surgical closure
Where does the narrowing in aortic coarctation typically occur?
Around the ductus arteriosus
Which genetic condition is associated with aortic coarctation?
Turner’s syndrome
How does aortic coarctation typically present in neonates?
Weak femoral pulses
What are the signs of aortic coarctation in infancy?
Tachypnoea and increased work of breathing
Poor feeding
Grey and floppy baby
What are the signs of aortic coarctation in childhood?
Left ventricular heave due to LVH
Underdevelopment of the left arm (where there is reduced flow to the left subclavian artery)
Underdevelopment of the legs
What would a four limb BP show in aortic coarctation?
High BP in limbs supplied by arteries that come before the narrowing
Lower BP in limbs that come after the narrowing
What are the management options for aortic coarctation?
Prostaglandin E2 to maintain the ductus arteriosus
Surgical
How does aortic stenosis present?
Mild stenosis: asymptomatic, discovered incidentally
Moderate stenosis: Fatigue SOB Dizziness Fainting Symptoms worse on exertion
Severe stenosis:
Heart failure in the first few months of life
What type of murmur is typically heard with aortic stenosis?
Ejection systolic, crescendo-decrescendo murmur
Radiates to carotids
Loudest in the 2nd ICS, upper right border of sternum
Ejection click just before murmur
Palpable thrill during systole
Describe the pulse felt in aortic stenosis.
Slow rising pulse
Narrow pulse pressure
What is the gold standard imaging modality for aortic stenosis?
Echocardiogram
What are the management options for aortic stenosis?
Percutaneous balloon aortic valvuloplasty
Surgical aortic valvotomy
Valve replacement
What are the potential complications of aortic stenosis?
LV outflow tract obstruction Heart failure Ventricular arrhythmia Bacterial endocarditis Sudden death, often on exertion
What conditions are associated with pulmonary valve stenosis?
Tetralogy of Fallot
William syndrome
Noonan syndrome
Congenital rubella syndrome
How does pulmonary stenosis present?
Fatigue on exertion
SOB
Dizziness
Fainting
What are the signs of pulmonary stenosis?
Ejection systolic murmur
Palpable thrill in pulmonary area
Right ventricular heave due to RVH
Raised JVP with giant ‘a’ waves
What is the gold standard imaging modality for pulmonary stenosis?
Echocardiogram
What is the treatment of choice in managing symptomatic/severe pulmonary stenosis?
Balloon valvuloplasty (inserting a catheter into the femoral vein, through the IVC and right side of heart to the pulmonary valve)
What is Ebstein’s anomaly?
Where the tricuspid valve is lower in the right side of the heart, causing a bigger right atrium and small right ventricle
Ingestion of which drugs predisposes a foetus to Ebstein’s anomaly?
Lithium and benzodiazepines
How does Ebstein’s anomaly typically present?
Evidence of heart failure (oedema) Gallop rhythm and S3 and S4 Cyanosis SOB Tachypnoea Poor feeding Collapse or cardiac arrest
What is the gold standard imaging modality for Ebstein’s anomaly?
Echocardiogram
How is Ebstein’s anomaly managed?
Medical management - treating arrhythmias and heart failure, prophylactic abx to prevent infective endocarditis
Definitive management - surgical correction
